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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
Q

What conditions is captopril used for

A 
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
Q

For any cardiac medication what will always be a side effect

A

Hypotension

26
Q

ARBS

A

Same as ace inhibitors except in blocks angiotensin II from receptor sites blocking it.

Losartan ( cozaar)

27
Q

What are arbs used for?

A

(Sartan)

Are used for HTN, diabetic neuropathy, left ventricular dysfunction

28
Q

What are drug interactions of arbs

A

Lithium, fluconazole ( yeast infections), indomethacin ( anti inflammatory for gout), rifampin ( TB patients) and grapefruit juice.

29
Q

What drink should losartan be avoided with

A

Grapefruit juice

30
Q

How can one minimize the adverse effects of losartan?

A

Monitor creatinine, BUN, hgb, and HCT levels

If taking a potassium supplement notify provider

31
Q

Name a way that cardiac myopathy can occur

A

Because of faulty heart valves

32
Q

What is a sign and symptom of hypotension

A

Dizziness

Confusion

33
Q

What is true of CO and HR

A

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
Q

How do beta adrenergic blockers work

A

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
Q

What is a important rule of thumb when administering cardiac meds

A

Cardiac meds needs to be monitored by a heart monitor

36
Q

An increased BUN and cr indicates what

A

Kidney failure

37
Q

What are contraindications and precautions of beta blockers

A

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
Q

Why wouldn’t a beta blocker be given to a person with asthma

A

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
Q

Name some beta blockers

A

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
Q

What do centrally acting alpha 2 agonist do

A

They inhibit the nervous system by stimulating the alpha2 receptors centrally in the medulla oblongata

41
Q

What’s the prototype drug of centrally acting alpha2 agonists

A

Clonidine ( catapres)

Used to lower BP

42
Q

Clonidine in addition to what drug is used for withdrawal

A

Clonidine in addition to methadone is used for withdrawal

43
Q

What are adverse effects of clonidine

A

Anticholinergic effects such as dry mouth dizziness, sedation, and constipation

44
Q

Centrally acting drugs blocks the sympathetic nervous system what are drug interactions of these class of drugs

A

Beta adrenergic blocking agents and TCAs.

45
Q

Direct acting vasodilators

A

Directly dilates arterioles, resulting in decreased peripheral resistance and BP

46
Q

What is the prototype drug of direct acting vasodilators

A

Hydralazine ( Apresoline)

Use as a IV push when HR is uncontrollable you want to dilate vessels fast.

47
Q

What are adverse effects of direct acting vasodilators

A

Sympathetic effects ( tachycardia, palpitations, nausea, and anorexia)

48
Q

What is a action of calcium

A

It causes vasoconstriction

49
Q

What happens when calcium is blocked from going into the smooth muscle

A

It causes vasodilation

50
Q

Quick vasodilation can cAuse what

A

Nausea and vomiting

51
Q

What are drugs used in hypertensive crisis

A

Sodium nitroprusside ( nitropress or nipride)

52
Q

What are the pharmacodynamics of sodium nitroprusside

A

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
Q

How can one maximize therapeutic effects of nitroprusside

A

Infusion rate for nitroprusside must b titrated to reduce BP without compromising organ perfusion

54
Q

How can one minimize adverse effects of nitroprusside

A

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
Q

Calcium channel blockers

A

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
Q

What are adverse effects of calcium channel blockers

A

Wheezing, constipation, headache, muscle cramps, hypotension and dizziness, bradycardia, heart block.

57
Q

Calcium channel blockers are contraindicated in who

A

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
Q

Name some calcium channel blocker meds

A 
Nifedipine (Procardia)
Amlodipine besylate  ( Norvasc)
dilatizem HCL ( Cardizem)
Verapamil ( Isoptin)
Feldipine ( Plendil)

NANJU #2/3 (3 decks)

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