Antihypertensive Medications

HCTZ

1. Lowers blood pressure in 2-4 weeks

2. Inhibits NaCl reabsorption in the distal tubule increasing excretion of Na+ and Cl 

3. Decreases extracellular fluid (ECF) decreases SVR (Systemic Vascular Restriction)

1. Fluid and electrolyte imbalances- hypokalemia (low potassium)

2. GI effects Anorexia, Nausea, Vomiting, Diarrhea (A/N/V/D) and Constipation.

3. Erectile dysfunction and decreased libido

4. Decreased glucose tolerance

1. Monitor for orthostatic Hypotension

2. Assess for electrolyte imbalances using lab values. Hypokalemia

3. Supplement with potassium rich foods

4. NSAIDS can decrease diuretic and antihypertensive effects

5. Monitor weight daily

A diuretic

Hydrochlorothiazide

Lasix

Furosemide

Bumex

Thiazide Diuretic

A loop diuretic

1. Inhibits NaCl reabsorption in the ascending limb of the loop of Henle, increasing excretion of Na+ and Cl-

2. More potent than thiazide but shorter duration

1. Fluid and electrolyte imbalances

2. If given too quickly through IV, causes permanent Ototoxicity-deafness, vertigo, and hearing impairment.

3. Increased LDL, cholesterol, and triglycerides.

4. Decreased HDL

5. Hyperglycemia- Increase in blood sugar.

1. Monitor for orthostatic hypotension

2. Assess for electrolyte imbalances through lab values

3. Effect increases with doses

4. Remain effective despite renal insufficiency

5. Daily weight

Aldactone

Spironolactone

Potassium-Sparing Diuretics/ Aldosterone Receptor Blockers

Hold on to potassium in the body.

1. Reduces K+ and Na+ exchange in the distal and connecting tubules. 

2. Reduces excretion of K+, H+, Ca+, and Mg+

1. Hyperkalemia

2. N/V/D

3. Headache

4. Leg cramps

5. Dizziness

6. Erectile Dysfunction and decreased libido

7. Menstrual Irregularities

1. Monitor for orthostatic hypotension and hyperkalemia

2. Contraindicated for clients with renal failure- Asses BUN and Creatine

3. Avoid potassium foods!

4. Use cautiously with patients on ACE inhibitors or angiotensin II blockers

5. Assess skin for rashes, could indicated a life threatening complication.

Tenormin

Atenolol

Lopressor

Metoprolol

B-Adrenergeric Blocker (Beta Blocker)

Beta Blocker

ACE Inhibitor

Steroid

1. Cardioselective agents that block B1-adrenergic receptors

2. Decreases cardiac output and reduces SVR (systemic Vascular Restriction)

3. Decreases Renin secretion in kidneys

1. Hypotension

2. Bronchospasm

3. Impaired peripheral circulation 

4. Nightmares

5. Depression

6. Erectile Dysfunction

7. Weakness

8. May exacerbate heart failure in some clients

1. Rebound HTN with sudden withdrawal 

2. Less effective decreasing BP with African American’s because of the decreased Renin

3. Change position slowly to decrease risk of orthostatic HTN

4. Caution with diabetics

5. Intake and output daily

6. Weight daily

7. Client at increasing risk for HF

Calan

Verapamil

Cardizem LA

Diltiazam Extended Release

Procardia XL

Nifidepine Long Acting

Norvasc

Amlodipine

Calcium Channel Blockers

Extended Release

Slow release

Long acting

Extended release

1. Block movement of extracellular calcium into cells causing vasodilation and decreased hear rate and contractility

2. Vascular smooth muscle relaxation resulting in decreased SVR and arterial BP

1. Bradycardia

2. First degree heart block

3. Nausea 

4. Dizziness

5. Headache

6. Rash

7. Constipation with verapamil

1. Grapefruit juice can cause toxicity 

2. Avoid in patients with 2nd or 3rd degree AV block

3. Intake and weight daily

4. Assess skin for rashes, could indicate a life threatening complication

Capoten

Captopril

Vasotec

Enalapril

Prinivil

Lisinopril

Angiotension Converting Enzyme Inhibitors (ACE inhibitors)

1. Reduces conversion of angiotensin I to angiotensin II

2. Inhibits angiotensin II vasoconstriction

1. Dry hacking cough

2. Dizziness

3. Loss of taste

4. Hyperkalcemia 

5. Acute renal failure

6. Skin rash

1. Use with caution with K+ sparing diuretics

2. ASA (aspirin) and NSAIDS, may decrease drug effectiveness

3. Assess for angioedema 

4. Monitor weight

5. Hypercalemia (high calcium levels)

Cozaar

Losartan

Diovan

Valsartan

Benicar

Olmesartan

Angiotensin II Receptor Blockers (ARB)

1. Prevent action of angiotensin II and produces vasodilation

2. Decreases blood pressure, peripheral resistance, and after load

1. Hyperkalemia

2. Decreased Renal Function

1. Full effect 3-6 weeks

2. Does not effect bradykinin levels so it is an alternate to ACE in clients with cough

3. Renal clients do NOT use ACE and ARB together

4. Assess for angioedema

5. Daily weight

6. Always look at renal function through lab work

7. Women have a lowered risk for a MI than men using an ARB

Apresoline

Hydrazaline

Vasodilator

Vasodilators

1. Reduces SVR and BP by direct vasodilation

2. At low doses causes venous dilation

3. Relaxes Arterial and venous smooth muscle, reducing preload and SVR

1. Anemia

2. Vasculitis

3. Glomerulonephritis

4. Headache

5. N/V

6. Tachycardia

7. Palpitations

8. Flushing

1. Use in conjunction with other therapies. 

2. Assess for pedal edema

3. Hospitalization required to monitor