Blood Pressure Meds
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| What is the prototype for ACE inhibitors? | captopril (capoten)
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| What is the mechanism of action of ACE inhibitors? | blocks conversion of angiotension I to angiotension II which causes vasodilation and excretion of sodium and water, but retention of potassium.
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| What is the suffix associated with ACE inhibitors? | "ril" or "pril"
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| What are the therapeutic uses for ACE inhibitors? | Heart failure, HTN, MI, diabetic and nondiabetic nephropathy.
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| What are the adverse effects/nursing considerations for ACE inhibitors? | Orthostatic HTN
Dry Cough
Hyperkalemia
Rash
Angioedema- life threatening allergic reaction!
Neutropenia- emergency, but rare monitor WBC
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| What are the pt. teaching points of ACE inhibitors? | take one hour before meals on an empty stomach
don't take in pregnancy Category D medication
monitor for cough, ortho HTN, infections and rash
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| What is the prototype for ANgiotensin II Receptor Blockers (ARBS)? | losartan (cozar)
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| What is the mechanism of action of ARBS? | blocks action of angiotensin II and causes vasodilation and excretion of sodium and water.
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| What is the suffix associated with ARBS? | "tan"
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| What are the therapeutic uses for ARBS? | HF, HTN, MI, diabetic and nondiabetic nephropathy
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| What are the adverse effects of ARBS? | Angioedema- life threatening emergency
ortostatic HTN
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| What are the pt. teaching points of ARBS? | lifestyle modifications
give with food
don't take in pregnancy cat. D
monitor for adverse effects- orth HTN
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| What is the prototype of Aldosterone Antagonists? | eplerenone (Inspira)
spironolactone (aldosterone)
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| What is the mechanism of action of Aldosterone Antagonists? | blocks aldosterone promoting the excretion of sodium and water.
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| What are the adverse effects of Aldosterone Antagonists? | hyperkalemia/hyponatremia
lithium toxicity-monitor levels
avoid potassium supplements and other medications that increase potassium
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| What is the prototype for Calcium Channel Blockers? | Selective- adalat(Procardia)
nonselective- diltazem(Cardizem)
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| What is the mechanism of action of Calcium Channel Blockers? | blocking calcium channels causing relaxation of arteries (selective) and slowing of conduction through the AV nodes and decreases force of contraction (nonselective)
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| What suffix do some Calcium Channel Blockers have? | "pine"
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| What is the therapeutic use of Calcium Channel Blockers? | angina, hypertension, cardiac arrhythmias(nonselective only)
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| What are the adverse effects of Calcium Channel Blockers? | Reflect tachycardia(s)
peripheral edema (b)
hypotension(b)
Bradycardia/dysrhythmias (ns)
avoid beta-blockers and other meds that slow HR with nonselectives
Give IV verapamil (2-3 min); cardizem given continuous infusion
avoid in MI, shock or HF
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| What are the pt teaching points of Calcium Channel Blockers? | Don't take in pregnancy
monitor BP
follow up/don't stop until consult with physician
avoid grapefruit juice in both!
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| What is the prototype of Alpha Adrenergic Blockers (selective to alpha 1)? | prazosin(minipress)
doxazosin mesylate (cardura)
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| What is the mechanism of action of Alpha Adrenergic Blockers? | selectively blocks alpha 1 receptors causing venous and arterial vasodilation; smooth muscle relaxation in prostate and bladder neck (used for BPH)
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| What are the therapeutic uses for Alpha Adrenergic Blockers? | HTN, Benign prostatic hyperplasia (BPH)
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| What are the adverse effects of Alpha Adrenergic Blockers? | on first dose- ortho HTN- start low and monitor BP for 2 hrs after admin
dizziness- careful driving and with anything causing mental alertness
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| What are the pt teaching points of Alpha Adrenergic Blockers? | avoid in pregnancy
manage ortho HTN
take first dose before bed
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| What is the prototype for Centrally Acting Alpha 2 Agonists? | clonidine (catapress)
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| What is the mechanism of action of Centrally Acting Alpha 2 Agonists? | act within CNS to decrease sympathetic simulation of adrenergic receptors (both alpha 2 and beta) of heart and peripheral vascular system leading to lowered BP and HR.
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| What are the therapeutic uses for Centrally Acting Alpha 2 Agonists? | HTN and other investigational purposes
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| What are the adverse effects/pt teaching points of Centrally Acting Alpha 2 Agonists? | drowsiness/sedation
dry mouth
constipation
rebound HTN- don't stop suddenly
administer patch on hairless, clean, dry skin and be sure to remove old patch
avoid taking with alcohol and other meds that cause drowsiness
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| What is the prototype for Beta Adrenergic Blockers? | metoprolol (lopressor)- cardioselective for Beta 1
propanolol (Inderal)- nonselective also block beta 2
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| What is the mechanism of action of Beta Adrenergic Blockers? | blocking beta 1 causes decreased heart rate(negative chronitropic action), decreased myocardial contractility (negative intropic action), decreases rate of conduction through AV node (negative dromotropic action
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| What is the suffix for Beta Adrenergic Blockers? | "lol"
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| What are the therapeutic uses for Beta Adrenergic Blockers? | HTN, tachyarrhytmias, HF, and MI
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| What is an adverse effect specific to nonselective beta blockers? | will cause bronchioconstriction and decreased blood glucose levels.
Use VERY CAUTIOUSLY in pts with pulmonary disorders.
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| What are adverse effects of Beta Blockers? | bradycardia(both)- hold if HR is under 60
decreased cardiac output
ortho HTN
masked symptoms of hypoglycemia (beta 1)- monitor diabetics closely
do not give to pts experiencing AV blocks & bradycardia or if receiving other meds that decrease HR or BP
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| How should you give Beta Blockers? | intravenously and slowly (over 5 minutes)
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| What are the pt. teaching points of Beta Blockers? | do not stop taking abruptly- wean off over 2 weeks
ortho htn
monitor HR and BP at home
may cause sexual dysfunction
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| What is the prototype for Hypertensive Crisis? | nitroprusside (nipride)
also use calcium channel blockers and ACE inhibitors
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| What is the mechanism of action for Hypertensive Crisis Meds? | direct acting vasodilation of arteries and veins causes rapid decrease in blood pressure
only used in critical care units
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| What pts are at an increased risk for toxicity when given Hypertensive Crisis meds? | Pts who are in kidney and liver failure.
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| What are the adverse effects of direct-acting vasodilators? | extreme hypotension- do NOT give rapidly, between 0.3-4mcg/kg/min on infusion pump
constant monitor of BP and ECG
maintain bedrest
thicyanate toxicity (byproduct)
cyanide poisoning (byproduct of metabolism)
protect meds from light & discard in 24hrs
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| What medication should you avoid prolonged use of and not give after three days? | Direct-Acting vasodilators
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| What are some good things to remember about antihypertensive agents in genera? | teach lifestyle changes
manage ortho HTN
monitor BP/HR
don't stop suddenly
keep appoinments
don't take in pregnancy
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