Direct Acting Vasodilators

Question 1

Hydralazine

Answer 1

• Medication Administration: IV, PO
• Mechanism of Action: Direct-acting vasodilator

Indication:

• Quick management of acute HTN
• Preeclampsia

Contraindication:

• RF
• Concurrently with sildenafil

Side effects, Adverse reactions:

• Less blood pressure in kidney –> fluid/Na retention (combine with diuretics)
• Increased permeability with arteriodilation (edema, nasal congestion, HA) combine with diuretics
• Orthostatic hypotension (fall)
• Tachycardia (reflex), patient reports palpitation

Question 2

Alpha 1 Blockers

Answer 2

Medication:

• For HTN & BPH: Prazosin, terazosin, doxazosin
• For BPH only: Tamsulosin, silodosin

Mechanism of Action:
- vasodilation (decrease peripheral resistance), relaxing prostate

• Indication: Hypertension

Side effects, Adverse reactions:

• Orthostatic hypotension (Fall risk)
• Na/water retention (use with diuretics & monitor daily weight & edema)
• Tachycardia (reflex)
• Erectile dysfunction

Question 3

Ace Inhibitors (-pril)

Answer 3

​​- Medication: benzepril, captopril, lisinopril, enalapril, enalaprilat

Mechanism of Action:

• angiotensin-converting enzyme inhibitor
• Prevent angiotensin II formation –> decrease peripheral resistance & afterload
• Can lead to AKI & hyperkalemia (b/c it inhibits aldosterone)

Indication:

• Hypertension
• HF

Contraindication:
- PAAK: pregnancy, allergy, AKI (helpful for CKD), K increase

Side effects, Adverse reactions:

• Increases bradykinin (inflammatory mediator) –> dry hacking cough, angioedema
• AKI, hyperkalemia (monitor K, dysrhythmia, paresthesia, weakness, cramps)
• Orthostatic hypotension, tachycardia (reflex), dizziness, fall (change position slowly, lie down if dizzy)

Question 4

Angiotensin Receptor Blockers (ARBs; -sartan)

Answer 4

• Medication: losartan, valsartan, telmisartan

Mechanism of Action:

• Block the receptor site of angiotensin II
• Very similar to ACEi but not as effective
• Prevents vasoconstriction –> low BP
• AKI & hyperkalemia
• Tachycardia (reflex)

Indication:

• Hypertension
• HF

Contraindication:
- PAAK: pregnancy, allergy, AKI (helpful for CKD), K increase

Side effects, Adverse reactions:

• AKI, hyperkalemia (monitor K, dysrhythmia, paresthesia, weakness, cramps)
• Orthostatic hypotension, tachycardia (reflex), dizziness, fall (change position slowly, lie down if dizzy)

Question 5

Amlodipine & Nifedipine

Answer 5

• Ca channel blocker

Mechanism of Action:

• Specific to vasculature
• Systemic vasodilation –> decreased BP
• Call the provider & hold for SBP < 90

Indication:

• Hypertension
• Angina

Side effects, Adverse reactions:

• Peripheral edema (daily weight, I/O)
• Low BP –> tachycardia (reflex)
• Low BP –> fall
• Low BP –> monitor renal panel for AKI
• Medication Administration: IV, PO