Drugs for HTN, Heart Failure

Question 1

When does stage 1 hypertension begin?

Answer 1

130/80

Question 2

When does stage 2 hypertension begin?

Answer 2

140/90

Question 3

When are meds indicated in hypertension?

Answer 3

Stage 2

Question 4

Consequences of HTN

Answer 4

-Heart disease - myocardial infarction, heart failure, angina pectoris
-Kidney disease
-Stroke

Question 5

Lifestyle modifications for HTN

Answer 5

-Sodium restriction
-DASH diet
-Alcohol restriction
-Aerobic exercise
-Smoking cessation

Question 6

Classes of antihypertensive drugs

Answer 6

-Diuretics
-Sympatholytics (antiadrenergic)
-Calcium channel blockers
-Drugs that suppress RAAS

Question 7

First HTN drug for patients without compelling indications (“just walking around with essential hypertension”)

Answer 7

First line Thiazide diuretics

Second line: ACE inhibitors, calcium channel blockers

Question 8

Which drugs would you prescribe for a patient with renal disease and/or diabetes?

Answer 8

ACE inhibitors

Question 9

What drugs are best for black pts?

Answer 9

Diuretics, Calcium blockers

(lots of black people in DC)

Question 10

Which drugs are contraindicated in pregnancy?

Answer 10

DRIs, ACE inhibitors, ARBs

Remember! DAA (drug addicts anonymous

Question 11

Tx for preeclampsia and eclampsia (BP elevates after 20 weeks)

Answer 11

-Labetolol
-Hydralazine
–Magnesium sulfate (anticonvulsant)
Sodium nitroprusside

Mneumonics:
Labetolol = “labor”
Hydralazine = hydro - like water birth
Magnesium - like a natural muscle relaxant
Sodium nitroprusside - pussy

Question 12

A patient with stage 2 hypertension has been prescribed a thiazide diuretic and angiotensin-converting enzyme inhibitor. What is the appropriate nursing action?

Answer 12

Administer both drugs to the patient, they work together

Question 13

A patient diagnosed with heart failure has stage 1 hypertension. Which medication, if ordered by the health care provider, should the nurse question?

A. Angiotensin-converting enzyme inhibitor
B. Calcium channel blocker
C. Thiazide diuretic
D. Beta blocker

Answer 13

Calcium channel blocker

-They weaken the strength of the heart’s contraction so they are not used in patients with heart failure

Question 14

What characterizes heart failure?

Answer 14

-Left ventricular dysfunction
-Reduced cardiac output
-Insufficient tissue perfusion
-Signs of fluid retention

Question 15

Primary drugs for heart failure

Answer 15

-Diuretics
-RAAS inhibitors
-Beta blockers
-Sacubitril/valsartan

Question 16

What are the RAAS inhibitors?

Answer 16

ACE inhibitors
Angiotensin II receptor blockers
Aldosterone antagonists
Direct renin inhibitors

Question 17

ACE inhibitors side effects

Answer 17

-Hypotension
-Hyperkalemia
-Cough
-Angioedema
-Renal failure if pt has bilateral renal artery stenosis
-Can cause fetal injury

Question 18

When are aldosterone antagonists like spironolactone and eplerenone added to treat heart failure?

Answer 18

Added to ACE inhibitors and ARBs to standard HF therapy in patients with moderately severe to severe symptoms

Question 19

Beta blockers adverse effects

Answer 19

-Fluid retention or worsening of HF
-Fatigue
-Hypotension
-Bradycardia or heart block

Question 20

Sacubitril/Valsartan
Mechanism of action

Answer 20

Sacubitril-inhibition of the enzyme that breaks down ANP and BNP, which promote loss of sodium and water

Question 21

Digoxin
MOA

Answer 21

-Positive inotropic actions - increases myocardial contractile
-Blocks sodium/potassium pump
-Increased cardiac output
-Decreased sympathetic tone

Question 22

Digoxin
Adverse effects

Answer 22

Can cause dysrhythmias
Potassium must be kept in range

Question 23

How do you manage digoxin-induced dysrhythmias?

Answer 23

-Stop the drug
-Replete potassium
-Lidocaine or phenytoin
-Digibind (for severe toxicity)

Question 24

Symptoms of digoxin toxicity

Answer 24

“Halos” around objects
GI symptoms

Question 25

What predisposing factors put you at risk of Digoxin toxicity?

Answer 25

Hypokalemia
Heart disease

Question 26

Which drugs are contraindicated for patients with HF?

Answer 26

Calcium channel blockers

Question 27

Interaction between verapamil and digoxin

Answer 27

Verapamil can raise digoxin levels by 60%

Question 28

Levels of which peptides produced by the heart are increased in heart failure? Do levels of one of these peptides correlate with the severity of heart failure?

Answer 28

Atrial natriuretic peptide (ANP) and B-natriuretic peptide (BNP)

BNP IS BAD

High levels of BNP indicate poor cardiac health and can predict a lower chance of survival

Question 29

Which combination of drugs are generally used for treatment of HF?

Answer 29

-Diuretics
-Loop diuretics over thiazides preferred when GFR or cardiac output is greatly reduced
-Potassium-sparing diuretics OR ACE OR ARB
-Beta blockers (metoprolol)
-Digoxin

Question 30

Are there drugs that make heart failure symptoms worse and should be avoided?

Answer 30

-Calcium channel blockers
-Antidysrhythmic agents
-NSAIDs - ibuprofen, naproxen

Question 31

What are the signs and symptoms of toxicity from digoxin?

Answer 31

-Visual disturbances like blurred vision or “Halos” around objects
-GI symptoms (N/V)

Question 32

What sort of monitoring should a patient have if we believe levels of digoxin are too high?

Answer 32

Serum potassium levels

Question 33

What is the antidote for digoxin toxicity? (there is something given to bind up the drug in the serum and also something given to treat dysrhythmias)

Answer 33

-Bind digoxin: Digifab, cholestyramine, activated charcoal
-Antidysrhythmic drugs: Phenytoin and lidocaine

Question 34

Take a look at a new drug for heart failure: sacubitril/valsartan (Entresto)? How does sacubitril work? You should be familiar with valsartan.

Answer 34

-Sacubitril is a new class of drug, called an ARNI
-Increases natriuretic peptides
-Suppresses the negative effects of the RAAS
-May be used instead of an ACE-inhibitor or ARB
-Similar side effect profile to ARB