McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 4 3 Drugs affecting blood pressure

consecutive blood pressure readings in the high range are recorded. B.R. may be able to have his blood pressure checked at work in a comfortable environment, which will improve the accuracy of the reading. In the past, many insurance companies and some employers, viewed hypertension as a hiring and insurability risk. As a business executive, B.R. may be well aware of this increased risk category—another reason to give him a little more time. He may wish to look into biofeedback for relaxation, a fitness program, smoking cessation programs (if appropriate) and stress reduction. As long as B.R. receives regular follow-up and frequent blood pressure checks, it may be a good idea to allow him to take some control and continue lifestyle changes. If at the end of the 2 weeks no further progress has been made or B.R.’s blood pressure has risen, drug therapy should be considered. Teaching should be aimed at helping B.R. to incorporate the drug effects into his lifestyle, to improve his compliance and tolerance of the therapy. CARE GUIDE FOR B.R.: CALCIUM CHANNEL BLOCKERS Assessment: History and examination Concentrate the health history on allergies to any calcium channel blocker, renal dysfunction, salt/volume depletion, or heart failure and concurrent use of barbiturates, hydantoins, erythromycin, cimetidine, ranitidine, antifungal agents and/or grapefruit juice. Focus the physical examination on the following: Cardiovascular: blood pressure, pulse, perfusion, baseline ECG CNS: orientation, affect Skin: colour, lesions, texture, temperature Respiratory system: respiration, adventitious sounds GI: abdominal examination, bowel sounds Laboratory tests: renal function tests, FBC, electrolyte levels Implementation Encourage lifestyle changes to increase drug effectiveness. Do not cut, crush or chew this tablet. Give with food if GI upset occurs. Provide comfort and safety measures. Reduce dosage if person has renal failure. Monitor for any situation that might lead to a drop in blood pressure. Provide support and reassurance to deal with drug effects. Provide teaching regarding drug, dosage, adverse effects, signs and symptoms of problems to report, and safety precautions. Evaluation Evaluate drug effects: maintenance of blood pressure within normal limits. Monitor for adverse effects: nausea, dizziness; hypotension, congestive heart failure, skin reactions.

Monitor for drug–drug interactions as listed. Evaluate effectiveness of teaching program and comfort and safety measures. TEACHING FOR B.R. • The drug that has been prescribed to treat your hypertension is called a calcium channel blocker. When used to treat high blood pressure, this drug is called an antihypertensive. High blood pressure is a disorder that may have no symptoms but that can cause serious problems, such as heart attack, stroke or kidney problems, if left untreated. • It is very important to take your medication every day, as prescribed, even if you feel perfectly well without the medication. It is possible that you may feel worse because of the adverse effects associated with the medication when you take it. Even if this happens, it is crucial that you take your medication. • If you find that the adverse effects of this drug are too uncomfortable, discuss the possibility of taking a different antihypertensive medication with your healthcare provider. • This drug should be taken on an empty stomach, 1 hour before or 2 hours after meals. • Common effects of these drugs include: • Dizziness, drowsiness, light-headedness: These effects often pass after the first few days. Until they do, avoid driving or performing hazardous or delicate tasks that require concentration. If these effects occur, change positions slowly to decrease the light-headedness. • Nausea, vomiting, change in taste perception: Small, frequent meals may help ease these effects, which may pass with time. If they persist and become too uncomfortable, consult with your healthcare provider. • Skin rash, mouth sores: Frequent mouth care may help. Keep the skin dry and use prescribed skin care (lotions, coverings, medication) if needed. • Report any of the following to your healthcare provider: difficulty breathing; mouth sores; swelling of the feet, hands, or face; chest pain; palpitations; sore throat; fever or chills. • Do not stop taking this drug for any reason. Consult with your healthcare provider if you have problems taking this medication. • You should avoid the use of grapefruit juice while you are taking this drug, because the combination of grapefruit juice and a calcium channel blocker may case toxic effects. • Tell any doctor, nurse or others involved in your healthcare that you are taking this drug. • Avoid taking over-the-counter medications while you are taking this drug. If you feel that you need one of these, consult with your healthcare provider for the best choice. Many of these drugs may interfere with the antihypertensive effect that usually occurs with this drug.