What is the MOA of hydrochlorothiazide?
Inhibits resorption of
sodium/potassium/chloride resulting in water loss
Relaxes arterioles decreasing peripheral vascular resistance
When is hydrochlorothiazide used?
First line treatment for mild hypertension
What are side effects of thiazide diuretics?
Can elevate glucose & cholesterol
What is the MOA of furosemide?
Inhibit reabsorption of sodium in the loop of henle results in profound water loss (diuresis) & decreased cardiac output
When is furosemide used?
Treats hypertension due to fluid volume overload
What are side effects with furosemide?
What is the normal potassium level?
3.5 - 5 mmol/L
What is the MOA of spironolactone?
Block the action of aldosterone resulting in potassium retention and excretion of sodium and water
When is spironolactone used?
Usually with other diuretics for increased effect with retention of potassium
What are side effects with spironolactone?
Deepened voice, impotence, hirsutism
What is the MOA of ACE inhibitors such as Captopril and Lisinopril?
Blocks angiotensin-converting enzyme thereby inhibiting production of angiotensin-2
What are side effects of lisinopril?
Hypotension Dry, nonproductive, persistent cough Dizziness Rash Angioedema
What is the MOA of losartan?
Blocks the action of angiotensin-2 after it is formed causing vasodilation and increased water & sodium secretion
What are side effects of angiotensin receptor blockers?
Do not use if pregnant
Use with caution with renal problems
How are calcium channel blockers used to control blood pressure?
Blocking calcium channels causes vasodilation (the ipines)
What are the side effects with nifedipine?
Drop in blood pressure
What is the MOA of hydralazine?
Relaxes smooth muscles of arteries and veins
What are side effects of hydralazine?
Hypotension Dizziness Headache Tachycardia Edema GI upset
MAO of metoprolol, propranolol, carvedilol
Increases nitric oxide= vasodilation response
Blocks stimulation of beta-1 receptors= Decreases HR and contractility
Side Effects of Beta-Blockers
Can mask hypoglycemia- prevents tachycardia, be careful with use in diabetics
Nursing Implications of Beta-Blockers
Recognize the RISK for hypotension and/or bradycardia
Hold & contact provider if HR is less than 60 or a systolic BP less than 100
MAO of Clonidine (catapress)
Decrease sympathetic outflow resulting in decreased stimulation of adrenergic receptors (both alpha AND beta receptors)
Main outcome: decreased blood pressure
Side Effects of Clonidine
Drowsiness- most common
Give at night to combat this
May worsen pre-existing liver disease
Nursing Implications of Clonidine
Do not abruptly discontinue- rebound HTN
MAO of Doxazosin (cardura)
Selective alpha-1 blockade
Venous AND arterial dilation
Side Effects of Doxazosin (cardura)
MOA of Ace Inhibitors- lisinopril, captopril
Blocks angiotensin-converting enzyme (ACE)
Inhibits production of Angiotensin-2 (powerful vasoconstrictor)
Inhibits aldosterone secretion- less water retention
Side Effects of lisinopril/captopril
Dry, nonproductive, PERSISTENT cough- (largest complaint from patients often reason people switch)
Can you take lisinopril, captopril while pregnant?
Nursing Considerations for lisinopril/captopril
Renal insufficiency- use cautiously in patients with history of renal disease
Captopril can cause neutropenia- monitor WBC
Risk of hyperkalemia especially if patient on potassium supplements
MOA of Losartan (cozaar)
blocks the action of angiotensin 2 AFTER it is formed
Increased sodium and water excretion
Side Effects of Losartan (cozaar)
Some risk of angioedema
Can you take Losartan while pregnant?
Requires the use of contraception if of childbearing age
Nursing Implications of Losartan (cozaar)
Use cautiously in patients with renal problems
MOA of Aliskiren (tekturna)
Direct inhibition of renin
Induces vasodilation, decreases blood volume, decreases SNS, and inhibitors cardiac and vascular hypertrophy
Side Effects of Aliskiren (tekturna)
relatively well tolerated
When given with ACEi watch for hyperkalemia, especially in patients with diabetes
Nursing Considerations of Aliskiren (tekturna)
Take several weeks to see full effect (half-life)
DO NOT take pregnant
Calcium Channel Blockers
Side Effects of Calcium Channel Blockers
Nursing Implications for CCB
CCB are often best for elderly and African Americans
Diuretics can be given for peripheral edema
MAO of Hydralazine (apresoline)
Vasodilators work directly on arterial and venous smooth muscles and cause relaxation
Direct vasodilation cause decreased systemic and peripheral vascular resistance
Side Effects of Hydralazine (apresoline)
Dizziness, headache, tachycardia, edema, dyspnea, GI upset
MAO of Hydrochlorothiazide [HCTZ] (HydroDiruil)
-Works on the distal convoluted tubule to inhibit resorption of sodium/potassium/ & chloride = decreased cardiac output
-Results in water loss
Also relaxes arterioles = decreased peripheral vascular resistance (PVR)
Side Effects of Hydrochlorothiazide
- Electrolyte and metabolic disturbances
- HYPOKALEMIA (low potassium)
- Orthostatic hypotension
- May worsen renal insufficiency
- Hyperuricemia- watch out with gout patients
- Can elevate levels of glucose, cholesterol, and triglycerides
Nursing Implications of Hydrochlorothiazide
- Can give potassium supplements
- Encourage food rich in potassium
MAO of Furosemide (Lasix)
- Inhibit the kidneys ability to reabsorb sodium in the LOOP OF HENLE
- Makes kidneys put more sodium in the urine
- WATER FOLLOWS SODIUM= more peeing out
Side Effects Furosemide
-HYPOKALEMIA And other electrolyte abnormalities -Dehydration -Hypotension -Ototoxicity = difficulty hearing, usually transient with furosemide
Nursing Implications of Furosemide
- Monitor potassium levels!
- Patients typically receive KCL supplements with their Lasix doses
MAO of Spironolactone (Aldactone)
Block the action of aldosterone (sodium & water retention)= potassium retention & excretion of sodium and water
Side Effects of Spironolactone
Can see HYPERkalemia
Endocrine effects: deepened voice, impotence, irregular menstrual cycles, gynecomastia, hirsutism
Nursing Implications of Spironolactone
- Only given PO
- Usually given in combination with other hypertensives/diuretics to get more effect with a lower chance of hypokalemia
- Only provides small amount of diuresis and hypotensive effect