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NANJU #2/3 > Ch 28 BP MEDS > Flashcards

Ch 28 BP MEDS Flashcards

0
Q

What can affect the kidneys

A

A bad heart, which causes less perfusion to reach the kidneys resulting in decreased function.

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1
Q

What is a indicator how well your heart is working

A

Blood pressure

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2
Q

Cardiac output

A

Amount of blood ejected from the LEFT VENTRICLE IN ONE MINUTE

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3
Q

What does the cardiac cycle consist of

A

Systolic and diastolic

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4
Q

Systolic

A

Contraction of the bicuspid and tricuspid valve

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5
Q

What is the bicuspid valve

A

The AV valve between the LEFT atrium and LEFT ventricle

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6
Q

What is a tricuspid valve

A

The AV valve between the RIGHT atrium and RIGHT ventricle has 3 cusps

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7
Q

How many valves does the heart have

A

The heart has 4 valves:

Pulmonic and aortic and bi and tri cuspid valves

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8
Q

The RIGHT side of the heart carries what type of blood

A

DEOXYGENATED BLOOD

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9
Q

What are signs and symptoms of RIGHT side heart failure

A

Edema

Jugular vein distention

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10
Q

What are signs and symptoms of LEFT sided heart failure

A

Rhonci, rales, respiratory distress, pulmonary congestion can happen very fast

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11
Q

For a pt in LEFT sided heart failure what would a nurse expect to be administered

A

A very potent lasix to drain fluid

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12
Q

Seeping edema indicates what

A

End stage RIGHT sided heart failure

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13
Q

Antihypertensive drugs act on what sites of the body

A

They act on the kidney to increase sodium and water loss
Arterioles: decrease peripheral resistance
Veins: decrease venous return and lower cardiac output
Heart: to reduce cardiac output
Sympathetic centers to the brain: to lower sympathetic stimulation

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14
Q

What are the major types of antihypertensive drugs

A 
Ace inhibitors 
Arbs
Anti adrenergic/ sympatholytic
Beta adrenergic blockers
Calcium channel blockers
Direct acting vasodilators
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15
Q

What does beta 1 do

A

It increases BP

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16
Q

What does beta2 do

A

Vasodilation

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17
Q

What is the role of adrenergic receptors

A

Adrenergic receptors in the nervous system have a role in BP mgmt.

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18
Q

Captopril ( Capoten)

A

Ace inhibitor

Client should have normal renal function to use this drug

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19
Q

What are the uses for ace inhibitors

A

HTN
HF
DIABETIC NEUROPATHY ( because of the vasodilation properties)
LEFT VENTRICULAR DYSFUNCTION ( promotes cardiac output)

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20
Q

What are adverse effects of ace inhibitors

A

Persistent non productive cough, angioedema, rash, orthostatic hypotension, neutropenia, and dyspnea

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21
Q

Name ace inhibitors drugs

A 
Captopril (capoten)
Lisinopril ( Prinivil)
Enalapril maleate (Vasotec)
Quinapril HCL ( Accupril)
Moexipril HCL ( Univasc)
Ramipril ( Altace)
Fosinopril ( Monopril)
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22
Q

When should captopril be administered

A

Take one hour before meals because food decreases absorption

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23
Q

What are post assessments of administering ACE inhibitors

A

Monitor BP for at least 2 hours after the initial dose until BP stabilizes.
Assess blood reports for hyperkalemia, hyponatremia, and neutropenia and assess urine for proteinuria)

Because of the diuresis effects the body automatically reserves K+ leading to hyperkalemia the diuresis effects depletes sodium

24
What conditions is captopril used for
``` CHF LEFT VENTRICULAR DYSFUNCTION PROTEINURIA History of ST elevation, MI History of non ST elevation MI with an anterior infarct Diabetes Systolic dysfunction Or proteinuric chronic renal failure ```
25
For any cardiac medication what will always be a side effect
Hypotension
26
ARBS
Same as ace inhibitors except in blocks angiotensin II from receptor sites blocking it. Losartan ( cozaar)
27
What are arbs used for?
(Sartan) | Are used for HTN, diabetic neuropathy, left ventricular dysfunction
28
What are drug interactions of arbs
Lithium, fluconazole ( yeast infections), indomethacin ( anti inflammatory for gout), rifampin ( TB patients) and grapefruit juice.
29
What drink should losartan be avoided with
Grapefruit juice
30
How can one minimize the adverse effects of losartan?
Monitor creatinine, BUN, hgb, and HCT levels | If taking a potassium supplement notify provider
31
Name a way that cardiac myopathy can occur
Because of faulty heart valves
32
What is a sign and symptom of hypotension
Dizziness | Confusion
33
What is true of CO and HR
The higher the heart rate the less CO. HR may be beating faster because of a decreased CO. when CO is low chambers and valves are t effective.
34
How do beta adrenergic blockers work
They block sympathetic stimulation at the sinus node, which decreases the HR and CO lowering BP They have been clinically proven to slow HR, decreases CO, and lower BP relief of symptoms of anxiety Less fluid volume retention Protection from anginal attacks and dysrhythmias
35
What is a important rule of thumb when administering cardiac meds
Cardiac meds needs to be monitored by a heart monitor
36
An increased BUN and cr indicates what
Kidney failure
37
What are contraindications and precautions of beta blockers
Bronchospasm and bronchoconstriction ( because of the it affecting betacells) Impotence Diarrhea Dizziness Elevations in BUN and serum creatinine levels, tingling of scalp, depression, impotence and fatigue
38
Why wouldn't a beta blocker be given to a person with asthma
Because it blocks both beta1 and beta2 stimulation they result if blocking beta2 stimulation is bronchoconstriction, for that reason it is contraindicated in asthmatic patients
39
Name some beta blockers
Propranolol Atenolol Acebutolol Metropolol tartrate (lopressor) can be given via IV. Monitor BP and ECG Q 5-15 min during administration push 5/mg/min
40
What do centrally acting alpha 2 agonist do
They inhibit the nervous system by stimulating the alpha2 receptors centrally in the medulla oblongata
41
What's the prototype drug of centrally acting alpha2 agonists
Clonidine ( catapres) | Used to lower BP
42
Clonidine in addition to what drug is used for withdrawal
Clonidine in addition to methadone is used for withdrawal
43
What are adverse effects of clonidine
Anticholinergic effects such as dry mouth dizziness, sedation, and constipation
44
Centrally acting drugs blocks the sympathetic nervous system what are drug interactions of these class of drugs
Beta adrenergic blocking agents and TCAs.
45
Direct acting vasodilators
Directly dilates arterioles, resulting in decreased peripheral resistance and BP
46
What is the prototype drug of direct acting vasodilators
Hydralazine ( Apresoline) | Use as a IV push when HR is uncontrollable you want to dilate vessels fast.
47
What are adverse effects of direct acting vasodilators
Sympathetic effects ( tachycardia, palpitations, nausea, and anorexia)
48
What is a action of calcium
It causes vasoconstriction
49
What happens when calcium is blocked from going into the smooth muscle
It causes vasodilation
50
Quick vasodilation can cAuse what
Nausea and vomiting
51
What are drugs used in hypertensive crisis
Sodium nitroprusside ( nitropress or nipride)
52
What are the pharmacodynamics of sodium nitroprusside
It is a mixed arterial and venous vasodilator Cyanide is a metabolite of this drug Cyanide poisoning may result from prolonged use Overdose causes profound hypotension and reflex tachycardia It is a emergency room med Slow infusion is necessary/ may develop headaches do not,expose this med to sunlight
53
How can one maximize therapeutic effects of nitroprusside
Infusion rate for nitroprusside must b titrated to reduce BP without compromising organ perfusion
54
How can one minimize adverse effects of nitroprusside
To avoid extreme hypotensive effect, start nitroprusside at a low infusion rate ( 0.3 mcg/kg/min) and increase it gradually until the desired effect is attained
55
Calcium channel blockers
Used to treat hypertension, dysrhythmias and angina pectoris It lowers BP by inhibiting the influx of calcium into the muscle cells reducing vasoconstriction and dilates coronary and peripheral arteries.
56
What are adverse effects of calcium channel blockers
Wheezing, constipation, headache, muscle cramps, hypotension and dizziness, bradycardia, heart block.
57
Calcium channel blockers are contraindicated in who
Contraindicated in ppl with liver or kidney failure, heart block, aortic stenosis, hypotension Discontinue gradually Contraindicated during pregnancy and lactation Avoid in serious respiratory disorders
58
Name some calcium channel blocker meds
``` Nifedipine (Procardia) Amlodipine besylate ( Norvasc) dilatizem HCL ( Cardizem) Verapamil ( Isoptin) Feldipine ( Plendil) ```

NANJU #2/3 (3 decks)

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