ANTIHYPERTENSIVE

DRUGS
PRESENTED BY GABRIELLE ANNE HABACON
 Discussion

HIGHLIGHTS
HYPERTENSION
Different types of Hypertension
Regulators of Blood Pressure
ANTIHYPERTENSIVE DRUGS
Beta Adrenergic Blockers
Centrally Acting A2 Agonists
Alpha-Adrenergic Blockers
Adrenerguc Neuron Blockers
Alpha1 and Beta1 Adrenergic Blockers
Direct Acting Vasodilators
Angiotensin-Converting Enzyme Inhibitors
Angiotensin II Receptor Blockers
Direct REnin Inhibitor
Calcium Channel Blockers
Hypertension

The increase in blood pressure such

that the systolic pressure is greater
than 140 mmHg and the diastolic is
greater than 90mmHg.
 ESSENTIAL HYPERTENSION

Most common type of hypertension. This affects

90% of persons with high

TYPES OF HYPERTENSION
blood pressure.

Origin: Unknown
Contributing factors: include family history of
hypertension,
hyperlipidemia, African-American background,
diabetes, aging, stress, excessive
alcohol ingestion, smoking, and obesity.
SECONDARY HYPERTENSION

This affects 10% of the persons

with high blood pressure.

TYPES OF HYPERTENSION
Origin: These are cases related
to renal end endocrine disorders.
 Selected Regulators
of Blood Pressure
Kidneys and blood vessels strive to regulate and maintain a
"normal" blood pressure with the help of the Renin-
Angiotensin-Aldosterone (RAA) System.

Renin -> Angiotensin II -> Aldosterone -> Sodium and

water retention

Other hormones such as antidiuretic hormone (ADH),

Natriuretic peptide (ANP) Hormone, and brain natriuretic
hormone also contribute to blood pressure regulation.
ORTHOSTATIC
HYPERTENSION

This episode of sudden low

blood pressure
presents dizziness due to
blood pooling in lower
extremities when an
individual
change to an upright
position.

If orthostatic hypotension
occurs, the antihypertensive
drug dose may need to be
decreased or another
antihypertensive drug used.
 ANGIOTENSIN II
ANTIHYPERTENSIVE RECEPTOR BLOCKERS

DRUGS Blocks the binding of Angiotensin II to AT1

(Angiotensin II receptor type 1) therefore
causing vasodilation.

DIURETICS ACE INHIBITORS

Promote sodium depletion, which

DIRECT-ACTING Inhibits ACE, therefore inhibits the

decreases extracellular fluid ARTERIOLAR formation of Angiotensin II and blocks

the release of aldosterone
volume. VASODILATORS
Relaxes smooth muscles of the CALCIUM CHANNEL
SYMPATHOLYTICS
blood vessels (arteries), causing BLOCKERS
Depress or inhibit the activity of vasodilation.
These block the calcium channels in
the sympathetic nervous system
the vascular smooth muscles
(SNS)
therefore promoting vasodilation.
SYMPATHOLYTICS
SYMPATHOLYTICS
BETA ADRENERGIC BLOCKERS
THESE ARE USED AS ANTI-HYPERTENSIVE DRUGS,
IN COMBINATION WITH DIURETICS,
ANTIANGINALS AND ANTIDYSRHYTHMICS.

THESE REDUCE CARDIAC OUTPUT BY

DIMINISHING THE SNS RESPONSE TO DECREASE
BASAL SYMPATHETIC TONE THIS DIMINISH THE
VASCULAR RESISTANCE THEREFORE LOWERING
THE BLOOD PRESSURE.

REDUCES THE HEART RATE, CONTRACTILITY AND

RENIN RELEASE
BETA ADRENERGIC BLOCKERS
TWO TYPES OF BETA
ADRENERGIC BLOCKERS
1.NONSELECTIVE BETA BLOCKERS
- INHIBITS B1 AND B2 RECEPTORS.
- DECREASE HEART RATE AND BP
- CAUSES BRONCHOCONSTRICTION

2. CARDIOSELECTIVE BETA BLOCKERS

– ACT DIRECTLY ON B1 RECEPTOR
- REDUCES THE OCCURENCE OF
BRONCHOCONSTRICTION.
 NONSELECTIVE BETA BLOCKERS

1. PROPANOLOL (Inderal)
This drug works by blocking the action of
certain natural chemicals in your body
(such as epinephrine) that affect the
heart and blood vessels. This effect
reduces heart rate, blood pressure, and
strain on the heart.

Used to treat tremors, angina (chest pain),

hypertension (high blood pressure), heart
rhythm disorders, and other heart or
circulatory conditions.
 NONSELECTIVE BETA BLOCKERS

2. CARVEDILOL (Coreg)
A mixture of nonselective alpha- and beta-
adrenergic blocking activity, that decrease
cardiac output, exercise-induced Tachycardia,
and reflex orthostatic tachycardia.

This causes vasodilation and reduction in

peripheral vascular resistance.

Used to treat high blood pressure, congestive

heart failure, and left ventricular dysfunction in
people who are otherwise stable.
SELECTIVE BETA BLOCKERS

1. METOPROLOL (Lopressor)
Used to control hypertension by promoting
blood pressure reduction via beta1 blocking effect. It
can also treat angina (Chest pain) and heart failure.

Metoprolol comes as immediate-release and

extended-release tablets, and an extended-release
capsule. It also comes in an injectable form that’s
only given by a healthcare provider.

Early intervention with Betaloc I.V. Injection in acute

myocardial infarction reduces infarct size and the
incidence of ventricular fibrillation. Pain relief may
also decrease the need for opiate analgesics.
SELECTIVE BETA BLOCKERS

2. ATENOLOL (Tenormin)
Used for Mild to moderate hypertension,
prophylaxis of anginal pectoris, and suspected or
known myocardial infraction (TIV).

Treatment should begin with the intravenous

administration of 5 mg TENORMIN over 5 minutes
followed by another 5 mg intravenous injection 10
minutes later. Closely monitor PR, BP and ECG.

TABLET
Initial dose: 50 mg orally once a day
Maintenance dose: 50 to 100 mg orally once a day
Maximum dose: 100 mg per day
SELECTIVE BETA BLOCKERS

3. ACEBUTOLOL (Sectral)
For mild to moderate hypertension and
management of PVC (premature ventricular
contraction) and cardiac dysrhythmia. This can
be used alone or with a thiazide diuretic.

Acebutolol oral capsule does not cause

drowsiness. Acebutolol may pass into breast
milk and cause serious effects in a child who is
breastfed

400 mg taken once per day, or 200 mg taken

twice per day
BETA ADRENERGIC BLOCKERS
Contraindications?
THESE ARE USED WITH CAUTION TO PATIENTS WITH
PRE-EXISTING BRONCHOSPASM OR OTHER
PULMONARY DISEASE.

THESE DRUGS ARE CONTRAINDICATED TO PATIENTS

WITH SECOND- OR THIRD DEGREE
ATRIOVENTRICULAR (AV) BLOCK OR SINUS
BRADYCARDIA AND PATIENTS WITH COPD
ESPECIALLY THE NONSELECTIVE BETA BLOCKERS.
BETA ADRENERGIC BLOCKERS
Side Effects and Adverse Effects
DECREASED PULSE RATE
MARKEDLY DECREASED BLOOD PRESSURE,
(WITH NONCARDIOSELECTIVE B BLOCKERS) BRONCHOSPASM.
BETA BLOCKERS SHOULD NOT BE ABRUPTLY DISCONTINUED,
BECAUSE REBOUND HYPERTENSION, ANGINA, DYSRHYTHMIAS,
AND MYOCARDIAL INFARCTION CAN RESULT.
BETA BLOCKERS CAN CAUSE DIZZINESS, INSOMNIA,
DEPRESSION, FATIGUE, NIGHTMARES, AND SEXUAL DYSFUNCTION
BETA ADRENERGIC BLOCKERS Nursing Considerations for
Nonselective Beta Blockers
·DO NOT DISCONTINUE ABRUPTLY AFTER CHRONIC THERAPY BECAUSE
HYPERSENSITIVITY TO CATECHOLAMINES MAY DEVELOP AND PATIENT COULD HAVE
SEVERE REACTION; TAPER DRUG SLOWLY OVER TWO WEEKS, MONITORING THE
PATIENT.
EDUCATE PATIENT ABOUT POSITIVE LIFESTYLE CHANGES (E.G. DIET, EXERCISE,
SMOKING CESSATION) TO AID IN LOWERING BLOOD PRESSURE.
ASSESS HEART RATE FOR CHANGES THAT MIGHT SUGGEST ARRHYTHMIA. OBTAIN
BLOOD PRESSURE IN VARIOUS POSITIONS TO ASSESS FOR ORTHOSTATIC
HYPOTENSION.
·MONITOR GI FUNCTION AND NEED FOR INCREASED ACCESS TO BATHROOM
FACILITIES AND NEED FOR INCREASED FLUID INTAKE RELATED TO DIARRHEA.
·PROVIDE COMFORT MEASURES TO HELP PATIENT COPE WITH DRUG EFFECTS.
·PROVIDE PATIENT EDUCATION ABOUT DRUG EFFECTS AND WARNING SIGNS TO
REPORT TO ENHANCE KNOWLEDGE ABOUT DRUG THERAPY AND PROMOTE
COMPLIANCE.
BETA ADRENERGIC BLOCKERS
Nursing Considerations for
Cardioselective Beta Blockers
·DO NOT STOP THESE DRUGS ABRUPTLY AFTER CHRONIC THERAPY, BUT
TAPER GRADUALLY OVER 2 WEEKS BECAUSE LONG-TERM USE OF THESE
DRUGS CAN SENSITIZE THE MYOCARDIUM TO CATECHOLAMINES, AND
SEVERE REACTIONS COULD OCCUR.
·CONTINUOUSLY MONITOR ANY PATIENT RECEIVING AN INTRAVENOUS
FORM OF THESE DRUGS TO AVERT SERIOUS COMPLICATIONS CAUSED BY
RAPID SYMPATHETIC BLOCKADE.
·GIVE ORAL FORMS OF METOPROLOL WITH FOOD TO FACILITATE
ABSORPTION.
·PROVIDE COMFORT MEASURES TO HELP PATIENT COPE WITH DRUG
EFFECTS.
PROVIDE PATIENT EDUCATION ABOUT DRUG EFFECTS AND WARNING
SIGNS TO REPORT TO ENHANCE KNOWLEDGE ABOUT DRUG THERAPY AND
PROMOTE COMPLIANCE.
CENTRALLY ACTING ALPHA1 AGONIST
THESE DRUGS DECREASE THE SYMPATHETIC RESPONSE FROM
THE BRAINSTEM TO THE PERIPHERAL VESSELS. THEY
DECREASE THE SYMPATHETIC ACTIVITY BY STIMULATING THE
ALPHA2 RECEPTORS.

IT INCREASES THE VAGUS ACTIVITY, DECREASES THE

CARDIAC OUTPUT AND DECREASE THE SERUM EPINEPHRINE,
NOREPINEPHRINE, AND RENIN RELEASE. ALL THESE HAPPEN
BECAUSE OF VASODILATION AND THE REDUCED PERIPHERAL
RESISTANCE.

BETABLOCKERS ARE NOT GIVEN WITH CENTRALLY ACTING

ALPHA2 AGONISTS BECAUSE IT CAN CAUSE BRADYCARDIA
DURING THERAPY AND REBOUND HYPERTENSION
 CENTRALLY ACTING ALPHA1 AGONIST

1. METHYLDOPA (Aldomet)
One of the first drugs widely used to control
hypertension. It can be used alone or with a
thiazide diuretic. It can be given TIV.

This can cause sodium and water retention

when given in high doses. (Increase BP)

This drug may make you dizzy or drowsy.

Alcohol or marijuana (cannabis) can make you
more dizzy or drowsy. Do not drive, use
machinery, or do anything that needs alertness
until you can do it safely
 CENTRALLY ACTING ALPHA1 AGONIST

2. CLONIDINE (Catapres)
For hypertension, long duration of action. It is
well absorbed in the GI tract and can be used
alone or with thiazide diuretics.

It decreases sympathetic effects and can

cause drowsiness, dizziness and dry mouth.
Decreases SVR and CO thus lowering BP

This can cause sodium and water retention

when given in high doses. (Increases BP)

Can be given orally (tablets) or Transdermal

(Patch)
CENTRALLY ACTING A1 AGONIST Contraindications?
THE USE OF THESE DRUGS IS CONTRAINDICATED WHEN PATIENTS
ARE HYPERSENSITIVE TO CLONIDINE AND HAS A LIVER DISEASE.

IT IS ALSO CONTRAINDICATED TO USE CLONIDINE IN

PREGNANCY SINCE IT CROSSES THE PLACENTAL BARRIER AND
SMALL AMOUNTS MAY ENTER THE BREAST MILK OF A LACTATING
PATIENT

THESE GROUP OF DRUGS SHOULD NOT BE ABRUPTLY

DISCONTINUED FOR IT CAN CAUSE REBOUND HYPERTENSION,
INSTEAD IS THEY ARE USUALLY PRESCRIBED WITH ANOTHER
ANTIHYPERTENSIVE DRUG TO AVOID REBOUND HYPERTENSION
SYMPTOMS LIKE RESTLESSNESS, TACHYCARDIA, TREMORS,
HEADACHE AND INCREASE BLOOD PRESSURE.
CENTRALLY ACTING A1 AGONIST

Side Effects and Adverse Effects

DROWSINESS
DRY MOUTH
DIZZINESS
SLOW HEART RATE (BRADYCARDIA).
SINCE THESE GROUP OF DRUGS MAY CAUSE SODIUM AND WATER
RETENTION, PERIPHERAL EDEMA MAY OCCUR.
CENTRALLY ACTING A1 AGONIST

Nursing Considerations for

Centrally Acting Alpha1 Agonist
·RECORD BASELINE VITAL SIGNS FOR FUTURE COMPARISON.
ASSESS THE PATIENT’S DRUG HISTORY.
DETERMINE PATIENT’S HEALTH HISTORY. MOST ADRENERGIC AGONISTS
ARE CONTRAINDICATED IF THE PATIENT HAS CARDIAC DYSRHYTHMIAS,
NARROW-ANGLE GLAUCOMA, OR CARDIOGENIC SHOCK.
·DETERMINE BASELINE GLUCOSE LEVEL.
SELECTIVE ALPHA1 ADRENERGIC
BLOCKERS
THESE ARE USED MAINLY TO REDUCE THE BLOOD PRESSURE,
BUT IT CAN ALSO BE USED TO TREAT BENIGN PROSTATIC
HYPERTROPHY

BLOCKS ALPHA1 RECEPTORS ON THE SMOOTH MUSCLE

LOWERING SYSTEMIC VASCULAR RESISTANCE (SVR), THUS
LOWERING THE BLOOD PRESSURE.
 SELECTIVE ALPHA1 ADRENERGIC BLOCKERS

1. PRAZOSIN (Minipress)
Used alone or with another antihypertensive.
Dizziness, headache and fainting may occur.
This is a commonly prescribed drug.

When prazosin is taken with alcohol or other

antihypertensives, the hypotensive state can be
intensified. 

This should not be taken by patients who will

undergo cataract surgery for it can cause
INTRAOCULAR FLOPPY IRIS SYNDROME (IFIS).
 SELECTIVE ALPHA1 ADRENERGIC BLOCKERS

2. TERAZOSIN (Hytrin)
This decreases the total vascular resistance
which is responsible for a decrease of blood
pressure. It also relaxes the muscles in the
prostate and bladder neck, making it easier to
urinate.

This is used to treat hypertension and to

improve urination in men with benign prostatic
hyperplasia (enlarged prostate).

Terazosin has a longer half-life than prazosin,

and they are normally given once at bedtime.