1. Drugs Affecting Blood Pressure Brenda B. Rowe

2. Vasopressors Treat shock Treat shock Dopamine (Intropin) – stimulates alpha-1 & beta-1 Dopamine (Intropin) – stimulates alpha-1 & beta-1 Isoproterenol (Isuprel) Isoproterenol (Isuprel) Stimulates beta 1 & beta 2 Stimulates beta 1 & beta 2 AE – too much beta stimulation – tachycardia, palpitations, nervousness AE – too much beta stimulation – tachycardia, palpitations, nervousness IV – need large catheter IV – need large catheter Other common vasopressors are epinephrine & norepinephrine (Levophed) Other common vasopressors are epinephrine & norepinephrine (Levophed)

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

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

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

6. Critical Thinking Exercise 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. 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 do you conclude? What type of orders might you seek from the physician or NP What type of orders might you seek from the physician or NP Which nursing actions would you implement? Which nursing actions would you implement?

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

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

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