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Nursing 2590 > Exam 1 Chapter 39 AntiHypertensives > Flashcards

Exam 1 Chapter 39 AntiHypertensives Flashcards

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1
Q

Purpose of DIURETICS

A

Decrease BP
Decrease edema

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2
Q

Beta blockers 1 and 2

A

Heart kidneys lungs Beta 1
Lungs Liver Beta 2

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3
Q

Metoprolol is a Beta Blocker
Non-selective or Selective

A

Selective - one receptor effect
Antagonist on Beta 1
Decrease in HR
Decrease in heart contractility
Decrease in BP
Decrease the workload of the heart, dec. oxygen need

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4
Q

Regulators of BP

A
  1. Kidneys - secrete - Renin
  2. Baroreceptor stimulation - coronary arteries/Adrenal glands
    if brady, will stim. neuor/catecholamines/norepinephrine
    Stimulate/agonize: beta 1,2 receptors alpha 1,
    will inc HR, BP
  3. Antidiuretic hormone - (ADH) Pituitary gland. Inc ADH (less pee, bp up less ADH, pee more, bp goes down, less volume.
  4. BNP Brain Natriuretic Peptide - released from the heart
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5
Q

BNP - Brain natriuretic Peptide

A

Muscles cells of the heart releases it.
when the heart senses it needs to contract more
with fluid overload it releases more.

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6
Q

RAAS System
Renin angiotensin aldosterone system

A
  1. Kidney releases renin
  2. Liver releases angiotensinogen
  3. Angiotensin I - weak vasoconstrictor
  4. ACE - angiotensin converting enzyme
  5. Angiotensin II - potent vasoconstrictor
    Two Functions -
  6. Peripheral vasoconstriction, inc BP
    ARBS (angiotensin receptor blocker) can stop this
  7. Aldosterone (Adrenal Glands) - sodium/water retention (inc. BP) - restores fluid
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7
Q

RAAS - review diagram

A
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8
Q

Lifestyle modifications for hypertension
COME FIRST and part of
ANY TREATMENT PLAN

A

Smoking cessation
Diet (Eat more colors, the rainbow) limit sodium
Control blood glucose and (Cholesterol) lipids (diabetes –heart disease)
Physical Activity (150 minutes/week)

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9
Q

Two main classes of drugs to control hypertension
(Also known as Anti-hypertension drugs)

A

ACE inhibitors (no converting to Angiotensin II)
ARBS (allows the conversion, but then blocks the receptors)

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10
Q

8 types of antihypertensive drug

A
  1. Diuretics (pee, decrease Na/water and ECFV)
  2. Angiotensin II receptor blockers ARBS
  3. Alpha Beta blockers
    4.Calcium Channel Blockers
  4. ACE inhibitors (no conversion to Angiotension II)
  5. Beta adrenergic blockers - Beta 1 or Beta 1/2
  6. Centrally acting Alpha 2 agonist
  7. Direct acting vasodilators -
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11
Q

Why do we give diuretics?

A

FIrst line for - Hypertension
Heart Failure
Fluid overload
pulmonary edema
peripheral edema

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12
Q

Diuretics - mechanism of action

A

Prevent kidneys from reabsorbing sodium/water
Vasodilation

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13
Q

Diuretic - Universal Assessment for all

A

I and O’s
Vital signs /BP. can cause hypotension
Kidney function
Daily weights - gain of more than 3 lbs/day or 5 lbs in a week notify HCP
Electrolytes. - esp. potassium
Safety - walking to bathroom, distance, already incontinent
*Teaching:
If 1x day med - take in the morning, so sleep not interrupted
No sudden position changes - elderly
most photosensitivity

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14
Q

What are the diuretic classes?

A
  1. Thiazides
  2. Loops
  3. Potassium Sparing
  4. Osmotic Diuretics
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15
Q

If you give a person a diuretic (foley) outcome would be

A

increased urine output

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16
Q

Kidney

A

Fluid enters at:
Nephron
Glomerulus/Bowman’s Capsule
Proximal Tubules 50-55% closest
Loop of Henle 35-40% loop diuretics
Distal Tubule 5-10%
Collecting Tubule < 3%

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17
Q

How much of sodium reabsorbed?

A

99%

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18
Q

Thiazide Diuretics - Pharmokinetics

A

Promotes sodium/water loss in distal tubule
Vasodilatory effect

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19
Q

Acute heart failure
would you use a thiazide diuretic?

A

No - maintenance hypertension heart failure
not for acute emergencies

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20
Q

List 3 Thiazide diuretics

A

Hydrochlorothiazide (HCT) MOST COMMON
Metolazone
Chlorthalidone

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21
Q

Thiazides are effective for immediate diuresis?
True or false

A

Thiazides are NOT effective for Immediate diuresis.
Maintenance therapy in heart failure

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22
Q

Potassium

A

3.5-5. mq/l
hypo excreted from distal renal tubule

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23
Q

Magnesium

A

1.2-2.5 mq/l
hypo occurs when K+ and Na+ are lost

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24
Q

Calcium

A

8.6-10.2 mg/dl hyper happens w thiazides as block excretion

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25
Q

Chloride

A

96-106 mEq/l hypo when Na+ and K+ are lost

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26
Q

BiCarbonate

A

24-28 mEq/L minimal from proximal tubule

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27
Q

Uric Acid

A

2.8-8.0 mg/dl hyperuricemia thiazides block release

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28
Q

Blood Glucose

A

70-99 mg/dl hyperglycemia thiazides inc blood sugar

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29
Q

Who should NOT use THIAZIDES?

A

CKF GFR > 30
Diabetics
Gout patients

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30
Q

Problems with Thiazides

A

LOW
HYPOkalemia. - low K+. ie K+=3. Low

HIGH
HYPERcalcemia - high Ca+
HYPERglycemia - high blood sugar
HYPERURICEMIA - gout - high uric acid

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31
Q

Loop Diuretics

A

promote loss of sodium and water
works in 5 minutes on IV
potent natriuretic effect

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32
Q

If patient is hypokalemia on thiazides
what can they do?

A

Foods with potassium
fruits and veg. potatoes
or supplements

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33
Q

If allergic to sulfa, can you take a thiazide?

A

No you will have an allergic reaction.

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34
Q

What to know about patient who is taking
a THIAZIDE -

A

Know electrolyte level
know K+ level
GFR<30
Allergies to sulfa
First line for hypertension

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35
Q

Loop Diuretics - potassium _______-

A

Potassium Wasting
at risk for hypokalemia

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36
Q

Name two diuretics are K+ wasting

A

Thiazides
Loop Diuretics

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37
Q

When are Loop diuretics used?

A

FV Fluid volume overload
Acute pulmonary edema
Heart failure
OTo get fluid out fast
promote the loss of sodium and water
aggressive drug IV onset 5 minutes

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38
Q

Name Loops

A

Furosemide (lasix)
Bumetanide (critical care) Bumex
Torsemide (heart failure) Demadex
IDE - LOOPS

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39
Q

S/S of fluid overload

A

edema
djv
inc rr
bounding pulse
inc pulse
crackles
sob
dec. pulse ox

40
Q

Black Box Warning for Loops

A

severe diaphoresis (urination)

41
Q

Loops can cause what -

A

electrolyte imbalances
everything doe
hypo K Mg Ca
orthostatic hypotension
HIGH
Hyperglycemia and
Hyperuricemia

42
Q

Similarities Thiazides and Loop

A

Hypo K. may need extra K+
Hyperglycemia
Hyperuricemia
Contraindication for Sulfa Allergies

43
Q

Differences thiazides and loops

A

thiazides ca up.
Loops ca down
Loops ototoxicity - if aminoglycicides combined worse

44
Q

Potassium Sparing diuretics works by

A

altering aldosterone action (less)
sodium/water excreted
so K+ increases, spared

45
Q

Name most common K+ sparing drug

A

Spironolactone
Eplerenone

46
Q

K+ Sparing diuretic used for

A

heart failure most common
blocking aldosterone action
sodium water are released (anti)ADH

47
Q

K+ concerns with K+ sparing diuretics
If 5.6 K+ what do you do

A

3.4-5.0
hyperkalemia
call provider

48
Q

Male patients with K+ sparing side effects

A

gynecomastia, will reverse

49
Q

S/S Hyperkalemia

A

lethargic
weak
paresthesia
N/V
arrhythmias
numbness, tingling

50
Q

Why dont take K+ sparing with ARBS or ACE

A

as they interfere with RAAS ARBS ACE
so can increase more K+ with these.
Can have hyperkalemia

51
Q

Osmotic diuretics work by

A

shifting fluid of greater concentration to less concentration
increase renal blood flow and renal vasodilation
cause large amounts of diuresis

52
Q

Why Osmotic diuretics?

A

High Pressure in 2 places not necessarily both
1. Cerebral Edema -head inc. intracranial pressure (tumor, trauma)
2. Glaucoma - IOP increased intraocular pressure
Fluid shift to lungs

53
Q

Osmotic diuretics look for …

A

Fluid shift to lungs
-crackles in lungs
-dec in pulse ox
-inc HR

54
Q

Beta Blockers - how do they work

A

decrease contractility beta 1
negative inotrope = dec cardiac contractility
decrease heart rate beta 1
Dec. Renin secretion beta 1
dec blood pressure beta 1

55
Q

Beta Blockers - selective and non-selective

A

Selective beta 1. one heart two kidneys
Non selective Beta 1 and 2 2 lungs one liver

56
Q

Name beta 1 (selective) blockers

A

Atenolol. PO
Metoprolol PO and IV
asthma/COPD can only have beta 1

57
Q

Name beta 1/2 non-selective beta blockers

A

Propanolol
Labetalol
Sotalol

58
Q

Why beta blockers

A

Heart failure
MI
angina
dysrhythmia
CHF
Post MI
To help heart not work as hard
by dec. bpr and contractivity
dec. oxygen demand

59
Q

Side effects of beta blockers

A

Fatigue
impotence
dry mouth
bradycardia
hypotension - ck hr and bp.
hold less than 90 systolic
hr less than 60 hold
masking of hypoglycemia NS or S
bronchospasm specific NS

60
Q

Hold beta blocker when

A

systolic less than 90
hr less than 60

61
Q

Beta blockers patient education

A

nonselective - copd asthma do NOT GIVE
DO not abruptly stop cause heart attack

62
Q

Antidote for beta blocker

A

GLUCAGON

63
Q

HYPERMAGNESEMIA S/S

A

antidote -calcium gluconate
dec reflexes bowel vital signs

64
Q

Patient Teaching for beta blockers

A

Teach how to take their pulse
masking of sugar
non-selective beta 2 less blood sugar release, need less insulin
pregnancy d - not use it

65
Q

ALPHA/Beta Blockers - how do they work

A

same as beta blockers - decrease contractility and hr
vasodilation

66
Q

Name Alpha/beta blockers

A

CARVEDILOL - think carvel - A+B
For HF
combine non selective beta and alpha
Beta 1 dec hr, dec contractility
Beta 2 bronchoconstriction, dec. glycogenolysis lower blood sugar,
Alpha 1 vasodilation
labetalol po and iv

67
Q

What are alpha/beta blockers used for?
(Non selective Betas and Alpha 1)

A

HTN
CHF
Pulmonary Edema

68
Q

Side effects of Alpha/beta blockers are…

A

same as beta blockers by
greater risk of HYPOTENSION beta 1 and alpha 1

69
Q

Teaching AB blockers

A

no copd, asthma, diabetes concern
parkinsonian

70
Q

ANGIOTENSION Converting Enzyme Inhibitor
ACE works -

A

Inhibits the conversion of angiotensin 1 to 2
Vasodilation
Inhibits aldosterone

71
Q

Name ACES
common ending

A

Lisinopril
Captopril
Fosinopril
Ramipril
Enalapril
PRIL - coming ending
Think APRIL. A for ACES + PRIL

72
Q

Who gets ACEs

A

Hypertension
CHF
Post MI

73
Q

ACE side effects/

A

irritating cough - dry hacking
first dose effect - drop BP after first dose
ADVERSE RX:
angioedema - indication of allergic rx swelling of tongue, lips, airway - can develop years later

hyperkalemia
hypotension

74
Q

ACE nursing concerns

A

monitor K+
Monitor BP
renal and kidney function
Pregnancy D drugs

75
Q

ACE and ARBS are similar because the both effect
the __________ system, but at different parts.

A

RAAS

76
Q

How does ARBS work

A

Blocks angiotensin 2 from AT1 receptors
Vasodilation
Inhibits aldosterone

77
Q

NAME 3 ARBS
common ending

A

Irbesartan
losartan
valsartan
THINK SARTAN - ARBS

78
Q

Indications for ARBS

A

Same as ACE
HTN
CHF
Most MI

79
Q

ARBS S/E AR

A

Same as as ACE but no coughfirst dose effect - drop BP after first dose
ADVERSE RX:
angioedema - indication of allergic rx swelling of tongue, lips, airway - can develop years later

hyperkalemia
hypotension

80
Q

ACES and ARBS nursing concerns similar

A

monitor renal hepatic function k+
hyperkalemia
pregnancy d

81
Q

Calcium channel blockers how do they work. - 2 types

A

inhibits the transport of calcium into vascular smooth muscle
promotes vasodilation
slows cardiac electrical conduction reduce tachy
help to dec angina
dec high bp and irregularities
and relax spasming of coronary arteries

82
Q

Ca channel blockers what are the 2 types

A

non-dihypyridens - nothing to do with BP, just HR
Verapamil
Dilitazem (cardazem)

dihyropyridene-
Amlodipine -

83
Q

Ca Channel Blockers side effects

A

Hypo tension
bradycardia
edema peripheral. ankles amlodipine

84
Q

Ca Channel blockers teaching

A

photosensitive
pulse check
no grapefruit

85
Q

Stable angina on ca channel blocker
how do you know its working

A

drug relaxes smooth cardiac muscle
are they still having angina ? less chest pain

86
Q

Direct Acting Vasodilators
EMERGENCY CARE
AGGRESSIVE DRUGS
what are they used for

A

relax smooth muscles
potent vasodilators

87
Q

Direct Acting Vasodilator drugs

A

Hydralazine - work well on african americans
Minoxidil

88
Q

Direct Acting Vasodilators side effects

A

Edema - retains Na/H20
Hypotension
Reflex tachycardia caused by change in blood pressure dropping quickly

89
Q

Centrally Acting alpha agonists work by. __

A

stimulating alpha 2 receptors (agonists)
vasodilation

90
Q

Centrally acting alpha agonist names

A

**Methyldopa - pregnancy safe
Clonidine

91
Q

What are CAAA used for?

A

HTN
PIH methydopa
sode effects edem,a drowsiness, bradycardia

92
Q

ACE ARBS THiazide, Ca Channel blockers most commonly for what ________

A

Hypertension

93
Q

Hypertension and pg drug

A

Methydopa
short duration beta blocker

94
Q

Compelling complications what drug used

A

For a Diabetic - use ACE and ARBS, to protect kidneys
Cultural backgrounds -different responses
***African american - not ACE or ARBS or beta blockers
most effective drugs are ca channel blockers and thiazides
**Asian/American - decrease dose, more sensitive
*Herbs inc. metabolism ephedra moo lang wt. lose supplements, they inc. blood pressure -reconciliation
Asses before and after
Diuretics electrolytes must be managed.
black box warning beta blockers and loop diuretics
Safety - elderly - safe on their feet, orthostatic move slowly.

95
Q

Case study for diuretic
52 year old black male, 158/92 bmi 30, smoking 1 pack 10 years, rx hct
What are risk factors? Similarities? Differences?
Should he eat K+ rich foods?
Pre assessment

A

risk: african american, elevated bmi, smoking
HCT (loop) vs Thiazide - both are K+ wasting, risk for hyperkalemia, monitor electrolytes. may require K+ supplementation. if sulfa allergy do not sue, will inc. uric acid and glucose.
Differences: Thiazides hyperkalemia, HCT - hypercalcemia
Loops have a black box warning for ototoxicity and more aggressive.
Yes eat k+ foods.
Preassessment - electrolytes uric acid, blood sugar vitals

96
Q

Case study 1 month later muscle weakness and fatigue
Na 135, K+ 3.2, Uric acid 4 mg glucose 120

A
  1. hypokalemia and elevated glucose
  2. Symptoms of hypokalemia
  3. increase K+ food intake and K+ supplementation.
97
Q

COMMON ENDINGS
ACE AND ARBS

A

PRIL AND SARTAN

Nursing 2590 (6 decks)

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