Microsoft word - medication management_2012.doc

Drug Classes
ƒ Angiotensin-II receptor blockers (ARBs) Side Effects/Monitoring
¾ Help the body get rid of excess sodium (salt) and • May decrease the body’s supply of Potassium. water by allowing more to be passed into the urine o Watch for symptoms such as weakness, leg by the kidneys. This reduces the amount of fluid in the bloodstream leading to lower pressure. ¾ Usually taken once or twice a day – or as directed o Dietary changes or a potassium supplement may be suggested by the physician to help Unless otherwise directed, try not to take med too late in the evening so as not to be awakened during o Also, the physician may change the drug to a Potassium-sparing diuretic. This may decrease the amount of potassium lost in the urine. 3 basic types of diuretics that work in different parts
Increases urination. Try not to take too late in the of the kidney:
• Thiazide diuretics: Hydrochlorothiazide (HCTZ),
Chlorthalidone (Hygroton), Clorothiazide (Diuril), • Because of the change in blood volume, blood sugar Indapamide (Lozol), Metolazone (Zaroxolyn) levels may increase. Notify the physician if this is • Loop diuretics: Furosemide (Lasix), Bumetanide
• Prolonged use may trigger an attack in someone • Potassium-sparing diuretics: Spironolactone
(Aldactone), Amiloride (Midamor), Triamterene • A small percentage of men may experience erectile • Combinations diuretics are also available:
• Try to take Metolazone (Zaroxolyn) about 30 minutes Triamterene + HCTZ (Maxzide, Dyazide), Amiloride+ BEFORE a dose of a loop diuretic (Lasix, Bumex, HCTZ (Moduretic), Spironolactone + HCTZ Demadex). This will increase the amount of fluid Drug Class: Angiotensin Converting Enzyme (ACE) Inhibitors Side Effects/Monitoring
¾ Angiotensin is a chemical that causes the arteries • Watch for a chronic dry or hacking cough. If this throughout the body to become more narrow – becomes severe or a nuisance, notify the These medications help to prevent the production of Angiotensin by blocking the enzyme that is needed for its conversion to an active form.This in turn helps the blood vessels relax and open up, which helps to lower ¾ These are usually taken once or twice a day, or as • Women who are pregnant or considering ¾ The progression of kidney disease or dysfunction due to pregnacy should see their physician immediately. high blood pressure or diabetes may be slowed. These drugs could potentially harm the fetus. Medications in this class include:
Benazepril (Lotensin), Moexipril (Univasc), Captopril
(Capoten), Perindopril (Aceon), Enalapril (Vasotec), Quinapril
(Accupril), Fosinopril (Monopril), Ramipril (Altace), Lisinopril
(Prinivil, Zestril), Trandolapril (Mavik)
Notice the generic names of these medications end Drug Class: Angiotensin-II Recptor Blockers (ARBs) Side Effects/Monitoring
¾ These drugs are somewhat similar to ACE • Chronic dry or hacking cough – but not as prevalent ¾ ARBs block the effects of Angiotensin on the body, a chemical which causes the arteries to become narrow. Angiotensin needs a receptor (like a “key fits into a lock”) in order to constrict blood vessels. • Women who are pregnant or considering pregnancy, should notify their physician immediately. These ARBs block these receptors, resulting in blood vessels staying relaxed and open. This helps to ¾ SO– Whereas ACE inhibitors help prevent Medications in this class include:
Angiotensin from becoming active, ARBs help block Candesartan (Atacand), Losartan (Cozaar), Eprosartan the receptors so that however much Angiotensin is (Teveten), Telmisartan (Micardis), Irbesartan (Avapro), ¾ The progression of kidney disease or dysfunction due to high blood pressure or diabetes may slowed. Notice that the generic names for these drugs end with the letters “SARTAN” Side Effects/Monitoring
¾ Beta Blockers interfere with specific receptors in the These medications reduce the heart rate, reduce the heart’s workload (strength of contractions), and reduce the output of blood (stoke volume). All of • Tiredness (“washed-out” feeling) these actions help to lower blood pressure and ¾ Beta blockers may also be useful in patients with heart failure, who have had a heart attack, or have • May affect blood sugar and response to insulin. ¾ These medications are usually taken once or twice a day or as directed by a physician. Dosing is • Irregular heart rhythms – notify physician usually started low, then increased as tolerated. • Consult physician if you are pregnant or considering Medications in this class include:
• Do not suddenly stop beta blockers or skip a number Acebutolol (Sectral), Metoprolol tartrate (Lopressor), of doses. Can result in heart racing, elevated blood Atenolol (Tenormin), Metoprolol succinate (Toprol XL), Betaxolol (Kerlone), Penbutolol (Levatol), Bisoprolol • Beta blockers may not be indicated for patients with (Zebeta), Pindolol (Visken), Carteolol (Cartrol), emphysema or COPD – discuss usage with Propranolol (Inderal), Carvedilol (Coreg), Sotalol (Betapace), Nadolol (Corgard), Timolol (Blocadren), Nebivolol (Bystolic), Labetolol (Trandate, Normodyne) –has both beta blocker & alpha blocker effects Notice that the generic names for these drugs end with Side Effects/Monitoring
¾ Renin is an enzyme produced in the kidneys that starts a chain of chemical steps which increase blood pressure.This chain reaction leads to the ¾ Swelling in legs or feet. If severe or nuisance, or This class of medication helps to block the occurs anywhere else in the body, contact the production of Renin. This is turn helps to reduce ¾ Use with caution in patients who already have ¾ Do not use if pregnant or considering pregnancy. Medications in this class include:
May result in harm to the fetus. Consult the Side Effects/Monitoring
¾ Help decrease the amount blood vessels can • Avoid grapefruit juice while on these medications. The levels of drug in the body may increase and The vessels narrow when calcium flows through calcium channels in the muscle cells within the arteries. This causes blood pressure to increase. ¾ The medication helps to block calcium entry into these channels allowing the vessels to widen. • Headache (although may be used for migraines) ¾ These effects lower blood pressure and heart rate. ¾ Usually taken once to three times a day – depending on formulation of the tablet/capsule or as • Monitor for changes in heart rhythm – notify ¾ Some drugs in this class may also be used to help
Medications in this class include:
Amlodipine (Norvasc), Felodipine (Plendil), Isradipine
(DynaCirc), Nicardipine (Cardene), Nifedipine (Procardia),
Nisoldipine (Sular), Diltiazem (Cardizem, Tiazac, Cartia),
Verapamil (Calan, Isoptin, Verelan)
Note that most of the generic names end in the letters “IPINE” –EXCEPT for Diltiazem and Verapamil Side Effects/Monitoring
¾ Reduces the resistance within arteries by blocking alpha receptors. This relaxes the muscle tone in the walls of the blood vessels and helps to lower blood • Rapid drop in blood pressure upon standing up ¾ May also be used in men to help with symptoms (orthostatic hypotension). May be directed to take medication at night to “sleep through” this side effect. • Men: this class of medication not usually indicated if Medications in this class include:
taking drugs for erectile dysfunction (Viagra, Cialis, Doxazosin (Cardura), Prazosin (Minipres), Terazosin (Hytrin), Labetolol (Normadyne, Trandate) –has both
Drug Class: Central Agonists
Side Effects/Monitoring
¾ Central agonists help to decrease the ability of the These medications follow a different pathway than • Dry mouth, constipation, blurred vision ¾ By decreasing constriction in the blood vessels, the blood pressure within the vessels is decreased. ¾ May be taken once or multiple times a day–as • May produce a greater drop in blood pressure when standing or walking, or feel faint. If this persists or is • Do not stop these medications suddenly because Medications in this class include:
Clonidine (Catapres), Guanfacine (Tenex), Methyldopa • Methyldopa may be considered for pregnancy because the adverse effects are infrequent for the • Clonidine is available in a once-a-week patch. There are different dosages and absorption through the skin may be variable in different patients. Side Effects/Monitoring
¾ These drugs act on small arteries through direct effects on the muscle in the walls of the arteries. This causes the muscles in the walls of the arteries to relax, allowing the vessels to dilate or widen. • Swelling (especially around the eyes) ¾ Therefore, blood flows easier through the vessels ¾ Usually taken once or multiple times a day – as Most side effects will usually go away after a few weeks. If they persist or are severe, inform the physician. Medications in this class include:
Hydralazine (Apresoline), Minoxidil (Loniten) Usually only used in resistant cases of severe high blood pressure or when kidney failure is present. Medications in this class include:
ACE Inhibitor + Diuretic
Beta Blocker + Diuretic
Central Agonist + Diuretic
ARBs + Diuretic
Refer to the previous slides on Candesartan + HCTZ (Atacand HCT) Methyldopa + HCTZ (Aldoril) Renin Antagonist + Diuretic
Calcium Channel Blocker
+ Renin Antagonist
Calcium Channel Blocker
+ ACE Inhibitor
Calcium Channel Blocker + ARBs
Calcium Channel Blocker
+ ARBs + Diuretic
Medications That Increase Blood Pressure Tricyclic antidepressants (Elavil, Asendin, others) Cyclosporine (Neoral, Sandimmune, others) ƒ Non-steroidal anti-inflammatory drugs (NSAIDS) such as adult aspirin, Advil, Motrin, and Aleve COX-2 inhibitors (Celebrex, Vioxx, Bextra) Well Aware/Hypertension/Handouts/Medication Management_2012

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