{"id":294,"date":"2019-12-08T22:29:21","date_gmt":"2019-12-08T22:29:21","guid":{"rendered":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/6-10-antihypertensives\/"},"modified":"2021-12-07T11:18:03","modified_gmt":"2021-12-07T11:18:03","slug":"6-10-antihypertensives","status":"publish","type":"chapter","link":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/6-10-antihypertensives\/","title":{"raw":"6.10 Antihypertensives","rendered":"6.10 Antihypertensives"},"content":{"raw":"Many different medication classifications are used to treat [pb_glossary id=\"2805\"]hypertension[\/pb_glossary]<\/strong>. It is important to understand the different mechanisms of action for different classes of antihypertensives because patients are often on a combination of medications that work synergistically to manage blood pressure. These medications are also discussed in the \"Autonomic Nervous System\" chapter, with more information provided regarding the specific receptors they affect.\n

<\/a>Alpha-2 Agonist<\/h3>\nClonidine<\/strong><\/a> is an Alpha-2 agonist. You can read more information about Alpha-2 agonists in the \"Autonomic Nervous System\" chapter.\n\nMechanism of Action<\/strong>\n\nClonidine stimulates the alpha-adrenergic receptors, resulting in vasodilation and decreased blood pressure, thus decreasing peripheral resistance, increased blood flow to the kidneys, and decreased afterload.\n\nIndications for Use<\/strong>\n\nClonidine is used to treat hypertension and ADHD.\n\nNursing Considerations Across the Lifespan<\/strong>\n\nMonitor BP and pulse rate. Dosage is usually adjusted to patient\u2019s blood pressure because it can cause hypotension, bradycardia, and sedation. Rebound hypertension may occur if stopped abruptly.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote]<\/sup>\n\nPatient Teaching & Education<\/strong>\n\nPatients should be compliant with medication therapy and take the medication at the same time each day.\u00a0 They should be careful not to take more than the prescribed dose within a 24-hour period.\u00a0 Do not abruptly cease medication as rebound hypertension might occur. Medications may cause orthostatic changes so individuals should change positions slowly.\u00a0 Additionally, medications may cause dry mouth and dry eyes.\u00a0 Individuals should also avoid the use of alcohol and other CNS depressants while taking these medications.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n\nNow let's take a closer look at the medication grid for clonidine in Table 6.10a.[footnote]This work is a derivative of\u00a0Daily Med<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a>\u00a0in the\u00a0public domain<\/a>. [\/footnote]<\/sup>\n\nTable 6.10a Clonidine Medication Grid\n\n\n\n\n
Class<\/strong><\/th>\nPrototype<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse Effects<\/strong><\/th>\n<\/tr>\n
Alpha-2 Agonist<\/th>\nclonidine<\/strong><\/a><\/td>\nMonitor blood pressure and pulse rate frequently\n\nDosage is usually adjusted to patient\u2019s BP and tolerance<\/td>\nTreat hypertension or ADHD<\/td>\nHypotension\n\nBradycardia\n\nSedation\n\nRebound HTN if stopped abruptly<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

<\/a>Beta-1 Antagonist<\/h3>\nMetoprolol<\/strong><\/a> is a selective Beta-1 blocker. You can read more information about Beta-1 antagonists in the \"Autonomic Nervous System\" chapter.\n\nMechanism of Action<\/strong>\n\nMetoprolol primarily blocks Beta-1 receptors in the heart, causing decreased heart rate and decreased blood pressure. However, higher doses can also block Beta-2 receptors in the lungs, causing bronchoconstriction.\n\nIndications for Use<\/strong>\n\nMetoprolol is commonly used to treat high blood pressure, chest pain due to poor blood flow to the heart, and several heart conditions involving an abnormally fast heart rate. It is used as an early intervention during myocardial infarction (MI) to reduce workload of the heart.\n\nNursing Considerations Across the Lifespan<\/strong>\n\nER formulations should not be crushed. Assess patient\u2019s apical pulse rate before administering; if it is less than 60 beats\/minute, withhold the drug and call the prescriber immediately, unless other parameters are provided. In diabetic patients, monitor glucose level closely because the drug masks common signs and symptoms of hypoglycemia.\n\nAdverse Effects<\/strong>\n\nThe most serious potential adverse effects are shortness of breath, bradycardia, and worsening heart failure. Other adverse effects include fatigue, dizziness, depression, insomnia, nightmares, GI upset, erectile dysfunction, dyspnea, and wheezing. Black Box Warning: When stopping therapy, taper dosage over 1 to 2 weeks because abrupt discontinuation may cause chest pain or MI.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote]<\/sup>\n\nPatient Teaching & Education<\/strong>\n\nPatients should be compliant with medication therapy and take the medication at the same time each day.\u00a0 Do not abruptly cease medication as arrhythmias, hypertension, or ischemia may develop.\u00a0 Patients and families should be instructed to check pulse and blood pressure and report abnormalities to the healthcare provider.\u00a0 Additionally, these medications may cause side effects of dizziness and cold sensitivity.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n\nNow let's take a closer look at the medication grid for metoprolol in Table 6.10b.[footnote]This work is a derivative of\u00a0Daily Med<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a>\u00a0in the\u00a0public domain<\/a>. [\/footnote]<\/sup>\n\nTable 6.10b Medication Grid for Metoprolol\n\n\n\n\n
Class<\/strong><\/th>\nPrototype - generic<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse Effects<\/strong><\/th>\n<\/tr>\n
Beta-1 Antagonist<\/th>\nSelective B blocker: metoprolol<\/strong><\/a><\/td>\nDo not crush ER formulations\n\nAlways assess apical HR and if less than 60, do not administer and call the prescriber unless other parameters are provided\n\nMonitor blood sugar in diabetic patients because drug can mask symptoms of hypoglycemia<\/td>\nDecreases blood pressure or controls rapid heart rate<\/td>\nMost serious: hypotension, bradycardia, and worsening HF\n\nOther:\n\nCNS: fatigue, dizziness, depression, insomnia, nightmares\n\nGI upset\n\nGU: erectile dysfunction\n\nRespiratory: dyspnea and wheezing<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \n

<\/a>ACE Inhibitor (Angiotensin Converting Enzyme)<\/h3>\nCaptopril is an example of an ACE (angiotensin converting enzyme) inhibitor.\n\nMechanism of Action<\/strong>\n\nThis medication blocks the conversion of Angiotensin I to Angiotensin II in the renin-angiotensin-aldosterone system. This will lead to vasodilation and sodium and water excretion by blocking aldosterone. See more information about the renin-angiotensin-aldosterone system in the \u201cReview of Basic Concepts\u201d section of this chapter.\n\nIndications for Use<\/strong>\n\nCaptopril is used to treat hypertension and heart failure. This medication also helps reduce diabetic nephropathy.\n\nNursing Considerations Across the Lifespan<\/strong>\n\nDo not administer to patients who are pregnant. Use with caution with patients who have diabetes.\n\nAvoid use with other medications that increase potassium. This medication may increase risk for lithium toxicity.\n\nAdverse\/Side Effects<\/strong>\n\nBlack Box Warning: Patients who become pregnant should discontinue this medication due to the risk of fetal harm or fetal death.\n\nPatients taking this medication may experience hypotension, cough, hyperkalemia, increased risk for infection, angioedema, anaphylactoid reactions, or proteinuria. Patients who experience increased facial swelling or difficulty swallowing or breathing should seek emergency medical attention. Report a persistent cough or angioedema to the health care provider.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote]<\/sup>\n\nPatient Teaching & Education<\/strong>\n\nMedications should be taken as directed.\u00a0 Patients taking ACE inhibitors should be cautioned to avoid salt substitutes or foods high in potassium.\u00a0 Additionally, the medication may alter the sense of taste, but this generally resolves within 2-3 months of medication therapy.\n\nPatients taking ACE inhibitors may also experience a persistent cough throughout the duration of medication therapy.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n\nNow let's take a closer look at the medication grid for captopril in Table 6.10c.[footnote]This work is a derivative of\u00a0Daily Med<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a>\u00a0in the\u00a0public domain<\/a>. [\/footnote]\u00a0<\/span><\/sup>\n\nTable 6.10c Captopril Medication Grid\n\n\n\n\n
Class\/<\/strong>\n\nSubclass<\/strong><\/th>\nPrototype-<\/strong>\n\ngeneric<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse\/Side Effects<\/strong><\/th>\n<\/tr>\n
ACE Inhibitor<\/th>\ncaptopril <\/a><\/td>\nBlack Box Warning: Do not use while pregnant\n\nMonitor blood pressure\n\nReport cough\n\nAssess for facial swelling or difficulty breathing<\/td>\nDecrease blood pressure\n\nDecrease fluid volume status<\/td>\nHypotension\n\nCough\n\nHyperkalemia\n\nNeutropenia or agranulocytosis\n\nAngioedema\n\nAnaphylactoid reactions\n\nProteinuria<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \n

<\/a>Angiotensin II Receptor Blocker (ARB)<\/h3>\nLosartan is an example of an Angiotensin II receptor blocker, also referred to as an ARB. ARBs are similar to ACE inhibitors in that they act on the renin-angiotensin-aldosterone system (RAAS). However, the difference is that they block Angiotensin II and cause vasodilation and decreased peripheral resistance, but are not likely to cause the cough that ACE inhibitors can.\n\nMechanism of Action<\/strong>\n\nLosartan blocks Angiotensin II in the renin-angiotensin-aldosterone system to produce vasodilation.\n\nIndications for Use<\/strong>\n\nARB is used for treatment of hypertension and to prevent nephropathy in diabetic patients.\n\nNursing Considerations Across the Lifespan<\/strong>\n\nDo not administer to patients who are pregnant. It is not recommended for children under 6. Anticipate dosage adjustment with hepatic impairment. This drug can cause renal impairment and hyperkalemia.\n\nAdverse\/Side Effects<\/strong>\n\nBlack Box Warning: Patients who become pregnant should discontinue this medication due to the risk of fetal harm or fetal death.\n\nPatients taking this medication may experience hypotension, dizziness, increased risk for infection, angioedema, or proteinuria. Patients who experience increased facial swelling or difficulty swallowing or breathing should seek emergency medical attention.\n\nPatient Teaching & Education<\/strong>\n\nMedications should be taken as directed at the same time each day.\u00a0 Patients should not discontinue therapy unless directed to by their healthcare provider.\u00a0 Patients should be careful to avoid salt substitutes and foods with high levels of potassium. ARBs may cause orthostatic changes and patients should be cautioned to change positions slowly.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]\n\nNow let's take a closer look at the medication grid for losartan in Table 6.10d.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote]<\/sup>\n\nTable 6.10d Medication Grid for Losartan\n\n\n\n\n
Class\/<\/strong>\n\nSubclass<\/strong><\/th>\nPrototype-<\/strong>\n\ngeneric<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse\/Side Effects<\/strong><\/th>\n<\/tr>\n
ARB<\/th>\nlosartan (Cozaar)<\/a><\/td>\nBlack Box Warning: Do not use while pregnant\n\nMonitor blood pressure<\/td>\nDecrease blood pressure<\/td>\nHypotension and dizziness\n\nHyperkalemia\n\nProteinuria<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \n
\n
\n

Critical Thinking Activity 6.10\n\"Image<\/h2>\n<\/header>\n
\n\nA male 65-year-old patient has the following medications ordered: metoprolol succinate 100 mg daily, lisinopril 5 mg daily, verapamil ER 100 mg daily, and hydrochlorothiazide 25 mg daily. He has a history of hyperlipidemia, hypertension, and coronary artery disease. The patient asks the nurse, \u201cWhy do I have to take so many medications?\u201d\n
    \n \t
  1. What is the class and mechanism of action of each of these medications?<\/li>\n \t
  2. What is the nurse\u2019s best response to the patient\u2019s question?<\/li>\n<\/ol>\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key\" sections at the end of the book.\n\n<\/div>\n<\/div>\n<\/div>\n

    <\/a>Vasodilator<\/h3>\nHydralazine is an example of a direct vasodilator.\n\nMechanism of Action<\/strong>\n\nHydralazine\u2019s direct mechanism of action is unknown, but it causes vasodilation via direct relaxation of vascular smooth muscle. Peripheral vasodilation results in a reduction of blood pressure and decreased vascular resistance, resulting in increased cardiac output.\n\nIndications for Use<\/strong>\n\nVasodilators are used to treat hypertension.\n\nNursing Considerations Across the Lifespan<\/strong>\n\nUse with caution in patients with coronary artery disease, mitral valve rheumatic heart disease, and cerebral vascular accidents.\n\nThis medication should only be used in pregnancy if the benefits outweigh the risks due to lack of safety studies.\n\nAdverse\/Side Effects<\/strong>\n\nPatients should be monitored for infection and are at risk of developing systemic lupus erythematosus (SLE). SLE is a chronic disease that causes inflammation in connective tissues. The signs and symptoms of SLE vary among affected individuals and can involve many organs and systems, including the skin, joints, kidneys, lungs, central nervous system, and blood-forming (hematopoietic) system. A characteristic sign of SLE is a flat, red rash across the cheeks and bridge of the nose. This rash is called a \"butterfly rash\" because of its shape.\n\nHypotension, palpitations, angina, tremors, numbness, tingling, disorientation, nasal congestion, headache, nausea, vomiting, and diarrhea are effects associated with hydralazine. [footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote]\n\nPatient Teaching & Education<\/strong>\n\nPatients should remain compliant with the therapeutic dosing regimen, even if symptoms resolve. The patient should be cautious not to double up on medication doses.\u00a0 Additionally, the patient should consult the healthcare provider if two or more doses of medication are missed for follow-up instruction.\u00a0 Patients should be instructed to monitor their weight and assess for fluid retention in the feet and ankles.\u00a0 Additionally, the medication can cause side effects of orthostatic hypotension and drowsiness.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]\n\nNow let's take a closer look at the medication grid on hydralazine in Table 6.10e.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote]<\/sup>\n\nTable 6.10e Medication grid for Hydralazine\n\n\n\n\n
    Class\/<\/strong>\n\nSubclass<\/strong><\/th>\nPrototype-<\/strong>\n\ngeneric<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse\/Side Effects<\/strong><\/th>\n<\/tr>\n
    Vasodilator<\/th>\nhydralazine (Apresoline)<\/a><\/td>\nMonitor blood pressure\n\nObtain complete blood count (CBC) and antibody titers prior to beginning this medication\n\nReport signs and symptoms of infection<\/td>\nReduce blood pressure<\/td>\nSystemic lupus erythematosus (SLE)\n\nHypotension, palpitations, and angina\n\nTremors, numbness, tingling, and disorientation\n\nNasal congestion\n\nHeadache, nausea, vomiting, and diarrhea<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n ","rendered":"

    Many different medication classifications are used to treat hypertension<\/strong>. It is important to understand the different mechanisms of action for different classes of antihypertensives because patients are often on a combination of medications that work synergistically to manage blood pressure. These medications are also discussed in the “Autonomic Nervous System” chapter, with more information provided regarding the specific receptors they affect.<\/p>\n

    <\/a>Alpha-2 Agonist<\/h3>\n

    Clonidine<\/strong><\/a> is an Alpha-2 agonist. You can read more information about Alpha-2 agonists in the “Autonomic Nervous System” chapter.<\/p>\n

    Mechanism of Action<\/strong><\/p>\n

    Clonidine stimulates the alpha-adrenergic receptors, resulting in vasodilation and decreased blood pressure, thus decreasing peripheral resistance, increased blood flow to the kidneys, and decreased afterload.<\/p>\n

    Indications for Use<\/strong><\/p>\n

    Clonidine is used to treat hypertension and ADHD.<\/p>\n

    Nursing Considerations Across the Lifespan<\/strong><\/p>\n

    Monitor BP and pulse rate. Dosage is usually adjusted to patient\u2019s blood pressure because it can cause hypotension, bradycardia, and sedation. Rebound hypertension may occur if stopped abruptly.[1]<\/sup><\/a><\/sup><\/p>\n

    Patient Teaching & Education<\/strong><\/p>\n

    Patients should be compliant with medication therapy and take the medication at the same time each day.\u00a0 They should be careful not to take more than the prescribed dose within a 24-hour period.\u00a0 Do not abruptly cease medication as rebound hypertension might occur. Medications may cause orthostatic changes so individuals should change positions slowly.\u00a0 Additionally, medications may cause dry mouth and dry eyes.\u00a0 Individuals should also avoid the use of alcohol and other CNS depressants while taking these medications.[2]<\/sup><\/a><\/sup><\/p>\n

    Now let’s take a closer look at the medication grid for clonidine in Table 6.10a.[3]<\/sup><\/a><\/sup><\/p>\n

    Table 6.10a Clonidine Medication Grid<\/p>\n\n\n\n\n
    Class<\/strong><\/th>\nPrototype<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse Effects<\/strong><\/th>\n<\/tr>\n
    Alpha-2 Agonist<\/th>\nclonidine<\/strong><\/a><\/td>\nMonitor blood pressure and pulse rate frequently<\/p>\n

    Dosage is usually adjusted to patient\u2019s BP and tolerance<\/td>\n

    		Treat hypertension or ADHD<\/td>\nHypotension<\/p>\n

    Bradycardia<\/p>\n

    Sedation<\/p>\n

    Rebound HTN if stopped abruptly<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    <\/a>Beta-1 Antagonist<\/h3>\n

    Metoprolol<\/strong><\/a> is a selective Beta-1 blocker. You can read more information about Beta-1 antagonists in the “Autonomic Nervous System” chapter.<\/p>\n

    Mechanism of Action<\/strong><\/p>\n

    Metoprolol primarily blocks Beta-1 receptors in the heart, causing decreased heart rate and decreased blood pressure. However, higher doses can also block Beta-2 receptors in the lungs, causing bronchoconstriction.<\/p>\n

    Indications for Use<\/strong><\/p>\n

    Metoprolol is commonly used to treat high blood pressure, chest pain due to poor blood flow to the heart, and several heart conditions involving an abnormally fast heart rate. It is used as an early intervention during myocardial infarction (MI) to reduce workload of the heart.<\/p>\n

    Nursing Considerations Across the Lifespan<\/strong><\/p>\n

    ER formulations should not be crushed. Assess patient\u2019s apical pulse rate before administering; if it is less than 60 beats\/minute, withhold the drug and call the prescriber immediately, unless other parameters are provided. In diabetic patients, monitor glucose level closely because the drug masks common signs and symptoms of hypoglycemia.<\/p>\n

    Adverse Effects<\/strong><\/p>\n

    The most serious potential adverse effects are shortness of breath, bradycardia, and worsening heart failure. Other adverse effects include fatigue, dizziness, depression, insomnia, nightmares, GI upset, erectile dysfunction, dyspnea, and wheezing. Black Box Warning: When stopping therapy, taper dosage over 1 to 2 weeks because abrupt discontinuation may cause chest pain or MI.[4]<\/sup><\/a><\/sup><\/p>\n

    Patient Teaching & Education<\/strong><\/p>\n

    Patients should be compliant with medication therapy and take the medication at the same time each day.\u00a0 Do not abruptly cease medication as arrhythmias, hypertension, or ischemia may develop.\u00a0 Patients and families should be instructed to check pulse and blood pressure and report abnormalities to the healthcare provider.\u00a0 Additionally, these medications may cause side effects of dizziness and cold sensitivity.[5]<\/sup><\/a><\/sup><\/p>\n

    Now let’s take a closer look at the medication grid for metoprolol in Table 6.10b.[6]<\/sup><\/a><\/sup><\/p>\n

    Table 6.10b Medication Grid for Metoprolol<\/p>\n\n\n\n\n
    Class<\/strong><\/th>\nPrototype – generic<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse Effects<\/strong><\/th>\n<\/tr>\n
    Beta-1 Antagonist<\/th>\nSelective B blocker: metoprolol<\/strong><\/a><\/td>\nDo not crush ER formulations<\/p>\n

    Always assess apical HR and if less than 60, do not administer and call the prescriber unless other parameters are provided<\/p>\n

    Monitor blood sugar in diabetic patients because drug can mask symptoms of hypoglycemia<\/td>\n

    		Decreases blood pressure or controls rapid heart rate<\/td>\nMost serious: hypotension, bradycardia, and worsening HF<\/p>\n

    Other:<\/p>\n

    CNS: fatigue, dizziness, depression, insomnia, nightmares<\/p>\n

    GI upset<\/p>\n

    GU: erectile dysfunction<\/p>\n

    Respiratory: dyspnea and wheezing<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n

    <\/a>ACE Inhibitor (Angiotensin Converting Enzyme)<\/h3>\n

    Captopril is an example of an ACE (angiotensin converting enzyme) inhibitor.<\/p>\n

    Mechanism of Action<\/strong><\/p>\n

    This medication blocks the conversion of Angiotensin I to Angiotensin II in the renin-angiotensin-aldosterone system. This will lead to vasodilation and sodium and water excretion by blocking aldosterone. See more information about the renin-angiotensin-aldosterone system in the \u201cReview of Basic Concepts\u201d section of this chapter.<\/p>\n

    Indications for Use<\/strong><\/p>\n

    Captopril is used to treat hypertension and heart failure. This medication also helps reduce diabetic nephropathy.<\/p>\n

    Nursing Considerations Across the Lifespan<\/strong><\/p>\n

    Do not administer to patients who are pregnant. Use with caution with patients who have diabetes.<\/p>\n

    Avoid use with other medications that increase potassium. This medication may increase risk for lithium toxicity.<\/p>\n

    Adverse\/Side Effects<\/strong><\/p>\n

    Black Box Warning: Patients who become pregnant should discontinue this medication due to the risk of fetal harm or fetal death.<\/p>\n

    Patients taking this medication may experience hypotension, cough, hyperkalemia, increased risk for infection, angioedema, anaphylactoid reactions, or proteinuria. Patients who experience increased facial swelling or difficulty swallowing or breathing should seek emergency medical attention. Report a persistent cough or angioedema to the health care provider.[7]<\/sup><\/a><\/sup><\/p>\n

    Patient Teaching & Education<\/strong><\/p>\n

    Medications should be taken as directed.\u00a0 Patients taking ACE inhibitors should be cautioned to avoid salt substitutes or foods high in potassium.\u00a0 Additionally, the medication may alter the sense of taste, but this generally resolves within 2-3 months of medication therapy.<\/p>\n

    Patients taking ACE inhibitors may also experience a persistent cough throughout the duration of medication therapy.[8]<\/sup><\/a><\/sup><\/p>\n

    Now let’s take a closer look at the medication grid for captopril in Table 6.10c.[9]<\/sup><\/a>\u00a0<\/span><\/sup><\/p>\n

    Table 6.10c Captopril Medication Grid<\/p>\n\n\n\n\n
    Class\/<\/strong><\/p>\n

    Subclass<\/strong><\/th>\n

    		Prototype-<\/strong><\/p>\n

    generic<\/strong><\/th>\n

    		Administration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse\/Side Effects<\/strong><\/th>\n<\/tr>\n
    ACE Inhibitor<\/th>\ncaptopril <\/a><\/td>\nBlack Box Warning: Do not use while pregnant<\/p>\n

    Monitor blood pressure<\/p>\n

    Report cough<\/p>\n

    Assess for facial swelling or difficulty breathing<\/td>\n

    		Decrease blood pressure<\/p>\n

    Decrease fluid volume status<\/td>\n

    		Hypotension<\/p>\n

    Cough<\/p>\n

    Hyperkalemia<\/p>\n

    Neutropenia or agranulocytosis<\/p>\n

    Angioedema<\/p>\n

    Anaphylactoid reactions<\/p>\n

    Proteinuria<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n

    <\/a>Angiotensin II Receptor Blocker (ARB)<\/h3>\n

    Losartan is an example of an Angiotensin II receptor blocker, also referred to as an ARB. ARBs are similar to ACE inhibitors in that they act on the renin-angiotensin-aldosterone system (RAAS). However, the difference is that they block Angiotensin II and cause vasodilation and decreased peripheral resistance, but are not likely to cause the cough that ACE inhibitors can.<\/p>\n

    Mechanism of Action<\/strong><\/p>\n

    Losartan blocks Angiotensin II in the renin-angiotensin-aldosterone system to produce vasodilation.<\/p>\n

    Indications for Use<\/strong><\/p>\n

    ARB is used for treatment of hypertension and to prevent nephropathy in diabetic patients.<\/p>\n

    Nursing Considerations Across the Lifespan<\/strong><\/p>\n

    Do not administer to patients who are pregnant. It is not recommended for children under 6. Anticipate dosage adjustment with hepatic impairment. This drug can cause renal impairment and hyperkalemia.<\/p>\n

    Adverse\/Side Effects<\/strong><\/p>\n

    Black Box Warning: Patients who become pregnant should discontinue this medication due to the risk of fetal harm or fetal death.<\/p>\n

    Patients taking this medication may experience hypotension, dizziness, increased risk for infection, angioedema, or proteinuria. Patients who experience increased facial swelling or difficulty swallowing or breathing should seek emergency medical attention.<\/p>\n

    Patient Teaching & Education<\/strong><\/p>\n

    Medications should be taken as directed at the same time each day.\u00a0 Patients should not discontinue therapy unless directed to by their healthcare provider.\u00a0 Patients should be careful to avoid salt substitutes and foods with high levels of potassium. ARBs may cause orthostatic changes and patients should be cautioned to change positions slowly.[10]<\/sup><\/a><\/p>\n

    Now let’s take a closer look at the medication grid for losartan in Table 6.10d.[11]<\/sup><\/a><\/sup><\/p>\n

    Table 6.10d Medication Grid for Losartan<\/p>\n\n\n\n\n
    Class\/<\/strong><\/p>\n

    Subclass<\/strong><\/th>\n

    		Prototype-<\/strong><\/p>\n

    generic<\/strong><\/th>\n

    		Administration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse\/Side Effects<\/strong><\/th>\n<\/tr>\n
    ARB<\/th>\nlosartan (Cozaar)<\/a><\/td>\nBlack Box Warning: Do not use while pregnant<\/p>\n

    Monitor blood pressure<\/td>\n

    		Decrease blood pressure<\/td>\nHypotension and dizziness<\/p>\n

    Hyperkalemia<\/p>\n

    Proteinuria<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n

    \n
    \n
    \n

    Critical Thinking Activity 6.10
    \n\"Image<\/h2>\n<\/header>\n
    \n

    A male 65-year-old patient has the following medications ordered: metoprolol succinate 100 mg daily, lisinopril 5 mg daily, verapamil ER 100 mg daily, and hydrochlorothiazide 25 mg daily. He has a history of hyperlipidemia, hypertension, and coronary artery disease. The patient asks the nurse, \u201cWhy do I have to take so many medications?\u201d<\/p>\n

      \n
    1. What is the class and mechanism of action of each of these medications?<\/li>\n
    2. What is the nurse\u2019s best response to the patient\u2019s question?<\/li>\n<\/ol>\n

      Note: Answers to the Critical Thinking activities can be found in the “Answer Key” sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

      <\/a>Vasodilator<\/h3>\n

      Hydralazine is an example of a direct vasodilator.<\/p>\n

      Mechanism of Action<\/strong><\/p>\n

      Hydralazine\u2019s direct mechanism of action is unknown, but it causes vasodilation via direct relaxation of vascular smooth muscle. Peripheral vasodilation results in a reduction of blood pressure and decreased vascular resistance, resulting in increased cardiac output.<\/p>\n

      Indications for Use<\/strong><\/p>\n

      Vasodilators are used to treat hypertension.<\/p>\n

      Nursing Considerations Across the Lifespan<\/strong><\/p>\n

      Use with caution in patients with coronary artery disease, mitral valve rheumatic heart disease, and cerebral vascular accidents.<\/p>\n

      This medication should only be used in pregnancy if the benefits outweigh the risks due to lack of safety studies.<\/p>\n

      Adverse\/Side Effects<\/strong><\/p>\n

      Patients should be monitored for infection and are at risk of developing systemic lupus erythematosus (SLE). SLE is a chronic disease that causes inflammation in connective tissues. The signs and symptoms of SLE vary among affected individuals and can involve many organs and systems, including the skin, joints, kidneys, lungs, central nervous system, and blood-forming (hematopoietic) system. A characteristic sign of SLE is a flat, red rash across the cheeks and bridge of the nose. This rash is called a “butterfly rash” because of its shape.<\/p>\n

      Hypotension, palpitations, angina, tremors, numbness, tingling, disorientation, nasal congestion, headache, nausea, vomiting, and diarrhea are effects associated with hydralazine. [12]<\/sup><\/a><\/p>\n

      Patient Teaching & Education<\/strong><\/p>\n

      Patients should remain compliant with the therapeutic dosing regimen, even if symptoms resolve. The patient should be cautious not to double up on medication doses.\u00a0 Additionally, the patient should consult the healthcare provider if two or more doses of medication are missed for follow-up instruction.\u00a0 Patients should be instructed to monitor their weight and assess for fluid retention in the feet and ankles.\u00a0 Additionally, the medication can cause side effects of orthostatic hypotension and drowsiness.[13]<\/sup><\/a><\/p>\n

      Now let’s take a closer look at the medication grid on hydralazine in Table 6.10e.[14]<\/sup><\/a><\/sup><\/p>\n

      Table 6.10e Medication grid for Hydralazine<\/p>\n\n\n\n\n
      Class\/<\/strong><\/p>\n

      Subclass<\/strong><\/th>\n

      		Prototype-<\/strong><\/p>\n

      generic<\/strong><\/th>\n

      		Administration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse\/Side Effects<\/strong><\/th>\n<\/tr>\n
      Vasodilator<\/th>\nhydralazine (Apresoline)<\/a><\/td>\nMonitor blood pressure<\/p>\n

      Obtain complete blood count (CBC) and antibody titers prior to beginning this medication<\/p>\n

      Report signs and symptoms of infection<\/td>\n

      		Reduce blood pressure<\/td>\nSystemic lupus erythematosus (SLE)<\/p>\n

      Hypotension, palpitations, and angina<\/p>\n

      Tremors, numbness, tingling, and disorientation<\/p>\n

      Nasal congestion<\/p>\n

      Headache, nausea, vomiting, and diarrhea<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

       <\/p>\n

      1. This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. ↵<\/a><\/li>
      2. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
      3. This work is a derivative of\u00a0Daily Med<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a>\u00a0in the\u00a0public domain<\/a>. ↵<\/a><\/li>
      4. This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. ↵<\/a><\/li>
      5. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
      6. This work is a derivative of\u00a0Daily Med<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a>\u00a0in the\u00a0public domain<\/a>. ↵<\/a><\/li>
      7. This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. ↵<\/a><\/li>
      8. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
      9. This work is a derivative of\u00a0Daily Med<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a>\u00a0in the\u00a0public domain<\/a>. ↵<\/a><\/li>
      10. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
      11. This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. ↵<\/a><\/li>
      12. This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. ↵<\/a><\/li>
      13. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
      14. This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. ↵<\/a><\/li><\/ol><\/div>
        definition<\/span>