Drugs for Hypertension- Nursing Pharmacology

by | Aug 7, 2020 | Pharmacology

Drugs for Hypertension- Nursing Pharmacology

This is a review of hypertension medications that nursing students will need to know for academic and clinical success.

For each class of medication the mechanism of action, side effects, adverse effects, and nursing considerations will be explored.

There are printable flashcards for each class of drugs reviewed in this post. You can simply download the PDF file and print them as 5×7 flashcards if you desire. This will save you lots of precious time!

The following are the types of hypertension drugs to be covered (you can click on each drug class to preview each individual flashcard):

If you download the flashcards and want to print them, be sure to set the paper size to 5×7 in.

Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors)

Mechanism of action: blocks the enzyme necessary for production of angiotensin II (angiotensin II causes blood vessels to tighten or contract); decreases buildup of water and salt

Drug names:

  • lisinopril
  • enalapril
  • quinapril
  • captopril

Side effects:

  • Hypotension
  • Hyperkalemia
  • Dry cough
  • Taste disturbances
  • Headache

Adverse effects:

  • Angioedema
  • Neutropenia
  • Photosensitivity

Nursing considerations:

  • Check blood pressure and heart rate before administration. (If blood pressure is less than 90/60 or heart rate is less than 60 beats per minute, hold medication and ask physician if patient should receive the medication)
  • Assess use of any diuretics (concurrent use will increase the hypotensive effect and hyperkalemia if taking a potassium sparing diuretic)
  • Continue to monitor blood pressure and heart rate after administration
  • Teach patients to take medication at the same time every day in the home setting
  • Teach patients to avoid salt substitutes (increased risk of hyperkalemia)
  • Teach patients to seek emergency treatment if they experience swelling in the face
  • AVOID in pregnancy and breastfeeding

Diuretics

Diuretics control blood pressure by eliminating excess salt and water from the body. The decrease in blood volume decreases the blood pressure.

The following are intended responses of diuretic therapy:

  • Increased urine output
  • Decreased blood volume
  • Dilated blood vessels
  • Decreased blood pressure
  • Decreased peripheral edema

Thiazide Diuretics

Mechanism of action: slows down/turns off sodium pumps in the nephron tube. This causes potassium, sodium, and water to be excreted through urination.

Drug names:

  • Hydrochlorothiazide
  • Chlorothiazide
  • Metolazone

Side effects:            

  • Postural hypotension
  • Hyponatremia
  • Hypokalemia
  • Dizziness

HIGH risk for falls due to postural hypotension and dizziness

Nursing Considerations:

-Check potassium level before administration (should be greater than 3.5 mEq/L)

 -Continue to monitor potassium level after administration and assess for hypokalemia

-Teach patients to report generalized weakness or an irregular heartbeat

-AVOID in pregnancy and breastfeeding

Loop Diuretics

Mechanism of action: slows down/turns off sodium pumps in the nephron tube. Sodium, potassium, calcium, and water is excreted through urination.

Drug names:

  • furosemide
  • bumetanide
  • Torsemide

Side effects:

  • Dizziness
  • Light-headedness
  • Hypokalemia
  • Hyponatremia
  • Ototoxicity (hearing loss)

 HIGH risk for falls due to postural hypotension and dizziness

Nursing Considerations:

-Check potassium level before administration (should be greater than 3.5 mEq/L)

 -Continue to monitor potassium after administration and asses for signs of hypokalemia (patient may need a potassium supplement)

-Assess for hearing loss and teach patient to report ringing in the ear

-AVOID in pregnancy and breastfeeding

Potassium Sparing Diuretics

Mechanism of action: slows down sodium pumps (sodium and water are excreted through urination) but does not cause excretion of potassium. This causes more potassium to return to the blood.

Drug names:

  • Spironolactone
  • Triamterene
  • Amiloride

Side effects:

  • Hyponatremia
  • Hyperkalemia
  • N/V, diarrhea

Women may experience hirsutism, irregular menses, and breast enlargement Men may experience trouble getting and maintaining an erection and gynecomastia

 Nursing Considerations:

  • Check potassium levels before administration- should be less than 5 mEq/L
  • Continue to reassess potassium levels and assess for signs of hyperkalemia after administration
  • Teach patients to avoid eating foods that are high in potassium (such as bananas, dairy, avocados, spinach, etc.)
  • Teach patients to avoid salt substitutes as they are high in potassium

Angiotensin II Receptor Antagonist

Mechanism of action: Blocks effects of angiotensin II by blocking the binding of angiotensin II to receptor sites. Angiotensin II causes vasoconstriction and sodium and water retention.

Inactivated by the liver and excreted by the kidney

Drugs names:

  • Losartan (Cozaar)
  • Valsartan (Diovan)

Side effects:

  • Dizziness, light-headedness
  • Headache
  • Hypotension
  • Hyperkalemia
  • Diarrhea

Adverse effects:

  • Kidney failure
  • Angioedema
  • Liver toxicity

Nursing Considerations:

  • Check kidney function before administration- BUN and creatinine
  • Ask patient about existing liver disease. (Patients with liver problems should not take these medications.)
  • Check blood pressure and heart rate before administration. (If BP is less than 90/60 mmHg or if the heart rate is less than 60 bpm, do not administer the medication)
  • Assess for signs of angioedema after administration
  • Record urine output and weight after administration and monitor for decreased output or an increase in weight
  • Check potassium levels and assess for signs of hyperkalemia
  • Teach patient to rise slowly from a lying or sitting position to prevent falls
  • AVOID during pregnancy and breastfeeding

Calcium Channel Blockers

Mechanism of action: Blocks calcium from entering the muscle cells of the heart and arteries. Decreases the contraction of the heart and dilates the arteries

Drug names:

  • Amlodipine (Norvasc)
  • Dilitiazem (Cardizem)
  • Nifedipine (Procardia)
  • Verapamil

Side effects:

  • Hypotension
  • Constipation
  • Headache
  • Dizziness, light-headedness

Adverse effects:

  • Dysrhythmias
  • Steven-Johnson Syndrome

Nursing Considerations:

  • Check blood pressure and heart rate before administration. Assess heart rate and rhythm. If blood pressure is less than 90/60 mmHg or heart rate is less than 60 bpm, do not administer the medication.
  • Ask the patient if they have a history of heart failure, blood vessel disease, liver disease, or kidney disease before administering as these medications can make those conditions worse
  • Continue to monitor heart rate and heart rhythm, report irregular rhythms to the physician

Beta-blockers

Mechanism of action: Blocks effects of epinephrine on the heart. Relaxes small arteries to decrease blood pressure. Decreases force and rate of contraction of the heart

Drug names:

  • Atenolol
  • Bisoprolol
  • Metoprolol
  • Propranolol

Side effects:

  • Impotence
  • Insomnia
  • Lethargy, weakness
  • Dizziness, light-headedness
  • Depression/ worsening of preexisting depression

Adverse effects:

  • “passing out”
  • Hypoglycemia or hyperglycemia in diabetic patients

Nursing Considerations:

  • Check blood pressure and heart rate before administering. If blood pressure is less than 90/60 mmHg or if the heart rate is less than 60 bpm, do not administer the medication.
  • Check blood glucose of diabetic patients (beta-blockers can mask signs of hypoglycemia
  • Continue to monitor blood pressure and heart rate after administration
  • Monitor for signs of developing depression or worsening of existing depression
  • Teach patients to avoid suddenly stopping beta-blockers- could increase risk of heart attack
  • Monitor older adults for mental confusion or changes in level of consciousness

Alpha Blockers

Mechanism of action: Blocks receptors in arteries and smooth muscle. Relaxes blood vessels and decreases blood pressure

Drug names:

  • Doxazosin
  • Prazosin
  • Terazosin

Side effects:

  • Dizziness
  • Drowsiness
  • Headache
  • Hypotension
  • Runny nose

Adverse effects:

  • Fainting
  • Shortness of breath

Nursing Considerations:

  • Check blood pressure and heart rate before administration. If blood pressure is less than 90/60 or heart rate is less than 60 bpm, do not administer the medication
  • Ask males if the are taking a medication for erectile dysfunction such as Viagra, Cialis, or Levitra. Men taking one of these medications should not take alpha blockers
  • Continue to monitor blood pressure and heart rate after administration
  • Monitor for weight gain and swelling in the ankles- report to physician if signs of fluid retention occur
  • Teach patients about orthostatic hypotension and to avoid standing quickly

Alpha-Beta Blocker

Mechanism of action: combines of alpha blocker and beta blocker. Relaxes blood vessels, slows heart rate, and decreases contraction of the heart

Drug names:

  • Carvedilol (Coreg)
  • Labetalol

Side effects:

  • Dizziness, light-headedness
  • Weakness
  • Hypotension
  • Hyperglycemia
  • Diarrhea
  • Impotence

Adverse effects:

  • Life-threatening dysrhythmias, hypertension, or chest pain can occur if alpha-beta blockers are suddenly stopped
  • Weight gain, swelling in ankles and feet

Nursing Considerations:

  • Check blood pressure and heart rate before administration. If blood pressures is less than 90/60 mmHg or heart rate is less than 60 bpm, do not administer the medication
  • Check glucose in patients with diabetes
  • Record a baseline weight
  • Continue to monitor blood pressure, heart rate, and blood glucose
  • Assess heart rate and rhythm- report an irregular rhythm or heart rate less than 50 bpm
  • Monitor intake and output
  • Assess for weight gain or fluid retention
  • Teach patients to avoid suddenly stopping the medication

Central- Acting Adrenergic Agents

Mechanism of action: stimulate CNS receptors to decrease constriction of blood vessels. Results in dilation of arteries and a decrease in blood pressure

Drug names:

  • Clonidine
  • Methyldopa

Side effects:

  • *high incidence of side effects*
  • Drowsiness
  • Lethargy
  • Dry mouth
  • Nasal congestion

Adverse effects:

  • Myocarditis with methyldopa

Nursing Considerations:

  • Check blood pressure and heart rate before administration. If blood pressure is less than 90/60 mmHg or heart rate is less than 60 bpm, do not administer the medication
  • Record a baseline weight
  • Continue to monitor blood pressure and heart rate
  • Monitor intake and output
  • Monitor for swelling and fluid retention
  • Monitor for signs/symptoms of depression
  • Teach patients to avoid suddenly stop taking a central-acting adrenergic agent
  • Frequent mouth care can help the incidence of a dry mouth
  • AVOID clonidine during pregnancy and breastfeeding

Direct Vasodilators

Mechanism of action: act on peripheral arteries causing them to dilate

Drug names:

  • Hydralazine (Apresoline)
  • Minoxidil

Side effects:

  • *high incidence of side effects*
  • Tachycardia
  • Hypernatremia

Adverse effects:

  • Minoxidil can cause Steven-Johnson syndrome

Nursing Considerations:

  • Check blood pressure before administration. If blood pressure is less than 90/60 mmHg, do not administer the medication
  • Record a baseline weight
  • Monitor heart rate and report an increase of more than 20 bpm
  • Monitor for fluid retention and edema formation
  • Report a weight gain of 3 pounds or more in one week
  • Teach patients to avoid suddenly stopping these medications- should be discontinued gradually

Please feel free to reach out to me and contact me if you have any questions or just want to chat.

More pharmacology flashcards will be uploaded soon, so be on the look out for them!

Happy Nursing!