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Pharmacotherapy for HTN, DVT

Pharmacotherapy for HTN, DVT. Drugs that decrease blood pressure Drugs that decrease fluid volume Drugs that affect coagulation Drug that decreases blood viscosity Herbals. Drugs that Decrease Blood Pressure. Alpha-adrenergic blockers —doxasozin (Cardura)*

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Pharmacotherapy for HTN, DVT

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  1. Pharmacotherapy for HTN, DVT • Drugs that decrease blood pressure • Drugs that decrease fluid volume • Drugs that affect coagulation • Drug that decreases blood viscosity • Herbals

  2. Drugs that Decrease Blood Pressure • Alpha-adrenergic blockers—doxasozin (Cardura)* • Beta-adrenergic blockers—atenolol (Tenormin) • Angiotensin Converting Enzyme Inhibitors (ACEIs)—enalapril (Vasotec) • Angiotension Receptor Blockers (ARBs)—losartan (Cozaar)

  3. Drugs to Decrease BP cont’d • Calcium-channel blockers—diltiazem (Cardizem) • Centrally-acting sympatholytics—clonidine (Catapres)* • Vasodilators—minoxidil (Loniten)*

  4. Alpha-BlockersPrototype: doxasozin • Note: all generics end in –sozin • Action: blocks alpha receptors in vascular smooth muscle, causing vasodilation. • Side effects: “first dose syncope”, orthostatic hypotension, tachycardia, palpitations, nasal congestion, impotence. • Nursing considerations: Give at hs to minimize risk of fainting. If 1st dose is given in daytime or if dose is increased, instruct pt to remain in bed for 3-4h. Pt is not to drive for 12-24h. Tell pt to change positions slowly.

  5. Beta-BlockersProtoype: atenolol • Note: all generics end in –lol • Action: blocks beta receptors, slows heart rate, decreases oxygen demand • Side effects: fatigue, dizziness, hypotension, bradycardia, bronchospasm (do not use in obstructive or restrictive respiratory diseases), agranulocytosis, thrombocytopenia, ED, depression • Nursing considerations: apical/radial pulse before adm. Notify prescriber for P<50, I&O, daily wts. Monitor BP.

  6. ACEIsPrototype: enalapril • Note: all generics end in -pril • Action: Suppresses renin-angiotensin-aldosterone system; prevents conversion of angiotensin I to angiotension II. Dilates arterial and venous vessels. • Side effects: Insomnia, dizziness, hypotension, dysrhythmias, proteinuria, renal failure, agranulocytosis, neutropenia, cough, hyperkalemia • Nursing Considerations: Monitor CBC, BP, P. If pt is on diuretic tx, monitor for syncope

  7. ARBsPrototype: losartan • Note: all generics end in -sartan • Action: Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II • Side effects: Dizziness, insomnia, CVA, MI, dysrhythmias, cough, diarrhea, indigestion, renal failure, angioedema • Nursing Considerations: BP, P. Monitor for edema, lytes, hepatic and renal function before tx begins

  8. CCBsPrototype: diltiazem • Action: inhibits calcium; dilates coronary and peripheral arteries • Side effects: HA, fatigue, drowsiness, dysrhythmias, CHF, heart block, ARF • Nursing considerations: Monitor VS, hold for SBP<90, Heart rate<60; monitor ECG

  9. Centrally Acting SympatholyticPrototype: clonidine • Action: stimulate alpha-receptors in the DNS to suppress sympathetic flow to heart and vessels. Suppresses cardiac output and causes vasodilation. • Side effects: dry mouth, sedation • Nursing considerations: Monitor BP and P. Tell pt not to stop suddenly—may cause severe rebound HTN. Administer at hs to minimize effects of sedation. Contraindicated in pregnancy.

  10. VasodilatorsPrototype: minoxidil • Action: relaxes vascular smooth muscle, especially arterioles and decreases systemic vascular resistance (SVR). Usually given with BB or diuretic. • Side effects: fluid retention, reflex tachycardia, orthostatic hypotension • Nursing considerations: Assess BP, P before and during tx. Monitor for edema and hear failure. Tell pt to change positions slowly. And to report muscle or joint aches or fever. May cause excessive hair growth

  11. Drugs that Decrease Fluid Volume • Thiazide diuretics—hydrochlorothiazide (HCTZ, HydroDIURIL)

  12. Thiazide DiureticsPrototype: hydrochlorothiazide • Action: Increases excretion of water, sodium, chloride, and potassium in the distal tubule and ascending limb of loop of Henle. • Indications: Edema, HTN, diuresis, CHF • Side effects: Dizziness, weakness, fatigue, hypokalemia, NV, anorexia, hepatitis, aplastic anemia, pancytopenia, glucosuria, allergic reaction (sulfa) • Nursing Considerations: Assess daily wts, I&O, postural BPs, lytes, blood sugar

  13. Drugs that Affect Coagulation • Drugs interfering with the clotting cascade—heparin sodium (no trade name), low-molecular weight heparin (Lovenox) • Drugs that interfere with synthesis of Vitamin K-dependent clotting factors—warfarin (Coumadin)

  14. Anticoagulant #1Prototype: heparin sodium • Action: prevents conversion of fibrinogen to fibrin and prothrombin to thrombin • Indications: Tx of pulmonary embolism, DVT • Side effects: fever, hemorrhage, rash, thrombocytopenia, anemia, anaphylaxis • Nursing considerations: Monitor PTT, CBC, signs of hemorrhage and allergy. If given SQ, give in abdomen. Do not aspirate or massage. Check labels closely so as not to confuse concentrations.

  15. Anticoagulant #2Prototype: LMWH • Action: prevents conversion of prothrombin to thrombin. More precise and predictable than heparin • Side effects: hemorrhage, bruising, thrombocytopenia • Nursing considerations: abdomen is best site for SQ administration. Do not remove air bubble from syringe before administration. Do not aspirate or massage.

  16. Anticoagulant #3Prototype: warfarin • Action: interferes with blood clotting by depressing hepatic synthesis of Vitamin K-dependent coagulation factors • Indications: prevention and tx of pulmonary emboli, DVT • Side effects: hepatitis, hemorrhage, WBC effects, rash • Nursing considerations: Monitor PT, CBC, and for hemorrhage and occult blood in stools.

  17. Trental (pentoxifylline) • Action: Decreases blood viscosity, increases blood flow by increasing flexibility of RBCs • Indication: Intermittent claudication • Forms: po, po XR • Side effects: HA, tremors, dizziness, indigestion, NV, leukopenia • Nursing Considerations: Watch BP if pt is on antihypertensives. Assess for improvement in activity with continued use.

  18. Herbals • Ingestion of Fish Oil/Omega-3 Fatty Acids has been associated with lower BP readings in people with hypertension • Hawthorne may be most commonly used herb for treating HTN, but should not be used with other antihypertensives and with cardiac glycosides

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