Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm > HTN & congestive heart failure > Flashcards

HTN & congestive heart failure Flashcards

1
Q

Captopril MOA

ACE Inhibitor

A
  • reduces levels of angiotensin II & increases bradykinin levels
  • dilates blood vessels
  • reduces blood volume (through kidney)
  • pathologic changes in the heart & the blood vessels by aldosterone and angiotensin II
  • used for HTN, heart failure, and diabetic nephropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Captopril Side Effects

A
  • Hyperkalemia (increase potassium lvls)
  • 1st does hypotension & orthostatic hypotension
  • HA
  • fetal injury
  • cough
  • angioedema (1%)
  • reduced WBC
  • renal failure in those w/ bilateral renal arteries stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Drug interactions with Captopril

A

Digoxin= hyperkalemia

lithium=increase lithium levels

NSAIDS= reduce affects

–other antihypertensive drugs.. diuretics– = hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Nurse education// pt teaching on Captopril

A
  1. signs & symptoms of hypotension… get up slowly
  2. take 1st dose at bedtime to prevent orthostatic hypotension
  3. educate signs & symptoms of angioedema
  4. if cough occurs, contact proscriber
  5. pregnancy and renal artery stenosis contraindictor
    monitor k+ lvls
  6. monitor renal lab work and urine for protein
    monitor CBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

IrbesarTAN & losarTAN

A

angiotensin II receptor blockers (ARBs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

IrbesarTAN & losarTAN MOA

A

selectively block the vasoconstriction effects of angiotensin II by blocking their access to the receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

IrbesarTAN & losarTAN Side Effects

A

angioedema
renal failure
fetal injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Nursing Education// Pt teaching for IrbesarTAN & losarTAN

A

does not cause hyperkalemia
does not cause a cough (does not increase lvls of bradykinin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Aliskiren

A

Direct renin inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Aliskiren MOA

A

binds to renin and inhibits the conversion of angiotensinogen into angiotensin I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Adverse Effects of Aliskiren

A

angioedema
cough
hyperkalemia
fetal harm//death
diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Nursing Education// PT teaching

A

avoid high fat meals with administration which effects absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Eplerenone

A

Aldosterone antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Eplerenone MOA

A

selective blockage of Aldosterone receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Eplerenone Adverse effects

A

hyperkalemia
–can cause gynecomastia, menstrual irregularities, impotence, hirsutism, deepening of the voice from other steroid binding

contraindicated in pt with impaired renal fnx or type II diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Eplerenone education

A

monitor K+ lvls

do not use in pts with renal disease or type II DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

verapamil & Diltiazem therapeutic use

A

calcium channel blockers that are used for HTN, Angina pectoris, cardiac dysrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

verapamil & Diltiazem MOA

A

promotes vasodilation, reduced arterial pressure & increased coronary perfusion

prevents Ca2+ from entering the HRT mm cells and the blood vessels

        vascular smooth mm -regulate contraction (vasodilation) --no sigif. effect on veins

                  Heart --Myocardium: blockage of + inotropic effect (decreases muscle    contraction) --SA node: reduce HR --AV node: decrease conduction --Coupling of cardiac calcium channels to beta1-adrenergic receptors: reduced force and decreased HR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

verapamil & Diltiazem Adverse Effects

A
  • constipation
  • From vasodilation= dizziness, flushing, HA, edema of ankles and feet
    bradycarda or AV block
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Drug interactions for verapamil & Diltiazem

A
  • digoxin increases risk of AV block
  • beta blockers have the same effects as calcium channel blockers
21
Q

Nursing implications and Pt education for verapamil & Diltiazem

A
  • severe hypotension
  • bradycardia
  • AV block
  • ventricular tachydysrythmias

IV calcium gluconate= treatment for toxicity

22
Q

Amlodipine

A

calcium channel blocker that works on the arterioles

blocks Ca2+ channels in the smooth mm tissue

little to no effect on the heart

Decreases Bp, increases HR & contractile force

23
Q

Adverse Effects// Drug interactions for Amlodipine

A

From vasodilation: dizziness, facial flushing, HA, edema of ankles and feet

beta blockers have the same effect as CCC, given together can prevent reflex tachycardia

educate patients that peripheral edema is the most common side effect

24
Q

CCC blockers therapeutic use

A

HTN
Angina pectoris
Cardiac dysrhythmias

25
Q

vasodilators Therapeutic uses

A

essential hypertension
hypertensive crisis
heart failure

26
Q

Hydralazine MOA

A

selective dilation of arterioles

27
Q

Hydralazine Adverse effects

A

postural hypotension
*cause= relaxation of smooth mm in veins

reflex tachycardia
*dilation of arterioles//veins

systemic lupus~~ erythematosus-like syndrome
(STOP DRUG IF OCCURS)

28
Q

nitroprusside therapeutic use

A

HTN crisis

29
Q

nitroprusside MOA

A

causes venous and arteriole dilation by increasing blood flow to the heart

30
Q

Nitroprusside Adverse effects

A

Excessive hypotension
Cyanide poisoning
Drug contains 5 cyanide groups when broken down

31
Q

Nitroprusside nursing implication//pt teaching

A

Monitor for Thiocyanate toxicity by drawing Cyanide levels
Must check BP frequently

32
Q

Beta-Adrenergic Blockers therapeutic use

A

MI
Angina
HTN
Hypertrophic cardiomyopathy
Supraventricular arrhythmias (tachycardias)

propranolol= non-selective B1-B2
metoprolol=selective=B1

33
Q

propranolol & metoprolol MOA

A

Beta adrenergic blockers

Prevent the stimulation of the sympathetic nervous system

Inhibit the action of catecholamines norepinephrine and epinephrine at beta adrenergic receptors

Improve LV ejection fraction

Increase exercise tolerance

Slow progression of Heart failure

Reduced the need for hospitalization and prolong survival

34
Q

propranolol & metoprolol Adverse Effects

A

Hypotension
Bradycardia
Palpitations
Hypoglycemia with insulin use

                     Non-selective GI: nausea vomiting Bronchospasm  Impotence

                           Drug interactions:  Antacids, barbiturates, anti-inflammatories, and Rifampin can decrease the effectiveness of BB
35
Q

propranolol & metoprolol nursing implication//pt teaching

A

Avoid in patients with asthma or COPD
Educate patient on the s/s of hypoglycemia
Educate on how to check blood pressure, how to keep blood pressure log, and how to monitor heart rate

36
Q

clonidine MOA

A

Act within the brainstem to suppress sympathetic outflow to the heart and blood vessels

Vasodilation and reduced CO lower BP

37
Q

adverse effects of clonidine

A

Dry mouth
Sedation
Rebound hypertension if abruptly stopped

38
Q

nursing implication// pt teaching for clonidine

A

monitor bp closely
education pt on rebound htn

39
Q

diuretics therapeutic use

A

CONGESTIVE HEART FAILURE

40
Q

MOA of:

thiazide diuretics (hydrochlorothiazide)

loop diuretics (Furosemide)

potassium sparing diuretics (spironolactone & scant diuretics)

A

Promote excretion of water and electrolytes by the kidneys

By reducing blood flow these drugs decrease venous pressure, arterial pressure, pulmonary edema, peripheral edema, and cardiac dilation

First line drug for all patients with signs of volume overload or with a history of volume overload

41
Q

Adverse effects of diuretics

A

Hypokalemia (thiazide and loop diuretics)

dysrhythmias when used with digoxin and related to hypokalemia

hypotension

hyperkalemia (potassium sparing diuretics)

**take diuretic in the morning to promote fluid loss

42
Q

digoxin MOA

A

Cardiac glycosides sides are best known for their positive Inotropic actions

Ability to increase myocardial contractile force

By increasing contractile force, digoxin can increase cardiac output

Negative chronotropic action

Depresses the sinoatrial node

Reduces conduction of the impulse through the atrioventricular node

Slows the heart rate

43
Q

digoxin therapeutic use

A

Congestive heart failure

Atrial tachycardia, atrial fibrillation, atrial flutter

44
Q

digoxin adverse effects

A

o Cardiac dysrhythmias (worse with hx of heart disease)
o Hypokalemia
o Bradycardia (sign of toxicity)
o Elevated digoxin levels
o Narrow therapeutic range
o Non cardiac adverse effects:
o GI symptoms
o anorexia, nausea, vomiting
o Central nervous system symptoms
o HA, drowsiness, visual disturbances, fatigue

45
Q

digoxin drug interactions

A

o Diuretics promote loss of potassium, increased risk of dysrhythmias, and toxicity

o ACE inhibitors and ARBs can increase potassium (hyperkalemia) and thereby decrease therapeutic responses to digoxin

o Sympathomimetics (dopamine dobutamine) increase heart rate an increased risk of tachydysrhythmias

o Quinidine can raise digoxin plasma levels

o Verapamil (CCC) can increase digoxin plasma levels

                 Contraindications: o	Second- or third-degree heart block o	Use cautiously in patients with renal disease, hypothyroidism, hypokalemia (potassium ions compete with Digoxin for binding)
46
Q

nursing implications// pt teaching for digoxin

A

o Monitor potassium levels closely
o Normal potassium level is 3.5 to 5

o s/s of hypokalemia is muscle weakness

o Monitored digoxin levels closely
o Therapeutic range is 0.5 to 2
o levels above 2 are toxic
o Levels should be drawn immediately before I dose or 4 to 10 hours after it does for accurate levels

o Monitor for signs of toxicity
o Anorexia, nausea, vomiting, visual disturbances, confusion, bradycardia, heart block, premature ventricular contractions, and tachydysrhythmias

o If concerned or toxicity hold medication and notify prescriber
o Monitor the apical pulse

o If below 60 BPM medications should be held in the physician notified
o Medication antidote:

o Digoxin immune FAB (Digibind)

Patient education:
o Avoid over the counter medications
o Eat foods high in potassium
o Fresh and dried fruits, fruit juices, vegetables, and potatoes
o How to measure the pulse and notify the physician if heart rate is < 60 BPM or > 100 BPM
o Educate on s/s of toxicity

47
Q

nursing implications for ACE inhibitors, ARBs and Renin inhibitors

A
  • Monitor BP closely for 2 hours after 1st dose
  • Mainly with Captopril - Obtain WBC Q 2 weeks for 1st 3 months &
    monitor for neutropenia
  • Target BP less than 140/90
  • Instruct pt. to lie down if hypotension develops
  • Warn about possible persistent, dry, irritating, nonproductive cough &
    to contact prescriber if occurs
  • Avoid K supplements unless prescribed
  • Warn woman of childbearing age – ACE inhibitors & ARB’s may lead
    to fetal injury and death
  • Angioedema – if occurs, D/C ACE inhibitors and NEVER take again
  • Withdraw diuretics 1 week prior to starting ACE inhibitors
  • Minimize NSAID use. NSAIDS decrease the effectiveness of the
    meds
48
Q

Nursing implications for CCC

A
  • Baseline BP & HR if hypotensive or bradycardia, withhold med,
    document, & notify the MD.
  • Contraindicated in pt.’s with severe hypotension, sick sinus syndrome,
    & 2nd-3rd degree Heart block
  • Use with caution in pt. taking digoxin or beta blockers
  • Teach pt. to self-monitor BP with a goal of 140/90.
  • Inform pt. about manifestations of heart block (slow heartbeat,
    shortness of breath, weight gain)
  • Watch for swelling in ankle
  • Advice that constipation can be minimized by increasing dietary fluid
    and fiber.
  • Patients should be instructed to swallow sustained-release tablets
    whole, without crushing or chewing
49
Q

Nursing implications for BB

A
  • Report any signs of Resp Distress (especially pt.’s with COPD or
    asthma)
  • Check pulse daily report any “extremes”
  • Monitor BP regularly and record. Bring BP log to appointments
  • If Patient is diabetic, warn of possible interaction with Insulin &
    masking the signs of hypoglycemia (low blood sugar)
  • Do not stop taking drug abruptly
  • Take oral forms with meals for better absorption
  • Antacids, barbiturates, anti-inflammatories, and Rifampin can
    decrease the effectiveness of Beta Blockers

Pharm (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions