Chapter 22: Antihypertensive Drugs Flashcards
Goal of antihypertensive therapy
Reduce renal morbidity and mortality
Which antihypertensive drug has a black box warning?
Aliskiren
Which antihypertensive drug has asthma as a contraindication?
Carvedilol
Which alpha 1 blocker is commonly prescribed?
Doxazosin ( cardura).
Treats: HTN and BPH.
Which antihypertensive drug causes lesser degree is sexual dysfunction?
Nebivolol
Which black box warning is given on Nitroprusside?
Hypotension
What is true about calcium channel blockers (CCB)?
CCBs relax vascular smooth muscle.
It vasodilates the blood vessels to lower BP
What is the appropriate site for clonidine patch application?
Upper arm
What interaction can happen between an angiotensin II blocker and NSAID?
Decreased effect of angiotensin II receptor blocker
Which medication will decrease vasoconstriction by blocking angiotensin II receptors?
Valsartan
Which intervention is needed for a patient who is taking hydrochlothiazide?
Encourage intake of foods rich in potassium.
What would the nurse teach the patient who is receiving transdermal clonidine?
Remove the old patch before applying new patch.
Which is a priority for nursing intervention for patient who is prescribed nonselective beta blocker?
Respiratory assessment
Treprostinil
An antihypertensive used to treat pulmonary artery hypertension related to severe heart failure
Adverse effects of Hydralazine
Dizziness
Headache
Vomiting and diarrhea
An adverse effect of ACE inhibitor that need immediate attention
Angioedema
Which drug should be administered at bedtime for the first dose?
Doxazosin
Which antihypertensive medication to avoid giving to a patient with DM?
Propranolol.
Because it can mask the indicators of hypoglycemia by blocking the sympathetic stimulation caused by low blood sugar.
Side effect of Enalapril
Dry, hacking cough
Which antihypertensive drug can be given to a patient with liver dysfunction?
Captopril and Lisinopril
What adverse effect would happen if ACE inhibitor and Lithium are combined?
Toxic level of Lithium
Common side effect of Clonidine
Constipation
What is most important to assess in a patient receiving sodium nitroprusside infusion for 4 days?
Serum cyanide level.
Because cyanide toxicity can happen for prolonged treatment
What is a nursing intervention for minoxidil toxicity?
Administer IV fluids.
Because minoxidil toxicity can cause excessive hypotension. IVF can counteract this.
Which parameter would the nurse evaluate to determine effectiveness of lisinopril in a hypertensive patient with heart failure?
Breathing sounds.
Because ACE inhibitors like lisinopril cause vasodilation which decreases after load and increase excretion of sodium and water. Breathing sounds should improve.
Which medication would be given to treat hypertension after having an MI?
Eplerenone. This medication treats HTN and improves survival after MI.
What action should the nurse perform for a patient who developed lisinopril toxicity?
Patient needs to be sent for hemodialysis as this toxicity will only respond to dialysis.
What do Ace Inhibitors do?
- reduce after load
- systemic vascular resistance (SVR) is decreased
Which antihypertensives can cause tachycardia?
Diazoxide
Hydralazine
Which medications could cause interaction with ACE inhibitors?
Spironolactone
Ibuprofen
Potassium chloride
What is contraindicated with captopril?
Spironolactone
What is the antidote for Beta Blockers/ Calcium Channel Blockers?
Glucagon (makes you puke).
Alpha 1 causes
Vasoconstriction
Alpha 1 antagonist
( Doxazosin)
Vasodilation, lowers BP
Alpha 2 causes
Calming effect, decrease BP.
Example: Clonidine
Clonidine
Lowers BP and HR by relaxing arteries.
Selective Beta Blocker
Selectively blocks Beta 1 in the heart
Non- Selective Beta Blocker
Blocks both Beta 1 & 2, Alpha 1.
Contraindications of Nonselective Beta Blockers
Patients w/ COPD, asthma
Natriuretic Peptides
Consists of ANP & BNP levels.
They naturally decrease BP.
BNP levels
Anything over 100 means heart failure .
RAAS System
(Renin Angiontensin Aldosterone System).
RAAS kicks in when it detects low blood volume and then increases BP.
What happens when angiotensin 1 converts to angiontensin 2?
Angiotensin 2 causes vasoconstriction in the body.
Therefore, BP is increased.
Angiontensin 2 also stimulates Thirst.
Aldosterone
Causes kidneys to retain Na & water, causing fluid retention. Therefore increase blood volume and BP.
Outcome: patient decrease in urination
ADH
(Anti diuretic hormone)
Released by the pituitary gland.
ADH causes kidneys to hold water.
Aldosterone excretes ____
Potassium out of the body
Vasodilators
A form of antihypertensives.
- Hydralazine : treats HTN
- Bosentan: helps lower BP in the lungs
Which 2 classes of antihypertensives are Nephro & Cardio protective?
ACE inhibitors and ARBS.
They slow progression of kidney failure, reduce cardiac work load and diabetes.
Angiontensin 2 causes _________ in blood vessels
Constriction
Rebound Hypertension
When you stop these medications abruptly, then BP comes back stronger.
(Rubberband effect)
Classes of AntiHypertensives
- ACE inhibitors + ARBs
- Beta Blockers
- Calcium Channel Blockers (CCB)
- Vasodilators
ACE inhibitors -pril
Examples: enalapril, captopril, lisinopril
Moa: prevents angiotensin 1 turning into 2
Cause: vasodilation (decrease BP and SVR). Also decreases Aldoesterone - causing excretion of Na + water, retains K.
S/E: (ACE) Angioedema, Cough, Elevated K
ARBs - sartan
Examples: losartan, candesartan, valsartan.
Moa: blocks angiotensin 2 receptors.
Cause: vasodilation (decrease BP, SVR).
S/E: less likely to get angioedema or cough
Beta Blocks - olol
Examples: metropolol, propanolol, carvedilol.
Moa: blocks Beta 1 receptors (sympathetic).
Cause: decrease HR & Bp, lower cardiac output and causes relaxation
S/E: (B’s) Bradycardia, Breathing problems, Blood sugar masking, hypotension
Calcium Channel Blockers - VND
( Very Nice Drugs)
Example: Verapamil, Nifedipine, Diltiazem
Moa: blocks movement of calcium & decreasing contraction of the heart.
Cause: calms vessels by blocking calcium. Decreases cardiac workload, increase oxygen to heart.
S/E: bradycardia, AV blocks, peripheral edema.
