Name of Drug Dosage Classification Mechanism of Actions Adverse Reaction Nursing Consideration

Brand Name: IV: 10-20 mg Antihypertensive May act in a manner that CNS: Chills, fever, headache, • Give tablets with food to increase
Apresoline (can) IM: 10 to 50 resembles organic nitrates peripheral neuritis bioavailability.
mg and sodium nitroprusside, CV: Angina, edema, • Monitor blood pressure and pulse rate
Generic Name: PO: 10 mg qid except that hydralazine is orthostatic hypotension, regularly and weigh patient daily
hydralazine selective for arteries. palpitations, tachycardia during therapy.
hydrochloride It exerts a direct EENT: Lacrimation, nasal • Check blood pressure with patient in
vasodilating effect on congestion lying, sitting, and standing positions,
vascular smooth muscle. GI: Anorexia, constipation, and watch for signs of orthostatic
Interferes with calcium diarrhea, nausea, vomiting hypotension.
movement in vascular RESP: Dyspnea • Expect prescriber to withdraw
smooth muscle by altering SKIN: Blisters, flushing, hydralazine gradually to avoid a rapid
cellular calcium pruritus, rash, urticaria increase in blood pressure.
metabolism. Dilates Other: Lupus-like symptoms, • Instruct patient to immediately notify
arteries, not veins, which especially with high doses; prescriber about fever, joint and
minimizes orthostatic lymphadenopathy muscle aches, and sore throat.
hypotension and increases • Urge patient to report numbness and
cardiac output and cerebral tingling in limbs, which may require
blood flow. Causes reflex treatment with another drug.
autonomic response that
 Caution patient against stopping drug
increases, cardiac output,
abruptly because doing so may cause
heart rate, and left
severe hypertension
ventricular ejection
fraction. Has a positive
inotropic effect on the
heart.
Name of Drug Dosage Classification Mechanism of Actions Adverse Reaction Nursing Consideration
Brand Name: IV: 250-1000 Antihypertensive Is decarboxylated in the CNS: Decreased • Instruct patient to take methyldopa
Aldomet mg q6h body to produce alpha- concentration, depression, exactly as prescribed and not to skip a
PO: 25 mg bid methylnorepinephrine, a dizziness, drowsiness, fever, dose.
Generic Name: metabolite that stimulates headache, involuntary motor • Suggest that patient take drug at
methyldopa central inhibitory activity, memory loss bedtime to minimize daytime
alphaadrenergic receptors. (transient), nightmares, drowsiness.
This action may reduce paresthesia, Parkinsonism, • For I.V. infusion, add methyldopate to
blood pressure by sedation, vertigo, weakness 100 ml of D5W and administer over 30
decreasing sympathetic CV: Angina, bradycardia, to 60 minutes.
stimulation of heart and edema, heart failure, • Expect to monitor CBC and
peripheral vascular myocarditis, orthostatic differential results before and
system. hypotension periodically during methyldopa
EENT: Black or sore tongue, therapy.
dry mouth, nasal congestion • Monitor blood pressure regularly
GI: Constipation, diarrhea, during therapy.
flatulence, hepatic necrosis, • Advise patient to change position
hepatitis, jaundice, nausea, slowly to minimize orthostatic
pancreatitis, vomiting hypotension
GU: Decreased libido, • Assess for edema and weight gain. If
impotence
they develop, give a diuretic, as
HEME: Agranulocytosis,
prescribed.
hemolytic anemia
• Notify prescriber if patient has signs of
SKIN: Eczema, rash
heart failure (dyspnea, edema,
hypertension) or involuntary, rapid,
jerky movements.
• Be aware that hypertension may return
within 48 hours after stopping drug
Name of Drug Dosage Classification Mechanism of Actions Adverse Reaction Nursing Consideration
Brand Name: IV- Loading Antiarrhythmic Assists all enzymes involved in CNS: Confusion,  Frequently assess cardiac status of
dose: (4-6g) , phosphate transfer reactions decreased reflexes, patient taking drugs that lower heart
Maintenance anticonvulsant, that use adenosine triphosphate dizziness, syncope rate, such as beta blockers, because
Generic Name: dose (1-2 g/h) (ATP). Magnesium is required CV: Arrhythmias, magnesium may aggravate symptoms of
magnesium for normal function of the ATP- hypotension heart block.
sulfate dependent sodium–potassium GI: Flatulence, vomiting  Provide adequate diet, exercise, and
pump in muscle membranes. It MS: Muscle cramps fluids for patient being treated for
may effectively treat digitalis RESP: Dyspnea, constipation.
glycoside–induced arrhythmias respiratory depression or  Monitor serum electrolyte levels in
because correction of paralysis patients with renal insufficiency because
hypomagnesemia improves the SKIN: Diaphoresis they’re at risk for magnesium toxicity
sodium–potassium pump’s  Avoid giving other oral drugs within
ability to distribute potassium 2 hours of magnesium-containing antacid.
into intracellular spaces and  Before giving drug as laxative, shake oral
because magnesium decreases solution, liquid, or liquid concentrate well
calcium uptake and potassium and give with a large amount of water.
outflow through myocardial  Observe for and report early evidence of
cell membranes. As an hypermagnesemia: bradycardia, depressed
anticonvulsant, magnesium deep tendon reflexes, diplopia, dyspnea,
depresses the CNS and blocks flushing, hypotension, nausea, slurred
peripheral neuromuscular speech, vomiting, and weakness.
impulse transmission
 When magnesium sulfate is administered
by continuous I.V. infusion (especially for
more than 24 hours preceding delivery) to
control convulsions in a toxemic woman,
monitor newborn for signs of magnesium
toxicity, such as neuromuscular or
respiratory depression and hypotonia
Name of Drug Dosage Classification Mechanism of Actions Adverse Reaction Nursing Consideration
Brand Name: Tablet: 2,5, 10 Anticonvulsant May potentiate effects of CNS: Anterograde • Use diazepam with extreme caution in
Valium mg gammaaminobutyric acid amnesia, anxiety, ataxia, patients with a history of alcohol or drug
Cap: 15 mg (GABA) and other confusion, dizziness, abuse because it can cause physical and
Inj: q 5-10 inhibitory drowsiness, fatigue, psychological dependence
Generic Name: min neurotransmitters by headache, insomnia, • Use diazepam cautiously in patients
diazepam binding to specific lethargy, light-headedness, with hepatic or renal impairment.
benzodiazepine receptors paradoxical reactions, • Expect to give a lower diazepam dose to
in limbic and cortical areas psychiatric effects, patient with chronic respiratory
of CNS. GABA inhibits sedation, sleepiness, insufficiency because of the risk of
excitatory stimulation, slurred speech, tremor, respiratory depression
which helps control vertigo • Give I.M. injection into deltoid muscle
emotional behavior. CV: Hypotension, for rapid, complete absorption. Using
Limbic system contains a palpitations, tachycardia other sites may cause slow, erratic
dense area of EENT: Blurred vision, absorption.
benzodiazepine receptors, diplopia, dry mouth, • Monitor patient closely for increase in
which may explain drug’s increased salivation frequency or severity of grand mal
antianxiety effects. GI: Anorexia, seizures when diazepam is used with
Diazepam suppresses constipation, diarrhea, standard anticonvulsant therapy
spread of seizure activity elevated liver enzymes, • Advise patient not to take drug to relieve
caused by seizure- jaundice, nausea, vomiting everyday stress
producing foci in cortex, GU: Libido changes, • Instruct patient not to stop taking drug
limbic, and thalamus urinary incontinence, urine
abruptly without prescriber’s
structures. retention
supervision. If patient has a history of
HEME: Neutropenia
seizures, warn that abrupt withdrawal
MS: Dysarthria, muscle
may trigger them.
weakness
• Check patient’s blood counts and liver
RESP: Respiratory
function periodically, as ordered,
depression
because prolonged diazepam therapy
SKIN: Dermatitis
rarely causes jaundice and neutropenia.
Name of Drug Dosage Classification Mechanism of Actions Adverse Reaction Nursing Consideration
Brand Name: Tablet: 30-60 antihypertensive May slow movement of CNS: Anxiety, ataxia, • Use cautiously in patients with cirrhosis
Apo-Nifed mg daily calcium into myocardial confusion, dizziness, because it is unknown how nifedipine
(CAN) and vascular smooth- drowsiness, headache, exposure may be altered in these patients.
muscle cells by nervousness • Know that when starting and stopping
Generic Name: deforming calcium CV: Arrhythmias nifedipine therapy, taper it, as prescribed,
nifedipine channels in cell (bradycardia, tachycardia), over 7 to 14 days.
membranes, inhibiting chest pain, heart failure, • Instruct patient to swallow E.R. tablets
ion-controlled gating hypotension, palpitations, whole, not to break, chew, or crush them.
mechanisms, and peripheral edema • Urge patient to take nifedipine exactly as
disrupting calcium EENT: Altered taste, blurred prescribed, even when she’s feeling well.
release from sarcoplasmic vision, dry mouth, epistaxis, Advise her to notify prescriber if she
reticulum. Decreasing gingival hyperplasia misses two or more doses.
intracellular calcium level GI: Anorexia; constipation; • Urge patient not to take drug within
inhibits smooth-muscle diarrhea; dyspepsia; elevated 1 hour of a high-fat meal or grapefruit.
cell contraction and liver enyzmes; gastrointestinal • Caution patient against stopping
dilates arteries, which bleeding nifedipine abruptly because angina or
decreases myocardial HEME: Anemia, leukopenia dangerously high blood pressure could
oxygen demand, RESP: Chest congestion, result.
peripheral resistance, cough, dyspnea, respiratory • Teach patient to measure blood pressure
blood pressure, and tract infection, wheezing
and pulse rate, and advise her to call
afterload.
prescriber if they drop below accepted
levels.
• Instruct patient to notify prescriber
immediately about chest pain, difficulty
breathing, ringing in ears, and swollen
gums.
• Advise patient to avoid hazardous
activities until drug’s CNS effects are
known
• Urge patient to avoid alcoholic beverages
because they may worsen dizziness
• Emphasize the need for good oral hygiene
and regular dental visits.
• Caution patient that hot tubs, prolonged
hot showers, and saunas may cause
 dizziness and fainting.
• Advise patient to avoid prolonged sun
exposure and to wear sunscreen outdoors.