ANTI

HYPERTENSIVE
MEDICATIONS
 ELEMENTS IN BLOOD
PRESSURE CONTROL
✔ Heart
✔ Blood vessels
✔ Blood
✔ Baroreceptos (pressure receptors)
✔ Cardiovascular center in the medulla
(brain).
 HYPERTENSION
✔ Prolonged force on the vessels of the
vascular system.
✔ Peple with increased blood pressure are
susceptible to the development of
coronary artery diseaese,
atherosclerosis, loss of vision,
decrease kidney function, and cerebral
function.
 ANTIHYPERTENSIVE THERAPY
✔ Because an underlying cause of
hypertension is usually unknown,
altering the body’s regulatory
mechanisms is the best treatment
currently available.
✔ Drugs used to treat hypertension work
to alter the normal reflexes that control
blood pressure.
✔ Treatment for essential hypertension does
not cure the disease but is aimed at
maintaining the blood pressure within
normal limits to prevent the damage that
hypertension can cause.
✔ Several different types of drugs that affect
different areas of blood pressure control may
need to be used in combination to
maintain a patient’s blood pressure
within normal limits.
 GENERAL CLASSIFICATIONS
✔ ACE inhibitors
✔ Angiotensin II–receptor blockers (ARBs)
✔ Calcium channel blockers
✔ Diuretic agents
✔ Renin inhibitors
✔ Sympathetic nervous system drugs.
 ACE INHIBITORS
✔ Benazepril (Lotensin)
✔ Captopril (Capoten)
✔ Enalapril (Vasotec)
✔ Enalaprilat (Vasotec IV)
✔ Fosinopril (Monopril),
✔ Lisinopril (Prinivil, Zestril)
✔ Moexipril (Univasc)
✔ Perindopril (Aceon)
✔ Quinapril (Accupril)
✔ Ramipril (Altace)
✔ Trandolapril (Mavik)
 ACTIONS/ INDICATIONS
✔ Otherwise known as “Angiotensin-
converting enzyme inhibitors”.
✔ It acts in the lungs to prevent ACE
from converting angiotensin I to
angiotensin II, a powerful
vasoconstrictor and stimulator of
aldosterone release.
✔ This action leads to a decrease in
blood pressure and in aldosterone
secretion, with a resultant slight
increase in serum potassium and
a loss of serum sodium and fluid.
✔ Commonly used in treatment of
hypertension in adults.
✔ These drugs are indicated for the
treatment of hypertension, alone or in
combination with other drugs.
✔ They are also used in conjunction
with digoxin and diuretics for the
treatment of heart failure and left
ventricular dysfunction.
✔ Their therapeutic effect in these
cases is thought to be related to a
decrease in cardiac workload
associated with the decrease in
peripheral resistance and blood
volume.
✔ They are also approved for the
treatment of diabetic nephropathy.
✔ It is thought that the
decrease in stimulation of the
angiotensin receptors in the
renal artery will slow the
damage to the renal artery that
occurs in diabetes.
 PHARMACOKINETICS
✔ All of the ACE inhibitors are
administered orally.
✔ Enalapril also has the advantage
of parenteral use (enalaprilat
[Vasotec IV]) if oral use is not
feasible or rapid onset is
desirable.
✔ These drugs are well absorbed, widely
distributed, metabolized in the liver, and
excreted in the urine and feces.
✔ They have been detected in breast
milk, are known to cross the placenta,
and have been associated with serious
fetal abnormalities, and so they should
not be used during pregnancy.
 CONTRAINDICATIONS
✔ Allergy to any of the ACE
inhibitors to prevent hypersensitivity
reactions and with impaired renal
function, which could be
exacerbated by the effects of this
drug in decreasing renal blood
flow.
✔ Patients with heart failure because the
change in hemodynamics could be
detrimental in some cases and in those with
salt/volume depletion, which could be
exacerbated by the drug effects.
✔ Pregnant women because of the potential
for serious adverse effects on the fetus and
during lactation because of potential
decrease in milk production and effects on
the neonate.
 ADVERSE EFFECTS
✔ Reflex tachycardia, chest pain,
angina, heart failure, and cardiac
arrhythmias; gastrointestinal (GI)
irritation,ulcers, constipation, and liver
injury; renal insuffi ciency, renal failure,
and proteinuria; and rash, alopecia,
dermatitis, and photosensitivity.
DRUG- DRUG INTERACTIONS
✔ The risk of hypersensitivity
reactions increases if these drugs are
taken with allopurinol.
✔ Risk of decreased antihypertensive
effects if taken with nonsteroidal
anti-infl ammatory drugs; patients
should be monitored.
DRUG- FOOD INTERACTIONS
✔ Absorption of oral ACE
inhibitors decreases if they are
taken with food.
✔ They should be taken on an
empty stomach 1 hour before or
2 hours after meals.
NURSING CONSIDERATIONS
✔ Assessment for allergies to drug.
✔ Impaired kidney function
✔ Pregnancy or lactation
✔ Salt volume depletion
✔ Heart failure
✔ Assess for baseline body temperature
and weight; skin color, lesions, and
temperature; pulse, blood pressure,
baseline electrocardiogram, and
perfusion; respirations and adventitious
breath sounds; bowel sounds and
abdominal examination; and renal
function tests, complete blood count with
differential, and serum electrolytes.
ANGIOTENSIN
RECEPTOR
BLOCKERS
 REPRESENTATIVE DRUGS
✔ Azilsartan (Edarbi)
✔ Candesartan (Atacand)
✔ Eprosartan (Teveten)
✔ Irbesartan (Avapro)
✔ Losartan (Cozaar)
✔ Olmesartan (Benicar)
✔ Telmisartan (Micardis)
✔ Valsartan (Diovan)
 THERAPEUTIC ACTIONS/
INDICATIONS
✔ Selectively bind with the angiotensin II
receptors in vascular smooth muscle and
in the adrenal cortex to block
vasoconstriction and the release of
aldosterone.
✔ These actions block the blood pressure–
raising effects of the renin–angiotensin
system and lower blood pressure.
✔ Use for the treatment of heart
failure in patients who are intolerant
to ACE inhibitors.
✔ Slows the progression of renal
disease in patients with hypertension
and type 2 diabetes.
 PHARMACOKINETICS
✔ Agents are all given orally.
✔ They are well absorbed and undergo
metabolism in the liver.
✔ Excreted in feces and in urine.
✔ They cross the placenta.
✔ It is not known whether they enter breast
milk during lactation.
 CONTRAINDICATIONS
✔ Presence of hepatic or renal
dysfunction, which could alter the
metabolism and excretion of these drugs.
✔ Hypovolemia because of the blocking of
potentially life-saving compensatory
mechanisms.
✔ Pregnant due fetal abnormalities and
death (2nd or 3rd trimester).
✔ Not be used during lactation
because of the potential for serious
adverse effects in the neonate.
✔ Women of childbearing age should be
advised to use barrier contraceptives
to avoid pregnancy; if a pregnancy
does occur, the ARB should be
discontinued immediately.
 ADVERSE EFFECTS
✔ Headache, dizziness, syncope, and
weakness.
✔ Hypotension; GI complaints, including
diarrhea, abdominal pain, nausea, dry
mouth, and tooth pain.
✔ Symptoms of upper respiratory tract
infections and cough; and rash, dry skin,
and alopecia.
 DRUG- DRUG
✔
INTERACTIONS
The risk of decreased serum levels
and loss of effectiveness increases if the
ARB is taken in combination with
phenobarbital, indomethacin, or
rifamycin.
✔ Decrease in antihypertensive effects if the
drug is taken with ketoconazole,
fluconazole, or diltiazem.
 NURSING
CONSIDERATIONS
✔ Assess for allergies
✔ Impaired kidney and liver function
✔ Pregnancy and lactation
✔ Hypovolemia
✔ Asses baseline VS, skin color, lesions,
ECG, renal and liver function test, bowel
sounds and adventitious breath sounds.
CALCIUM
CHANNEL
BLOCKERS
 REPRESENTATIVE DRUGS
✔ Amlodipine (Norvasc)
✔ Felodipine (Plendil)
✔ Isradipine (DynaCirc, DynaCirc CR)
✔ Nicardipine (Cardene, Cardene SR)
✔ Diltiazem (Cardizem, Dilacor CR)
✔ Nifedipine (Procardia XL)
✔ Nisoldipine (Sular)
✔ Verapamil (Calan SR)
THERAPEUTIC ACTIONS/ INDICATIONS
✔ Inhibits the movement of calcium
ions across the membranes of
myocardial and arterial muscle
cells, altering the action potential
and blocking muscle cell
contraction.
✔ This effect depresses myocardial
contractility, slows cardiac impulse
formation in the conductive tissues,
and relaxes and dilates arteries,
causing a fall in blood pressure and
a decrease in venous return.
 PHARMACOKINETICS
✔ Agents are all given orally.
✔ They are well absorbed and undergo
metabolism in the liver.
✔ Excreted in urine.
✔ They cross the placenta.
✔ Enter breast milk during lactation.
✔ Nicardipine and clevidipine are available in an
intravenous form for short-term use
 CONTRAINDICATIONS
✔ Patients with heart block or sick sinus syndrome,
which could be exacerbated by the
conduction-slowing effects of these drugs.
✔ With renal or hepatic dysfunction, which could
alter the metabolism and excretion of these
drugs.
✔ Not be used during pregnancy unless the
benefit to the mother clearly outweighs any
potential risk to the fetus.
 ADVERSE EFFECTS
✔ CNS effect includes dizziness, light-
headedness, headache, and fatigue.
✔ GI problems include nausea and hepatic
injury related to direct toxic effects on hepatic
cells.
✔ Cardiovascular effects include hypotension,
bradycardia, peripheral edema, and heart
block. Skin flushing and rash
 DRUG- FOOD
INTERACTIONS
✔ Advise patients to avoid the use of
GRAPE FRUIT JUICE because it may
lead to inceased concentrations of
calcium channel blockers in the body
leading to toxicity.
VASODILATORS
 VASODILATORS
✔ They are reserved for use in severe
hypertension or hypertensive
emergencies.
✔ Examples are Hydralazine
(Apresoline), Minoxidil (Loniten),
and Nitroprusside (Nitropress).
 THERAPEUTIC ACTION
✔ Act directly on vascular smooth
muscle to cause muscle relaxation,
leading to vasodilation and drop in
blood pressure.
✔ They do not block the reflex
tachycardia that occurs when blood
pressure drops.
REPRESENTATIVE AGENTS
 PHARMACOKINETICS
✔ Nitroprusside is used intravenously; hydralazine is
available for oral, intravenous, and intramuscular use.
✔ Minoxidil is available as an oral agent only.
✔ These drugs are rapidly absorbed and widely
distributed.
✔ They are metabolized in the liver and primarily
excreted in urine.
✔ They cross the placenta and enter breast milk.
 CONTRAINDICATIONS
✔ Caution should be used in patients with
peripheral vascular disease, CAD, heart
failure, or tachycardia, all of which could
be exacerbated by the fall in blood pressure.
✔ These drugs are also contraindicated with
pregnancy unless the benefi t to the mother
clearly outweighs the potential risk.
 ADVERSE EFFECTS
✔ Dizziness, anxiety, and headache; reflex tachycardia, heart
failure, chest pain, and edema; skin rash and lesions
(abnormal hair growth with minoxidil).
✔ GI upset, nausea, and vomiting.
✔ Cyanide toxicity (dyspnea, headache, vomiting, dizziness,
ataxia, loss of consciousness, imperceptible pulse, absent
reflexes, dilated pupils, pink color, distant heart sounds, and
shallow breathing) may occur with nitroprusside, which is
metabolized to cyanide and also suppresses iodine uptake
and can cause hypothyroidism.
 RENIN
INHIBITORS
 MECHANISM OF ACTION
✔ Representative drug is Aliskiren
(Tekturna).
✔ Inhibition of renin leads to decreased
plasma renin activity and inhibits the
conversion of angiotensinogen to angiotensin
I.
✔ Inhibition of RAAS leads to decreased blood
pressure, decreased aldosterone release, and
 PHARMACOKINETICS
✔ It is slowly absorbed from the GI tract,
with peak levels in 3 hours.
✔ It is metabolized in the liver, with a half-
life of 24 hours, and is excreted in the
urine.
✔ It crosses the placenta and enters
the breast milk.
 CONTRAINDICATIONS
✔ It should be avoided in the second
and third trimesters of pregnancy and
used in the first trimester only if the
benefit clearly outweighs the risk.
✔ Women who are breastfeeding should
find another method of feeding the
baby if this drug is needed.
 NURSING RESPONSIBILITIES
✔ Monitor potassium levels due to risk of
hyperkalemia.
✔ If combined with furosemide, there may
be a loss of diuretic effect.
✔ Monitor client for cases of angioedema
with respiratory involvement.
✔ Report any dyspnea or swelling of the
face, lips, or tongue.
 SYMPHATETIC
NERVOUS SYSTEM
BLOCKERS
 1.) BETA BLOCKERS
✔ Acebutolol (Sectral) ✔ Nadolol (Corgard)
✔ Atenolol (Tenormin) ✔ Nebivolol (Bystolic)
✔ Betaxolol (Kerlone) ✔ Penbutolol (Levator)
✔ Bisoprolol (Zebeta) ✔ Pindolol (Visken)
✔ Carteolol (Cartrol) ✔ Propranolol (Inderal)
✔ Metoprolol (Lopressor) ✔ Timolol (Blocadren)
 MECHANISM OF ACTION
✔ Block vasoconstriction, decrease heart
rate, decrease cardiac muscle contraction,
and tend to increase blood flow to the
kidneys, leading to a decrease in the
release of renin.
✔ These drugs have many adverse effects
and are not recommended for all people.
✔ They are often used as monotherapy.
 2.) ALPHA & BETA
BLOCKERS
✔ Useful in conjunction with other agents and tend
to be somewhat more powerful, blocking all of the
receptors in the sympathetic system.
✔ Patients often complain of fatigue, loss of libido,
inability to sleep, and GI and genitourinary
disturbances.
✔ Representative drugs include Carvedilol
(Coreg), Guanabenz (Wytensin), and Labetalol
(Normodyne, Trandate).
 3.) ALPHA-ADRENERGIC
BLOCKERS
✔ Inhibit the postsynaptic alpha1-adrenergic
receptors, decreasing sympathetic tone in
the vasculature and causing vasodilation,
which leads to a lowering of blood
pressure.
✔ However, these drugs also block
presynaptic alpha2-receptors, preventing
the feedback control of norepinephrine
✔ The result is an increase in the reflex
tachycardia that occurs when blood
pressure decreases.
✔ These drugs are used to diagnose and
manage episodes of
pheochromocytoma.
✔ Representative agents includes
Phenoxybenzamine (Dibenzyline) and
phentolamine (Regitine).
 4.) ALPHA 1 BLOCKERS
✔ It has the ability to block the
postsynaptic alpha1-receptor sites.
✔ This decreases vascular tone and
promotes vasodilation, leading to a
fall in blood pressure.
✔ These drugs do not block the
presynaptic alpha2-receptor sites, and
therefore, the refl ex tachycardia that
accompanies a fall in blood pressure
does not occur.
✔ It includes the following agents:
Doxazosin (Cardura), Prazosin
(Minipress), and Terazosin (Hytrin).
 5.) ALPHA 2 AGONIST
✔ It stimulate the alpha2-receptors in the CNS
and inhibit the cardiovascular centers, leading
to a decrease in sympathetic outflow from the
CNS and a resultant drop in blood pressure.
✔ Associated with many adverse CNS and GI
effects, as well as cardiac dysrhythmias.
✔ It includes Clonidine (Catapres),
Guanfacine (Tenex), and methyldopa
(generic).