Drugs antihypertensive

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clugger
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258418
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Drugs antihypertensive
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2014-01-30 08:11:21
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drugs classifications actions adverse effects
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  1. thiazide and thiazide-like diuretics
    • name: hydrochlorthiazide (Hydro-diuril, HCTZ)
    •           Metolazone (Zaroxolyn)
    • action: act on the renal tubules to inhibit reabsorption of sodium chloride. Inhibiting sodium reabsorption increases potassium loss
    • adverse effects: dehydration, electrolyte imbalance, orthostatic hypotension, digoxin toxicity, erectile dysfunction
  2. Loop Diuretics
    • name: Furosemide (Lasix)
    •           Bumetanide (Bumex)
    • action: inhibit NACl reabsorption in the descending loop of Henle->increasing excretion of sodium and potassium. Bumex has more stronger action than Lasix, but is shorter acting.
    • adverse effects: electrolyte imbalance, orthostatic hypotension, ototoxicity (usually reversible), dehydration
  3. Potassium Sparing (Diuretic)
    • name: Amiloride (Midamor)
    •           Triamterene (Dyrenium)
    •           Spironolactone (Aldactone)
    • action: cause urinary excretion of sodium and reduce excretion of potassium
    • adverse effects: hyperkalemia (presence of abnormally high concentration of potassium in the blood, also called hyperpotassemia),
    • hypotension
  4. What are the nursing considerations with diuretics ?
    • monitor electrolytes esp. potassium
    • monitor for dehydration (thirst, weakness, muscle cramping, hypotension, tachycardia)
    • monitor intake and output every shift
    • weigh client every day
    • instruct patient to change position slowly (dizziness, falls)
    • monitor BP for effectiveness
  5. ACE inhibitors
    (Angiotensin Converting Enzyme Inhibitors)
    • name: Captopril (Capoten)
    •           Enalapril (Vasotec)
    •           Lisinopril (Zestril)
    • action: blocks the action of ACE->angiotensin II can't form->prevents systemic and renal vasoconstriction and the release of aldosterone
    • use: mild to severe hypertension, first drug of choice, do not increase heart rate
    • adverse effects: ACE coughs (dry, hacking)
    • first dose syncope (severe hypotension and fainting after 1-4 hours after initial dose or after significant increase in dose)
  6. Nursing considerations regarding ACE inhibitors
    • give one hour before meals
    • monitor BP hourly after initial dose
    • for subsequent doses, take BP before each dose and every 4 hours
    • be sure the drug name is correct (several of these drugs sound similar)
    • instruct the client to lie down for 3-4 hours after first dose
    • caution client to avoid activities requiring alertness until his reaction is known
    • instruct patient to avoid substances that interfere with ACE inh. e.g. coffee, tea, cola,OTC colt meds
    • inform client that cough will go away after the meds are discontinued
  7. Alpha Adrenergic Agonists
    • Methyldopa (Aldomet-this name does not exist any more)
    • Clonidine (Catapres)
    • action: alpha2 stimulation->decreases sympathetic outflow from the brainstem to the heart + blood vessels->decrease in PVR->lower BP
    • adverse effects: dry mouth, sedation, erectile dysfunction, sleep disturbance, nightmares
  8. Nursing considerations regarding Alpha Adrenergic Agonists
    • caution the patient to take hot baths/showers->worsens hypotension
    • avoid excessive use of caffeinated beverages (>4/day)
    • take meds at bedtime to avoid daytime sleepiness
    • caution the patient not to suddenly withdraw meds->withdrawal symptoms
    • suggest chewing gum/hard candies to relieve mouth dryness
    • caution client that alcohol will worsen sedation
  9. Alpha Adrenergic Antagonists (Blockers)
    • Doxazosin mesylate (Cardura)
    • Prazosin (Minipress)
    • action: block alpha2 adrenergic receptors-> decrease PVR
    • Adverse effects: first dose syncope, Orthostatic hypotension, reflex tachycardia & increased workload of the heart (may cause myocardial ischemia or infarction)
  10. Nursing considerations regarding Alpha Adrenergic Agonists
    • Monitor for Orthostatic hypotension
    • instruct clients to change positions slowly
    • Monitor client for tachycardia
    • Advise the client to avoid driving for 12 hours after first dose until reaction is known
    • Instruct patient to report weight gain of 1-2 pounds over one week, check for edema
  11. Beta-Adrenergic Antagonists
    (Blockers)
    • Atenolol (Tenormin)
    • Metoprolol (Lopressor)
    • Nadolol (Corgard)
    • Propanolol (Internal)
    • Action: block the action of the sympathetic nervous systems catecholamines (epinephrineand + norepinephrine) on cardiac receptors ->slower heart rate, reduced contractility of the heart muscle, vasodilation of arterials-> reduction of PVR->BP reduction
    • Adverse effects: hypotension, bronchospasm, bradycardia, erectile dysfunction, fatigue, weakness, may include congestive heart failure in susceptible clients
  12. Nursing considerations regarding Beta-Adrenergic Antagonists (Blockers)
    • Assess heart rate and BP prior to administration
    • Delay dose and notify physician if systolic BP<90 or apical rate is <60
    • give o hour before meals
    • Assess breath sounds for wheezing and crackles
    • tech client to avoid caffeine containing beverages and OTC-meds
    • Instruct patient to report weight gain of >3lbs/day or 5lbs/week
    • Sudden cessation can cause rebound hypertension: severe headache, palpitations (in German: Herzklopfen), trembling (in german: zittern), sweating, chest pain
  13. Calcium Channel Blockers
    • Name: Amlodipine (Norvasc)
    •            Diltiazem (Cardizem)
    •            Nifedipine (Procardia)
    •            Verapalim (Calan)
    • Action: inhibit flow of extracellular calcium ions across the cell membranes in cardiac and vascular tissue-> relaxation of arterial smooth muscle + decreased heartrate
    • Adverse effects: flushing, headache, dizziness, weakness, bradycardia, Orthostatic hypotension, sexual dysfunction
  14. Nursing considerations regarding Calcium Channel Blockers
    • Give. Before meals
    • Delay the dose and notify MD if HR<60, systolic BP <90, diastolic < 60
    • Instruct client to dangle before walking + change positions slowly
    • Advise to avoid activities that require alertness until effect of drugs are known
    • Withdrawing of drugs can cause serious reaction
    • Avoid caffeine
    • avoid grapefruit when taking nifedipine (Procardia)
    • Consult doctor before using OTC meds
  15. What should the nurse teach every client that is checking own BP ?
    • No smoking, coffee or exercise prior
    • Take BP after resting for 3-5 minutes
    • Average of 3 readings, separated by one minute should be used as the reading
    • Take BP daily when treatment is begun or changed, then weekly
    • Keep record of the readings
    • Do not get anxious over a single high reading
    • Do not self adjust medication after seeing BP results
  16. Classification: ACE inhibitors
    Name: Lisinopril
    • Action: block the action of ACE-> angiotensin cannot form-> prevents systemic and renal vasoconstriction and release of aldosterone
    • uses: mild to severe hypetension
    • Normal dose:: PO 100mg-20mg-40mg daily
    • Side effects: dry hacking cough, severe hypertension and fainting within 1-4 after initial dose
    • Nursing indications: check drug name
    • Instruct client to lie down for 3-4 hours after the first dose do not drive, do not take OTC or caffeine beverages
    • Inform that cough will go away after medication is discontinued

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