Ch.

12: Drugs That Affect

Urine Output

Diuretics
! The primary therapeutic goal of a diuretic use is

to reduce edema
! TYPES:
! Natriuretic Diuretics
! Loop Diuretics
! Potassium-Sparing Diuretics
! Thiazide Diuretics

! Osmotic Diuretics
! Carbonic Anhydrase Diuretics

DIURETICS: Loop
Diuretics
! Acts on the Loop of Henle- inhibiting Na

reabsorption
! Used to treat hypertension and CHF, renal

insufficiency
! Side Effects: Dehydration, Hypokalemia/natremia
! Nursing Indications: monitor VS, monitor output and

check potassium & sodium labs

! Adverse reaction: ototoxic & hyperglycemia
! Example: Furesomide (Lasix); Bumetanide (Bumex)

Rev. April 2006

DIURETICS: Potassium
Sparing
! Example: Spironolactone (Aldactone)
! Useful as a antihypertensive
! Side Effects: hyperkalemia, hyponatremia,

postural hypotension,
! Nursing indications: Check potassium labs,
! Adverse reaction: cardiac arrhythmias,

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DIURETICS: THIAZIDE
o Treatment of hypertension
o Works at distal convoluted tubule
o Nursing Assessment: assess for allergy to
Sulfonamides; decrease electrolytes (<Na & K),
postural hypotension
o Example: Hydrochlorothiazide [HCTZ](HydroDIURIL)

DIURETICS: Osmotic
!

Prophylaxis against renal dysfunction, Reduces

ICP, decreases IOP, Promotes excretion of toxic
substances

! Side Effects: headaches, edema, CHF, fluid and

electrolyte imbalance
! Nursing Indications: check labs
! Sample: Mannitol (Osmitrol)

Rev. April 2006

DIURETICS: Carbonic
Anhydrase
Proximal convoluted tubules
Treats Glaucoma
Example:
Acetazolamide (Diamox)
Methazolamide (Neptazane)

Overactive Bladder
! Overactive bladder (OAB) incontrollable

spasm of bladder muscle (detrusor)

causing urgency & incontinence
! Urinary Antispasmodic: Sample-

Oxybutynin (Ditropan)
! Adverse reaction: anuria, dysuria, edema
! Nursing consideration: assess BP & HR,

baseline weight, risk for heatstroke

Benign Prostatic Hyperplasia

! Androgen (testosterone) promotes prostate cell

growth & activity resulting in BPH

! Nursing assessment: Lab test- prostate specific

antigen (>PSA), monitor for orthostatic

hypotension
! Sample: Finasteride (Proscar)

Critical Thinking
If your patient develop severe diuresis, what would
you do?

Check vital signs.

Monitor urine output, via graduated cylinder
Assess alert and orientation x4
Assess capillary refill on extremities (digits), signs of
cyanosis at lip area
Determine adequate perfusion by looking at the mean
arterial pressure (MAP) calculated as systolic plus
diastolic (x2) divided by 2.
Hold the medication while you inform the MD of
assessment

Ch. 13: Drugs for

Hypertension

Pathophysiology
Arteriosclerosis- hardening of the
arterial walls
Atherosclerosis- plaques are
formed inside the wall of the
arteries
Cardiomegaly: enlarged
heart
Types of hypertension:
Primary- no known
cause
Secondary- caused by
other disease & drugs
that affect blood pressure

INTRODUCTION HEART

Antihypertensive

Nursing considerations:
check BP & HR Q4-8 hrs
Assess for Orthostatic hypotension:
Changes in 3 minutes- SBP <20mmHg from

sitting to standing; HR>20BPM

Take it as prescribed
Health teaching: controls HTN not cure
Balance diet & exercise

Antihypertensive
! Antihypertensive: Used to prevent or control

high blood pressure.

! There are sub classifications or families that

function as antihypertensive (p. 228):

! Diuretics
! ACE Inhibitors
! Angiotensin II receptor antagonists
! Calcium channel blockers
! Beta blockers
! Alpha-beta blockers
! Central-acting adrenergic agents
! Direct vasodilators

Antihypertensives

Rev. April 2006

Critical Thinking

If your patient develop

hypotension, an expected
outcome when giving antihypertensive medication, what
would you do?

BETA-ADRENERGIC
BLOCKING AGENTS
Rev. April 2006

Beta blockers block the affects

of epinephrine (adrenaline) on
the heart

Classified as cardioselective and noncardioselective

Rev. April 2006

Rev. April 2006

Calcium Channel Blocking

Agents
Medications ending in - pine
Blocks calcium ions
Sample:
Amlodipine (Norvasc)
Nifedipine (procardia)
Nicardipine (Cardene)

Rev. April 2006

Calcium Channel Blockers

! Side effect: hypotension, constitpation, nausea,

headache, dizziness, light headedness, gingival

hyperplasia; gynecomastia
! Adverse Effect: Stevens-Johnson syndrome

(eryhthema multiforme); severe bradycardia

<50BPM

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Rev. April 2006

Angiotensin II Receptor
Antagonists
! Blocks effect of angiotensin II (vasocontriction, sodium, &

water retention). Inactivated by the liver & excreted from

the body by the kidney.
! Side effects: hyperkalemia, hypotension, headache, dizziness
! Adverse reaction: hepatotoxicity, angioedema (severe edema

that may cause breathing problems)

! Nursing consideration: monitor electrolytes (K+), I & O,

ECG (increase T-waves= hyperkalemia).

! Sample: -tans Losartan (Cozaar), Valsartan (Diovan)

Alpha Blockers
! Blocks receptors in arteries and smooth muscles

resulting in relaxation of muscle, increase blood flow,

& lowering BP.
! Interacts with phosphodiesterase type 5 inhibitors such

as sildenafil (Viagra)- used for erectile dysfunctioncausing severe hypotension

! Side effect: dizziness, drowsiness, headache, orthostatic

hypotension & runny nose

! Adverse reaction: sycope, dyspnea, irregular heart

rhythm
! Sample: -zosin Doxazosin (Cardura)

Alpha-Beta Blockers
Combined effect of alpha & beta blockers: relax
blood vessels & slows HR
Side effect: weakness, hypotension, diarrhea,
hyperglycemia, & impotence
Adverse reaction: cardiac dysrhythmias
Nursing consideration: assess patient with
diabetes
Sample: Carvedilol (Coreg)

Central- Acting Adrenergic

Stimulate central nervous system receptors to
decrease constriction of blood vessels, which leads to
dilation (widening) of arteries, and to lower blood
pressure.
Side effect: drowsiness, dry mouth, nasal congestion
Adverse reaction: myocarditis secondary to allergic
reaction to methyldopa (rare)
Nursing consideration: mental monitoring, VS & weight
Sample:
Methyldopa (Aldomet)- pregnancy category B
(safe) PO. Treatment for PIH
Clonidine (catapres)- topical route

Vasodilators
! Used to treat peripheral blood vessel disease,

coronary artery disease and hypertension.

They increase size of blood vessels resulting
in increased blood flow and decreased vessel
resistance.
! Used to treat PVD, CAD & HTN
! Increase size of blood vessels resulting in
increased blood flow & decreased vessel
resistance.
! Sample:
! Hydralazine (Apresoline)
! Nitroglycerin (many brand names)

Vasodilators
! Nursing consideration: Nitroglycerin
! Wear gloves when applying (topical)
! P. 257 Figure 14-6

! Nitroglycerin tab: 3X every 5-10 mins only

! Rotate & clean site
! Remove old patch;
! Have a drug-free time- lose effectiveness in

24 hrs; tablet is light sensitive (colored

bottled)

Ch. 14: Drugs for Heart

Failure

INTRODUCTION HEART
Ejection fraction:
normal 50%-70%

Preload versus afterload

Heart Failure
Left Sided Heart Failure
u C- coughing &

dyspnea
u H- Hemoptysis
u O- Orthopnea
u P- Pulmonary

Right Sided Heart Failure

u H- Hematomegaly
u E-Edema
u A- Ascites
u D- Distended neck

veins

congestion
Systolic left Heart Failure- heart contraction is weak
Diastolic left heart failure- ventricle not able to relax

Compensatory Mechanism for

Heart Failure
! Sympathetic Nervous

System: release of
epinephrine &
norepinephrine
! Renin-angiotensin

system (RAS):
angiotensin II
(increase afterload) &
aldosterone
(increase preload)

Heart Failure
! Nursing consideration:
! Assess medical history including medication list
! Monitor VS & HR & baseline weight
! Assess for hypotension, dizziness, edema, weight
!
!
!
!

gain, dyspnea,
Encourage a balance diet & exercise (<Na, <Fat)
Health teaching: medication side effect & adverse
reaction
Take medication regularly & as prescribed
Report adverse reaction

Types of Drugs to treat HF

ACE Inhibitors
Beta blockers
Vasodilators
Cardiac Glycosides (Digoxin)
Diuretics
Human B-Type Natriuretic peptides
Positive Inotropes (Heart Pump Drugs)
Potassium & Magnesium

CARDIAC GLYCOSIDES
!

Cardiotonic: are used to stimulate(contract) and

regulate (relaxes) the heart.

! Effective for maintenance therapy for HF

! Side effects- bradycardia, vision disturbance:

yellow halos or light around objects

! Adverse effect: cardiac dysrhythmias

! Nursing consideration: Monitor HR/BP & ECG
! Example: Digoxin (Lanoxin)

Digoxin
! Nursing Considerations:
! must take heart rate for 60 seconds if the

heart rate falls below 60bpm hold the med

and call md
! Check potassium labs
! Check Digitalis labs
! >2ng/ml is considered toxic

Human BNP
Human B-Type Natriuretic Peptide- a hormone
produced by the heart ventricle
Action: increase water elimination & vasodilation
Route: IV
Sample: Nesiritide (Natrecor)
Side effect: hypotension, polyuria, confusion,
palpitations
Adverse reaction: apnea
Nursing consideration: check IV patency, HR &
BP, check lab test (BNP), monitor urine output

Positive Inotropes
Heart pump drugs:: muscle contraction &
relaxes blood vessels
Effect is dose related: low dose- increase kidney
perfusion; high dose- causes vasoconstriction=
>BP
Route: IV
Adverse reaction: ventricular dysrhythmias
Nursing consideration: check IV patency, HR &
BP, check lab test (BNP), monitor urine output
Sample: Dopamine (Intropin)

Potassium & Magnesium

! Supplements: Provide diet sources rich in K &

Mg (p. 265 Figure 14-3 & 14-4)

! Nursing consideration: monitor lab values (K

3.5-5.0 MEq/L) (Mg 1.2-2.1 MEq/L). Monitor

hyperkalemia (increase muscle activity) &
hypermagnesemia (neuromuscular depression)
! Monitor ECG, check IV patency, HR & BP, check

lab test (BNP), monitor urine output

! Potassium- not given IV push

Ch. 17 Drugs That Affect

Blood Clotting

ANTICOAGULANTS
! Anticoagulants:

They increase the time it takes

blood to coagulate.

! Labs: PTT/PTT/INR
! Example:
! Heparin (heparin)
! Warfarin (Coumadin)
!
Clopidogrel (Plavix)
!
Lovenox (Enoxaparin)- administered SQ
! Side effects: rash and potential for hemorrhage.

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