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ACE Inhibitor Drugs - ANS-Captopril (Capoten), Enalapril (Vasotec), Enalaprilat (Vasotec IV), Fosinopril (Monopril), Lisinopril (Prinivil) ACE Inhibitors/ARBs Use - ANS-Uses: Hypertension, HF, MI, diabetic neuropathy. Precautions/interactions: caution with diuretic therapy, monitor potassium levels. Side effects of ACE inhibitor/ARBs - ANS-Persistent non-productive cough with ACE. Angioedema (administer epinephrine), hypotension, should not be used in second and third trimester of pregnancy Captopril time to take - ANS-1 hour before meals Calcium channel blocker drugs - ANS-Nifedipine (Adalat, Procardia), verapamil (Calan), Diltiazem (Cardizem), Amlodipine (Norvasc) Ca++ channel blocker Use - ANS-Angina, hypertension. Verapamil and diltiazem used for a fib, atrial flutter, or SVT. Use cautiously with digoxin and beta blockers, contraindicated for those with HF, heart block, bradycardia. NO GRAPEFRUIT JUICE. IV injection over 2-3 minutes. Slowly taper if discontinuing Side effects of calcium channel blockers - ANS-Constipation, reflex tachycardia, peripheral edema, toxicity Alpha Adrenergic Blockers (Sympatholytics) - ANS-Selectively inhibit alpha, adrenergic receptors, resulting in peripheral arterial and venous dilation that lowers BP. Side effects: dizziness, fainting. Take at bed time to minimize effects of hypotension. Alpha Adrenergic Blockers Drugs - ANS-Prazosin (Minipress), Doxazosin mesylate (Cardura) Centrally Acting Alpha2 Agonists - ANS-Stimulate alpha-adrenergic receptors in the brain to reduce peripheral vascular resistance, heart rate, and systolic and diastolic blood pressure. Used for HTN, hypertensive crisis, severe cancer pain. Centrally Acting Alpha2 Agonist Drugs - ANS-Clonidine (Catapres), Guanfacine HCl (Tenex), Methyldopa (Aldomet) Centrally Acting Alpha2 Agonist Drug Precautions - ANS-Contraindicated with anticoagulant therapy, hepatic failure. Do not administer to clients taking MAOIs. Do not administer methyldopa through IV line with barbiturates or sulfonamides. Use cautiously in CVA, MI, DM, depression, or chronic renal failure. Do not use during lactation Centrally Acting Alpha2 Agonist Drug Side Effects - ANS-Dry mouth, drowsiness, sedation, rebound HTN, black or sore tongue, leukopenia Beta Adrenergic Blockers (Sympatholytics) - ANS-Inhibit stimulation of receptor sites, resulting in decreased cardiac excitability, cardiac output, myocardial oxygen demand, lower BP by decreasing release of renin by kidney. Hypertension, angina, tachydysrhythmias, HF, MI. Beta Adrenergic Blocker Medications (Cardioselective Beta1 meds) - ANSMetoprolol (Lopressor), atenolol (Tenormin), Metoprolol succinate (Toprol XL) Beta Adrenergic Blocker Medications (Nonselective beta1 and 2 meds) - ANSPropranolol (Inderal), Nadolol (Corgard), Labetalol (Normodyne) Beta Adrenergic Blocker Precautions - ANS-Contraindicated in clients who have AV block and sinus bradycardia, do not administer nonselective beta blockers to clients who have asthma, bronchospasm, HF, propranolol may mask effects of hypoglycemia in DM, do not administer labetalol in same IV line with furosemide. Do not administer if systolic less than 100 and pulse less than 60. Beta adrenergic blocker side effects - ANS-Bradycardia, nasal stuffiness, AV block, rebound myocardium excitation if stopped abruptly, bronchospasm Vasodilators - ANS-Direct vasodilation of arteries and veins resulting in rapid reduction of BP (decreased preload and afterload). Used for hypertensive emergencies. Precautions: clients who have hepatic or renal disease, older adults, electrolyte imbalances Vasodilator medications - ANS-Nitroglycerin (Nitrostat IV): Enalaprilat (Vasotec IV), Nitroprusside (Nipride), Hydralazine (Apresoline). Vasodilator Side Effects - ANS-Dizziness, headache, profound hypotension, cyanide toxicity, thiocyanate poisoning Nitroprusside Interventions - ANS-Should not be mixed with any medication, apply protective cover to container, discard unused fluid after 24 hour, provide continuous ECG and blood pressure monitoring Cardiac Glycosides - ANS-Used in the treatment of clients who have cardiac failure or ineffective pumping mechanism of the heart muscle. Increase the force and velocity of myocardial contractions to improve stroke volume and CO. Slow the conduction rate, allowing for increased ventricular filling. Used for HF, a fib Cardiac Glycoside Medication - ANS-Digoxin (Lanoxin, Lanoxicaps, Digitek) Digoxin Precautions/interactions - ANS-Thiazide or loop diuretics increase risk of hypokalemia and precipitate digoxin toxicity. ACE and ARBs increase risk of hyperkalemia. Verapamil (Calan) increases risk of toxicity
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