Pharmacology: Exam #2
Anticoagulants
Mechanism of Action
● Inhibit the action or formation of clotting factors and prevent clot formation - inhibit
platelet aggregation/prevents platelet plugs
● Prevent (not dissolve) blood clots (ex. Heparin/ Lovenox/ Coumadin)
● No direct effect on a blood clot that is already formed (does not lyse)
● Used prophylactically to prevent clot formation (thrombus)/an embolus (dislodged
clot that travels
● MoA vary with drug (different points of clotting cascade)
○ Heparin and low molecular weight heparins
■ Turn off coagulation pathway and prevent clot formation
○ Warfarin (Coumadin)
● Prevention of Clot Formation Prevents: stroke, MI, DVT, pulmonary embolism
Adverse Effects
● Must observe bleeding sites on anticoagulants
● Nosebleeds, emesis (hemoccult test/guaiac test for bleeding), black + tarry stool, easily
bruised (petechiae)
● IM injections avoided because cannot stop bleeding after venipuncture
● Internal bleed → intracranial bleed or into joints
Nursing Indications/Implications
● Prevents clot formation in likely settings
○ MI, unstable angina, atrial fibrillation, indwelling devices (mechanical heart
valves), major orthopedic surgery
● Anticoagulant Candidates:
○ Previous blood clot → more prone to developing clots
○ Immobilized for long periods
○ Elderly/dehydrated → prone to hyper coagulation (sludgy blood)
○ Phlebitis or inflammation of the veins
■ Usually in the leg → “throw” a clot to lungs
○ Recovering from heart valve surgery
■ Clots stick to the new heart valve
● Avoid ASA / steroids (caution - side effect of GI ulcer) - interact/interfere many drugs
● Pregnant women avoid
● No straight edge razors (use electric) + soft bristle toothette (no hard)
● Direct pressure (gloved) on venipuncture site for 2x as long as usual (3-5 minutes)
○ Many of the heparinized patients may have PPTs done twice a day, initially and
then at least once a day)
Patient Education
● Importance of regular lab testing
● Measures to prevent bruising, bleeding or tissue injury + know abnormal bleed signs
● Wearing a medical alert bracelet
● Aware of foods high in vitamin K
○ Tomatoes, dark leafy green vegetables
● Consult physician before taking other meds or OTCs/herbals + let dentist/doctor know
before surgery/dental work (need to stop few days before)
Heparin:
Antidote: Protamine Sulfate (1 mg for every 100 units of Heparin) - check med book - on
standby if patient is receiving IV Heparin - dangerous!! (toxic/narrow therapeutic range, ↑ risk)
Routes
Never ORAL! (not absorbed well) - orders given in UNITS
IV: incompatible w/ a lot of drugs, run drips separate (x mix drug), continuous, short half-life
● IV bolus directly into vein → continuous IV infusion (gtt) by pump
● Must be on a calibrated infusion pump for IV (intermittent or continuous drip) - full
dose anticoagulation
● Pharmacy will mix the IV infusion mixture of so many units in a big IV bottle
○ Ex.: 20,000 units per 500 mL of IV solution→ 40 units per mL
■ You must calculate how many units are in one
● Order Ex. Int: 10,000 units sub Q now, followed by 5,000-10,000 units sub Q, Q6 hours
● Order Ex. Cont: Heparin IV gtt→ inject 5,000 units IV bolus now, then give 1000
units/hr continuous IV
SubQ: deep SubQ 1 ½-2 in from navel/fatty area (lower ab wall) + admin w/ tuberculin
syringe (precise calibrated syringe - small calibrations for tuberculin syringe)
● Small vials and dose on vials vary - 100 units/mL to 1000 units/mL to 20,000 units/mL
● Mini-dose Heparin = 5000 units, subQ, BID → often daily serum PTT times are not done
○ Ex. older hip surgery patient with smoking history
Mechanism of Action
● Prevents new clots but does not dissolve clots
● Interfering conversion of prothrombin → thrombin
● Open heart surgery, bypass machines, renal dialysis, DVT and pulm. embolism treatment
○ With bypass machine/renal dialysis, do it while blood filters through machine
■ MUST reverse with antidote before off bypass machine
● Given to evolving stroke patient if the stroke/CVA is caused by a blood clot not a bleed
Adverse Effects
● Bleeding - risk increases with ↑ dosages (localized/systemic) - any site int/ext. (esp. IV)
○ Risk increases with increased dosages
○ May be localized or systemic (easily bleed, take longer for patient to clot)
● Heparin induced thrombocytopenia → ↓ platelets, nausea, vomiting, abdominal cramps
Nursing Implications
● Assess patient history, med history and allergies + review contraindications/drug interact.
○ History of abnormal bleeding conditions
○ Check med book!
● Baseline vital signs, lab values (done daily to monitor coagulation effects - aPTT)
● IV doses are double checked with another nurse (double check calc!)
● Ensure that SubQ doses are given subcutaneously not IM
○ No umbilicus, abdominal incisions, open wound, tubes, stomas (within 2 inches)
○ Areas of deep subcutaneous fat and sites rotated on abdomen daily/every dose
○ Do not aspirate (pull back plunger when injecting) subcutaneous injections or
massage injection site → may cause hematoma formation/bruising
● IV doses given by bolus or IV infusions (anticoagulant effects seen immediately)
Monitored By:
● Anti-Xa lab test *monitor Heparin tracking for therapeutic dosing (PTT same purpose)*
● Activated partial thromboplastin times (aPTTs)/PTT lab tests
○ Sufficient Anticoagulation = PTT 1.5-2 times normal control value
■ Ex. if the patient is on a Heparin IV drip infusion and the control value is
30 seconds→ the client’s result should be 60 seconds
Low Molecular Weight Heparin
● Enoxaparin (Lovenox) and Dalteparin (Fragmin) - given SubQ
● More predictable anticoagulant response → does not require laboratory monitoring
● Similar to “mini-dose” heparin for immobilized/post surgical hip/knee joint replacements
Coumadin (Warfarin):
Antidote: Vitamin K (NOT Potassium)
Route
● Oral anticoagulant → always a pill (well absorbed in GI tract)
Mechanism of Action
● Interferes with clotting factors (inhibits Vit K synthesis in liver) → prevents new clots
○ Alcoholics have bleeding tendencies → lost ability to clot (x produce vit K)
Side Effects
● Assess sites for bleeding (GI, nose, skin, anus, urine, gums, vagina)
● Monitor this by:
○ Prothrombin Time (PT) or Protime
■ 2-2.5 times greater than the control value, if on Coumadin
○ INR (International Normalized Ratio)
■ 2-3.5 times greater than the normal value (more accurate than PT) ■ Takes longer for person to clot/person bleeds easily
○ If the patient’s lab value is 40 seconds (normal control value for the patient is
about 12 seconds) → what does this mean?
■ Patient is receiving too much Coumadin and is too anticoagulated → the
patient will bleed easily
Nursing Implications
● Patient history for allergies/meds + daily lab tests
● Patients often get drug for lifetime or several months (outpatient basis) - med bracelet
● Avoid bleeding episodes (use elec. razor) + drug interactions (change clotting times)
● Aware of foods high in vitamin K
● Takes 2-3 days to reach therapeutic level → half life is 36 hours
○ Patient will still be on IV heparin for those 2-3 days for blood levels of
coumadin to reach adequate levels (PT-INR levels)
■ Heparin has a very short half life → when infusion is stopped, it’s pretty
much gone out of the body
■ Monitor PT-INR regularly → keep follow up appointments
● Herbal products/meds have potential interactions → increased bleeding may occur
○ Capsicum pepper, garlic, ginger, gingko, ginseng, feverfew
Thrombolytic Drugs
Streptokinase, Urokinase, tPa (tissue Plasminogen activator)*, anisoylated
plasminogen-streptokinase activator complex (APSAC)* - new*
Mechanism of Action
● DISSOLVES and BREAKS DOWN already existing clots!!!
● Use for acute MI, arterial thrombosis, DVT, occlusion of shunts/catheeters, pulmonary
embolism, acute ischemic stroke - (evolving strokes caused by clot)
● Give within 6 hrs of S&S to prevent serious complications
Adverse Effects
● Bleeding (intracranial, internal, superficial), N/V/D, hypotension, cardiac dysrhythmias
(dangerous)
Nursing Implications
● Watch for peripheral bleeding
Cardiac Medications:
● Drugs affecting conduction system
● Drugs affecting circulation/blood supply
● Drugs having and indirect actions on pumping mechanisms
● Cardiac Meds should be taken during the waking hours! (6, 2, 10)
Cardiac Glycoside
Digoxin (Lanoxin):
Antidote: Digibind (binds the molecule in ECF → pulls away from the site of action)
Dosage
● 0.125-0.25 mg/day maintenance for adults
○ Often given loading dose or digitalizing dose
■ T ½ = 36 hours
■ Excreted primarily by kidneys
● Routes: oral (liquid/pills) or IV
Mechanism of Action
● Negative “chronotropic effect”
○ Works on conduction system to slow rate across AV node
○ Decreased HR during diastole
■ Allows for more left ventricle filling time
■ Coronary arteries perfuse heart better
● Positive inotropic effect → increases contractility of heart to perfuse body
● Indirect effect on kidney (increased heart function; therefore increased renal blood flow)
● Uses for congestive heart failure (CHF), atrial and supraventricular arrhythmias
○ CHF: left side → lungs; right side → rest of the body (such as peripheral edema)
Adverse Effects
● 7-20% of patients have clinical or EKG symptoms of digoxin toxicity
○ Anorexia, N/V, fatigue (mimicking flu)
○ Visual disturbances → yellow/green halos around light
○ Very slow or very rapid cardiac rate/bradycardia with PVC and tachycardia
■ EKG shows definite changes
○ Narrow therapeutic range before adverse reaction and symptom of toxicity
■ Usually notice toxicity by clinical symptoms
○ Toxicity most common in elderly and persons tendency toward low serum K+,
acid-base imbalance, hypoxemia
Nursing Implications
● Take on time (do not give if pt forgot to take)
● Check apical pulse for 1 full minute and document
○ Withhold if <60 bpm
● Use a syringe for accurate measures
● Check K+ levels (approx 1 hour before scheduled medication)
Vasodilators: Nitrates
Nitroglycerin:
● Other Nitrates - Isordil/Amyl Nitrate (inhaled)
Routes
Sublingual: tabs. can be taken prn for chest pain (0.4 mg or gr 1/150)
Skin Patches/Paste: topical, slow release, wear gloves, usually on a schedule
● Often removed from 9 am - 9 pm (3 day life span)
Inhalant
IV: continuous drips (gtts) - always on an IV pump
Mechanism of Action
● Dilation of blood vessels → increases lumen and opening of the blood vessel to
improve circulation away from the heart and decrease workload and decreases BP
○ However, if no peripheral resistance, blood pools in extremities
○ Decreases BP → reflex stimulation from increased rate of contraction
● Used for angina pectoris (decreases duration and intensity of the pain with more O2
supply to coronary arteries)
● Prophylactic use decreases frequency of anginal attacks + prevent/delay onset of MI
Side Effects
● Flushing (from dilation of vessels to skin)
● Throbbing headache (vascular congestion of cerebral bid vessels)
● N/V, fainting, dizziness (decreased BP)
● Reflex tachycardia (decreased pressure in aortic/carotid sinuses - compensatory)
● Postural hypotension (vasodilation - interferes with compensatory mechanism)
Nursing Implications
● Protect from light → brown bottle
● “Pop rock” effect
● Taken lying down (SL)
● Measure skin patch in inches not mg
● Take BP before administration + withhold if <90 systolic
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Diuretics
All diuretics → avoid high salt foods/liquids
Kidney: nephron, glomerulus, PCT, loop of Henle, DCT
Filtration: glomerulus
Reabsorption: active transport, active tubular secretion, renin-angiotensin loop
MoA: H2O, Na+, Cl-, increase urine output, adverse impact hypovolemia, acid-base,
electrolytes
Loop Diuretics:
Furosemide (Lasix)
● 20-40 mg BID or 160-320 mg (very high dose) - doses vary with patients
● 20-80 mg twice daily if po
● IV: 20-40 mg for acute fluid retention (heart failure) + do not mix with other IV meds
● Always giving before too late in evening → prevent urinating all night long
Bumetanide (Bumex)
● Similar to Lasix (use if resistant)
Mechanism of Action
● Ascending loop of henle → high ceiling (more effective)
● Blocks Na+ and Cl- reabsorption
● Uses → pts with ♥ failure, CHF, pts with excess fluid
● Gets rid of fluid → decreases circulation blood volume, decreased BP, reduced
peripheral vascular resistance
Side Effects
● Hypokalemia (loss of K+ with H2O and Na+ ) → hearing loss, dry skin + mucous
membranes, higher blood viscosity, hyperuricemia (gout in toe joints), weakness,
dizziness, decreased BP, reduced PVR, hypovolemia, acid-base imbalances
● Dehydration → weights daily/weekly
● Ototoxicity → use caution if taking with aminoglycosides
● Hypotension → monitor BP
● Hypokalemia → labs with K+ replacement (3.5-5) - check labs daily/be on K+ supplem.
● Hyperuricemia → monitor uric acid
● Hyperglycemia → monitor blood glucose
Nursing Implications/Teachings
● Serum K+ monitoring, teach S&S low K+, teach foods with K+
○ Caution with K+ depleting steroids
● Empty foley before IV administration (know if IV worked well) - assess outputs
● Avoid high salt foods
● Take on schedule + take weekly weights/daily (if IV + watching fluid balance)
● Oral care because pt cannot have water
● Frequent labs for uric acid buildup
● Blood viscous → prone to clots
Thiazide Diuretics:
Hydrodiuril/Hydrochlorothiazide
Zaroxolyn (Metolazone)
Mechanism of Action
● Works in distal convoluted tubule - inhibit reabsorption
● Direct arterial vasodilator → used for high BP
● Uses → pts with CHF, HTN, liver cirrhosis, and edema
Side Effects
● Dizziness, headache, impotence, decreased libido, hypokalemia, hyperglycemia, gout,
S/S of fluid loss, HA
● Hyperuricemia → monitor uric acid
● Hyperglycemia → monitor blood glucose
Nursing Implications
● Similar to loop diuretics
● No extra fluids
● Always check for K+ levels and ensure pt is sufficiently replacing K+ losses
○ When H2O goes out, so does Na+ and K+
● Causes blood sugar levels to rise with diabetes mellitus
Potassium-Sparing Diuretics:
Spironolactone (Aldactone)
Triaterene (Dyrenium)
Mechanism of Action
● Blocks aldosterone receptors → inhibits aldosterone (synthetic steroid)
● Interferes with Na+/K+ exchange
● Uses → pts with HTN
● Given PO → watch for too high of K+ (especially if renal problems of present)
Side Effects
● Hyperkalemia - never combine with K+ supplements/other K+ sparing diuretics &
caution with Na+ substitutes
● High BP
Nursing Implications
● Avoid high K+ food & watch for salt substitutes
○ Monitor K+ levels and watch for endocrine changes (teach S&S)
Antidysrhythmics
Arrhythmias vs Dysrhythmias
Rhythm Problems: lack of O2 + electrolyte problems + blocked conductions
● Rates are compatible with tissue oxygenation
● Lots of rhythm disturbances but some are not life-threatening
● Rhythms can sometimes originate in sinus node, atria or AV junction
● When all the higher pacemakers fail → rhythms start in the ventricles
● There are fast rhythms or very slow HR that interfere with perfusion at times
○ Results in inadequate perfusion + poor oxygenation
● Treatment for slow rhythms → atropine
● Treatment for fast atrial rhythms → Ca++ channel blockers
● Treatment for ventricular rhythms → quinidine, pronestyl, lidocaine
BP = CO x SVR
CO = HR x SV
CO = amount of blood ejected from the left ventricle (L/min - normal value 4-8 L/min)
Systemic Vascular Resistance = force (resistance) the left ventricle has to overcome to eject the
volume of blood
Stroke Volume = amount of blood ejected from the left ventricle in 1 contraction (mL/beat)
Quinidine:
Mechanism of Action
● Directly depresses automaticity and decreases conductivity
● Uses → ventricular rhythms, PVC, AFib
Side Effects
● Toxic dosage, NV, paresthesia (numbness and tingling), vertigo, visual disturbances
● GI and lupus
Nursing Implications
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Use quinaglute SR-time released
PO → give with meals
Rarely given parental
Check BP
Pronestyl:
● Oral (sustained/slow release)
Mechanism of Action
● Similar to quinidine
● Use → ventricular rhythms
Side Effects
● Decreased BP, lupus symptoms (fever, butterfly rash on cheeks, urinary retention)
Lidocaine:
● IV bolus followed by immediate drip infusion
○ IV push injection into IV tubing
○ IV continuous infusion on an infusion pump
○ Very effective in ICU/CCU settings/stepdown ICU
● Never oral (cannot take home)
● Short ½ life
Mechanism of Action
● Depresses automaticity of the ventricles (not contractility)
● For PVCs and ventricular arrhythmias → V-tach/ V-FIB
○ Usually given if V-tach is seen, immediate IV push bolus, followed by repeat
bolus around 15 min
■ Then started on continuous drip (up to 3-4 days)
● Numb areas in heart to eliminate extra heart sounds (S3, S4)
Side Effects
● Numbing, visual disturbances, paresthesia, seizures/convulsions, muscle twitching
● Toxicity - serum lidocaine blood drug levels
Atropine:
Mechanism of Action
● Increases heart rate at the SA node and blocks the vagus nerve
● Uses → only drug for bradycardia
Side Effects
● Dry mouth, urinary retention
● If dose is too low → paradoxical/inconsistent slowing of the HR
Nursing Implications
● Must find source of problem - pt might need pacemaker
● Monitor BP carefully
Amiodarone:
● Given IV or orally
Mechanism of Action
● Slow conduction through AV node with atrial fib, controlled V-tach and V-fib (like
Digoxin) - originally used for PVC’s
Anti-Hypertensive Medications
What is Hypertension?
Prehypertension: 120-139/80-89 mm Hg
Primary Hypertension: specific cause is unknown (essential or idiopathic)
Secondary Hypertension: most commonly caused by some other disease or condition
● If the cause of secondary condition is resolved→ BP usually returns to normal
● Common, asymptomatic (silent killer) - BP > 140/90 mm Hg
● Patients will be put on BP meds with mild to moderate hypertension
○ May be placed on one or several BP medications because they work on different
sites of action, lower doses may be indicated to reach desired effect
■ Several medications can offset side effects of another medication, but this
depends on the patient’s response to the medications
Alpha and Beta Sympathetic Nervous System Receptors (Adrenergic Receptors)
Alpha: located in peripheral arteries and veins - stimulates vasoconstriction
Beta 1: located primarily in heart - stimulates increased heart rate, increase AV node conduction,
increase myocardial contractility
Beta 2: located primarily on smooth muscle of bronchioles and blood vessels - stimulates
increased smooth muscle dilation → results in vasodilation of vessels and bronchioles
Common Side Effects of Beta Blockers, ACE Inhibitors and CCB
● Orthostatic hypotension, sedation, decreased renal perfusion ( ↓ urine output, wt gain),
decrease sexual performance, impaired ejaculation & gynecomastia (breast
enlargement in males)
Nursing Implications with Antihypertensive Medications
● Notify physician of unwanted side effects
● Do not stop suddenly or adjust rate doses
● Hold BP meds prior to dialysis (drop in BP after dialysis)
● Take baseline BP prior to giving med and HOLD if BP is < 90 mm Hg or 30 mm Hg
less than the pt’s normal (repeat in 10-20 min.)
● Spread out doses over the day (so evenly dosed i.e. 6am, 2pm, and 10 pm) or times that
work for the patient
● Don’t double up on missed doses - just take regular does at next time
● High BP reading it is important to take 3 separate readings and try non medical
interventions first if not a hypertensive crisis prior to giving medications
● Some patients monitor BP at home, but usually in cases of extreme hypertension,
usually only 1-2 times per week
● Often takes sev. weeks to full effect and pts may want to stop them
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Instruct pt to call HC provider if weird effects (usually can easily be switch to another)
Something for dry mouth (adrenergic effect)
When first started, often tired
Orthostatic hypertension
Calcium Channel Blockers (Calcium Antagonists):
Verapamil (Calan), Diltiazem (Cardizem SR), Nifedipine (Procardia)
Mechanism of Action
● Decreases BP and peripheral resistance
● Causes smooth muscle relaxation by blocking the binding of Ca+ to receptors →
blocks constriction and causes vasodilation
● Inhibits Ca+ influx to slow channels of myocardial and vascular smooth muscle cells
○ Decreases myocardial contractility and oxygen demand
● Dilates coronary arteries and arterioles
● Uses → angina, mild to moderate HTN, arrhythmias, atrial tachycardia
Side Effects
● Bradycardia, peripheral edema, hypotension
Nursing Implications
● Instruct patient not to bite or chew pill if time released
● Don’t take with grapefruit juice (increases bioavailability of drug)
● Not recommended to give sublingual route for treatment of hypertension
● Hypertensive crisis → verapamil poke with needle and give sublingual
○ Monitor BP and EKG if used for hypertensive crisis event
Beta-Adrenergic Blockers:
Propranolol (Inderal), Atenolol (Tenormin), Metoprolol (Lopressor, Toprol XL), Carvedilol
(Coreg)
Mechanism of Action
● Block the beta effect → decrease heart rate and CO
○ Beta receptor normally → increase HR, conduction, contractility + dilates vessels
● Uses → HTN, angina, MI, CHF, arrhythmia, cardiomyopathy, mitral valve prolapse,
migraine headache, endocrine disorders, psychiatric disorders
Side Effects
● Fatigue, sexual dysfunction, bronchoconstriction
● Endocrine: worsening of peripheral resistance to insulin (hyperglycemia), may cause
hypoglycemia by blocking catecholamine ability of glycogenolysis
● CNS: insomnia, depression, hallucination and dizziness
● CV: bradycardia, heart block
● GI: N/V/D, gastric pain, flatulence
Nursing Implications
● DO NOT give to pts with CHF (uncomp) or respiratory problems (blocks beta - ex.
COPD) → causes bronchoconstriction
● Educate about therapeutic effects/adverse effects
● Difficulty with compliance due to adverse fx - take as prescribed + never stop abruptly
○ Reduce gradually over 1-2 weeks
● Hold if <90 systolic and hold if < 60 bpm - check pulse and BP prior to giving/hospital
● Contraindicated for diabetes patients
● Drug interactions - need to assess other meds pt is taking so does not interfere
● Avoid anything that causes vasodilation (alcohol, caffeine, CNS stimulants, heat)
○ Alcohol can cause hypotension
● Change positions slowly to avoid dizziness
● May mask S/S of hypoglycemia or cause hyperglycemia
● Contact physician if experiencing: palpitations, chest pain, confusion, wt gain, shortness
of breath, excessive fatigue, dizziness and syncope
● Pt should report constipation or development of urinary hesitancy or bladder
distention, or nightmares
Alpha-Adrenergic Blockers:
Prazosin (Minipress)
Mechanism of Action
● Acts in the periphery and blocks the alpha receptors (vasoconstriction stimulation) →
vasodilation, decreased BP, constriction of pupil, suppressed ejaculation
Side Effects
● Contraindicated in pts with drug allergies, peripheral vascular disease, renal disease,
coronary artery disease, peptic ulcer, sepsis
● Main side effect → dizziness
Nursing Implications
● Instruct patient to get up slowly to avoid orthostatic hypotension
● First dose may be given at night to help with lightheadedness and dizziness
● Needs to stay on drug ~ 3 weeks to see full effect
● Avoid alcohol, caffeine, OTC meds
ACE Inhibitors:
Captopril (Capoten), Enalapril (Vasotec)
Mechanism of Action
● Inhibits formation of angiotensin II (potent vasoconstrictor)
● Decreases aldosterone secretion
● Decreases BP
● Prevents the breakdown of bradykinin→ prevents formation of angiotensin II
Side Effects
● Decreases BP
Nursing Implications
● Non-compliance is an issue
○ Shortest half life → must be dosed more frequently
● Do not take if pregnant (detrimental effects on fetus)
● Must have normal renal function to be taking ACE inhibitors
Central Brainstem Action (Alpha Adrenergic Agonist):
Clonidine, Methyldopa
Mechanism of Action
● Stimulate the alpha 2 adrenergic receptors centrally and inhibit the central
vasomotor centers (suppresses sympathetic action)
● Decrease sympathetic outflow to the heart, kidneys and peripheral vascular →
decreased peripheral vascular resistance, decreased BP and HR
Side Effects
● Orthostatic hypotension, tiredness, dry mouth
Nursing Implications
● May be given at night to avoid daytime sedation
● Do not double up on doses
● Take 3 separate readings
● Pt can monitor their own BP at home in extreme cases
● Pt should call HCP if strange side effects occur
Smooth Muscle Relaxers:
Hydralazine (Apresoline), Minoxidil
Mechanism of Action
● Vasodilation - primarily relaxes arteriolar smooth muscle