• prevention of thrombosis
• reduction of risk of MI in patients with previous MI or unstable angina
• transient ischemic attack

• vitamin K deficiency
• hemophilia
• chronic rhinitis
• chronic urticaria
• CHF
• peptic ulcer
  

• hypersensitivity reactions
• anaphylactic shock
• laryngeal edema
• bronchospasm
• urticaria rash
• purplish red spots (petechiae)
• bruising
• nausea and vomiting
• diarrhea
• abdml cramps
  

• MIO
• monitor for chronic salicylate overdose
• observe for signs of bleeding
• salicylate hypersensitivity is more common in patient with asthma, hay fever, chronic urticaria, nasal polyps and perennial rhinitis
• DC for 1week before surgery to reduce risk for bleeding
  

• warfarin (Coumadin)
• heparin
• enoxaparin (Lovenox)

• inhibits Vit K dependent activation of clotting factors II, VII, IX and X, formed in the liver
• increases the action of antithrombin which blocks the conversion of prothrombin to thrombin and the conversion of fibrinogen to fibrin

• pulmonary embolism r/t deep vein thrombosis
• MI
• rheumatic heart dse with heart valve damage

• pt. with bleeding d/o
• vit K deficiency
• advance renal, kidney or liver dse

• hypersensitivity reaction
• dermatitis
• urticaria
• pruritus
• fever
• bronchospasm
• nausea and vomiting
• diarrhea
• abdml cramps
• anorexia

• MIO
• monitor the pt. for signs of overt or hidden bleeding
• monitor for signs of toxicity
• be aware that protamine sulfate is the antidote for heparin and vit K for warfarin

blocks binding of Angiotensin II to its receptor in the blood vessels to prevent vasoconstriction; and in the adrenal cortex to prevent release of aldosterone

"sartan"

• losartan (Cozaar)
• valsartan (Diovan)
• irbesartan (Avapro)
• telmisartan (Micardis)
  

• headache
• dizziness
• weakness
• GI upset
• URTI symptoms
• dry skin
• alopecia
  

• monitor BP prior to each use
• maintain hydration
• administer without regard to meals
• caution about exercising in hot weather
• make sure female client is not pregnant before use. Use barrier method of contraception.
  

blocks conversion of angiotensin I to angiotensin II by inhibiting ACE, resulting to dilation of peripheral blood vessels

"pril"

• benazepril (Lotensin)
• captopril (Capoten)
• enalapril (Vasotec)
• lisinopril (Prinivil, Zestril)
• quinapril (Accupril)
  

• hypotension
• headache
• dizziness
• tachycardia
• cough
• rash
• pruritis
• neuropenia
• agranulocytosis
• hyperkalemia
  

• Monitor BP
• Should be administered on an empty stomach; 1hr before meals
• monitor client fo signs of infection
• avoid excessive tea, coffee and colas
• instruct to avoid intake of food with high amount of potassium
• inform client that taste of food may be diminished during the first month of therapy
• monitor bruising, petechiae or bleeding with captopril
  

act by relaxing the smooth muscles of the blood vessels

For moderate to severe HPN

     Hydralazine HCL (Apresoline HCL)

     Minoxidil (Loniten, Rogaine)

For acute hypertensive emergency

     Nitroprusside Na (Nipride)

• tachycardia
• palpitations
• edema
• nasal congestion
• dizziness
• GI bleeding

• May give diuretics to reduce edema
• excess hair growth for minoxidil
• beta blockers can be given to counteract reflex tachycardia
  

blocks Ca access to the cells causing a decrease in contractility, decrease arteriolar constriction (vasodilation)

• amlodipine (Norvasc)
• felodipine (Plendil)
• nicardipine (Cardene)
• nifedipine (Procardia, Adalat)
• diltiazem (Cardizem)
• verapamil (Calan, Isoptin)
  

• bradycardia
• hypotension
• headache
• constipation
• flushing of the skin
• edema
• changes in liver and kidney function
  

• monitor vital signs
• monitor for the presence of side effects
• instruct patient not to discontinue drug abruptly
  

labetalol (Normodipine)

carteolol (Cartrol)

• orthostatic hypotension
• GI disturbances
• nervousness
• dry mouth
• fatigue
  

• use cautiously in patients with asthma
• large doses may cause AV heart block
  

treating hypertension in clients with lipid abnormalities

Selective Alpha 1 adrenergic blockers:

     prazosin HCL (Minipress)

     terazosin HCL (Hytrin)

     doxazosin HCL (Cardura)

Non-selective adrenergic blockers:

     phentolamine (Regitine)

• dizziness
• drowsiness
• headache
• nausea and vomiting
• dry mouth
• orthostatic hypotension
• reflex tachycardia
• palpitation
  

• monitor vital signs
• change position slowly
• comply with drug regimen
• instruct client to report presence of edema
• encourage to decrease salt intake
• impotence may occur if high dosage is prescribed
  

• methyldopa (Aldomet)
• clonidine (Catapres)
• guanfacine HCL (Tenex)
• guanabenz acetate (Wytensin)
  

• sedation
• transient drowsiness
• headache
• dry mouth
• constipation
• hypotension
• bradycardia
• edema
  

• Catapres may be given to rapidly decrease BP in hypertensive emergencies
• Recommend that last dose of the day be taken at bedtime
• give medication with a snack
• weigh patient daily
• sugarless gum, sips of water may relieve dry mouth
• do not discontinue abruptly to prevent hypertensive crisis
• urine may darken in color
  

Peripherally Acting Alpha Adrenergic Blockers MOA

block norepinephrine release from the sympathetic nerve endings causing a decrease in norepinephrine release --> decreased cardiac output and peripheral vascular resistance --> lower BP

• guanadrel (Hylorel)
• guanethidine (Ismelin)
• phenoxybenzamine (Dibenzyline)
• phentolamine (Regitine)
• prazosin (Minipress)
• reserpine (Serpasil)
  

• hypotension
• weight gain
• salt and water retention
• nasal congestion
• GI disturbances
• drowsiness
  

• monitor vital signs
• instruct client to change positions slowly
• instruct client to monitor for edema due to Na and water retention.  Can be taken with a diuretic
• Reserpine can cause depression, vivid dreams, nightmares and suicidal ideation, GI irritation and impotence
  

"Olol"

Cardioselective

     acebutolol (Sectral)

     atenolol (Tenormin)

     metoprolol (Lopressor)

Nonselective

     nadolol (Corgard)

     penbutolol (Levatol)

     pindolol (Visken)

     propranolol (Inderal)

     timolol (Blocadren)

Beta Adrenergic Blocking Agents Side Effects

• bradycardia
• bronchospasm
• hypotension
• weakness
• nausea
• vomiting
• agranulocytosis
• impotence
  

• angina pectoris
• cardiac dysrhythmias
• symptoms of hyperthyroidism
  

• monitor apical pulse for a full minute prior to administration of a drug.  Withhold medication if pulse is below 60 or more than 100bpm
• monitor client for breathing difficulty or bradycardia
• instruct client not to stop medication abruptly because rebound HTN, angina, dysrhythmias, and MI may occur
• instruct client to change positions slowly
• nonselective beta blockers inhibit the liver's ability to convert glycogen to glucose in response to hypoglycemia thus should be used with caution in clients with DM