o .

- Indications for the PRILS

o Hypertension
o Congestive Heart Failure
o Left Ventricular Dysfunction
o Diabetes
- Contraindications and Precautions in the Use of ACE Inhibitors
o Presence of Allergy
o Renal Dysfunction
o Pregnant women
- Adverse Effects
o CVS – Tachycardia
o CNS – Dizziness, Drowsiness, ligheadedness
o GIT – GI irritation, Nausea, vomiting, peptic ulcer, constipation and liver
damage
o Renal – Renal Insufficiency, proteinuria
o Others – Rash, photosensitivity, dermatitis, alopecia, sodium excretion,
potassium retention, fatal pancytopenia.
o COUGH – unrelenting and bothersome
- Implementation / Consideration
o Encourage to implement lifestyle changes such as weight reducation,
smoking cessation, decrease intake of alcohol, dietary restriction of dalt / fats
and increase exercise.
o Give drug on an empty stomach, either 1 hour before or 2 hours after meals
to ensure proper drug absorption.
o Monitor patient who is at risk of developing fluid volume alteration
o Provide health teaching, drug information
o Caution patient to change position slowly and to avoid hazard on delicate
tasks and driving if drowsiness is a problem.

A. Angiotensin II Receptor Blockers “ the SARTANS”

- These agents work by attaching to angiotensin II receptors in the vascular smooth
muscles and in the adrenal gland.
- The action results in Vasodilation because AII action (Constriction) is inhibited and
blockage of aldosterone release.
- Clinical Use
o Hypertension
o Used if the patient cannot tolerate the unrelenting cough associated with
ACE inhibitors
- Contraindications
o Allergy
o Pregnant women
o Lactating mothers
- Adverse Effects
o CNS – headache, dizziness, weakness, syncope, orthostatic hypotension
o GIT – Diarrhea , Abd. Pain, nausea and vomiting, dry motuhg
o Respiratory – mild cough
 o Skin – rash , alopecia
- Implementation / Consideration
o Encourage to implement lifestyle changes
o Administer without regard to meals, give with food to decrease GI distress if
needed.
o Alert the surgeon if the patient is for operation, can cause hypotension.
o Ensure that patient is not pregnant before beginning the therapy.
o Provide comfort measures

B. Calcium Channel Blockers

- These agents prevent the movement of calcium into the cardiac and smooth
muscle cells when the cells are stimulated.
- The blocking of calcium will interfere with the muscle cell’s ability to contract,
leading to a loss of smooth muscle tone, vasodilation, and a decrease in
peripheral resistance.
- These effects will decrease blood pressure, cardiac workload, and myocardial
oxygen consumption.
- These are very effective in the treatment of angina because they decrease the
cardiac workload.

- Mechanism of action
o The calcium channel blocker inhibits the movement of calcium ions across
the membranes of myocardial and arterial muscle cells, altering the
action potential and blocking muscle cell contraction.
o This effect will depress myocardial contractility, slow cardiac impulse
formation in the conductive tissues, and relax and dilate arteries, causing
a fall in blood pressure and decrease in venous return.
- Contraindications
o Presence of allergy
o Patients with heart block or sick sinus syndrome
o Patients with renal and hepatic dysfunction
- Adverse Effects
o Dizziness, headache, fatigue
o Hepatic injury
o Hypotension, bradycardia, peripheral edema and heart block
o Skin flushing, rash
- Indications
o Angina
o Hypertension
o Vascular Spasm
- Implementation
o Monitor Blood pressure carefully while patient is on therapy because of
increased hypotensive episodes.
o If possible, obtain serum ECG tracing
o Provide comfort measures to help patients tolerate drug effects – serving
small frequent feeding, safety precaution due to hypotension and
dizziness.
 o Provide health teaching as to drug name, dosage, administration, side
effects and warning manifestations to report.

C. Vasodilators
- Produce relaxation of vascular smooth muscle, decreasing peripheral resistance
and reducing blood pressure.
- Use to treat severe hypertension

- Mechanism of Action

o Vasodilators act directly on vascular smooth muscle to cause muscle

relaxation, leading to vasodilation and drop in Blood pressure.
o Indicated for treatment of severe hypertension that has not responded to
other therapy;
- Contraindications
o Allergy
o Pregnancy
o Lactation
o Cerebral insufficiency
- Adverse Effects
o Dizziness, anxiety, headache
o Reflex tachycardia, CHF, Chest pain
o Edema, skin rash, lesions
o Abnormal hair growth ( Minoxidil)
o Hypotension
o Cyanide toxicity
- Implementation
o Lifestyle changes
o Monitor closely during administration to evaluate for effectiveness and to
ensure quick response if blood pressure falls rapidly or too much.
o Monitor blood glucose and serum electrolytes to avoid potentially serious
adverse effects.
o Provide comfort measures to help patient tolerate drug effects.
o Provide thorough patient teaching