00:00 / 00:00
|DRUG NAME||hydralazine (Apresoline), minoxidil (Loniten), |
sodium nitroprusside (Nipride, Nitropress)
*High Alert Medication*
|MECHANISM OF ACTION||Prevent the increase of intracellular calcium concentration within vascular smooth muscle cells → vasodilation → reduced total peripheral resistance and blood pressure|
|ROUTE(S) OF ADMINISTRATION|
|CONTRAINDICATIONS AND CAUTIONS|
|NURSING CONSIDERATIONS: DIRECT-ACTING VASODILATORS|
|ASSESSMENT AND MONITORING||Baseline assessment|
Direct-acting vasodilators are a class of antihypertensive medications that are used for severe refractory hypertension, malignant hypertension, and hypertensive emergencies. These medications include hydralazine, which can be administered orally, intravenously, and intramuscularly; minoxidil, which can be administered orally or topically; and sodium nitroprusside, which is given intravenously.
Once administered, direct acting vasodilators rapidly work on the vascular smooth muscle cells by preventing the increase of intracellular calcium concentration.
Now, since direct acting vasodilators tend to work rapidly, they can result in sudden vasodilation and hypotension. This may lead to side effects, including dizziness, headache, reflex tachycardia, palpitations, and edema.
Other side effects include nausea, vomiting, and gastrointestinal distress. So to counteract side effects like reflex tachycardia and edema, direct acting vasodilators can be used in combination with beta-blockers or diuretics, but under close monitoring for adverse effects.
Now, through an unclear mechanism, hydralazine may trigger a lupus-like syndrome, which can involve multiple organs. Clients may experience severe malaise, myalgia, arthralgia, pericarditis, and hepatosplenomegaly, and upon blood tests, they may present with leukopenia, thrombocytopenia, and positive autoantibodies.
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