1. Drugs Affecting Blood Pressure

2. Vasopressors Treat shock isoproterenol (Isuprel)
stimulates beta 1 & beta 2
AE - too much beta stimulation = tachycardia, palpitations, nervousness
IV - need large catheter
other common vasopressors are dopamine, epinephrine, norepinephrine (Levophed)

3. Management of Hypertension
Try diet modification, stress reduction, & exercise first
once started usually long term drug therapy, possibly for life
must have follow up to monitor effectiveness of drug therapy
compliance a problem
education for patient

4. ACE Inhibitors
Prevent conversion of angiotensin I to angiotensin II (prevents sodium & water retention) & decreases peripheral vascular resistance
Captopril: food decreases absorption, give 1 hour before meals
chronic cough can occur
monitor BP

5. Alpha & Beta Blockers Normodyne (labetalol)
blocks alpha 1 & beta 1 & beta 2
watch for cardiac failure
do not stop drug suddenly

6. Critical Thinking Excercise
Your pt. is receiving labetalol for hypertension. Today, he has rales and has gained 3 lbs. Since he was last weighed 2 days ago. Urinary output has decreased in the last 2 days.
What do you conclude?
What type of orders might you seek from the physician or NP
Which nursing actions would you implement?

7. Alpha 2 agonists Inhibits sympathetic response
decrease vasoconstriction & decrease BP
Clonidine (Catapres): side effects are dry mouth, drowsiness, sedation & constipation
not suited for initial monotherapy
also used to alleviate discomfort from narcotic withdrawal

8. Direct Acting Vasodilators
hydralazine (apresoline): relaxes arterioles
have reflex mechanism of increase HR & CO
administer with food
usually given with beta blocker & diuretic because of reflex tachycardia & increase NA & water retention
side effects: tachycardia, palpitations, & angina
used as adjunct therapy

9. nitroprusside Hypertensive crisis maximum effects in 1-2 minutes
given IV, sensitive to light
relaxes vascular smooth muscle
patient can get excessive hypotension
given with other longer acting antihypertensives concurrently