Anti hypertensive drugs nikhil

Drug presentation on anti hypertensive drugs

1. SUMANDEEP COLLEGE OF NURSING
DRUG PRESENTATION ON
ANTIHYPERTENSIVE DRUGS


PRESENTED BY
NIKHIL VAISHNAV
M.Sc. 2
nd
YEAR

2. ANTIHYPERTENSIVE DRUGS
Centrally acting alpha adrenergic antagonists.
Peripheral acting alpha adrenergic antagonists.
Alpha blockers
Beta blockers
CCB
Diuretics
ARB
ACE INHIBITORS
Renin inhibitors
Aldosterone inhibitors
Vasodilators

3. CENTRALLY ACTING ALPHA
ADRENERGIC ANTAGONISTS
Action: These drugs reduce sympathetic
outflow from CNS, reduces peripheral
sympathetic tone, produces vasodilation,
decrease SVR and BP.
1.Clonidine
2.Guanabenz
3. Guanfacine
4. Methyldopa

4. CLONIDINE
Generic name: Clonidine hydrochloride
Brand name: Catapres
Availability: 0.1 mg, 0.2 mg, 0.3 mg tablets; 0.1 mg/24 h, 0.2 mg/24 h,
0.3 mg/24 h transdermal patch; 100 mcg/mL, 500 mcg/mL injection.
Action: It stimulates alpha
2-adrenergic receptors in CNS to inhibit sympathetic
vasomotor centres. Due to inhibition of nor epinephrine blood pressure reduces.

5. INDICATIONS
Hypertension, either alone or with diuretic or other
antihypertensive agents.
Prophylaxis for migraine
treatment of dysmenorrhea, menopausal flushing,
diarrheal, alcohol, smoking, opoid and
benzodiazepine withdrawal.

6. CONTRAINDICATIONS
• Pregnancy (category C)
•lactation.
•Use of clonidine patch in polyarthritis nodosa,
scleroderma, SLE.

7. SIDE EFFECTS
• Hypotension (epidural).
•Postural hypotension (mild).
•Peripheral edema.
•ECG changes.
• Tachycardia.
• Dry mouth.
•constipation, abdominal pain, Drowsiness,
sedation, dizziness, headache, fatigue, weakness,
sluggishness.

8. NURSING CONSIDERATIONS
1. Monitor BR closely. Determine positional
changes (supine, sitting, standing).
2.With epidural administration, frequently
monitor BP and HR. Hypotension is a common
side effect that may require intervention.
3.Monitor BP closely whenever a drug is added to
or withdrawn from therapeutic regimen.
4.Monitor I&O during period of dosage
adjustment. Report change in I&O ratio or
change in voiding pattern.

9. PERIPHERAL ACTING ALPHA
ADRENERGIC ANTAGONISTS
• Peripheral adrenergic inhibitors work in the
brain to inhibit the release of epinephrine and
nor epinephrine.
• This reduces resistance to blood flow in the
small arteries and lower blood pressure.
• Examples are reserpine & Guanethidine.

10. RESERPINE
• Action: It is an antihypertensive drug that
causes depletion of nor adrenaline ,
catecholamine resulting in a reduction in BP.
•Decreased cardiac output and peripheral
resistance results in low blood pressure.

11. INDICATION
Hypertension
Agitated
psychotic
states

12. CONTRAINIDCATIONS
Peptic ulcer.
Ulcerative
colitis.
Depression.

13. SIDE EFFECTS
Nasal congestion.
Headache.
GI disturbances.
gnacomastia.
impotence.
dry mouth.
dysuria.

14. NURSING CONSIDERATIONS
Contraindicated in patient
with history of depression.
Monitor mood and mental
status regularly.

15. ALPHA ADNERGIC BLOCKERS
• These drugs block alpha-1-adrenergic
receptors in arteries, smooth muscles, and
central nervous system tissues.
• It is mainly used to treat benign prostatic
hyperplasia (BPH), hypertension and post-
traumatic stress disorders.
• It is not usually recommended as
monotherapy.

16. •They selectively block postsynaptic alpha
1 -
adrenergic receptors.
• Commonly used drugs are:
• Prazosin.
• Doxazosin
• Terazosin.

17. PRAZOSIN
• Action: Prazosin blocks postsynaptic alpha
adrenoreceptors of veins and arterioles
causing vasodilation and reduction in blood
pressure.

18. INDICATION& USAGE
• Hypertension: Initial: 1 mg PO q8-12hr
•Maintenance: 6-15 mg/day divided 2 or 3
times daily; alternatively, 1-5 mg PO BID; may
increase dose to 20 mg/day in divided doses.
• some patients may benefit from up to 40
mg/day in divided doses .

19. CONTRAINDICATIONS
• CHF.
•Hypersensitivity.
•pregnancy.

20. SIDE EFFECTS
• Syncope.
• Palpitations.
• nausea.
•Edema.
• chest pain.
•Vomiting.
•Depression.
•Nervousness.
•epistaxis.

21. NURSING CONSIDERATIONS
• Monitor for potential side effects and
overdosage.

22. ACE INHIBITORS
• Angiotensin-converting enzymes inhibitors
(ACE Inhibitors) are antihypertensive agents
that act in the lungs to prevent the conversion
of angiotensin I into angiotensin II, which is a
potent vasoconstrictor.
• Action: By preventing the production of
angiotensin II which is a potent
vasoconstrictor and a stimulator of
aldosterone release.

23. INDICATIONS
• hypertension and can be used alone or in
combination with other drugs.
•it is also combined with diuretics and digoxin
in the treatment of heart failure and left
ventricular dysfunction.
• diabetic nephropathy.

24. CONTRAINDICATIONS
• Allergy to ACE inhibitors.
•Prevent severe hypersensitivity reactions.
• Renal impairment.
•Heart failure.
• Hyponatremia and hypovolemia.
•Pregnancy and lactation.

25. SIDE EFFECTS
• Peptic ulcer.
•Constipation.
•liver injury.
•renal failure.
•renal insufficiency.
•chest pain.
•cardiac dysaarthmias.

26. NURSING CONSIDERATIONS
• Assess for the mentioned contraindications to drug (e.g.
renal impairment, hyponatremia, hypovolemia, etc.) to
prevent potential adverse effects.
•Obtain baseline status for weight, vital signs, overall skin
condition, and laboratory tests like renal and hepatic
function tests, serum electrolyte, and complete blood
count (CBC) with differential to assess patient’s response to
therapy.
•Administer drug on empty stomach one hour before or two
hours after meal to ensure optimum drug absorption.
•Monitor renal and hepatic function tests to alert doctor for
possible development of renal and/or hepatic failure as
well as to signal need for reduced drug dose.

27. ANGIOTENSIN II RECEPTOR BLOCKERS
• ARBs are antihypertensive agents that exert
their action by blocking vasoconstriction and
release of aldosterone through selective
blocking of angiotensin II receptors in vascular
smooth muscles and adrenal cortex.
• Action: The main action is to block the blood
pressure raising effect of the renin-
angiotensin-aldosterone system (RAAS).

28. LOSERTAN
• Generic name: Losartan potassium
• Brand name: Cozaar
• Action: Angiotensin II receptor (type AT
1)
antagonist acts as a potent vasoconstrictor
and primary vasoactive hormone of the renin–
angiotensin–aldosterone system

29. INDICATION
• In hypertension : 50 mg once daily , increased
100 mg daily as a single dose or in 2 divided
doses if needed.

30. CONTRAINDICATION
• Pregnancy
• Lactation

31. SIDE EFFECTS
• Headache.
•Dizziness.
•back pain.
• myalgia, fatigue.
•Rash.
• neutropenia.
•Hypererkalemia.
• impaired renal function.

32. NURSING CONSIDERATIONS
• Monitor BP at drug trough (prior to a
scheduled dose).
•Monitor drug effectiveness, especially in
African-Americans when losartan is used as
monotherapy.
•Inadequate response may be improved by
splitting the daily dose into twice-daily dose.
•Lab tests: Monitor CBC, electrolytes, liver &
kidney function with long-term therapy.

33. CALCIUM CHANNEL BLOCKERS
• Calcium-channel blockers as antihypertensive
agents decrease blood pressure, cardiac
workload, and myocardial consumption of
oxygen.
• Action: These drugs inhibit the movement of
calcium ions across myocardial and arterial
muscle cell membranes.

34. • Indications: They can be used alone for
treatment of hypertension or in combination
with other antihypertensive agents.
• Contraindications: Allergy to calcium channel
blockers, Heart block (sick sinus
syndrome),Renal and hepatic impairment,
Pregnancy and lactation.

35. ADVERSE EFFECTS
• CNS: headache, dizziness, light-headedness,
fatigue, CV: hypotension, bradycardia,
peripheral edema, heart block, GI: nausea,
hepatic injury,EENT: rash, skin flushing.

36. NURSING CONSIDERATIONS
• Assess for the mentioned contraindications to
this drug (e.g. headache, rash, bradycardia,
etc.) to prevent potential adverse effects.
•Monitor cardiopulmonary status closely as the
drug can cause severe effects on these two
body systems.

37. VASODILATORS
• Direct vasodilators are used when the
previous drugs mentioned are not effective.
These antihypertensive agents are reserved
for severe hypertension and hypertensive
emergencies.
• Action: These antihypertensive agents exert
their effect by acting directly on smooth
muscles.

38. HYDRALAZINE
• Mechanism of action: It is a direct acting
vasodilator.
• It acts predominantly on the arterioles.
•It reduces blood pressure and resistance but
produces fluid retention.

39. INDICATION & USAGE

•Oral (Hypertension): 40-50 mg daily in divided
doses, increased according to dosage.
•Intravenous ( Hypertensive crisis): 5-10 mg
via slow iv injection, repeated if necessary
after 20-30 minutes.

40. • Contraindications: Severe tachycardia, heart
failure with high cardiac output. Cor
pulmonale, coronary artery disease.
•Side effects: Tachycardia, palpitations, angina
pectoris, hemolytic anemia, paralytic ileus,
headache, flushing, nasal congestion,
peripheral neuropathy, fluid retention,
postural hypotension.

41. •Nursing considerations:
•It should not be used as monotherapy
because of side effects.
•Contraindicated in patient with coronary
artery disease.
•Used with caution in patients over 40 years of
age.

42. BETA BLOCKERS
Beta blockers are also reffered to as beta –
adrenergic antagonists are a class of medication
that are particularly used to manage abnormal
heart rhythms and in heart attack.
They are also particularly used to treat high
blood pressure.

43. • Beta 1 receptors are located in the heart and
kidney.
•Bet 2 receptors are located mainly in the
lungs, gastrointestinal tract, liver, uterus etc.
•Beta 3 receptors are found in adipose tissue.
Beta blockers block the receptor sites for the
endogenous catecholamines ( epinephrine and
nor epinephrine) on adrenergic beta receptor.

44. CLASSIFICATION
They are divided into 2 types.
Non selective Beta blockers: Act on
beta 1 and 2 receptors.
Cardioselective Beta blockers: Block
only beta 1 receptors.

45. MECHANISM OF ACTION
Beta blockers bind to adrenoreceptors and block the
binding of nor adrenaline and adrenaline to these
receptors.
Due to blocking of catecholamine heart beats slowly and
with less force.
Therefore there is less cardiac output thus blood pressure
is reduced.

46. INDICATIONS
Cardiac
arrhythmias
Heart failure
Coronary
artery
disease
Post heart
attack
Hypertension

47. CONTRAINDICATIONS
A: Asthma
B: Block (Heart block)
C: COPD
D: Diabetes mellitus
E: Electrolyte
(Hyperkalaemia)

48. SIDE EFFECTS
• Main side effects include Dizziness, weakness,
drowsiness, cold hands and feet, dry mouth,
headache, upset stomach, diarrhoea or
constipation. Less common side effects
include depression, shortness of breath,
wheezing, erectile dysfunction, sore throat,
joint pain, skin rash, trouble sleep

49. NURSING CONSIDERATIONS
• Nurse should monitor client’s blood pressure,
heart rate and rhythm.
•Monitor the clients for the signs of edema.
•Nurse should assess the lung sounds for signs
of rales and rhonchi.
•To monitor the change in lab value of BUN,
Creatinine.

50. DIURETICS
Diuretics are medicines that are often used to treat
high blood pressure.
Diuretics have been classified in several types like
thiazide, loop diuretics, potassium sparring diuretics,
osmotic diuretics & carbonic anhydrase inhibitors.
There are different types of diuretic, but the type
most commonly used to treat high blood pressure is
called “thiazide” diuretics

51. THIAZIDE
The thiazides are the most widely used of the diuretic
drugs .
Thiazide diuretics are sulfonamide derivatives
All thiazides affect the distal tubule, and all have equal
maximum diuretic effects.
They are called ceiling diuretics.

52. Thiazide agents are used as monotherapy.
They inhibit the reabsorption of sodium and chloride at
distal tubule.
Examples of thiazide include Chlorothiazide,
hydrochlorothiazide, chorthialidone, methylclothiazide etc.

53. HYDROCHLOROTHIAZDE
• Generic name: Hydrochlorothiazide
•Brand name: Apo-hydro (CAN), Ezide, Hydro-
par.
•Classification: Thiazide diuretic
•Available forms: Tablets—25, 50, 100 mg;
solution—50 mg/5 mL; capsules—12.5 mg

54. DOSES & USAGE
• Edema: 25–200 mg daily PO until dry weight
is attained. Then, 25–100 mg daily PO or
intermittently, up to 200 mg/day.
•Hypertension: 12.5–50 mg PO.
•Calcium nephrolithiasis: 50 mg daily or bid PO.

55. ACTION
• Hydrochlorothiazide inhibits the reabsorption
of Na and chloride at the beginning of the
distal convoluted tubule.
• It causes natriuretic effect mainly by
decreasing Na and chloride reabsorption in
the cortical segment of the ascending limb of
the loop of Henley by inhibition of a specific
Na+Cl- co-transporter.

56. INDICATION
Adjunctive therapy in edema associated
with CHF, cirrhosis, corticosteroid, and
oestrogen therapy; renal impairment.
Hypertension as sole therapy or in
combination with other
antihypertensive.

57. CONTRAINDICATIONS
Severe hepatic and renal impairment.
Addison’s disease.
pre-existing hypocalcaemia.
anuria.
sulphonamide allergy.
Pregnancy.
lactation.

58. SIDE EFFECTS
Volume depletion and electrolyte imbalance, dry mouth,
thirst, lethargy, drowsiness, muscle pain and cramps,
hypotension, hypersensitivity reactions e.g. rashes,
photosensitivity, thrombocytopenia, jaundice, pancreatitis;
fatigue, weakness.
Potentially Fatal: Hypersensitivity reactions

59. NURSING CONSIDERATIONS
•History: Allergy to thiazides, sulfonamides; fluid or electrolyte imbalance;
renal or liver disease; gout; SLE; glucose tolerance abnormalities, diabetes
mellitus; hyperparathyroidism; manic-depressive disorders; lactation,
pregnancy
•Physical: Skin color, lesions, edema; orientation, reflexes, muscle strength;
pulses, baseline ECG, BP, orthostatic BP, perfusion; R, pattern, adventitious
sounds; liver evaluation, bowel sounds, urinary output patterns; CBC,
serum electrolytes, blood glucose, LFTs, renal function tests, serum uric
acid, urinalysis
•Give with food or milk if GI upset occurs.
•Mark calendars or provide other reminders of drug for alternate day or 3–
5 days/wk therapy.
•Reduce dosage of other antihypertensive by at least 50% if given with
thiazides; readjust dosages gradually as BP responds.
•Administer early in the day so increased urination will not disturb sleep.
•Measure and record weights to monitor fluid changes.

60. POTASSIUM SPARING DIURETICS
• Potassium sparing diuretics interfere with the
sodium reabsorption at the distal tubule,
decreasing potassium excretion.
• Potassium sparring diuretics have a weak
diuretics and antihypertensive effect when
used alone.
• Example of potassium sparing diuretics used
in HTN is triamterene, Amiloride etc.

61. LOOP DIURETICS
•Loop diuretics act on the ascending limb of
the loop of Henley, inhibiting the reabsorption
of sodium and chloride.
• Loop diuretics do not reduce blood pressure
as effectively as thiazide diuretics when they
are used as monotherapy, especially if they
are dosed once daily.

62. RENIN INHIBITORS
Renin inhibitors are a group of pharmaceutical
drugs used primarily in treatment of essential
hypertension (high blood pressure).
These drugs inhibit the first and rate-limiting
step of the renin–angiotensin–aldosterone
system (RAAS), namely the conversion of
angiotensinogen to angiotensin I.

63. ALISKIREN
• Generic name: Aliskiren
•Brand name: Rasilez
•Action: Inhibition of renin results
in decreased formation of
angiotensin II, a powerful vaso-
constrictor.

64. • Indication: In Hypertension
•Contraindication: Hypersensitivity, lactation,
pregnancy.
• Side effects: Cough, hypotension, diarrhoea,
dyspepsia, abdominal pain.

65. NURSING CONSIDERATIONS

•Monitor BP and pulse frequently during initial
dose adjustment and periodically during
therapy.
•Monitor frequency of prescription refills to
determine adherence.

66. ALDOSTERONE ANTAGONISTS
They are also known as antiminerelocorticoid
drugs.
It is a diuretic drug which antagonizes the action
of aldosterone at mineralocorticoid receptors.
Examples are spironolactone and eplerenone.

67. ACTION
• They block mineralocorticoid receptor thus
reduce the inhibition of sodium in collecting
duct of the nephron.