Niki Numamoto

Med-Surg 1
1.) Angiotensin Converting Enzyme (ACE) Inhibitors
Common names:
Generic Name: -pril
benazepril
captopril
enalapril
fosinopril
lisinopril
perindopril
quinapril
ramipril
trandolapril

Brand Name:
Lotensin
Capoten
Vasotec
Monopril
Prinivil, Zestril
Aceon
Accupril
Altace
Mavik

Mechanism of Action:
Angiotensin-converting enzyme inhibitors reduce the activity of the renin-angiotensinaldosterone system (RAAS) as the primary etiologic (causal) event in the development of
hypertension. ACE inhibitors block the conversion of angiotensin I to angiotensin II. They lower
arteriolar resistance and increase venous capacity; decrease cardiac output, cardiac index, stroke
work, and volume; lower resistance in blood vessels in the kidneys; and lead to increased
natriuresis (excretion of sodium in the urine).
Indications:
Hypertension and CHF
Common side effects:
Hypotension, cough, hyperkalemia, headache, dizziness, fatigue, nausea, and renal impairment
Nursing Considerations:
May produce a first-dose phenomenon, resulting in profound hypotension which may result in
syncope, DO not admin if pt is pregnant! Monitor Electrolytes esp potassium. Educate patient to
report dry cough immediately.
2.) Angiotensin II Receptor Blockers
Generic Name: -sartan
candesartan
eprosartan
irbesartan
losartan
olmesartan
telmisartan
valsartan

Brand Name:
Atacand
Teveten
Avapro
Cozaar
Benicar
Micardis
Diovan

Mechanism of Action:
ARBs are AT1-receptor antagonists; that is, they block the activation of angiotensin II AT1
receptors. Blockage of AT1 receptors directly causes vasodilation, reduces secretion of
vasopressin, and reduces production and secretion of aldosterone, among other actions. The
combined effect reduces blood pressure.
Indications:
Hypertension where the patient is intolerant of ACE inhibitor therapy
Common Side Effects:
Dizziness, headache, and/or hyperkalemia. Infrequently associated with therapy include: first
dose orthostatic hypotension, rash, diarrhea, dyspepsia, abnormal liver function, muscle
cramp, myalgia, back pain, insomnia, decreased hemoglobin levels, renal impairment,
pharyngitis, and/or nasal congestion.
Nursing Considerations:
Asses for s/s of angioedema (dyspnea, facial swelling, instruct pt to notify HCP if swelling
of face, eyes, lips or tongue occurs or if difficulty swallowing or breathing occurs. Educate
patient about need for compliance.
3.) Beta antagonist (Beta Blockers)
Generic Name: -olol
acebutolol
atenolol
betaxolol
bisoprolol
carvedilol
metoprolol
nadolol
penbutolol
pindolol
propanolol

Brand Name:
Sectral
Tenormin
Monocor
Coreg
Lopressor, Toprol
Corgard
Levatol
Inderal

Mechanism of Action:
Stimulation of 1 receptors by epinephrine and norepinephrine induces a positive
chronotropic and inotropic effect on the heart and increases cardiac conduction velocity and
automaticity. The primary antihypertensive mechanism of beta blockers is unclear, but may
involve reduction in cardiac output (due to negative chronotropic and inotropic effects). It
may also be due to reduction in renin release from the kidneys, and a central nervous system
effect to reduce sympathetic activity (for those beta blockers that do cross the bloodbrain
barrier, e.g. propranolol).

Indications:
Angina pectoris, Atrial fibrillation, Cardiac arrhythmias, Congestive Heart Failure,
Hypertension, cardiac myopathies etc.
Common side effects:
Orthostatic hypotension, nausea, diarrhea, bronchospasm, dyspnea, cold extremities,
exacerbation of Raynaud's syndrome, bradycardia, hypotension, heart failure, heart block,
fatigue, dizziness, alopecia (hair loss), abnormal vision, hallucinations, insomnia, nightmares,
sexual dysfunction, erectile dysfunction and/or alteration of glucose and lipid metabolism.
Nursing Considerations:
Monitor ECG, BP and pulse frequently, assess the pulse and BP before oal admin, hold if
pulse is below 60 beats/min or if pt is hypotensive. Do not crush or chew SR, safety under
age 6 has not been established, risk for dizziness and falls.
4.) Calcium Channel Blockers:
Generic Name: -dipine
amlodipine
felodipine
isradipine
nicardipine
nifedipine
diltiazem
nisoldipine
verapamil

Brand Name:
Norvasc
Plendil
Dynacirc
Cardene
Procardia XL, Adalat
Cardizem, Dilacor, Tiazac, Diltia XL
Sular
Isoptin, Calan, Veralan, Covera-HS

Mechanism of Action:
In the body's tissues, the concentration of calcium ions (Ca2+) outside of cells is normally
about ten-thousand-fold higher than the concentration inside of cells. Embedded in the
membrane of some cells are calcium channels. When these cells receive a certain signal, the
channels open, letting calcium rush into the cell. The resulting increase in intracellular
calcium has different effects in different types of cells. Calcium channel blockers prevent or
reduce the opening of these channels and thereby reduce these effects.
Indications:
Hypertension
Common side effects:
Vasodilation-headache, dizziness, peripheral edema and flushing. Immediate acting can
cause reflex tachycardia. Discontinue gradually, rarely can cause paradoxical increase in
chest pain possibly r/t hypotension of HF

Nursing Considerations:
do not admin if impending MI is suspected or within 2 weeks following an MI, do not crush
or chew. Educate patient on reflex tachycardia and orthostatic hypotension.
5.) Diuretics
Loop diuretics

Thiazide diuretics

Potassium Sparing diuretics

furosemide
bumetanide
torsemide
hydrochlorothiazide
methylclothiazide

Lasix
Bumex
Demadex
Microzide
Enduron

spironolactone
triamterene

Aldactone
Dyrenium

Also included are osmotics, low ceiling diuretics, xanthines, aquaretics and many others.
Mechanism of Action:
Chemically, diuretics are a diverse group of compounds that either stimulate or inhibit
various hormones that naturally occur in the body to regulate urine production by the
kidneys.
Indications:
treat heart failure, liver cirrhosis, hypertension, water poisoning, and certain kidney diseases
Common side effects:
Depending on diuretic being used ADRs include: hypovolemia, hypokalemia, hyperkalemia,
hyponatremia, metabolic alkalosis, metabolic acidosis, and hyperuricemia
Nursing Considerations:
Monitor for cardiac abnormalities, electrolytes. Note ABGs and supplements. Educate
patient about symptoms of electrolyte imbalance. Maintain hydration.
6.) Digoxin (Digitalis)
Mechanism of Action:
Digoxins primary mechanism of action involves inhibition of the sodium-potassium pump,
mainly in the myocardium. This inhibition inhibits sodium-calcium exchange, which
increases the intracellular calcium concentration that is available to the contractile proteins,
resulting in an increase in the force of myocardial contraction. The inhibition of the sodium
pump may also improve baroreceptor sensitivity in HF and may explain some of the neurohormonal effects of digoxin.

Indications:
Atrial fibrillation and atrial flutter with rapid ventricular response, not commonly used for
CHF anymore.
Common side effects:
Loss of appetite, nausea, vomiting and diarrhea as gastrointestinal motility increases. Other
common effects are blurred vision, visual disturbances (yellow-green halos and problems
with color perception), confusion, drowsiness, dizziness, insomnia, nightmares, agitation, and
depression.
Nursing considerations:
Monitor for therapeutic dosage range, report signs of toxicity: anorexia, blurred vision
(yellow halos). Teach patient how to take pulse, do not give if below 60 bpm.
References:
Common current heart drug names found from WebMD:
http://www.webmd.com/heart-disease/guide/heart-disease-calcium-channel-blocker-drugs
http://www.webmd.com/heart-disease/guide/beta-blocker-therapy
http://www.webmd.com/hypertension-high-blood-pressure/ace-inhibitors-for-high-bloodpressure
http://www.webmd.com/heart-disease/angiotensin-ii-receptor-blockers-arbs
http://www.webmd.com/hypertension-high-blood-pressure/diuretics-for-high-blood-pressure

Adams, M., Holland, N., & Urban, C. (2014). Drugs for Hypertension, Drugs for Heart Failure.
In Pharmacology for nurses: A pathophysiologic approach (4th ed., pp. 335-346). Upper
Saddle River: Pearson Education.