Beta Blockers, Antianginals, Ace Inhibitors, ARBs Flashcards
What are selective beta blockers vs non-selective
Cardio selective only block beta 1 receptors in heart, while non-selective block both beta 1 and 2
What is the difference between beta 1 receptors and beta 2 receptors
Beta 1 receptors are found in the heart (and kidneys) so their blockage causes cardiovascular effects, while beta 2 receptors are found in the lungs so their blockage causes bronchial effects as well as inhibition of glycogenolysis
Is propranolol selective or nonselective
Non selective
Propranolol indications
Angina, Hypertension, Cardiac Dysrhythmias, MI, Migraine Prophylaxis, Stage fright, Hypothyroidism, pheochromocytoma, glaucoma
What VS are important to observe before administering Propranolol
BP and HR
What are the 3 objectives of antianginal therapy
- Minimize the frequency and duration of attacks and intensity of pain
- Improve patient’s functional capacity with as few side effects as possible
- Prevent or delay MI, decrease morbidity and mortality
What are the 3 types of angina
- Chronic Stable Angina: chronically narrowed arteries due to atherosclerosis, causes pain with increased demand
- Variant Angina: due to vasospasm, heart doesn’t get enough blood and causes pain
- unstable angina: like chronic angina, but clot causes total block of artery, leading to medical emergency
Which preparations of nitroglycerin are and aren’t affected by the the first pass effect
- first pass: oral
- No first pass: sublingual, translingual,transdermal, topical, IV
Which preparations of Nitroglycerin are rapid and brief, vs slow and long
Rapid and Brief: Sublingual, translingual, and IV
Slow and Long: Oral, transdermal, topical
What are the indications of rapid forms of nitroglycerin vs slower and longer lasting
Rapid: terminate ongoing angina, acute treatment, HF with MI or perioperative HTN
Slow: prophylaxis, long term protection
What is an important nursing consideration for antianginals regarding vitals
Decreases BP so ensure vitals are taken beforehand and mobilize patient slowly
What are the side effects of antianginals
Headache, orthostatic Hypotension, reflexive tachycardia, contact dermatitis, Tolerance
What is reflexive tachycardia caused by nitroglycerin
Because of the rapid vasodilation. BP is lowered by decreasing venous return and dilating arteries. This can activate baroreceptor reflex, causing sympathetic stimulation of the heart resulting in increased HR and contractile force (cardiac demand) which negates the purpose of the nitro in the first place.
What 3 things trigger the RAAS cycle
Low Na, Low water, High K+
Ace Inhibitors MOA
Inhibit the conversion of A1->A2 in the lungs by ACE
What are the Side effects of Ace inhibitors
Cough, angioedema, hypotension, lung hyperplasia, Hyperkalemia, renal failure, Anuria, teratogenic
What are important assessments to complete before administering Ace inhibitors
BP, K+, Na+
Why is it important to monitor potassium when giving Ace inhibitors
Can cause a buildup due to increased retention in the kidneys which can cause heart problems
What do ace inhibitors interact with
Other antihypertensives, lithium, NSAIDs, Diuretics, potassium increasing agents
Why is it important for patients using ACE inhibitors to start with a low dose, temporarily discontinue diuretics and monitor BP for first 2 hours after initial therapy
First dose hypotension
What is the difference between aces and arbs
Aces prevent A2 from forming, while ARBs block its effects, meaning ARBs pose less of a risk for cough and hyperkalemia
What ARB provides the most diverse range of treatment
Telmisartan
Which ACE inhibitor provides the most diverse range of treatment
Ramipril
What are the indications for the main ACE inhibitors
Ramipril (Everything)
Captopril (DN, MI)
Enalapril (RN, MI)
Trandopril (MI, HF)
Lisinopril (Acute MI)
Perindopril (LVD, MI)
What are the indications of the main ARBs
Telmisartan (prevention)
Losartan (DN, CVA)
Valsartan (HF, MI)
Irbesartan (DN)
Candesartan (HF)
What are the adverse effects of ARBs
Angioedema, teratogenic, renal failure
What do ARBs interact with
Antihypertensives
What are contraindications for Beta Blockers
Nonselectives shouldn’t be given to asthmatics, diabetics, pts with a history of anaphylaxis, or pts with cardiac or respiratory disorders
What are side effects of beta 1 blockades
Bradycardia, rebound cardiac excitement, AV heart block, HF, decrease output
What do beta blockers interact with
Calcium channel blockers and insulin
