Exam 2 Flashcards
1
Q
What type of drug is memantine?
A
An NMDA receptor blocker
2
Q
What is the first and only drug in the NMDA drug class?
A
memantine
3
Q
What is memantine used for?
A
moderate to severe Alzheimer’s disease
4
Q
How does memantine work in the body?
A
It blocks NMDA receptors, which reduces high levels of glutamate that cause neuronal damage in Alzheimer’s
5
Q
What are adverse effects on memantine?
A
CNS effects: dizziness, headache, increased confusion; constipation
6
Q
What are some nursing considerations for NMDA drugs (memantine)?
A
Assist with ambulation (client can be dizzy), increase fluids and fiber, monitor adverse effects and include caregiver in instructions
7
Q
When are cholinesterase inhibitors indicated?
A
For mild to moderate Alzheimer’s disease
8
Q
T/F Cholinesterase inhibitors are effective in 1 of 12 patients.
A
True
9
Q
How long do cholinesterase inhibitors delay or slow progression of AD?
A
A few months
10
Q
How do cholinesterase inhibitors work?
A
They prevent the breakdown of ACh by cholinesterase and increase ACh levels in the brain
11
Q
What are patients taking cholinesterase inhibitors at risk for?
A
Falls and safety issues
12
Q
Cholinesterase drugs need to be tapered when discontinued. T/F
A
True
13
Q
What are some cholinergic effects that may be shown in cholinesterase inhibitors?
A
They affect the GI system mostly; can cause N/V/D, increased salivation, involuntary defecation; Cardiovascular: bradycardia, hypotension, syncope
14
Q
What drugs are contraindicated in cholinesterase inhibitors?
A
NSAIDS (cause GI bleed and ulcers) and anticholinergic drugs (reduce drug responses)
15
Q
What drug is the prototype for cholinesterase inhibitors?
A
donepezil
16
Q
What are nursing considerations for cholinesterase inhibitors (donepezil)?
A
Administer with food to decrease GI effects, assist with ambulation, monitor HR, weight loss, GI bleeding, CNS effects
17
Q
T/F antipsychotics cause an increased risk of mortality in dementia.
A
True
18
Q
What is the most prevalent neurologic disorder?
A
Epilepsy
19
Q
What major risk is associated with seizure disorders?
A
Family planning risks (risk of abnormalities)
20
Q
T/F Seizure meds need to be continued during pregnancy because of greater risk of seizures.
A
True
21
Q
T/F Pregnant women and elderly have a higher frequency of seizures.
A
True
22
Q
generalized onset seizures begin in ____ area of the brain and rapidly spread throughout ____ hemispheres of the brain
A
one, both
23
Q
Tonic-clonic seizures may have an ____ and last ___ minutes.
A
aura, 1-2
24
Q
T/F Absence seizures are more common in children starting at 3 years old, and go away in adolescence.
A
True
25
Absence seizures can be characterized by 'staring into "space". T/F
True
26
What is an atonic seizure?
A drop attack, lasting a few seconds.
27
What is the biggest concern for atonic seizures (drop attacks)?
Falls and injuries
28
What are myoclonic seizures?
Seizures involving the neck, shoulders and arms with 2 types of seizures.
29
What can status epilepticus (medical emergency) lead to?
hypoglycemia, acidosis, hypothermia, hypoxia, brain damage, death
30
What period of time must withdrawing antiepileptic drugs be done over?
6-12 weeks
31
What are problems associated with withdrawing antiepileptic drugs?
Physical dependence and risk for reoccurrence of seizures
32
What needs to be kept in consideration to antiepilectic drugs?
Family planning since this is a category D drug.
33
Which cultural groups metabolize antiseizure drugs differently and what needs to be done to achieve the same therapeutic effects as those of other cultural groups?
Arab Americans and Asian Americans; they may require lower doses and frequent dose adjustment
34
What drug type is for absence seizures?
Succinimides
35
What are the prototypes for barbiturates?
phenobarbital and primidone
36
How are barbiturates helpful as AED's?
They reduce tonic-clonic, muscular and emotional responses to stimulation
37
What are disadvantages of barbiturates (phenobarbital and primidone)?
Low safety margin, profound CNS depression, respiratory depression, bradycardia, syncope and hypotension, and a high potential for drug abuse
38
What is the MOA of benzodiazepines?
Increases GABA
39
What do benzodiazepines end in?
-pam
40
What is the benzodiazepine prototype?
Diazepam
41
What should never be done and why regarding benzodiazepines?
Discontinuing abruptly can cause status epilepticus
42
What is the #1 treatment for status epilepticus?
benzodiazepines
43
What can benzodiazepines also be used for, besides seizures?
alcohol withdrawal
44
What is the only antidote for benzodiazepine toxicity?
flumazenil
45
What should be avoided with benzodiazepines (diazepam)?
Other CNS depressants/alcohol and grapefruit juice
46
What adverse effect is the most common with diazepam (benzos)?
CNS depression
47
What is the most serious adverse effect with diazepam?
Cardiovascular collapse; assess for bradycardia, tachycardia, hypotension and edema
48
What are hydantoins?
Antiepileptic drugs
49
What is the prototype for hydantoins?
Phenytoin
50
What is the use for phenytoin?
tonic-clonic and partial seizures
51
What do all hydantoins end in?
-toin
52
What is the most common adverse effect of phenytoin?
CNS effects--mild drowsiness and CNS depression
53
What are serious adverse effects of phenytoin?
Gingival hyperplasia, bone marrow suppression, and skin rash
54
What is gingival hyperplasia?
The swelling and overgrowth of gums
55
What is the black box warning for phenytoin?
If given too fast, it can cause hypotension and arrhythmias
56
How fast should phenytoin be given?
50mg/minute is the IV rate
57
What are signs of phenytoin toxicity?
nystagmus, ataxia, sedation, blurred/double vision
58
T/F IV phenytoin is incompatible with dextrose solutions.
True
59
T/F phenytoin decreases effects to oral contraceptives, warfarin and glucocorticoids.
True
60
What are some nursing considerations for hydantoins (phenytoin)?
Do not drive/perform hazardous activities if experiencing CNS effects, obtain regular dental checkups and brush teeth with a soft bristled toothbrush, do not abruptly stop medication
61
What is the only drug type used for absence seizures?
Succinimides
62
What is the prototype for succinimides?
ethosuximide
63
How long does it take ethosuximide to reach optimal effects?
4-7 days
64
ethosuximide, a succinimide, is ineffective at treating simple or complex partial and tonic clonic seizures. T/F
True
65
T/F ethosuximide cannot cause fatal pancytopenia and bone marrow suppression.
False
66
What drug can be used for all seizure types, migraines and mania?
valproic acid
67
What are serious adverse effects in valproic acid?
liver toxicity and neural tube defects
68
What is the serum drug level for valproic acid?
50-100 mcg/ml
69
What medication is used for valproic acid overdose?
naloxone
70
What are some nursing considerations for valproic acid?
Fall precautions and enteric coated tabs to minimize GI distress
71
What are goals of treatment for status epilepticus?
maintaining ventilation, correcting hypoglycemia and termination the seizure as well as initiating or continuing long term suppression drugs
72
What are two drugs that are used in status epilepticus?
lorazepam or diazepam
73
What drug is used alone or in combination for treating partial seizures?
carbamazepine
74
What drug can be used for neuropathy and partial seizures?
gabapentin
75
What drug should be taken into consideration with Asian ancestry and why?
carbamazepine, Asian ancestry has a high risk of Steven-Johnson syndrome
76
What are dermatologic adverse effects of carbamazepine?
rash, photosensitivity, alopecia, toxic epidermal necrosis and Stevens-Johnson syndrome
77
What is the black box warning for carbamazepine?
It can cause cytosis and aplastic anemia
78
What is something unique about carbamazepine?
It can decrease effectiveness of contraceptives and give false negatives on pregnancy tests
79
What are nursing considerations for carbamazepine?
Give at bedtime if possible (CNS effects), give with meals to reduce GI symptoms, use sunscreen, fall precautions
80
What pregnancy category is gabapentin?
C
81
What are adverse effects of gabapentin?
increased frequency of viral infections, weight gain and gastric upset
82
What two drugs should be avoided with gabapentin?
Morphine and hydrocodone
83
What are muscle spasms?
cramps or charlie horses
84
What is muscle spasticity?
a neurological condition where certain muscle groups remain in a continuous state of contraction
85
T/F Patients experiencing muscle spasticity are able to voluntarily relax their limbs.
False
86
What drug class is the 1st line for mild to moderate pain d/t muscle overexertion?
NSAIDS
87
How do centrally acting skeletal muscle relaxants work in the body?
They relieve actions in the CNS and do not work on the muscles themselves
88
What is the prototype for centrally acting muscle relaxants?
cyclobenzaprine
89
What is the MOA of cyclobenzaprine?
Enhances the inhibitory effects of GABA on receptors in the spinal cord
90
What are patients at risk for when coming off of cyclobenzaprine (a centrally acting muscle relaxant?)
physical dependence; abstinence syndrome, anxiety, restlessness, hallucinations and seizures
91
What age group should be cautioned with use of cyclobenzaprine?
65 and older; they are more likely to experience CNS effects
92
What are drugs used for spasticity?
baclofen, diazepam and dantrolene
93
T/F Baclofen has no direct effect on skeletal muscle, so it doesn't decrease muscle strength.
True
94
How long of a period should baclofen be withdrawn over?
1-2 weeks d/t physical dependence
95
T/F PO Baclofen should be taken with food/milk.
True
96
What will nursing education of baclofen focus on?
Safety
97
What is the only benzo approved for spasticity?
diazepam
98
How does diazepam work in the body?
It acts in the CNS and mimics the actions of GABA
99
Which drug used for spasticity is direct acting on muscles and decreases muscle strength?
Dantrolene
100
T/F Dantrolene is also the treatment of malignant hyperthermia.
True
101
T/F Women taking estrogen and dantrolene are at a higher risk of hepatic toxicity.
True
102
What is the black box warning for dantrolene?
hepatotoxic death
103
higher virulence causes _____
more harm to the patient
104
What is pathogenicity?
The ability of an organism to cause disease
105
What is virulence?
A quantitative measure of an organism's pathogenicity
106
What are exotoxins?
Proteins released by bacteria to surrounding tissues that can inactivate or kill host cells
107
What are endotoxins?
Harmful non-protein chemicals that are part of the outer layer of a normal cell and are released after a bacteria dies, causing inflammation, fever and chills.
108
T/F antibiotics may make a person feel worse before they feel better.
True
109
Describe gram positive bacteria.
Thick cell wall, retain violet color in stains
110
Describe gram negative bacteria.
Thin cell wall, lose violet color in stains
111
Which gram is harder to penetrate?
gram negative, because it has three layers.
112
Bactericidal drugs _____
kill bacteria
113
Bacteriostatic drugs ____
kill bacteria indirectly by slowing bacterial growth and allow natural defenses to eliminate the microorganism
114
Inhibition of bacterial cell wall synthesis works by ______
causing the cell wall to swell and burst
115
T/F in acquired resistance to antimicrobial drugs, the microbes become resistant, not the person.
True
116
Which antibiotics promote resistance?
Broad spectrum
117
How does antibiotic use promote resistance?
Antibiotics kill all of an infection besides one resistant organism, which rapidly divides
118
What is the most common site of HAIS (Healthcare Associated Infections)?
Catheters
119
What is important regarding cultures and antibiotics?
You must obtain the culture first and then start antibiotics.
120
What are indicators for success of antimicrobial therapy?
Fever reduction, resolution of s/s
121
What is a severe form of hypersensitivity reaction to abx?
Anaphylaxis
122
When do we see superinfections appear?
With broad spectrum abx use or long term abx
123
How can you prevent superinfections?
lactobacillus (probiotic) or yogurt
124
What are examples of superinfections?
C-diff, fungal infections in skin or oral mucous membranes
125
What are the drug classes that affect cell walls?
Penicillins, Cephalosporins, Carbapenems, Vancomycin
126
What is the MOA of penicillins (prototype PCN G (natural) and Ampicillin (broad spectrum)?
weaken and destroy cell wall, bactericidal
127
What is an enzyme that makes penicillin inactive?
penicillinase or anything ending in -ase
128
What penicillins can work against penicillinase?
Penicillinase-resistant PCNs
129
T/F allergies to penicillin may also happen in cephalosporins.
True
130
T/F you cannot outgrow a penicillin allergy.
False
131
T/F penicillin is effective against gram positive, gram negative and pseudimonas.
True
132
PCN G (a natural penicillin) is ____ spectrum and includes most gram __ bacteria.
narrow, positive
133
Ampicillin is a ___ spectrum and includes gram __ and some dram ___ bacteria.
broad, positive, negative
134
What is the prototype for cephalosporins?
Cefazolin
135
What is the prefix for all cephalosporins?
Cef- or Ceph-
136
When is Cefazolin (a cephalosporin) used?
As a broad spectrum, against gram - infections and for those who are allergic to PCN or PCN resistant
137
What happens when cefazolin is taken with alcohol?
A disulfiram like reaction (violent vomiting)
138
Which generation of cephalosporins is only effective against gram +?
1st generation
139
What is the prototype for carbapenems?
Imipenem
140
When is imipenem used?
for more serious infections
141
What class is imipenem in?
Carbapenem
142
What drugs antagonize carbapenems (Imipenem)?
PCN, cephalosporins and aztreonam
143
T/F you should take carbapenems (Imipenem) at the same time as PCN, cephalosporins and aztreonam.
False; should be at different times d/t cross sensitivity.
144
What is the suffix for carbapenems?
-penem
145
What is the most effective drug against MRSA and c diff?
Vancomycin
146
T/F If a systemic infection is present, vancomycin has to be given via IV.
True
147
T/F vancomycin has a low safety margin and peak and trough needs to be monitored.
True
148
What are some serious adverse effects of vancomycin?
Renal failure, ototoxicity, red man syndrome
149
What are signs of ototoxicity?
tinnitus, high tone hearing loss and deafness
150
What are signs of red man syndrome?
hypotension, tachycardia, rash and flushing of the face and trunk
151
How can a person get red man syndrome?
From a rapid Vanco IV infusion
152
How can red man syndrome be prevented?
By infusing vanco over 60 mins or more.
153
What are the three drug classes that affect bacterial protein synthesis?
Tetracyclines, macrolides and aminoglycosides
154
When are tetracyclines used?
When an infection is resistant to first line abx
155
What is the prototype for tetracyclines?
tetracycline
156
How does tetracycline work in the body?
It inhibits protein synthesis
157
How can GI irritation be treated with tetracycline?
It can be reduced if taken with food; food must be nondairy
158
How soon must tetracycline be given before ingesting dairy?
1-2 hours
159
What are some adverse effects of tetracycline?
photosensitivity (severe sunburn type reaction) and teeth discoloration
160
Why should tetracycline be avoided for kids under 8 or pregnant/lactating women?
They are at higher risk for teeth discoloration and it can slow down growth rates in fetuses and children
161
Why should patients taking tetracycline have their hepatic or renal function monitored?
It forms insoluble content in the body
162
What is the prototype for macrolides?
Erythromycin
163
What type of abx is erythromycin?
broad spectrum, most effective against gram + bacteria
164
What is the first line drug for Legionnaires' disease, whooping cough and diphtheria?
Erythromycin
165
T/F erythromycin can increase effects of warfarin.
True
166
T/F erythromycin is safe but in rare cases can kill you.
True
167
What are important adverse effects of erythromycin?
ventricular dysrhythmias, cardiotoxicity and ototoxicity
168
What is the prototype for aminoglycosides?
Gentamycin
169
When would gentamycin be given?
As a second line abx, where there are no less toxic alternatives
170
T/F gentamycin is a narrow spectrum abx and works against gram - bacteria.
True
171
Which serious adverse effects are present in gentamycin?
ototoxicity and nephrotoxicity
172
What should a nurse educate a patient on when taking gentamycin?
signs of hearing loss, tinnitus and vertigo
173
What are things that should be monitored when taking gentamycin and why?
I/O's, BUN & Creatinine; if irregularities are not caught early on, this medication can cause irreversible kidney damage
174
What is the prototype for fluoroquinolones?
ciprofloxacin (2nd generation)
175
What type of inhibitor is ciprofloxacin (a fluoroquinolone)?
bacterial DNA replication inhibitor
176
Which medication can cause tendonitis as an adverse effect?
ciprofloxacin
177
What are some adverse effects for ciprofloxacin?
tendon toxicity (Achilles tendon rupture), photosensitivity, cardiotoxicity, fatal dysrhythmias and prolonged QT intervals
178
Who is at risk for tendon toxicity for ciprofloxacin?
children, older adults and those taking glucocorticoids
179
What are contraindications for ciprofloxacin?
tendon pain, those under 18; also monitor patients with impaired renal function or CNS disorders
180
T/F antacids or mineral supplements speed up absorption when taking ciprofloxacin.
False; they delay absorption
181
What is the time period for taking antacids or mineral supplements when taking ciprofloxacin (fluoroquinolones)?
2 hours after or 6 hours before taking fluoroquinolones
182
What is the suffix for fluoroquinolones?
-floxacin
183
What medication is used for protozoal infections, peptic ulcer disease and infections caused by obligate anaerobic bacteria?
Metronidazole
184
What is the black box warning for metronidazole?
it can cause cancer
185
What are adverse effects of metronidazole?
It can cause violent vomiting with alcohol and causes harmless darkening of urine
186
What are sulfonamides used for?
Broad spectrum abx (gram + and gram -), UTI prophylaxis and tx
187
sulfonamides inhibit synthesis of folic acid T/F
True
188
What are some adverse effects of sulfonamides?
Kernicterus (a fatal type of jaundice), crystalluria and renal damage
189
How can crystalluria be prevented in sulfonamides?
by encouraging fluids
190
How much fluid intake and output should be encouraged to prevent the development of crystals when taking sulfonamides?
3 liters of fluid a day with 1500 mL of urine output in 24 hours
191
What are contraindications for sulfonamides?
pregnancy, nursing, children under the age of 2, folate deficiency anemia and severe renal impairment, hyperkalemia
192
Oral anticoagulants ______ ______ when taken with sulfonamides
increase bleeding
193
Potassium supplements and potassium sparing diuretics can _____ effectiveness when taken with sulfonamides.
Increase
194
What are the prototypes for sulfonamides?
TMP-SMZ
195
TMP-SMZ are used in ________ and when given ____ they ___ more bacteria.
combination, together, kill
196
TMP-SMZ carries the risk of kernicterus, which is ___
a fatal type of jaundice
197
What pregnancy category is TMP-SMZ?
Category D
198
Why are mycobacterial infections difficult to treat?
They have a thick layer and are often resistant
199
mycobacterial infections are ____ growing and require _____ treatment
slow, prolonged
200
What are the 3 species (diseases) of mycobacteria?
tuberculosis, leprosy, and mycobacterium avum which is secondary to HIV and AIDS
201
Primary tuberculosis is obtained through _______
inhaling particles from someone with TB
202
postprimary TB is special because ______
dormant bacteria reactivates upon weakened immune system
203
What is DOT therapy?
where each dose of TB needs to be taken in front of an observer
204
T/F TB is always treated with 4 or more drugs.
False; 2 or more.
205
What is the drug regimen for active or latent TB?
3-4 drugs for 6-12 months
206
What is the drug regimen for multi-drug resistant TB?
Up to 7 drugs for up to 2 years
207
What is the drug regimen for prophylactic treatment of TB?
2 drugs for 2 months
208
What is the first line of drugs for tx for active TB?
RIPE (rifampin, isoniazid, pyraziniamide, ethambutol)
209
What is the prototype for anti-tubercular drugs?
isoniazid
210
What is special about the adverse effect of rifampin?
orange body fluids
211
T/F Rifampin decreases effectiveness of oral contraceptives.
True
212
what are some adverse effects of isoniazid (anti-tb drug)?
Visual defects, CNS effects such as dizziness, seizures and psychosis, peripheral neuropathies and hepatotoxicity/hepatitis
213
How can peripheral neuropathies be treated when taking isoniazid (anti-tb drug)?
Vitamin B6
214
How can hepatotoxicity/hepatitis be treated when taking isoniazid (anti-tb drug)?
Pyroxidine
215
What are the viral infections that an be treated with antivirals?
influenza, herpes simplex virus, herpes zoster (shingles), RSV and HIV
216
How do antiviral medications work?
They shorten the course of the virus by inhibiting DNA or RNA replication
217
What is the most important molecule reabsorbed in the tubules?
Water
218
Aldosterone stimulates _______ reabsorption in the distal nephron which promotes _______ excretion
sodium, potassium
219
Antidiuretic hormone (ADH) increases _____ reabsorption by making the collecting ducts more ______ to water
water, permeable
220
What are some dietary restrictions a person with renal failure may have?
potassium, phosphate and sodium
221
T/F Loop diuretics prevent reabsorption of sodium in the renal tubules.
False; they promote reabsorption of sodium in the Loop of Henle.
222
Which drug group of diuretics act by blocking sodium in the distal tubule?
Thiazides
223
Which diuretic drug group have minimal effect of potassium ion excretion?
Potassium-sparing
224
What type of diuretics are the most effective, and what is their suffix?
Loop diuretics, -mide or -nide
225
T/F Loop diuretics (furosemide) are able to increase urine output even when blood flow to kidneys is diminished.
True
226
What are some serious adverse effects when taking furosemide (loop diuretics)?
Dehydration, low bp and syncope, electrolyte imbalances, hypokalemia, hyperuricemia (can cause exacerbations of gout); tachycardia, dysrhythmias, n/v, ototoxicity (permanent)
227
What is the black box warning referring to regarding furosemide (loop diuretics)?
diuresis, water and electrolyte depletion
228
What are contraindications for furosemide?
Hypersensitivity, anuria, severe fluid or electrolyte depletion
229
What is a nursing consideration for furosemide?
Check vitals before giving a loop diuretic
230
What is one of the main differences between thiazide and loop diuretics?
You cannot use thiazide if you do not have enough renal function, but you can with loop diuretics.
231
What is the most commonly prescribed class of diuretics?
Thiazide-like diuretics
232
What is the prototype for thiazide like diuretics?
hydrochlorothiazide
233
Which diuretics do not cause ototoxicity?
thiazide and thiazide like diuretics (hydrochlorothiazide)
234
What are patients taking thiazide and thiazide like diuretics (hydrochlorothiazide) at risk for?
Falls, fluid and electrolyte imbalances, hypotension and orthostatic hypotension
235
What causes dysrhythmias in hydrochlorothiazide or thiazide like diuretics?
hypokalemia
236
What medication can have toxic effects if taken with thiazide and thiazide like diuretics?
Digoxin
237
What is an advantage of potassium sparing diuretics?
They retain potassium not waste it
238
What is the prototype for potassium sparing diuretics?
Spironolactone
239
What patient population is potassium sparing diuretics useful for?
Those who are at high risk for hypokalemia
240
What is an individual taking spironolactone (a potassium sparing diuretic) at risk for?
Hyperkalemia d/t retaining potassium; gynecomastia (man boobs), impotence, diminished libido in men; menstrual irregularities, hirsutism (excessive hair growth), breast tenderness, decreased fertility
241
Can the adverse effects for taking spironolactone be reversed?
Yes, when the medication is stopped.
242
what is the black box warning for spironolactone?
It produces tumors in lab animals
243
What should be avoided when taking spironolactone?
Potassium supplements, ACE inhibitors, ARBs (can cause severe hyperkalemia) and foods high in potassium
244
What class does spironolactone belong to?
potassium sparing diuretics
245
What is stroke volume?
the amount of blood pumped out of ventricles with each heartbeat
246
What are the 3 elements that control blood pressure?
Heart rate, stroke volume, and total peripheral resistance
247
What is primary hypertension?
HTN with no underlying cause
248
What is secondary hypertension?
HTN with an identifiable cause
249
What is important to educate on regarding HTN?
routine screenings and risks if noncompliant with meds
250
What are repercussions of uncontrolled HTN?
Damage to vessels, heart, brain, kidneys, eyes
251
What does CCB stand for?
Calcium Channel Blockers
252
What is important regarding ACE inhibitors or ARBs?
They can only be on one or the other.
253
What is important to remember in black patients regarding HTN tx?
Thiazides or CCBs are given before ACE or ARBs
254
T/F African Americans are most responsive to single drug therapy for HTN.
True
255
What is the goal of medication for HTN?
To decrease morbidity and mortality
256
What medications are the 1st line of treatment for mild to moderate HTN?
Thiazide diuretics
257
Renin releases when blood pressure is ______ to ______ blood pressure
lower, increase
258
Renin forms angiotensin I from angiotensinogen, which then converts to ________
angiotensin II.
259
Angiotensin II ______ blood pressure.
raises
260
ACE inhibitors ____ blood pressure from _____
blocks, increasing
261
ARBs stands for ____
Angiotensin receptor blockers
262
Aldosterone antagonists ________
prevent aldosterone induced blood pressure increase
263
Direct renin inhibitors ______
inhibit renin so angiotensin I and its cascade does not occur
264
What is the 1st line treatment for HTN?
ACE inhibitors--they reduce HTN related morbidity and mortality
265
How do ACE inhibitors work?
They block the conversion of angiotensin I to angiotensin II.
266
What is the suffix for ACE inhibitors?
-pril
267
T/F ACE inhibitors are used with thiazide diuretics because effects are enhanced.
True
268
What is the prototype for ACE inhibitors?
Lisinopril
269
What are the most prominent adverse effects with lisinopril (an ACE inhibitor)?
Persistent dry cough, angioedema.
270
What is the black box warning for lisinopril?
A risk for major congenital defects if taken during pregnancy
271
Which medication class should not be taken with lisinopril due to decreasing antihypertensive activity and worsening renal disease?
NSAIDS
272
What is the prototype for ARBS?
Losartan
273
What is the suffix for ARBS?
-sartan
274
What is the difference between losartan (ARBS) and lisinopril (ACE Inhibitor)?
They do not cause a cough and have a lower risk of angioedema
275
T/F ARBS (losartan) have the lowest incidence of serious adverse effects of any of the antihypertensive classes.
True
276
What forms are calcium channel blockers (CCBS) available in?
sustained or extended release
277
What is the function of calcium channel blockers?
They decrease BP, cardiac workload and myocardial oxygen demand
278
What is the suffix for calcium channel blockers?
-pine
279
What is the prototype for calcium channel blockers?
Amlodipine
280
What two medications are CCBs but not used for HTN?
Verapamil, diltiazem
281
Regarding administration of CCBs, what is the biggest concern as an adverse effect?
Hypotension when taken with alcohol (will be on exam!)
282
What are adverse effects of CCBs (amlodipine)?
hypotension, bradycardia, peripheral edema, heart block, flushing and skin rash
283
What are alpha 1 antagonists used for?
BPH and hypertension
284
T/F Caution must be used in nonspecific beta blockers w/ those who have COPD and asthma.
True
285
What are Beta II agonists used for?
asthma and preterm labor
286
What is the 2nd line of drugs for HTN?
Adrenergic antagonists
287
What do adrenergic antagonists do?
They prevent symptoms of the fight or flight response
288
What are adrenergic antagonists used for?
To treat HTN, angina pectoris, dysrhythmias and MI prophylaxis
289
What is the suffix for Alpha 1-adrenergic antagonists?
-sin (think -sin and BPH)
290
What is the prototype for Alpha 1-adrenergic antagonists?
Prazosin
291
What is Prazosin used for?
HTN, BPH and Raynaud's disease
292
How does Prazosin (an alpha 1-adrenergic antagonist) help BPH?
it relaxes the bladder and prostate
293
What is the first dose phenomenon with prazosin and other alpha 1 adrenergic antagonists?
pronounced orthostatic hypotension
294
What are adverse effects caused by in prazosin (alpha 1 adrenergic antagonists)?
the increased parasympathetic activity
295
Why is hypotension a risk in prazosin?
because of vasodilation
296
What is the treatment for reflex tachycardia in alpha 1-adrenergic antagonists?
Beta blockers
297
What are some adverse effects with alpha 1 adrenergic antagonists (prazosin)?
nasal congestion, decreased libido, erectile dysfunction or ability to ejaculate
298
What is the most important nursing consideration with beta blockers?
HOLD medication if systolic BP is less than 100 or HR is less than 60
299
What is the suffix for beta blockers?
-olol
300
What is the nonselective prototype for beta blockers?
propranolol
301
What is the selective (cardioselective) prototype for beta blockers?
metoprolol
302
Why should a beta blocker be withdrawn gradually over several weeks?
abrupt withdrawal can cause rebound cardiac excitation
303
What type of beta blockers are safe for those with COPD and asthma to take?
cardioselective
304
How do you treat a beta blocker overdose?
with an anticholinergic (atropine) or beta adrenergic agonist (isoproterenol)
305
Which drugs that are nonselective alpha 1 and beta adrenergic antagonists block alpha 1?
carvedilol and labetalol
306
What is the prototype for direct acting vasodilators?
hydralazine
307
When is hydralazine indicated?
When severe HTN has not responded to other therapy
308
What are adverse effects of direct acting vasodilators?
hypotension, reflex tachycardia, sodium and water retention, and a lupus like syndrome
309
When should hydralazine be discontinued gradually?
If there is an appearance of a lupus like syndrome: rash, hives, weakness, fatigue.
310
How can reflex tachycardia be prevented?
By administration of a beta blocker
311
How is a hypertensive emergency defined?
diastolic pressure is >120 mmHg with evidence of target organ system damage
312
what causes a hypertensive emergency (HTN-E)?
untreated or poorly controlled essential HTN
313
What are common symptoms of a hypertensive emergency (HTN-E)?
chest pain, dyspnea, headache
314
What is the goal of management of hypertensive emergencies (HTN-E)?
To lower BP quickly but not too fast; lower BP progressively by 20-25% over 30-60 minutes and gradually reduce it further over 12-48 hrs until BP is in a normal range
315
What is the 1st line drug for aggressive, life threatening HTN?
Nitroprusside Sodium
316
Nitroprusside Sodium is limited to __ hours because ____
72, toxic thiocyanate and cyanide
317
What is an adverse effect of nitroprusside sodium?
Thiocyanate toxicity
318
What are s/s of thiocyanate toxicity?
hypotension, lethargy, blurred vision, metabolic acidosis, faint heart sounds, LOC
319
T/F Nitroprusside sodium must be diluted prior to infusion.
True; if not diluted, it can cause irreversible ischemic injury and death d/t significant drops in BP.
320
serum thiocyanate levels must be monitored and discontinued if it exceeds __ mg/dL
12
321
What are other adverse effects of nitroprusside sodium?
inadequate cerebral circulation and kidney impairment.
