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2. ANTIHYPERTENSIVES AND
DIURETICS
PRESENTED BY
G.SIVAGAMI
M.SC(N) 1ST YEAR

3. ANTIHYPERTENSIVES
•The drugs that control the high hypertension.

4. METHYLDOPA
Preparations : Aldomet, Dopamet
Mechanism Of Action Dose Side Effects Contra Indication
Drug of choice.
Central and
peripheral anti
adrenergic action.
Effective and safe
for both mother and
the fetus.
Orally: 250 mg bid
– may be increased
to 1g qid depending
upon the response.
IV infusion: 250 –
500 mg.
Maternal
1. postural
hypotension
2. Hemolytic anemia
3. Sodium retension
4. Excessive sedation
5. Bradycardia
6. Thrombocytopenia
7. Weight gain
Fetal
1. Intestinal ileus
Active hepatic
disorders
Psychiatric patients
Congestive cardiac
failure
Blood dyscrasias
hypersensitivity

5. NURSING CONSIDERATIONS FOR METHYLDOPA
1. Assess
 Blood values: neutrophils, platelets
 Renal studies: protein, BUN, creatinine, LFT
 Blood pressure before beginning treatment and periodically thereafter.
2. Provide
 Storage of tablets in tight container.
3. Evaluate
 Decrease in blood pressure
 Allergic reaction- rash, fever, pruritis, urticaria
 Symptoms of congestive heart failure[ edema , dyspnea, wet rales]
 Renal symptoms – polyuria, oliguria, frequency

6. LABETALOL
Preparations : Trandate, Normodyne
Mechanism of
action
Dose Side effects contraindication
Non selective
beta blocker.
Combined
alpha and beta
adrenergic
blocking agent
Orally: 100 mg tid
may be increased
upto 2400 mg daily.
IV infusion:
(hypertensive crisis)
20 – 40 mg IV
every 10 – 15 min
until desired effect,
Maximum upto
220mg
 Orthostastic hypotension
 Bradycardia
 Chest pain , ventricular
dysrhythmia
 Drowiseness, headache,
night mares, tremors
 Agranulocytosus,
thrombocytopenia, sore
throat
 Dry burning eyes.
 Asthma, congestive
cardiac failure
Hepatic
disorders
Sinus
bradycardia
Bronchial
asthma
Congestive
cardiac failure

7. NURSING CONSIDERATIONS FOR LABETALOL
1. Assess
 Intake and output and weight daily
 Blood pressure and pulse check 4th
hourly.
 Apical or radial pulse before
administration
2. Administer
 Per oral before food and HS
 IV keep client recumbent for 3 hours
3. Provide
 Storage in dry area at room
temperature
4. Evaluate
 Therapeutic response – decrease BP
after 1- 2 weeks
 Edema in feet, legs daily
 Skin turgor and dryness of mucous
membranes for hydration status

8. PROPONOLOL
PREPARATIONS : INDERAL
Mechanism of action Dose Side effects Contraindications
Beta adrenergic
blocker, decreases
preload, after load,
which is responsible
for decreasing left
ventricular diastolic
pressure and systemic
vascular resistance.
Orally: 80 –
240 mg in
divided
doses
Maternal
•Severe hypotension
•Sodium retention
•Bradycardia
•Bronchospasm
•Cardiac failure
Fetal
•Bradycardia
•IUGR with prolonged therapy
•Neonatal hypoglycemia
Bronchial asthma
Renal
insufficiency
Diabetus mellitus
Cardiac failure

9. NURSING CONSIDERATIONS FOR PROPONOLOL
1. Assess
 Intake and output and weight daily
 Blood pressure and pulse check 4th hourly
2. Administer
 Administer with 240 ml of water on empty stomach
3. Evaluate
 Tolerance if taken for long period
 Headache, light headedness, decreased BP

10. HYDRALAZINE
Preparations: Apresoline, Hydralyn, Rolazine
Mechanism of action Dose Side effects contraindications
Vasodilates arteriolar
smooth muscles by
direct relaxation and
peripheral
vasodilatation.
Reduction in blood
pressure with reflex
increase in cardiac
function.
Orally: 100 mg /day
in four divided
doses.
IV: 5 – 10 mg every
20 min maximum 30
mg
Maternal
Hypotension
Tachycardia
Arrhythmia
Palpitation
Drowsiness, headache
Pruritis, fluid retention
Fetal
Reasonably safe but in
neonates
thrombocytopenia
Coronary artery
disease
Mitral valvular
rheumatic heart
disease.

11. NURSING CONSIDERATIONS FOR HYDRALAZINE
1. Assess
 Intake and output and weight daily
 Blood pressure and pulse check 4th
hourly
 Blood studies: Electrolytes, CBC
and serum glucose
2. Administer
 Recumbent position : keep that
position for 1 hour after
administration
3. Provide
 Storage in dry area at room temperature
4. Evaluate
 Skin and mucous membrane for
hydration
 Rales, dyspnea, orthopnea
 Edema in feet, legs, daily
 Joint pain, tachycardia, palpitation

12. NIFIDIPINE
Preparations: Adalat, Procardia
Mechanism of
action
Dose Side effects Contra indications
Calcium channel
blocker
Direct arteriolar
vasodilatation by
inhibition of
inward calcium
channels in
vascular smooth
muscles.
Orally: 5 – 10 mg
tid,
Maximum dose:
60 – 120 mg/ day
 Hypotension
 Bradycardia
 Flushing
 Droasiness,
headache,
nightmares,
lethargy
 Inhibition of
labour
Stimultaneous use of
magnesium sulphate
could be hazardous due
to synergistic effect.
Second or third
degree heart block

13. NURSING CONSIDERATION FOR NIFIDIPINE
1. Assess
Blood levels of the drug, therapeutic levels 0.025 – 0.1 Microgram/Ml
2. Administer
Per oral before food and HS
3. Storage
 Storage in dry area at room temperature
4. Evaluate
Therapeutic response – Decreased BP after 1- 2weeks
Blood Pressure, Respiration and ECG

14. SODIUM NITROPRUSSIDE
Preparations : Nipride, Nitropress
Mechanism of
action
Dose Side effects Contra indications
Peripheral
vasodilator, directly
relaxes arteriolar,
venous smooth
muscle, resulting in
reduction of cardiac
preload and after
load.
IV infusion:
0.5 to 10
mg/kg/minu
te
Maternal
 Hypotension
 Nausea , vomiting,
restlessness
 Loss of consciousness
Fetus
 Toxicity due to metabolites-
cyanide and thiocyanide
Drug of last resort
for acute
hypertension.
Should be used in
critical care unit for
very short time (10
minutes)

15. NURSING CONSIDERATIONS
1. Assess
 Intake and output and weight daily
 Blood pressure and pulse check 4th hourly
 Serum electrolytes, bun, creatinine, liver function tests
2. Administer
 Using an infusion pump only
 Wrap bottle with aluminum foil to protect from light
3. evaluate
 Therapeutic response- decreased BP and absence of bleeding
 Edema in feet, legs daily
 Skin turgor and dryness of mucous membrane for hydration status.

16. DIURETICS

17. FRUSEMIDE
PREPARATIONS : LASIX
Mechanism of
action
Dose Side effects Nursing considerations
It directly prevents
reabsorbtion of
sodium and
potassium mainly
from the loop of
henle
Oral: 40 mg
daily for 5
days
IV : 40 -120
mg daily
Maternal
Fatigue
Muscle cramps
Hypokalemia
Postural hypotension
Fetal
Placental perfusion
Thrombocytopenia
Hyponatraemia
Monitor intake and
output chart
Monitor vital signs and
bp
Evaluate about the
signs of metabolic
acidosis.

18. THIAZIDE
Preparation: Hydrocholorothiazide
Mechanism
of action
Dose Side effects
Contra
indication
Nursing
considerations
It cause a
change in
sodium
concentration
distal to the
distal
convoluted
tubule[DCT]
Oral:
25 – 50 mg
daily after
breakfast
 Hyponatraemia
 Acute
pancreatitis
 Increase in uric
acid levels
 Neonatal
thrombocytopenia
 Hyperglycemia
hypersensitivity  monitor intake and
output , serum
electrolytes levels.
Monitor blood
glucose levels
Administer diuretics
in the morning to
prevent nocturia.

19. SPIRONOLACTONE
Preparation : Aldactone
Mechanism of
action
Dose Side effects
Contra
indications
Nursing
considerations
Competitive binding
of receptors of the
aldesterone-
dependent sodium –
potassium exchange
site in the distal
convoluted renal
tubule.
Oral: 1 – 3
mg/kg/day
in 2 bd
doses
Maximum
100 mg/ day
Dizziness
Muscle or leg
cramps
Feeling tired
Hyperkalemia
Addison’s
disease
Acute renal
insufficiency
Avoid giving
food rich in
potassium
Measure and
record regular
weight to
monitor
mobilization of
edema fluid.

20. SUMMARY
• The use of medications during pregnancy should be carefully
administered because it brings about affect in both mother and the
baby. The side effects of the drugs elicited by the mothers should be
monitored carefully and reported to the physician at the earliest by
the midwives for early interventions and also to prevent
complications.

21. CONCLUSION
• Here with, I conclude that the students have understood the meaning,
action, side effects, dose, indications, contraindications and nursing
considerations of antihypertensive and diuretics.

22. EVALUATION
• ASSIGNMENTS
1. Explain about diruetics.
2. Submit the assignment on day after tomorrow.
WRITTEN TEST TOTAL MARKS : 25
SECTION - A
Essay 1 × 10 = 10
1. Explain about labetalol- action, dose, indication, contra indication, side effects and nursing
considerations.
SECTION - B
WRITE SHORT NOTES 3 × 5 = 15
1. Write about the drug methydopa.
2. Explain diuretics and its uses in pregnancy.
3. Write about the drug nifidipine.