Risk factors

Modifiable risk factors include unhealthy diets (excessive salt consumption, a diet high in saturated fat and trans
fats, low intake of fruits and vegetables), physical inactivity, consumption of tobacco and alcohol, and being
overweight or obese.

non-modifiable risk factors include a family history of hypertension, age over 65 years and co-existing diseases
such as diabetes or kidney disease.

Treatment
Lifestyle changes can help lower high blood pressure. These include:

 eating a healthy, low-salt diet

 losing weight
 being physically active
 quitting tobacco.

If you have high blood pressure, your doctor may recommend one or more medicines. Your recommended blood
pressure goal may depend on what other health conditions you have.

Blood pressure goal is less than 130/80 if you have:

 cardiovascular disease (heart disease or stroke)

 diabetes (high blood sugar)
 chronic kidney disease
  high risk for cardiovascular disease.

For most people, the goal is to have a blood pressure less than 140/90.

There are several common blood pressure medicines:

 ACE inhibitors including enalapril and lisinopril relax blood vessels and prevent kidney damage.
 Angiotensin-2 receptor blockers (ARBs) including losartan and telmisartan relax blood vessels and prevent
kidney damage.
 Calcium channel blockers including amlodipine and felodipine relax blood vessels.
 Diuretics including hydrochlorothiazide and chlorthalidone eliminate extra water from the body, lowering
blood pressure.
 DRUG NAME DOSAGE/FREQUENCY INDICATION MECHANISM CONTRAINDICATION ADVERSE NURSING RESPONSIBILITIES
ROUTE OF ACTION REACTION
BRAND NAME: Adults: 1 to 2 mg/kg IV To prevent or Stimulates - Allergy to CNS: Antiemetic: Assess for
Reglan 30 minutes before reduce nausea motility of metoclopramide • Anxiety, dehydration (poor skin
chemotherapy; repeat and vomiting upper GI tract, - GI hemorrhage Drowsiness, turgor, dry mucous
METOCLOPRAMIDE every 2 hours for two from emetogenic increases lower - Mechanical dystonic membranes, longitudinal
HYDROCHLORIDE doses, then every 3 cancer esophageal obstruction or reactions, furrows in tongue). Assess
hours for three doses chemotherapy. sphincter tone, perforation fatigue, for nausea, vomiting,
Therapeutic class: and blocks Pheochromocytoma lassitude, abdominal distention, bowel
GI Stimulants dopamine - Epilepsy restlessness, sounds.
Adults: 10 to 20 mg IM To prevent or receptors at the seizures,
Pharmacologic near end of surgical reduce chemoreceptor Precaution suicidal
class: procedure postoperative trigger zone. - Previously ideation, Before:
Dopamine nausea and detected breast akathisia, - Observe 10 rights in drug
Antagonists vomiting. cancer confusion, administration.
Route: - Lactation depression, - Assess for allergy to
Adults and children older To facilitate small- PO - Pregnancy dizziness, metoclopramide.
than age 14: 10 mg IV as bowel intubation Onset: 30-60 - Fluid overload extrapyramidal - Assess for other
a single dose over 1 to 2 min - Renal impairment symptoms, contraindications.
minutes. Children age 6 Peak: 1-2 hr fever, - Keep diphenhydramine
to 14: 2.5 to 5 mg IV as a Duration: 1-2 hr hallucinations, injection readily available in
single dose slowly over 1 headache, case extrapyramidal
to 2 minutes. Children IV insomnia, reactions occur (50 mg IM).
younger than age 6: 0.1 Onset: 1-3 min tardive, - Have phentolamine readily
mg/kg IV as a single dose Peak: Unknown dyskinesia available in case of
slowly over 1 to 2 Duration: 1-2 hr hypertensive crisis.
minutes CV:
To aid in IM Bradycardia, During:
Adults: 10 mg IV as a radiologic exam Onset: 10-15 Supraventricular - Monitor for anxiety,
single dose over 1 to 2 min tachycardia, restlessness, extrapyramidal
minutes Peak: Unknown Hypotension, symptoms (EPS) during IV
Delayed gastric Duration: 1-2 hr Transient HTN, administration.
Adults: 10 mg PO 30 emptying Half-life: 4 to 6 HF Hydrofluoric - Monitor daily pattern of
minutes before each secondary to hours acid bowel activity, stool
 meal and at bedtime for diabetic GI: consistency.
mild symptoms. gastroparesis Bowel - Assess skin for rash.
Maximum daily dosage is disorders, - Monitor diabetic patients.
40 mg or Give 10 mg IM Diarrhea, - Evaluate for therapeutic
or by slow IV push over 1 Nausea response from gastroparesis
to 2 minutes 30 minutes GU: (nausea, vomiting, bloating).
before each meal and at Incontinence, - Monitor renal function, B/P,
bedtime for up to 10 urinary heart rate.
days for severe frequency,
symptoms then PO dose erectile After:
may be started and dysfunction - Educate patient about side
continued for 2 to 8 effects.
weeks. GERD Hematologic: - Instruct not to use alcohol,
Gastroesophageal Agranulocytosis, sleep remedies or sedatives;
Adults: 10 to 15 mg PO Reflux Disease Neutropenia serious sedation could occur.
q.i.d., (four times a day)
as needed, 30 minutes Skin: PATIENT/FAMILY TEACHING
before meals and at Rash, Urticaria - Avoid tasks that require
bedtime. alertness, motor skills until
Other: response to drug is
Loss of libido, established.
Prolactin - Report involuntary eye,
secretion, facial, limb movement
Gynecomastia, (extrapyramidal reaction).
Amenorrhea

DRUG NAME DOSAGE/FREQUENCY INDICATION MECHANISM CONTRAINDICATION ADVERSE NURSING RESPONSIBILITIES

 ROUTE OF ACTION REACTION
GENRERIC Adults: 20 mg PO, daily Symptomatic Inhibits proton - Hypersensitive to CNS: Assess other medications
DRUG: for 8 weeks patients who GERD without pump activity drug or its • asthenia, patient may be taking for
OMEPRAZOLE respond poorly to esophageal by binding to components dizziness, effectiveness and interactions
customary medical lesions hydrogen- - use cautiously in headache (especially those dependent on
BRAND NAME: treatment potassium patients with cytochrome P450 metabolism
Losec (CAN), adenosine hypokalemia and GI: or those dependent on acid
Prilosec triphosphate, respiratory alkalosis Abdominal pain, environment for absorption).
Adults: 20 mg PO daily Erosive located at and in patients in constipation,
esophagitis (EE) secretory low-sodium diet diarrhea, Monitor therapeutic
CLASSIFICATION: surface of - risk of fundic gland flatulence, effectiveness and adverse
Proton Pump gastric parietal polyps increases nausea, reactions at beginning of
Inhibitor Adults: initially, 60 mg PO Pathologic cells, to with long-term use, vomiting, acid therapy and periodically
daily; adjust dosage hypersecretory suppress gastric esp. beyond 1 year regurgitation throughout therapy.
based on patient conditions (such acid secretion. - long term
response. as Zollinger- administration of Musculoskeletal Assess GI system: bowel
Ellison bicarbonate with : sounds every 8hours, abdomen
syndrome) calcium or milk Back pain, for pain and swelling, appetite
Adults: 20 mg PO as - may increase risk weakness loss.
delayed-released form or Duodenal ulcer of CDAD
oral suspension, daily for (short-term Respiratory:
4 weeks treatment) - pregnancy and Cough, URI Monitor hepatic enzymes: AST,
lactation ALT, increased alkaline
Skin: phosphatase during treatment.
Adults: 40 mg PO every Rash
morning with H. pylori Assess knowledge/teach
clarithromycin 500mg PO infection and appropriate use of this
given t.i.d. for 14 days duodenal ulcer medication, interventions to
disease, to reduce side effects, and
eradicate H. adverse symptoms to report.
pylori with
clarithromycin Caution patient to avoid
(dual therapy) alcohol, salicylates, ibuprofen:
Adults: 20 mg once daily Dyspepsia may cause GI irritation
 for 4-to-8-week trial; may
continue longer if s/sx Patient may experience
improve. anorexia; small frequent meals
may help to maintain adequate
nutrition

Report severe headache,

unresolved severe diarrhea, or
changes in respiratory status.

Inform physician if patient is or

intends to become pregnant.
Breast-feeding is not
recommended.

PATIENT TEACHING:
Tell patient to swallow tablets
whole and not to open, crush,
or chew them.

Instruct patient to take drug at

least 30 to 60 minutes before
meals.

DRUG NAME DOSAGE/FREQUENCY INDICATION MECHANISM OF CONTRAINDICATIO ADVERSE NURSING RESPONSIBILITIES

ROUTE ACTION N REACTION
GENRERIC one tablet per day. indicated for the lower blood - is contraindicated CNS: Monitor BP prior to the
DRUG: treatment of pressure by in patients who are • dizziness, administration of medication of
LOSARTAN + may be administered with essential reducing hypersensitive to headache scheduled dose
AMLODIPINE or without food. hypertension. peripheral any component of
Recommended to take resistance. this product. GI: Monitor drug for effectiveness
with water may be used in Calcium influx Abdominal
If there is inadequate response
patients whose blockade and - should not be discomfort,
split the daily dose in a day is
may be administered with blood pressure is reduction of administered with dyspepsia,
other antihypertensive not adequately angiotensin II aliskiren in patients nausea, reflux into twice daily is recommended
agents. controlled on vasoconstriction with diabetes esophagitis Lab tests: Monitor CBC,
either are electrolytes, liver & kidney
Use in patients with renal monotherapy. complementary CV:
function with long-term therapy.
impairment: No dosage mechanisms. Palpitation
adjustment is necessary in Inform client to not stop taking
patients with mild renal Respiratory: this drug without doctor’s order
impairment (i.e. Dyspnea
creatinine clearance 20-50 6. Report fever, chills, dizziness
mL/min). For patients Renal:
with moderate to severe Pollakiuria
renal impairment (i.e.
creatinine clearance <20 Skin:
mL/min) or patients on Pruritus,
dialysis, administration of uticaria
LOSARTAN POTASSIUM +
AMLODIPINE CAMSYLATE
(COZAAR XQ) is not
recommended.

Use in patients with

intravascular volume
depletion: For patients
with intravascular volume-
depletion (e.g., those
treated with high-dose
diuretics), a starting dose
of 25 mg losartan once
daily should be
considered

Use in patients with

hepatic impairment: In
cases where a lower dose
of losartan (i.e. 25 mg
once daily) is required for
patients with a history of
hepatic impairment,
administration of
LOSARTAN POTASSIUM +
AMLODIPINE CAMSYLATE
(COZAAR XQ) is not
recommended.

Use in the elderly:

Because of decreased
clearance in the elderly,
amlodipine therapy
should usually be initiated
at 2.5 mg daily.