Drugs Affecting Blood Drugs Affecting Blood PressurePressure

Brenda B. RoweBrenda B. Rowe

VasopressorsVasopressors

Treat shockTreat shock Dopamine (Intropin) – stimulates alpha-1 & Dopamine (Intropin) – stimulates alpha-1 &

beta-1beta-1 Isoproterenol (Isuprel)Isoproterenol (Isuprel) Stimulates beta 1 & beta 2Stimulates beta 1 & beta 2 AE – too much beta stimulation – AE – too much beta stimulation –

tachycardia, palpitations, nervousnesstachycardia, palpitations, nervousness IV – need large catheterIV – need large catheter Other common vasopressors are Other common vasopressors are

epinephrine & norepinephrine (Levophed)epinephrine & norepinephrine (Levophed)

Management of Management of HypertensionHypertension

Stepped ProgramStepped Program Try diet modification, stress Try diet modification, stress

reduction, & exercise firstreduction, & exercise first once started usually long term once started usually long term

drug therapy, possibly for lifedrug therapy, possibly for life must have follow up to monitor must have follow up to monitor

effectiveness of drug therapyeffectiveness of drug therapy compliance a problemcompliance a problem education for patienteducation for patient

ACE InhibitorsACE Inhibitors

Prevent conversion of angiotensin I to Prevent conversion of angiotensin I to angiotensin II (prevents sodium & angiotensin II (prevents sodium & water retention) & decreases water retention) & decreases peripheral vascular resistanceperipheral vascular resistance

Captopril (Capoten): food decreases Captopril (Capoten): food decreases absorption, give 1 hour before mealsabsorption, give 1 hour before meals

chronic cough can occur chronic cough can occur monitor BPmonitor BP

Alpha & Beta BlockersAlpha & Beta Blockers

Normodyne (labetalol)Normodyne (labetalol) blocks alpha 1 & beta 1 & beta 2blocks alpha 1 & beta 1 & beta 2 watch for cardiac failurewatch for cardiac failure do not stop drug suddenlydo not stop drug suddenly

Critical Thinking ExerciseCritical Thinking Exercise Your pt. is receiving labetalol for Your pt. is receiving labetalol for

hypertension. Today, he has rales and hypertension. Today, he has rales and has gained 3 lbs. Since he was last has gained 3 lbs. Since he was last weighed 2 days ago. Urinary output has weighed 2 days ago. Urinary output has decreased in the last 2 days.decreased in the last 2 days.

What do you conclude?What do you conclude? What type of orders might you seek from What type of orders might you seek from

the physician or NPthe physician or NP Which nursing actions would you Which nursing actions would you

implement?implement?

Alpha 2 agonistsAlpha 2 agonists

Inhibits sympathetic responseInhibits sympathetic response decrease vasoconstriction & decrease BPdecrease vasoconstriction & decrease BP clonidine (Catapres): side effects are dry clonidine (Catapres): side effects are dry

mouth, drowsiness, sedation & mouth, drowsiness, sedation & constipationconstipation

not suited for initial monotherapynot suited for initial monotherapy also used to alleviate discomfort from also used to alleviate discomfort from

narcotic withdrawalnarcotic withdrawal

Direct Acting VasodilatorsDirect Acting Vasodilators hydralazine (Apresoline): relaxes hydralazine (Apresoline): relaxes

arteriolesarterioles have reflex mechanism of increase HR have reflex mechanism of increase HR

& CO& CO administer with foodadminister with food usually given with beta blocker & usually given with beta blocker &

diuretic because of reflex tachycardia diuretic because of reflex tachycardia & increase NA & water retention& increase NA & water retention

side effects: tachycardia, palpitations, side effects: tachycardia, palpitations, & angina& angina

used as adjunct therapyused as adjunct therapy

nitroprusside (Nipride)nitroprusside (Nipride)

Hypertensive crisisHypertensive crisis maximum effects in 1-2 minutesmaximum effects in 1-2 minutes given IV, sensitive to lightgiven IV, sensitive to light relaxes vascular smooth musclerelaxes vascular smooth muscle patient can get excessive hypotensionpatient can get excessive hypotension given with other longer acting given with other longer acting

antihypertensives concurrentlyantihypertensives concurrently