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NURS202 Exam III Pt2
Antihypertensive Drugs- Actions,Indications,Adverse Effects (Except Diuretics)
| Question | Answer |
|---|---|
| Name the different classes of antihypertensive drugs. | adrenergics, angiotensin coverting enzyme (ACE), angiotensin II receptor blockers (ARB), calcium channel blockers, diuretics, vasodilators |
| Name the 5 subcategories of adrenergics. | centrally/peripherally adrenergic blockers centrally acting a2-receptor agonists peripherally acting a1-receptor blockers peripherally acting dual a1 and b receptor blockers peripherally acting b blockers (cardioselective: b1 nonselective: both b1 and |
| What is the mechanism of action of centrally acting a2-receptor agonists? | stimulate a2-adrenergic receptors in brain (reduces renin activity in the kidneys), sympathetic outflow from CNS decreased, norepinephrine production decreased |
| What is the result of a2-receptor agonists, b-blockers and dual action a1 and b-receptor blockers? | decreased BP |
| What is the mechanism of action of peripherally acting a1-blockers/antagonists? | block the a1-adrenergic receptors |
| What is the result of peripherally acting a1-blockers? | reduces SVR which decreases BP |
| What is the mechanism of action of b-blockers? | reduce BP reducing HR through b1-blockade, cause reduced secretion of renin, long-term use causes reduced peripheral vascular resistance (PVR) |
| What is the mechanism of action of dual action a1 and b-receptor blockers? | block the a1-adrenergic receptors, reduce HR (b1-receptor blockade), vasodilation (a1-receptor blockade) |
| What is the only centrally and peripherally acting neuron blocker still available in the U.S. and why is it rarely used? | resperine is rarely used due to frequent and adverse effects |
| What are indications for adrenergic centrally acting a2-receptor agonists? | usually used after other meds have failed because of adverse effects, severe dysmenorrhea, menopausal flushing, glaucoma,treatment of HTN either alone or with other meds |
| Which adrenergic centrally acting a2-receptor agonists can be useful in the management of withdrawal symptoms in opoid/nicotine dependent persons? | clonidine (Catapres) |
| What are indications for adrenergic peripherally acting a1-receptor blockers? | relieve symptoms of BPH, management of severe HF when used with cardiac glycosides and diuretics, HTN |
| What are some side effects of adrenergic drugs? | Most common: dry mouth, drowsiness, sedation, constipation Other: headaches, sleep disturbances, nausea, rash, cardiac disturbances (palpitations) |
| What is there a high incidence of with patients taking adrenergic drugs? | orthostatic hypotension which puts them at a high risk for falls |
| What is the mechanism of action of b-blockers? | act in the periphery, reduce HR due to b-blockade |
| What is the mechanism of action of dual a1 and b-receptor blockers? | act in the periphery at heart and blood vessels, reduce HR (b1-receptor blockade), cause vasodilation (a1-receptor blockade) |
| What are indications for ACE inhibitors? | HF (either alone or in combo with diuretics or other drugs- maybe combined with a thiazide diuretic or CCB), slow progression of L ventricular hypertrophy after an MI (cardioprotective), renal protective effects in patients with diabetes, HTN |
| What antihypertensive group of drugs is often used as the first-line drugs for HF and HTN? | ACE inhibitors |
| What antihypertensive group of drugs is the first choice for HTN in diabetic patients and/or patients with HF? | ACE inhibitors |
| What is the mechanism of action of ACE inhibitors? | inhibit angiotensin-converting enzyme -> stops angiotensin I from becoming (help of renin) angiotensin II (potent vasoconstrictor)-> stops aldosterone (stimulates H20 and Na+ resporption) secretion, stop bradykinin breakdown |
| What are the results of ACE inhibitors? | decreased BV and BP, decreased preload and afterload (systemic vascular resistance), vasodilation |
| What is preload? | total volume of blood in the left ventricle of the heart and the pressure it exerts before the left ventricle contracts |
| What is afterload? | mount of pressure exerted by the left ventricle when it contracts |
| What are adverse effects of ACE inihibitors? | dry non-productive cough which stops with drug use, fatigue, dizziness, headache, mood changes, impaired taste, possible hyperkalemia (worsens with diuretic), angioedema- rare, but serious, first dose hypotensive effect |
| What are indications of angiotensin II receptor blockers? | adjunctive drug for HF, used alone or with other meds like diuretics, for patients who cannot tolerate ACE inhibitors, HTN |
| What are adverse effects of ACE inhibitors? | upper resp infections, nasal congestion, back pain, insomnia, diarrhea, dyspnea, heartburn, fatigue, headache, dizziness less likely to have hyperkalemia |
| What is the mechanism of action of angiotensin II receptor blockers (ARB's)? | allow angiotensin to be converted to II, but block the receptors that receive angiotensin II block vasoconstriction and release of aldosterone |
| Why are ARB's better than ACE inhibitors? | they are newer, well tolerated and do not cause a dry cough |
| What is the mechanism of action of calcium channel blockers? | smooth muscle relaxation by blocking the binding of calcium to it's receptors, preventing muscle contraction, which causes decreased peripheral smooth muscle tone and decreased vascular resistance |
| What is the result of CCB's? | decreased BP |
| What are indications of CCB's? | angina, dysrhythmias, migraine headaches, raynaud's, HTN |
| What are adverse effects of CCB's? | hypotension, palpitations, tachycardia, constipation, nausea, rash, flushing, peripheral edema, dermatitis cardizem causes gingivitis |
| What is the mechanism of action of vasodilators? | directly relax arteriolar and/or venous smooth muscle |
| What are the results of vasodilators? | decreased afterload and peripheral vasodilation |
| What are indications of vasodilators? | oral diazoxide as an antihypoglycemic, sodium nitroprusside and IV diazoxide are for emergencies (ICU, codes, ER IV) |
| What adverse effects of vasodilators? | hydralazine: anemia,anxiety,dizzy,headache, tachycardia,nausea/vomiting,diarrhea, dyspnea,edema,nasal congestion sodium nitroprusside:bradycardia, hypotension,cyanide toxicity (rare) diazoxide: Na+/H20 retention, hyperglycemia in diabetics,see hydralazin |
| What nursing assessments should you make before beginning drug therapy? | thorough health hx and head to toe including drug allergies, check for contraindications and cautions to specific drugs, |
| What should a patient be educated about before taking these drugs? | try not to miss a dose, take exactly as prescribed, never double up on a dose-check with physician about what to do, monitor BP reg and keep log, encourage positive lifestyle changes |
| What nursing actions/implications are involved with these drugs? | oral forms should be given with meals so absorption is more gradual, admin IV forms with extreme caution and use an IV pump |
| What should patients be cautioned about before/while taking these drugs? | do not stop abruptly because of rebound hypertensive crisis which could lead to stroke, avoid smoking and eating high sodium foods, no other meds including OTC's(cold/cough) without approval |
| A patient should report the following: | unusual shortness of breath, difficulty breathing, swelling of feet,ankles,face or around eyes, weight gain/loss, chest pain, palpitations, excessive fatigue |
| What side effect for men could possibly influence compliance? | impotence, discuss if ED meds may be used (dr decision), question about s/s |
| What should a patient be educated about concerning hypotension? | change positions slowly to avoid postural hypotension, hot tubs, showers, baths or hot weather, prolonged sitting or standing, physical exercise and alcohol may aggravate low BP which could lead to syncope/injury. sit or lie down until symptoms are gone |
| What should you monitor for a patient taking these drugs? | adverse side effects, toxic effects, therapeutic effects: BP should be less than 130/90, patient with diabetes or renal disease BP is less than 130/80 |
| Which antihypertensive type meds have shown to be more effective in white patients? | b-blockers and ACE inhibitors |
| Which anithypertensive type meds have shown to be more effective in African American patients? | CCB's and diuretics |
Created by:
kgrabo99
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