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-Blockers Prototype: 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-Blockers Protoype: 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. ACEIs Prototype: 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. ARBs Prototype: 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. CCBs Prototype: 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 Sympatholytic Prototype: 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. Vasodilators Prototype: 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 Diuretics Prototype: 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 #1 Prototype: 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 #2 Prototype: 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 #3 Prototype: 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