Ch 20 Meds Affecting BP Flashcards
What is the prototype drug of ACE inhibitors and other drugs in that class?
captopril ( Capoten) enalapril ( Vasotec) Enalaprilat ( Vasotec intravenous) fosinopril ( Monopril) Lisinopril ( Prinivil) ramipril ( Altace) moexipril ( Univasc)
What are actions of ACE inhibitors
It is used for hypertension, HF, MI, diabetic and nondiabetic neuropathy
For clients at high risk for cardiovascular event, ramipril may be used to prevent MI, stroke, or death.
ACE inhibitors block the conversion of angiotensin I to angiotensin II leading to vasodilation, excretion of sodium and water, and retention of K+ by action of the kidneys
What are potential complications of ACE INHIBITORS?
1st dose orthostatic hypotension
Cough, in which the med should be discontinued.
Hyperkalemia (monitor K+ levels to maintain at a levels within 3.5 to 5
Advise client to avoid use of salt substitutes)
Rash and dysgeusia ( altered taste) primarily with captopril
What category are ACE INHIBITORS
Pregnancy category D
Ace inhibitors are contraindicated in who
Clients who have history of allergy angioedema to ace inhibitors, in bilateral renal artery stenosis, or who have a single kidney
Use cautiously in ppl who have renal impairment and collagen vascular diseas because they are at risk of developing neutropenia monitor closely for signs of infection
What class of drugs can contribute to first dose hypertension?
Diuretics
What med interaction can cause an additive hypotensive effect
Other hypotensive meds
What drug can increase the risk of hyperkalemia in combination of ACE INHIBITORS
Potassium supplements and potassium sparing diuretics
What increases the levels of lithium carbonate ( Eskalith)
ACE INHIBITORS
The use of what drug may decrease the antihypertensive effects ACE INHIBITORS
NSAIDS
All ACE INHIBITORS are administered PO except what drug
enalaprilat which is the only ACE INHIBITOR FOR IV USE
What 2 ace inhibitors should be taken one hrs before meals
Captopril and moexipril
What are ARB’s
Angiotensin II receptor blockers; Used for hypertension HF and prevention of mortality following MI stroke prevention Delay progression of diabetic neuropathy
What is the major difference between ARBs and ACE INHIBITORS
is that cough and hyperkalemia are not adverse effects of ARBs
What pregnancy category are ARBs
D
can cause angioedema ( instruct clients to observe for skin wheels, swelling of the tongue and notify provider)
Can cause fetal injury ( advise of risk during second and third trimester)
ARBS are contraindicated in ppl who what?
In ppl who have 1 kidney
Ppl with renal stenosis
What are aldosterone antagonists
Meds that treat hypertension and HF
Name drugs of the class aldosterone antagonists
eplerenone (Inspira)
spironolactone ( Aldactone)
What does aldosterone agonists do
It antagonizes blood volume by blocking aldosterone receptors in the kidney thus promoting excretion of sodium and water
What are adverse effects of aldosterone agonists
Hyperkalemia hyponatremia
Monitor serum k+ levels
Advise client to not use k+ supplements or slat substitutes
Flulike manifestations
Dizziness
Aldosterone agonists are contraindicated in who
Ppl with high k+ levels, kidney impairment, and type 2 diabetes
Use cautiously in liver impairment
Med food interactions of aldosterone antagonists
Verapamil, ace inhibitors, ARBs, erythromycin and ketoconazole can increase risk of hyperkalemia lithium toxicity may occur if taken concurrently.
Do not administer with K+ supplements
Direct renin inhibitors aliskiren ( Tekturna)
Inhibits production of angiotensin I
Relieves hypertension
Adverse effects of direct renin inhibitors
Allergic reactions, angioedema
Hyperkalemia
Diarrhea- dose related often seen in females and older adults
Contraindications of direct renin inhibitors
Pregnancy category C ;D during 2&3rd trimesters
Clients who have hyperkalemia
Asthma other respiratory disorders, history of angioedema, diabetes, older adults.
Med food interactions of direct renin inhibitors
Decreases serum levels of furosemide, furosemide dosage may need to be increased.
Increased effects of other hypertensive meds
Atorvastatin ( Lipitor) and ketoconazole increase levels of aliskiren, monitor for hypotension if used concurrently)
What should the nurse instruct the client about regarding direct renin inhibitors
High fat meals interfere with absorption
Take at the same time daily away from foods high in fat
Avail alone or in combination
Name Calcium channel blockers
Nifedipine ( Adalat, Procardia)
Verapamil ( Calan)
Dilatizem ( Cardizem)
Other MEDS;
amlodipine (Norvasc)
Felodipine (Plendil)
Nicardipine ( Cardene, cleviprex)
The calcium channel blocker nifedipine does what
It blocks calcium channels in blood vessels which leads to vasodilation of peripheral arterioles and arteries/ aterioles of the heart.
It acts primarily on the arterioles the veins are not significantly affected
What 4 drugs are used for angina pectoris
The calcium channel blockers nifedipine,amlodipine, nicardipine, verapamil, dilatizem.
What drugs are used to treat hypertension
The calcium channel blockers nifedipine, amlodipine, nicardipine, felodipine, and verapamil and dilatizem.
What drug treats angina pectoris, hypertension and cardiac dysrhythmias
The calcium channel blocker verapamil, dilatizem
What are aldosterone antagonists
Used to treat HTN
HF
What does aldosterone do
Aldosterone antagonists reduce blood volume by blocking aldosterone receptors in the kidney, this promoting excretion of sodium and water
What are adverse effects of aldosterone antagonists
Hyperkalemia,
Flulike manifestations, fatigue, headache, mild GI manifestations dizziness
Aldosterone antagonists are contraindicated in who
It is contraindicated in ppl who have high potassium levels, kidney Impairment and type 2 diabetes mellitus with albuminuria.
Uses cautiously in ppl who have liver impairment
What are interactions of aldosterone antagonists
Verapamil, ace inhibitors, ARBs, erthromycin, and ketoconazole ca increase risk of hyperkalemia
Lithium toxicity may occur if taken concurrently
What is a nursing consideration of aldosterone antagonists
Administer orally with or without food
Do not administer with potassium supplements
What are meds used for a hypertensive crisis
Nitroprusside (nitropress) a centrally acting vasodilator
Nitroglycerin ( nitrostat IV) a vasodilator
Nicardipine ( Cardene) a calcium channel blocker
clevidipine ( Cleviprex) a calcium channel blocker
enalaprilat ( Vasotec IV) a ace inhibitor
Esmolol HCL ( Brevibloc) a ace inhibitor
What is the expected pharmalogical action of meds for a hypertensive crisis
Direct vasodilation of arteries and veins resulting in rapid reduction of BP ( decreased preload and afterload)
What are adverse effects of meds used in a hypertensive crisis
Excessive hypotension... Keep client supine during administration Cyanide poisoning ( headache and drowsiness may lead to cardiac arrest( nitroprusside only) Thiocyanate toxicity ( CNS findings include delirium, psychosis) accumulates when nitroprusside is given over several days.
Meds used in a hypertensive crisis should be used cautiously in who
Those who have liver and kidney dysfunction,or fluid and electrolyte imbalances and older adults.
Name the 10 MEDS used to treat BP
- Thiazide diuretics ( often the 1st, med given for HTN)
- Angiotensin converting enzymes ( ACE) inhibitors
- Angiotensin II receptor blockers ( ARB’s)
- Aldosterone antagonists
- Direct renin inhibitors
- Calcium channel blockers ( CCB)
- Centrally acting alpha2 agonists
- Alpha adrenergic blockers
- Beta adrenergic blockers
- Vasodilators
