DRUGS AFFECTING BLOOD PRESSURE

A.2 Anti-hypotensive Medications

(3) Sympathomimetic Adrenegic Agonists/Vasopressors

DOPAMINE
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Category Sympathomimetic Adrenegic Agonists/Vasopressors

Route Intravenous
Generic Name Dopamine hydrochloride
Brand Name Intropin
Mechanism of Stimulates adrenergic and dopaminergic receptors. Effects are dose dependent.
Action Lower dosage stimulates dopaminergic receptors, causing renal vasodilation.
Increases renal blood flow, urinary flow, sodium excretion. Low to moderate
dosage (5–10 mcg/kg/ min): Increases myocardial contractility, stroke volume,
cardiac output. High dosage (greater than 10 mcg/kg/ min): Increases peripheral
resistance, vasoconstriction, B/P.
Indications (2)  Effects of DOPamine are dose dependent.
 Titrate to desired response. Doses greater than 20 mcg/kg/min may not
have beneficial effect on BP and may increase risk of tachyarrhythmias.

Contraindications Hypersensitivity to dopamine, sulphites.

(2) Pheochromocytoma, ventricular fibrillation. Uncorrected tachyarrhythmias.
Cautions: Ischemic heart disease, occlusive vascular disease, hypovolemia,
Adverse Effects Cardiovascular: Ventricular arrhythmia, atrial fibrillation (at very high doses),
(2) ectopic beats, tachycardia, anginal pain, palpitation, cardiac conduction
abnormalities, widened QRS complex, bradycardia, hypotension, hypertension,
vasoconstriction.
Respiratory: Dyspnea
Gastrointestinal: Nausea, vomiting
Metabolic/nutritional: Azotemia
Central nervous system: Headache, anxiety
Endocrine: Piloerection
Ocular: Increased intraocular pressure; dilated pupils
Nursing Continuously monitor for cardiac arrhythmias.
Interventions (4) Measure urinary output frequently. If extravasation occurs, immediately infiltrate
affected tissue with 10–15 mL 0.9% NaCl solution containing 5–10 mg
 phentolamine mesylate.
Monitor B/P, heart rate, respirations q15min during administration (more often if
indicated).
Assess cardiac output, pulmonary wedge pressure, or central venous pressure
(CVP) frequently.
Assess peripheral circulation (palpate pulses, note color/temperature of
extremities).
Immediately notify physician of decreased urinary output, cardiac arrhythmias,
significant changes in B/P, heart rate, or failure to respond to increase or decrease
in infusion rate, decreased peripheral circulation (cold, pale, mottled extremities).
Taper dosage before discontinuing (abrupt cessation of therapy may result in
marked hypotension).
Be alert to excessive vasoconstriction (decreased urine output, increased heart
rate, arrhythmias, disproportionate increase in diastolic B/P, decrease in pulse
pressure); slow or temporarily stop infusion, notify physician. when infusion rate
exceeds 20 mcg/kg/min, monitor patient for excessive vasoconstriction and loss
of renal vasodilating effects.

Extra (1) Keep in mind that the drugs under sympathomimetic agents usually ends
with “INE”

EPINEPHRINE
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Category Sympathomimetic Adrenegic Agonists/Vasopressors

Route Intramuscular, Subcutaneous, Inhalation
Generic Name Epinephrine
Brand Name Adrenaline
Mechanism of Stimulates alpha-adrenergic receptors (vasoconstriction, pressor effects), beta1-
Action adrenergic receptors (cardiac stimulation), beta2-adrenergic receptors (bronchial
dilation, vasodilation). Therapeutic Effect: Relaxes smooth muscle of bronchial
tree, produces cardiac stimulation, dilates skeletal muscle vasculature.
Indications (2)  Anaphylaxis. Hypotension
 Cardiac Arrest
Contraindication Preexisting hypertension; occlusive vascular disease; angle-closure glaucoma
s (2) (eye drops); hypersensitivity; cardiac arrhythmias or tachycardia. When used in
addition to local anaesthetics: Procedures involving digits, ears, nose, penis or
scrotum
Adverse Effects CNS effects; GI disturbances; epigastric pain; CV disorders; difficulty in
(2) micturition with urinary retention; dyspnoea; hyperglycaemia; sweating;
 hypersalivation; weakness, tremors; coldness of extremities; hypokalaemia.
Gangrene, tissue necrosis and sloughing (extravasation) when used in addition to
local anaesthetics.

Eye drops: Severe smarting, blurred vision, photophobia; naso-lachrymal ducts

obstruction. Oedema, hyperaemia and inflammation of the eyes with repeated
administration
Nursing Monitor changes Assess lung Monitor ABGs. In cardiac arrest,
Interventions (4) of B/P, HR sounds for adhere to ACLS
rhonchi, protocols.
wheezing, rales

Extra (1) WARNING: Use extreme caution when calculating and preparing doses;
epinephrine is a very potent drug; small errors in dosage can cause serious
adverse effects. Double-check pediatric dosage.

NOREPINEPHRINE
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Category Sympathomimetic Adrenegic Agonists/Vasopressors

Route IV
Generic Name norepinephrine bitartrate
Brand Name Levophed
Mechanism of Stimulates beta1-adrenergic receptors, alpha-adrenergic receptors, increasing
Action contractility, heart rate and producing vasoconstriction. Therapeutic Effect:
Increases systemic B/P, coronary blood flow.
Indications (2)  Acute Hypotension Unresponsive to Fluid Volume Replacement.
Contraindication Hypersensitivity to norepinephrine.
s (2) Hypotension related to hypovolemia (except in emergency to maintain
coronary/cerebral perfusion until volume replaced), mesenteric/ peripheral
vascular thrombosis (unless it is lifesaving procedure).

Adverse Effects Extravasation may produce tissue necrosis, sloughing. Overdose manifested as
(2) severe hypertension with violent headache (may be first clinical sign of
overdose), arrhythmias, photophobia, retrosternal or pharyngeal pain, pallor,
 diaphoresis, vomiting. Hypotension may recur if plasma volume is not
maintained.

Nursing Assess ECG, B/P . Be alert to complaint of headache. IV flow rate. Assess for
Interventions (4) extravasation characterized by blanching of skin over vein, coolness color,
temperature of IV site extremity (pallor, cyanosis, mottling). nailbed capillary
refill. Monitor I&O; measure output hourly, report urine output less than 30
mL/hr. Once B/P parameter has been reached, IV infusion should not be restarted
unless systolic B/P falls below 90 mm Hg.

Extra (1) N-OTE FOR EXTRAVASATION O-OUTPUT AND INPUT MONITOR R-

ESTROSTERNAL ADVERSE EFFECT

B. Agents for treating Heart Failure

CARDIAC GLYCOSIDE

LANOXIN
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Category Cardiotonic (inotropic) drugs

Route PO AND IV
Generic Name digoxin
Brand Name LANOXIN
Mechanism of Inhibits sodium/potassium ATPase pump in myocardial cells. Promotes calcium
Action influx. Increases contractility.
Indications (2)  chronic atrial fibrillation, fetal tachycardia with or without hydrops;
supraventricular tachyarrhythmias
Contraindication Hypersensitivity to digoxin. Ventricular fibrillation. Cautions: Renal impairment,
s (2) sinus nodal disease, acute MI (within 6 mos), second- or third-degree heart block
(unless functioning pacemaker), concurrent use of strong inducers or inhibitors of
P-glycoprotein (e.g., cyclosporine), hyperthyroidism, hypothyroidism,
hypokalemia, hypocalcemia.
Adverse Effects GI disturbances (anorexia, nausea, vomiting), neurologic abnormalities
(2) (fatigue, headache, depression, weakness, drowsiness, confusion,
nightmares). Facial pain, personality change,ocular disturbances
(photophobia, light flashes, halos around bright objects, yellow or green
color perception) may occur. Sinus bradycardia, AV block, ventricular
arrhythmias noted

Nursing Assess apical pulse. If pulse is 60 or less/min (70 or less/min for children),
Interventions (4) withhold drug, contact physician. Blood samples are best taken 6–8 hrs after dose
or just before next dose Monitor pulse for bradycardia, ECG for arrhythmias for
1–2 hrs after administration, serum potassium, magnesium, calcium, renal
function. . Assess for GI disturbances, neurologic abnormalities (signs of
toxicity) q2–4h during loading dose (daily during maintenance).

Extra (1) D-EPRESSION ADVERSE EFFECT I-NHIBIT SODIUM/ POTASSIUM ATP

PUMP

Thrombolytic Agents
Alteplase
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Category Thrombolytic Agents

Route Iv and po
Generic Name Alteplase
Brand Name (Activase)
Mechanism of Binds to fibrin in a thrombus and converts entrapped plasminogen to plasmin,
Action initiating local fibrinolysis. Therapeutic Effect: Degrades fibrin clots, fibrinogen,
other plasma protein
Indications (2) Acute MI, Acute Pulmonary Emboli, Acute Ischemic Stroke, Central Venous
Catheter Clearance, Usual Neonatal Dosage

Contraindication Hypersensitivity to alteplase. Active internal bleeding, AV malformation or

s (2) aneurysm, bleeding diathesis CVA, intracranial neoplasm, intracranial or
intraspinal surgery or trauma, recent (within past 2 mos), severe uncontrolled
 hypertension, suspected aortic dissection.

Adverse Effects Severe internal hemorrhage, intracranial hemorrhage may occur.

(2) Lysis of coronary thrombi may produce atrial or ventricular arrhythmias or
stroke.

Nursing Assess for contraindications to therapy. Obtain baseline B/P, apical pulse. Record
Interventions (4) weight. Evaluate 12-lead ECG, cardiac enzymes, electrolytes. Assess Hct,
platelet count, thrombin time (TT), prothrombin time (PT), activated partial
thromboplastin time (aPTT), fibrinogen level before therapy is instituted. Type
And screen blood. Perform continuous cardiac monitoring for arrhythmia. Check
peripheral pulses, Monitor for chest pain relief and notify physician of
continuation or recurrence (note location, type, intensity). Assess for bleeding.

Extra (1) Keep in mind that the drugs under thrombolytic agents usually ends with
“ase”

Reteplase (Retavase)

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Category Thrombolytic Agents

Route Intravenous
Generic Name Reteplase
Brand Name (retavase)
Mechanism of Reteplase binds to fibrin rich clots via the fibronectin finger-like domain and the
Action Kringle 2 domain. The protease domain then cleaves the Arg/Val bond in
plasminogen to form plasmin. Plasmin in turn degrades the fibrin matrix of the
thrombus, thereby exerting its thrombolytic action.
Indications (2) For lysis of acute pulmonary emboli, intracoronary emboli, and management of
myocardial infarction. acute ST-elevation myocardial infarction (STEMI) to
reduce the risk of death and heart failure.
Contraindication Active internal bleeding, Recent stroke, Intracranial or intraspinal surgery or
s (2) serious head trauma within 3 months, Intracranial conditions thaT increase the
risk of bleeding (e.g. neoplasms, arteriovenous malformation, or aneurysms),
Bleeding diathesis and current severe uncontrolled hypertension

Adverse Effects Reperfusion arrhythmias, hypotension, Dizziness, fever, severe headache,

(2) Anemia, cholesterol embolization, GI/GU bleeding, intracranial hemorrhage,
Nausea, vomiting, Cardiac reinfarction, Cardiogenic shock, Muscle pain, Allergic
reaction, injection site reaction

Nursing  Watch for signs of bleeding. Be alert for signs of intracranial bleeds,
Interventions (4) including sudden severe headache, confusion, vomiting, paralysis,
numbness, speech problems, and visual disturbances. signs of recurrent
cardiac ischemia (chest pain, pain radiating into the arm or jaw, shortness
of breath, dizziness, sweating, anxiety) or recurrent peripheral arterial
thrombosis (pain, cramping, coldness, cyanosis in the affected limb)
Notify physician immediately if these signs occur. Assess blood pressure,
muscle of joint pain Assess injection site during and after IV
administration, and report signs of bleeding or phlebitis (local pain,
swelling, inflammation).

Extra (1) Keep in mind that the drugs under thrombolytic agents usually ends with
“ase”