Angiotensin II Receptor BlockersExamples Cozaar (Losarten) Atacand (Candesarten) Diovan (Valsartan) | MOA: Prevent action of A-II and produce vasodilation and increased salt and water excretion | Side effects Hyperkalemia Impaired renal function | Drug Interactions: None listed | Nursing Implications Monitor b/p and heart rate Full effect may take 3-6 weeks Watch for hyperkalemia and renal dysfunction |
Patient EducationScreening B/P measurement Cardiovascular risk factors | Therapeutic regime Lifestyle modification Medication adherence |
Nursing ManagementAssessment History and physical exam BP measurement | Nursing Diagnoses Ineffective health maintenance Anxiety Sexual dysfunction | Goals Lower BP and enhance patient compliance | Interventions Early identification of medication side effects or complications Patient and family education | Evaluation Achieve and maintain goal BP Understand, accept, and implement therapeutic plan Experience minimal or no side effects |
Calcium Channel BlockersExamples: Diltiazem (Cardizem SR) Nifedipine (Procardia, Procardia XL, Adalat) Nicardipine (Cardene) Verapamil (Isoptin, Calan, Calan SR) Amlodipine (Norvasc) | Mechanism of action: Blocks movement of calcium into cells Vasodilatation, ↓ SVR, ↓ contractility, ↓ HR | Side Effects: Bradycardia, 1st degree AV heart block, nausea, headache, dizziness, peripheral edema, flushing, rash gingival hyperplasia, and constipation with verapamil. | Adverse drug Interactions: Cautious use in patients with heart failure. Contraindicated in patients with 2nd and 3rd degree heart block. | Avoid grapefruit juice | Watch for bradycardia, first degree heart block |
| | DiureticsThiazide | Loop | MOA: Inhibit NaCL reabsorption in distal tubules. Initial decrease in ECF and sustained decrease in SVR. Lowers B/P over 2 -4 weeks. | MOA: Inhibits NaCl reabsorption in the ascending limb of loop of Henle, Increase excretion NaCl. | Chlorothiazide (Diuril), hydrochlorothiazide (Microzide) | Furosemide( Lasix), bumetanide(Bumex) | Side effects: fluid and E- imbalance, volume depletion, metabolic alkalosis. Vertigo, headache, weakness. Anorexia, N/V, constipation, pancreatitis, sexual dysfunction, photosensitivity, decreased glucose tolerance | Adverse rxn: Fluid and electrolyte imbalances. Ototoxicity, vertigo, Metabolic: hyperurecemia, hyperglycemia, inc. LDL and triglycerides and dec. HDL | Drug Interactions: Potentiate digoxin NSAIDS may decrease diuretic and antihypertensive effect | Drug Interactions: None listed | Nursing Considerations: Monitor VS , orthostatic hypotension, Monitor for hypokalemia. Teach about supplementation with K+ rich foods | Nursing Interventions: Monitor fluid and E imbalances |
DiureticsPotassium Sparing | Aldosterone Receptor Blockers | MOA: Reduce K+ and Na+ exchange distal and collecting tubules reduce excretion of K+, H+, Ca+ and Mg+ | MOA: inhibits Na+ retaining and K+ excreting effects of aldosterone in distal and collecting tubules ( K+ sparing) | Amiloride(Midamor | Spirolactone(Aldactone | Side effects: Hyperkalemia: N/V, diarrhea, leg cramps, dizziness, Tall t waves | Side effects: Hyperkalemia, gynecomastia, erectile dysfunction menstrual irregularity | Drug interactions: Caution in pts on ACE inhibitors and Angiotensin II blockers avoid potassium supplements | Drug Interactions: Do not combine with K+ sparing diuretics or supplements, cautious use with ACE Inhibitors or angiotensin II blockers | Nursing Interventions: monitor for orthostatic hypotension, contraindicated in pts with renal failure and cautious use in pts on ACE inhibitors and Angiotensin II blockers. Avoid K+ supplements | NursNursing Interactions: monitor for orthostatic hypotension and hyperkalemia.ing Interventions: Monitor fluid and E imbalances |
| | Direct VasodilatorsExamples: Hydralazine (Apresoline) Minoxidil (Loniten) Sodium nitropurusside (Nipride) | Mechanism of action: Relax vascular smooth muscle Decrease SVR | Often given IV for hypertensive crisis | Side Effects: Reflex tachycardia, nausea, flushing, headache, hypotension | Nursing Interventions: Monitor for hypotension and tachycardia |
ACE Inhibitors"pril" | Examples: Captopril (Capoten) Enalapril (Vasotec) Lisinopril (Zestril, Prinivil) Ramipril (Altace) Benazepril (Lotensin) Quinapril (Accupril) | Mechanism of action: Inhibits angiotensin-converting enzyme Decreases vasoconstriction and water retention | Side Effects: Cough: 1/3 will develop Hypotension, Dizziness, headache, vertigo Angioedema Photosensitivity Abdominal pain, loss of taste Hyperkalemia: inhibits aldosterone | Drug Interactions: Diuretics enhance effect NSAIDS and ASA may reduce effect | Nursing Implications Monitor blood pressure Monitor serum potassium Monitor renal function Antacids may decrease absorption |
| | Beta BlockersBeta Blockers “-olol” | Metropolol(Lopressor), propanolol(Inderal), carvediol(Coreg) | Mechanism of action: Block beta receptor sites which are responsive to epinephrine and norepinephrine.. | Side Effects Hypotension Headache Fatigue Peripheral edema Erectile dysfunction Diabetics : may mask hypoglycemia Asthma: symptoms to monitor for | Nursing Implications Monitor heart rate and blood pressure Monitor for symptoms of HF | Drug Interactions: cautious use with diabetics and asthma patients | Nursing Interactions: Monitor pulse and BP regularly. IV administration short onset and duration |
Hypertensive CrisisSudden, severe increase in diastolic BP | Clinical manifestations: Hypertensive encephalopathy Renal insufficiency Cardiac decompensation Neurologic compromise | Hypertensive Crisis: Nursing-Collaborative Management | Hospitalization IV antihypertensive drugs Intensive monitoring Invasive blood pressure monitoring Frequent physical assessments Treatment guided by MAP Use caution not to decrease BP too fast! |
Types of MedicationsDiuretics | Beta-Blockers | Calcium Channel Blockers | ACE Inhibitors | ARBs | Vasodilators |
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