VASODILATORSMost of the vasodilators are reserved for use in severe hypertension, malignant hypertension, or hypertensive emergencies•Diazoxide (Hyperstat): IV for hospitalized patients with severe hypertension; increases blood glucose levels•Hydralazine (Apresoline): Maintains increased renal blood flow•Minoxidil (Loniten): Used only for severe and unresponsive hypertension•Nitroprusside (Nitropress): Used for hypertensive crisis; maintain hypertension during surgery
Copyright © 2017 Wolters Kluwer • All Rights ReservedVASODILATORS (CONT.) Actions•Acts directly on vascular smooth muscle to cause muscle relaxation, leading to vasodilatation, and drop in blood pressureIndications•Severe hypertensionPharmacokinetics•Rapidly absorbed and widely distributed, metabolized in the liver, and primarily excreted in the urineContraindications•Allergy, pregnancy, lactation, cerebral insufficiency
Copyright © 2017 Wolters Kluwer • All Rights ReservedVASODILATORS (CONT.) Caution•Peripheral vascular disease, CAD, CHF, or tachycardiaAdverse Effects •Related to changes in the blood pressure•GI upset•Cyanide ToxicityDrug-to-Drug Interactions•Based on individual drug
Copyright © 2017 Wolters Kluwer • All Rights ReservedNURSING CONSIDERATIONS FOR VASODILATORSAssess:•History and Physical Exam•Known allergy•Impaired kidney or liver function, pregnancy or lactation•Baseline status to include, VS, LS, BS, skin, ECG, and appropriate lab values
Copyright © 2017 Wolters Kluwer • All Rights ReservedPROTOTYPE VASODILATORS
Copyright © 2017 Wolters Kluwer • All Rights ReservedDIURETICSIncrease the excretion of sodium and water from the kidney to lower blood pressure (Figure 43.3). See Chapter 51 for a detailed discussion of these agents.•Thiazide and thiazide-like diuretics: chlorothiazide (Diuril), hydrochlorothiazide (HydroDIURIL), methyclothiazide (generic), chlorthalidone (generic), indapamide (generic), and metolazone (Zaroxolyn)•Potassium-sparing diuretics: amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium)
Copyright © 2017 Wolters Kluwer • All Rights ReservedANTIHYPOTENSIVE AGENTS SYMPATHETIC ADRENERGIC AGONISTS OR VASOPRESSORSIf BP becomes too low (hypotension) the vital centers in the brain and the rest of the tissues of the body may not receive sufficient oxygenated blood to continue functioning•Dobutamine (generic), dopamine (generic), ephedrine (generic), epinephrine (Adrenalin, AdrenaClick), isoproterenol (Isuprel), orepinephrine (Levophed), and phenylephrine (generic).
Copyright © 2017 Wolters Kluwer • All Rights ReservedANTIHYPOTENSIVE AGENTS SYMPATHETIC ADRENERGIC AGONISTS OR VASOPRESSORSActions- Activates alpha-receptors in arteries and veins to produce an increase in vascular tone and an increase in blood pressureIndications- Symptomatic treatment of orthostatic hypotensionPharmacokinetics- Absorbed from GI tract, metabolized in the liver, and excreted in the urineContraindications- Supine hypertension, CAD, pheochromocytoma, and with urinary retention
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