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|Thiazide Diuretic increase sodium & water excretion by inhibiting sodium reabsorption in the distal tubule of the kidney. Used for hypertension and peripheral |
|edema. Not effective for immediate dieresis. Used in clients w/normal renal function. |
|Hydrochlorothiazide |Relatively inexpensive, |Gout, known sensitivity |dry mouth, thirst, weakness, drowsiness, |Monitor for signs of |
| |effective orally. Effective |to sulfonamide-derived |lethargy, muscle aches, muscular fatigue, |electrolyte imbalance because |
| |long-term admin. Mild side |medications, severely |tachycardia, GI disturbance. |this causes loss of sodium, K+,|
|Thiazide diuretics should be used |effects. Enhances other |impaired kidney function,|Postural hypotension may be potentiated by|Ma. Encourage intake of K+ rich|
|w/caution in clients taking |antihypertensive meds. |and history of |alcohol, barbiturates, opioids, or hot |foods. GerI: risk of postural |
|lithium because lithium toxicity |Counter sodium retention |hyponatremia. |weather/baths, strenuous exercise |hypotension. Measure BP in 3 |
|can occur in client taking |effects of other | | |positions. Caution pt to rise |
|digoxin, corticosteroids, or |antihypertensive meds. | |sulfa-based – allergic reaction |slowly. |
|hypoglycermice meds. | | |- at risk for hypokalemia, hyperglycemia, |i/o, lytes, FUN Cr. Give in AM,|
| | | |Hypercalcemia, hyperlipidemia and |Diet, BUN, uric acids. |
| | | |hyperuricemia. | |
|Loop Diuretic Inhibit sodium and chloride reabsorption. More potent than Thiazide diuretics. Causing rapid dieresis, and thus decreasing vascular fluid volume, |
|cardiac output and BP |
| |Gout, known sensitivity to |risk of volume and elect.|Geri: risk of postural hypotension. | |
|Rapid Action. Potent. Used when |sulfonamide-derived |Depletion from the |Measure BP in 3 positions. Caution pt to | |
|Thiazides fail or pt needs rapid |medications, severely |profound diuresis |rise slowly. | |
|dieresis. |impaired kidney function, |occurring. Fluid & elec | | |
| |and history of hyponatremia.|replacement may be req. | | |
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|Bumetanide – diuretic used to decrease venous return when client is in bed.(paroxysmal |adverse – hypotension. monitor BP |Put on K+ supplements. |
|nocturnal Dyspnea due to increased venous return) | | |
| | | |
|Furosemide – Administer Lasix slowly - may cause hearing loss if injected too rapidly. | | |
| | | |
|Potassium Sparing Diuretic – promotes sodium and water excretion and potassium retention. Used for edema and HTN to increase urine output, fluid retention, and |
|overload associated w/heart failure, ascites. |
|Causes Potassium retention |Contraindicated in Renal |Drowsiness, lethargy, headache. |Monitor for Hyperkalemia if |
| |Disease, Azotemia, severe |Hyperkalemia, N & V, diarrhea. Rash, |given with ACE inhibitor or |
| |hepatic disease, hyperkalemia |Dizziness, weakness, dry mouth |Angiotensin receptor blocker. |
|Spironolactone - Considered an Aldosterone Receptor | |photosensitivity, anemia, |Diarrhea & GI symptoms – admin.|
|Blocker as well as Potassium sparing diuretic. | |thrombocytopenia. |meds after meals |
| | | |Monitor Vital signs. Monitor |
| | | |Urine Output. Avoid foods high |
| | | |in K+. Avoid salt substitutes –|
| | | |high in K+. |
|Centrally Acting Sympatholytic (Adrenergic Blockers) Alpha Agonist – stimulate alpha receptors in the CNS to inhibit vasoconstriction – reducing peripheral |
|resistance. |
| |slows pulse, which |history of depression, |Sodium and water retention, drowsiness, |Monitor VS. Not to discontinue med – can|
| |counteracts tachycardia of |psychosis, obesity, |dizziness, dry mouth, Bradycardia, edema, |cause severe rebound hypertension. |
| |Hydralazine |chronic sinusitis, |impotence, hypotension, depression. |Monitor liver function tests. Use with |
| | |peptic ulcer |May cause severe depression – but mainly |caution if history of gallbladder, |
| | | |those with depression; report |renal, or cardiac disease, or seizure |
| | | |manifestations, as this may require that |disorder. Geri: depression and postural |
| | | |drug be omitted. Nasal congestion. |hypotension common in elderly |
|Methyldopa – |drowsiness, dizziness, dry mouth; nasal |Geri: May produce mental and behavioral |
| |congestion. (troublesome at first but then |changes in the elderly. |
|Dopa-decarboxylase, inhibitor; displaces norepinephrine from storage sites. |tends to disappear) Use with caution | |
|Drug of choice for pregnant women w/HTN (Laura’s METH-Pregnant Lady) Useful in|w/Renal Disease. | |
|patients w/renal failure or prostate disease. Does not decrease cardiac output| | |
|or renal blood flow. Does not induce oliguria. |Liver disease | |
|Clonidine | through CNS, produces blood |little or no orthostatic|Drowsiness, dry mouth, withdrawal |monitor BP when stopping medication |
| |pressure reduction. |effect. Moderately |phenomenon. | |
|Patch |If BP is above 160 give Clonidine –|potent, | |sometimes is effective when other meds |
| |Centrally acting. CNS – Quick. | | |fail to lower blood pressure. |
| | | | | |
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|Beta Blockers block the sympathetic nervous system, especially the sympathetic to the heart, producing a slower heart rate and lowered blood pressure. Reduces |
|Hearts Contractility work load and oxygen demands. |
| |Reduce pulse rate in |Bronchial asthma, allergic |Mental depression manifested by |I/O, Wt, HR Avoid sudden |
|Glucose monitoring. |patients with |rhinitis, right ventricular |insomnia, lassitude, weakness, and|discontinuation, check HR before |
| |tachycardia and BP |failure from pulmonary |fatigue. Light headedness & |giving. Geri: Risk of toxicity is |
|Used for angina, Dysrhythmia, |elevation. Indicated for|hypertension, heart failure, |occasional N & V, Epigastric |increased for elderly patient |
|hypertension, migraine headaches, |patients who also have |depression , DM, |distress |w/decreased renal and liver function. |
|prevention of myocardial |stable angina pectoris |Dyslipidemia, Heart block, | |Take BP in 3 positions and observe for|
|infarction, and glaucoma. |and silent ischemia. |PVD, | |hypotension. Antacids may cause |
| | |HR < 50bpm, apical | |malabsorption. |
| | |BP < 110 | | |
|Atenolol |
|Propranolol – watch out for bronchospasms indicated by audible expiratory wheezes. |
|Metoprolol |
|Calcium Channel Blockers – Inhibit CA ion influx across membranes. Vasodilating effects on coronary and peripheral arteriole. Decrease cardiac work and energy |
|consumption, increase delivery of O2 to myocardium VASODIALATORS, relax smooth muscle in vessel walls – sexual dysfunction. Used as Antirhythmic agents. |
|Rapid action. Effective by oral or sublingual route. To |None (except Heart |Muscle cramps, joint stiffness, |Monitor for hypotension, Bradycardia and |
|tendency to slow SA nodal activity or prolong AV node |Failure for Nifedipine) |sexual difficulties may disappear |pedal edema. Administer on empty stomach. Use|
|conduction. Isolated systolic hypertension. | |when dose decreased. |w/caution in diabetic patient w/diabetes. |
| | | |Small frequent meals if nausea. |
|Used in Raynaud’s Disease | |May cause dizziness |Report irregular Heartbeat, constipation, |
| | | |SOB, edema. |
| | |hyperglycemia. | |
|Amlodipine |
|Felodipine |
|Nifedipine- for blood pressure |
|Nisoldipine |
|Diltiazem - Bradycardia due to affect on AV and SA nodes. CA blockers used to treat Arrhythmias. |
|Verapamil |slows velocity of |Sinus or AV node |Bradycardia. |Administer on empty stomach or before meal. |
| |conduction of cardiac |disease; severe heart | |Do not discontinue suddenly. Depression may |
|Bradycardia due to affect on AV |impulse. |failure; severe | |subside when medication is discontinued. To |
|and SA nodes. CA blockers used to |Effective antiarrhythmic|hypotension | |relieve headaches, reduce noise, monitor |
|treat Arythmias. |Rapid IV onset. Blocks | | |electrolytes. Decrease dose for patients with|
| |SA and AV node channels.| | |liver or renal failure. |
| | | | | |
| | | | | |
|Peripherally Acting Alpha Blocker – Decrease sympathetic vasoconstriction by reducing the effects of norepinephrine at peripheral nerve endings, resulting in |
|vasodilation and decreased BP |
|Doxazosin | | |Orthostatic hypotension, reflex |Monitor VS, Fluid retention , |
|Prazosin | | |tachycardia, sodium and water retention, |edema. change positions slowly.|
|Terazosin | | |GI disturbances, N, drowsiness, nasal | |
| | | |congestion edema Weight Gain. | |
|Combined alpha & beta blocker |
|Carvedilol | | | | |
|Labetalol | | | | |
|Peripheral Vasodilators – work directly on the vessels to cause vasodilation, given for chest pain. decrease Peripheral Resistance. Increased blood flow to |
|extremities. Effective for disorders resulting from vasospasm Reynaud’s disease.. May decrease symptoms of cerebral vascular insufficiency. |
|Hydralizine | | |light-headedness, dizziness, Orthostatic|Assess Headaches |
|Minoxidil | | |Hypotension, Tachycardia, Palpitations, |Monitor for Orthostatic hypotension. BP VS HR. |
| | | |Flushing, GI distress. |inadequate blood flow – pallor, feeling cold, pain. |
| | | | |Instruct patient it may take up to 3 months for |
| | | | |desired therapeutic response. Quit smoking – increases|
| | | | |vasospasm.. Avoid Aspirin or aspirin-like compounds. |
|Angiotensin-Converting Enzyme ACE Inhibitors and) – lowers total peripheral resistance. by blocking Angiotensin I to Angiotensin II. Good for Heart Failure. |
|Reduces Cardiac workload. Prevents Peripheral Vasoconstriction. |
|Used to treat HTN, HF, |PRIL |Causes Decrease |N & V, diarrhea, |check urinary protein |
|cardioprotective effect after |Play right in Las vegas |Aldosterone Avoid use |Persistent dry cough |Monitor VS, WBC, Protein, Albumin, |
|myocardial infarction. |you need a ACE |with potassium |hypotension |BUM, Creatinine, K+. |
| | |supplements and |Hyperkalemia |Hypoglycemic reactions. |
| | |potassium=sparing |tachycardia |Inform pt food may diminish taste |
| | |diuretics. |headache dizziness, fatigue, insomnia |during 1st month of therapy. |
| | | |hypoglycemic reaction in pt w/DM, | |
| | | |bruising, Petechiae, bleeding Diminished| |
| | | |Taste. | |
|Benazepril |
|Captopril – take 20 – 60 minutes before a meal. |
|Enalapril |
|Fosinopril |
|Lisinopril |
|Ramipril |
|Angiotensin II receptor blockers (ARBs)– sit at receptor site on II, blocks so I can’t go to II. Produces Vasodilation. |
|“artan” |
|Irbesartan | | | | |
|Losartan | | | | |
|Olmesatrtan | | | | |
|Valsartan | | | | |
Normal BUN 7 – 20
Normal Creatinine 0.8 – 1.4 K+ 3.5 – 5.5 Norm
PT 11 – 13, or PTT is 1-2 times the pt’s control for warfarin
INR prophylaxis and Tx of venous thrombosis 2-3
Tx pulmonary, Prevention of systemic embolism 2-3
all other INR 3-4.5
Digoxin therapeutic 0.5 – 2ng.
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