Pharmacotherapy for HTN, DVT

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Pharmacotherapy for HTN, DVT

• Drugs that decrease blood pressure
• Drugs that decrease fluid volume
• Drugs that affect coagulation
• Drug that decreases blood viscosity
• Herbals

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Drugs that Decrease Blood Pressure

• Alpha-adrenergic blockersdoxasozin (Cardura)
• Beta-adrenergic blockersatenolol (Tenormin)
• Angiotensin Converting Enzyme Inhibitors
  (ACEIs)enalapril (Vasotec)
• Angiotension Receptor Blockers (ARBs)losartan
  (Cozaar)

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Drugs to Decrease BP contd

• Calcium-channel blockersdiltiazem (Cardizem)
• Centrally-acting sympatholyticsclonidine
  (Catapres)
• Vasodilatorsminoxidil (Loniten)

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Alpha-BlockersPrototype doxasozin

• Note all generics end in sozin
• Action blocks alpha receptors in vascular smooth
  muscle, causing vasodilation.
• Side effects first dose syncope, orthostatic
  hypotension, tachycardia, palpitations, nasal
  congestion, impotence.
• Nursing considerations Give at hs to minimize
  risk of fainting. If 1st dose is given in daytime
  or if dose is increased, instruct pt to remain in
  bed for 3-4h. Pt is not to drive for 12-24h. Tell
  pt to change positions slowly.

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Beta-BlockersProtoype atenolol

• Note all generics end in lol
• Action blocks beta receptors, slows heart rate,
  decreases oxygen demand
• Side effects fatigue, dizziness, hypotension,
  bradycardia, bronchospasm (do not use in
  obstructive or restrictive respiratory diseases),
  agranulocytosis, thrombocytopenia, ED, depression
• Nursing considerations apical/radial pulse
  before adm. Notify prescriber for Plt50, IO,
  daily wts. Monitor BP.

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ACEIsPrototype enalapril

• Note all generics end in -pril
• Action Suppresses renin-angiotensin-aldosterone
  system prevents conversion of angiotensin I to
  angiotension II. Dilates arterial and venous
  vessels.
• Side effects Insomnia, dizziness, hypotension,
  dysrhythmias, proteinuria, renal failure,
  agranulocytosis, neutropenia, cough, hyperkalemia
• Nursing Considerations Monitor CBC, BP, P. If
  pt is on diuretic tx, monitor for syncope

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ARBsPrototype losartan

• Note all generics end in -sartan
• Action Blocks the vasoconstrictor and
  aldosterone-secreting effects of angiotensin II
• Side effects Dizziness, insomnia, CVA, MI,
  dysrhythmias, cough, diarrhea, indigestion, renal
  failure, angioedema
• Nursing Considerations BP, P. Monitor for
  edema, lytes, hepatic and renal function before
  tx begins

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CCBsPrototype diltiazem

• Action inhibits calcium dilates coronary and
  peripheral arteries
• Side effects HA, fatigue, drowsiness,
  dysrhythmias, CHF, heart block, ARF
• Nursing considerations Monitor VS, hold for
  SBPlt90, Heart ratelt60 monitor ECG

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Centrally Acting SympatholyticPrototype
clonidine

• Action stimulate alpha-receptors in the DNS to
  suppress sympathetic flow to heart and vessels.
  Suppresses cardiac output and causes
  vasodilation.
• Side effects dry mouth, sedation
• Nursing considerations Monitor BP and P. Tell pt
  not to stop suddenlymay cause severe rebound
  HTN. Administer at hs to minimize effects of
  sedation. Contraindicated in pregnancy.

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VasodilatorsPrototype minoxidil

• Action relaxes vascular smooth muscle,
  especially arterioles and decreases systemic
  vascular resistance (SVR). Usually given with BB
  or diuretic.
• Side effects fluid retention, reflex
  tachycardia, orthostatic hypotension
• Nursing considerations Assess BP, P before and
  during tx. Monitor for edema and hear failure.
  Tell pt to change positions slowly. And to report
  muscle or joint aches or fever. May cause
  excessive hair growth

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Drugs that Decrease Fluid Volume

• Thiazide diureticshydrochlorothiazide (HCTZ,
  HydroDIURIL)

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Thiazide DiureticsPrototype hydrochlorothiazide

• Action Increases excretion of water, sodium,
  chloride, and potassium in the distal tubule and
  ascending limb of loop of Henle.
• Indications Edema, HTN, diuresis, CHF
• Side effects Dizziness, weakness, fatigue,
  hypokalemia, NV, anorexia, hepatitis, aplastic
  anemia, pancytopenia, glucosuria, allergic
  reaction (sulfa)
• Nursing Considerations Assess daily wts, IO,
  postural BPs, lytes, blood sugar

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Drugs that Affect Coagulation

• Drugs interfering with the clotting
  cascadeheparin sodium (no trade name),
  low-molecular weight heparin (Lovenox)
• Drugs that interfere with synthesis of Vitamin
  K-dependent clotting factorswarfarin (Coumadin)

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Anticoagulant 1Prototype heparin sodium

• Action prevents conversion of fibrinogen to
  fibrin and prothrombin to thrombin
• Indications Tx of pulmonary embolism, DVT
• Side effects fever, hemorrhage, rash,
  thrombocytopenia, anemia, anaphylaxis
• Nursing considerations Monitor PTT, CBC, signs
  of hemorrhage and allergy. If given SQ, give in
  abdomen. Do not aspirate or massage. Check labels
  closely so as not to confuse concentrations.

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Anticoagulant 2Prototype LMWH

• Action prevents conversion of prothrombin to
  thrombin. More precise and predictable than
  heparin
• Side effects hemorrhage, bruising,
  thrombocytopenia
• Nursing considerations abdomen is best site for
  SQ administration. Do not remove air bubble from
  syringe before administration. Do not aspirate or
  massage.

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Anticoagulant 3Prototype warfarin

• Action interferes with blood clotting by
  depressing hepatic synthesis of Vitamin
  K-dependent coagulation factors
• Indications prevention and tx of pulmonary
  emboli, DVT
• Side effects hepatitis, hemorrhage, WBC
  effects, rash
• Nursing considerations Monitor PT, CBC, and for
  hemorrhage and occult blood in stools.

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Trental (pentoxifylline)

• Action Decreases blood viscosity, increases
  blood flow by increasing flexibility of RBCs
• Indication Intermittent claudication
• Forms po, po XR
• Side effects HA, tremors, dizziness,
  indigestion, NV, leukopenia
• Nursing Considerations Watch BP if pt is on
  antihypertensives. Assess for improvement in
  activity with continued use.

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Herbals

• Ingestion of Fish Oil/Omega-3 Fatty Acids has
  been associated with lower BP readings in people
  with hypertension
• Hawthorne may be most commonly used herb for
  treating HTN, but should not be used with other
  antihypertensives and with cardiac glycosides