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Diuretics
· They are a preferred treatment and relatively safe, Preferred for the elderly and obese clients , usually as the first line of therapy, later combined with other meds and are particularly effective in blacks ·
Prevent reabsorption of sodium thus prompting water excretion and lowering blood volume · Usually given with potassium for replacement ·
Diuretics are contraindicated in pt with known hypersensitivity to the drugs, electrolyte imbalances , and anuria (cessation of urine output)
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Diuretics Nursing considerations –Assess
Signs of metabolic alkalosis;
drowsiness, restlessness ·
Signs of hyperkalemia ;
postural hypotension,
malaise , fatigue, tachycardia, leg cramps, weakness·
Rashes, temp elevation daily·
Confusion , esp in geriatric·
Hearing including tinnitus and hearing loss ·
Weight I &O daily to determine fluid loss ,
effect of product may be decreased if used daily·
Electrolytes esp Potassium K+ ·
Skin turgor , edema, condition of MM ·
Rate rhythm an depth of respiration, effect of excertion and lung sounds·
B/P lying, standing postural hypotension may occur
Glucose in urine
Administer – In the A.M to avoid interfering with sleep , and potassium replacement if potassium is less than 3
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Loop diuretics -furosomide (Lasix)-
increase the excretion of sodium 40 mg Bid,used for edema due to Heart failure , cirrhosis of the liver, renal disease, acute pulmonary edema
Adverse reactions –electrolyte and hematologic imbalances, anorexia, n/v, dizziness rash, photosensitivity, orthostatic hypotension, glycosuria
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Potassium sparing diuretics –sprironlactone-(aldactone
can gv up 400 depress the excretion of K+ and depress the reabsorption of sodium used for HTN , edema, due to HF, cirrhosis , renal disease, hyperkalemia, prophylaxis of hypokalemia in at risk pts, hyperaldosteronism
Adverse reactions- headache, diarrhea, drowsiness, lethargy, hyperkalemia, cramping, gastritis, erectile dysfunction, gynescomastia
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Thiazides:- Hydronchlorthiazide –(hydrodiuril)
inhibits the reabsorption of sodium and chloride ions used for HTN, edema due to HF , cirrhosis , corticosteroid and estrogen therapy
Adverse reactions – Dizziness, OT HTN, gastric distress ,n/v, diarrhea, constipation, hematologic changes, photosensitivity, hyperglycemia , fluid and electrolyte imbalances, reduced libido
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Beta blockers
· The LOLs – reduce BP by preventing beta receptors in the heart to be stimulated, t hereby lowering blood pressure decrease the heart rate and dilate the blood vessels, controls the heart excitability and decrease cardiac work load·
They are contraindicated in pts with bradycardia, asthma, chronic lung diseases, heart block .·
Asses b/p and pulse before giving and notify doc is vitals are out of their established parameter· Report adverse effects ·
Teach pt to change positions slow to prevent dizziness and falls and report fatigue imootence to doc. Also if you develop a cough swelling of extremites ·
If diabetic check glucose frequent because Hypo may develop·
Talk to doc about taking over the counter meds · One of the side effects sis impotence
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Atenolol -(Tenormin)
50-200 ,used for HTN, angina, acute MI
Adverse reactions – Bradycardia , dizziness, hypotension, bronchospasm , n/v, diarrhea, nervousness,
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Metoprolol(Lopressor)-
used for HTN, angina, mi, HF
Adverse reactions – dizziness hypotension,HF, cardiac arrhythmia, nausea, vomiting, diarrhea
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Nadolol (corgard)-
, used for HTN, angina
Adverse reactions – dizziness hypotension,HF, cardiac arrhythmia, nausea, vomiting, diarrhea
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Ace Inhibitors – The prils
· May cause a significant drop in blood pressure when treatment is initiated causing orthostatic HTN,
usually begins with small dose and work up ,
prevents sodium and water from being retained and b/p decreases·
Common side effect is a dry cough that dies not subside until med is d/c·
Contraindicated in pt with impaired renal studies, HF, salt or volume depletion, bilateral stenosis, or angio edema and during pregnancy ·
Less effective in blacks ·
Assess b.p and WBC before giving the first dose and monitor 2hrs after the first dose ·
Give PO 1 hr before meals ·
Report changes in wbc , BUN and serum creatinin, Hyperkalemia to primary health provider ·
Do not administer with pt with renal arterial stenosis or pregnant·
Immediately report s/s of angioedema (giant wheels of edema of the tongue, glossitis)
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Catapril (capoten)-
)- 12.5-25 day in divided does ,used for HTN, HF, LVD after MI, diabetic nephropathy
Adverse reaction – rash
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Ramipril(Altace)
- 2.5 daily, used for HTN, HF, decreases rsk of cv disease, CAD,
- Adverse reactions –dizziness and cough
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Lisinopril (Prinivil)-
)- 10-40 mg day used for HTN, HF, post MI
Adverse reactions- Headache, cough,dizziness diarrhea, OT HTN
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Calcium channel Blockers
· Inhibit the flow of CA+ ions across cardiac cells so they relax arterial smooth muscle and lower blood pressure through vasodilation·
Assess B/P , apical pulse, liver and renal failure , may be given oral or IV·
Contraindicated w pt on verapamil or diltiazem to pt with severe HTN, SINUS, or av blocks and admin with caution with pt taking digoxin or BB·
Periodically monitor b/p and apical pulse during theraphy, promply report signs of bradycardia, av block or HF to DOC·
Notify doc if pulse if less than 60bmp or not within specific range ·
Drug may cause constipation , pt should drink 6-8 glasses of water ·
Report shortness of breath weight gain or swelling of the feet to DOC
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Amlodipine(Norvasc)
used for HTN , angina
Adverse reaction- headache
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diltiazem (Cardizem
30MG qid-used for HTN, angina, atrial fibrillation/flutter,
Adverse reactions- Headache, dizziness, atroventricular block, braydacardia, edema, dyspnea, rhinitis
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Digoxin(digitek)-
Used for HF, aril fibrillation –
Adverse reactions - Headache , weakness, drowsiness, visual distubances, n/v, anorexia, arrthythmias,
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Liptor (atorvastatin)-
10-80mg day, reduces risk of CHD events , hyperlipidemia , familial hyper cholesterol, The statins are the first line of treatment for the LDL used with dies and life changes
Nursing considerations·
Monitor serum cholesterol and liver enzyme levels before and during therapy·
- Assess
- for muscle pain and tenderness ,if taking digoxin monitor of toxicity
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Nitroglycerin-
dilates both arterial and venous vessals, depending on the does increase blood flow and o2
· 1 tb under tongue at 1st sign of angina attack may repeat q 5 mins until relief or or 3tbs have been taken ,
for acute relief of an attack or prophylaxis or angina pectoris if pain is longer than 20 min seek medical help ·
Wear gloves when applying paste , rotate the side of the patches,·
Keep an supply of tablets with you, pt may develop headache and burning, tingling sensation under tongue
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Nitroglycerin-
Adverse reactions- headache, hypostenison, dizziness, weakness , flushing , restlessness, rach
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Atropine- Mydriatic-dialates(Adrenergic antagonists
Dilates the pupil ,decrease the production of aqueous humor and increase it absorption , reducing intraocular pressure in open angle glaucoma
· Assess for allergic reactions ·
- Side effects of anxiety and nervousness , muscle tremors
- Adverse reactions- drowsiness blurred vision, tachycardia, dry mouth, urinary hesitancy
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Pilocarpine-
- - miotic constricts the pupil –
- draw the iris away from the angle and from the canal schelemmAdverse reactions –
Topical admiration usually produces few
adverse effects but a temporary reduction of visual acuity and headache may occur.
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Timoptic-
reduces intraocular pressure by decreasing the production of aqueous humor but donot affect pupil size and lens accommodation
Nursing considerations ·
Assess the pt for allergies or contradictions to BBs , including asthma, copd, and HF·
Maintain pressure over lacramal sac after administration to prevent systematic absorption ·
Sides effects of bradycardia, hypotension, and depression
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