DRUG STUDY

BETA BLOCKERS
ACTION:
 Beta blockers, also known as beta-adrenergic blocking agents, are medications that
reduce your blood pressure.
 Beta blockers work by blocking the effects of the hormone epinephrine, also known
as adrenaline.
 Beta blockers cause your heart to beat more slowly and with less force, which lowers
blood pressure.
 Beta blockers also help open up your veins and arteries to improve blood flow.
INDICATIONS:
 Hypertension
 Angina
 Cardiac arrhythmia
 Congestive heart failure
 Myocardial infarction
 Glaucoma
 Migraine prophylaxis
 Symptomatic control (tachycardia, tremor) in anxiety and hyperthyroidism
 Essential tremor
 Phaeochromocytoma, in conjunction with α-blocker
CONTRAINDICATIONS:
 DIABETES
 ASTHMA
 PARTIAL HEART BLOCK
 SLOW HEART RATE
INTERACTIONS:
 Anti-arrhythmic, for managing irregular heartbeats
 Anti-hypertensive, which lower blood pressure
 Antipsychotics, for treating severe mental health problems
 Clonidine, for treating high blood pressure and migraine
 Mefloquine, to treat or prevent malaria
ADVERSE EFFECT:
Beta blockers may cause:
 Diarrhea
 Stomach cramps
 Nausea
 Vomiting
Other important side effects include:
 Rash
 Blurred vision
 Disorientation
 Insomnia
  Hair loss
 Weakness
 Muscle cramps
 Fatigue
Central nervous system effects of beta blockers include:
 Headache
 Depression
 Confusion
 Dizziness
Nightmares
 Hallucinations
Other serious side effects of beta blockers include:
 Toxic epidermal necrolysis
 Raynaud's phenomenon
 Lupus erythematosus
 Bronchospasm
 Serious allergic reactions
 Erythema multiform
 Steven Johnson Syndrome
 Toxic epidermal necrolysis
NURSING CONSIDERATION:

Before administering beta-blockers

 Check for allergies

 Know what other drugs the patient is receiving including over the counter (OTC) and
herbs. Do any of them have the same “effect” as the beta-blocker?
 Know why the patient is receiving the drug
 Obtain current BP and apical pulse rate; if below 90 systolic or 60 beats per
minute(BPM) hold the drug and notify the health care provider (HCP). Check your
institution’s policy, some say hold below 50 BPM

After administering beta-blockers

 Observe for intended effect

 Monitor for side effects, especially orthostatic hypotension
 Monitor older patient for mental confusion or changes in LOC which may indicate an
overdose
 Diabetics are not usually given beta-blockers because they can Effect the blood
glucose level and because the drugs will mask the cardiovascular effects of hypoglycemia
such as tachycardia, mild tremors and diaphoresis. If your patient is a diabetic and on a beta-
blocker monitor closely for signs of hypoglycemia unique to the patient and monitor blood
glucose frequently
 Patients with COPD (including asthma) should be monitored closely for respiratory
issues such as wheezing and difficulty breathing. They should not be given nonselective beta-
blockers.

VASODILATION
ACTION:

 Direct vasodilators are used when the previous drugs

mentioned are not effective.
 These antihypertensive agents are reserved for severe
hypertension and hypertensive emergencies.

INDICATIONS:
  These drugs are only used for hypertension cases that do not
respond to other drug therapies.
 Nitroprusside is used in maintaining controlled hypotension during
surgery.
 Nitroprusside is administered intravenously; hydralazine is
available for oral, intravenous, and intramuscular use; and
minoxidil is available for oral use only.
THERAPEUTIC ACTION:
 These antihypertensive agents exert their effect by acting directly
on smooth muscles. Consequently, there will be muscle relaxation
and vasodilation. Both of these will cause drop in blood pressure.
CONTRAINDICATIONS:
 Allergy to direct vasodilators. Prevent severe hypersensitivity reactions.
 Cerebral insufficiency. Can be exacerbated by drug’s action to cause sudden
drop in blood pressure.
 Peripheral vascular disease, CAD, heart failure, tachycardia. These conditions
can be exacerbated by sudden drop in blood pressure.
 Pregnancy and lactation. Can cause potential adverse effects to the fetus and
should not be used unless the benefit to the mother clearly outweighs the risk
to the fetus. The drug can enter the breast milk and can cause potential adverse
effects to the neonate. If needed by lactating mothers, another method of
feeding is instituted.

DRUG INTERACTION:
  Each drug in this group act differently on the body so each drug
should be checked for potential drug-to-drug and drug-to-food
interactions.

ADVERSE EFFECT:
 CNS: headache, dizziness, anxiety
 CV: reflex tachycardia, heart failure, edema, chest pain
 GI: nausea, vomiting, GI upset
 EENT: rash, lesions (e.g. minoxidil is associated with abnormal hair growth.)
 Nitroprusside is metabolized into cyanide so it can cause cyanide toxicity
characterized by dyspnea, ataxia, loss of consciousness, distant heart sounds,
and dilated pupil.
 Nitroprusside suppresses iodine uptake which leads to development of
hypothyroidism.

NURSING CONSIDERATION:
 Assess for the mentioned contraindications to this drug (e.g. drug
allergy, CAD, cerebral insufficiency 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, and
serum electrolyte to assess patient’s response to therapy.

CALCIUM CHANNEL BLOCKERS

ACTION:
 Calcium-channel blockers as antihypertensive agents decrease
blood pressure, cardiac workload, and myocardial consumption of
oxygen.
 Since these drugs can significantly decrease cardiac workload, they
are effective in treatment of angina.
INDICATIONS:
 Like ACE inhibitors and ARBs, they can also be used alone for
treatment of hypertension or in combination with other
antihypertensive agents.
 Extended-release preparations are usually indicated for
hypertensions in adults.
 Children: calcium-channel blockers is the drug group that is first
considered in cases of hypertension in this age group that needs
drug therapy.
 Adults: these drugs are not allowed during pregnancy.
 Older adults: are more susceptible to drug toxicity because of
underlying conditions that would interfere with metabolism and
 excretion of drug. Renal and hepatic function should always be
monitored.
CONTRAINDICATIONS:
 Allergy to calcium-channel blockers. Prevent severe hypersensitivity
reactions.
 Heart block (sick sinus syndrome). Can be exacerbated by
conduction-slowing effect of the drug.
 Renal and hepatic impairment. Can alter metabolism and excretion
of drugs which can increase the risk for toxicity.
 Pregnancy and lactation. Can cause potential adverse effects to the
fetus and should not be used unless the benefit to the mother
clearly outweighs the risk to the fetus. It is not clear whether this
drug can enter breast milk so another method of feeding is
implemented for lactating mothers who are taking this drug.

INTERACTION:
 Increased serum level and toxicity of cyclosporine if taken with
diltiazem.
 Grapefruit juice can increase serum level and toxicity of calcium-
channel blockers.
ADVERSE EFFECT:

 CNS: headache, dizziness, light-headedness, fatigue

 CV: hypotension, bradycardia, peripheral edema, heart block
 GI: nausea, hepatic injury
 EENT: rash, skin flushing
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.
ACE INHIBITORS
ACTION:
 Angiotensin-converting enzymes inhibitors are antihypertensive
agents that act in the lungs to prevent the conversion of
angiotensin I into angiotensin II, which is a potent vasoconstrictor.
THERAPEUTIC ACTION:
 By preventing the production of angiotensin II which is a potent
vasoconstrictor and a stimulator of aldosterone release, blood
 pressure is decreased with resultant loss of serum sodium and fluid
but with a slight increase in serum potassium.

INDICATIONS:
 Primarily indicated for hypertension and can be used alone or in
combination with other drugs.
 Aside from its indication in treating hypertension, it is also
combined with diuretics and digoxin in the treatment of heart
failure and left ventricular dysfunction. The resultant effect is
decreased in peripheral resistance and blood volume leading to
decreased cardiac workload.
 It is also approved for treatment of diabetic nephropathy, in which
the renal artery is being damaged by diabetes. It is thought that
decreased in stimulation of angiotensin receptors in the kidney will
slow down the damage in the renal artery.
 Children: safety and efficacy of ACE inhibitors has not been
established in this age group.
 Adults: ACE inhibitors are not allowed during pregnancy.
 Older adults: are more susceptible to drug toxicity because of
underlying conditions that would interfere with metabolism and
excretion of drug. Renal and hepatic function should always be
monitored.

CONTRAINDICATIONS:
 Allergy to ACE inhibitors. Prevent severe hypersensitivity reactions.
 Renal impairment. Decreased renal blood flow effect of these drugs
can exacerbate renal impairment.
 Heart failure. Changes in hemodynamics caused by these drugs can
exacerbate heart failure.
 Hyponatremia and hypovolemia. Can be exacerbated by the
therapeutic effects of the drug.
 Pregnancy and lactation. Can cause potential adverse effects to the
fetus and can decrease milk production. Pregnant women are
advised to use barrier type of contraceptives while taking this drug.
INTERACTION:
 Allopurinol: increased risk for hypersensitivity
 NSAIDs: increased risk for decreased antihypertensive effects
ADVERSE EFFECT:
 GI: irritations, ulcer, constipation, liver injury
 GU: renal insufficiency, renal failure, proteinuria
 CV: reflex tachycardia, chest pain, heart failure, cardiac arrhythmias
 EENT: rash, alopecia, dermatitis, photosensitivity
 Captopril is associated with sometimes-fatal pancytopenia, cough,
and GI distress.
NURSING CONSIDERATION:
 Assess for the mentioned contraindications to this 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.
ANGIOTENSIN II RECEPTOR BLOCKER
ACTION:
 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.
THERAPEUTIC ACTION:
 The main action is to block the blood pressure raising effect of the renin-
angiotensin-aldosterone system.
INDICATIONS:
 Like ACE inhibitors, they can also be used alone for treatment of
hypertension or in combination with other antihypertensive agents.
 Utilized in treatment of heart failure for patients who do not
respond to ACE inhibitors.
 By blocking the effects of angiotensin receptors in vascular
endothelium, these drugs are able to slow down the progress of
renal disease in patients with type 2 diabetes and hypertension.
 Children: safety and efficacy of ARBs has not been established in
this age group.
 Adults: ARBs are not allowed during pregnancy.
 Older adults: are more susceptible to drug toxicity because of
underlying conditions that would interfere with metabolism and
excretion of drug. Renal and hepatic function should always be
monitored.
CONTRAINDICATION:
 Allergy to ARBs. Prevent severe hypersensitivity reactions.
 Renal and hepatic impairment. Can alter metabolism and excretion
of drugs which can increase the risk for toxicity.
 Hypovolemia. Can be exacerbated by the drug’s action on blocking
important life-saving compensatory mechanisms.
 Pregnancy and lactation. Can cause potential adverse effects to the
fetus and potential termination of pregnancy between second and
third trimester. It is still not known whether ARBs can enter breast
milk but it is generally not allowed in lactating women because of
potential adverse effects to the neonate.
INTERACTION:
 Phenobarbital, indomethacin, rifamycin: loss of effectiveness of
ARBs
 Ketoconazole, fluconazole, diltiazem: decreased antihypertensive
effects of ARBs
ADVERSE EFFECTS:
 CNS: headache, dizziness, syncope, weakness
 Respiratory: symptoms of upper respiratory tract infections (URTI),
cough
 GI: diarrhea, abdominal pain, nausea, dry mouth, tooth pain
 EENT: rash, alopecia, dry skin
NURSING CONSIDERATIONS:
 Assess for the mentioned contraindications to this drug (e.g. drug
allergy, hypovolemia, renal impairment, 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, and
serum electrolyte to assess patient’s response to therapy.

THIAZIDE
ACTION:
 Thiazide diuretics belong to a chemical class of drugs
called sulfonamides. Thiazide-like diuretics have different chemical
structure but work in the same mechanism as that of thiazide
diuretics.
 This is among the most commonly used class of diuretics.
THERAPEUTIC ACTION:
 It causes active pumping out of chloride from the cells lining the
ascending limb of Loop of Henle and distal tubule by blocking the
chloride pump. Since sodium passively moves with chloride to
 maintain electrical neutrality, both sodium and chloride are
excreted in the urine.
INDICATIONS:
 Considered to be a milder form of diuretics compared to loop
diuretics.
 First-line drugs for management of essential hypertension
 Children
 Has established pediatric dosing guidelines used for the treatment
of edema in heart defects and hepatorenal diseases; control of
hypertension in children.
 Effect of diuretics may be abrupt in children because of their rapid
metabolism so caution is exercised by careful monitoring of serum
electrolyte changes and for evidence of fluid volume changes.
 Adults
 Are more likely to use diuretics on long-term basis and should be
educated on warning signs of fluid volume changes that need
prompt medical attention.
 They should be instructed to weigh themselves daily to monitor for
fluid retention or sudden fluid loss.
 Conditions that may aggravate fluid loss like vomiting, diarrhea, and
profuse sweating should be emphasized to them because these
may change the need for diuretics.
 Use of diuretics to influence fluid shifts in pregnant patients is not
appropriate. However, it should not be stopped if indicated for a
specific medical cause provided that they are made aware of the
possible effects to the fetus. Lactating women should switch to an
alternative method of feeding as this drug may have potential effect
to the baby.
 Older adults
 Have medical conditions where thiazide diuretics and thiazide-like
diuretics are usually indicated.
 The possibility of older adult patients having renal and hepatic
impairments requires health care team to be cautious of the use of
this drug.
 The lowest dose possible is started initially and it is titrated slowly
based on patient’s response.
 Frequent monitoring of serum electrolytes, activity level, and
dietary intake is a must.

CONTRAINDICATIONS:
 Allergy to loop diuretics. Prevent severe hypersensitivity reactions.
 Fluid and electrolyte imbalances. Can be potentiated by the
changes in fluid and electrolyte levels caused by diuretics.
 Severe renal failure, anuria. May prevent diuretics from working;
can precipitate crisis stage due to blood flow changes brought
about by diuretics.
 Systemic lupus erythematosus (SLE). Can precipitate renal failure
because the disease already causes changes in glomerular
filtration.
 Glucose tolerance abnormalities and diabetes mellitus. Worsened
by glucose-elevating effect of some diuretics
 Gout. Already reflects abnormality in tubular reabsorption and
secretion.
 Liver disease. Could interfere with drug metabolism and lead to
drug toxicity.
 Bipolar disorder. Can be exacerbated by calcium changes brought
about by the use of this drug.
 Pregnancy, lactation. Can cause potential adverse effects to the
fetus and baby. Routine use of this drug in pregnancy is not
appropriate and should be used only when there is underlying
pathological conditions. For lactating women, an alternative
method of feeding should be instituted.

INTERACTION:
 Cholestyramine or colestipol: decreased absorption of diuretics;
must be taken separated by at least 2 hours.
 Digoxin: increased risk for digoxin toxicity because of changes in
serum potassium levels
 Quinidine: increased risk for quinidine toxicity
 Antidiabetic agents: decreased effectivity of antidiabetics
 Lithium: increased risk for lithium toxicity
ADVERSE EFFECT:
 CNS: weakness
 CV: hypotension, arrhythmias
 GI: GI upset
 GU: hypokalemia (can precipitate hyperglycemia), hypercalcemia,
hyper-uremia, slightly-alkalinized urine (can lead to bladder
infections)
NURSING CONSIDERATIONS:
 Check blood urea nitrogen and creatinine levels regularly; if they're
increased, notify the health care practitioner.
 Monitor uric acid levels and assess your patient for signs and symptoms
of gout.
 Give thiazides in the morning to prevent nocturia, and keep a urinal or
commode at the bedside.