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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. |

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|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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