HTN Pharmacology Flashcards
- Diuretics
1) Examples
2) Primarily goal?
1) Lasix
2) HCTZ
3) Spironolactone*
Includes loop diuretics, potassium-sparing diuretics, and thiazides (and thiazide-like diuretics)
*What is first line therapy for hypertension?
Diuretics
Are loop diuretics potassium sparing or wasting?
Aka “Potassium wasting diuretics”
HTN risk factor for?
CAD CVD Death from cardiovascular causes Stroke HF Kidney failure PVD
7 main categories of drugs used in HTN?
1) DIuretics
2) Adrenergic drugs (includes beta blockers)
3) Vasodilators
4) ACEI
5) Angiotensin II receptor blockers (ARBs)
6) Calcium channel blockers
7) Renin inhibitors
Which drug is NOT considered first light therapy for HTN (esp in those over 60)?
Beta blockers
Examples of ACE inhibitors?
Mechanism of action?
Block angiotensin II, lowering PVR and blood volume
**In addition to htn, then are diuretics used?
HF
**Common adverse effects of diuretics?
Decreased K levels + Na, Ca, Cl
Hypotension
Dehydration
**nursing considerations for diuretics?
BP, HR, K, Na
Teaching
**Lifespan considerations for diuretics?
Elderly –>
Which kind of diuretics are most commonly used for HTN?
Thiazides
Which drugs end in “pril”
ACE inhibitors
Lab values to focus on for all antihypertensives?
Renal: BUN, creatinine, GFR
Hepatic: (why??)
Electrolytes
Diagnostics important for antihypertensives?
For diuretics - only ECG
For all others: ECG, angiogram, stress test
What is considered “prehypertension”?
same as high normal
sys 120-139 and dias 80-89 or both
Antihypertensive lab tests according to lilley?
- Those pertaining to Fluid + electrolyte imbalances, heart function and tissue damage, kidney and liver fx
- Serum Na, K, cl, Mg and Ca
- Serum troponin
- Kidney fx
- Liver fx:
**because HTN leads to kidney, retinal, hepatic, heart and vascular damage…
What assessment tool might you use to determine vascular damage d/t hypertension?
Look at retina with opthalmascope
In which populations does extra caution need to be taken when administering antihypertensives?
Elderly + chronically ill –> at high risk for further compmprise of their physical condition if they suffer from uncontrolled or untreated HTN or the adverse effects of antihypertensives (such as dehydration, electrolyte imbalances, hypotension)
Why is it important to know if is beta1 or beta2 receptor blocker?
beta1 will only affect cardio system, less concern for respiratory effects
–> beta1 specific drug would be used to minimize impact on lungs, when issues such as restrictive airway problems would be exacerbated by bronchoconstrictive effects
What what BP and pulse should a phyisician be notified prior to administering a beta blocker?
BP
**Beta blocker baseline values to include in nursing considerations?
BP
HR (apical pulse)
* May cause bradycardia
Also from Lilley:
- Breath + heart sounds
Why is respiratory status very important assessment in use of ACE inhibitors?
AE: dry, hacking cough
Baseline data for admin of ACEIs?
BP
apical pulse rate
resp status
serum lyte levels
Why must special consideration be taken with the elderly when administering vasodilators?
more sensitive to drug’s effect of lowering BP and subsequent problems with hypotension, dizziness, and syncope
Which antihypertensive requires neurological assessment?
Vasodilators
The “social” aspects to be assessed when administering antihypertensives?
- Ethnocultural background
- Racial or ethnic group
- Reading level
- Learning needs
- Dev and cognitive status
- Support systems
- Overall physical health (other illnesses?)
Why do many patients have trouble adhering to antiHTN treatment regimens?
Is a silent disease so could be unaware of BP or thik that if they do not feel ill there is nothing wrong
- Also disruptive to factors such as sexual functioning, which can cause a person to stop taking them
Importance of not rapidly discontinuing antihypertensives?
May lead to REBOUND HTN: sudden and extremely high elevation of BP –> high risk for stroke or other cerebral or heart adverse event
Which kind of drugs do you need to be very careful when first administering d/t possible severe hypotension or first dose syncope?
Alpha adrenergic agonists
–> be sure are supine for first dose
What is the difference between a nonselective Beta blocker and cartdioselective beta blocker?
nonselective block both beta1 and beta2 receptors
cardioselective block beta1 (
Patients taking beta blockers may experience exacerbation of what kind of issues
Respiratory - astham, bronchospasm, and COPD or HF because drug’s negative inotropic effect (beta1 blocking)
If a beta1 blocker causes SOB, what would most likely be the cause?
d/t dema or exacerbation of CH
**Examples of beta blockers?
- Atenolol
- Propanolol
- Doxazosin
- Terazosin
**Mechanism of action of beta blockers (or adrenergic in general)?
Affecte SNS, block A1, b2 receptors
oCentrally acting adrenergic drugs modify the SNS by stimulating the alpha 2 adrenergi receptors in the brain->lack of NE production->dec BP as well as dec the production of rennin
**Which drug is not typically the first line med for htn?
Beta blockers
**What conditions, in addition to HTN are beta blockers used for?
Angina
MI
CHF (Lilley says not for this?)
Migraines
**Common adverse effects of beta blockers (and adrenergic in general)
A1 –> dec BP, bradycardia, dizzy, nausea
B1 + B2 –> impotence (sexual dysx), bronchoconstriction
**Lifespan considerations for all diuretics?
Pregnant and elderly (only elderly under diuretics)
**Examples of vasodilators?
Mechanism of action?
Nipride
Hydralyzine
Direct relaxation of arteriolar smooth muscle
**AE of direct vasodilator action?
- Reflex tachycardia
- Rapid hypotension –> may have more drastic effects than other antihypertensives
**Nursing considerations for vasoilators?
(need to be well monitored!!)
- Continual BP
- 5-lead ECG
- O2 sats
- RR
**Typically used in ER and ICU (?)
**Which antihypertensives are often used in combination therapy? (such as combo of these drugs and thiazides for those with ventricular hypertrophy)?
ARB’s
ACEI’s
**Which antihypertensives are used in HTN crisis (220/130)
Vasodilators
**Examples of ARB’s?
mechanisms of action?
Atacand
Cozaar
Micardis
Arteriolar dilation and increased Na excretion by kidneys (H20 follows)
**Common AE’s of ARBs?
Cough
Inc K
Dec BP
Dizzy, headache, diarrhea, rash
**ARB nursing considerations?
Baselines BP, pulse, K
Teaching
**Examples of ACE inhibitors?
"pril" cptopril enalapril ramipril quinapril
Lock antiotensin II –> lowering PVR and blood volume
**Which conditions will ace inhibitors likely be used in?
MI
CHF
**Adverse effects of ACE inhibitors?
basline data?
Persistent cough
Postural hypotension
Angioedema
BP, pulse,
Teaching
Examples of Ca channel blockers
Mechanism of action
Verapamil
Diltiazem
Norvasc
Renidil
Block Ca from entering cell —> smooth muscle relaxation, dec in pvr
Negative inotropes, slow heart rate and contractility
Which condition uses ca channel blockers?
Angina
Common adverse effects of ca channel blockers?
dec BP
Reflex tachycardia
Which populations have target BP of 130/80mmHg?
DM + renal disease (rather than 140/90)
Important teaching for those taking antihypertensives?
- Do not rapidly come off drugs –> rebound hypertension
- Always take exactly as prescribed.
- Successful tx requires drugs in combo with dietary restrictions (salt + cholesterol intake limited)
- Avoid smoking, excess alcohol, hot climates, exercise exercise, hot tubs, etc. –> heat precipitates vasodilation which could cause fainting and injury
- Remind of importance of follow-ups: lab tests may be needed for duration of tx
- Encourage to have medical alert bracelet
- Pt should weigh themselves daily
- Frequent BP recorded
- Move cautiously, change positions slowly
- Remind to have eye exams q6months
- Fluid, sugar-free hard candies or saliva substitutes for dry mouth
- Openly report sexual dysfx
- Measure for constipation
- may lead to depression –> notify hp
Contraindications for antiypertensives according to Lilley?
Hx of MI
Chronic kidney disease
What is a way to minimize the potential for lightheadedness and dizziness with these drugs?
Stagger drugs (take ACEI at 0800, B blocker at 1000)
Which drugs should not be mixed with grapefruit juice?
Ca channel blockers
Which antihypertensives cause vasodilation?
Vasodilators
ACE inhibitors
Calcium channel blcokers
Angiotensin II blockers