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pharm test 4

pharm antihypertensive agents ch. 24

QuestionAnswer
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