Lardizabal, Rafael Joseph P.

11/21/20
NDA4

CKD

DRUG NAME MECHANISM OF ACTION NURSING RESPONSIBILITIES

Generic Name Selectively blocks binding of -If patient has known or suspected
Candesartan angiotensin (AT) II to AT1 receptor hypovolemia and/or salt depletion such as
sites in many tissues, including may occur with prolonged diuretic therapy,
Brand Name vascular smooth muscle and adrenal dietary salt restriction, dialysis, diarrhea or
Biopress glands. This inhibits vasoconstrictive vomiting, expect to provide treatment, such as
and aldosterone-secreting effects of I.V. normal saline solution, as prescribed, to
Classification AT II, which reduces blood pressure correct it before starting candesartan.
Angiotensin II receptor Continue to monitor blood pressure
antagonist Antihypertensive throughout candesartan therapy, especially
after a dosage increase.
Dose: 8-32 mg daily -Monitor patient closely during major surgery
and anesthesia because candesartan
Route: PO increases risk of hypotension by blocking
renin-angiotensin system. •Watch for elevated
BUN and serum creatinine levels, especially if
patient has heart failure or impaired renal
function; drug may cause acute renal failure.
Report significant or persistent increases
immediately.
If blood pressure isn’t controlled with
candesartan alone, expect to give a diuretic,
such as hydrochlorothiazide, as prescribed.
 DRUG NAME MECHANISM OF ACTION
Generic Name May act in a manner that resembles
Hydralazine organic nitrates and sodium
nitroprusside, except that hydralazine is
Brand Name selective for arteries. It exerts a direct
Apresoline vasodilating effect on vascular smooth
muscle interferes with calcium
Classification movement in vascular smooth muscle
Phthalazine derivative , by altering cellular calcium metabolism
Antihypertensive, vasodilator dilates arteries, not veins, which
minimizes orthostatic hypotension and
Dose: 40 mg increases cardiac output and cerebral
blood flow causes reflex autonomic
Route: PO response that increases heart rate,
cardiac output, and left ventricular
ejection fraction has a positive inotropic
effect on the heart.
NURSING RESPONSIBILITIES
-Monitor CBC, lupus erythematosus cell
preparation, and ANA titer before therapy and
periodically as appropriate during long-term
treatment. •Anticipate that drug may change color
in solution. Consult pharmacist if color changes.
-Be aware that hydralazine may change color
when exposed to a metal filter.
-Give tablets with food to increase bioavailability.
-Monitor blood pressure and pulse rate regularly
and weigh patient daily during therapy.
-Check blood pressure with patient in lying, sitting,
and standing positions, and watch for signs of
orthostatic hypotension. Expect orthostatic
hypotension to be most common in the morning,
during hot weather, and with exercise.
 DRUG NAME MECHANISM OF ACTION
Generic Name By inhibiting angiotensin-converting
Captopril enzyme, captopril prevents
conversion of angiotensin I to
Brand Name angiotensin II, a potent
Capoten vasoconstrictor that also stimulates
Classification the adrenal cortex to secrete
ACE inhibitor , Antihypertensive aldosterone. Inhibiting aldosterone
Pregnancy category: D increases sodium and water
excretion, reducing blood pressure.
Dose: 25mg May inhibit renal and vascular
production of angiotensin II.
Route: PO Decreases serum angiotensin II
level and increases renin activity.
This decreases aldosterone
secretion, slightly increasing serum
potassium level and fluid loss.
decreases vascular tone and blood
pressure
NURSING RESPONSIBILITIES
-Closely monitor patient’s blood pressure,
especially when therapy starts and dosage
increases. Keep patient supine if hypotension
occurs.
-Monitor patient’s blood pressure and
electrolytes routinely if patient is receiving
other drugs that also affect the
reninangiotensin system because
hypotension and hyperkalemia may occur.
-Monitor renal function tests for signs of
nephrotic syndrome, such as proteinuria and
increased BUN and serum creatinine levels.
Also watch for such renal evidence as
oliguria, polyuria, and urinary frequency or
other signs of impaired renal function,
especially in patients who are receiving other
drugs that also affect the renin-angiotensin
system.
-Monitor WBC regularly, as ordered,
especially if patient has collagen vascular
disease or renal disease.