Ch 28 BP MEDS Flashcards
What can affect the kidneys
A bad heart, which causes less perfusion to reach the kidneys resulting in decreased function.
What is a indicator how well your heart is working
Blood pressure
Cardiac output
Amount of blood ejected from the LEFT VENTRICLE IN ONE MINUTE
What does the cardiac cycle consist of
Systolic and diastolic
Systolic
Contraction of the bicuspid and tricuspid valve
What is the bicuspid valve
The AV valve between the LEFT atrium and LEFT ventricle
What is a tricuspid valve
The AV valve between the RIGHT atrium and RIGHT ventricle has 3 cusps
How many valves does the heart have
The heart has 4 valves:
Pulmonic and aortic and bi and tri cuspid valves
The RIGHT side of the heart carries what type of blood
DEOXYGENATED BLOOD
What are signs and symptoms of RIGHT side heart failure
Edema
Jugular vein distention
What are signs and symptoms of LEFT sided heart failure
Rhonci, rales, respiratory distress, pulmonary congestion can happen very fast
For a pt in LEFT sided heart failure what would a nurse expect to be administered
A very potent lasix to drain fluid
Seeping edema indicates what
End stage RIGHT sided heart failure
Antihypertensive drugs act on what sites of the body
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
What are the major types of antihypertensive drugs
Ace inhibitors Arbs Anti adrenergic/ sympatholytic Beta adrenergic blockers Calcium channel blockers Direct acting vasodilators
What does beta 1 do
It increases BP
What does beta2 do
Vasodilation
What is the role of adrenergic receptors
Adrenergic receptors in the nervous system have a role in BP mgmt.
Captopril ( Capoten)
Ace inhibitor
Client should have normal renal function to use this drug
What are the uses for ace inhibitors
HTN
HF
DIABETIC NEUROPATHY ( because of the vasodilation properties)
LEFT VENTRICULAR DYSFUNCTION ( promotes cardiac output)
What are adverse effects of ace inhibitors
Persistent non productive cough, angioedema, rash, orthostatic hypotension, neutropenia, and dyspnea
Name ace inhibitors drugs
Captopril (capoten) Lisinopril ( Prinivil) Enalapril maleate (Vasotec) Quinapril HCL ( Accupril) Moexipril HCL ( Univasc) Ramipril ( Altace) Fosinopril ( Monopril)
When should captopril be administered
Take one hour before meals because food decreases absorption
What are post assessments of administering ACE inhibitors
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
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
For any cardiac medication what will always be a side effect
Hypotension
ARBS
Same as ace inhibitors except in blocks angiotensin II from receptor sites blocking it.
Losartan ( cozaar)
What are arbs used for?
(Sartan)
Are used for HTN, diabetic neuropathy, left ventricular dysfunction
What are drug interactions of arbs
Lithium, fluconazole ( yeast infections), indomethacin ( anti inflammatory for gout), rifampin ( TB patients) and grapefruit juice.
What drink should losartan be avoided with
Grapefruit juice
How can one minimize the adverse effects of losartan?
Monitor creatinine, BUN, hgb, and HCT levels
If taking a potassium supplement notify provider
Name a way that cardiac myopathy can occur
Because of faulty heart valves
What is a sign and symptom of hypotension
Dizziness
Confusion
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.
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
What is a important rule of thumb when administering cardiac meds
Cardiac meds needs to be monitored by a heart monitor
An increased BUN and cr indicates what
Kidney failure
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
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
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
What do centrally acting alpha 2 agonist do
They inhibit the nervous system by stimulating the alpha2 receptors centrally in the medulla oblongata
What’s the prototype drug of centrally acting alpha2 agonists
Clonidine ( catapres)
Used to lower BP
Clonidine in addition to what drug is used for withdrawal
Clonidine in addition to methadone is used for withdrawal
What are adverse effects of clonidine
Anticholinergic effects such as dry mouth dizziness, sedation, and constipation
Centrally acting drugs blocks the sympathetic nervous system what are drug interactions of these class of drugs
Beta adrenergic blocking agents and TCAs.
Direct acting vasodilators
Directly dilates arterioles, resulting in decreased peripheral resistance and BP
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.
What are adverse effects of direct acting vasodilators
Sympathetic effects ( tachycardia, palpitations, nausea, and anorexia)
What is a action of calcium
It causes vasoconstriction
What happens when calcium is blocked from going into the smooth muscle
It causes vasodilation
Quick vasodilation can cAuse what
Nausea and vomiting
What are drugs used in hypertensive crisis
Sodium nitroprusside ( nitropress or nipride)
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
How can one maximize therapeutic effects of nitroprusside
Infusion rate for nitroprusside must b titrated to reduce BP without compromising organ perfusion
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
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.
What are adverse effects of calcium channel blockers
Wheezing, constipation, headache, muscle cramps, hypotension and dizziness, bradycardia, heart block.
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
Name some calcium channel blocker meds
Nifedipine (Procardia) Amlodipine besylate ( Norvasc) dilatizem HCL ( Cardizem) Verapamil ( Isoptin) Feldipine ( Plendil)
