Summary ADN 221 Drugs for Hypertension Review

Drug Therapy for Hypertension- RAAS has 4 types of
Suppressants
ACE Inhibitors- “-pril” ARBs “-sartan” Aldosterone Direct Renin Calcium Channel
[A-pril] Antagonists Inhibitor Blockers
(Dihydropyridine)
Treatme -HF, HTN -HTN (all arbs) -HTN -HTN -HTN-> (mild- moderate)
-Diabetic neuropathy -stroke (losartan only) -symptoms of HF following MI -stable (exertional), variant (vasospastic)
nt -Left ventricle dysfn followed MI. -diabetic neuropathy anginas
for: -HF (valsartan, candesartan)
-migraine HA (candesartan)
Prototyp *captopril (Capoten) *losartan (Cozaar) *eplerenone (Inspra) *aliskiren (Tekturna) *Nifedipine (Adalat)
-enalapril (Vasotec) -valsartan (Diovan) -spironolactone (Aldactone) -verapamil (Calan)
e -fosinopril (Monopril) -irbesartan (Avapro)
-lisinopril (Prinivil) -candesartan (Atacand)
Action -blocks production of angiotensin II  -blocks angiotensin II recptrs  -blocks angiotensin II receptors incrs -binds w/renininhibits -blocks Ca channel in muscle cells of
vasodilation urinary excretion of Na, vasodilation  urinary excretion excretion Na, H2O, retain K activation of angiotensin peripheral, cardiac arterioles, cardiac
H2O, retain K of Na, H2O, retain K 1vasodilation incrs arteries vasodilation arteriolar decr
excretion of Na, H2O, incrsg K BP, incrs coronary perfusion-> indirect
incrs HR.
*Retention of K*
Admin -po only, bid-tid for HTN, Tid for HF -po only, give w/combo wih -po only, give along or combine w/other -po only, hi fat meals reduce -po, SR tab (swallow whole, no
-take captopril 1 hr AC thiazide, hctz, w/food or w/o HTN drugs. Max effect4 eplerenone is absorption, 2-4 wks for full crushed/chew), caps
-1st dose decrs w/pt taking upto 4 wks, decrs dose 4pts taking effect -combine w/beta blockers
diuretics or liver failure. SYP3A4 inh. -check for hypotension 1st dose
Side -severe hypotension at 1st dose -HA, insomnia -HyperKalemia -hyperKalemia -reflex tachycardia caused incrs angina
-dry, non-productive hacking cough d/t -angioedema (less than ACE inh -cough/angioedema pain in pts w/angina
Effect incrs in brady kinin but still a potential risk) -diarrhea, abd pain at hi doses -lightheadedness (LgHD), dizziness, facial
-edema, rash, metallic taste in mouth -severe hypotension may occur flushing
-incrs K, neutropenia w/overdose or in volume -perip edema of feet, legs
depletion -hypotension w/Overdose, gingival
hyperplasia (bleeding gum)
Interven -start low, incrs gradually -treat angioedema with IV epi & -monitor/rep: K level, BUN, creatinine in -check K levels, BUN, creatinine -give nifedipine along w/beta-blockers to
-diuretics may be stopped b4 1st dose d/c if it occurs pt at risk of HyperK, palpitations, muscle -rep: persistent cough, edema prevent tachycardia, check HR, BP
tion -monitor BP at 1st dose closely, K level, WBC-monitor CNS effects, BP b4 give twitching, weakness, paresthesia in stat w/epilepsy, sore throat -Rep/advs: LgHD, dizziness, tachycardia,
& Pt’s count losartan. Hypotension- give IV extremities -check GI symptoms incrs in angina pain, edema, syncopy,
Teaching -rep: persistent cough, rash, metallic taste, fluid to expand volume -assure pt not taking K sparing diuretics, -no on K supplements, salts subsflushing can occur, be aware
edema, palpitations, muscle twitching, sore -rep: swelling of mouth, throat, drugs incrs K levels, no K supls, or K salt -not for Pregnancy, cat D risk, -hold BP if <90, inspect bleeding gum,
throat, infection, not while pregnant, HA, insomnia, dizziness, fainting, subs fetal inj adv dental care
breast feeding. call 911 if severe. -take as prescribed, not incr dose.
rd
Contra -preg cat D (fetal damage), lactation -preg risk cat D on 2,3 trim. -serum K >5.0 meq/L -Preg cat D, allergy to aliskiren, -allergy to nifedipine, acute MI, unstable
-edema, allergy to ace inh -allergic to losartan -type 2 DM with microalbuminuria incs K, Ca or dehydration angina, aortic stenosis, obstruction in GI
And -hypotension -<6 yrs or child >6 w/low creat -incrs serum creatinine or decrs creat -<18 yrs tract
Precauti *liver dis w/incrs liver enzyme, auto- clearance clearance *older adults, DM, hx of airway -children
on immune d/o *concurrent use of diuretic, -lactation surg, hx of angioedema, pt *HF
*CVD, cerebral vasc dis, HF, hyperK, hyperK, liver/renal d/o, 1st trim *children, liver failure w/low creatinine clearance, resp *Gastroesophageal reflux dis
hypoNa, older adults of pregnancy. *concurrent use of drugs that incr K levl d/o