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303 Med Surg > Antihypertensive Meds > Flashcards

Antihypertensive Meds Flashcards

1
Q

What is the Mechanism of Action of Thiazide Diuretics?(Chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide, metolazone)

A

Inhibits NaCl reabsorption in the distal convoluted tubule.
Increases the excretion of Na+ and Cl-
Initial decrease in ECF
Sustained decrease in SVR
Lowers BP moderately in 2-4 weeks

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2
Q

What is the Mechanism of Action for Loop Diuretics? (Bumetanide, Furosemide, Torsemide)

A

Inhibits NaCL reabsorption in the ascending limb of the loop of Henle.
Increases excretion of Na+ and Cl-
More potent than Thiazides, but shorter duration of action
Less effective for hypertension

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3
Q

What are the nursing considerations for Thizaide Diuretics?

A

Monitor for orthostatic hypotension, hypokalemia, and alkalosis
May potentiate cardiotoxins of Digoxin
NSAIDs can decrease diuretic and antihypertensive effects of thiazides
Advise patients to supplement with potassium rich foods.

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4
Q

What are the nursing considerations for Loop Diuretics?

A

Monitor for orthostatic hypotension and electrolyte abnormalities
Loop diuretics remain effective despite renal insufficiency
Diuretic effect of drug increases at higher doses

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5
Q

What is the mechanism of action for potassium-sparing diuretics? (Amiloride, Triamterene)

A

Reduce K+ and Na+ exchange in the distal and collecting tubules.
Reduce the excretion of K+, H+, Ca2+, Mg2+

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6
Q

What are the nursing considerations for potassium-sparing diuretics?

A

Monitor for orthostatic hypotension and electrolyte abnormalities
Contraindicated in patients with renal failure
Use with caution in patients also using ACE inhibitors or angiotensin II blockers.
Avoid K+ supplements and K+ rich foods

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7
Q

What is the mechanism of action for Aldosterone Receptor Blockers? (Spironolactone, Eplerenone)

A

Inhibit the Na+ retaining and K+ excreting effects of aldosterone in the distal and collecting tubules

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8
Q

What are the nursing considerations for Aldosterone Receptor Blockers?

A

Monitor for orthostatic hypotension and electrolyte abnormalities
Do not combine with K+ sparing diuretics or K+ supplements
Use with caution in patients also using ACE inhibitors or angiotensin II blockers.
Also classified as K+ sparing diuretics

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9
Q

What is the mechanism of action of central acting alpha adrenergic agonists? (Clonidine, methyldopa, guanfacine)

A

Reduces sympathetic outflow from the CNS

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10
Q

What are the nursing considerations for Central Acting Alpha Adrenergic Agonists?

A

Sudden discontinuation can cause withdrawal syndrome
Causes dry mouth
Increases sedation effects of alcohol and sedatives
Instruct patient about daytime sedation and avoidance of hazardous activities
Educate patient to take at night before bed

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11
Q

What is the Mechanism of Action of Peripheral Acting Alpha Adrenergic Agonists? (Reserpine)

A

Depletes central and peripheral stores of norepinephrine resulting in peripheral vasodilation decreasing SVR and BP

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12
Q

What are nursing considerations for Peripheral Acting Alpha Adrenergic Agonists?

A

Must be given BID
Contraindicated in patients with history of depression
Monitor mood and mental status regularly
Advise patient to avoid barbiturate, alcohol and opiates

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13
Q

What class of drugs do Central Acting Alpha Adrenergic Agonists and Peripheral Acting Alpha Adrenergic Agonists fall under?

A

Adrenergic inhibitors

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14
Q

What is the mechanism of action of Alpha I Adrenergic Blockers? (Doxazosin, prazosin, terazosin, phentolamine)

A

Block alpha-I adrenergic effects, producing peripheral vasodilation (decrease in SVR and BP)
Beneficial Effects on lipid profile
Phentolamine- blocks alpha-I adrenergic receptors, resulting in peripheral vasodilation (decreases SVR and BP)

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15
Q

What are nursing considerations of Alpha I Adrenergic Blockers?

A

Block alpha-I adrenergic effects, producing peripheral vasodilation (decrease in SVR and BP)
Beneficial Effects on lipid profile
Phentolamine- blocks alpha-I adrenergic receptors, resulting in peripheral vasodilation(decreases SVR and BP

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16
Q

What is the mechanism of action for CARDIOSELECTIVE Beta-1 Adrenergic blockers? (Acebutolol, atenolol, betaxolol, bisoprolol, esmolol, metoprolol, nebivolol)

A

Cardioselective agents block Beta-I adrenergic receptors
Reduce BP by blocking Beta-adrenergic effects
Decrease CO and reduce sympathetic vasoconstrictor tone
Decrease renin in the kidneys

17
Q

What are the nursing considerations for CARDIOSELECTIVE Beta Blockers?

A

Monitor PUlse and BP regularly
Use cautiously in patients with diabetes
Drug of choice in patient with a history of MI or HF
Less effective BP reduction in African American patients
Cardioselective agents lose cardioselectivity at higher doses

18
Q

What is the mechanism of action of NON-CARDIOSELECTIVE Beta Blockers? (Nadolol, pindolol, propranolol)

A

Non Selective agents block B-I and Beta adrenergic receptors
Reduce BP by blocking B-I and B-II adrenergic effects

19
Q

What are the nursing considerations for NON-CARDIOSELECTIVE Beta Blockers?

A

Monitor PUlse and BP regularly
Use cautiously in patients with diabetes
Drug of choice in patient with a history of MI or HF
Less effective BP reduction in African American patients
Cardioselective agents lose cardioselectivity at higher doses
May cause bronchospasm especially in patients with a history of asthma

20
Q

What is the mechanism of action for mixed alpha and beta blockers? (Carvedilol, labetalol)

A

Alpha-1, Beta-I, and Beta-II adrenergic blocking properties producing peripheral vasodilation and decreased heart rate.
Reduce CO, SVR, and BP

21
Q

What are the nursing considerations for mixed alpha and beta blockers?

A

Monitor Pulse and BP regularly
Use cautiously in patients with diabetes
Drug of choice in patient with a history of MI or HF
Less effective BP reduction in African American patients
Cardioselective agents lose cardioselectivity at higher doses
IV available for hypertensive crisis, however, patient must remain supine during administration

22
Q

What is the mechanism of action of Fenoldopam?

A

Activates dopamine receptors, resulting in systemic and renal vasodilation

23
Q

What are the nursing considerations for Fenoldopam?

A

IV use only for hypertensive crisis in hospitalized patients.
Use cautiously in patients with glaucoma
Patient should remain flat for 1 hour after administration

24
Q

What is the mechanism of action for Hydralazine and minoxidil?

A

Reduces SVR and BP by direct arterial vasodilation

25
Q

What are the nursing considerations for hydralazine and minoxidil?

A

V use for hypertensive crisis in hospital patient
BID oral dosage
Contraindicated in patients with CAD
Reserved for treatment of severe hypertension associated with renal failure and resistant to other therapy (Minoxidil)

26
Q

What is the mechanism of action for Na+ Nitroprusside?

A

Direct vasodilation reduces SVR and BP

27
Q

What class of drugs do Fenoldopam, Hydralazine, Minoxidil, and Na+ Nitroprusside fall under?

A

Direct vasodilators

28
Q

What is the mechanism of action for Angiotensin-Converting-Enzyme Inhibitors? (ACE) (-pril)

A

Inhibit ACE and reduce conversion of angiotensin I to angiotensin II
Inhibits AII vasoconstriction

29
Q

What are the nursing considerations for ACE inhibitors?

A

Aspirin and NSAIDs may reduce drug effectiveness
Addition of diuretic enhances drug effect
Should not be used with K+sparing diuretics
Can cause increase in serum creatinine
Inhibits breakdown of bradykinin which may cause a dry, hacking cough***
Captopril may be given PO for hypotensive crisis

30
Q

What is the mechanism of action for Angiotensin II Receptor Blockers? (ARBS) (-sartan)

A

Prevents action of Angiotensin II and produces vasodilation and increased Na+ and H2O excretion

31
Q

What are the nursing considerations for ARBS?

A

Full effect on BP may not be seen for 3-6 weeks***
Do not affect bradykinin levels: alternative for ACE Inhibitors
Should not be used with ACE Inhibitor in patients with kidney disease

32
Q

What is the mechanism of action for non-Dihydropyridines calcium channel blockers?

A

nhibit movement of Ca2+ across cell membrane resulting in vasodilation
Cardioselective resulting in decrease in HR and slowing of AV conduction (verapamil)

33
Q

What calcium channel blockers are non-dihydropyridines (myocardial selective)?

A

Diltiazem ER, Verapamil intermediate release, Verapamil Long-acting, Verapamil timed-release

34
Q

What are the nursing considerations for non-dihydropyridines Calcium channel blockers?

A

Use with caution in patients with HF
Serum concentration and toxicity of certain calcium channel blockers may be increased by grapefruit juice; avoid concurrent use
Used for SVT
Avoid in patients with 2nd or 3rd degree AV heart block or left ventricular systolic dysfunction

35
Q

What is the mechanism of action for dihydropyridines (vascular selective) calcium channel blockers?

A

Cause vascular smooth muscle relaxation resulting in decreased SVR and arterial BP

36
Q

What calcium channel blockers are dihydropyridines (vascular selective)?

A

Amlodipine, clevidipine, felodipine, isradipine, nicardipine sustained release, nifedipine long acting, nisoldipine

37
Q

What are the nursing considerations for dihydropyridine calcium channel blockers?

A

More potent peripheral vasodilators
Clevidipine is for IV use only
Use of sublingual short-acting nifedipine in hypertensive emergencies in unsafe and not effective
Serious adverse events such as CVA and MI have been reported
IV nicardipine is available for hypertensive crisis in hospitalized patients and the peripheral IV infusion site needs to changed q12h

303 Med Surg (5 decks)

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