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ATI: PHARM > Ch 20 Meds Affecting BP > Flashcards

Ch 20 Meds Affecting BP Flashcards

1
Q

What is the prototype drug of ACE inhibitors and other drugs in that class?

A 
captopril ( Capoten)
enalapril ( Vasotec)
Enalaprilat ( Vasotec intravenous)
fosinopril ( Monopril)
Lisinopril ( Prinivil)
ramipril ( Altace)
moexipril ( Univasc)
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2
Q

What are actions of ACE inhibitors

A

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

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3
Q

What are potential complications of ACE INHIBITORS?

A

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

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4
Q

What category are ACE INHIBITORS

A

Pregnancy category D

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5
Q

Ace inhibitors are contraindicated in who

A

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

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6
Q

What class of drugs can contribute to first dose hypertension?

A

Diuretics

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7
Q

What med interaction can cause an additive hypotensive effect

A

Other hypotensive meds

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8
Q

What drug can increase the risk of hyperkalemia in combination of ACE INHIBITORS

A

Potassium supplements and potassium sparing diuretics

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9
Q

What increases the levels of lithium carbonate ( Eskalith)

A

ACE INHIBITORS

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10
Q

The use of what drug may decrease the antihypertensive effects ACE INHIBITORS

A

NSAIDS

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11
Q

All ACE INHIBITORS are administered PO except what drug

A

enalaprilat which is the only ACE INHIBITOR FOR IV USE

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12
Q

What 2 ace inhibitors should be taken one hrs before meals

A

Captopril and moexipril

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13
Q

What are ARB’s

A 
Angiotensin II receptor blockers;
Used for hypertension
HF and prevention of mortality following MI
stroke prevention
Delay progression of diabetic neuropathy
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14
Q

What is the major difference between ARBs and ACE INHIBITORS

A

is that cough and hyperkalemia are not adverse effects of ARBs

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15
Q

What pregnancy category are ARBs

A

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)

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16
Q

ARBS are contraindicated in ppl who what?

A

In ppl who have 1 kidney

Ppl with renal stenosis

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17
Q

What are aldosterone antagonists

A

Meds that treat hypertension and HF

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18
Q

Name drugs of the class aldosterone antagonists

A

eplerenone (Inspira)

spironolactone ( Aldactone)

19
Q

What does aldosterone agonists do

A

It antagonizes blood volume by blocking aldosterone receptors in the kidney thus promoting excretion of sodium and water

20
Q

What are adverse effects of aldosterone agonists

A

Hyperkalemia hyponatremia

Monitor serum k+ levels
Advise client to not use k+ supplements or slat substitutes

Flulike manifestations
Dizziness

21
Q

Aldosterone agonists are contraindicated in who

A

Ppl with high k+ levels, kidney impairment, and type 2 diabetes
Use cautiously in liver impairment

22
Q

Med food interactions of aldosterone antagonists

A

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

23
Q

Direct renin inhibitors aliskiren ( Tekturna)

A

Inhibits production of angiotensin I

Relieves hypertension

24
Q

Adverse effects of direct renin inhibitors

A

Allergic reactions, angioedema
Hyperkalemia
Diarrhea- dose related often seen in females and older adults

25
Q

Contraindications of direct renin inhibitors

A

Pregnancy category C ;D during 2&3rd trimesters
Clients who have hyperkalemia

Asthma other respiratory disorders, history of angioedema, diabetes, older adults.

26
Q

Med food interactions of direct renin inhibitors

A

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)

27
Q

What should the nurse instruct the client about regarding direct renin inhibitors

A

High fat meals interfere with absorption
Take at the same time daily away from foods high in fat

Avail alone or in combination

28
Q

Name Calcium channel blockers

A

Nifedipine ( Adalat, Procardia)
Verapamil ( Calan)
Dilatizem ( Cardizem)

Other MEDS;
amlodipine (Norvasc)
Felodipine (Plendil)
Nicardipine ( Cardene, cleviprex)

29
Q

The calcium channel blocker nifedipine does what

A

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

30
Q

What 4 drugs are used for angina pectoris

A

The calcium channel blockers nifedipine,amlodipine, nicardipine, verapamil, dilatizem.

31
Q

What drugs are used to treat hypertension

A

The calcium channel blockers nifedipine, amlodipine, nicardipine, felodipine, and verapamil and dilatizem.

32
Q

What drug treats angina pectoris, hypertension and cardiac dysrhythmias

A

The calcium channel blocker verapamil, dilatizem

33
Q

What are aldosterone antagonists

A

Used to treat HTN

HF

34
Q

What does aldosterone do

A

Aldosterone antagonists reduce blood volume by blocking aldosterone receptors in the kidney, this promoting excretion of sodium and water

35
Q

What are adverse effects of aldosterone antagonists

A

Hyperkalemia,

Flulike manifestations, fatigue, headache, mild GI manifestations dizziness

36
Q

Aldosterone antagonists are contraindicated in who

A

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

37
Q

What are interactions of aldosterone antagonists

A

Verapamil, ace inhibitors, ARBs, erthromycin, and ketoconazole ca increase risk of hyperkalemia
Lithium toxicity may occur if taken concurrently

38
Q

What is a nursing consideration of aldosterone antagonists

A

Administer orally with or without food

Do not administer with potassium supplements

39
Q

What are meds used for a hypertensive crisis

A

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

40
Q

What is the expected pharmalogical action of meds for a hypertensive crisis

A

Direct vasodilation of arteries and veins resulting in rapid reduction of BP ( decreased preload and afterload)

41
Q

What are adverse effects of meds used in a hypertensive crisis

A 
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.
42
Q

Meds used in a hypertensive crisis should be used cautiously in who

A

Those who have liver and kidney dysfunction,or fluid and electrolyte imbalances and older adults.

43
Q

Name the 10 MEDS used to treat BP

A
  1. Thiazide diuretics ( often the 1st, med given for HTN)
  2. Angiotensin converting enzymes ( ACE) inhibitors
  3. Angiotensin II receptor blockers ( ARB’s)
  4. Aldosterone antagonists
  5. Direct renin inhibitors
  6. Calcium channel blockers ( CCB)
  7. Centrally acting alpha2 agonists
  8. Alpha adrenergic blockers
  9. Beta adrenergic blockers
  10. Vasodilators

ATI: PHARM (39 decks)

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