DRUG NURSING

ACTION INDICATION CONTRAINDICATION PHARMACOKINETICS ADVERSE EFFECTS

CLASSIFICATION RESPONSIBILITIES
Assess contraindication or
Antihypertensive Specific:  Used alone or as  Anuria, hypovolemia, Route: Oral  hyperkalemia cautions: known allergies to
Agents Drugs Ambrisentan is a part of renal artery stenosis, In healthy subjects,  atrial fibrillation these drugs; pregnancy or
Affecting the Renin- selective endothelin- combination renal failure, renal pharmacokinetic  vasculitis lactation; hepatic or renal
Angiotensin- A receptor therapy in impairment parameters are dose  ventricular disease; CV dysfunction;
Aldosterone System antagonist. treatment of  Asthma, penicillin proportional. Ambrisentan tachycardia hypertension; and hypovolemia.
Endothelin-1 (ET-1), adults with hypersensitivity, is highly bound to plasma  arrhythmia
(Renin Inhibitor) a potent autocrine hypertension. sulfonamide proteins (99%). It is exacerbation Assess for baseline status
and paracrine peptide hypersensitivity, metabolized by CYP3A, before beginning therapy and
 bradycardia
produced primarily thiazide diuretic CYP2C19, and uridine 5'- for any potential adverse
 pancreatitis
by vascular hypersensitivity diphosphate effects; these includes body
endothelial cells, glucuronosyltransferases  seizures temperature and weight; skin
Sample Drugs:  ACE-inhibitor induced
possesses powerful (UGTs) 1A9S, 2B7S, and  visual impairment color, lesions, and temperature;
angioedema,
 Aliskiren vasoconstrictor and 1A3S. Additionally, in  teratogenesis pulse, BP, baseline ECG, and
angioedema, Black
(Tekurna) mitogenic properties. patients, hereditary vitro data indicate that it is  angioedema perfusion; respiration and
Plasma ET-1 angioedema, surgery a substrate of Organic  anaphylactoid adventitious breath sounds.
concentrations are  Breast-feeding Anion Transport Protein reactions
elevated in patients  Aortic stenosis, (OATP) and P-  pulmonary edema
with pulmonary hyponatremia, glycoprotein (P-gp).  interstitial
arterial hypertension hypotension, Ambrisentan is eliminated nephritis
(PAH) and correlate orthostatic primarily by non-renal  azotemia
with increased mean hypotension, pathways; however,
right atrial pressure sympathectomy relative contributions of
and disease severity.  Angina, coronary artery metabolism and biliary.
disease, myocardial
infarction
 Biliary cirrhosis,
hepatic disease
 Heart failure
 Systemic lupus
erythematosus (SLE)

 Antihypertensive Agents Drugs
Affecting the Renin-
Angiotensin-Aldosterone System

(Renin Inhibitor)
Vasodilators for Pulmonary
Artery Hypertension
 DRUG NURSING
ACTION INDICATION CONTRAINDICATION PHARMACOKINETICS ADVERSE EFFECTS
CLASSIFICATION RESPONSIBILITIES
Assess contraindication or
Vasodilators for Specific:  Used for  Hepatic disease, Route: Oral  angioedema cautions: known allergies to
Pulmonary Artery Inhibits renin, leading pulmonary hepatitis Site of Metabolisn: Liver  teratogenesis these drugs; pregnancy or
Hypertension to decreased plasma arterial  Anemia Site of Excretion: Kidney  peripheral edema lactation; hepatic or renal
renin activity and hypertension  Geriatric, peripheral  anemia disease; CV dysfunction;
inhibiting the (PAH) edema  fluid retention hypertension; and hypovolemia.
conversion of  Pulmonary edema,  elevated hepatic
angiotensinogen to veno-occlusive disease Assess for baseline status
enzymes known
Sample Drugs: angiotensin I. This (VOD) before beginning therapy and
 jaundice known
inhibition of the RAS  Pulmonary fibrosis for any potential adverse
leads to decreased  hyperbilirubinemi effects; these includes body
 Ambrisentan  Pregnancy
BP, decreased a known temperature and weight; skin
(Letairis)  Breast-feeding
aldosterone release,  testicular atrophy color, lesions, and temperature;
 Contraception hypotension
and decreased sodium pulse, BP, baseline ECG, and
requirements,
reabsorption. perfusion; respiration and
infertility, pregnancy
adventitious breath sounds.
testing, reproductive
risk
 DRUG NURSING
ACTION INDICATION CONTRAINDICATION PHARMACOKINETICS ADVERSE EFFECTS
CLASSIFICATION RESPONSIBILITIES
Assess contraindication or
Specific:  Indicated for  Bosentan is Route: Oral  cirrhosis cautions: known allergies to
 Bosentan Bosentan is an pulmonary contraindicated in  hepatic failure these drugs; pregnancy or
(Tracleer) endothelin-receptor arterial patients who are It has a small distribution  hepatotoxicity lactation; hepatic or renal
antagonist. Bosentan hypertension in hypersensitive to volume (18 L) and is  Drug Reaction disease; CV dysfunction;
is a highly substituted ages 3 and older. bosentan or any of its highly bound (more than with Eosinophilia hypertension; and hypovolemia.
pyrimidine ingredients. 98%) to plasma proteins, and Systemic
derivative, with no Coadministration of mainly to albumin. Symptoms Assess for baseline status
chiral centers; it is cyclosporine A or Bosentan does not (DRESS) before beginning therapy and
chemically and glyburide is also penetrate into erythrocytes.  anaphylactoid for any potential adverse
pharmacologically contraindicated with It is extensively reactions effects; these includes body
related to the bosentan. metabolized to 3 temperature and weight; skin
 angioedema
parenteral agent  Hepatic disease, metabolites, one of which color, lesions, and temperature;
 teratogenesis
tezosentan. hepatitis, is pharmacologically active pulse, BP, baseline ECG, and
Endothelin-1 (ET-1) and may contribute about  Moderate perfusion; respiration and
hepatotoxicity,
is a potent 10% to 20% of the effects.  elevated hepatic adventitious breath sounds.
jaundice
endothelium-derived Total clearance after a enzymes
 Edema, heart failure,
peptide that has been single IV dose is  fluid retention
peripheral edema,
proposed to pulmonary edema, approximately 4 L/hour in  edema
contribute to the veno-occlusive disease patients with pulmonary  peripheral edema
pathogenesis of heart (VOD), ventricular arterial hypertension. Due  chest pain
failure and dysfunction to autoinduction, multiple  hypotension
pulmonary  Anemia dosing gradually leads to  palpitations
hypertension. ET-1  Geriatric plasma concentrations
has vasoconstrictive  Phenylketonuria which are 50% to 65% of
and mitogenic those seen after a single
 Pregnancy
properties. ET-1 dose. Steady-state is
 Breast-feeding
concentrations are reached within 3 to 5 days.
elevated in plasma  Contraception The terminal elimination
and lung tissue of requirements, half-life is about 5 hours.
patients with infertility, pregnancy Following hepatic
pulmonary arterial testing, reproductive metabolism, bosentan is
hypertension, risk eliminated by biliary
suggesting a excretion. Less than 3% of
pathogenic role for an administered oral dose
ET-1 in this disease. is recovered in the urine.
Sympathetic Nervous System
Drugs
(Beta-Blockers)
 DRUG NURSING
ACTION INDICATION CONTRAINDICATION PHARMACOKINETICS ADVERSE EFFECTS
CLASSIFICATION RESPONSIBILITIES
Assess contraindication or
Sympathetic Specific:  Treatment of  Beta-blocker Route: Oral  Severe cautions: known allergies to
Nervous System Beta-adrenergic hypertension in hypersensitivity,  bradycardia these drugs; pregnancy or
Drugs antagonists counter patients who do sulfonamide The effects of atenolol on  pancreatitis lactation; hepatic or renal
the effect of not respond to hypersensitivity, blood pressure do not  AV block disease; CV dysfunction;
sympathomimetic monotherapy. thiazide diuretic coincide with effects on  heart failure hypertension; and hypovolemia.
(Beta-Blockers) neurotransmitters hypersensitivity heart rate, nor does the
 bronchospasm
(i.e., catecholamines)  Anuria, renal disease, antihypertensive effect Assess for baseline status
 Stevens-Johnson
by competing for renal failure, renal exhibit a linear before beginning therapy and
syndrome
receptor sites. Similar impairment dose/pharmacodynamic for any potential adverse
to metoprolol, response. Atenolol is  exfoliative effects; these includes body
Sample Drugs:  Hypotension,
atenolol, in low distributed throughout the dermatitis temperature and weight; skin
hypovolemia,
doses, selectively body and into breast milk.  erythema color, lesions, and temperature;
 Atenolol orthostatic
blocks sympathetic It also crosses the placenta, multiforme pulse, BP, baseline ECG, and
hypotension,
stimulation mediated with fetal serum atenolol  toxic epidermal perfusion; respiration and
sympathectomy,
by beta1-adrenergic concentrations approaching necrolysis adventitious breath sounds.
syncope
receptors in the heart those of the mother. Unlike  periarteritis
 Abrupt discontinuation
and vascular smooth propranolol, atenolol is less  hemolytic anemia
 Depression
muscle. The lipid soluble and its  pancytopenia
 AV block, bradycardia,
pharmacodynamic cardiogenic shock, distribution into the CNS  aplastic anemia
consequences of this heart failure, via penetration of the  renal failure
activity include: pulmonary edema, sick blood-brain barrier is  interstitial
reduction of resting sinus syndrome, minimal. Atenolol is  azotemia known
heart rate and, ventricular dysfunction minimally bound to plasma  teratogenesis
subsequently, cardiac proteins, averaging only
 Cerebrovascular
output; reduction of 10%, which, along with it
disease
both systolic and low lipophilicity, may
diastolic blood explain some of its
pressure at rest and distribution characteristics.
with exercise; and The serum half-life of
possible reduction of atenolol in adults with
reflex orthostatic normal renal function is 6
hypotension. With —7 hours. Atenolol
higher doses (>100 undergoes little or no
mg/day), atenolol metabolism by the liver,
also competitively and the absorbed portion is
blocks beta2- eliminated primarily by
 adrenergic responses renal excretion. The rest of
in the bronchial and the dose is excreted via the
vascular smooth fecal route as unchanged
muscles. In addition, drug. Atenolol is removed
serum free fatty acid by hemodialysis.
concentrations are
decreased and
triglyceride levels
increased by atenolol.

DRUG NURSING
ACTION INDICATION CONTRAINDICATION PHARMACOKINETICS ADVERSE EFFECTS
CLASSIFICATION RESPONSIBILITIES
Assess contraindication or
Specific:  Treatment of  Abrupt discontinuation Route: Orally and  bradycardia cautions: known allergies to
 Betaxolol Actions that make hypertension.  Hyperthyroidism, ophthalmically  heart failure these drugs; pregnancy or
betaxolol useful in thyroid disease,  myocardial lactation; hepatic or renal
treating hypertension thyrotoxicosis It appears to be well infarction disease; CV dysfunction;
include a decrease in  AV block, bradycardia, distributed throughout the  arrhythmia hypertension; and hypovolemia.
heart rate at rest and cardiogenic shock, body but this has not been exacerbation
after exercise heart failure, fully characterized. The  thrombosis Assess for baseline status
(negative pheochromocytoma, drug is about 50% bound to before beginning therapy and
 AV block
chronotropic effect); sick sinus syndrome, plasma proteins, primarily for any potential adverse
 bronchospasm
a decrease in cardiac vasospastic angina, albumin, but also to alpha- effects; these includes body
output (negative 1-acid glycoprotein (AGP).  hyperkalemia temperature and weight; skin
ventricular dysfunction
inotropic effect); It crosses the placenta and  agranulocytosis color, lesions, and temperature;
 Diabetes mellitus
reduction of is distributed into breast  toxic epidermal pulse, BP, baseline ECG, and
 Acute bronchospasm, necrolysis
sympathetic outflow asthma, bronchitis, milk. Because of its lipid perfusion; respiration and
from the CNS; and solubility, betaxolol  keratitis adventitious breath sounds.
chronic obstructive
suppression of renin theoretically crosses into  visual impairment
pulmonary disease
release from the (COPD), emphysema, the CNS. Systemic
kidneys. Thus, like pulmonary disease betaxolol is extensively
other beta-blockers,  Surgery metabolized to at least five
betaxolol affects metabolites, most of which
 Dialysis, renal disease,
blood pressure via have no significant
renal failure, renal
 multiple mechanisms. impairment pharmacological activity
In general, beta- and are cleared by renal
blockers without processes. The
intrinsic hydroxylated metabolite,
sympathomimetic however, possesses
activity (ISA) exert approximately 50% of the
detrimental effects on beta-adrenergic blocking
LVH and the lipid activity of the parent drug.
profile, and cause Less than 15% is
sexual dysfunction. eliminated unchanged in
Betaxolol appears to the urine. The elimination
have little or no effect half-life is approximately
on serum lipid 15 hours. Small amounts
concentrations. are excreted in the feces
via the bile.

Sympathetic Nervous System

Drugs
 (Alpha1-Blockers)

DRUG NURSING
ACTION INDICATION CONTRAINDICATION PHARMACOKINETICS ADVERSE EFFECTS
CLASSIFICATION RESPONSIBILITIES
Assess contraindication or
Sympathetic Specific:  Treatment of  General Information Route: Oral Administration  visual impairment cautions: known allergies to
Nervous System hypertension.  Hypotension,  infarction these drugs; pregnancy or
Drugs Doxazosin orthostatic The primary hypotensive  bradycardia lactation; hepatic or renal
competitively inhibits hypotension, syncope effect is usually evident  stroke disease; CV dysfunction;
alpha-1-adrenergic  Hepatic disease from 2 hours onward, with  bronchospasm hypertension; and hypovolemia.
(Alpha1-Blockers) receptors in the  Pregnancy peak hypotensive effects
 edema
sympathetic nervous  Breast-feeding occurring in 5—6 hours. Assess for baseline status
 dyspnea
Sample Drug: system. Doxazosin  Ocular Surgery Antihypertensive effects of before beginning therapy and
causes peripheral a single dose of doxazosin  orthostatic for any potential adverse
 Priapism hypotension
 Doxazosin vasodilation, last approximately 24 effects; these includes body
 Geriatric  hypotension
reducing peripheral hours. The drug is temperature and weight; skin
vascular resistance extensively protein-bound  chest pain color, lesions, and temperature;
and blood pressure. It (98%). Although it appears  palpitations pulse, BP, baseline ECG, and
causes the blood to cross the placenta,  impotence perfusion; respiration and
pressure to decrease animal studies have not (erectile adventitious breath sounds.
in both the standing revealed evidence of drug- dysfunction)
and the supine induced fetal harm. It is not
positions. Standing known whether doxazosin
heart rates increase is distributed in the breast
 slightly, and the milk of humans, but studies
drug's effects on in rats suggest
blood pressure and accumulation in breast
heart rate are more milk does occur.
pronounced while the
patient is standing. Doxazosin is highly
Doxazosin also alters metabolized in the liver,
lipid metabolism, with the majority of an oral
decreasing the levels dose being eliminated via
of total cholesterol, the feces and the remainder
low-density (9%) excreted in the urine.
lipoprotein (LDL) Enterohepatic recycling is
cholesterol, and suggested by significant
triglycerides, and fecal elimination of drug
increasing the high- and secondary peaking of
density doxazosin plasma
lipoprotein/total concentrations. Elimination
cholesterol ratio. The is biphasic, and terminal
implications of these elimination half-life is
changes are not approximately 22 hours.
known. As an
antihypertensive,
doxazosin does not
worsen and may
decrease LVH, does
not worsen insulin
resistance, and exerts
mild to negligible
effects on sexual
dysfunction.

DRUG NURSING
ACTION INDICATION CONTRAINDICATION PHARMACOKINETICS ADVERSE EFFECTS
CLASSIFICATION RESPONSIBILITIES
 Assess contraindication or
Specific:  Treatment of  Angina, hypotension, Route: Oral Administration  pancreatitis cautions: known allergies to
 Prazosin hypertension. orthostatic  bradycardia these drugs; pregnancy or
Prazosin is a hypotension, syncope Prazosin is administered  vasculitis lactation; hepatic or renal
competitive  Pregnancy orally. Complete  palpitations disease; CV dysfunction;
antagonist at  Breast-feeding antihypertensive effects  depression hypertension; and hypovolemia.
postsynaptic alpha1-  Ocular surgery may not occur for 4—6
 edema
receptors, unlike  Priapism weeks. The drug distributes Assess for baseline status
 peripheral edema
phenoxybenzamine  Geriatric widely throughout the body before beginning therapy and
and phentolamine, tissues and is extensively  dyspnea for any potential adverse
which are nonspecific protein-bound (97%).  orthostatic effects; these includes body
alpha-receptor Prazosin is highly hypotension temperature and weight; skin
antagonists. By metabolized in the liver by  constipation color, lesions, and temperature;
sparing presynaptic demethylation and  blurred vision pulse, BP, baseline ECG, and
alpha2-receptors, conjugation, with the  hyperemia perfusion; respiration and
prazosin does not majority of an oral dose  hallucinations adventitious breath sounds.
activate being eliminated via biliary  sinus tachycardia
norepinephrine excretion (in the feces) and elevated hepatic
release and, in turn, the remainder excreted in enzymes
prazosin has a lower the urine. Four prazosin
incidence of reflex metabolites possess 10—
tachycardia than does 15% of the activity of the
either parent drug and may
phenoxybenzamine contribute to prazosin's
or phentolamine. antihypertensive effects.
Prazosin causes Antihypertensive effects
peripheral peak in 2—4 hours. The
vasodilation by plasma half-life of prazosin
selective, competitive is 2—4 hours, and the
inhibition of vascular duration of
postsynaptic alpha1- antihypertensive effects is
adrenergic receptors, less than 24 hours.
thus reducing
peripheral vascular
resistance and blood
pressure.Prazosin
reduces blood
pressure when
patients are in either
the supine or standing
positions, with more
dramatic effects on
diastolic blood
pressure. Since alpha-
receptors are
predominantly
located in the
peripheral, superficial
circulation, prazosin
is effective in the
treatment of
Raynaud's
phenomenon.