Clonidine treats high blood pressure by reducing sympathetic tone in the brain and lowering peripheral vascular resistance. Nurses should not abruptly discontinue clonidine to avoid rebound hypertension and other complications. They monitor blood pressure and assess compliance with the medication regimen. Isosorbide nitrates treat angina by dilating blood vessels and reducing preload and afterload. Nurses educate patients about potential side effects like lightheadedness and interactions with alcohol or breastfeeding. Losartan treats hypertension by blocking angiotensin receptors, lowering blood pressure. Nurses monitor blood pressure and renal function when using losartan.

1. GENERIC
NAME
BRAND
NAMES
INDICATIONS MECHANISM OF
ACTION
CONTRAINDICATION/S NURSING RESPONSIBILITIES
clonidine
hydrochloride
Apo-
Clonidine
(CAN)
Hypertension, used
alone or as part of
combination therapy
Treatment of severe
pain in cancer patients
in combination with
opiates; epidural more
effective with
neuropathic pain
(Duraclon)
Clonidine treats high blood
pressure by stimulating α2-
receptors in the brain, which
decreases peripheral vascular
resistance, lowering blood
pressure. It has specificity
towards the presynaptic α2-
receptors in the vasomotor
center in the brainstem. This
binding decreases
presynaptic calcium levels,
thus inhibiting the release of
norepinephrine (NE). The net
effect is a decrease in
sympathetic tone. Its
mechanism of action in the
treatment of ADHD is to
increase noradrenergic tone
in the prefrontal cortex
(PFC) directly by binding to
postsynaptic α2A adrenergic
receptors and indirectly by
increasing norepinephrine
input from the locus
coeruleus.
Contraindicated with
hypersensitivity to clonidine
or any adhesive layer
components of the
transdermal system.
Use cautiously with severe
coronary insufficiency,
recent MI, cerebrovascular
disease; chronic renal
failure; pregnancy,
lactation.
- WARNING: Do not discontinue abruptly;
discontinue therapy by reducing the dosage
gradually over 2–4 days to avoid rebound
hypertension, tachycardia, flushing, nausea,
vomiting, cardiac arrhythmias (hypertensive
encephalopathy and death have occurred after
abrupt cessation of clonidine).
- Do not discontinue prior to surgery; monitor
BP carefully during surgery; have other BP-
controlling drugs readily available.
- Store epidural injection at room temperature;
discard any unused portions.
- Reevaluate therapy if clonidine tolerance
occurs; giving concomitant diuretic increases
the antihypertensive efficacy of clonidine.
- Monitor BP carefully when
discontinuing clonidine; hypertension usually
returns within 48 hr.
- WARNING: Remove transdermal patch
before defibrillation to prevent arcing.
- Assess compliance with drug regimen in a
supportive manner with pill counts, or other
methods.
-
isosorbide
nitrates ,
isosorbide
dinitrate ,
Isordil Dinitrate: Treatment
and prevention of
angina pectoris
Nitrate vasodilator; relaxes
vascular smooth muscle and
dilates peripheral arteries and
veins; venous dilatation
reduces left ventricular end
Contraindicated with allergy
to nitrates, severe anemia,
head trauma, cerebral
hemorrhage, hypertrophic
cardiomyopathy, narrow-
- Make position changes slowly, particularly
from recumbent to upright posture, and dangle
feet and ankles before walking.
- Lie down at the first indication of light-
headedness or faintness.

2. isosorbide
mononitrate
Mononitrate:
Prevention of angina
pectoris
Unlabeled use
(dinitrate): Used with
hydralazine in patients
with advanced CHF
diastolic pressure and
pulmonary capillary wedge
pressure (preload); arteriolar
relaxation reduces systemic
vascular resistance, systolic
arterial pressure, and mean
arterial pressure (afterload);
dilates the coronary artery.
angle glaucoma, postdural
hypotension
Use cautiously with
pregnancy, lactation, acute
MI, CHF.
- Keep a record of anginal attacks and the
number of sublingual tablets required to
provide relief.
- Do not drink alcohol because it may increase
possibility of light-headedness and faintness.
- Do not breast feed while taking this drug
without consulting physician.
losartan Cozaar diabetic nephropathy
in type 2 diabetes with
hypertension
Angiotensin formed in the
blood by the action of
angiotensin converting
enzyme (ACE) is a powerful
chemical that attaches to
angiotensin receptors found
in many tissues but primarily
on smooth muscle cells of
blood vessels. Angiotensin's
attachment to the receptors
causes the muscle cells to
contract and the blood
vessels to narrow
(vasoconstrict) which leads
to an increase in blood
pressure
Concomitant aliskiren in
patients with diabetes
- Monitor patients BP.
- Monitor patients who are also taking diuretics
for symptomatic hypotension.
- Assess patients renal function
- Tell patient to avoidsalt substitute
amlodipine
besylate
Norvasc Angina pectoris due to
coronary artery spasm
(Prinzmetal’s variant
angina)
Chronic stable angina,
alone or in
combination with
other agents
Essential
hypertension, alone or
in combination with
other
antihypertensives
Amlodipine belongs to a
class of medications called
calcium channel blockers
(CCBs). These medications
block the transport of
calcium into the smooth
muscle cells lining the
arteries of the heart
(coronary arteries) and other
arteries of the body. Since
the action of calcium is
important for muscle
contraction, blocking
calcium transport relaxes
Contraindicated with allergy
to amlodipine, impaired
hepatic or renal function,
sick sinus syndrome, heart
block (second or third
degree), lactation.
Use cautiously with CHF,
pregnancy.
- WARNING: Monitor patient carefully (BP,
cardiac rhythm, and output) while adjusting
drug to therapeutic dose; use special caution if
patient has CHF.
- Monitor BP very carefully if patient is also on
nitrates.
- Monitor cardiac rhythm regularly during
stabilization of dosage and periodically during
long-term therapy.
- Administer drug without regard to meals.

3. arterial muscles and expands
(dilates) coronary arteries
and other arteries of the
body. By dilating coronary
arteries, amlodipine
increases the flow of blood
to the heart and is useful in
preventing heart pain
(angina) resulting from
reduced flow of blood to the
heart caused by coronary
artery spasm (contraction).
simvastatin Zocor Adjunct to diet in the
treatment of elevated
total cholestrol and
LDL cholesterol with
primary
hypercholesterolemia
(types IIa and IIb) in
those unresponsive to
dietary restriction of
saturated fat and
cholesterol and other
nonpharmacologic
measures
To reduce the risk of
coronary disease,
mortality, and CV
events, including
CVA, TIA, MI and
reduction in need for
bypass surgery and
angioplasty in patients
with coronary heart
disease and
hypercholesterolemia
Treatment of patients
with isolated
hypertriglyceridemia
Simvastatin is a prodrug and
is hydrolyzed to its active β-
hydroxyacid form,
simvastatin acid, after
administration. Simvastatin
is a specific inhibitor of 3-
hydroxy-3-methylglutaryl-
coenzyme A (HMG-CoA)
reductase, the enzyme that
catalyzes the conversion of
HMG-CoA to mevalonate,
an early and rate limiting
step in the biosynthetic
pathway for cholesterol. In
addition, simvastatin reduces
VLDL and TG and increases
HDL-C.
Acute liver disease or
unexplained persistent
elevations of serum
transaminases.
Pregnancy, lactation.
Porphyria.
- Ensure that patient has tried a cholesterol-
lowering diet regimen for 3–6 mo before
beginning therapy.
- Give in the evening; highest rates of
cholesterol synthesis are between midnight and
5 AM.
- Advise patient that this drug cannot be taken
during pregnancy; advise patient to use barrier
contraceptives.
- Arrange for regular follow-up during long-
term therapy. Consider reducing dose if
cholesterol falls below target.

4. Treatment of type III
hyperlipoproteinemia
Treatment of
adolescents 10–17 yr
with heterozygous
familial
hypercholesterolemia