Exam 3: Cardiac (HTN) Flashcards
HTN complications
Coronary artery disease
Left ventricular hypertrophy
Myocardial Infarction
Heart failure
Cerebrovascular disease
Intercranial aneurysm
Increase risk of hemorrhage in high pressure vessels
Aneurysm (AAA) and rupture
Renal insufficiency/failure
Retinal damage/hemorrhage
What are the HTN goals of therapy?
Reduce CV & renal morbidity and control BGL
When do you begin drug therapy?
Majority people will begin drug therapy at a SBP >130 OR DBP > 80
HTN diagnostics
24 hours monitoring BP or Two more measurements 5 minutes apart
Electrolytes
glucose
lipids
ECG
UA
Diuretics:
MOA: Blockade of sodium and chloride reabsorption (water excretes w/Na); produces diuresis -> reduces ECF
ADRs: Hypovolemia, hypotension, change in pH-Acid Base Imbalance, electrolyte imbalances, sleep disturbances, Hyperglycemia, Cholesterol levels: ↑ LDL ↓ HDL, Hyperuricemia (gout)
Interactions: other antihypertensives, NSAIDs, Digoxin, Lithium, drugs that impact electrolytes/minerals
Nursing Implications: teach pt to take in the morning, minimize sleep disturbances ** look in book
Diuretic site of action
Nephron; “high activity diurectics create greatest water loss” the higher up the greater the action
Furosemide (Lasix)
Loop diuretic
SOA: ascending limb of the Loop of Henle -> potent and rapid
ADRs: all diuretics ADRs + OTOTOXICITY
Indic.: rapid or continued mobilization of fluid, IV for emergent or urgent diuretic needs (significant edema, HTN)
Interactions: all diuretics inter. + ototoxic drugs
Nursing Implications: K+ rich foods, changes to hearing/balance, orthostatics, daily weights, insulin, take in the morning
Hydrochlorothiazide (HCTZ)
Thiazide diuretic
**dependent on GFR (renal function is necessary)
SOA: early distal tube of nephron (moderate reabsorption, less than loop)
ADRs: all diuretics ADRs + HYPERCALCEMIA
Indic.: mild/mod. HTN, edema, postmenopausal osteoporosis (reabsorb Ca+)
Contras: hypersensitivity (SJS), renal disease
Nursing Implications: K+ rich foods, orthostatics, daily weights, insulin, take in the morning
Spironolactone
Potassium sparing diuretic (aldosterone antagonist -> also included in RAAS agents)
MOA: blocks action of aldosterone in the distal tubule; K+ retention
SOA: late distal tube of nephron (weak diuretic)
ADRs: HYPERKALEMIA + ENDOCRINE EFFECTS (estrogen-like gynecomastia/impotence & amenorrhea)
Indic.: HTN, edema, HF, hyperaldosteronism, hormonal acne/PCOS, hypokalemia (used with other antihypertensives to counteract K+ loss)
Contras: hypersensitivity, hyperkalemia, anuria, AKI
Nursing Implications: monitor for K+ (salt substitutes and no supplements)
Mannitol
Osmotic diuretic
MOA: creates osmotic force w/in lumen of the nephron - H2O stays in nephron, not reabsorbed UOP increases (degree of diuresis is dose dependent)
rapid IV and potent
ADRs: Edema (leaves vascular sys at ALL capillary beds except brain bringing water w/), HA, N/V, F&E imbalances, GI, rash, vision disturbances, rebound ^ ICP
Indic.: reduce ICP (ECF drawn into blood vessels), reduce intraocular pressure (glaucoma), prevent renal failure in acute states, toxic OD, GU irritation
Contras: Dehydration (serum osmolarity >310), renal or cardiac dysfunction, active intracranial bleeding, severe pulmonary edema
Interactions:
Nursing Implications: dehydration/fluid overload precautions, intraocular pressures, renal function monitoring, crystallizes in low temp.
Beta blockers
-lol
MOA: decrease HR, conduction, contractility, supress reflect tachy, inhibits renin release, decreases PVR “cardio-protective”
SOA: Beta1 receptors in heart and kidneys
ADRs: bradycardia, worsen HF, pulmonary edema, masks the S/S of hypoglycemia, fatigue, insomnia, impotence + (Bronchoconstriction & hypoglycemia in propanolol)
Indic.: HTN, MI (& prevent 2nd MI), angina, dysrhymias, HF, hyperthyroidism, Migraine prophylaxis, anxiety, pheochromocytoma, glaucoma
Contras: sick sinus syndrome, AV block, uncontrolled DM, HF (could worsen)
Interactions: other antihypertensives, antidiabetics, anesthesia
Nursing Implications: cannot stop abruptly, avoid OTC decongestants, hypotension precautions, lifestyle management
1st v. 2nd v. 3rd gen beta blockers
1st - non-selective (worry about lungs and BGL) Propanolol
2nd - selective - Metoprolol and Atenolol
3rd - combo drugs that affect both heart and PVR - Carvedilol & Labetolol
Alpha1 blockers
-zosins
MOA: blocks sympathetic response to blood vessels -> lowers PVR & venous return
Prototype: Doxazosin and Prazosin
ADRs: Orthostatic hypotension
Nursing Implications: 1st dose hypotension warning
Central acting Alpha2agonist
MOA: blocks sympathetic stimulation from the brainstem (decrease CO and vasodilate)
Prototype: Clonidine and Methyldopa
ADRs: dry mouth, sedation, rebound HTN
Nursing Implications: don’t stop abruptly, methyldope = safest for pregnancy
Calcium Channel blockers
MOA: promote dilation of arteries and some have suppressant effects on heart
ADRs: reflex tachy, HA, dizzy, flush
Nursing Implications: no grapefruit, assess HR before dose
Dihydropyridines
MOA: selective to calcium block in arterioles
Prototype: Nifedipine & Amlodipine
ADRs: severe reflex tachy
Indic.: angina, HTN, Prophylaxis for vascular headaches
Nursing Implications: assess HR before dose
Nondihydropyridines
MOA: blocks calcium channels in heart and arterioles
Prototype: Verapimil & Diltiazem
Indic.: angina, HTN, supraventricular dysrhythmias (fib/flutter, SV tach)
Contras: use w/ caution w/ pts bradycardia, HF or AV block
Nursing Implications: no grapefruit**
Captopril or Lisinopril
-pril
MOA: angiotensin converting enzyme inhibitors (ACEis) -> block vasoconstriction and fluid retention
ADRs: persistent cough, first dose hypotension, angioedema, hyperkalemia, fetal harm
Indic.: HTN, HF, diabetic & non- DM nephropathy, MI
Contras: renal failure
Interactions: other HTN, lithium, NSAIDs, ^K+ drugs
Nursing Implications: monitor first dose, hyperkalemia warnings and diet restrictions
Losartan
-sartan
MOA: Angiotensin II Receptor Blockers (ARBs) -> similar to ACEis
ADRs: first dose hypotension, angioedema, fetal harm
Indic.: HTN, HF, diabetic & non- DM nephropathy, MI
Contras: renal failure
Nursing Implications: monitor first dose
Aliskiren
MOA: direct renin inhibitor -> blocks entire RAAS
ADRs: less hyperkalemia, cough, and angioedema, BUT sam fetal danger and some GI upset
Contras: pt w/ DM also taking ACEis or ARBs -> cause renal impairment
Hydralazine
MOA: direct-acting vasodilator (arterioles)
ADRs: reflex tachy, excessive hypotention -> renin release, fluid retention, **SLE-like syndrome (arthralgia, myalgia, fever, and serositis)
Indic.: HTN, HF
Sodium nitroprusside
MOA: direct-acting vasodilator (arteries and veins)
ADRs: Severe hypotension -> triggers retention of Na+, reflex tachy*, n/v, sweating, angina, MI -> sudden BP drop with resultant organ ischemia
Indic.: VERY potent; used in HTN emergencies
Interactions: toxicity after 72 hours
Nursing Implications: short acting and continuous IV - stay bedside and cardiac monitor
fenoldepam and labetalol also used in emergencies
