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