Medications for HTN

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SHIM
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241798
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Medications for HTN
Updated:
2013-10-21 02:25:42
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Medications for HTN
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  1. Alpha-1 Blockers

    The "-zosin"
    • Example:
    • Doxazosin (Cardura), Prazosin (Minipress), and Terazosin (Hytrin)

    • Major Action:
    • Venous & arterial vasodilation cause decrease in BP.

    • Side-effects/Nursing Interventions:
    • Orthostatic at night, reflex tachycardia, Na/H20 retention, GI disturbances, monitor for edema, and fluid retention. 

    • Contraindications:
    • Angina and CAD
  2. Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors) 

    The "-prils"
    • Examples:
    • Benazapril (Lotensin), Captapril (Capoten), Enalapril (Vasotec), Lisinopril (Prinivil, Zestril), Quinapril (Accupril), Ramipril (Altace) 

    • Major Action:
    • Prevents vasocontriction by blocking conversion of angiotensin I to angiotensin II. Used to treat HTN, heart failure, renal protection in diabetes, cardioprotective effect following MI 

    • Side-effects:
    • N/V, persistent DRY COUGH, HYPOtension, HYPERkalemia, diminished taste, dizziness, fatigue, bruising, bleeding w/ Captopril, hypoglycemia w/ diabetes 

    • Nursing Action:
    • Altered taste may take up to month to abate, take Captopril 20-60 min before meal, avoid use with K supplements and K sparing diuretics; instruct pt to notify MD if dry cough develops as well as development of angioedema; monitor lithium level to avoid toxicity. 

    • Contraindications:
    • Renal stenosis or in pts with single kidneys; Hx of angioedema following use of ACE inhibitors; pregnancy; cautious with renal impairment
  3. Angiotensin II Receptor Blockers (ARBs) 

    The "-sartans"
    • Examples:
    • Candesartan (Atecand), Irbesartan (Avapro), Losartan (Cozaar), Valsartan (Diovan), Olmesartan (Benicar) 

    • Major action:
    • Blocks action of angiotensin II resulting in vasoDILATION and excretion of sodium and water, and retention of potassium. Use to treat HTN, HF, and prevention of mortality following MI, stroke prevention, delays progression of diabetic nephropathy

    • Side-effects:
    • Same as ACE inhibitors, except majority of pts who experienced dry cough or developed angiodema do not experience it with ARBs. They should still be monitored closely; usually don't see the increase in potassium. 

    • Nursing Action:
    • Angioedema is rare but possible. 

    • Contraindications:
    • Pregnancy; renal stenosis or pt with single kidney remaining
  4. Beta Adrenergic Blockers (Sympatholytics)

    The "-olol"
    • Examples:
    • Metoprolol (Lopressor), Atenolol (Tenormin), Metoprolol Succinate (Toprol XL), Esmolol (Breviblock) 

    • NON-SELECTIVE (BETA 1 & BETA 2)
    • Examples:
    • Propranolol (Inderal), Nadolol (Corgard), Labetolol (Normodyne)

    • Major action:
    • Primary effect of beta adrenergic blockade in myocardium and in electrical conduction system of heart; decrease CO and block release of renin decreasing vasocontriction of peripheral vasculature; DECREASED HEART RATE and DECREASED MYOCARDIAL CONTRACTION, AND DECREASED RATE OF CONDUCTION through AV node; indicated in tx of MI and unstable angina as well as tx of HTN and tachycardia

    • Two Types:
    • 1) Selective: use cautiously with asthma, COPD, and HR
    • 2) Nonselective: contraindicated in asthma, COPD, and HF

    • Side-effects:
    • depression, weakness, fatigue, lightheadedness, sexual dysfunction; BB can mask hypoglycemia

    • Nursing Actions:
    • If there is concern for too low HR, obtain EKG. Hold BB in presence of heart block
    • **If stopped abruptly, rebound hypertension may occur

    • Contraindications:
    • using non-selective BB in pts with asthma, bronchospasm, and heart failure; Contraindicated in AV block and bradycardia
  5. Calcium Channel Blockers (CCB)

    The "-zem" and "-mil" (NONDIHYD)
    The "-dipine" (DIHYD)
    • NON-DIHYDROPYRIDINES
    • Diltiazem ER (Cardizem CD or Dilacor XR), Cardizem LA, Verapamil (Calan, Isopton), Verapamil LA (Calan SR or Isoptin SR)

    • DIHYDROPYRIDINES:
    • Amlodipine (Norvasc), Felodipine (Plendil), Nifedipine LA (Procardia XL)

    • Major action:
    • Alter movement of calcium ions thru cell membrane causing VASODILATION and LOWERED BP; 2 divisions

    • Side-effects/Nursing Interventions:
    • sedation, headache, flushing, dry mouth, orthostatic hypotension, impotence can be probelmatic; pt should know how to take pulse; avoid GRAPEFRUIT JUICE with Verapamil and Diltiazem; edema can be side effect with amlodipine, procardia. Do not abruptly stop; dry mouth

    CCBs INTENSIFY AFFECTS of BB; use cautiously with HF 

    Verapamil can increase DIGOXIN levels and can cause constipation

    • Contraindications:
    • SSS, AVB, severe HF, hypotension, and pregnancy
  6. Central Alpha Agonist
    • Examples:
    • Clonidine (Catapres) and Methyldopa (Aldomet)

    • Major action:
    • reduces peripheral vascular resistance and decreases BP by inhibiting reuptake of norepinephrine; not indicated for 1st line management of HTN; ALDOMET can be used during pregnancy 

    • Side-effects/Nursing actions:
    • sedation, dry mouth, orthostatic hypotension, and impotence can be problematic

    • Contraindications:
    • Clonidine- pregnancy; severe CAD
  7. Diuretics
    1) Aldosterone Receptor Blocker
    2) Thiazide Diuretics 
    3) Loop Diuretics 
    4) Potasium-Sparing Diuretics 
    5) Osmotic Diuretics
    • Aldosterone Receptor Blocker
    • Spironolactone (Aldactone)- competitive inhibitors of aldosterone binding promotes retention of potassium and excretion of sodium/water. 

    Indication- weak diuretic and anti-HTN effect compared to other diuretics; may benefit pts with hx of MI, CHF

    Side-effects/Nursing actions- diarrhea, GI upset, give after meals, teach signs of hyperkalemia, don't use K supplements o salt substitutes containing K; avoid grapefruit juice and St John's Wart; Gynecomastia may be cause by spironolactone; possible increase in triglycerides

    Contraindications- hyperkalemia, impaired renal function
  8. Diuretics
    1) Aldosterone Receptor Blocker
    2) Thiazide Diuretics 
    3) Loop Diuretics 
    4) Potasium-Sparing Diuretics 
    5) Osmotic Diuretics
    • Examples:
    • HCTZ (Hydrodiuril), Chlorthalidone (Hygroton), Metalazone (Zaroxolyn) 

    • Action:
    • increase sodium and water excretion by inhibiting sodium reabsorption in distal tubule of kidney; used for HTN and edema; not effective for immediate diuresis; use in pts with normal renal function

    • Side-effects/Nursing actions:
    • use caution when used with steroids, digoxin, and hypoglycemic meds; caution when used with lithium due to lithium toxicity; monitor for electrolyte imbalance; possible increase calcium, glucose, and uric acid; decrease in K, sodium. 

    Contraindicaitons- renal failure
  9. Diuretics
    1) Aldosterone Receptor Blocker
    2) Thiazide Diuretics 
    3) Loop Diuretics 
    4) Potasium-Sparing Diuretics 
    5) Osmotic Diuretics
    • Examples:
    • Furosemide (Lasix), Bumetadine (Bumex), Torsemide (Demadex), Ethacrynic Acid (Edecrin) 

    • Major action:
    • inhibit sodium and chloride reabsorption from loop of henle; little effect on blood glucose; more potent than thiazide, causing rapid diuresis

    • Side-effects/Nursing Actions:
    • DECREASE potassium, sodium, choloride, calcium, and magnesium. INCREASE uric acid. Ototoxicity and deafness are possible side effects; instruct pt on taking K supplements; administer IV lasix slowly because of ringing in ears or hearing loss if injected too quickly; orthostatic hypotension 

    Contraindications-same as thiazides
  10. Diuretics
    1) Aldosterone Receptor Blocker
    2) Thiazide Diuretics 
    3) Loop Diuretics 
    4) Potasium-Sparing Diuretics 
    5) Osmotic Diuretics
    • Examples:
    • Spiroaldactone (Aldactone), Triamterene (Dyrenium), Amiloride (Midamor)

    • Major action:
    • act on distal tubule to promote Na and water excretion and potassium retention; used for edema, HTN, increase urine output, HF, ascites, resulting from ascites or nephrotic syndrome 

    • Side-effects/Nursing actions:
    • increase K, N/V, diarrhea, weakness, rash, photsensitivity, anemia, thrombocytopenia; avoid foods high in K and Na; avoid direct sunlight; take with or after meal to decrease GI effects 

    • Contraindications:
    • caution with DM, ACEs or ARBs due to increase chance of HYPERkalemia; monitor when using lithium
  11. Diuretics
    1) Aldosterone Receptor Blocker
    2) Thiazide Diuretics 
    3) Loop Diuretics 
    4) Potasium-Sparing Diuretics 
    5) Osmotic Diuretics
    Examples: Mannitol (Osmitrol) 

    • Major action:
    • reduces intracranial pressure (ICP) and intraocular pressure by raising serum osmolality and drawing fluid back into vascular and extravascular spaces; used in cerebral edema, prevention of renal failure

    • Side-effects/Nursing actions:
    • HF, pulmonary edema, renal failure, fluid and electrolyte imbalances
  12. Vasodilators
    Hydralazine (Apresoline) decreases peripheral resistance but also increases CO. 

    Sodium nitroprusside (Nipride) causes peripheral dilation by relxation of sooth muscle. FAST acting and only used in hypertensive emergency.

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