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pharm test 4
pharm antihypertensive agents ch. 24
| Question | Answer |
|---|---|
| the nurse is administering antihypertensive drugs to older adult pt's. the nurse knows that which adverse effect is of most concern for these pt's? | hypotension |
| when giving antihypertensive drugs, the nurse must consider giving the first dose at bed time for which class of drugs? | alpha blockers such as doxazosin (cardura) |
| a 56 y/o man started antihypertensive drug therapy 3 mos. earlier and is in the office for a follow-up visit. the nurse takes BP, & he informs her that he has had problems w/ sexual intercourse. which would be the most appropriate response by the nurse? | "the physician can work with you on changing the dose and/or drugs" |
| when a pt. is being taught about the potential adverse effects of an ACE inhibitor, which of the following should the nurse mention as possibly occurring when this drug is taken to treat HTN? | dry, non productive cough (does not happen with ARB's) |
| a pt. has new prescription for a beta blocker. during a review of pt's list of current meds, which would cause concern for a possible interaction with this new prescription? | -benzodiazepine taken as needed for allergies -opioid used for occasional severe pain |
| Which is more dangerous high diastolic BP or high systolic BP? | High systolic BP (SBP) |
| WHich should be the initial drug therapy for patients with hypertension? | Thiazide-type diuretics **you use diuretics to get rid of volume (you get rid of salt and fluids follow the salt) |
| Adrenergic Agents #1: centrally and peripherally acting adrenergic neuron blocker **depletes norepinephrine stores in NT storage vesicles | Reserpine: the only centrally & peripherally acting neuron blocker in U.S **used if you have infiltration of an adrenergic drug b/c it dilates the blood vessels so you wouldnt lose that arm (lowers BP but also causes depression, so we dont like it) |
| Adrenergic Agents #2: centrally acting alpha2 adrenergic receptor agonists | norepinephrine production is decreased resulting in decreased BP |
| Adrenergic Agents #2: centrally acting alpha2 adrenergic receptor agonists | -clonidine (catapres)--> used for alcohol withdrawal -guanfacine (tenex) -methyldopa (aldomet)--> drug of choice for HTN in pregnancy |
| Adrenergic Agents #2: centrally acting alpha2 adrenergic receptor agonists | **also may be used for treatment of severe dysmenorrhea, menopausal flushing, glaucoma -clonidine is useful in the management of withdrawal symptoms in opioid- or nicotine-dependent persons |
| Adrenergic Agents #3: peripherally acting alpha1 receptor antagonists | block alpha 1 adrenergic receptors; SNS not stimulated -doxazosin (cardura) -prazosin (minipress) -terazosin (hytrin) |
| Adrenergic Agents #4: Beta blockers | act in periphery; reduce HR d/t beta1-blockade -propranolol (inderal), atenolol (tenormin) **WATCH OUT FOR 1ST DOSE FAINT EFFECT** |
| Adrenergic Agents #5: dual alpha1 and beta receptor blockers | -act in periphery at heart and blood vessels -reduce HR (beta1 blockade) -cause vasodilation (alpha1 blockade) **labetalol (normodyne), carvedilol (coreg) |
| ACE inhibitors indications **end in -pril | -HTN -HF (either alone or in combo with diuretics or other agents) -slows progression of left ventricular hypertrophy after an MI -renal protective effects in pt's with diabetes -drugs of choice in HTN pt's with HF |
| ACE inhibitors | -catopril (capoten)--> not a pro drug so it would be the drug of choice if pt had a liver problem b/c it does not need to be metabolized to be in its active form -enalapril (vasotec) -Lisinopril (prinivil, zestril), quinapril, benazepril, fosinopril, |
| side effects of ACE inhibitors | impaired taste, dry non productive cough, possible hyperkalemia (b/c u get rid of sodium when you take ACE inhibitors but you tend to hold on to your potassium) **1st dose hypotensive effect may occur! |
| Angiotensin II receptor blockers **end in -tan | DO NOT CAUSE DRY COUGH -losartan, valsartan, irbesartan **used primarily in pt's that cannot tolerate ACE inhibitors |
| calcium channel blockers | **used to treat angina, HTN, used in some cardiac diseases -benzothiazepines, phenylalkamines, dihydropyridines |
| vasodilators **these are given with beta blockers also b/c since BP lowers, HR speeds up so you give beta blocker to slow down the HR | -diazoxide -hydralazine (apresoline)--> used in pregnancy -sodium nitroprusside (nipride, nitropress) --> serious drugs given IV used in emergency cases **you can expect tachycardia with any of these; usually given with a beta blocker also |
| what is used for management of hypertensive emergencies? | vasodilators (sodium nitroprusside & diazoxide) |
| nursing implications | instruct pts not to stop these drugs abruptly b/c this may cause rebound hypertensive crisis, & perhaps lead to stroke **oral forms should be given with meals so absorption is more gradual and effective |
| nursing implications | men taking these agents may not be aware that impotence is an expected effect. This may influence compliance with drug therapy |
| what is the select prototype medication for ACE inhibitors? | catopril (capoten) |
| what is the select prototype medication for ARBs? | losartan (cozaar) |
| what are the major differences btwn ACE inhibitors and ARBs? | cough and hyperkalemia are not side effects of ARBS |
Created by:
lissy11
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