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pharm exam 2
| Question | Answer |
|---|---|
| Digoxin Notes: | Used for heart failure. Controls rate it beats at and how it contracts. Monitor blood levels 0.5-2 ng/m? Antidote - digiphagm? Always check HR before. Below 60 don't really wanna give it. Looking for yellow and green halos(common sign of toxicity).< Brady |
| Blood Pressure | BP = CO x SVR Cardic output Systemic vascular resistance Hypertension = high BP 60 years or older: systolic blood pressure (SBP) of greater than 150 mm Hg or diastolic blood pressure (DBP) greater than 90 mm Hg Younger than 60 years and those who h |
| Classification of BP | Hypertension can also be defined by its cause. Unknown cause Essential, idiopathic, or primary hypertension 90% of cases Known cause Secondary hypertension 10% of cases |
| Antihypertensive Drugs | Medications used to treat hypertension Categories Adrenergic drugs Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Calcium channel blockers (CCBs) Diuretics Vasodilators Direct renin inhibitors |
| Adrenergic Drugs: Five Subcategories | Adrenergic neuron blockers (central and peripheral) Alpha2 receptor agonists (central) Alpha1 receptor blockers (peripheral) Beta receptor blockers (peripheral) Combination alpha1 and beta receptor blockers (peripheral). |
| Centrally Acting Adrenergic Drugs | Clonidine and methyldopa ** *Stimulate alpha2-adrenergic receptors in the brain *Decrease norepinephrine production Decrease sympathetic outflow from the central nervous system Stimulate alpha2-adrenergic receptors, thus reducing renin activity in the |
| Peripherally Acting Alpha1 Blockers | Doxazosin, prazosin, and terazosin Block alpha1-adrenergic receptors When alpha1-adrenergic receptors are blocked, BP is decreased. Dilate arteries and veins Alpha1 blockers also increase urinary flow rates and decrease outflow obstruction by preventi |
| Beta Blockers | Propranolol, metoprolol, and atenolol Reduction of the heart rate through beta1 receptor blockade Cause reduced secretion of renin Long-term use causes reduced peripheral vascular resistance. Reduced pumped outflow. Check HR and BP |
| Dual-Action Alpha1 and Beta Receptor Blockers | Labetalol and carvedilol Dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade) These can cause bronchoconstriction. |
| Adrenergic Drugs: Indications | All used to treat hypertension Glaucoma BPH: doxazosin, prazosin, and terazosin Management of severe heart failure (HF) when used with cardiac glycosides and diuretics |
| Adrenergic Drugs: | Adverse Effects High incidence of orthostatic hypotension Most common Bradycardia with reflex tachycardia Dry mouth Drowsiness, sedation Constipation Depression Edema Sexual dysfunction Other Headaches Sleep disturbances Nausea Rash Cardi |
| When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of a. hypotension. b. hyperkalemia. c. oliguria. d. respiratory distress. | Correct answer: A Rationale: These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy. |
| Alpha2-Adrenergic Receptor Stimulators (Agonists) | Clonidine and methyldopa Not typically prescribed as first-line antihypertensive drugs High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness Adjunct drugs to treat hypertension after other drugs have failed Used i |
| Alpha1 Blockers | doxazosin (Cardura) prazosin (Minipress) tamsulosin (Flomax)* terazosin (Hytrin) *Tamsulosin is not used to control BP but is indicated solely for symptomatic control of BPH |
| Doxazosin (Cardura) | Commonly used alpha1 blocker Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels |
| Dual-Action Alpha1 and Beta Receptor Blockers | Carvedilol (Coreg) Widely used drug that is well tolerated Uses: hypertension, mild to moderate HF in conjunction with digoxin, diuretics, and ACE inhibitors Contraindications: known drug allergy, cardiogenic shock, severe bradycardia or HF, bronchospa |
| Beta Receptor Blocker | Nebivolol (Bystolic) Uses: hypertension and HF Action: blocks beta1 receptors and produces vasodilatation, which results in a decrease in SVR Less sexual dysfunction** Do not stop abruptly; must be tapered over 1 to 2 weeks. |
| Angiotensin-Converting Enzyme (ACE) Inhibitors | Large group of safe and effective drugs Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic or CCB End in -pril |
| ACE Inhibitors | captopril (Capoten)* lisinopril (Prinivil) * benazepril (Lotensin) enalapril (Vasotec) fosinopril (Monopril) moexipril (Univasc) perindopril (Aceon) quinapril (Accupril) ramipril (Altace) trandolapril (Mavik) Common side effect of these is dry |
| ACE Inhibitors: Mechanism of Action | Inhibit ACE, which is responsible for converting angiotensin I (through the action of renin) to angiotensin II Angiotensin II is a potent vasoconstrictor and causes aldosterone secretion from the adrenal glands. Block ACE, thus preventing the formation |
| ACE Inhibitors: Indications | Hypertension HF (either alone or in combination with diuretics or other drugs) Slow progression of left ventricular hypertrophy after myocardial infarction (MI) (cardioprotective) Renal protective effects in patients with diabetes |
| A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her physician has never told her that she has hypertension. What is the best explanation for this order? a. The doctor knows best. b. The | Correct answer: D Rationale: ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for patients with diabetes. |
| ACE Inhibitors (Cont.) | Captopril and lisinopril are NOT prodrugs Prodrugs are inactive in their administered form and must be metabolized in the liver to an active form so as to be effective. Captopril and lisinopril can be used if a patient has liver dysfunction, unlike othe |
| A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? a. Clonidine b. Prazosin c. Diltiazem d. Captopril | Correct answer: D Explanation: Captopril is not a prodrug; therefore, it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease. |
| ACE Inhibitors: Mechanism of Action | Renin-angiotensin-aldosterone system ACE Inhibitors thus lower BP. |
| Primary Effects of the ACE Inhibitors | Cardiovascular and renal BP: reduce BP by decreasing SVR HF Prevent sodium and water resorption by inhibiting aldosterone secretion *Diuresis: decreases blood volume and return to the heart Decreases preload, or the left ventricular end-diastolic vol |
| Cardioprotective Effects of the ACE Inhibitors | ACE inhibitors decrease SVR (a measure of afterload) and preload. Used to prevent complications after MI Ventricular remodeling: left ventricular hypertrophy, which is sometimes seen after MI ACE inhibitors have been shown to decrease morbidity and mor |
| ACE Inhibitors: Adverse Effects | Fatigue Dizziness Headache Mood changes Impaired taste Possible hyperkalemia* Dry, nonproductive cough, which reverses when therapy is stopped Angioedema: rare but potentially fatal Note: First-dose hypotensive effect may occur. |
| Captopril (Capoten) | Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI Shortest half-life Must be administered multiple times throughout the day |
| Enalapril (Vasotec) * | Only ACE inhibitor available in both oral and parenteral preparations. Enalapril intravenous (IV) does not require cardiac monitoring Oral enalapril: prodrug Improves patient's chances of survival after an MI Reduces the incidence of HF |
| Angiotensin II Receptor Blockers | Also referred to as angiotensin II blockers Well tolerated Do not cause a dry cough -sartan valsartan (Diovan) irbesartan (Avapro) Similar to ACES but don't cause dry cough |
| Angiotensin II Receptor Blockers: Mechanism of Action | ARBs affect primarily vascular smooth muscle and the adrenal gland. Selectively block the binding of AII to the type 1 AII receptors in these tissues ARBs block vasoconstriction and the secretion of aldosterone |
| Comparison of ACE Inhibitors and Angiotensin II Receptor Blockers | ACE inhibitors and ARBs appear to be equally effective for the treatment of hypertension. Both are well tolerated. ARBs do not cause cough. Evidence that ARBs are better tolerated and are associated with lower mortality after MI than ACE inhibitors No |
| Angiotensin II Receptor Blockers: Indications Hypertension | Adjunctive drugs for the treatment of HF May be used alone or with other drugs such as diuretics ) Angiotensin II Receptor Blockers: Adverse Effects |
| Which statement about ARBs does the nurse identify as being true? a. Hyperkalemia is more likely to occur than when using ACE inhibitors. b. Cough is more likely to occur than when using ACE inhibitors. c. Chest pain is a common adverse effect. d. O | Correct answer: C Rationale: The most common adverse effects of ARBs are chest pain, fatigue, hypoglycemia, diarrhea, urinary tract infection, anemia, and weakness. Hyperkalemia and cough are less likely to occur than with the ACE inhibitors. Overdose m |
| Losartan (Cozaar) | Beneficial in patients with hypertension and HF Used with caution in patients with renal or hepatic dysfunction and in patients with renal artery stenosis |
| Calcium Channel Blockers | Primary use: treatment of hypertension and angina. Hypertension: cause smooth muscle relaxation by blocking the binding of calcium to its receptors, thereby preventing contraction |
| Calcium Channel Blockers: Mechanism of Action | Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction Results in: Decreased peripheral smooth muscle tone Decreased SVR Decreased BP |
| Calcium Channel Blockers: Indications | Angina *Hypertension: amloDIPINE (Norvasc) Dysrhythmias Migraine headaches Raynaud's disease Prevent the cerebral artery spasms after subarachnoid hemorrhage: nimodipine |
| Diuretics | First-line antihypertensives in the JNC 8 guidelines for the treatment of hypertension Decrease plasma and extracellular fluid volumes Results Decreased preload Decreased CO Decreased total peripheral resistance Overall effect Decreased workload of |
| Vasodilators | diazoxide (Hyperstat) *hydralazine (Apresoline) minoxidil nitroprusside (Nitropress) |
| Vasodilators: Mechanism of Action | Directly relax arteriolar or venous smooth muscle (or both) Results in: Decreased SVR Decreased afterload Peripheral vasodilation |
| Vasodilators: Indications | Treatment of hypertension May be used in combination with other drugs Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies. |
| Vasodilators: Adverse Effects | Hydralazine: dizziness, headache, anxiety, tachycardia, edema, dyspnea, nausea, vomiting, diarrhea, hepatitis, systemic lupus erythematosus, vitamin B6 deficiency(numbness and tingling), and rash Sodium nitroprusside: bradycardia, decreased platelet aggr |
| Vasodilators: Hydralazine (Apresoline)** | Orally: routine cases of essential hypertension Injectable: hypertensive emergencies BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients Respond differently to each hypertensive meds |
| Nursing Implications | Before beginning therapy, obtain a thorough health history and head-to-toe physical examination. Assess for contraindications to specific antihypertensive drugs. Assess for conditions that require cautious use of these drugs. For all these check HR a |
| Nursing Implications (Cont.) Educate patients about the importance of not missing a dose, or double dose, and taking the medications exactly as prescribed. Instruct patients to check with their physicians for instructions on what to do if a dose is mi | |
| Nursing Implications (Cont | Instruct patients that these drugs should not be stopped abruptly because this may cause a rebound hypertensive crisis and perhaps lead to stroke. Oral forms should be given with meals so that absorption is more gradual and effective. Administer IV form |
| Nursing Implications (Cont.) | Teach patients to change positions slowly to avoid syncope from postural hypotension. Instruct patients to report unusual shortness of breath; difficulty breathing; swelling of the feet, ankles, face, or around the eyes; weight gain or loss; chest pain; |
| Nursing Implications (Cont.) | Male patients who take these drugs may not be aware that impotence is an expected effect, and this may influence compliance with drug therapy. If patients are experiencing serious adverse effects or if they believe the dose or medication needs to be chan |
| Nursing Implications (Cont.) | Male patients who take these drugs may not be aware that impotence is an expected effect, and this may influence compliance with drug therapy. If patients are experiencing serious adverse effects or if they believe the dose or medication needs to be chan |
| Nursing Implications (Cont.) | Hot tubs, showers, or baths; hot weather; prolonged sitting or standing; physical exercise; and alcohol ingestion may aggravate low BP, leading to fainting and injury; patients should sit or lie down until symptoms subside. Patients should not take any o |
| Nursing Implications (Cont.) | Educate patients about lifestyle changes that may be needed. Weight loss Stress management Supervised exercise Dietary measures Monitor for adverse effects (dizziness, orthostatic hypotension, fatigue) and for toxic effects. Monitor for therapeutic |
| ACE Inhibitors and Laboratory Values | ACE inhibitors can cause renal impairment, which can be identified with serum creatinine. ACE inhibitors can also cause hyperkalemia, so potassium levels need to be monitored |
Created by:
Jrachele35
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