Antihypertensive Drugs Flashcards
Describe Hydrochlorothiazide (type of drug, Indications, Action, Contraindication, Cautious Usage, Adverse Reactions/Side Effects)
Diuretic
Indications: Management of mild to moderate hypertension
Action (look at eq’n on slides):
- Increases excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule
- Promotes excretion of chloride, potassium, magnesium, and bicarbonate.
- Inhibits the sodium-chloride co-transporter in the early section of the distal convoluted tubule.
- Less potent than loop diuretics
Contraindication: Lactation
Use cautiously in:
- Renal or hepatic impairment
- Pregnancy: Concerns around fluid balance
- Diabetes: Can impair insulin sensitivity, increase hepatic glucose production, and impair peripheral uptake
- Gout: Increased urate reabsorption in the proximal renal tubules→ increased risk for gout
Adverse reactions/side effects:
- Symptomatic hypotension
- Hypokalemia
- Gout – decreases uric acid excretion -> increase serum uric acid -> gout
- Hyperglycemia - Exact mechanism is unknown. Theory: worsening insulin resistance, inhibition of glucose uptake, and decreased insulin release.
- Hypercalcemia – Reduces urine calcium excretion and stimulates bone formation
What should you describe in Hydrochlorothiazide nursing implication and patient/family teaching?
Nursing implications:
- Monitor BP
- Monitor intake, output, and daily weights
- If hypokalemia occurs, consideration may be given to potassium supplements, decreasing dose, or even holding medication
- Monitor kidney function
Patient/family teaching:
- Instruct patient to monitor weight biweekly and notify health care professional of significant changes
- Caution patient to change positions slowly to minimize orthostatic hypotension
- Instruct patient to discuss dietary potassium requirements with health care professional
Describe B-Receptors-Selective Metroprolol/Bisoprolol (type of drug, Indications, Action, Contraindication, Cautious Usage, Adverse Reactions/Side Effects)
Adrenergic Drug
Indications: Hypertension
Action:
- Blocks stimulation of beta1 (myocardial)-adrenergic receptors
- Does not usually affect beta2 (pulmonary, vascular, uterine)-adrenergic receptors
Contraindications:
- Decompensated HF – negative chronotropic drugs can decrease force of contraction and these patients need force of contraction
- Cardiogenetic shock – same as above
- Bradycardia
- Heart block
Use cautiously in:
- Renal impairment
- Hepatic impairment
- Asthma – at higher doses, they may obtain affinity for B2 receptors
- Diabetes - can mask normal symptoms of hypoglycemia
Adverse reactions/Side effects:
- Bradycardia
- HF – in patients with decompensated HF
- Pulmonary edema – same as above
- Hypotension
- Weakness
- Fatigue
- Erectile dysfunction – restriction of blood flow
What should you describe in B-Receptors-Selective Metroprolol/Bisoprolol nursing implication and patient/family teaching?
Nursing implications:
- Monitor BP, ECG, and pulse frequently during dose adjustment and periodically during therapy.
- Monitor VS and ECF every 5-15 min during and for several hrs after IV administration.
- If HR <40 bpm, especially if cardiac output is also decreased, administer atropine
Patient/family teaching:
- Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia
- Teach patient and family how to check pulse daily and BP biweekly and to report significant changes to HCP
- May cause drowsiness. Caution patient to avoid driving or other activities that require alertness until response to the drug is known
Describe Ramipril (type of drug, Indications, Action, Contraindication, Cautious Usage, Adverse Reactions/Side Effects)
ACE Inhibitor
Indication:
- Alone or with other agents in the management of hypertension
Action:
- Block the conversion of angiotensin I to the vasoconstrictor angiotensin II
- Prevent the degradation of bradykinin and other vasodilatory prostaglandins
- Increase plasma renin levels and decrease aldosterone levels
- Net result: systemic vasodilation
Contraindicated in:
- *Known drug allergy (Especially with a previous reaction of angioedema) – swelling of skin
- *High Potassium (5 mmol/L or greater) – potassium not excreted as much
- *Kidney disease or function decline
- Women who are pregnant, lactating, or breastfeeding – causes congenital malfunctions
- Children
- Bilateral renal artery stenosis – lack of perfusion to the kidneys
Use cautiously in:
- Renal impairment
- Hepatic impairment
- Concurrent diuretic therapy
Adverse reactions/side effects:
- Fatigue, dizziness, mood changes, and headaches.
- Dry non-productive cough* (bradykinin accumulation-through RASS), loss of taste
- Angioedema* which can lead to anaphylaxis – often the first time they take the med.
- Serum electrolyte imbalance:*
- Monitor for hyperkalemia
What should you describe in Ramipril nursing implication and patient/family teaching?
Nursing implications:
- Assess patient for sings of angioedema (swelling of face, extremities, eyes, lips, tongue, difficulty in swallowing or breathing). May occur at anytime of the therapy, but usually after initial doses.
- Monitor renal function
Patient/family teaching:
- Medication interactions with NSAIDS (ibuprofen)(constrict the efferent arterials of the kidneys – risk for AKI), & potassium-sparing diuretics
- Risk for hypotensive events
- Risk for kidney injury*
Describe Candesartan (type of drug, Indications, Action, Contraindication, Cautious Usage, Adverse Reactions/Side Effects)
Angiotensin II Receptor Antagonist
Indication: Alone or with other agents in the management of hypertension
Action: Blocks vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites, including vascular smooth muscle and the adrenal glands
Contraindicated in:
- 2nd or 3rd trimester of pregnancy
- Lactation
- Not to be given with ACE inhibitor due to potential kidney damage*
Use cautiously in:
- Caution in kidney dysfunction*
Adverse effects/side effects:
- Fatigue, dizziness, mood changes, and headaches.
- Angioedema* which can lead to anaphylaxis – often the first time they take the med.
- Serum electrolyte imbalance:*
- Monitor for hyperkalemia
What should you describe in Candesartan nursing implication and patient/family teaching?
Nursing implications:
- Assess patient for sings of angioedema (swelling of face, extremities, eyes, lips, togue, difficulty in swallowing or breathing). May occur at anytime of the therapy, but usually after initial doses.
- Monitor renal function
Patient/family teaching:
- Medication interactions with NSAIDS (ibuprofen)(constrict the efferent arterials of the kidneys – risk for AKI), & potassium-sparing diuretics
- Risk for hypotensive events
- Risk for kidney injury*
Describe Amlodipine (type of drug, Indications, Action, Contraindication, Cautious Usage, Adverse Reactions/Side Effects)
Calcium Channel Blockers
Indication: Hypertension (as monotherapy or in combination with other antihypertensive agents)
Action: Inhibits the transport of calcium into the myocardial and vascular smooth muscle cells -> inhibition of excitation-contraction coupling and subsequent contraction
Contraindication:
- Acute MI*
- Second or Third-Degree AV block (no pacemaker)*
- 2nd or 3rd trimester of pregnancy
- Lactation
Use cautiously in: Renal impairment
Adverse effects/side effects:
- Reflex tachycardia, peripheral edema*
- Rashes and flushing
- Arrhythmias, heart block, heart failure
- Excessively low BP, dizziness, dyspnea
What should you describe in Amlodipine nursing implication and patient/family teaching?
Nursing implications:
- Monitor BP and pulse before therapy, during dose titration, and periodically during therapy
- Monitor ECG periodically if prolonged therapy
Patient/family teaching:
- Take CCBs with a meal or glass of milk to protect stomach
- Avoid grapefruit juice (increases the bioavailability of the meds)* and alcohol
- Don’t stop abruptly (reflex tachycardia)!
Describe Aspirin (type of drug, Indications, MOA, Evaluation/Desired Outcome, Contraindication, Cautious Usage, Adverse Reactions/Side Effects, Drug-Drug Interactions)
Antiplatelet therapy
Indication:
- Prophylaxis of transient ischemic attacks and myocardial infarction
- Antiplatelet agent
Mechanism of action:
- Inhibits the production of prostaglandins -> decreases platelet aggregation
- Irreversibly inhibits cyclooxygenase-1 and prevents platelet-dependent thromboxane formation
Evaluation/desired outcome:
- Prevention of TIA
- Prevention of MI
Contraindications:
- 30 weeks of gestation
- Bleeding disorders
- Thrombocytopenia – People who have low platelet counts (e.g., Leukemia, HIV, Sepsis)
Use cautiously in:
- History of GI bleed or ulcer disease
- Chronic alcohol use
- Severe hepatic and/or renal disease
Adverse effects/side effects:
- GI Bleeding
- Epigastric distress and nausea
- DRESS – Drug Reaction with Eosinophilia and Systemic Symptoms
- Severe drug reaction
- Involves severe skin rash, lymphadenopathy (swelling of lymph nodes), eosinophilia (too many eosinophils), and lymphocytosis (increased WBCs)
Drug-drug interactions:
- May increase the risk of bleeding with warfarin, heparin, clopidogrel, or eptifibatide – However, these agents are often used safely in combination and in sequence.
- Ibuprofen – may negate the cardioprotective antiplatelet effects of low-dose aspirin
What should you describe in Aspirin nursing implication and patient/family teaching?
Nursing implications:
- Patients who have asthma, allergies, and nasal polyps are at an increased risk for developing hypersensitivity reactions (NTK)
- Aspirin-induced asthma (AIA) – clinical triad of asthma, chronic rhinosinusitis with nasal polyps, and asthma and rhinitis attacks in response to aspirin
(FYI)
- Pathway for AIA is complex and not fully understood (FYI)
- Theory: Inhibition of COX-1 -> cysteinyl leukotrien -> bronchoconstriction and increased mucus production (FYI)
- Monitor for toxicity/overdose: tinnitus, headache, hyperventilation, agitation, mental confusion
- Monitor for signs and symptoms of DRESS during therapy. If it does occur, stop treatment and call MRP
Patient/family teaching:
- Instruct patient to take with a full glass of water and to remain in an upright position for 15-30 min after administration
- Advise patient to report tinnitus, unusual bleeding of gums, bruising, black and tarry stools
- Caution patient to avoid concurrent use of alcohol with this medication – 3 or more glasses of alcohol per day may increase risk of GI bleeding
Describe Atorvastatin (type of drug, Indications, MOA, Evaluation/Desired Outcome, Contraindication, Cautious Usage, Adverse Reactions/Side Effects, Drug-Drug Interactions)
Lipid Lowering Therapy: HMG-CoA Reductase
Inhibitors (Statins)
Indication:
- Adjunctive management of primary hypercholesterolemia and mixed dyslipidemias
- Primary prevention of CVD – decreased risk of MI or stroke in patients with multiple risk factors for CAD
Mechanism of action: Inhibit HMG-CoA reductase enzyme – an enzyme responsible for catalyzing an early step in the synthesis of cholesterol
Evaluation/desired outcome:
- Decrease in LDL and total cholesterol levels
- Increase in HDL
- Decrease in triglyceride
- Slowing of the progression of CAD
- Prevention of CVD
Contraindications:
- Active liver disease – extensively metabolized in the liver
- Pregnancy
- Lactation
Use cautiously in:
- History of liver disease
- Increased alcohol use
Adverse effects/side effects:
- Rhabdomyolysis – breaking down of skeletal muscle fibers
- Most common complaint – muscle pain throughout body
- Risk: heart and kidney complications due to the release of amino acids and electrolytes into the circulation when the muscle fibers breakdown
Drug-drug interactions:
- No common ones
What should you describe in Atorvastatin nursing implication and patient/family teaching?
Nursing implications:
- Obtain dietary history, especially with regards to fat consumption
- Monitor liver function tests before initiating therapy and if signs of liver injury (e.g., fatigue, anorexia, right upper abd ominal
discomfort, dark urine, or jaundice) occur
- If patient develops muscle tenderness during therapy, monitor creatine kinase (CK) levels
- CK: Enzymes found in your skeletal (CK-MM) and heart muscles (CK-MB). Released into the blood stream when there is cellular damage.
- If CK levels are > 10 times the upper limit of normal or myopathy occurs, therapy should be discontinued.
Patient/family teaching:
- Advise patient that this medication helps to control, but does not cure, elevated serum cholesterol levels. Therefore, medication should
be used in conjunction with diet restrictions, exercise, and cessation of smoking.
- Instruction patient to notify healthcare provider immediately if sings of liver injury or if unexplained muscle pain, tenderness, or
weakness occurs.
Describe Nitroglycerin (type of drug, Indications, MOA, Evaluation/Desired Outcome, Contraindication, Cautious Usage, Adverse Reactions/Side Effects, Drug-Drug Interactions)
Nitrate
Indication:
- Acute (translingual or sublingual) and long-term (oral, transdermal) prophylactic management of angina pectoris
- Antianginals
Mechanism of action:
- Vasodilation via relaxation of vascular smooth muscle cells
- Dilation of coronary arteries -> increases in coronary blood flow -> increase O2 supply
- Increased vasodilation -> decrease left ventricular end-diastolic pressure and left ventricular end-diastolic volume (decrease preload) -> decrease O2 demand
- Increased vasodilation -> decreased afterload -> decreased O2 demand
Evaluation/desired outcome:
- Decrease in frequency and severity of anginal attacks
- Increase in activity tolerance
Contraindications:
- Increased intracranial pressure – further will increase ICP with the vasodilation
- Inferior MI (Right Coronary Artery) -> RV infarct are preload dependent
- Pericardial tamponade – preload dependent
- Uncorrected hypovolemia – further will decrease preload
Use cautiously in:
- Head trauma
- Cerebral hemorrhage
- Pregnancy or lactation
- Hypertrophic cardiomyopathy – Preload dependent
Adverse effects/side effects:
- Symptomatic hypotension
- Reflex tachycardia - over compensation by the heart
- Syncope
- Headaches
- Contact dermatitis – for those using a patch
Drug-drug interactions: Additive hypotension with antihypertensives and other vasodilators (e.g., erectile dysfunction drugs)
