| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|
| Captopril (Capoten)—PO 50 mg 3 times daily | Hypertension, heart failure | Prevents production of angiotensin II; vasodilation | Hypotension; loss of taste perception; proteinuria; rashes |
| NURSING IMPLICATIONS: Monitor VS and weight; take 1 hr before or 2 hr after meals; change positions slowly; avoid salt and salt substitutes |
| Clonidine (Catapres)—PO 200–600 mcg/day; transdermal 100–300 mcg applied every 7 days | Mild to moderate hypertension; also used for epidural pain management | Stimulates alpha-adrenergic receptors in CNS | Drowsiness; dry mouth; postural hypotension |
| NURSING IMPLICATIONS: Instruct client to take same time each day; avoid sudden position changes; report: mental depression, swelling of feet, paleness or cold feeling in fingertips or toes, vivid dreams or nightmares |
| Guanadrel (Hylorel)—PO 5 mg twice daily (range: 20–75 mg/day) | Moderate to severe hypertension | Prevents release of norepinephrine in response to sympathetic stimulation | Confusion; fainting; fatigue; diarrhea; orthostatic hypotension; dizziness |
| NURSING IMPLICATIONS: Give with diuretics to minimize tolerance and fluid retention; weigh twice weekly; fewer side effects after 8 wk of therapy |
| Guanethidine SO4 (Ismelin)—PO 10–50 mg daily in divided doses | Severe to moderately severe hypertension | Blocks norepinephrine at postganglionic synapses | Orthostatic hypotension; diarrhea; inhibition of ejaculation |
| NURSING IMPLICATIONS: Postural hypotension is marked in the morning, accentuated by hot weather, alcohol, and exercise; teach to rise slowly, with assistance |
| Guanfacine hydrochloride (Tenex)—PO 1 mg daily to maximum dose of 3 mg/day | Hypertension, in combination with thiazide-like diuretics | Centrally acting alpha-adrenergic receptor agonist | Drowsiness; weakness; dizziness; dry mouth; constipation; impotence |
| NURSING IMPLICATIONS: Warn client not to drive or perform activities requiring alertness; take at bedtime to minimize sedation; monitor BP and pulse |
| Hydralazine HCl (Apresoline)—PO 10–50 mg 4 times daily | Moderate hypertension | Dilates peripheral blood vessels, increases renal blood flow | Palpitations, tachycardia, angina pectoris, tremors; depression |
| NURSING IMPLICATIONS: Encourage moderation in exercise and identification of stressful stimuli |
| Obstetric use: preeclampsia, eclampsia | Relaxes peripheral blood vessels (opens vascular bed—physiological dehydration) | Headache, heart palpitation; gastric irritation; coronary insufficiency; edema; chills, fever; severe depression |
| NURSING IMPLICATIONS: Side rails up; must not stand without assistance; may be given with diuretics; observe carefully; IM route only; monitor BP; IV for severe hypertension and preeclampsia; in pregnancy, must not decrease arterial pressure too much or too rapidly; otherwise, will jeopardize uteroplacental perfusion |
| Lisinopril (Prinivil)—PO 10 mg/day, up to 20–40 mg daily or twice daily | Hypertension; heart failure; post-MI | Inhibits angiotensin-converting enzyme; alters hemodynamics without reflex tachycardia | Headache, fatigue, hypotension; cough, rash; ↑ BUN and creatinine |
| NURSING IMPLICATIONS: Notify physician if sudden drop in BP with supine positioning 1–5 hr after initial drug dose. Check BP before dose to determine 24-hr control |
| Methyldopa (Aldomet)—PO 500 mg–2 gm in divided doses | Severe to moderately severe hypertension | Severe to moderately severe hypertension | Initial drowsiness, depression with feelings of unreality, edema, jaundice, dry mouth |
| NURSING IMPLICATIONS: Contraindicated in acute and chronic liver disease; encourage not to drive car if drowsy |
| Minoxidil (Loniten)—PO 5 mg/day (range: 10–40 mg/day) | Severe hypertension; end-stage organ failure | Relaxes vascular smooth muscle | ECG changes; tachycardia; Na+, water retention; hypertrichosis |
| NURSING IMPLICATIONS: Depilatory cream may minimize increased hair growth; report resting pulse increase more than 20 beats/min; caution client to change positions slowly |
| Phentolamine hydrochloride (Regitine)—PO 50 mg 4–6 doses daily; IV, IM, local 5–10 mg, diluted in minimum 10 mL normal saline | Prevents dermal necrosis; hypertensive crisis; pheochromocytoma | Blocks alpha-adrenergic receptors | Weakness, dizziness, orthostatic hypotension; nausea, vomiting, abdominal pain |
| NURSING IMPLICATIONS: When giving parenterally, client should be supine; monitor for overdosage (precipitous drop in BP); do not give with epinephrine |
| Prazosin (Minipress)—PO 6–15 mg 2 or 3 times daily | Mild to moderate hypertension | Dilates arteries and veins by blocking postsynaptic alpha1-adrenergic receptors | Dizziness, headache, weakness, palpitations; orthostatic hypotension with first dose |
| NURSING IMPLICATIONS: Monitor: I&O, VS, and weight at beginning of therapy; teach client/family to check BP at least weekly; need to comply with other interventions (weight reduction, diet, smoking cessation, exercise) |
| Reserpine (Serpasil)—PO 0.25 mg daily | Mild to moderate hypertension | Depletes catecholamines and decreases peripheral vasoconstriction, heart rate, and BP | Depression; nasal stuffiness; increased gastric secretions; rash, pruritus |
| NURSING IMPLICATIONS: Watch for signs of mental depression; closely monitor pulse rates of clients also receiving digitalis; avoid alcohol |
| Obstetric use: Preeclampsia-eclampsia | CNS-depressant tranquilizer; sedation is major effect; decreases neural transmission to nerves; decreases tone in blood vessels | Low level of toxicity; weight gain; diarrhea; allergic reactions—dry mouth, itching, skin eruptions |
| NURSING IMPLICATIONS: Side rails up; must not stand up without assistance; observe carefully; monitor BP |
| Timolol (Timoptic)—PO 20–40 mg/day; ophthalmic 1 gtt 1–2 times/day | Hypertension, migraine, glaucoma | Blocks stimulation of myocardial (beta1) and pulmonary/vascular (beta2) receptors | Fatigue, weakness; depression; insomnia; peripheral vasoconstriction; diarrhea, nausea, vomiting |
| NURSING IMPLICATIONS: Check VS and evidence of heart failure; do not take if pulse <50; avoid OTC cold remedies, coffee, tea, and cola |