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Pharm Exam 2 > BP Agents > Flashcards

BP Agents Flashcards

1
Q

Blood pressure is determined by….

A

Heart Rate
Stroke Volume: Amount of blood pumped out of the ventricle with each heartbeat
Total Peripheral Resistance: Resistance of the muscular arteries to the blood being pumped through
Baroreceptors
Renin-Angiotensin-Aldosterone system

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2
Q

Renin-Angiotensin System

A
  1. Decreased perfusion pressure in the afferent arteriole stimulates secretion of renin by the juxtaglomerular cells
  2. Liver produces angiotensinogen
  3. Activation of angiotensin I to angiotensin II occurs in the pulmonary capillary bed by converting enzyme
  4. Angiotensin II: powerful vasoconstrictor
  5. Angiotensin II becomes angiotensin III which causes the release of aldosterone from the adrenal cortex
  6. Aldosterone causes increased sodium and water reabsorption by the tubules of the kidney. Result is increased blood volume
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3
Q

Risks related to hypertension

A 
Coronary Artery Disease: thickening of the heart muscle; increased pressure generated by the muscle on contraction; increased workload of the heart
CAD and Cardiac Death
Stroke
Loss of vision
Renal failure
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4
Q

Normal BP

A

SBP <120 mm Hg and DBP <80 mm Hg

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5
Q

Elevated BP

A

SBP 120-129 mmHg and DBP <80 mm Hg

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6
Q

Hypertension Stage 1

A

SBP 130-139 mm Hg and DBP 80-89 mm Hg

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7
Q

Hypertension Stage 2

A

SBP >140 mm Hg and DBP >90 mm Hg

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8
Q

Factors that increase BP

A 
High levels of psychological stress
Exposure to high-frequency noise
High salt diet
Lack of rest
Genetic predisposition
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9
Q

Children

Use of drugs affecting BP across the lifespan

A

National Standards - new
May start in childhood
More likely to be secondary
Use of drug therapy with caution
Lifestyle changes first
Follow-up needed (monitor BP, monitor for adverse effects)
Mild diuretic - monitor glucose and electrolytes
Calcium Channel Blockers
Beta blockers - adverse effects possible
NO: angiotensin receptor blockers (ARBs) and angiotensin-converting enzymes (ACEs) - no established safety

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10
Q

Adults

Use of drugs affecting BP across the lifespan

A

Education - adverse effects that should be reported immediately
Safety precautions - situations that may cause dehydration
Drug-drug interactions
Lifestyle modifications
Caution with pregnancy and lactation - ACEI/ARB/Renin inhibitors should not be used; if benefit outweighs risk, labetalol is the first choice if absolutely needed in pregnancy; drugs enter breastmilk and can cause serious adverse effects

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11
Q

Older Adults

Use of drugs affecting blood pressure across the lifespan

A

More susceptible to toxic effects
underlying conditions that may effect drug metabolism and excretion: reduced dose, close monitoring
Drug-Drug interactions including herbal therapies
Safety precautions: sustained-release or extended release medication (do not cut, crush or chew; may have a toxic dose); fall risk reduction; monitoring for dehydration; Evaluating BP (in institutional settings, BP should be taken immediately before administration)

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12
Q

Stepped Care Management of Hypertension

A
  1. lifestyle modifications are instituted
  2. Inadequate response = drug therapy added
  3. Inadequate response = consider change in drug dose or class or addition of another drug for combined effect
  4. inadequate response = second or third agent or diuretic is added if not already prescribed
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13
Q

Drugs affecting the RAAS

A

ACE Inhibitors
Angiotensin II Receptor Blockers (ARBs)
Renin Inhibitors

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14
Q

Sympathetic Nervous System Blockers

A 
Beta Blockers (selective/nonselective)
Alpha Adrenergic Blockers (non selective and Alpha1 blockers)
Alpha and Beta Blockers (aka nonselective adrenergic blocking agents)
Alpha2 agonist
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15
Q

Antihypertensive agents

A 
Drugs affecting the RAAS
Calcium Channel blockers
Vasodilators
Diuretics
Sympathetic Nervous System Blockers
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16
Q

ACE Inhibitors - action/indication

“-pril”

A

Action: Blocks ACE from converting angiotensin I to angiotensin II in the RAAS –> this blocks aldosterone leading to vasodilation, sodium and water excretion, and small increase in serum potassium
Indication: HTN; Congestive heart failure and left ventricular dysfunction (in conjunction with other meds); diabetic nephropathy prevention
Drugs: Benazepril, Captopril, Enalapril, Lisinopril, Ramipril

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17
Q

ACE Inhibitors - contraindications, caution, interactions, adverse effects

A

Contraindications: allergy; impaired renal function; pregnancy (Black box warning)
Caution: Acute/unstable CHF; african americans
Drug-Drug Interactions: Allopurinol; other drugs affecting the RAAS; NSAIDs
Adverse Effects related to vasodilation and alterations in blood flow: reflex tachycardia; hypotension;renal insufficiency; dizziness; fatigue; erectile dysfunction
Adverse effects (other): Pancytopenia; GI Irritation; Rash; Hyperkalemia; cough

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18
Q

ACE Inhibitors - Nursing Considerations

A

Assessment - Labs: CBC

Implementation - Administer on an empty stomach; patient teaching regarding cough

19
Q

Angiotensin II Receptor Blockers - action/indication

“-sartan”

A

Action: Angiotensin II receptor antagonist —> blocks angiotensin II from binding with the receptors on the vascular smooth muscle and in the adrenal cortex which prevents vasoconstriction and release of aldosterone
Indication: HTN, CHF, Diabetic nephropathy prevention
Drugs: Candesartan, Irbesartan, Losartan, Olmesartan, Telmisartan, Valsartan

20
Q

Angiotensin II Receptor Blockers - contraindications/cautions, adverse effects, interactions

A

Contraindications: Allergy, black box warning for pregnancy
Caution: hepatic dysfunction; renal dysfunction; hypovolemia
Adverse Effects: CNS: HA, dizziness, syncope, weakness; CV: hypotension; GI complaints; Rash; hyperkalemia; renal damage
Drug-Drug Interactions: NSAIDs, other drugs affecting RAAS

21
Q

Angiotensin II Receptor Blockers - Nursing Considerations

A

Assessment: Liver impairment; Labs - liver function
Implementation: Can take with or without food; If GI effects, give with food

22
Q

Renin Inhibitor: Aliskiren

A

Action: Inhibits renin which inhibits the RAAS —> Decreased BP —> decreased aldosterone —> decreased sodium reabsorption
Indications: HTN
Contraindications: Pregnancy
Adverse effects: Hyperkalemia
Drug-Drug Interactions: Furosemide, other drugs affecting the RAAS

23
Q

Drugs affecting the RAAS: Nursing Process

A

Assessment: History - allergy, pregnancy, impaired kidney function; Physical - baseline (cardiac, respiratory, abdominal, skin), vitals and weight; Labs - renal function tests, electrolytes, pregnancy test
Nursing Diagnoses: Ineffective tissue perfusion; impaired skin integrity; acute pain; deficient knowledge
Implementation: Encourage lifestyle changes, use of barrier contraceptives, monitor the patient carefully in any situation that might lead to a drop in fluid volume, provide thorough patient teaching
Evaluation: evaluate response to drug, effectiveness of teaching plan, effectiveness of comfort and safety measures, compliance with regimen

24
Q

Calcium Channel Blockers - actions/indications

“-dipine”; verapamil and diltiazem

A

Actions: inhibits the movement of calcium ions across the cell membranes of cardiac and arterial muscle, depressing the impulse and leading to slowed conduction, decreased myocardial contractility, and relaxing and dilating the arteries —> decreases BP, cardiac workload and myocardial oxygen consumption
Indications: HTN, angina, arrhythmias
Drugs: Amlodipine, felodipine, nifedipine, verapamil, diltiazem

25
Q

Calcium Channel Blockers - Contraindications/Cautions, adverse effects, interactions

A

Contraindications/Cautions: Allergy, renal or hepatic dysfunction, heart block or sick sinus syndrome, CHF
Adverse Effects: Related to effects on cardiac output - CNS, CV; Other - GI, Skin
Interactions: Drug Drug - Cyclosporine and diltiazem; digoxin and verapamil; Drug Food - grapefruit juice

26
Q

Calcium Channel Blockers - Nursing Process

A

Assessment: History - allergy, heart block, sick sinus syndrome, heart failure, liver and kidney impairment; Physical - skin, respiratory cardiac neuro abdominal, vitals, ECG, pain; Labs - liver and renal function
Nursing Diagnoses: decreased cardiac output; risk for injury; ineffective tissue perfusion; deficient knowledge
Implementation: monitor bP, cardiac rhythm and cardiac output; comfort measures including environmental controls; safety precautions; thorough patient teaching
Evaluation: Evaluate response to drug, effectiveness of teaching plan, effectiveness of comfort and safety measures, compliance with regimen

27
Q

Vasodilators - Actions/Indications

A

Actions: Acts directly on vascular smooth muscle to cause muscle relaxation and decrease in BP —> also results in decreased peripheral vascular resistance which increases cardiac output
Indications - severe HTN, malignant HTN, hypertensive emergencies
Drugs: Hydralazine, nitroprusside, minoxidil

28
Q

Vasodilators - Contraindications/cautions, interactions, adverse effects

A

Contraindications: Allergy
Cautions: Conditions exacerbated by decreased BP - peripheral vascular disease, CAD, CHF, cerebral insufficiency or tachycardia
Drug Drug Interactions: Based on individual drug
Adverse Effects: Related to changes in BP- CNS and CV; skin; GI upset; Cyanide toxicity with Nitroprusside - pink/cherry red skin, headache, dizziness, tachycardia

29
Q

Vasodilators - Nursing Process

A

Assessment: history - allergy, CV dysfunction; Physical - skin, cardiac, respiratory, abdominal;, vitals, ECG, weight; Labs: renal and hepatic function
Nursing Diagnoses: ineffective tissue perfusion; impaired skin integrity; acute pain; deficient knowledge
Implementation: Encourage lifestyle changes, monitor BP closely, monitor the patient carefully in any situation that might lead to a drop in fluid volume, comfort measures, thorough patient teaching
Evaluation: Evaluate response to drug, effectiveness of teaching plan, effectiveness of comfort and safety measures, compliance with regimen

30
Q

Diuretics

A

Action: Increase the excretion of sodium and water from the kidney to lower BP
Thiazide and Thiazide-Like Diuretics: chlorothiazide, hydrochlorothiazide
Potassium-Sparing Diuretics: Spironolactone, triamterene

31
Q

Beta-Blockers - actions/indications
Sympathetic Nervous System Blockers
“-olol”

A

Actions: blocks beta receptors in the heart —> decreases heart rate and cardiac muscle contraction —> vasodilates which increases blood flow to the kidneys leading to a decrease in the release of renin
Indications: Hypertension, angina, tachyarrhythmias, migraine headache, MI, glaucoma, heart failure and hyperthyroidism
Drugs: Atenolol, Metroprolol, Propranolol (nonselective)

32
Q

Beta-Blockers - contraindications/cautions, adverse effects, interactions

A

Contraindications: Acute/unstable heart failure, bradycardia and heart block; bronchospasm, COPD, acute asthma
Cautions: Renal and hepatic dysfunction, diabetes
Adverse Effects: CNS - headache, fatigue, dizziness, depression, sleep issues, disorientation, memory loss; CV - bradycardia, hypotension; Pulmonary - bronchospasm, laryngospasm, cough, pulmonary edema; GU - decreased libido and impotence; alterations in glucose levels
Drug-Drug interactions: Clonidine, NSAIDs, insulin/hypoglycemic agents

33
Q

Beta-Blockers - nursing considerations

A

Assessment: History of lung conditions or diabetes
Implementation: Take apical pulse prior to administering and hold if below 60 bpm; do not abruptly stop medication; patients with diabetes should monitor blood glucose closely

34
Q

Alpha-adrenic blocker (non-selective) - Actions/Indications
Sympathetic Nervous System Blockers
“Phen-“ and “-amine”

A

Actions: blocks Alpha1 receptors - vasodilations resulting in decreased BP —> blocks Alpha2 receptors - prevents norepinephrine feedback loop resulting in increase in reflex tachycardia
Indications - diagnose and manage episodes of pheochromocytoma
Drugs: Phenoxybenzamine, Phentolamine

35
Q

Alpha-adrenergic blocker (non-selective) - contraindications/cautions, interactions, adverse effects

A

Contraindications/cautions: Allergy, CAD, MI
Drug Drug interactions: alcohol
Adverse Effects: Increased reflex tachycardia; GI effects; CNS - HA, weakness, dizziness; Related to vasodilation and decreased BP - hypotension, flushing, arrhythmia, angina

36
Q

Alpha1-Blockers
Sympathetic Nervous System Blockers
“-azosin”

A

Actions: Blocks alpha1-receptor sites —> decreases vascular tone resulting in vasodilation –> decreases blood pressure
Indications: HTN
Contraindications/Cautions: Allergy, heart failure, renal failure or hepatic impairment
Adverse Effects: CNS, CV, GI/GU
Drug Drug Interactions: Vasodilators/antihypertensives
Drugs: Doxazosin, Prazosin, Terazosin

37
Q

Alpha- and Beta- Blockers (nonselective adrenergic blocking agents) - actions/indications
Sympathetic nervous system blockers

A

Actions: Blocks norepinephrine at all alpha and beta receptors in the SNS —> lower BP and HR —> increased renal perfusion —> decreased renin
Indications: HTN
Drugs: Carvedilol, Labetalol

38
Q

Alpha- and Beta- Blockers - contraindications/cautions, AEs, interactions, considerations

A

Contraindications/Cautions: Allergy, heart block, bradycardia, lung disease/bronchospasm, diabetics
Adverse Effects: CNS, Cardiovascular, Pulmonary, hypoglycemia, rash, GI/GU issues
Drug Drug Interactions: Antidiabetic Agents
Nursing Considerations: Do not stop abruptly, ND: ineffective airway clearance r/t lack of bronchodilating effects

39
Q

Alpha2-agonist: Clonidine

Sympathetic Nervous System Blocker

A

Actions: Stimulate the alpha receptors in the CNS and inhibits the CV centers, leading to a decrease in sympathetic outflow from the CNS resulting in a drop in BP
Indications: HTN
Adverse Effects: CNS, CV
Drug Drug Interactions: beta-blockers, adrenergic antagonists, CNS depressants/alcohol
Nursing Considerations: do not stop abruptly, given oral or transdermal for HTN

40
Q

Sympathetic Nervous System Blockers - Nursing Process

A

Assessment: History- contraindications and cautions; Physical - baseline CNS, cardiac respiratory abdominal, urinary and perfusion. Vitals and ECG; Labs - electrolytes, renal and hepatic function, glucose
Nursing Diagnoses: Acute pain; ineffective tissue perfusion; decreased cardiac output; risk for injury; risk for activity intolerance; non compliance; disturbed sensory perception; deficient knowledge
Implementation: Take apical pulse prior to administration and hold if below 60 bpm, monitor blood pressure, do not abruptly stop meds, encourage patient to make lifestyle modifications; change position slowly, safety and comfort measures, do not crush ER formulations; Patient teaching - consult a healthcare professional before taking any OTC meds or herbal alternative therapies, emphasize importance of follow up exam
Evaluation: evaluate response to drug, effectiveness of teaching plan, effectiveness of comfort and safety measures, compliance with regimen

41
Q

Hypotension

A

When the heart muscle is damaged and unable to pump effectively; with severe blood or fluid loss, when volume drops dramatically; when there is extreme stress and the body’s levels of norepinephrine are depleted leaving the body unable to respond to stimuli to raise BP

42
Q

Antihypotensive Agents

Sympathetic adrenergic agonists/ Sympathomimetics/ Alpha- and Beta- adrenergic agonists/ vasopressors

A

Drugs: Dopamine and dobutamine; epinephrine and norepinephrine
Action: stimulate all adrenergic receptors/SNS —> HR and myocardial contractility increases —> blood vessels constrict and BP increases —> bronchi dilate and rate/depth of breathing increases
Indications: Hypotensive states - shock, heart failure; anaphylaxis; bronchospasm; asthma
Contraindications/Cautions: allergy, tachyarrhythmias/ventricular fibrillation; hypovolemia; pheochromocytoma
Adverse Effects: CV, GI, CNS, Hypokalemia
Drug Drug Interactions: Ma huang/guarana/caffeine; cold medicine

43
Q

Antihypotensive Drugs - Nursing Process

A

History: Allergy, impaired kidney or liver function; CV dysfunction, visual problems, urinary retention, and pheochromocytoma; Physical - Respiratory, cardiac, abdominal, skin, perfusion, weight, vitals; Labs: kidney and liver function
Nursing Diagnosis: ineffective tissue perfusion; disturbed sensory perception; acute pain; deficient knowledge
Implementation: monitor BP and HR; provide thorough patient teaching; safety and comfort measures; monitor patient with known visual problems; encourage patient to void before taking a dose of the drug
Evaluation: Evaluate response to drug, effectiveness of teaching plan, effectiveness of comfort and safety measures, compliance with regimen

Pharm Exam 2 (7 decks)

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