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
