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Generic: metolazone Trade: Zaroxolyn Pharmocologic: Thiazide diuretic Therapeutic: Antihypertensive/Diuretic Dosage: PO (Adults): Hypertension—2.5– 5 mg/day; edema 5– 20 mg/day ACTION: SIDE EFFECTS:
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HTN, fluid retention (edema) in pt w/ CHF or nephrotic disorder Severe liver disease, unable to pass urine, Using metolazone during pregnancy could cause side effects in the newborn baby, such as blood cell problems, or jaundice (yellowing of the skin or eyes). <18 years of age, sulfonamides allergy Dizziness, drowsiness, depressed mood, muscle or joint pain, numbness or tingly, nausea, stomach pain, loss of appetite, diarrhea, constipation, dehydration, electrolyte imbalance, orthostatic hypotension, digoxin toxicity, ED Increases excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule. Promotes excretion of chloride, potassium, magnesium, and bicarbonate. May produce arteriolar dilation. Monitor for S/S of dehydration (thirst, weakness, muscle cramping, hypotension, tachycardia), Monitor BP, I&O, and daily weight, and assess feet, legs, and sacral area for edema daily. Instruct pt to change positions slowly to avoid dizziness and falls, Instruct pt to take the last dose in the afternoon to avoid nocturia, May cause ↑ serum cholesterol, LDL, and triglyceride concentrations. Monitor electrolytes (especially potassium), blood glucose, BUN, and serum creatinine and uric acid levels.
Generic: furosemide Brand: Lasix Pharmacologic: LOOP DIURETIC Therapeutic: Diuretics PO (Adults): 20 – 80 mg/day as a single dose initially, may repeat in 6– 8 hr dose by 20– 40 mg q 6– 8 hr until desired response. MODE OF ACTION: SIDE EFFECTS:
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Inhibits NaCl reabsorption in the ascending loop of Henle, thereby ↑ the excretion of sodium & potassium. May have peripheral vasodilatory effects. Electrolyte imbalances (primarily hypokalemia), orthostatic hypotension, ototoxicity (usually reversible), dehydration, increased BUN, hyperglycemia, blood dyscrasias, BMS, photosensitivity. Commonly ↓serum K+. May ↓serum NA, calcium, and magnesium concentrations. May also cause↑ BUN, serum glucose, creatinine, and uric acid levels. Tx of edema due to CHF, hepatic or renal failure and HTN. Instruct pt to change positions slowly, consume high K+ foods or prescribed K+ supplements ut dict, use sunscreen. Watch EKG for arrhythmias, especially with altered K+ levels. Instruct pt to take the last dose in the afternoon to avoid nocturia. Monitor for S/S of dehydration (thirst, weakness, muscle cramping, hypotension, tachycardia). Assess fluid status. Monitor daily weight, I&O, amount and location of edema, lung sounds, skin turgor, and mucous membranes. Monitor BP and pulse before and during administration. Assess patient for tinnitus and hearing loss. Assess patients receiving digoxin for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion. Allergy to sulfonamides/thiazides, anuria. Pregnancy Category C. Monitor electrolytes, renal/hepatic function, glucose, and uric acid levels before and periodically throughout therapy.
Generic: amiloride Pharmacologic: Potassium-sparing diuretics Therapeutic: Diuretic Usual dosage: 5-20 mg po/day MODE OF ACTION: SIDE EFFECTS:
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Inhibition of sodium resorption in the kidney, saving potassium and hydrogen ions. Therapeutic Effects: Weak diuretic and antihypertensive response Hyperkalemia, agranulocytosis, muscle cramps dizziness, HA, gynecomastia (males), breast tenderness, deepening of voice, increased hair growth (females), hyponatremia. May cause ↑serum magnesium, uric acid, BUN, creatinine, K+ and urinary calcium excretion levels. May also cause ↓NA levels Primary hyperaldosteronism, mgmt. of edema associated w/ CHF, cirrhosis and nephrotic syndrome. Mgmt of essential HTN. Tx hypokalemia (counteracts K+ loss caused by other diuretics). Kidney problems, unable to urinate, or hyperkalemia. Pregnancy category C. Check BP before administration, Monitor for S/S of dehydration (thirst, weakness, muscle cramping, hypotension, tachycardia), Monitor intake & output Q shift, Weigh pt QD, have the pt change positions slowly to avoid dizziness and falls, Instruct the pt to take the last dose in the afternoon to avoid nocturia, Monitor the BP for effectiveness, Monitor EKG for signs hyperkalemia (tented T waves). Teach pt to avoid NACL substitutes and high K+ foods. Evaluate K+ levels before and routinely during therapy. Withhold drug and notify health care professional if patient becomes hyperkalemic. Monitor BUN, serum creatinine, and electrolytes before and periodically during therapy.
Generic: triamterene Brand: Dyrenium Pharmacologic: POTASSIUM-SPARING DIURETIC Usual dose for Edema: 100 mg po Bid, Max. 300 mg/day HTN: 50-100 mg po daily MODE OF ACTION: SIDE EFFECTS:
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Kidney problems, anuria, severe hepatic disease. US FDA pregnancy category: Not Assigned. This drug should be used during pregnancy only if the benefit outweighs the risk. Causes loss of NA bicarbonate and CA+ while saving K+ and hydrogen ions by antagonizing aldosterone. Blocks reabsorption of NA in the distal convoluted tubules and collecting ducts of the nephrons, while conserving K+. Hyperkalemia, agranulocytosis, muscle cramps dizziness, HA, gynecomastia (males), breast tenderness, deepening of voice, increased hair growth (females), hyponatremia Primary hyperaldosteronism, mgmt. of edema associated w/ CHF, cirrhosis (ascites) and nephrotic syndrome. Mgmt of essential HTN (off label use, including tx in peds). Tx hypokalemia (counteracts K+ loss caused by other diuretics). Monitor for S/S of dehydration (thirst, weakness, muscle cramping, hypotension, tachycardia), Monitor intake & output Q shift, Weigh pt QD, have the pt change positions slowly to avoid dizziness and falls, Instruct the pt to take the last dose in the afternoon to avoid nocturia, Monitor the BP for effectiveness, Monitor EKG for signs hyperkalemia (tented T waves). Teach pt to avoid NACL substitutes and high K+ foods. Monitor response of signs and symptoms of hypokalemia (weakness, fatigue, ECG changes, arrhythmias, polyuria, polydipsia). Evaluate K+ levels prior to and routinely during therapy. Withhold drug and notify health care professional if patient becomes hyperkalemic. Monitor BUN, serum creatinine, and electrolytes prior to and periodically during therapy.
Generic: captopril Trade: Capoten Pharmacologic: ACE I Therapeutic: Antihypertensive Dosage: 12.5-25 mg 2-3 times/day Max: 450 mg/day MODE OF ACTION: SIDE EFFECTS:
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Ace inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II 1st dose phenomena, hypotension, dry cough, HA, angina pectoris, insomnia, tachycardia, taste disturbance, nausea, diarrhea, proteinuria, ED, hyperkalemia, angioedema, drowsiness, neutropenia Monitor weight, I&O and assess pt routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention). Always ck BP prior to administration. Monitor for signs angioedema. Advise pt to change position slowly to minimize orthostatic hypertension. Caution pt to avoid salt substitute or foods containing high levels of K+ or NA unless directed by HCP. Advise diabetic patients to monitor blood glucose closely, especially during first month of therapy HTN, Left Ventricular Dysfunction after MI, CHF, DM nephropathy If pt has DM, do not use captopril together with any medication. Do not administer captopril tablet within 36 hours of switching to or from sacubitril/valsartan, a nepriltsin inhibitor that contains aliskiren (Amturnide, Tekturna, Tekamlo). Anuria, dialysis, severe liver disease. US FDA pregnancy category D. Monitor renal function. May cause ↑ in BUN and serum creatinine. May cause hyperkalemia. Monitor CBC periodically during therapy in patients with collagen vascular disease and/or renal disease. May rarely cause slight ↓ hemoglobin and hematocrit and agranulocytosis. May cause ↑ AST, ALT, alkaline phosphatase, and serum bilirubin.
Generic: valsartan Trade: Diovan Pharmacologic: ARB Therapeutic: ANTIHYPERTENSIVE Usual adult Dose: 80-160 mg/day, Ped’s up to 2.7 mg/kg Max 160 mg MODE OF ACTION: SIDE EFFECTS:
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Reduce vasoconstriction and lower peripheral resistance. Prevents angiotensin II from binding to angiotensin II receptors on the muscles surrounding blood vessels. They also limit aldosterone production and promote diuresis and ↓ blood volume. HA, diarrhea, rash, fatigue, orthostatic hypotension, drug induced hepatitis, hyperkalemia, renal failure, drowsiness, angioedema, rhabdomyolysis HTN age 6 and older, heart failure, ↓ risk of death s/p MI +DM, do not use valsartan together with any medication that contains aliskiren (Amturnide, Tekturna, Tekamlo, Valturna). US FDA pregnancy category D, High K+, CKD Give 1 hour before meals. Monitor BP hourly after initial dose x 4 hours. For subsequent doses, take BP before each dose and Q 4 hours. Ck w/ HCP if SBP <100. Instruct pt not to use salt substitutes. Instruct pt to get up slowly to reduce risk of falls. In prolonged use monitor EKG for prolonged PR interval. Monitor I&O, daily weights. Assess signs CHF. Assess patients for signs of angioedema (dyspnea, facial swelling) Monitor renal function. May cause increase in BUN/creatinine. May cause hyperkalemia. May cause ↑ AST/ALT. May cause slight ↓ in HCT/HGB, or neutropenia. May ↑level and may ↑the risk of lithium toxicity.
Generic: diltiazem Brand: Cardizem, Cardizem LA, Cartia XT, Dilacor XR, Diltia XT, Tiazac Pharmacological: CCB Therapeutic: Antihypertensive Usual dose: PO 30-120 mg 3-4 x’s /day SR180-240 mg/day, LA up to 360 mg/day MODE OF ACTION: ADVERSE EFFECTS:
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Inhibit the flow of extracellular calcium ions across the cell membranes in cardiac and vascular tissue. This results in relaxation of arterial smooth muscle, vasodilatation, ↓ peripheral resistance, and a decreased heart rate. Peripheral edema, flushed skin, HA, dizziness, nausea, constipation, fatigue, weakness, impotence, MI, hepatotoxicity, heart failure, confusion, bradycardia, tachycardia, orthostatic hypotension HTN, angina pectoris and Prinzmetals angina and arrythmia’s (SVT, RVR w/ afib/aflutter)
Helps increase esophageal motility.
Severe hypotension, SSS, AV block. Recent MI w/ fluid build up in lungs. US FDA pregnancy category: Not assigned. Give before meals. Take BP/Pulse prior to administration. Delay the dose and notify HCP if: heart rate <60, systolic BP <100. Monitor EKG, I&O, and daily weight. Assess for signs of HF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention). Monitor for s/s of digoxin toxicity, if on. Instruct pt to “dangle” for a few minutes before ambulating and to change positions slowly. Advise pt to avoid activities requiring alertness until the effects of the drug are known. Explain that stopping these drugs suddenly can result in serious reactions. Ck with HCP before taking any OTC cold or allergy meds. Avoid caffeine This med is also antianginal, antiarrhythmic agent (class IV) Total serum CA concentrations are not affected by CCB. Monitor K+ periodically. Hypokalemia ↑the risk of arrhythmias and should be corrected. Monitor renal and hepatic functions periodically during long-term therapy. May cause ↑in LFT after several days of therapy, which return to normal after stopping. ). Monitor RFT, CBC, serum glucose, and Dig if on.
Generic: telmisartan Brand: Micardis Pharmacological: Angiotensin Receptor II Antagonist (ARB) Therapeutic: Antihypertensive Usual dose: 40-80 mg/day Usual dose: 40-80 mg / day MODE OF ACTION: SIDE EFFECTS:
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Keeps blood vessels from narrowing, which lowers blood pressure and
improves blood flow. Blocks the
vasoconstrictor and aldosterone- secreting effects of angiotensin II at various receptor sites, including vascular smooth muscle and the adrenal glands. HTN >18 year old, cardiovascular risk reduction Bilateral renal artery stenosis, concurrent use with aliskiren in patients with diabetes or moderate-to-severe renal impairment (CCr 60 mL/min), obstructive biliary disorders or hepatic impairment. Pregnancy category D Hypotension, dizziness, fatigue, angioedema, hyperkalemia Assess patients for signs of angioedema (dyspnea, facial swelling). Caution pt to avoid salt substitutes containing K+ or foods containing ↑ levels of K+ or NA unless directed by HCP. Caution pt to avoid sudden changes in position to ↓ orthostatic hypotension. of etoh, standing for long periods, exercising, and hot weather may increase orthostatic hypotension. Assess BP (lying, sitting, standing) and pulse frequently during initial dose adjustment and periodically during therapy.
Monitor renal function. May cause
↑ BUN/creatinine. May cause
hyperkalemia. May ↑ digoxin
levels.
Generic: quetiapine Trade: Seroquel Therapeutic: antipsychotics, mood stabilizers Usual Dose: Max dose 750 mg in schizophrenia and 300 mg in depression MODE OF ACTION: SIDE EFFECTS:
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Probably acts by serving as an antagonist of dopamine and serotonin. Also antagonizes histamine H1 receptors and alpha1-adrenergic receptors. Neuroleptic malignant syndrome, hyperglycemia, asthenia constipation, hypotension, drowsiness, headache, increased serum cholesterol, increased serum triglycerides/LFT, xerostomia, Steven Johnson syndrome. May cause ↑ in AST & ALT. May cause ↑ cholesterol/triglycerides. Obtain fasting blood glucose and cholesterol levels initially and throughout therapy. Monitor serum prolactin prior to & periodically during therapy. May cause ↑ serum prolactin levels. Schizophrenia, bipolar disorder (manic depressive), depression, agitation and dementia.
Causes fetal toxicity, pregnancy
category C
Monitor for tremors or other uncontrollable muscle movements. Monitor for hypotension. Monitor mental status (mood, orientation, behavior) before and periodically during therapy. Assess for suicidal tendencies, especially during early therapy.
Generic: amlodipine Trade: Norvasc Pharmacologic: CCB Therapeutic: Antihypertensive Usual dose: 2.5-10 mg PO tablet daily MODE OF ACTION: SIDE EFFECTS: INDICATIONS: CONTRAINDICATIONS: LAB TEST CONSIDERATIONS: NURSING CONSIDERATIONS: Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction. Decreases myocardial excitability Therapeutic Effects : Systemic vasodilation resulting in decreased BP. Coronary vasodilation resulting in decreased frequency and severity of attacks of angina. Alone or with other agents in the mgmt. of hypertension, angina pectoris, and vasospastic (Prinz metal's) angina. Peripheral edema, HA, bradycardia, drowsiness, orthostatic hypotension. Dizziness, palpitations, flushing, photosensitive to sunlight, BMS, antiarrhythmic agents can interfere with electrolytes responsible for cardiac conduction, new arrythmias can occur and cause CHF. CK CBC Q 2 weeks the 1st 3 months of therapy, monitor ANA, LFT chemistries during prolonged therapy Monitor BP/pulse during therapy, ck EKG periodically with prolonged tx, Monitor I&O and daily wt. Assess for signs HF, serum calcium concentrations are not affected by CCB, instruct pt to call MD if heart rate <50, develop rash, joint pain/edema, change positions slowly, maintain good dental hygiene, caution to wear protective clothing & sunscreen when outdoors Pregnancy category: C Avoid large amounts of grapefruit juice (6-8 glasses daily)
Generic: Aldactone Brand: Spironolactone Pharmacologic: POTASSIUM SPARING Therapeutic: DIURETIC/ANTIHYPERTENSIVES Usual dose: 25-400 mg po daily MODE OF ACTION: SIDE EFFECTS:
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Causes excretion of sodium and reduce excretion of potassium. Loss of NA bicarb and CA+ while saving K+ and hydrogen ions. By antagonizing aldosterone. Blocks reabsorption NA is distal convoluted tubules and collecting ducts of the nephrons, while conserving K+. Mgmt of primary aldosteronism, mgmt. of edema associated w/ CHF, cirrhosis and nephrotic syndrome. Mgmt of essential HTN. TX of hypokalemia (counteracts K+ loss caused by other diuretics). Hyperkalemia, hypotension, dizziness, hyponatremia, gynecomastia (men), increased hair growth, breast tenderness, agranulocytosis, muscle cramps, dehydration Always ck BP before administration, Monitor for S/S of dehydration (thirst, weakness, muscle cramping, hypotension, tachycardia), Monitor intake & output Q shift, Weigh pt QD, have the pt change positions slowly to avoid dizziness and falls, Instruct the pt to take the last dose in the afternoon to avoid nocturia, Monitor the BP for effectiveness, Monitor EKG for signs hyperkalemia (tented T waves)
Monitor electrolytes, especially K+.
Anuria, ARF, Pregnancy Category C
Generic: hydrochlorothiazide Trade: Microzide, Oretic Pharmacologic: Thiazide diuretic Therapeutic: Antihypertensive Usual dose: 12.5-100 mg DAILY MODE OF ACTION: SIDE EFFECTS:
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Inhibits sodium reabsorption and increases potassium loss. Increase excretion NA and H2O by inhabitation reabsorption NA is distal tubule. Promotes excretion K+, Mg and HCO3. May produce arteriolar dilation. Dehydration, Electrolyte imbalance (hypokalemia), Orthostatic hypotension, Digoxin toxicity, ED, fatigue, hyperglycemia, BMS Watch EKG for sign arrythmia, Monitor for S/S of dehydration (thirst, weakness, muscle cramping, hypotension, tachycardia), Monitor intake & output every shift, Weigh pt QD, Instruct the pt to change positions slowly to avoid dizziness/falls, Instruct the pt to take the last dose in the afternoon to avoid nocturia, Monitor the BP for effectiveness, teach pt to consume K+ foods, use sunscreen Mgmt mild-moderate HTN, tx edema associated w/ CHF, renal dysfunction, cirrhosis, corticosteroid therapy and estrogen therapy.
Allergy to sulfonamides. Pregnancy
Category B Monitor electrolytes, especially potassium. Always ck K+ prior to administration, monitor CBC, monitor dig level (low k+ causes digoxin toxicity), monitor LFT, amylase, lipase
Generic: lisinopril Trade: Zestril, Prinivil Pharmacologic: ACE I Therapeutic: Antihypertensive Usual Adult Dose: 10 mg once daily, can be ↑up to 20– 40 mg/day MODE OF ACTION: ADVERSE EFFECTS:
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Block the action of ACE. As a result, angiotensin II can’t form, which prevents systemic and renal vasoconstriction and the release of aldosterone. They are considered the “first drug of choice” for patients with HTN because they don’t increase the heart rate. Left Ventricular Dysfunction, Improves sx’s CHF, protect renal in DM pt, ↓risk of MI/CVA diabetic neuropathy and new onset DM Pregnancy category D (Don’t use in pregnancy!) Should not be used with potassium sparing diuretics (hyperkalemia) dry, hacking cough, first-dose syncope – severe hypotension and fainting within 1- 4 hrs after the initial dose or after a significant increase in dose, taste disturbances, electrolyte disturbances, ED, drowsiness, fatigue, HA, rash, diarrhea Give 1 hour before meals, monitor BP hourly after initial dose x 4 hours, for subsequent doses, take BP before each dose and every 4 hours, check with health care provider if SBP <100, Instruct the pt to lie down for 3-4 hours after the first dose. Caution pt to avoid activities requiring alertness until his reaction is known. Instruct the pt to avoid substances that interfere with ACE-I – coffee, tea, cola, OTC cold meds, Inform pt that the cough will go away after the meds are discontinued, Caution pt to avoid NACL substitute or foods containing high levels of K+ or NA unless directed by HCP. Monitor BUN, creatinine, and electrolyte levels periodically.
Generic: bisoprolol Trade: Monocor, Zebeta Pharmocologic: BB Therapeutic: Antihypertensive Usual adult dose: Start 5 mg, max daily dose 20 mg MODE OF ACTION: SIDE EFFECTS:
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Block the action of the sympathetic nervous systems catecholamines (epinephrine and norepinephrine) on cardiac receptors. This results in slower heart rate, reduced contractility of the heart muscle, and vasodilation of the arterioles, with reduction of PVR and BP. Management of hypertension Fatigue, weakness, bradycardia, pulmonary edema, ED, insomnia hypo/hyperglycemia, difficulty physical exertion, sensitivity to cold. Rebound HTN if d/c suddenly (severe HA, palpitations, trembling, sweating and chest pn) hypotension, bronchospasm, and may induce CHF in susceptible pt AV block, severe HF, bradycardia, do not give to clients with COPD/Asthma/Bronchospasm. US FDA pregnancy category: C Have call bell within reach and assist w/ ambulation, monitor BG q6h, assess BP and heart rate prior to administration, assess for orthostatic hypotension, teach pt to change position slowly, delay dose and notify the MD if the systolic BP is <90 or the apical rate is <60, give with meals or directly after, assess breath sounds for wheezing and crackles, teach the pt to avoid substances such as caffeine-containing beverages and OTC cold remedies (interferes with this medication), instruct the pt to report weight gain of >3 lbs in a day or 5 lbs in a week (edema), warn the pt against sudden cessation of this medication. May cause increased BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels. May cause increased ANA titers. May cause increase in blood glucose levels
