T:

Classification: Therapeutic
Pharmacologic

Action:
Metabolized:
Uses:
Side Effects:
Desired Outcomes:
Antihypertensive

Metoprolol T: Betaloc [Can], Lopresor [Can], Lopresor SR [Can], Lopressor, Toprol-XL

(PO, PO-ER, IV)

Classification: Therapeutic antianginals, antihypertensives

Pharmacologic beta blockers
Route: Tablets, IV (IM)
Action: Blocks stimulation of beta1(myocardial)-adrenergic receptors. Does not usually affect beta2(pulmonary, vascular,
uterine)-adrenergic receptor sites.
Metabolized: Liver.
Uses: Hypertension. Angina pectoris. Prevention of MI and decreased mortality in patients with recent MI.
Side Effects: CNS: Insomnia, dizziness mental changes, hallucinations, depression, anxiety, headaches, nightmares,
confusion, fatigue CV: Hypotension, palpitations, CHF, dysrhythmias, bradycardia, cardiac arrest, AV block, pulmonary/peripheral
Desired outcomes: Decrease in blood pressure. Reduction in frequency of angina attacks. Increase in activity tolerance.
Prevention of MI.

Carvedilol T: Coreg, Coreg CR

(PO, PO-CR)
Classification: Therapeutic Antihypertensives
Pharmacologic Beta blockers
Route: Caps, Tabs
Action: Blocks stimulation of beta1(myocardial) and beta2 (pulmonary, vascular, and uterine) adrenergic receptor sites. Also
has alpha1 blocking activity, which may result in orthostatic hypotension.
Metabolized: Liver
Uses: Hypertension. CHF (ischemic or cardio myopathic ) with digoxin, diuretics, and ACE inhibitors. Left ventricular
dysfunction after myocardial infarction.
Therapeutic Effects: Decreased heart rate and blood pressure. Improved cardiac output, slowing of the progression of CHF
and decreased risk of death.
Side Effects: CNS: dizziness, fatigue, weakness, anxiety, depression, drowsiness, insomnia, memory loss, mental status
changes, nervousness, nightmare CV: BRADYCARDIA, CHF, PULMONARY EDEMA.
Desired Outcomes: Decrease in blood pressure with out appearance of detrimental side effects Decrease in severity of
CHF.

Bisoprolol T: Monocor, Zebeta (PO)

Classification: Therapeutic Antihypertensives
Pharmacologic Beta blockers

Action: Blocks stimulation of beta1(myocardial)-adrener- gic receptors. Does not usually affect beta2(pulmonary, vascular,
uterine)-receptor sites.
Metabolized: Kidney
Uses: Management of hypertension.
Side Effects: CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, men- tal status
changes, nervousness, nightmares. CV: BRADYCARDIA, CHF, PULMONARY EDEMA, hypotension, peripheral
vasoconstriction.
Desired Outcomes: Decrease in blood pressure.

Atenolol T: Apo-Atenolol, Novo-Atenolol, Tenormin (PO)

Classification: Therapeutic antianginals, antihypertensives
Pharmacologic beta blockers
Action: Blocks stimulation of beta1(myocardial) adrenergic receptors. Does not usually affect beta2(pulmonary, vascular,
uterine)-receptor sites.
Metabolized: Kidney
Uses: Management of hypertension. Management of angina pectoris. Prevention of MI.
Side Effects: CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status
changes, nervousness, nightmares. CV: BRADYCARDIA, CHF, PUL- MONARY EDEMA, hypotension, peripheral
vasoconstriction.
Desired Outcomes: Decrease in blood pressure. Reduction in frequency of angina. Increase in activity tolerance.
Prevention of MI.

Labetalol T: Trandate

(PO,IV)
Classification: Therapeutic antianginals, antihypertensives
Pharmacologic beta blockers
Action: Blocks stimulation of beta1 (myocardial)- and beta2 (pulmonary, vascular, and uterine)-adre- nergic receptor sites.
Also has alpha1-adrenergic blocking activity, which may result in more ortho- static hypotension.
Metabolized: Liver
Uses: Management of hypertension.
Side Effects: CNS: fatigue, weakness, anxiety, depression, diz- ziness, drowsiness, insomnia, memory loss, men- tal status
changes, nightmares. CV: ARRHYTHMIAS, BRADYCARDIA, CHF, PULMONARY EDEMA, orthostatic hypotension.
Desired Outcomes: Decrease in blood pressure.

(PO,IV)

Perindopril T: Aceon, Coversyl

Ramipril T: Altace, Altace,
Lisinopril T: Prinivil, Zestril
Classification: Therapeutic antihypertensives
Pharmacologic ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS
Action: ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent
the degradation of bradykinin and other vasodilator prostaglandins. ACE inhibitors also increase plasma renin levels and
decreases aldosterone levels. Net result is systemic vasodilation .
Metabolized: Liver
Uses: management of hypertension, CFH. Reduction of risk of MI, stroke, and death from cardiovascular disease in patients
at risk ( 55 yr old with a history of CAD, stroke, peripheral vascular dis ease, or diabetes with another cardiovascular risk factor).
Side Effects: CNS: dizziness, drowsiness, fatigue, headache, insomnia, vertigo, weakness. CV: hypotension, chest pain,
edema, tachycardia.
Desired Outcomes: Decrease in blood pressure without appearance of excessive side effects. Decrease in signs and
symptoms of CHF(some drugs may also improve survival).Decrease in development of overt CHF (enalapril). Reduction of risk
of death or development of CHF following MI. Reduction of risk of death from cardiovascular causes and MI in patients with
stable CAD (perindopril). Reduction of risk of MI, stroke, or death from cardiovascular causes in patients at high-risk for these
events (ramipril). Decrease in progression of diabetic nephropathy (captopril).
(PO)

Irbesartan
Candesartan
Losartan
Valsartan

T: Avapro
T: Atacand
T: Cozaar
T: Diovan

Classification: Therapeutic antihypertensives

Pharmacologic angiotensin II receptor antagonists

Action: Blocks vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites, including vascular smooth
muscle and the adrenal
Metabolized: Liver
Uses: management of hypertension. Treatment of diabetic nephropathy in patients with type 2 diabetes and hypertension
(irbesartan and losartan only). Management of CHF in patients who cannot tolerate ACE inhibitors (candesartan and
valsartan only) or in combination with an ACE inhibitor and beta-blocker (candesartan only). Prevention of stroke in patients
with hypertension and left ventricular hypertrophy (losartan only). Reduction of risk of death from cardiovascular causes in
patients with left ventricular systolic dysfunction after MI (valsartan only).
Side Effects: CNS: dizziness, anxiety, depression, fatigue, head- ache, insomnia, weakness. CV: hypotension, chest pain,
edema, tachycardia.
Desired Outcomes: Decrease in blood pressure with out appearance of excessive side effects. Slowed progression of
diabetic nephropathy (irbesartan, losartan).Decreased cardiovascular death and CHF elated hospitalizations in patients with
CHF (candesartan). Decreased hospitalizations in patients with CHF (valsartan). Decreased risk of cardiovascular death in
patients with left ventricular systolic dysfunction after MI (valsartan). Reduced risk of stroke in patients with hypertension and
left ventricular hypertrophy (losartan).

Amlodipine

T: Norvasc (PO)
Classification: Therapeutic antihypertensives
Pharmacologic calcium channel blockers
Action: Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in in- hibition of excitationcontraction coupling and subsequent contraction.
Metabolized: Liver

Uses: management of hypertension, angina pectoris, and vasospastic (Prinzmetals) angina.

Side Effects: CNS: headache, dizziness, fatigue. CV: peripheral edema, angina, bradycardia, hypotension, palpitations.
Desired Outcomes: Decrease in blood pressure, in frequency and severity of angina attacks, in need for nitrate therapy.
Increase in activity tolerance and sense of well being.