Anti-Hypertensive Therapy: Part 1 Flashcards
α2 agonists a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol d. Lisinopril e. losartan f. aliskiren
a. clonidine, methyldopa
• α1 blockers a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol d. Lisinopril e. losartan f. aliskiren
b. prazosin
• ß blockers a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol d. Lisinopril e. losartan f. aliskiren
c. metoprolol
carvedilol, propranolol, labetalol
•ACE Inhibitors a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol d. Lisinopril e. losartan f. aliskiren
d. Lisinopril
•ARBs a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol d. Lisinopril e. losartan f. aliskiren
e. losartan
•Direct Renin Inhibitor a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol d. Lisinopril e. losartan f. aliskiren
f. aliskiren
.Sympathetic Nervous System a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol d. Lisinopril e. losartan f. aliskiren
a. clonidine, methyldopa
b. prazosin
c. metoprolol
carvedilol, propranolol, labetalol
2.Renin-Angiotensin-Aldosterone System (RAAS)
a. clonidine, methyldopa
b. prazosin
c. metoprolol
carvedilol, propranolol, labetalol
d. Lisinopril
e. losartan
f. aliskiren
d. Lisinopril
e. losartan
f. aliskiren
USED TO TREAT ◦ MAIN USE #1: Benign prostatic hyperplasia (BPH) a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol d. Lisinopril e. losartan f. aliskiren
b. prazosin
USED TO TREAT ◦ MAIN USE # 2: Bladder Outlet Obstruction (kidney stones!) a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol d. Lisinopril e. losartan f. aliskiren
b. prazosin
• defined as a fall in blood pressure brought on by moving from a supine
or seated position to an upright position
a. ORTHOSTATIC/POSTURAL HYPOTENSION
b. REFLEX TACHYCARDIA
a. ORTHOSTATIC/POSTURAL HYPOTENSION
◦ Caused by dilation of arteries/veins (sudden drop in BP)
a. ORTHOSTATIC/POSTURAL HYPOTENSION
b. REFLEX TACHYCARDIA
b. REFLEX TACHYCARDIA
ADVERSE EFFECTS ◦ First dose Orthostatic (postural) hypotension ◦ Reflex tachycardia ◦ Sexual dysfunction ◦ Rebound hypertension a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
b. prazosin
ADMINISTRATION:
◦ Common to see this drug class given at bedtime to reduce
risk for postural/orthostatic hypotension
a. clonidine, methyldopa
b. prazosin
c. metoprolol
carvedilol, propranolol, labetalol
b. prazosin
NURSING PROCESS ASSESSMENT- Check Blood pressure before giving a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
b. prazosin
NURSING PROCESS PLAN/IMPLEMENTATION- Educate about sexual dysfunction, “first dose phenomenon”, never stop suddenly a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
b. prazosin
NURSING PROCESS EVALUATION- Increased Urine Output, relief of retention symptoms, lower Blood Pressure a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
b. prazosin
NURSING PROCESS Orthostatic hypotension/reflex tachycardia a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
b. prazosin
ADMINISTRATION Patients often times take at bedtime to avoid the “first dose” phenomenon a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
b. prazosin
USED TO TREAT: ADHD, Pain Management (epidurals) a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
clonidine
USED TO TREAT: ◦ Withdrawal- Substance Use Disorders a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
clonidine
USED TO TREAT: ◦ Symptoms of Withdrawal- Opioid Withdrawal a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
clonidine
USED TO TREAT: - Used for Hypertension in pregnancy a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
methyldopa
ADVERSE EFFECTS: ◦ Drowsiness/CNS Depressant ◦ Dry Mouth ◦ Rebound Hypertension ◦ Orthostatic Hypotension a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
a. clonidine, methyldopa
NURSING CONSIDERATIONS: ◦ Reassure clients that dry mouth usually resolves in 2 to 4 weeks. a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
a. clonidine, methyldopa
◦ Encourage clients to chew gum or suck on hard candy, and to take small amounts of water or ice chips. a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
a. clonidine, methyldopa
a. clonidine, methyldopa
NURSING CONSIDERATIONS:
◦ Reassure clients that dry mouth usually resolves in ? to ? weeks.
2 to 4
is a tablet ◦ Used daily and PRN a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
clonidine
is a Patch ◦ once weekly patch a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
clonidine
Adverse Side effect ◦ Dry Mouth a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
a. clonidine, methyldopa
Which it true to APPLY to clonidine patch
◦ Hairless part of body
◦ Intact skin
◦ Clean with soap and water (Not Alcohol!)
Clean with soap and water
◦ (With Alcohol!)
◦ Hairless part of body
◦ Intact skin
◦ Clean with soap and water (Not Alcohol!)
◦ Prevent glycogenolysisin liver (further hypoglycemia) a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
c. metoprolol
carvedilol, propranolol, labetalol
Ischemic Heart Disease a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
c. metoprolol
carvedilol, propranolol, labetalol
Make sure to educate about sexual dysfunction a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
c. metoprolol
carvedilol, propranolol, labetalol
COUNSELLING POINT: Patients should immediately report a weight
gain of 2 lb or more in 1 day or 5 lb or more in 1 week (WEIGH
DAILY)
a. clonidine, methyldopa
b. prazosin
c. metoprolol
carvedilol, propranolol, labetalol
c. metoprolol
carvedilol, propranolol, labetalol
SUDDEN STOPPAGE- MAY CAUSE MYOCARDIAL INFARCTION a. clonidine, methyldopa b. prazosin c. metoprolol carvedilol, propranolol, labetalol
c. metoprolol
carvedilol, propranolol, labetalol
ACE-Inhibitors, the “?”
prils
sartans
Aliskiren
prils
Angiotensin II Receptor Blockers (ARBS), the “?”
prils
sartans
Aliskiren
sartans
Direct Renin Inhibitor (DRI)s, only one out,?
prils
sartans
Aliskiren
Aliskiren
- Decreased aldosterone release
- Decreased vasoconstriction
- Decreases Preload and Afterload (SVR)
d. Lisinopril
e. losartan
f. aliskiren
d. Lisinopril
e. losartan
f. aliskiren
ADVERSE EFFECTS ◦ Hyperkalemia ◦ Chronic, non-productive cough ◦ Angioedema d. Lisinopril e. losartan f. aliskiren
d. Lisinopril
e. losartan
f. aliskiren
ADVERSE EFFECTS Bradykinin retention ◦ Very serious and can be fatal d. Lisinopril e. losartan f. aliskiren
d. Lisinopril
– BOXED WARNING: • Drugs that work on the RAAS can cause injury and death to a developing fetus d. Lisinopril e. losartan f. aliskiren
d. Lisinopril
e. losartan
f. aliskiren
Not recommended in pregnancy (class C in 1st
trimester and class D in 2nd/3rd trimester)
d. Lisinopril
e. losartan
f. aliskiren
d. Lisinopril
e. losartan
f. aliskiren
First dose orthostatic hypotension – Monitor blood pressure for 2 hr after initiation of treatment. d. Lisinopril e. losartan f. aliskiren
d. Lisinopril
e. losartan
f. aliskiren
◦ Rash- report! ◦ Altered Taste! ◦ Neutropenia d. Lisinopril e. losartan f. aliskiren
d. Lisinopril
◦ Neutropenia
d. Lisinopril
e. losartan
f. aliskiren
d. Lisinopril
◦ Rash- report!
d. Lisinopril
e. losartan
f. aliskiren
d. Lisinopril
◦ Altered Taste!
d. Lisinopril
e. losartan
f. aliskiren
d. Lisinopril
RAS?
d. Lisinopril
e. losartan
f. aliskiren
d. Lisinopril
DRUG INTERACTIONS ◦ Hyperkalemia d. Lisinopril e. losartan f. aliskiren
d. Lisinopril
e. losartan
f. aliskiren
DRUG INTERACTIONS ◦ Additive Hypotensive Effect (especially with diuretics) d. Lisinopril e. losartan f. aliskiren
d. Lisinopril
e. losartan
f. aliskiren
DRUG INTERACTIONS ◦ Lithium can accumulate, potential for toxicity d. Lisinopril e. losartan f. aliskiren
d. Lisinopril
e. losartan
f. aliskiren
DRUG INTERACTIONS ◦ COX Inhibitors/NSAIDs ◦ use can decrease effectiveness ◦ increase risk for AKI d. Lisinopril e. losartan f. aliskiren
d. Lisinopril
e. losartan
f. aliskiren
NURSING CONSIDERATIONS Avoid potassium supplements (+ Salt substitutes) d. Lisinopril e. losartan f. aliskiren
d. Lisinopril
e. losartan
f. aliskiren
MECHANISM OF ACTION ◦ blocks the binding of angiotensin II d. Lisinopril e. losartan f. aliskiren
e. losartan
Used to Treat HTN Post- MI Heart Failure d. Lisinopril e. losartan f. aliskiren
d. Lisinopril
e. losartan
f. aliskiren
Kidney Injury, Sexual dysfunction
d. Lisinopril
e. losartan
f. aliskiren
d. Lisinopril
e. losartan
f. aliskiren
MECHANISM OF ACTION ◦ direct renin inhibitor, resulting in blockade of the conversion of angiotensinogen to angiotensin I d. Lisinopril e. losartan f. aliskiren
f. aliskiren