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Nursing 232 > HTN Pharmacology > Flashcards

HTN Pharmacology Flashcards

1
Q
  • Diuretics
    1) Examples
    2) Primarily goal?
A

1) Lasix
2) HCTZ
3) Spironolactone*

Includes loop diuretics, potassium-sparing diuretics, and thiazides (and thiazide-like diuretics)

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2
Q

*What is first line therapy for hypertension?

A

Diuretics

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3
Q

Are loop diuretics potassium sparing or wasting?

A

Aka “Potassium wasting diuretics”

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4
Q

HTN risk factor for?

A 
CAD
CVD
Death from cardiovascular causes
Stroke 
HF
Kidney failure
PVD
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5
Q

7 main categories of drugs used in HTN?

A

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

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6
Q

Which drug is NOT considered first light therapy for HTN (esp in those over 60)?

A

Beta blockers

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7
Q

Examples of ACE inhibitors?

Mechanism of action?

A

Block angiotensin II, lowering PVR and blood volume

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8
Q

**In addition to htn, then are diuretics used?

A

HF

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9
Q

**Common adverse effects of diuretics?

A

Decreased K levels + Na, Ca, Cl
Hypotension
Dehydration

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10
Q

**nursing considerations for diuretics?

A

BP, HR, K, Na

Teaching

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11
Q

**Lifespan considerations for diuretics?

A

Elderly –>

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12
Q

Which kind of diuretics are most commonly used for HTN?

A

Thiazides

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13
Q

Which drugs end in “pril”

A

ACE inhibitors

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14
Q

Lab values to focus on for all antihypertensives?

A

Renal: BUN, creatinine, GFR
Hepatic: (why??)
Electrolytes

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15
Q

Diagnostics important for antihypertensives?

A

For diuretics - only ECG

For all others: ECG, angiogram, stress test

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16
Q

What is considered “prehypertension”?

A

same as high normal

sys 120-139 and dias 80-89 or both

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17
Q

Antihypertensive lab tests according to lilley?

A
  • 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…

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18
Q

What assessment tool might you use to determine vascular damage d/t hypertension?

A

Look at retina with opthalmascope

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19
Q

In which populations does extra caution need to be taken when administering antihypertensives?

A

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)

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20
Q

Why is it important to know if is beta1 or beta2 receptor blocker?

A

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

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21
Q

What what BP and pulse should a phyisician be notified prior to administering a beta blocker?

A

BP

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22
Q

**Beta blocker baseline values to include in nursing considerations?

A

BP
HR (apical pulse)
* May cause bradycardia

Also from Lilley:
- Breath + heart sounds

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23
Q

Why is respiratory status very important assessment in use of ACE inhibitors?

A

AE: dry, hacking cough

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24
Q

Baseline data for admin of ACEIs?

A

BP
apical pulse rate
resp status
serum lyte levels

25
Q

Why must special consideration be taken with the elderly when administering vasodilators?

A

more sensitive to drug’s effect of lowering BP and subsequent problems with hypotension, dizziness, and syncope

26
Q

Which antihypertensive requires neurological assessment?

A

Vasodilators

27
Q

The “social” aspects to be assessed when administering antihypertensives?

A
  • Ethnocultural background
  • Racial or ethnic group
  • Reading level
  • Learning needs
  • Dev and cognitive status
  • Support systems
  • Overall physical health (other illnesses?)
28
Q

Why do many patients have trouble adhering to antiHTN treatment regimens?

A

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

29
Q

Importance of not rapidly discontinuing antihypertensives?

A

May lead to REBOUND HTN: sudden and extremely high elevation of BP –> high risk for stroke or other cerebral or heart adverse event

30
Q

Which kind of drugs do you need to be very careful when first administering d/t possible severe hypotension or first dose syncope?

A

Alpha adrenergic agonists

–> be sure are supine for first dose

31
Q

What is the difference between a nonselective Beta blocker and cartdioselective beta blocker?

A

nonselective block both beta1 and beta2 receptors

cardioselective block beta1 (

32
Q

Patients taking beta blockers may experience exacerbation of what kind of issues

A

Respiratory - astham, bronchospasm, and COPD or HF because drug’s negative inotropic effect (beta1 blocking)

33
Q

If a beta1 blocker causes SOB, what would most likely be the cause?

A

d/t dema or exacerbation of CH

34
Q

**Examples of beta blockers?

A
  • Atenolol
  • Propanolol
  • Doxazosin
  • Terazosin
35
Q

**Mechanism of action of beta blockers (or adrenergic in general)?

A

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

36
Q

**Which drug is not typically the first line med for htn?

A

Beta blockers

37
Q

**What conditions, in addition to HTN are beta blockers used for?

A

Angina
MI
CHF (Lilley says not for this?)
Migraines

38
Q

**Common adverse effects of beta blockers (and adrenergic in general)

A

A1 –> dec BP, bradycardia, dizzy, nausea

B1 + B2 –> impotence (sexual dysx), bronchoconstriction

39
Q

**Lifespan considerations for all diuretics?

A

Pregnant and elderly (only elderly under diuretics)

40
Q

**Examples of vasodilators?

Mechanism of action?

A

Nipride
Hydralyzine

Direct relaxation of arteriolar smooth muscle

41
Q

**AE of direct vasodilator action?

A
  • Reflex tachycardia

- Rapid hypotension –> may have more drastic effects than other antihypertensives

42
Q

**Nursing considerations for vasoilators?

A

(need to be well monitored!!)

  • Continual BP
  • 5-lead ECG
  • O2 sats
  • RR

**Typically used in ER and ICU (?)

43
Q

**Which antihypertensives are often used in combination therapy? (such as combo of these drugs and thiazides for those with ventricular hypertrophy)?

A

ARB’s

ACEI’s

44
Q

**Which antihypertensives are used in HTN crisis (220/130)

A

Vasodilators

45
Q

**Examples of ARB’s?

mechanisms of action?

A

Atacand
Cozaar
Micardis

Arteriolar dilation and increased Na excretion by kidneys (H20 follows)

46
Q

**Common AE’s of ARBs?

A

Cough
Inc K
Dec BP
Dizzy, headache, diarrhea, rash

47
Q

**ARB nursing considerations?

A

Baselines BP, pulse, K

Teaching

48
Q

**Examples of ACE inhibitors?

A 
"pril"
cptopril
enalapril
ramipril
quinapril

Lock antiotensin II –> lowering PVR and blood volume

49
Q

**Which conditions will ace inhibitors likely be used in?

50
Q

**Adverse effects of ACE inhibitors?

basline data?

A

Persistent cough
Postural hypotension
Angioedema

BP, pulse,
Teaching

51
Q

Examples of Ca channel blockers

Mechanism of action

A

Verapamil
Diltiazem
Norvasc
Renidil

Block Ca from entering cell —> smooth muscle relaxation, dec in pvr
Negative inotropes, slow heart rate and contractility

52
Q

Which condition uses ca channel blockers?

53
Q

Common adverse effects of ca channel blockers?

A

dec BP

Reflex tachycardia

54
Q

Which populations have target BP of 130/80mmHg?

A

DM + renal disease (rather than 140/90)

55
Q

Important teaching for those taking antihypertensives?

A
  • 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
56
Q

Contraindications for antiypertensives according to Lilley?

A

Hx of MI

Chronic kidney disease

57
Q

What is a way to minimize the potential for lightheadedness and dizziness with these drugs?

A

Stagger drugs (take ACEI at 0800, B blocker at 1000)

58
Q

Which drugs should not be mixed with grapefruit juice?

A

Ca channel blockers

59
Q

Which antihypertensives cause vasodilation?

A

Vasodilators
ACE inhibitors
Calcium channel blcokers
Angiotensin II blockers

Nursing 232 (12 decks)

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