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NSG 323 (mcp) > HTN Drugs > Flashcards

HTN Drugs Flashcards

1
Q

5 Classes for HTN Drugs

A

1) Diuretics
2) Adrenergic agents
3) CCBs
4) RAAS drugs
5) Vasodilators

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2
Q

What are the 2 Actions of Diuretics?

A
  1. Decrease BLOOD VOLUME by urinary excretion of water and electrolytes
  2. Decrease arterial resistance
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3
Q

What are the 3 Classes of Loop Diuretics?

Indicate the Prototype for each:

A
  1. Loop: Furosemide (Lasix)
  2. Thiazide: Hydrochlorothiazide (HCTZ)
  3. K+-sparing: Spironolactone (Aldactone)
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4
Q

Can we use Diuretics for both HTN & HF?

A

YES!
HTN: ↓ Blood volume (arterial resistance)

HF: ↓ Blood volume (Preload) & Workload on heart

  • only treats SYMPTOMS
  • 1st line therapy for acute pulmonary edema
  • usually used in combo w/ other HF drugs
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5
Q

Furosemide (Lasix) MOA & Uses:

A
  1. DECREASES BLOOD VOLUME
    Inhibits reabsorption of Na & Cl at the loop of Henle

Uses:

  1. Mainly used for HTN uncontrolled by other diuretics, or in pts with Kidney disease
  2. HF Sxs (pulmonary edema)
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6
Q

Furosemide (Lasix) Routes:

Indicate Onset & Duration

A
  1. PO
    onset: 1 hr
    Duration: 8 hrs
  2. IV
    Onset: 5 min
    Duration: 2 hrs
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7
Q

Furosemide (Lasix) Side Effects:

A
  1. Electrolyte imbalances (Na, Cl, K+)
    - HYPOkalemia
  2. Dehydration
  3. Orthostatic hypotension + hypotension
  4. Ototoxicity
  5. Gout exacerbation
    - Increases uric acid
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8
Q

Furosemide (Lasix) Contraindications:

A
  1. PREGNANCY!
  2. Digoxin & lithium
    - Risk for toxicity!
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9
Q

Hydrochlorothiazide (HCTZ) MOA & Uses:

A
  1. DECREASES BLOOD VOLUME (fast)
    Acts on DCT resulting in excretion of H20, Na, and K+
  2. Decreases Arterial resistance (slow/over time)

Uses:

  1. MOST WIDELY USED diuretic for HTN
  2. HF
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10
Q

Hydrochlorothiazide (HCTZ) Routes:

Indicate Onset, Peak, & Duration

A
  1. PO
    Onset: 2 hrs
    Peak: 4-6 hrs
    Duration: 12 hrs
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11
Q

Hydrochlorothiazide (HCTZ) Side Effects:

A
  1. electrolyte imbalances (K+, Na, Cl)
    - HYPOkalemia
  2. Dehydration, hypovolemia (FVD)
  3. Hyperglycemia (DM)
    - inhibits insulin release
  4. Gout exacerbation
    - Increases uric acid
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12
Q

Hydrochlorothiazide (HCTZ) Contraindications:

A
  1. Digoxin & lithium

- Risk for toxicity!

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13
Q

Spironolactone (Aldactone) MOA & Uses:

A
  1. DECREASES BLOOD VOLUME
    Competes with & thus Blocks Aldosterone at receptors in the DCT, resulting in loss of H2O (K+ remains)

Uses:

  1. HTN
    - used in combo with Loop/Thiazide diuretics to decrease K+ loss
  2. HF: Edema Sxs; Blocks negative effects of Aldosterone (cardiac remodeling)
    - NOT used in severe HF (reduces mortality)
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14
Q

Spironolactone (Aldactone) Routes:

Indicate Onset

A
  1. PO

Onset: up to 48 hrs

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15
Q

Spironolactone (Aldactone) Side Effects:

A
  1. HYPERkalemia risk
  2. Endocrine effects
    - gynecomastia, voice deepening, hirsutism
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16
Q

Spironolactone (Aldactone) Contraindictions:

A
  1. Concurrent use with other RAAS drugs (ACE, ARBs, DRIs, ARNI)
  2. K+ Supplements
    - increase HYPERkalemia risk & cardiac dysrhythmias
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17
Q

Nursing Considerations for Diuretics:

A
  1. Administer early in the day
    - don’t want pts up all night tinkling
  2. Obtain K+ levels before administration
  3. Monitor hydration status
    - Daily weights
    - I/O measurements
  4. Teach about foods high in K+ for diuretics that cause HYPOkalemia (Loop/Thiazide)
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18
Q

How does the dosing of diuretics differ with HTN and HF? How do we determine the dosing in HF?

A

Diuretic Dosing in HF is based on DAILY WEIGHTS

Patients may be given a “Sliding scale” based on daily weight measurements

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19
Q

What are the 4 Classes of Adrenergic Agents used for HTN?

Identify the Prototype for each class:

A
  1. Alpha2 AGONIST: Clonidine (Catapres)
  2. Alpha1 Blocker: Prazosin (Minipress) “osins”
  3. Beta-Blocker: Metoprolol (Lopressor, Topol XL) “lols”
  4. Alpha/Beta Blocker: Carvedilol (Coreg)
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20
Q

Clonidine (Catapres) Uses & MOA:

A

Uses:

  1. HTN: SEVERE HTN MANAGEMENT (PRN orders)
  2. Off-label uses: Pain management, ADHD

MOA:
Alpha2 AGONIST; Sympathomimetic/Adrenergic Agonist

Blocks the SNS action on arterioles and veins resulting in VASODILATION (↓ CO –> ↓ BP)

Centrally-acting:
Acts on the brainstem to decrease the Sympathetic outflow, thereby decreasing SNS stimulation on the heart & blood vessels (decreases NE production at presynaptic terminals)

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21
Q

Clonidine (Catapres) Routes:

A
  1. PO
  2. Patch (transdermal)
    - q7 days
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22
Q

Clonidine (Catapres) Side Effects:

A
  1. Dry mouth
  2. Sedation/Drowsiness
  3. Rebound HTN
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23
Q

Clonidine (Catapres) Nursing Considerations:

A
  1. Instruct pt to NOT STOP USE ABRUPTLY
    - risk for rebound HTN
  2. Assess pt for Abuse potential
    - Potential for abuse in pts using opioids, benzos, cocaine, etc.
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24
Q

Prazosin (Minipress) Uses & MOA

A

Uses:

  1. HTN
    - NOT 1st line therapy
    - NOT as a monotherapy
  2. BPH

MOA:
Alpha1 AGONIST; Antiadrenergic

Blocks the SNS action on arterioles and veins resulting in vasodilation
Also, causes relaxation of smooth muscles in the bladder neck and prostatic capsule (BPH)

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25
Q

Prazosin (Minipress) Routes

A

PO

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26
Q

Prazosin (Minipress) Side Effects

A
  1. Nasal congestion
  2. Orthostatic hypotension
    - 1st dose phenomenon
  3. Reflex Tachycardia
  4. Inhibits ejaculation
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27
Q

Prazosin (Minipress) Nursing Considerations:

A
  1. Administer at bedtime to decrease fall risk
    OR
  2. Instruct pt not to get up for 3 hrs after 1st dose
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28
Q

Metoprolol (Lopressor, Topol XL) Uses & MOA:

A

Uses:

  1. HTN
  2. HF
    - usually in combo with an ACE &/or Diuretic
MOA:
Beta1 Blocker (Cardioselective); Antiadrenergic Agent

Heart: ↓ HR, Contractility, & AV Conductivity resulting in ↓ Cardiac output

Kidney: ↓ release of renin resulting in ↓ PVR over time

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29
Q

Metoprolol (Lopressor, Topol XL) Routes:

30
Q

Metoprolol (Lopressor, Topol XL) Side Effects:

A
  1. Bradycardia
  2. AV Heart Block
  3. Rebound cardiac excitation
  4. HF exacerbation
    - ↓ Cardiac Output

Common SEs:
fatigue, drowsiness, dizziness, HA, sexual dysfunction, depression

Nonselective BB (Propranolol):

  1. Hypoglycemia
    - S/S can be masked
31
Q

Metoprolol (Lopressor, Topol XL) Nursing Considerations:

A
  1. Check BP & Pulse rate before administration
    • Hold if apical pulse <60 bpm
  2. Monitor for S/S of HF
    • edema, wt gain, SOB

Patient Teaching:

  1. DON’T stop drug abruptly –> NEED TO WEAN
  2. If given nonselective BB (Propranolol), teach DM pts to monitor Glu levels more closely and look for other signs of HYPOGLYCEMIA.
32
Q

Carvedilol (Coreg) Uses & MOA:

A

Uses:

  1. HTN
  2. HF

MOA:
Alpha/Beta Blocker; Antiadrenergic
Blocks alpha1, beta1, and beta2 receptors

Alpha blockade: Dilation of arterioles & veins

Beta blockade: ↓ HR, ↓ contractility, ↓ conduction

33
Q

Carvedilol (Coreg) Route:

34
Q

Carvedilol (Coreg) Side Effects:

A
  1. Bradycardia (beta1)
  2. AV Heart block (beta1)
  3. Orthostatic Hypotension (alpha1)
  4. Bronchoconstriction (beta2)
35
Q

Carvedilol (Coreg) Contraindications:

36
Q

Carvedilol (Coreg) Nursing Considerations:

A
  1. Check BP & Pulse rate before administration
    - Hold if apical pulse <60 bpm
  2. Teach DM pts to monitor Glu levels more closely and look for other signs of HYPOGLYCEMIA.
37
Q

Name the 3 Calcium Channel Blockers used for HTN:

A
  1. Nifedipine (Procardia)
  2. Verapamil (Calan)
  3. Diltiazem
38
Q

Nifedipine (Procardia) Uses & MOA:

A

Uses:

  1. HTN
  2. Angina

MOA:
Work primarily on blood vessels and causes VASODILATION of arterioles and arteries

39
Q

Nifedipine (Procardia) Routes:

40
Q

Nifedipine (Procardia) Side Effects:

A
  1. Eczematous rash
  2. Gingival hypertrophy
    - an overgrowth of gum tissue

Vasodilator Effects:

  1. flushing, dizziness
  2. Peripheral edema (HF exacerbation)
  3. orthostatic hypotension
  4. Reflex tachycardia
41
Q

Nifedipine (Procardia) Nursing Considerations:

A
  1. Monitor for reflex tachycardia
    • Can give Beta-blocker for treatment
  2. Get up slowly to decrease fall risk
42
Q

Verapamil (Calan)/Diltiazem Uses & MOA:

A

Uses:

  1. HTN
  2. Angina

MOA:

  1. Blood vessels: VASODILATION
  2. Heart: ↓ HR, ↓ contractility, ↓ conduction, & ↑ Coronary perfusion
43
Q

Verapamil (Calan)/Diltiazem Routes:

A
  1. PO (both)

2. IV (Verapamil only)

44
Q

Verapamil (Calan)/Diltiazem Side effects:

A
  1. Constipation
    - less severe w/ Diltiazem

Vasodilator SEs:

  1. Dizziness, facial flushing
  2. Edema in ankles/feet
  3. HF exacerbation

Heart SEs:

  1. Bradycardia
  2. AV Heart Block

IV Administration (Verapamil)

  1. Tachycardia
  2. Hypotension
45
Q

Verapamil (Calan)/Diltiazem Contraindications:

A
  1. Concurrent use with Beta Blockers!!

- increased risk for AV Heart Block

46
Q

Verapamil (Calan)/Diltiazem Nursing Considerations:

A
  1. Check BP and pulse

2. IV administration (Verapamil): Monitor for tachycardia and hypotension

47
Q

Food-Drug Interaction with ALL CCBs:

A

GRAPEFRUIT!

48
Q

Name the 4 Drug Classes of RAAS drugs used for HTN:

Indicate the prototype for each

A
  1. ACE Inhibitors: Lisinopril (Zestril)
  2. Angiotensin II Receptor Blockers (ARBs): Valsartan (Cozaar) “sartans”
  3. Direct Renin inhibitor (DRI): Aliskiren (Tekturna)
  4. Aldosterone Receptor Blocker: Spironolactone (Aldactone)
49
Q

Lisinopril (Zestril) Uses & MOA:

A

Uses:

  1. HTN
  2. HF
  3. DM Neuropathy prevention
  4. CVA/MI prevention

MOA: ACE Inhibitor
Inhibits conversion of Angiotensin I to Angiotensin II
↑ Vasodilation (↓ Preload/Afterload)
↓ Blood volume
↓ Cardiac & Vascular remodeling by blocking Aldosterone

50
Q

Lisinopril (Zestril) Route

51
Q

Lisinopril (Zestril) Side Effects:

A
  1. Dry cough
  2. Angioedema
  3. Hypotension
    - 1st dose phenomenon
  4. HYPERkalemia
52
Q

Lisinopril (Zestril) Contraindications:

A
  1. PREGNANCY
  2. Concurrent use with Spironolactone
    - risk for HYPERkalemia
  3. K+ supplements
53
Q

Lisinopril (Zestril) Nursing Considerations:

A
  1. Monitor K+ levels
  2. Monitor for S/S of Angioedema
  3. Teach pt that cough will subside, but if still present in two weeks, adjustments can be made
  4. Teach pt safety precautions for 1st dose hypotension
54
Q

Valsartan (Cozaar) Uses & MOA:

A

Uses:

  1. HTN
  2. HF
MOA:
Block receptors for Angiotensin II after it is formed
Potent vasodilator 
Prevents bad effects from AT2
Blocks aldosterone
55
Q

Valsartan (Cozaar) Route:

56
Q

Valsartan (Cozaar) Side Effects

A

SAME AS ACE INHIBITORS, BUT LESS SEVERE

  1. Dry cough
  2. Angioedema
    - 8% cross-sensitivity with ACE inhibitors
  3. Hypotension
    - 1st dose phenomenon
  4. HYPERkalemia
57
Q

Valsartan (Cozaar) Contraindications:

A
  1. PREGNANCY
  2. High-fat meals (decrease bioavailability)
  3. Concurrent use with Spironolactone
    - risk for HYPERkalemia
  4. K+ supplements
58
Q

Valsartan (Cozaar) Nursing Considerations:

A
  1. Monitor K+ levels
  2. Monitor for S/S of Angioedema
  3. Teach pt that cough will subside, but if still present in two weeks, adjustments can be made
  4. Teach pt safety precautions for 1st dose hypotension
59
Q

Aliskiren (Tekturna) Uses & MOA:

A

Uses:
1. HTN

MOA:
Blocks the entire RAAS process by inhibiting the production of renin

60
Q

Aliskiren (Tekturna) Route:

61
Q

Aliskiren (Tekturna) Side Effects:

A
  1. Dry cough
  2. Angioedema
  3. Diarrhea
62
Q

Aliskiren (Tekturna) Contraindications:

A
  1. PREGNANCY
  2. High-fat meals
  3. HF?
63
Q

What is the prototype for Aldosterone Receptor Blockers?

A

Spironolactone (Aldactone)

Others: Eplerenone (Inspra)

64
Q

Name the two Direct Vasodilators used for HTN:

A
  1. Hydralazine (Apresoline)

2. Nitroprusside (Nitropress)

65
Q

Hydralazine (Apresoline) Uses & MOA:

A

Uses:
1. HTN EMERGENCY!

MOA: VASODILATION
Causes direct relaxation of arteriolar smooth muscle

66
Q

Hydralazine (Apresoline) Route:

A
  1. IV primarily
67
Q

Hydralazine (Apresoline) Side Effects:

A
  1. Severe hypotension
  2. Reflex tachycardia
  3. Increased Blood volume
  4. SLE Syndrome
68
Q

Hydralazine (Apresoline) Nursing Considerations:

A
  1. If reflex Tachycardia occurs, give BB

2. If Increased blood volume occurs, give diuretic (furosemide)

69
Q

Nitroprusside (Nitropress) Uses & MOA:

A

Uses:
1. HTN –> DOC for HTN Emergency!!

MOA:
Causes venous and arteriolar dilation
↑ peripheral vasodilation of arterioles:
↓ PVR → Effects Afterload

↑ peripheral vasodilation of veins:
↓ PVR → Effects Preload
(↓ ventricular filling, ↓ing work of the heart)

70
Q

Nitroprusside (Nitropress) Route:

A

IV

Onset: immediate

71
Q

Nitroprusside (Nitropress) Side Effects:

A
  1. Severe hypotension
  2. Increased Blood volume
  3. Thiocyanate toxicity
72
Q

Nitroprusside (Nitropress) Nursing Considerations:

A
  1. Don’t use >72 hrs
    - thiocyanate toxicity
  2. If Increased blood volume occurs, give diuretic (furosemide)
  3. Use caution w/ other antihypertensives

NSG 323 (mcp) (14 decks)

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