8/13/2019 Review of Antihypertensive Drugs

1/3

Drug Action Adverse Effects Nursing Implications

DiureticsThiazide diuretics

Chlorothiazide(Diuril)

Hydrochlorothiazide(Esidrex, HydroDiuril, Oretic)Chlorthalidone(Hygroton)Metolazone(Zaroxolyn)

Loop (High-Ceiling)diureticsFurosemide (Lasix)Ethacrynic acid(Edecrin)Bumetanide (Bumex)

Table 2-17 Review of Antihypertensive Drugs

Block sodium reabsorption inascending tubule of kidney;

water excreted withsodium, producingdecreased blood volume

Inhibit reabsorption ofsodium and chloride at theproximal portion ofascending loop of Henle

Hyperuricemia,hyperglycemia,

hypercalcemia, elevatedBUN; hypokalemia,orthostatic hypotension,anorexia, nausea, vomiting,light-headedness,headache, drowsiness, rash

Similar to thiazides butintensity differs.Hypocalcemia, hearingloss.

Monitor I&O and observe for excessivediuresis.

Encourage client to make positionalchanges slowly to decrease occurrenceof orthostatic hypotension.

Perform baseline and periodic determi-nations of electrolytes, BUN, uric acid,blood sugar, weight, and blood pressur

If possible, administer in the morning toavoid nocturia.

Administer with food to minimize gastrdistress.

Encourage inclusion of high-potassiumfoods in diet to decrease possibility ofhypokalemia. Advise client to avoidhigh-sodium foods.

Stress the importance of taking the

drugs regularly as prescribed.

See above.

(continues)

NCLEX-RNREVIEW

Sixth EditionRebeccaCaldwell Oglesby

MSN, RN

8/13/2019 Review of Antihypertensive Drugs

2/3

NCLEX-RN Review

Drug Action Adverse Effects Nursing Implications

Potassium-sparingdiureticSpironolactone(Aldactone)

Drugs acting on theCNS Methyldopa(Aldomet)

Clonidine(Catapres)

Beta-AdrenergicBlockersPropranolol (Inderal)Nadolol (Corgard)

Drugs acting on renin-angiotensin systemCaptopril (Capoten)Enalapril (Vasotec)

VasodilatorsHydralazine(Apresoline)

Table 2-17 Review of Antihypertensive Drugs (continued)

Antagonizes the effect ofaldosterone on the tubularcells of the kidney; sodiumexcreted in exchange forpotassium

Metabolized into a falseneurotransmitter displacingnorepinephrine from itsreceptor sites; sympatheticactivity reduced

Stimulates alpha-adrenergicreceptor in brain, causinginhibition of sympathetic

vasoconstriction

Reversible competitiveblocking action at beta-adrenergic receptor sites.Results in decreased heartrate and force ofcontraction, slowed AVconduction, decreasedplasma renin, and loweredblood pressure

Depresses the functioning ofthe renin-angiotensin-aldosterone mechanism byinhibiting angiotensin-converting enzyme (ACE) inthe plasma

Direct relaxation of arteriolarsmooth muscle producingdecreased peripheralresistance

Hyperkalemia, gynecomastia,hirsutism, irregular menses,rash, drowsiness or confusion

Orthostatic hypotension,sedation, weakness,drowsiness, dry mouth,liver damage

Orthostatic hypotension,sedation, drowsiness, drymouth, anxiety, depression

Drowsiness, light-headedness, lethargy,cramping, nausea, andbradycardia

Rash, pruritus, proteinuria(mainly captopril),agranulocytosis (mainlycaptopril), excessivehypotension, blooddyscrasias

Headache, nausea, vomiting,diarrhea, sweating,palpitations, andtachycardia. Systemiclupus-like symptoms (highdoses).

Monitor I&O, blood pressure, andweight regularly.

Instruct client to be alert for signs ofhyponatremia.

Inform client that swelling and

tenderness of the breasts occur mostoften with prolonged therapy. Monitor serum potassium levels daily

during early stages of therapy. Advise client to avoid excessive intake of

potassium-rich foods.

Advise slow positional changes and avoidprolonged standing in one position.

Inform client the drug may darken urine. Advise client to observe for signs of liver

dysfunction.

Closely observe clients with prior historyof mental depression because the drugmay cause depressive episodes.

Advise slow positional changes. Encourage client to dangle feet for a fewminutes before standing.

Record I&O and clients weight andnotify physician of any significantchanges.

Advise client to rise slowly, avoidprolonged standing, and be carefulwhen operating machinery.

Inform client that smoking may reduceeffectiveness of drug.

Evaluate heart rate and rhythm beforeadministration of the drug.

Warn client that alcohol may enhancethe hypotensive effect of the drug.

Perform urinary protein estimates prior totherapy and at monthly intervals thereafter.

Administer (captopril) one hour before meals. Instruct client to report blood dyscrasias (sore

throat, fever) and excessive hypotension(dizziness) and rashes immediately.

Advise client that headache and palpitationsmay occur during early stages of therapy.

Perform periodic blood counts, LE cellpreparations, and antinuclear antibodytiter determinations.

Advise client to make positional changes

slowly. Observe clients receiving large amountsof hydralazine closely for signs ofdeveloping lupus-like reaction.

8/13/2019 Review of Antihypertensive Drugs

3/3

98. A client is started on prazosin (Minipress) 1 mgPO daily. Which client teaching instructionshould the nurse stress?

1. Rise slowly from a lying or sitting position.

2. Take the drug on an empty stomach.3. Force fluids to 2 liters/day.

4. Take the medication in the morning.

99. Which of the following should the nursespecifically assess for prior to clients starting oncaptopril (Capoten) therapy?

1. Depression.

2. Renal dysfunction.

3. Liver disease.

4. Hyperglycemia.

100. Which antihypertensive drug may be linked tobreast cancer and may cause suicidaldepression?

1. Guanethidine (Ismelin).

2. Hydralazine (Apresoline).

3. Reserpine (Serpalan).

4. Clonidine (Catapres).

101. Which of the following actions should the nursetake when administering nitroprusside (Nipride)?

1. Mix the solution in normal saline.

2. Administer the drug by IV push.

3. Monitor neuro checks and VS every hour.

4. Wrap IV bottle and tubing with aluminum foil.

Sample Questions102. Which side effect should the client be aware of

when taking clonidine (Catapres)?

1. Anxiety.

2. Diarrhea.

3. Dry mouth.

4. Irritability.

Answers and Rationales

98. 1. As with most antihypertensives, initial therapof prazosin (Minipress) may produce orthostatichypotension; client should rise slowly.

99. 2. Renal damage is an adverse response tocaptopril (Capoten) that is more apt to occur inclients with renal dysfunction.

100. 3. Reserpine (Serpasil) has been known to caus

suicidal depression; an increased incidence ofbreast cancer has also been noted with thisdrug.

101. 4. Nitroprusside (Nipride) is sensitive to lightand becomes less active; therefore the IV tubingand container should be covered.

102. 3. Clonidine (Catapres) can cause dry mouth duto decreased salivary flow.