Exam 1 Flashcards
Hydrochlorothiazide
[HCTZ]
CLASS: Thiazide Diuretics
MOA:
-works on distal convoluted tubule of the kidney to inhibit reabsorption of Na/K & chloride = decrease cardiac output
-results = water loss
-relaxes arterioles = decreased peripheral vascular resistance (PVR)
ADVERSE REACTIONS:
-electrolyte & metabolic disturbances (hypokalemia- low potassium)
-orthostatic hypotension
-worsen renal insufficiency
-hyperuricemia (watch for gout)
-elevate levels of glucose, cholesterol, & triglycerides
NURSE CONSIDERATIONS:
-Monitor potassium levels
-May need potassium supplements
-Encourage potassium rich foods
furosemide
CLASS: loop diuretic
MOA:
-inhibit kidneys ability to reabsorb sodium in the Loop of Henle
-Makes kidneys put more sodium in urine
ADVERSE REACTIONS:
-hypokalemia
-profound diuresis = dehydration
-hypotension
-ototoxicity = difficulty hearing
NURSE CONSIDERATIONS:
-Monitor potassium levels
-May need potassium supplements
-Monitor daily weight
spironolactone
CLASS: Potassium-Sparing Diuretics
MOA:
-block action of aldosterone (Na & water retention) = potassium retention & excretion of Na & water
ADVERSE REACTIONS:
-Hyperkalemia
-Endocrine effects: deepened voice, impotence, irregular menstruation cycles, gynecomastia, hirsutism
NURSE CONSIDERATIONS:
-Monitor potassium levels (hyperkalemia)
-Monitor for abnormal effects of endocrine system
metoprolol [selective]
CLASS: Beta-Blocker
MOA:
-Increases nitric oxide= vasodilation response
-Block stimulation of beta-1 receptors =
Decreases HR and contractility
ADVERSE REACTIONS:
-Fatigue/lethargy
-Bradycardia
-Hypotension
-Can mask hypoglycemia
NURSE CONSIDERATIONS:
-Wean slowly when discontinuing (possibility of rebound HTN = critical rise in BP, high risk for CV event/stroke/death)
-Do NOT use non-selective beta blocker with pt. who have asthma/breathing conditions
-Recognize risk for hypotension and/or bradycardia (Hold & contact provider if HR < 60 or systolic BP < 100)
propranolol [non-selective]
CLASS: Beta-Blocker
MOA:
-Increases nitric oxide= vasodilation response
-Block stimulation of beta-1 receptors =
Decreases HR and contractility
ADVERSE REACTIONS:
-Fatigue/lethargy
-Bradycardia
-Hypotension
-Can mask hypoglycemia
NURSE CONSIDERATIONS:
-Wean slowly when discontinuing (possibility of rebound HTN = critical rise in BP, high risk for CV event/stroke/death)
-Do NOT use non-selective beta blocker with pt. who have asthma/breathing conditions
-Recognize risk for hypotension and/or bradycardia (Hold & contact provider if HR < 60 or systolic BP < 100)
carvedilol [alpha & beta]
CLASS: Beta-Blocker
MOA:
-Increases nitric oxide= vasodilation response
-Block stimulation of beta-1 receptors =
Decreases HR and contractility
ADVERSE REACTIONS:
-Fatigue/lethargy
-Bradycardia
-Hypotension
-Can mask hypoglycemia
NURSE CONSIDERATIONS:
-Wean slowly when discontinuing (possibility of rebound HTN = critical rise in BP, high risk for CV event/stroke/death)
-Do NOT use non-selective beta blocker with pt. who have asthma/breathing conditions
-Recognize risk for hypotension and/or bradycardia (Hold & contact provider if HR < 60 or systolic BP < 100)
clonidine
CLASS: Alpha-2 Adrenergic Agonist
MOA:
-Decrease sympathetic outflow resulting in decreased stimulation of adrenergic receptors (both alpha & beta receptors) = decreased BP
ADVERSE REACTIONS:
-drowsiness
-rebound HTN
-may worsen pre-existing liver disease
NURSE CONSIDERATIONS:
-Do not abruptly discontinue = rebound HTN
doxazosin
CLASS: Selective Alpha-1 Blockers
MOA:
-selective alpha-1 blockade (result in venous and arterial dilation)
ADVERSE REACTIONS:
-hypotension
-dizziness
NURSE CONSIDERATIONS:
-Monitor BP
-Monitor LOC
captopril
CLASS: ACE Inhibitor
MOA:
-blocks angiotensin-converting enzyme (ACE)
-inhibits production of Angiotensin-2 (powerful vasoconstrictor)
-inhibits aldosterone secretion = less water retention)
-slows progression of left ventricular hypertrophy associated with HTN
ADVERSE REACTIONS:
-First dose = hypotension common (15-20% drop in 6-8 hours)
-Dry, nonproductive, persistent cough = BIG complaint often leads to switch
-Dizziness
-Rash
-Angioedema (rare, more common in African Americans) = swelling of airway
-DO NOT use if pregnant
NURSE CONSIDERATIONS:
-Renal insufficiency = use cautiously in pt. with history of renal disease
-Captopril can cause neutropenia = monitor WBC (risk for infection)
-Risk of hyperkalemia especially on potassium supplements
-Safe for those w/ diabetes = renal protective effects
-often given w/ thiazide diuretics
lisinopril
CLASS: ACE Inhibitor
MOA:
-blocks angiotensin-converting enzyme (ACE)
-inhibits production of Angiotensin-2 (powerful vasoconstrictor)
-inhibits aldosterone secretion = less water retention)
-slows progression of left ventricular hypertrophy associated with HTN
ADVERSE REACTIONS:
-First dose = hypotension common (15-20% drop in 6-8 hours)
-Dry, nonproductive, persistent cough = BIG complaint often leads to switch
-Dizziness
-Rash
-Angioedema (rare, more common in African Americans) = swelling of airway
-DO NOT use if pregnant
NURSE CONSIDERATIONS:
-Renal insufficiency = use cautiously in pt. with history of renal disease
-Captopril can cause neutropenia = monitor WBC (risk for infection)
-Risk of hyperkalemia especially on potassium supplements
-Safe for those w/ diabetes = renal protective effects
-often given w/ thiazide diuretics
losartan
CLASS: Angiotensin Receptor Blockers (ARBs)
MOA:
-block action of angiotensin 2 AFTER it is formed
-causes vasodilation
-increased sodium and water excretion
ADVERSE REACTIONS:
-well tolerated
-some risks of angioedema
-DO NOT use if pregnant
-use cautiously w/ pt. with renal problems
NURSE CONSIDERATIONS:
-know pt. reason for taking
aliskiren
CLASS: Renin Inhibitor
MOA:
-induces vasodilation, decreases blood volume, decreases SNS activation, and inhibits cardiac & vascular hypertrophy
ADVERSE REACTIONS:
-GI discomfort
-when given w/ ACEi watch for hyperkalemia, especially in pt. with diabetes
NURSE CONSIDERATIONS:
-takes several weeks to see full effect (long half-life)
-DO NOT take if pregnant
nifedipine
CLASS: Calcium Channel Blocker
MOA:
-block calcium channels = causes vasodilation of smooth muscle (peripheral arterioles)
ADVERSE REACTIONS:
-orthostatic hypotension
-peripheral edema
NURSE CONSIDERATIONS:
-CCB are often best for elderly and African Americans
-Diuretics can be given for peripheral edema
nicardipine
CLASS: Calcium Channel Blocker
MOA:
-block calcium channels = causes vasodilation of smooth muscle (peripheral arterioles)
ADVERSE REACTIONS:
-orthostatic hypotension
-peripheral edema
NURSE CONSIDERATIONS:
-CCB are often best for elderly and African Americans
-Diuretics can be given for peripheral edema
verapamil
CLASS: Calcium Channel Blocker
MOA:
-block calcium channels = causes vasodilation of smooth muscle (peripheral arterioles)
ADVERSE REACTIONS:
-orthostatic hypotension
-peripheral edema
NURSE CONSIDERATIONS:
-CCB are often best for elderly and African Americans
-Diuretics can be given for peripheral edema
