Antihypertensive Medications

  1. Diuretics
    Mechanism of Action
    Loop diuretics: action is in loop of Henle; Inhibits the re-uptake of Na+ in the nephron

    Potassium sparing diuretics: action is in collecting tubules; Inhibits the re-uptake of Na+ in the nephron  and inhibits aldosterone

    Thiazide diuretics: action is in distal tubule; Inhibits the re-uptake of Na+ in the nephron
  2. Diuretics
    Loop diuretics: water follows sodium: produces increased urine flow; reduces fluid volume and preload 

    Potassium sparing diuretics: block sodium channels thus preventing re-uptake in the kidneys; acts as Competitive antagonist for aldosterone receptor sites thus blocking the action of aldosterone

    Thiazide diuretics: direct endothelial/vascular smooth muscle mediated vasodilation; Inhibits the re-uptake of Na+ and Cl- in the nephron
  3. Diuretics
    • Promoting diuresis for volume depletion 
    • Hypertension
  4. Diuretics Examples
    • Loop:
    • Furosemide (Lasix)
    • Bumetanide (Bumex)
    • Demodicidae (Demedex) 

    • Potassium Sparing:
    • Spironolactone (Aldactone) 

    • Thiazide:
    • Hydrochlorothiazide (Hydrodiuril)
    • Metolazone (Zaroxolyn)
  5. Diuretics
    Nursing Considerations
    • Check orthostatic signs
    • Monitor Lab values
    • Caution w/ Digoxin (Thiazides, Loop)
    • Caution with Lithium
    • Caution with NSAIDS (Thiazides)
    • Advise client to eat K+ rich foods (Thiazides, Loop)
    • K+ Sparing - caution with Angiotensin inhibitors
  6. Calcium Channel Blockers(“-dipine”)
    Mechanism of Action
    Block or slow calcium flow into muscle cells.
  7. Calcium Channel Blockers(“-dipine”)
    • reduce cardiac conduction
    • reduce force of contraction (negative inotrope)
    • reduce afterload
    • vasodilate smooth muscle
    • block calcium on adrenal cortex reducing aldosterone and lowering blood pressure
  8. Calcium Channel Blockers(“-dipine”)
    • Hypertension
    • Angina
    • Atrial fibrillation
    • Paroxysmal SVT
  9. Calcium Channel Blockers(“-dipine”)
    • Amlodipine (Norvasc)
    • Nifedipine (Procardia)
    • Verapamil (Calan)
    • Dilitiazem (Cardizem)
  10. Calcium Channel Blockers(“-dipine”)
    Nursing Considerations
    • monitor digoxin
    • levels monitor for bradycardia and hypotension
    • may cause headache, constipation and/or peripheral edema
  11. Angiotensin Converting Enzyme (ACE) Inhibitor(“-pril”)
    Mechanism of Action
    Inhibit angiotensin-converting enzyme, a component of the renin-angiotensin-aldosterone system that converts angiotensin I to angiotensin II.
  12. Angiotensin Converting Enzyme (ACE) Inhibitor(“-pril”)
    • relaxation of blood vessels
    • lowers peripheral resistance; reduces afterload
    • reduced blood volume (decreased preload)
  13. Angiotensin Converting Enzyme (ACE) Inhibitor(“-pril”)
    • Hypertension
    • Heart failure
  14. Angiotensin Converting Enzyme (ACE) Inhibitor(“-pril”)
    • Captopril (Capoten)
    • Enalapril (Vasotec)
    • Lisinipril (Zestril)
  15. Angiotensin Converting Enzyme (ACE) Inhibitor(“-pril”)
    Nursing Considerations
    • monitor P (1st dose hypotension)
    • caution with ASA and NSAIDS
    • side effects: rash, cough, loss of taste, neutropenia
  16. Beta-blockers(“-lol”)
    Mechanism of Action
    Block the action of endogenous catecholamine’s (epinephrine/ norepinephrine) effect on beta receptors; decrease responsiveness of the heart to the symp. nervous system
  17. Beta-blockers(“-lol”)
    • Beta 1:
    • reduces heartrate reduce force of contraction (negative inotrope)
    • reduces cardiac output
    • reduces blood pressure (SVR)
    • reduces renin release
    • Beta 2:
    • bronchial and vascular smooth muscle constriction
  18. Beta-blockers(“-lol”)
    • Hypertension
    • Angina
    • Tachycardia
    • Heart failure
    • Tremors
  19. Beta-blockers(“-lol”)
    • Atenolol (Tenormin)
    • Propranolol (Inderal)
    • Metoprolol (Lopressor)
    • Nadolol (Corgard)
  20. Beta-blockers(“-lol”)
    Nursing Considerations
    • do not discontinue abruptly
    • monitor for bradycardia and hypotension
    • monitor for orthostatic hypotension
    • insomnia major side effect
    • caution with asthma
  21. Aldosterone Receptor Blockers(ARB’s)
    Mechanism of Action
    Block activation of angiotensin II; reduce secretion of aldosterone and vasopressin
  22. Aldosterone Receptor Blockers(ARB’s)
    • relaxation of blood vessels
    • lowers peripheral resistance; reduces afterload
  23. Aldosterone Receptor Blockers(ARB’s)
    • Hypertension
    • CHF
  24. Aldosterone Receptor Blockers(ARB’s)
    • Losartin (Cozaar)
    • Valsartan  (Diovan)
  25. Aldosterone Receptor Blockers(ARB’s)
    Nursing Considerations
    • same as with ACE inhibitors
    • monitor for hyperkalemia
  26. Alpha-blockers
    Mechanism of Action
    Receptor antagonist of a-adrenergic receptors
  27. Alpha-blockers
    vasodilation of peripheral blood vessels
  28. Alpha-blockers
    • Hypertension
    • Panic disorders
  29. Alpha-blockers
    Doxazosin (Cardura)
  30. Combined Alpha- and Beta-blockers
    Mechanism of Action
    • Alpha 1 Blockers (Antagonists)
    • Alpha 2 Agonists (Central acting antagonists)
  31. Combined Alpha- and Beta-blockers
    peripheral vasodilation and decreased PVR
  32. Combined Alpha- and Beta-blockers
  33. Combined Alpha- and Beta-blockers
    Carvedilol (Coreg)
  34. Combined Alpha- and Beta-blockers
    Nursing Considerations
    monitor for orthostatic hypotension
  35. Vasodilators (nitrates only)
    Mechanism of Action
    Converted to nitric oxide (a vasodilator)
  36. Vasodilators (nitrates only)
    peripheral vasodilation of smooth muscle
  37. Vasodilators (nitrates only)
    • Hypertension
    • Angina
  38. Vasodilators (nitrates only)
  39. Vasodilators (nitrates only)
    Nursing Considerations
    • monitor for hypotension
    • monitor for headache
  40. Less Common Anti-hypertensive Drugs
    • Alpha-Beta Blockers
    • Ganglionic Blockers
    • Post-Ganglionic Blockers (Peripheral-acting antagonists)
Card Set
Antihypertensive Medications
Antihypertensive Medications