MedSurg I HTN Meds

olanjones's version from 2016-12-07 03:37

Classification by Action

Question Answer
DiureticsThiazide and Related Diuretics, Loop diuretics, Potassium-Sparing Diuretics, Aldosterone Receptor Blockers
Adrenergic InhibitorsCentral-Acting α-Adrenergic Antagonists, Peripheral-Acting α-Adrenergic Antagonists, α1-Adrenergic Blockers, β-Adrenergic Blockers, Mixed α- and β-Blockers
Angiotensin InhibitorsAngiotensin-Converting Enzyme Inhibitors, Angiotensin II Receptor Blockers
Calcium Channel BlockersNon-Dihydropyridines, Dihydropyridines

Names & Classifications

Question Answer
Thiazide & related diureticsbendroflumethiazide, chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide, metolazone
Loop diureticsbumetanide, ethacrynic acid, furosemide, torsemide
Potassium-Sparing Diureticsamiloride, triamterene
Aldosterone Receptor Blockersspironolactone, eplerenone
Central-Acting α-Adrenergic Antagonistsclonidine, guanabenz, guanfacine, methyldopa
Peripheral-Acting α-Adrenergic Antagonistsguanethidine, guanadrel, reserpine
α1-Adrenergic Blockersdoxazosin, prazosin, terazosin, phentolamine
β-Adrenergic Blockers Cardioselective Blockersacebutolol, atenolol, betaxolol, bisoprolol, esmolol, metoprolol, nebivolol
β-Adrenergic Blockers Nonselective Blockersnadolol, penbutolol, pindolol, propranolol, timolol
Mixed α- and β-Blockerscarvedilol, labetalol
Direct Vasodilatorsfenoldopam, hydralazine, minoxidil, nitroglycerin, sodium nitroprusside
Ganglionic Blockerstrimethaphan
Angiotensin-Converting Enzyme Inhibitorsbenazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril,
Angiotensin II Receptor Blockerscandesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan
Renin Inhibitorsaliskiren
CCB Non-Dihydropyridinesdiltiazem extended release, verapamil intermediate release, verapamil long-acting, verapamil timed-release
CCB Dihydropyridinesamlodipine, clevidipine, felodipine, isradipine, nicardipine sustained release, nifedipine long acting, nisoldipine

Mechanism of Action

Question Answer
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 diureticsInhibit 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 DiureticsReduce K+ and Na+ exchange in the distal and collecting tubules. Reduce excretion of K+, H+, Ca+, and Mg
Aldosterone Receptor BlockersInhibit 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 AntagonistsPrevents 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 BlockersBlock 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 BlockersNonselective agents block β1- and β2-adrenergic, reducing BP by blocking effects.
Mixed α- and β-Blockersα1-, 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 BlockersInterrupts adrenergic control of arteries, results in vasodilation, and reduces SVR and BP
Angiotensin-Converting Enzyme InhibitorsInhibit ACE, reduce conversion of angiotensin I to angiotensin II (A-II). Inhibit A-II–mediated vasoconstriction
Angiotensin II Receptor BlockersPrevent action of A-II and produce vasodilation and increased Na+ and water excretion.
Renin InhibitorsDirectly inhibits renin, thus reducing conversion of angiotensinogen to angiotensin I.
CCB Non-DihydropyridinesInhibit movement of Ca2+ across cell membrane, resulting in vasodilation. Cardioselective resulting in decrease in heart rate and slowing of AV conduction.
CCB DihydropyridinesCause vascular smooth muscle relaxation resulting in decreased SVR and arterial BP.

Nursing Considerations

Question Answer
Thiazide & related diureticsMonitor 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 diureticsMonitor for orthostatic hypotension and electrolyte abnormalities.
-Loop diuretics remain effective despite renal insufficiency. Diuretic effect of drug increases at higher doses.
Potassium-Sparing DiureticsMonitor 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 BlockersMonitor 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 BlockersSame 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 BlockersIV 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 BlockersFull 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 InhibitorsMay 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.

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