Hypertension 

Diagnosis: Systolic BP > 140 and/or Diastolic BP > 80

8th Report of TJC on High BP:

• SBP 120-139 or DBP 80-89 = prehypertensive
• lifestyle changes needed to prevent CAD
• Thiazide diuretics are the first line of treatment 
• PTs w/ HTN may need 2 or more meds to reach goal 

Types of Antihypertensives

• ACE inhibitors
• ARBs
• Anti-adrenergics
• Beta Adrenergic Blockers
• Calcium Channel Blockers
• Vasodilators
• Diuretics

Diuretics 

• Thiazide diuretics = first line tx for HTN
• Used as monotherapy or in combo w/ other HTN drugs
• Decreases plasma & ECF volumes, decreases preload
• GIVE IN THE AM
• Three Types:
• Loop 
• K+ sparing 
• Thiazide 

Loop Diuretics 

Drug:

• furosemide (Lasix) 

Action: Increases water excretion by blocking reabsoprtion of Na+ & Cl in loop of Henle

Use: pulmonary edema / edema / HTN

Adverse: hypokalemia / dehydration / decreased BP / ototoxicity (hearing loss) 

Nursing Implications:

• Monitor weight, electrolytes, BP
• decreased effectiveness w/ NSAIDS
• Prolonged use of high doses leads to hearing loss
• PO or IV

Drug:

• spironolactone (Aldactone) 

Action: causes loss of Na+ in urine but spares K+ / inhibits aldosterone

Use: heart failure / HTN / edema / ascites (extra fluid in the belly) 

Adverse: hyperkalemia 

Nursing Implications:

• monitor K+ , Intake & Output, & Weight
• PO only 

Thiazide Diuretics 

Drug:

• hydroclorothiazide (Hydrodiuril) 

Action: decreases reabsorption of Na+, H20, Cl, and HCO3 in distal convoluted tubules 

Use: HTN / heart failure 

Adverse: electrolyte imbalance / dehydration 

Nursing Implications:

Calcium Channel Blockers 

Drug:

• Protoype: nifedipine (Procardia, Adalat) 
• amlodipine (Norvasc)
• diltizem (Cardizem) 

Action: inhibits influx of calcium entering slow channels / produces vasodilation 

Use: angina / HTN / Raynaud's phenomenon: autoimmune dz that causes vasospasms of the hand 

Adverse: hypotension / flushing / lower limb edema 

Caution: liver impairment 

Nursing Implications:

• don't take meds with grapefruit juice
• do not crush meds
• check BP

Vasodilators 

Drug:

• nitroprusside (nipride) - IV 
• hydralazine (Apresoline) - IV, PO (LESS COMMONLy USED) 

Action: causes direct vasodilation 

Use: severe HTN emergencies 

Adverse: tachycardia 

Caution: cyanide is metabolite drug, so cyanide poisoning can occur 

Nursing Implications:

Drugs That Affect Blood Coagulation 

• Anticoagulants
• Antiplatelets
• Thrombolytics

- These are some of the most dangerous drugs used today

- Commonly associated w/ adverse drug reactions 

Antiplatelet Drugs 

Drug:

• ASA
• clopidogrel (Plavix) 
  

Action: decreases platelet aggregation 

Use: prevent MI / CVA / improve graft patentcy (stent) 

Adverse: bleeding 

Nursing Implications:

Anticoagulants 

Drug:

• heparin 
• enoxaparin (Lovenox) 
• fondaparinux (Arixtra) 

Action: intefere w/ coagulation cascade 

Use: thrombotic disorders / prevent clot extension & formation (do not break up the clots) 

Caution:  bleeding disorders / ulcers / pregnancy 

Anticoagulants: Heparin 

Drug:

• heparin - subQ or IV 

Use: prevention of thrombi & treatment of current clot / central line flushes / prevention of DVT

Nursing Implications:

• monitor PTT for infusions (measures how long it takes for blood to clot 

Anticoagulants: Warfarin 

 Drug:

• warfarin (Coumadin) - PO 

Action: intefere w/ vitamin K - dependent clotting 

Use: anticoagulant 

Caution:  many drug interactions  (for example, antibiotics) 

Anticoagulants: Others

Drug:

• enoxaparin (Lovenox)
• no lab work needed
• Sub Q only
• can be given at home 
• used for prevention of DVT
• Do not give this with heparin 
• Fondaparinux (Arixtra)
• prophylaxis of DVT for hip fracture surgery, knee replacement surgery, or abdominal surgery
• subQ 
• rivaroxaban (Xarelto) 
• No labs needed
• given PO
• used more frequently than warfarin
• No reversal agent 

Thrombolytics

Drug:

• alteplase (Activase) 

Action:  dissolves clots, reestablish blood flow, prevent or limit tissue damage 

Use: acute MI / stroke / PE 

Adverse:  bleeding

Caution:  pregnancy or delivery within 10 days / bleeding 

Nursing Implications: 

• Given immediately following symptoms
• check bleeding every 15 min during first hour, every 30 minutes for next hour and then every 4 hours
• oral temps only
• check pulses every hour
• maintain bed rest, avoid trauma 

Misc:

Adrenergic Response 

¡Beta 2: bronchodilation and peripheral basal dilation 

Adrenergic Agents 

Drug:

• Prototype: epinephrine (Adrenalin) 
• used in anaphylaxis (allergic rxn) 
• norepinephrine (Levophed) - Alpha drug
• potent peripheral vasoconstrictor -> for significant hypotension 
• dopamin (Intropin) 
• increases BP
• stimulates alpha and beta dependent on dose gien given 
• low dose = increases renal perfusion 
• medium dose = increases cardiac output 
• high dose = increases BP 
• phenylephrine (Neo-Synephrine) 
• alpha drug
• vasoconstrictor
• nasal decongestant

Action:  Mimic SNS 

Use: cardiac arrest / hypotension / bronchospasm / anaphylaxis / heart failure / bleeding 

Adverse:  arrythmias / HTN / palpitations / angina / nervousness 

Interactions: TCAs and MAO (central nervous system agents)  

Nursing Implications: 

• extreme care w/ calculations of meds
• moitor VS, ECG, urine output, CO
• For allergic rxn, carry EPI pen at all times
• Tolerance to meds can develop