Cardiovascular Medications and Anticoagulants

Antihypertensive Medications: ACE Inhibitors, ARBs, Beta-Blockers, and Calcium Channel Blockers

Antihypertensive medications help lower blood pressure through various mechanisms, and client safety starts with proper data collection. The practical nurse must measure the client's blood pressure prior to administering any antihypertensive medication. When blood pressure drops, clients can experience lightheadedness, much like feeling unsteady after standing up too fast from a warm chair. To minimize this risk, the practical nurse reinforces teaching that clients taking antihypertensive medications should change positions slowly to prevent orthostatic hypotension and falls.

Angiotensin-converting enzyme (ACE) inhibitors typically end in the suffix -pril and lower blood pressure by blocking the conversion of angiotensin I to angiotensin II. During therapy, the practical nurse monitors for adverse reactions. A persistent, dry, hacking cough is an adverse effect of ACE inhibitors that the practical nurse must report to the RN. A far more dangerous reaction is angioedema, characterized by swelling of the face, lips, tongue, or airway; this is a life-threatening reaction requiring emergency intervention and immediate reporting to the RN. Both ACE inhibitors and angiotensin receptor blockers (ARBs) can cause hyperkalemia, so the practical nurse reviews available potassium results as directed and reports elevated levels to the RN. Angiotensin receptor blockers typically end in the suffix -sartan and are commonly prescribed for clients unable to tolerate ACE inhibitors due to cough.

Beta-blockers typically end in the suffix -lol and decrease blood pressure and heart rate by blocking beta-adrenergic receptors. Before administering a beta-blocker, the practical nurse must count the apical pulse for one full minute and check blood pressure. If the adult client's apical pulse is below 60 beats per minute, the practical nurse holds the beta-blocker and promptly reports the finding to the RN. Respiratory safety is also critical because nonselective beta-blockers can cause bronchospasm; they are generally avoided in clients with asthma and require caution in clients with chronic obstructive pulmonary disease. Additionally, beta-blockers can mask classic signs of hypoglycemia such as tachycardia and tremors, leaving diaphoresis as a key recognizable symptom that requires vigilant observation.

Calcium channel blockers lower blood pressure through vasodilation, but diltiazem and verapamil also slow heart rate and atrioventricular conduction; before administering either drug, the practical nurse checks blood pressure and pulse, follows ordered hold parameters, and reports concerning findings to the RN. The practical nurse checks for and reports adverse effects, including peripheral edema and dizziness, keeping in mind that constipation is particularly associated with verapamil. Nutrition education is another important consideration: the practical nurse reinforces prescribed teaching about grapefruit juice because it can increase the effects of some calcium channel blockers, although this interaction does not apply equally to all drugs in the class.