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Pharmacotherapy
Primary:
Diuretics
ACE Inhibitors
ARBs
Beta-blockers
Calcium channel
blockers
Alternate:
Alpha1-blockers
Alpha2-blockers
Direct-acting vasodilators
Peripheral adrenergic
antagonist
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Diuretics
Therapeutic Effects (overall)
General site of action is the nephron
structure in the kidney (exact area
depends on drug)
Increases urine formation and output
resulting in a net loss of H2
O from the
body and decreased BP
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Loop Diuretics
Mechanism of action:
Inhibits Na+and Cl-
resorption in theloop of Henle and
so H2O (water
follows sodium)
Dilates blood
vessels
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Loop Diuretics
Therapeutic effects:
Potent diuresis resulting in substantial fluid loss
Treats edema associated with CHF and hepatic
or renal disease
Adverse effects:
hypokalemia
metabolic alkalosis
dehydration (hypovolemia), leading tohypotension
dose-related hearing loss (ototoxicity)
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Loop Diuretics
Specific Drugs
furosemide
Torsemide
bumetanideNursing actions:
Monitor I/O and BP
Monitor effects of Lanoxin (digoxin)
Baseline and close monitoring of K+ Assess for:
Dehydration
Hypotension
Hearing loss
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Thiazide
Mechanism of action: inhibit the sodium-chloride
transporter in the distal
tubule. Because this
transporter normally onlyreabsorbs about 5% of
filtered sodium, these
diuretics are less
efficacious than loopdiuretics in producing
diuresis and natriuresis.
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Thiazide
Therapeutic effects:
Excretion of Na+, Cl-, K+and H2O
without altering pH Treatment of edema
Side effects
Hypokalemia
Headache, dizziness
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ThiazideSpecific Drug
Hydrodiuril (hydrochlorthiazide)
Zaroxolyn (Metolazone)
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NCs: Thiazide
Nursing actions: Monitor I/O, BP and K+
Monitor effects of Lanoxin (digoxin)
Monitor electroytes
Adequate dietary K+
Monitor uric acid
Crosses placenta and into breastmilk
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Potassium Sparing Diuretics
contAdverse effects:
Electrolyte imbalance with potentialelevation in K+
Headache, dizziness
Prototype:
Aldactone (spironolactone)
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NCs: Potassium Sparing
DiureticsNursing actions:
Monitor I/O, BP and K+
Monitor effects of Lanoxin (digoxin)
No salt substitutes or K+ rich foods
Contraindicated:
Pregnancy, lactation
Initial and follow-up uric acid levels
Monitor CBC
Watch for s/s of infection
Spironalactone
Gynecomastia
Testicular atrophy
Hirsutism
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Calcium Channel Blockers
Mechanism of action:
Inhibits transport of calcium intomyocardial and smooth muscle cells
Dilates peripheral arterioles, decreasingafterload
Decreases heart contractility (negativeionotrope)
Decreases SA node firing rate andconductivity of AV node (negativechronotrope)
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Calcium Channel Blockers cont.
Therapeutic Effects:
Lowers HR and BP- Depending on drug in
class Decreases myocardial O2demand
Decreases coronary artery spasm
Decreases angina and rhythmdisturbances
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Calcium Channel Blockers cont.
Side effects:
Bradycardia, reflex tachycardia
Peripheral edemaInteractions:
Other antihypertensives and diuretics
(increased hypotensive effects)
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Calcium Channel Blockers cont.
Prototypes:
Calan (verapamil), Cardiazem (diltiazem)and Norvasc (amlodipine)
Nursing considerations:
Monitor BP, HR, I/O, daily weight, sideeffects
Focus assessment-cardiac and pulmonary
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NCs: Calcium Channel Blockers
Baseline ECG, HR, BP
Frequent assessment of VS
Contraindicated: complete heart block
Pregnancy Category C
No grapefruit juice May worsen Heart Failure
Evaluate any c/o chest pain
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Angiotensin Converting Enzyme
Inhibitors (ACE-I)- prils
Mechanism: Blocks interaction between
Angiotensin I and Renin, preventing production
of Angiotensin II
Angiotensin II not produce resulting indecreased vasoconstriction and decreased
afterload
Decreased aldosterone production results in
decreased Na and H2O reabsorption so
decreased BP
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Angiotensin Converting Enzyme
Inhibitors (ACE-I)- prils cont.
Adverse Effects
Most common: dry, nonproductive cough
Dizziness, increased potassium levels
Interactions: Other antihypertensives and
diuretics (increased hypotensive effects)
Prototypes:
Vasotec (enalapril) and Zestril (lisinopril)
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NCs: ACE Inhibitors
Baseline VS
Captopril- oral dose 1 hour pc
First dose phenomenon
IV: monitor BP carefully Monitor for Angioedema
Monitor K+, CBC
Assess for S/S infection
Pregnancy Category D
Assess for minor side effects
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Angiotensin II Receptor Blockers
(ARBs)- sartans
Mechanism of action: Blocks binding of
Angiotensin II to its receptor sites
Therapeutic effects
Decreased BP: Decreased vasoconstriction,decreased vascular resistance, decreased afterload
Major use is afterload reduction in CHF and MI
Frequently a second line treatment for patients who
do not tolerate ACE-I
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Angiotensin II Receptor Blockers
(ARBs)- sartans cont
Nursing considerations
Monitor BP, I/O, daily weight, side effects
Monitor Potassium levels and renal function
Reinforce patient education
Contraindicated to pregnant women
Can be taken without regard to food
First Dose Phenomenon Orthostatic BP checks
Monitor renal, hepatic, and electrolyte level
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Beta Blockers- olols
Mechanism of action:
Cardioselective: Bind to and block B1receptors
on the hearts conduction system and throughout
the myocardium Nonselective: bind to, and block, B1and B2
receptors (heart and lungs)
Decreases heart contractility (Negative
ionotrope) reducing O2requirements ofmyocardial cells
Decrease SA node firing rate (negative
chronotrope)
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Beta Blockers- olols cont.
Therapeutic Effects
Decreased heart rate and decreased
myocardial oxygen demand Decreased angina
Fewer rhythm disturbances
Decreased renin release
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Beta Blockers- olols cont.
Adverse effects:
Dysrhythmias (bradycardia), heartfailure
Bronchospasm / bronchoconstriction
Fatigue, depression, impotence
Interactions:
Other antihypertensives and diuretics(increased hypotensive effects)
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NCs: Beta-adrenergic Blockers
May take two weeks for optimal therapeuticresponse
Check BP and pulse prior to dose
Monitor cardiac function Assess for:
Respiratory distress
Bradycardia, heart block, fatigue, activityintolerance
DO NOT STOP SUDDENLY
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Alpha1-adrenergic Antagonists
Mechanism of action-selectively inhibits alpha-1 adrenergic
receptors. Blockages of the alpha-1adrenergic action on the vascular smooth
muscles lead to a decrease in vascular
resistance and antihypertensive activity.
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NCs: Alpha1-adrenergic
Blockers First dose phenomenon
Assess BP prior to and during RX
Persistent orthostatic hypotension Assess for:
Weakness, dizziness, headache, GI
complaints
Closely monitor elderly
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Direct Vasodilators
Relaxes smooth muscle in arterioles