Blood Pressure Agents

Question 1

What is angiotensin-converting enzyme responsible for?

Answer 1

converting angiotensin I to angiotensin II in the lungs

Question 2

What is the MOA of ACE inhibitors?

Answer 2

blocks ACE, which prevents the vasoconstriction and aldosterone release related to angiotensin II

Question 3

What are angiotensin II receptors?

Answer 3

specific receptors found in blood vessels and in the adrenal gland that react with angiotensin II to cause vasoconstriction and release of aldosterone

Question 4

What are baroreceptors?

Answer 4

Pressure receptors located in the arch of the aorta and in the carotid artery that respond to changes in blood pressure and influence the medulla to stimulate the sympathetic system to increase or decrease blood pressure

Question 5

What is the cardiovascular center and where is it located?

Answer 5

area of the medulla at which stimulation will activate the sympathetic nervous sytem to increase blood pressure and heart rate

Question 6

What is essential hypertension?

Answer 6

sustained blood pressure above normal limits with no discernible underlying cause

Question 7

What is peripheral resistance?

Answer 7

the force that resists the flow of blood through the vessels, mostly determined by the arterioles, which contract to increase resistance; important in determining overall blood pressure

Question 8

What is the ultimate goal of the Renin-Angiotensin System?

Answer 8

The RAAS system causes vasoconstriction and Na2+ and H2O retention which results in an increase in BP.

Increased BP and increased blood volume with increase perfusion to the kidney.

Question 9

How does HTN affect the RAAS system?

Answer 9

In the case of HTN, there is a miscommunication. The increased BP results in vasoconstriction so the kidneys don’t get as much pressure as they want so they release Renin and activate RAAS so they can try to get more blood.

BUT, it has the opposite effect b/c now we have vasoconstriction that decrease reduces blood flow further, which activates the RAAS again.

Question 10

What is shock?

Answer 10

Severe hypotension that can lead to accumulation of waste products and cell death

Question 11

What is stroke volume?

Answer 11

the amount of blood pumped out of the left ventricle with each beat

SV = end diastolic vol - end systolic vol

important in determining BP

Question 12

What is the formula for BP?

Answer 12

HR X SV

Question 13

Hypertension raises a patient’s risk for CAD. Explain the pathophysiology behind this risk.

Answer 13

HTN is due to increased peripheral resistance. This resistance causes thickening of the heart muscle. When it gets too thick, the heart cannot contract completely anymore, which causes hypertrophy, or enlargement of the heart. This causes congestive heart failure (CHF) and CAD.

Question 14

List 4 conditions related to untreated HTN:

Answer 14

CAD and Cardiac Death

Stroke

Renal Failure

Loss of Vision

Question 15

What is the nurse’s job concerning HTN and the patient?

Answer 15

Our job is to educate the patient about the risks of untreated HTN. Often patients see no symptoms of HTN and they don’t enjoy the lifestyle changes needed and adverse effects of the drugs, so they don’t want to continue. We need to teach them and be truthful.

Question 16

List 5 things that increase BP

Answer 16

High levels of psychological stress

Exposure to high-frequency noise

High-salt diet (leads to fluid retention)

Lack of rest (physiological stress)

Genetic predisposition

Question 17

Which blood pressure agents can we use with children?

Answer 17

Mild diuretics - monitor glucose and electrolytes

Calcium Channel Blockers

Beta-Blockers - Adverse effects are possible, so not the first choice

Question 18

Childhood hypertension is usually ______________.

Answer 18

secondary to a primary disease process.

Question 19

What are the signs of high BP?

Answer 19

HA
Vision Changes
Nosebleeds
Ringing in the ear

Question 20

Why is dehydration a complication of HTN?

Answer 20

It can cause hypotension.

It can cause hypertension. The brain releases vasopressin as a result of dehydration, which vasoconstricts vessels, increasing BP.

Also, when dehydrated, the kidneys decrease urine formation which causes the capillaries in the heart and brain to constrict, which increases BP.

The combo of vasopressin and kidney changes causes serious kidney damage and renal disease.

Question 21

How do blood pressure agents affect pregnancy and lactation? Which ones can we give?

Answer 21

Drugs enter breastmilk and can cause serious adverse effects, so we need to find an alternative to breastmilk.

IF benefits outweigh the risk, LABETALOL may be used in pregnancy.

Question 22

For older adults, we start _____ and go ________. Why?

Answer 22

low
slow

Because the elderly are more susceptible to toxic effects. Also, the metabolism has slowed and there may be underlying conditions that effect metabolism and excretion.

Question 23

We should monitor the elderly for dehydration. Why?

Answer 23

Older adults lack a thirst trigger, so they often don’t drink enough.

Question 24

What should we teach our patients about sustained-release or extended-release tablets of Blood Pressure meds?

Answer 24

Do not cut, crush, or chew them because it may cause a toxic dose.

Question 25

Should the nurse take BP before or after administering BP meds?

Answer 25

immediately before

Question 26

Explain hypOtension.

Answer 26

BP BECOMES TOO LOW When the heart muscle is damaged and unable to pump effectively With severe blood or fluid loss, the volume drops dramatically When there is extreme stress and the body's levels of NE are depleted, it leaves the body unable to respond to stimuli and raise BP.

Question 27

Step 1 of Care Management for HTN

Answer 27

Lifestyle modifications: Wt reduction, smoking cessation, moderation of alcohol intake, reduction of dietary salt, increase in aerobic physical activity

Question 28

Step 2 of Care Management for HTN

Answer 28

Result of inadequate response to step 1 Add drug therapy to lifestyle changes

Question 29

Step 3 of Care Management for HTN

Answer 29

Result of inadequate response to step 2 Consider change in drug dose or class, or addition of another drug for combined effect

Question 30

Step 4 of Care Management for HTN

Answer 30

Result of inadequate response to step 3 Second or third agent or diuretic is added if not already prescribed

Question 31

What is the suffix for ACE Inhibitors and what are the 5 we need to know?

Answer 31

"-PRIL" ``` benazePRIL captoPRIL enalaPRIL lisinoPRIL ramiPRIL ``` **NOTE: ACE Inhibitors can also end in "at", ex. ramiPRAT. The "-at" drugs have all the same MOAs and effects, they just work faster and stronger.

Question 32

What are the Labs to assess for before admin of ACE Inhibitors?

Answer 32

CBC | Electrolytes

Question 33

What should the nurse assess for before giving ACE Inhibitors?

Answer 33

Regular things Any Salt/Volume Depletion

Question 34

What are the nursing interventions to remember for ACE Inhibitors?

Answer 34

Make sure the patient implemented lifestyle changes and encourage the patient to continue Administer drugs on an empty stomach 1 hour before or 2 hours after meals Alert the surgeon and mark the patient's chart prominently if the patient is to undergo surgery

Question 35

What is the suffix for Angiottensin II Receptor Blockers and what are the 6 we need to know?

Answer 35

``` "-SARTAN" candeSARTAN irbeSARTAN loSARTAN olmeSARTAN telmiSARTAN valSARTAN ```

Question 36

What are the Labs to assess for before admin of Angiotensin II Receptor Blockers?

Answer 36

Renal/Liver Fxn

Question 37

What are the nursing interventions to remember for Angiotensin II Receptor Blockers?

Answer 37

Alert the surgeon and mark the patient's chart prominently if the patient is to undergo surgery Ensure that the female patient is not pg before beginning therapy and suggest the use of barrier contraceptives

Question 38

What is the Renin Inhibitor we need to know?

Answer 38

aliskiren

Question 39

What is the suffix for Calcium Channel Blockers and what are the 5 we need to know?

Answer 39

"-DIPINE" amloDIPINE feloDIPINE nifeDIPINE diltiazem verapamil

Question 40

What does the nurse assess for before admin of Calcium Channel Blockers?

Answer 40

Heart block | Sick sinus syndrome

Question 41

What nursing interventions to remember about Calcium Channel Blockers?

Answer 41

Monitor the patient's blood pressure, cardiac rhythm, and cardiac output

Question 42

What are the 3 Vasodilators we need to know?

Answer 42

Hydralazine Minoxidil (also used 4 hair regrowth) Nitroprusside

Question 43

What labs should the nurse look at before administering Vasodilators?

Answer 43

Renal/hepatic fxn | Blood glucose for diabetics (vasodilators decrease blood glucose)

Question 44

Which diuretics are used to lower BP?

Answer 44

Thiazides Potassium-sparing diuretics

Question 45

What is the suffix for Beta-Blockers and what are the 3 we need to know?

Answer 45

"-OLOL" atenOLOL metoprOLOL propranOLOL

Question 46

What labs should the nurse assess for before admin of Beta-Blockers?

Answer 46

Electrolytes | Renal/Hepatic Fxn

Question 47

What interventions should the nurse perform for patients on Beta-Blockers?

Answer 47

Take the apical pulse prior to administering Do not abruptly withdrawal medication b/c it causes chest pain, MI, and death Change position slowly Emphasize the importance of follow-up exams to monitor progress

Question 48

What is the suffix for Alpha-adrenergic Blockers and what are the 2 we need to know?

Answer 48

"-amine" phenoxybenzAMINE phentolAMINE

Question 49

What is a pheochromocytoma?

Answer 49

a benign tumor in the adrenal gland that results in too much hormone production. This leads to increased BP, sweating, HA

Question 50

What is the suffix for Alpha-1 Blockers and what are the 3 we need to know?

Answer 50

"-AZOSIN" doxAZOSIN prAZOSIN terAZOSIN

Question 51

What are the Alpha-2 agonists and what are the 3 we need to know?

Answer 51

Clonidine Guanfacine Methyldopa

Question 52

What are the 2 Alpha- and Beta- blockers we need to know?

Answer 52

Carvedilol | Labetalol

Question 53

What are the suffixes for Sympathetic adrenergic agonists, vasopressors, and what are the 6 we need to know?

Answer 53

"-AMINE" dobutAMINE dopMINE ``` "-RINE" ephedRINE epinephRINE norepinephRINE phenylephRINE ```

Question 54

What are the Blood Pressure-Raising/Orthostatic Hypotension Agents and what are the 2 we need to know?

Answer 54

Midodrine | Droxidopa

Question 55

What should a nurse assess for before administering a antihypertensive drug?

Answer 55

CV dysfunction: Vision problems Urinary Retention Pheochromocytoma

Question 56

What nursing interventions should the nurse perform when administering antihypertensive drugs?

Answer 56

Do not administer Midodrine or Droxidopa to patients who are bedridden Encourage the patient to void before taking a dose of the drug