MedSurg I HTN Medsrename
olanjones's version from 2016-12-07 03:37
Classification by Action
|Diuretics||Thiazide and Related Diuretics, Loop diuretics, Potassium-Sparing Diuretics, Aldosterone Receptor Blockers|
|Adrenergic Inhibitors||Central-Acting α-Adrenergic Antagonists, Peripheral-Acting α-Adrenergic Antagonists, α1-Adrenergic Blockers, β-Adrenergic Blockers, Mixed α- and β-Blockers|
|Angiotensin Inhibitors||Angiotensin-Converting Enzyme Inhibitors, Angiotensin II Receptor Blockers|
|Calcium Channel Blockers||Non-Dihydropyridines, Dihydropyridines|
Names & Classifications
|Thiazide & related diuretics||bendroflumethiazide, chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide, metolazone|
|Loop diuretics||bumetanide, ethacrynic acid, furosemide, torsemide|
|Potassium-Sparing Diuretics||amiloride, triamterene|
|Aldosterone Receptor Blockers||spironolactone, eplerenone|
|Central-Acting α-Adrenergic Antagonists||clonidine, guanabenz, guanfacine, methyldopa|
|Peripheral-Acting α-Adrenergic Antagonists||guanethidine, guanadrel, reserpine|
|α1-Adrenergic Blockers||doxazosin, prazosin, terazosin, phentolamine|
|β-Adrenergic Blockers Cardioselective Blockers||acebutolol, atenolol, betaxolol, bisoprolol, esmolol, metoprolol, nebivolol|
|β-Adrenergic Blockers Nonselective Blockers||nadolol, penbutolol, pindolol, propranolol, timolol|
|Mixed α- and β-Blockers||carvedilol, labetalol|
|Direct Vasodilators||fenoldopam, hydralazine, minoxidil, nitroglycerin, sodium nitroprusside|
|Angiotensin-Converting Enzyme Inhibitors||benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril,|
|Angiotensin II Receptor Blockers||candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan|
|CCB Non-Dihydropyridines||diltiazem extended release, verapamil intermediate release, verapamil long-acting, verapamil timed-release|
|CCB Dihydropyridines||amlodipine, clevidipine, felodipine, isradipine, nicardipine sustained release, nifedipine long acting, nisoldipine|
Mechanism of Action
|Thiazide & related diuretics||-Inhibit NaCl reabsorption in the distal convoluted tubule. Increase excretion of Na+ and Cl−.|
-Initial decrease in ECF. Sustained decrease in SVR.
-Lower BP moderately in 2-4 wk.
|Loop diuretics||Inhibit NaCl reabsorption in the ascending limb of the loop of Henle. Increase excretion of Na+ and Cl−.|
-More potent diuretic effect than thiazides, but shorter duration of action.
-Less effective for hypertension.
|Potassium-Sparing Diuretics||Reduce K+ and Na+ exchange in the distal and collecting tubules. Reduce excretion of K+, H+, Ca+, and Mg|
|Aldosterone Receptor Blockers||Inhibit the Na+-retaining and K+-excreting effects of aldosterone in the distal and collecting tubules.|
|Central-Acting α-Adrenergic Antagonists||Reduce sympathetic outflow from CNS. Reduce peripheral sympathetic tone, produces vasodilation, decreases SVR and BP.|
|Peripheral-Acting α-Adrenergic Antagonists||Prevents peripheral release of norepinephrine, resulting in vasodilation. Lowers CO and reduces SBP more than DBP. |
Depletes central and peripheral stores of norepinephrine. Results in peripheral vasodilation (decreases SVR and BP).
|α1-Adrenergic Blockers||Block α1-adrenergic effects, producing peripheral vasodilation (decreases SVR and BP). Beneficial effects on lipid profile. |
Blocks α1-adrenergic receptors, resulting in peripheral vasodilation (decreases SVR and BP).
|β-Adrenergic Blockers Cardioselective Blockers||-Cardioselective agents block β1-adrenergic receptors. Reduce BP by blocking β-adrenergic effects. |
-Decrease CO and reduce sympathetic vasoconstrictor tone.
-Decrease renin secretion by kidneys.
|β-Adrenergic Blockers Nonselective Blockers||Nonselective agents block β1- and β2-adrenergic, reducing BP by blocking effects.|
|Mixed α- and β-Blockers||α1-, β1-, and β2-adrenergic blocking properties producing peripheral vasodilation and decreased heart rate. Reduce CO, SVR, and BP.|
|Direct Vasodilators|| -Activates dopamine receptors, resulting in systemic and renal vasodilation. |
-Reduces SVR and BP by direct arterial vasodilation.
-Nitroglycerin relaxes arterial and venous smooth muscle, reducing preload and SVR. At low dose, venous dilation predominates; at higher dose, arterial dilation is present
|Ganglionic Blockers||Interrupts adrenergic control of arteries, results in vasodilation, and reduces SVR and BP|
|Angiotensin-Converting Enzyme Inhibitors||Inhibit ACE, reduce conversion of angiotensin I to angiotensin II (A-II). Inhibit A-II–mediated vasoconstriction|
|Angiotensin II Receptor Blockers||Prevent action of A-II and produce vasodilation and increased Na+ and water excretion.|
|Renin Inhibitors||Directly inhibits renin, thus reducing conversion of angiotensinogen to angiotensin I.|
|CCB Non-Dihydropyridines||Inhibit movement of Ca2+ across cell membrane, resulting in vasodilation. Cardioselective resulting in decrease in heart rate and slowing of AV conduction.|
|CCB Dihydropyridines||Cause vascular smooth muscle relaxation resulting in decreased SVR and arterial BP.|
|Thiazide & related diuretics||Monitor for orthostatic hypotension, hypokalemia, and alkalosis. Dietary sodium restriction reduces the risk of hypokalemia. |
-Thiazides may potentiate cardiotoxicity of digoxin by producing hypokalemia.
-NSAIDs can decrease diuretic and antihypertensive effect of thiazide diuretics.
-Advise patient to supplement with potassium-rich foods.
|Loop diuretics||Monitor for orthostatic hypotension and electrolyte abnormalities.|
-Loop diuretics remain effective despite renal insufficiency. Diuretic effect of drug increases at higher doses.
|Potassium-Sparing Diuretics||Monitor for orthostatic hypotension and hyperkalemia. Avoid potassium supplements. |
-Contraindicated in patients with renal failure. Use with caution in patients on ACE inhibitors or angiotensin II blockers.
|Aldosterone Receptor Blockers||Monitor for orthostatic hypotension and hyperkalemia. |
-Do not combine with potassium-sparing diuretics or potassium supplements. Use with caution in patients on ACE inhibitors or angiotensin II blockers.
-These drugs are also classified as potassium-sparing diuretics.
|Central-Acting α-Adrenergic Antagonists||-Sudden discontinuation may cause withdrawal syndrome, including rebound hypertension, tachycardia, headache, tremors, apprehension, sweating. |
-Chewing gum or hard candy may relieve dry mouth.
-Transdermal patch (clonidine only) may be related to fewer side effects and better adherence.
-Alcohol & sedatives increase sedation. Instruct patient about daytime sedation & avoidance of hazardous activities. q HS dosing minimizes sedative effect.
|Peripheral-Acting α-Adrenergic Antagonists||-May cause severe orthostatic hypotension. Not recommended for use in patients with cerebrovascular or coronary insufficiency or in older adults. |
-Advise patient to rise slowly and wear support stockings. Hypotensive effect is delayed for 2-3 days and lasts 7-10 days after withdrawal.
-Some must be given twice daily.
-Contraindicated in patients with history of depression. Monitor mood and mental status regularly. Advise patient to avoid barbiturates, alcohol, opioids
|α1-Adrenergic Blockers||-Reduced resistance to the outflow of urine in benign prostatic hyperplasia. Taking drug at bedtime reduces risks associated with orthostatic hypotension. |
-Phentolamine is used in short-term management of pheochromocytoma. Also used locally to prevent necrosis of skin and subcutaneous tissue after extravasation of adrenergic drug. No oral formulation
|β-Adrenergic Blockers Cardioselective Blockers||-Monitor pulse and BP regularly. Use with caution in patients with diabetes mellitus because drug may depress the tachycardia associated with hypoglycemia. |
-Esmolol is for IV use only.
-Cardioselective agents lose cardioselectivity at higher doses.
|β-Adrenergic Blockers Nonselective Blockers||Same as cardioselective, except nonselective agents may cause bronchospasm, especially in patients with a history of asthma|
|Mixed α- and β-Blockers||-Same as β-adrenergic blockers. IV form available for hypertensive crisis in hospitalized patients. |
-Patients must be kept supine during IV administration.
-Assess patient tolerance of upright position (severe orthostatic hypotension) before allowing upright activities (e.g., commode).
|Direct Vasodilators||-IV use only for hypertensive crisis in hospitalized patients. Use cautiously in patients with glaucoma. Patient should remain supine for 1 hr after administration. |
-Hydralazine twice-daily oral dosage. Not used as monotherapy because of side effects. Contraindicated in patients with coronary artery disease.
-Minoxidil reserved for treatment of severe hypertension associated with renal failure and resistant to other therapy. Once- or twice-daily dosage.
-Sodium nitroprusside intraarterial monitoring of BP recommended. Protect from light. Stable for 24 hr. Metabolized to cyanide, then thiocyanate. Monitor thiocyanate levels with prolonged use or large doses.
|Ganglionic Blockers||IV use for initial control of BP in patient with dissecting aortic aneurysm. Administered by continuous IV infusion with pump or control device|
|Angiotensin-Converting Enzyme Inhibitors||-Aspirin and NSAIDs may reduce drug effectiveness. Addition of diuretic enhances drug effect. |
-Should not be used with potassium-sparing diuretics.
-Inhibit breakdown of bradykinin, which may cause a dry, hacking cough. Captopril may be given orally for hypertensive crisis.
|Angiotensin II Receptor Blockers||Full effect on BP may not be seen for 3-6 wk. Do not affect bradykinin levels, therefore acceptable alternative to ACE inhibitors in people who develop dry cough|
|Renin Inhibitors||May cause angioedema of the face, extremities, lips, tongue, glottis, and/or larynx. Not to be used in pregnancy|
|CCB Non-Dihydropyridines||-Use with caution in patients with heart failure. Serum concentrations and toxicity of certain calcium channel blockers may be increased by grapefruit juice; avoid concurrent use. |
-Used for supraventricular tachydysrhythmias. Avoid in patients with second- or third-degree AV block or left ventricular systolic dysfunction.
|CCB Dihydropyridines||-More potent peripheral vasodilators. Clevidipine is for IV use only. Use of sublingual short-acting nifedipine in hypertensive emergencies is unsafe and not effective. |
-Serious adverse events (e.g., stroke, acute MI) have been reported.
-IV nicardipine available for hypertensive crisis in hospitalized patients. Change peripheral IV infusion sites every 12 hr.