-thiazides and thiazide like

-loop or high ceiling

-osmotic

-potassium sparing

-carbonic anhydrase inhibitors

thiazide and thiazide like diuretics

hydrochlorothiazide

-hypertension and peripheral edema

-distal convoluted tubule

-excretes Na+, Cl, K=, mg and H2O,reabsorbs Ca -vasodilates

-hypercalcemia, hyperglycemia, hypokalemia

-monitor electrolytes, digoxin and lithium levels

-don't give to pts with renal failure 

Loop or High ceiling diuretics

furosemide

-cardiac + pulmonary edema + endstage renal disease

-not  effective for HTN

-ascending loop of henle

-inhibits Na+,  Cl, K+, Ca, and Mg reabsorption

-no vasodilation

-increased renal blood flow

-works within 30-60 min, IV 5 min

-monitor electrolytes (hypo K+)

-take K+ supplement monitor digoxin level sulfa allergies 

osmotic diuretics

mannitol, urea

-prevent acute renal failure, decrease cerebral,  cerebrospinal and ocular pressure

-proximal tubule, loop of henle

-pulls water into vessels and nephrons form  surrounding tissues

-caution in pts with heart disease or failure

-heartfailure, cirrosis

-distal renal tubule

-excrete Na+ +H2O, retain K+

-combined with thiazide or loop diuretics

-Hyperkalemia >5.3!

-not with ACE or ARBs

Carbonic Anhydrase Inhibitors

"...lamide"

-high altitude sickness, epilepsy, glaucoma

-enzyme inhibition

-excrete Na+, K+, and bicarbonate

-metabolic acidosis!

-kidney stones

-not in pregnancy!

nursing responsibilities 

diuretics

-weigh daily

-I/O

-monitor BP and ortho hypo

-monitor elecrolytes (Na+, K+, Ca+)

-Hypo K+ <3.5: muscle weakness, abdominal distention, leg cramps, dysrythmias

-Hyper K+ >5.5: nausea, diarrhea, abdominal cramps, bradycardia, ecg change,  oliguria

-Hypo Na+: LOC, headache, irritability,neurochanges, seizures, hallucinations

-take in AM

-drink!

• beta adrenergic blockers
• centrally acting alpha2 agonists
• alpha adrenergic blockers
• adrenergic neuron blockers
• alpha1 and beta1 adrenergic blockers

Angiotensin converting enzyme inhibitors (ACE)

"...pril"

-blocks AC

-reduces PVR, Na+retention, BP

-increases renal function in diabetics

-Na+ and H2O excreted

-African Americans respond less

-irritating cough, Hyper K+, tachycardia

-NSAIDs lower effectiveness, may increase lithium toxicity, don't give pregnant

-1 hr before meals

-monitor WBCs, BUN, ser. creat., +weight

angiotensin II receptor antagonist/blocker (ARB)

"...sartan"

-bind to angiotensinII receptor sites

-vasodilate and reduce PVR

-may cause angioedema

-not during pregnancy

-Hyperkalemia

-cough and tickling in throat

alpha adrenergic blockers

"...zosin", phentolamine, flomax

-blocks norepinephrine release form sympathetic nerve  endings

-for severe HTN, prostatic hypertrophy

-raise HDL, lower LDL

-dilates venous and arterial systems

-ortho hypo common, edam, congenstion, GI

-no broncho effects

-D/D: nitrates and antiinflammatories

Beta Blockers

cardioselsctive (beta1): lopressor

nonselective(beeta1+2)

"...olol"

-prevent SNS response, lower basal sympathetic response

-lower CO,HR,VR,BP, renin release

-african americans respond less, asians more

-don't give nonselective to COPD pts=> bronchospasm

-taper off (arrhythmias, MI)

-ok for diabetics

-check liver and renal fuction(BUN, creatinin,AST,+LDH)

-suppresses reflex tachycardia caused by vasodilators

centally acting alpha 1 agonists

clonidine, methyldopa, hydrochloride

-brainstem- decrease sympathetic response

-stimulates vagus nerve

-decreases renin, epinephrine, norepinephrine, HR, CO,    PVD,BP

-increases vasodilation

-given with diuretic

-clonodine= transdermal patch

-Na+ and H2O retnetion

-sexual dysfunction

-check liver enzymes

direct acting arterial vasodilators

diazoside, hydralazine, minosidil

-smooth muscle of blood vessels= vasodilates

-blocks renin

-lowers BP

-fluid retntion

-combined with diuretic

-nitroprusside IV in HTN emergency

-may cause hyperglycemia

Calcium Channel Blockers

diltiazem, verapamil, "...dipine"

-block Ca+ access to cells (cardiac, vascular, and smooth  muscle)

-lower cardiac contractilityand conductivity

-decreased afterload and O2 demand

-effective for african americans

-vasodilate coronary and cerebral arteries

 not with beta blockers!

-headache and arrhythmias, dizziness, peripheral edama, abdominal distention

-monitor for digitalis toxicity! 

-monitor electrolytes and fluids

-I/O

-weigh in AM

-take BP same time in AM and record

-get up slow, ortho hypo

-taper off

-side effects

-lifestyle modification, exercise, low sodium diet