ACE Inhibitors, ARB's, and Beta Blockers

Question 1

describe the mechanism of ACE inhibitors, expected pharmacological effects, therapeutic uses

Answer 1

MOA: reducing levels of angiotensin II through inhibition of ACE

expected effects: dilation of blood vessels, reduce blood volume, prevent or reverse pathologic changes in the heart and blood vessels mediated by angiotensin II and aldosterone.

therapeutic uses: treating HTN (reduce symptoms), heart failure, diabetic neuropathy (delay onset), MI.

Question 2

ae’s and nursing teaching points for ACE inhibitors

Answer 2

ae’s: first dose-hyPOtension, cough, hyperkalemia, renal failure, fetal injury, angioedema (LIFE-THREATENING)

nursing teaching points: lie down if hypotension develops
warn patients about the possibility of a cough and to call the provider if it’s bothersome
instruct patients to avoid potassium supplements and potassium containing salt substitutes unless they are prescribed by the provider.
warn women of child-bearing age that taking these drugs during pregnancy can cause major fetal injury.
instruct patients to seek medical help immediately if angioedema develops
advise patients to minimize NSAID use.
with neutropenia, inform patients about early signs of infection and to notify the prescriber if these occur.

Question 3

list advantagEs of ACE inhibitors over beta-blockers. What is the major reason patients STOP taking ACE inhibitors?

Answer 3

ACE inhibitors advantagEs: can hElp with a variety of conditions (heart failure, acute MI, LV dysfunction, diabetic/nondiabetic neuropathy), generally wEll tolerated by patients.

the major reason that patients stop taking ACE inhibitors is the cough

Question 4

regarding ARB’s-how does the mechanism of action differ from ACE inhibitors?

list therapeutic uses

how does a different moa impact the possible ae’s?

Answer 4

moa: blocking access of angiotensin II to its receptors in blood vessels, the adrenals, and all other tissues, thus causing dilation of arterioles and veins.

therapeutic uses: hypertension, heart failure, diabetic neuropathy, MI, stroke prevention, diabetic retinopathy, prevention of MI, stroke and death in patients at high cardiovascular risk.

being that the moa is different, the ae’s are impacted by not having hyperkalemia since the potassium isn’t affected, and also having a lower incidence of cough. But you need to be careful of angioedema, fetal harm if pregnant, and renal failure.

Question 5

recall the nursing implications in giving ACE inhibitors, ARB’s and Beta Blockers. Describe the associated patient teaching for these meds.

ACE INHIBITORS:

Answer 5

All ace inhibitors are given orally except enalaprilat (IV).

first dose hypotension-instruct patient to lie down if hypotension develops
cough-warn patients about the possibilty of a cough (productive or non-productive) as a side effect
hyperkalemia: instruct patients to avoid potassium supplements or supplements with potassium containing salt substitutes
fetal injury: warn women of child-bearing age that ACE inhibitors can cause great harm to the fetus
angioedema: instruct patients to seek IMMEDIATE medical attention if symptoms of angioedema develop.
neutropenia *mainly with captopril: inform patients about early signs of infection (fever, sore throat, mouth sores, and instruct them to notify the prescriber if these occur.
NSAIDs: advise patients to minimize NSAID use.

Question 6

recall the nursing implications in giving ARB’s and describe the associated patient teaching for these medications

Answer 6

all ARB’s are given orally, with or without food.

ae’s:
angioedema (swelling of the tounge, glottis and pharynx)–instruct patients to seek immediate medical attention should symptoms develop
fetal injury: warn women of childbearing age that ARBs can cause fetal injury during the second and third trimester of pregnancy, and may pose a risk earlier in pregnancy as well.

Question 7

recall the nursing implications for Beta blockers and describe the associated patient teaching that comes with.

Answer 7

help patients develop and exercise program encourage patients to consume no more than 2300 mg of salt daily
DASH diet
limit alcohol consumption to 1 ounce a day
smoking cessation

educate patients about the long term effects of hypertension
make sure that patients know the treatment goal
encourage patients to be an active participant in their own recovery
teach patients to self monitor their bp and maintain a bp record.