Exam 3

Question 1

captopril (Capoten)

Answer 1

Antihypertensive. ACE inhibitor; not a pro drug, so can give to pt with liver problems. Can cause rash and altered taste (dysguesia) and neutropenia (rare). Has to be given 1 hour before all other meds.

Question 2

losartan (Cozaar)

Answer 2

Angiotensin 2 Receptor Blocker; Antihypertensive.

Question 3

spironolactone (Aldactone)

Answer 3

Potassium-sparing diuretic; also acts as an aldosterone antagonist, which has been shown to reduce the symptoms of heart failure.

Question 4

verapamil (Calan)

Answer 4

Phenylalkylamine CCB. Treats prinzmetal’s angina (vasospastic); Think V.

Question 5

diltiazem (Cardizem)

Answer 5

Benzothiazepine CCB; Antihypertensive.

Question 6

amlodipine (Norvasc)

Answer 6

Dihydropyridine CCB; Antihypertensive.

Question 7

prazosin (Minipress)

Answer 7

Alpha Adrenergic Blocker; Antihypertensive. Causes both arterial and venous dilation, reducing peripheral vascular resistance and BP. Usually not first line tx.

Question 8

clonidine (Catapress)

Answer 8

Centrally acting Alpha2 Agonist. Used for hypertension. Results in vasodilation, bradycardia and decreased CO. Causes drowsiness, sedation, MI, DM, major depressive disorder, CRF. Don’t stop abruptly, change positions slowly, bid larger dose at night. Produces analgesia by inhibiting pain signals to brain through spinal cord.

Question 9

metoprolol (Lopressor)

Answer 9

Cardioselective beta blocker (beta 1). Give for cardiac protection after a MI to increase survival. Antihypertensive.

Question 10

propanolol (Inderal)

Answer 10

Nonselective (beta1 and beta2); 1st beta blocker. Pheochromocytoma, migraine. Antihypertensive.

Question 11

carvedilol (Coreg)

Answer 11

Nonselective; Alpha and Beta blocker. Used for chronic heart failure to prevent progression.

Question 12

nitroprusside (Nitropress)

Answer 12

Causes direct vasodilation to the arteries and veins, resulting in rapid BP reduction. Used in a hypertensive crisis.
Contra: Liver/Kidney disease, F&E imbalance in elderly, Preg cat C.
Adverse FX: excessive hypotension, thiocyanate tox. Causes cyanide poisoning if given too fast/too long (3+ days).
Nursing Conx: protect from light, monitor vitals and heart constantly. give slow.

Question 13

nitroglycerine (Nitrostat)

Answer 13

Antianginal drug; Large first pass effect with oral forms. Used for symptomatic treatment of ischemic heart conditions (angina). IV form used for BP control in perioperative hypertension, treatment of HF, ischemic pain, pulmonary edema associated with acute MI, and hypertensive emergencies.

Question 14

isosorbide mononitrate (Imdur)

Answer 14

Antianginal drug; sustained release form most common.

Question 15

JNC8 Guidelines 2013.

Answer 15

Based on RCT studies.
Never use an ACE inhibitor with an ARB.
Alpha meds show worse CV and HF than other drugs for HTN.
Beta blockers show increased rates of CV death and MI than other drugs for HTN.

Question 16

JNC8 Guidelines: Blood Pressure

Answer 16

• 60 years or older, initiate Tx if SBP 150+, DBP 90+. Goal: less than 150/90
• 60 years and under/all ages with Diabetes Mellitus or Chronic Kidney Disease, initiate Tx if SBP 140+, DBP 90+. Goal: less than 140/90

Question 17

JNC8 Guidelines: Races

Answer 17

Non-Black: Thiazide type diuretics, ACE inhibitor; CCB; ARB. If not at goal after a month, add next med. If need 3+ meds, use alpha adrenergic or beta blocker.

Black: Thiazide type diuretics (first line), CCB.

CKD all races: use ACE or ARB.

Question 18

ACE Inhibitors

Answer 18

• Prils
• Large group; safe and effective
• Often first-line drug for HF and HTN
• Can be used w/ thiazide diuretic or CCB
• DO NOT USE w/ ARB
• captopril (Capoten), enalapril (Vasotec)

Question 19

ACE inhibitors: Mechanism of Action

Answer 19

• inhibits ACE; prevents conversion of angiotensin I to angiotensin II
• Results in decreased systemic vascular resistance (afterload), vasodilation and therefore decreased blood pressure.

Question 20

ACE Inhibitors: Adverse Effects

Answer 20

Dry, non-productive cough, angioedema (rare but can be fatal, give epinephrine), hyperkalemia

Question 21

ACE Inhibitors: Nursing Implications

Answer 21

Monitor potassium level, no salt substitutes that contain potassium

Question 22

Angiotensin II Receptor Blockers

Answer 22

• sartans
• “ARBs”
• well tolerated and very similar to ACE inhibitors, but doesn’t cause a dry cough
• has decreased risk of hyperkalemia
• losartan (Cozaar), valsartan (Diovan)
• not as much angioedema

Question 23

valsartan (Diovan)

Answer 23

Angiotensin 2 Receptor Blocker. Heart Failure drug. Decreases systemic vascular resistance (afterload).

Question 24

ARB: Mechanism of Action

Answer 24

Allow angiotensin I to be converted to angiotensin II, but block the receptors that receive angiotensin II
Block vasoconstriction and release of aldosterone
Results in decreased systemic vascular resistance (afterload), vasodilation, and therefore decreased blood pressure

Question 25

ARB: Adverse Effects

Answer 25

Upper respiratory infections
Headache
Nasal congestion

Question 26

ARB: Nursing Implications

Answer 26

Do not use salt substitutes that contain potassium

Question 27

Aldosterone Antagonists

Question 28

Aldosterone Antagonists Drugs

Answer 28

• “one”
• eplerenone (Inspra); spironolactone (Aldactone)
• Hypertension and Heart Failure
• do not give with K⁺ supplements

Question 29

Calcium Channel Blockers (CCB)

Answer 29

• verapamil (Calan)
• diltiazem (Cardizem)
• nifedipine (Adalat, Procardia)
• amlodipine (Norvasc)
• Used for hypertension, angina (prinzmetal), cardiac dysrhythmias

Question 30

Calcium Channel Blockers (CCB)
 Adverse Effects

Answer 30

Constipation

Question 31

Alpha Adrenergic Blockers

Answer 31

• prazosin (Minipress)
• treats hypertension
• Give 1st dose at night; take medication with food, check orthostatic vitals