ANTIHYPERTENSIVE DRUGS

SIDE EFFECTS / NURSING

CLASSIFICATION DRUGS PHARMACODYNAM PHARMACOKINETICS INDICATIONS INTERACTIONS CONSIDERATIONS
ICS
Antihypertensive Absorption: 65% to 75% Hypertension. Adult SIDE EFFECTS Monitor fluid intake and
VII. DIURETICS action: Exact mechanism of absorbed from the GI tract.  s:  12.5 to 50 mg CV: volume depletion output, weight, blood
 HYDROCHLOROTHIAZIDE antihypertensive effect of Distribution: Unknown.  P.O. once daily. Daily and dehydration, pressure, and serum
A. THIAZIDES drug is unknown. It may Metabolism: None.  dose increased or orthostatic hypotension, electrolyte levels. 
result partially from direct Excretion: Excreted decreased based on allergic myocarditis,
arteriolar vasodilation and a unchanged in urine, usually blood pressure. vasculitis. 
decrease in total peripheral within 24 hours; half-life is 5 Doses greater than INTERACTIONS
resistance.  1/2 to 14 1/4 hours. 25 mg usually don’t Amphetamine,
show added benefit. methenamine
compounds (such as
methenamine
mandelate),
quinidine:  Causes
alkaline urine,
decreased urinary
excretion of some
amines, decreased
therapeutic
efficacy. Monitor patient
for drug effect.

Antihypertensive
B. POSTASSIUM-  SPIRONOLACTONE action: The mechanism of
SPARING action is unknown.
Spironolactone may block
the effect of aldosterone on
arteriolar smooth muscle.  are more than 90% plasma
Absorption: About 90% is Hypertension. Adult SIDE EFFECTS Give drug with meals to
absorbed after oral s:  50 to 100 mg P.O. CNS: headache, enhance absorption. 
administration.  daily in divided drowsiness, lethargy,
Distribution: Drug and its doses.  confusion, ataxia. 
major metabolite, canrenone, Children:  1 to 2
mg/kg P.O. b.i.d. has INTERACTIONS
protein-bound.  been used.  Aspirin: May slightly
Metabolism: Rapidly and decrease response to
extensively metabolized to spironolactone. Watch
canrenone.  for diminished effect.
Excretion: Canrenone and
other metabolites are excreted
primarily in urine, and a small
amount is excreted in feces via
the biliary tract; half-life of
canrenone is 13 to 24 hours.
Half-life of parent compound is
1 to 2 hours. 
 Antihypertensive
action: Amiloride is
commonly used with more
 AMILORIDE effective diuretics to
manage edema from heart
failure, hepatic cirrhosis,
and hyperaldosteronism.
Mechanism of amiloride’s
hypotensive effect is
unknown.  function.  ually 5 mg P.O. daily. lithium and increase
Diuretic
 TRIAMTERENE action: Triamterene acts
directly on the distal renal
tubules to inhibit sodium
reabsorption and potassium
excretion, reducing
potassium loss. 
Triamterene is commonly
used with other more
effective diuretics to treat
edema related to excessive
aldosterone secretion,
hepatic cirrhosis, nephrotic
syndrome, and heart
failure. 
VIII. VASODILATORS  NITROPRUSSIDE Antihypertensive
action: Nitroprusside acts
directly on vascular smooth
muscle, causing peripheral
vasodilation.  rapidly in erythrocytes and
Absorption: About 50% is Hypertension; SIDE EFFECTS Monitor patient for signs of
absorbed from GI tract. Food edema related to CNS: headache, weakne hyperkalemia, including
decreases absorption to 30%.  heart failure, ss, paresthesia, muscular
Distribution: Wide usually in patients dizziness, encephalopa weakness, fatigue, flaccid
extravascular distribution.  who are also thy, fatigue. paralysis of the limbs,
Metabolism: Insignificant.  taking thiazide or bradycardia, shock, and
Excretion: Most is excreted in other potassium- INTERACTIONS ECG abnormalities. 
urine; half-life is 6 to 9 hours wasting Lithium: May reduce
in patients with normal renal diuretics. Adults: Us renal clearance of
Dose may be blood lithium level. Use
increased to 10 mg together cautiously.
daily, if necessary.
Don’t exceed 20 mg
daily. 
Absorption: Absorbed rapidly Edema. Adults: Initi SIDE EFFECTS  Monitor blood
ally, 100 mg P.O.
after oral administration, but CNS: dizziness, pressure, CBC,
b.i.d. after meals.
the extent varies. Diuretic weakness, fatigue, and blood uric
Total daily dose
effect may be delayed 2 to 3 headache.  acid, blood
shouldn’t exceed 300
days if used alone; maximum glucose, BUN,
mg. 
antihypertensive effect may be INTERACTIONS and serum
delayed 2 to 3 weeks.  Antihypertensives: Enhances electrolyte
Distribution: About 67% hypoglycemia. Monitor levels. 
patient closely. May be a
protein-bound.  
therapeutic advantage.
Metabolism: Metabolized by Watch for
hydroxylation and sulfation.  blood
Excretion: Excreted in urine; dyscrasia. 
half-life of triamterene is 100
to 150 minutes. 
Absorption: Administered Hypertensive SIDE EFFECTS Nitroprusside can cause
I.V.  emergencies. Adult CNS: headache, cyanide toxicity; therefore,
Distribution: Unknown.  s and children: Initial dizziness, loss of check serum thiocyanate
Metabolism: Metabolized dose is 0.25 to 3 consciousness, levels every 72 hours.
mcg/kg/minute by apprehension,  increase Levels above 100 mcg/ml
tissues to a cyanide radical and I.V. infusion titrated d intracranial are linked to cyanide
then converted to thiocyanate to blood pressure, pressure,  restlessness. toxicity, which can produce
in the liver.  with a range of 0.3 to profound hypotension,
Excretion: Excreted primarily 10 mcg/kg/minute. INTERACTIONS metabolic acidosis, dyspnea,
as metabolites in urine. Blood Maximum infusion Drug-drug. Antihypert ataxia, and vomiting. If
pressure returns to rate is 10 ensives:  May potentiate such symptoms occur,
pretreatment level 1 to 10 mcg/kg/minute for antihypertensive effects discontinue infusion and
minutes after completion of 10 minutes. If an of nitroprusside. Use reevaluate therapy. Keep
infusion.  adequate blood together cautiously. cyanide antidote available. 
pressure response
 isn’t achieved at this
rate, discontinue
infusion. 

SIDE EFFECTS  Headache and

Absorption: Absorbed rapidly Moderate to severe CV: orthostatic palpitations may
Antihypertensive from GI tract after oral hypertension. Adult hypotension, tachycardi occur 2 to 4 hours
 HYDRALAZINE
action: Hydralazine has a administration; bioavailability s:  Initially, 10 mg a, edema, after first oral dose
direct vasodilating effect on is 30% to 50%. Food enhances P.O. q.i.d. for 2 to 4 angina, palpitations,  flu but should
vascular smooth muscle, absorption.  days; then increased shing.  subside. 
thus lowering blood Distribution: Distributed to 25 mg q.i.d. for
pressure. The effect of widely throughout the body; remainder of week. If INTERACTIONS  Sodium retention
hydralazine on resistance drug is about 88% to 90% needed, increase Diuretics and other can occur with
vessels (arterioles and protein-bound.  dosage to 50 mg antihypertensives:  Incre long-term use. 
arteries) is greater than that Metabolism: Metabolized q.i.d. Maximum ases effects of these
on capacitance vessels extensively in the GI mucosa recommended dose drugs. Use cautiously.
(venules and veins).  and the liver. Hydralazine is is 200 mg daily, but
subject to polymorphic some patients may
acetylation. Slow acetylators require 300 to 400
have higher plasma levels, mg daily.
generally requiring lower
doses. 
Excretion: Mostly excreted in
urine, primarily as metabolites;
about 10% of an oral dose is
excreted in feces.
Antihypertensive effect persists
2 to 4 hours after an oral dose
and 2 to 6 hours after I.V. or
I.M. administration. 

SIDE EFFECTS
Severe
Antihypertensive Absorption: Absorbed rapidly CV: edema, • Assess intake, output, and
 MINOXIDIL hypertension. Adult
action: Drug produces its and almost completely from s and children older
tachycardia, pericardial body weight for sodium and
antihypertensive effect by a the GI tract.  than age 12: Initially,
effusion and water retention. 
direct vasodilating effect on Distribution: Distributed 2.5 to 5 mg P.O. as a
tamponade,  heart • Monitor patient for heart
vascular smooth muscle; widely into body tissues; it failure, ECG changes, failure, pericardial effusion,
single daily dose.
the effect on resistance isn’t bound to plasma rebound hypertension.  and cardiac tamponade;
Dose may be
vessels (arterioles and proteins.  have phenylephrine,
increased at 3-day
arteries) is greater than that Metabolism: About 90% of a intervals (minimum) INTERACTIONS dopamine, and vasopressin
on capacitance vessels given dose is metabolized.  on hand to treat
to 10 mg, 20 mg, Diuretics, hypotensive
(venules and veins).  Excretion: Excreted primarily hypotension. 
and then 40 mg. If drugs,
in urine. Average plasma half-
rapid control is nitrates:  Increases
life is 4 1/4 hours. 
needed, dose may be hypotensive
adjusted q 6 hours.
Effective dosage effects. May be used to
range is usually 10 to therapeutic advantage.
40 mg daily in one to
two divided doses.
Maximum dose is
100 mg/day.