c26 - mod 7

Question 1

Enalapril (Vasotec) classes

Answer 1

Therapeutic Class: Drug for hypertension and heart failure

Pharmacologic Class: ACE inhibitor

Question 2

Enalapril (Vasotec) actions/uses

Answer 2

most frequently prescribed ACE inhibitors for HTN

enalapril has a prolonged half-life, which permits administration once or twice daily

acts by reducing angiotensin II and aldosterone levels to produce a significant reduction in blood pressure with few serious adverse effects.

Question 3

Enalapril (Vasotec) administration alerts

Answer 3

may produce a first-dose phenomenon, resulting in profound hypotension, which may result in syncope.

Do not administer if the patient is pregnant.

Question 4

Enalapril (Vasotec) adverse effects

Answer 4

have little effect on electrolyte balance but may cause hyperkalemia

ACE inhibitors cause few cardiac adverse effects.

may cause orthostatic hypotension when the patient moves quickly from a supine to an upright position.

Question 5

black box warning of Enalapril (Vasotec)

Answer 5

Fetal injury and death may occur when ACE inhibitors or ARBs are taken during pregnancy.

Question 6

interactions of Enalapril (Vasotec)

Answer 6

When given concurrently, other antihypertensives have additive effects with enalapril on blood pressure.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the hypotensive action of ACE inhibitors.

The most likely sign of overdosage is hypotension, which may be treated with an IV infusion of normal saline solution.

Question 7

Nifedipine (Adalat CC, Procardia XL) classes

Answer 7

Therapeutic Class: Drug for hypertension and angina

Pharmacologic Class: Calcium channel blocker

Question 8

Nifedipine action/uses

Answer 8

prescribed for HTN and variant or vasospastic angina

acts by selectively blocking calcium channels in myocardial and vascular smooth muscle, including those in the coronary arteries.

results in less oxygen utilization by the heart, an increase in cardiac output, and a fall in blood pressure. It is available as immediate-release capsules and as extended-release tablets (XL).

Question 9

Nifedipine administration alerts

Answer 9

Do not administer immediate-release formulations of nifedipine if an impending MI is suspected or within 2 weeks following a confirmed MI.

Administer nifedipine capsules or tablets whole. If capsules or extended-release tablets are chewed, divided, or crushed, the entire dose will be delivered at once.

Question 10

Nifedipine onset

Answer 10

30–60 min (immediate release capsules); 6 h (extended release tablet)

Question 11

Nifedipine adverse effects

Answer 11

related to vasodilation such as headache, dizziness, peripheral edema, and flushing.

avoid rebound hypotension, the drug should be discontinued gradually

Question 12

Nifedipine interactions

Answer 12

have additive effects with nifedipine on blood pressure

may increase serum levels of digoxin, leading to bradycardia and digoxin toxicity

Grapefruit juice may enhance the absorption of nifedipine. Melatonin may increase blood pressure and heart rate.

Question 13

Doxazosin (Cardura) classes

Answer 13

Therapeutic Class: Drug for hypertension and benign prostatic hyperplasia

Pharmacologic Class: Alpha1-adrenergic blocker

Question 14

Doxazosin (Cardura) actions/uses

Answer 14

available as immediate release (Cardura) or extended release (Cardura XL) tablets.

Because it is selective for blocking alpha1 receptors in vascular smooth muscle, it has few adverse effects on other autonomic organs and is preferred over nonselective beta blockers.

dilates arteries and veins and is capable of causing a rapid fall in blood pressure.

Patients who have benign prostatic hyperplasia (BPH) sometimes receive this drug to relieve symptoms of dysuria

Question 15

administration alerts of Doxazosin (Cardura)

Answer 15

Monitor patients closely for profound hypotension and possible syncope 2–6 hours following the first few doses due to the first-dose phenomenon.

The first-dose phenomenon can recur when the medication is resumed after a period of withdrawal and with dosage increases.

Swallow Cardura XL whole: Do not crush, chew, or split the tablet.

Question 16

adverse effects of Doxazosin (Cardura)

Answer 16

dizziness, dyspnea, asthenia, headache, hypotension, othostatic hypotension, and somnolence, although these effects are rarely severe enough to cause discontinuation of therapy. On starting doxazosin therapy, some patients experience serious orthostatic hypotension, although tolerance often develops to this side effect after a few doses.

Question 17

Doxazosin (Cardura) interactions

Answer 17

Concurrent administration of doxazosin with phosphodiesterase-5 inhibitors such as sildenafil (Viagra) can result in additive blood pressure lowering effects and symptomatic hypotension.

Treatment of Overdose: The most likely sign of overdosage is hypotension, which is treated with a vasopressor and/or IV infusion of fluids.

Question 18

Hydralazine (Apresoline) classes

Answer 18

Therapeutic Class: Drug for hypertension and heart failure

Pharmacologic Class: Direct-acting vasodilator

Question 19

Hydralazine (Apresoline) Actions and Uses

Answer 19

direct vasodilation of arterial smooth muscle; it has no effect on veins.

begun with low doses, which are gradually increased until the desired therapeutic response is obtained

tolerance to the drug develops and a dosage increase may be necessary.

parenteral formulations of hydralazine are for the treatment of hypertensive emergency.

Question 20

administration alerts of Hydralazine (Apresoline)

Answer 20

Abrupt withdrawal of the drug may cause rebound HTN and anxiety.

Question 21

Hydralazine (Apresoline) adverse effects

Answer 21

Headache, reflex tachycardia, palpitations, flushing, nausea, and diarrhea are common but may resolve as therapy progresses. Patients taking hydralazine often receive a beta-adrenergic blocker to counteract reflex tachycardia.

Sodium and fluid retention is a potentially serious adverse effect. Because of these adverse effects, the use of hydralazine is limited mostly to patients whose condition cannot be controlled with other, safer medications.

Question 22

Hydralazine (Apresoline) interactions

Answer 22

Administering hydralazine with other antihypertensives may cause severe hypotension. This includes all drug classes used as antihypertensives. NSAIDs may decrease the antihypertensive action of hydralazine.

Treatment of Overdose: The most likely sign of overdosage is hypotension, which may be treated with a vasopressor and/or an IV infusion of fluids.