Question

Case Study, Chapter 43, Drugs Affecting Blood Pressure

A staff nurse has to administer medications for blood pressure to several patients in the coronary care unit. The medications include captopril, diltiazem, and nitroprusside. The medications have to be administered to three older adults. (Learning Objectives 3, 4, and 5)

1. What are the indications for captopril?
2. What are the therapeutic actions for diltiazem?
3. What are the most common adverse reactions for nitroprusside?
4. What are the lifespan considerations in the older adult for the use of drugs that affect blood pressure?
5. What are the nursing implementation considerations for a patient receiving nitroprusside for blood pressure?

Answer 1

1. Captopril comes under the class of ACE inhibitors ( angiotensin converting enzyme inhibitors) . The indications of captopril are :-

- Hypertension

- Congestive heart failure

- Diabetic nephropathy

- Left ventricular dysfunction after myocardial infarction

2. Diltiazem is a calcium antagonist ,widely used in the treatment of angina and heart related diseases . The therapeutic actions of diltiazem is it's ability to inhibit the cellular influx of calcium ions during membrane depolarization of cardiac and vascular smooth muscle . It produces relaxation coronary vascular smooth muscle and dilation of both small and large coronary arteries at drug level which causes little or no negative ionotropic effect.

3. Nitroprusside is a antihypertensive drug indicated for immediate reduction of blood pressure in adults and paediatric patients .

It's side effects are :-

- abdominal pain

- excessive low blood pressure

- headache

- dizziness

- muscle twitching

- sweating

- nausea

- palpitations

- restless

- flushing

- rash

- slow or fast heart rate

- irritation at infusion site

- retching

4. The lifespan of older adults taking antihypertensives is some what 30 to 40 % prolonged because there are many other variables which affect the lifespan like diabetes , alcohol, smoking , adherence to antihypertensive medications etc .