Cardiovascular Part 1 Flashcards
What is the ACE inhibitor suffix?
-pril
Adverse Effects
Angiotensin-Converting Enzyme Inhibitors - captopril
Severe hypotension following first dose (most likely in clients taking diuretics, with high BP, or who have hyponatremia)
Dry, nonproductive cough due to increase in bradykinin
Rash and report of metallic taste in mouth
Angioedema (swelling of mouth, throat due to inhibition of kinase II)
Hyperkalemia
Neutropenia (decrease in white blood cells with increased risk of infection)
Contraindications
ACE Inhibitors - captopril
Teratogenic effects
Angioedema or allergy to ACE inhibitors
Hypotension
Liver disease with elevated liver enzymes
Interactions
ACE Inhibitors - captopril
Potassium diuretics, potassium supplements, or use of salt substitutes increase risk of hyperkalemia
Antihypertensive drugs, diuretics, and nitrates (such as nitroglycerin) increase risk for hypotension
NSAIDs may decrease effectiveness
Food decreases absorption of ACE Inhibitors
ACE Inhibitors may cause lithium toxicity
What is the suffix for Angiotensin II Receptor Blockers (ARBs)?
sartan
Expected Pharmacological Action
ARBs - losartan
Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II
Selectively blocks the binding of angiotensin II to the AT receptor found in tissues
Client Education
ARBs - losartan
Report minor swelling of the mouth, throat to provider; call 911 immediately if severe reaction occurs
Report frequent headaches or insomnia
Do not take losartan if pregnant or breastfeeding
Tell provider if pregnancy is a possibility
Adverse Effects
Aldosterone Antagonist - eplerenone
Hyperkalemia
Client Education
Aldosterone Antagonist - eplerenone
Do not take potassium supplements, use potassium-containing salt substitutes or drugs which raise potassium levels unless prescribed by the provider
Report palpitations, muscle twitching, weakness, or paresthesia in extremities to provider
Expected Pharmacological Action
Direct Acting Renin Inhibitors - aliskiren
Binds to renin at its active site, stopping the cleavage of angiotensin, in turn inhibiting the formation of angiotensin I. This ends the cascade of angiotensin II mediated mechanisms that normally increase the blood pressure
Medication Administration
Direct Acting Renin Inhibitors - aliskiren
Available in oral form only
High-fat meals decrease absorption
Give at a consistent time daily before eating
Expect 2 weeks before full effect is seen
Monitor for hypotension at beginning of therapy and after any dose increase
Client Education
Direct Acting Renin Inhibitors - aliskiren
Do not take potassium supplements, salt substitutes, or drugs that raise potassium levels unless prescribed by provider
Report palpitations, muscle twitching, weakness, or paresthesia in extremities to provider
Report persistent cough to provider
Report minor swelling of mouth, throat to provider; call 911 immediately if severe reaction occurs
Report GI symptoms to provider
Stop taking aliskiren if pregnant; fetal injury can occur
What is the suffix for vascular Calcium Channel Blockers (CCB)?
dipine
Expected Pharmacological Action
Calcium Channel Blockers (CCB) - nifedipine
Dihydropyridine CCBs block calcium channel in vascular smooth muscle (VSM) cells of peripheral arterioles, and minimally block calcium channels in cardiac arteries. This results in vasodilation and a lower blood pressure. CCBs indirectly increase heart rate, called reflex tachycardia, because the decrease in blood pressure stimulates the baroreceptor reflex. This increase in heart rate does not occur due to direct effect on the electrical conduction system of the heart
Nursing Interventions
Calcium Channel Blockers (CCB) - nifedipine
Give nifedipine along with ordered beta-blocker to prevent reflex tachycardia
Monitor heart rate
Assist with ambulation as needed
Inform client that facial flushing may occur
Monitor for and report edema (a diuretic may be prescribed if edema occurs)
Notify provider and withhold dose for BP below 90mmHg systolic or for prearranged parameter
Advise regular dental care
Adverse Effects
Alpha 1 Blockers - doxazosin
Orthostatic hypotension-especially with first dose and with dosage increases
Reflex tachycardia may also occur
Headache or dizziness
Client Education
Alpha 1 Blockers - doxazosin
Report dizziness, syncope, rapid HR, or palpitations to provider
Take this drug at bedtime
Rise slowly from lying to sitting or standing to prevent injury
Do not perform hazardous activities, such as driving for at least 12 hours following first dose and subsequent dosage increases
Report increase in frequency of headache or dizziness to provider
What is the suffix for Beta-Blockers
lol
Expected Pharmacological Action
Beta Blockers - atenolol
Completely blocks stimulation of beta-adrenergic receptor within vascular smooth muscle; produces negative chronotropic activity
Adverse Effects
Beta Blockers - atenolol
Bradycardia due to blockade of beta1 receptors; may lead to reduced cardiac output
Heart failure (HF) (SOB, edema, coughing at night)
Rebound excitation causing angina pain or MI with sudden withdrawal of betablocker in client with CHD
Nursing Interventions
Beta Blockers - atenolol
Monitor heart rate and report rate slower than 60 beats/min (or prearranged parameter) to provider
Monitor for signs of heart failure and report to provider
Teach client not to stop taking beta blocker suddenly
On discontinuation, taper dose slowly over 1 to 2 weeks
Adverse Effects
Adrenergic Neuron Blockers - reserpine
Severe depression and risk for suicide, which can linger after reserpine is discontinued
Bradycardia and orthostatic hypotension
GI symptoms: diarrhea, abdominal cramping
Contraindications
Adrenergic Neuron Blockers - reserpine
Previous allergy to alkaloids Depressive disorders Peptic ulcer or ulcerative colitis Cardiac dysrhythmias, or cerebrovascular disease Older adults
Therapeutic Use
Centrally Acting Alpha 2 Adrenergic Agonist - clonidine
Treats Hypertension
Severe pain relief (administered by epidural infusion)
ADHD
Client Education
Centrally Acting Alpha 2 Adrenergic Agonist - clonidine
Take at bedtime to minimize CNS effects
Do not perform hazardous activities, such as driving, until effects are known
Suck hard candies, chew sugarless gum, sip water to minimize dry mouth.
Do not abruptly stop taking clonidine; when discontinued, taper according to instructions
Therapeutic Use
Alpha Beta Blockers - carvedilol
Treats hypertension
Treats heart failure along with digoxin, ACE inhibitors, and diuretics
Prolongs chance of survival following MI
Expected Pharmacologic Action
Direct-Acting Vasodilators - hydralazine
Acts by dilating the arterioles, which in turn decrease peripheral resistance, decrease arterial blood pressure without affecting venous pressure, increase heart rate, and increase contractility of the heart
Adverse Effects
Direct-Acting Vasodilators - hydralazine
Headache, dizziness, weakness and fatigue, reflex tachycardia
A systemic lupus erythematosus (SLE)-like syndrome can occur (face rash, joint pain, fever, nephritis, pericarditis)
Most likely with high doses, fluid retention, edema
Abrupt withdrawal can cause hypertensive crisis and HF
Nursing Interventions
Direct-Acting Vasodilators - hydralazine
Advise client that headache and tachycardia can occur
Monitor pulse and report tachycardia
A beta blocker can be added to decrease tachycardia; watch for hypotension with additional antihypertensive agent
Monitor for and report signs of facial rash, joint pain, or fatigue to provider (hydralazine will be discontinued)
Monitor for edema, crackles in the lungs; can be combined with a diuretic to minimize this effect
Taper hydralazine slowly when discontinued
Adverse Effects
HMG-CoA Reductase Inhibitors (Statins) - atorvastatin
Myopathy (pain in muscles, which can progress to rhabdomyolysis [breakdown of muscle protein causing kidney damage])
Hepatotoxicity
Medication Administration
HMG-CoA Reductase Inhibitors (Statins) - atorvastatin
Available orally only
For greatest effectiveness, take in the evening with or without food
Client Education
HMG-CoA Reductase Inhibitors (Statins) - atorvastatin
Report muscle pain to the provider
Report abdominal pain, jaundice, and fatigue to provider
Comply with periodic liver function testing
Therapeutic Use
Fibrates - gemfibrozil
Reduces high levels of plasma triglycerides
Increases HDL cholesterol
Adverse Effects
Fibrates - gemfibrozil
GI symptoms: nausea, abdominal pain, diarrhea
Gallstones, myopathy, liver toxicity
Interactions
Fibrates - gemfibrozil
Statin antilipemic greatly increase risk for myopathy
Warfarin with fibrates increases risk for bleeding
Therapeutic Use
Nitrates - nitroglycerin
Treatment and prophylaxis of angina pectoris, rapid-acting forms (only transmucosal tablets, translingual spray and sublingual tablets treat an angina attack)
Longer acting forms such as regular tablets, immediate release or sustained release tablets/capsules are used to prevent attacks from occurring
IV nitroglycerin is used for severe unstable angina attacks and to control blood pressure preoperatively and to treat heart failure after acute MI
Medication Administration
Nitrates - nitroglycerin
Oral extended-release capsules Sublingual tablet Translingual spray Topical ointment Transdermal patch Intravenous
