Hypertensive Drugs- Chapter 33

Question 1

Side effects associated with Fenoldopam, a direct vasodilator?

Answer 1

Tachycardia, angina, headache, nausea, flushing.

Question 2

Nursing Considerations for Fenoldopam?

Answer 2

IV use only for hypertensive crisis in hospitalized patients.

Use cautiously in patients with glaucoma.

Patient should remain supine for 1 hr after administration

Question 3

Side effects associated with hydralazine, a direct vasodilator?

Answer 3

Headache, nausea, flushing, palpitation, tachycardia, dizziness, and angina.

Hemolytic anemia, vasculitis, and rapidly progressive glomerulonephritis. .

Question 4

Nursing Considerations for Hydralazine?

Answer 4

IV use for hypertensive crisis in hospitalized patients.

Twice-daily oral dosage.

Not used as monotherapy because of side effects.

Contraindicated in patients with coronary artery disease; use with caution in patients >40 yr.

Question 5

Minoxidill (Loniten)- what side effects should the nurse monitor for?

Answer 5

Reflex tachycardia, marked sodium and fluid retention (may require loop diuretics for control), and hirsutism.

May cause ECG changes (flattened and inverted T waves) not related to ischemia.

Question 6

Nursing Considerations for Minoxidill?

Answer 6

Reserved for treatment of severe hypertension associated with renal failure and resistant to other therapy. Once- or twice-daily dosage.

Question 7

Nitroglycerin - what adverse effects should be expected?

Answer 7

Hypotension, headache, vomiting, flushing.

Question 8

Nursing Considerations for Nitroglycerin? (a direct vasodilator) ?

Answer 8

IV use for hypertensive crisis in hospitalized patients with myocardial ischemia.

Administered by continuous IV infusion with pump or control device. \

Question 9

What side effects should you monitor for in a patient taking Sodium Nitroprusside?

Answer 9

Acute hypotension, nausea, vomiting, muscle twitching.

Signs of thiocyanate toxicity include anorexia, nausea, fatigue, disorientation.

Question 10

Nursing considerations for a patient taking Sodium Nitroprusside?

Answer 10

IV use for hypertensive crisis in hospitalized patients.

Administered by continuous IV infusion with pump or control device.

Intraarterial monitoring of BP recommended.

Wrap IV solutions with an opaque material to protect from light; stable for 24 hr.

Metabolized to cyanide, then thiocyanate. Monitor thiocyanate levels with prolonged use (>3 days) or doses (≥4 mcg/kg/min).

Question 11

Trimethaphan, a Ganglionic Blocker - What side effects?

Answer 11

Visual disturbance, dilated pupils, dry mouth, urinary hesitancy, subjective chilliness.

Question 12

Nursing Considerations for Tripethaphan?

Answer 12

IV use for initial control of BP in patient with dissecting aortic aneurysm.

Administered by continuous IV infusion with pump or control device,

Question 13

What are the side effects that you should monitor for in Angiotensin-Converting-Enzyme-Inhibitors Benazepril (Lotensin), captopril (Capoten)

enalapril (Vasotec)

fosinopril (Monopril)

lisinopril (Prinivil, Zestril)

moexipril (Univasc)

perindopril (Aceon)

quinapril (Accupril)

ramipril (Altace)

trandolapril (Mavik)

Answer 13

Hypotension, dizziness, loss of taste, cough, hyperkalemia, acute renal failure, skin rash, angioedema.

Question 14

Nursing Considerations for Benzepril, and all of the other Angiotensin-Converting Enyzme Inhibitors, ending in “pril” ?

Answer 14

Aspirin and NSAIDs may reduce drug effectiveness.

Addition of diuretic enhances drug effect.

Should not be used with potassium-sparing diuretics.

Inhibit breakdown of bradykinin, which may cause a dry, hacking cough.

Captopril may be given orally for hypertensive crisis.

Question 15

Nursing Considerations for Enalapril, an Angiotensin-Converting Enzyme Inhibitor?

Answer 15

This drug inhibits ACE when oral agents are not appropriate.
Given IV over 5 min; monitor BP

Question 16

What side Effects should you monitor for Angiotensin II Receptor blockers?
(candesartan (Atacand)

eprosartan (Teveten)

irbesartan (Avapro)

losartan (Cozaar)

olmesartan (Benicar)

tasosartan (Verdia)

telmisartan (Micardis)

valsartan (Diovan)

Answer 16

Hyperkalemia

Decreased Renal Function

Question 17

Nursing Considerations for Angiotensin II receptor blockers?

(candesartan (Atacand)

eprosartan (Teveten)

irbesartan (Avapro)

losartan (Cozaar)

olmesartan (Benicar)

tasosartan (Verdia)

telmisartan (Micardis)

valsartan (Diovan)

Answer 17

Full effect on BP may not be seen for 3-6 wk.

Do not affect bradykinin levels. Therefore acceptable alternative to ACE inhibitors in people who develop dry cough.

Question 18

Renin inhibitors - Alisken- What side effects should you monitor for?

Answer 18

Rash, diarrhea, increased creatine kinase level, cough, hypotension, torsades de pointes, acute renal failure, angioedema.

Question 19

Nursing Considerations for Alisken, a Renin Inhibitor?

Answer 19

May cause angioedema of the face, extremities, lips, tongue, glottis, and/or larynx.

Not to be used in pregnancy.

Question 20

What side Effects should you monitor for with Calcium Channel Blockers -

Amlodipine (Norvasc)

clevidipine (Cleviprex)

diltiazem extended release (Cardizem CD, Cardizem LA, Dilacor XR, Tiazac)

felodipine (Plendil)

isradipine (DynaCirc CR)

nicardipine sustained release (Cardene SR)

nifedipine long acting (Adalat CC, Procardia XL)

verapamil intermediate release (Isoptin, Calan)

nisoldipine (Sular)

verapamil long acting (Isoptin SR, Covera-HS, Calan SR)

verapamil timed release (Verelan PM)

Answer 20

Bradycardia, first-degree AV block, nausea, headache, dizziness, peripheral edema, flushing, rash, gingival hyperplasia, constipation (with verapamil).

Question 21

What are the Nursing Considerations for Calcium Channel Blockers?

Answer 21

Use with caution in patients with heart failure. Contraindicated in patients with second- or third-degree heart block.

Avoid grapefruit when on nifedipine.

Use of sublingual short-acting nifedipine in hypertensive emergencies is unsafe and not effective. Serious adverse events (e.g., stroke, acute Ml) have been reported.

IV nicardipine available for hypertensive crisis in hospitalized patients. Change peripheral IV infusion sites every 12 hr.

Clevidipine is for IV use only.

Question 22

What are the side effects that the nurse should monitor for in a patient taking a Thiazide Diuretic?

( bendroflumethiazide (Naturetin)

benzthiazide (Aquatag, Exna)

chlorothiazide (Diuril)

chlorthalidone (Hygroton)

hydrochlorothiazide (Microzide, Esidrix, HydroDIURIL, Oretic)

methyclothiazide (Enduron)

metolazone (Zaroxolyn)

trichlormethiazide (Metahydrin, Naqua))

Answer 22

Fluid and electrolyte imbalances: volume depletion, hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypercalcemia, hyperuricemia, metabolic alkalosis; CNS effects: vertigo, headache, weakness. GI effects: anorexia, nausea, vomiting, diarrhea, constipation, pancreatitis.

Sexual problems: erectile dysfunction, decreased libido.

Dermatologic effects: photosensitivity, skin rash.

Blood dyscrasias; decreased glucose tolerance.

Question 23

Nursing Considerations for Thiazide diuretics?

Answer 23

Monitor for orthostatic hypotension, hypokalemia, and alkalosis. T
hiazides may potentiate cardiotoxicity of digoxin by producing hypokalemia.
Dietary sodium restriction reduces the risk of hypokalemia. NSAIDs can decrease diuretic and antihypertensive effect of thiazide diuretics.

Advise patient to supplement with potassium-rich foods. Current doses are lower than previously recommended.

Question 24

What side effects should be monitored for in a patient taking a Loop Diuretic?
( bumetanide (Bumex)

ethacrynic acid (Edecrin)

furosemide (Lasix)

torsemide (Demadex))

Answer 24

Fluid and electrolyte imbalances as with thiazides, except no hypercalcemia.

Ototoxicity: hearing impairment, deafness, vertigo, that are usually reversible.

Metabolic effects: hyperuricemia, hyperglycemia, increased LDL cholesterol and triglycerides, decreased HDL cholesterol.

Question 25

Nursing Considerations for Loop Diuretics?

Answer 25

Monitor for orthostatic hypotension and electrolyte abnormalities. Loop diuretics remain effective despite renal insufficiency. Diuretic effect of drug increases at higher doses.

Question 26

What side affects should you monitor for in a patient taking a Potassium Sparing diuretic? (amiloride, or Trimterene?)

Answer 26

Hyperkalemia, nausea, vomiting, diarrhea, headache, leg cramps, dizziness.

Question 27

Nursing Considerations for Potassium Sparing diuretics? (trimterene or amiloride) ?

Answer 27

Monitor for orthostatic hypotension and hyperkalemia. Contraindicated in patients with renal failure. Use with caution in patients on ACE inhibitors or angiotensin II blockers. Avoid potassium supplements.

Question 28

Side effects for Aldosterone Receptor Blockers? (Spironolactone, or Eplerenone)?

Answer 28

Same as amiloride and triamterene. May cause gynecomastia, erectile dysfunction, decreased libido, menstrual irregularities.

Question 29

Nursing Considerations for Aldosterone Receptor Blockers? - Spironolactone or Eplerenone?

Answer 29

Monitor for orthostatic hypotension and hyperkalemia. Do not combine with potassium-sparing diuretics or potassium supplements. Use with caution in patients on ACE inhibitors or angiotensin II blockers. These drugs are also classified as potassium-sparing diuretics.

Question 30

What side effects should you expect for Central-Acting α-Adrenergic Antagonists clonidine (Catapres)? (also guanabenz, guanfacine)

Answer 30

Dry mouth, sedation, erectile dysfunction, nausea, dizziness, sleep disturbance, nightmares, restlessness, depression.

Question 31

Nursing Considerations for Central-Acting α-Adrenergic Antagonists clonidine (Catapres) (also guanabenz, guanfacine)

Answer 31

Sudden discontinuation may cause withdrawal syndrome including rebound hypertension, tachycardia, headache, tremors, apprehension, and sweating. Chewing gum or hard candy may relieve dry mouth. Alcohol and sedatives increase sedation.

Question 32

Side effects for the clonidine patch, a Central-Acting α Adrenergic Antagonist?

Answer 32

Symptomatic bradycardia in patients with conduction disorder. Patch may cause pruritus, redness, or darkening of skin.

Question 33

Nursing Considerations for the clonidine patch, a Central-Acting α Adrenergic Antagonist?

Answer 33

Transdermal patch may be related to fewer side effects and better compliance.

Question 34

Side effects for Methyldopa, a Central-Acting α Adrenergic Antagonist?

Answer 34

Sedation, fatigue, orthostatic hypotension, decreased libido, erectile dysfunction, dry mouth, hemolytic anemia, hepatotoxicity, sodium and water retention, depression.

Question 35

Nursing Considerations for Methyldopa, a Central-Acting α Adrenergic Antagonist?

Answer 35

Instruct patient about daytime sedation and avoidance of hazardous activities. Administration of a single daily dose at bedtime minimizes sedative effect.

Question 36

Side effects for Guanethidine, A Peripheral-Acting α Adrenergic Antagonist?

Answer 36

Marked orthostatic hypotension, diarrhea, cramps, bradycardia, retrograde or delayed ejaculation, sodium and water retention.

Question 37

Nursing Considerations for Guanethidine, A Peripheral-Acting Alpha Adrenergic Antagonist?

Answer 37

May cause severe orthostatic hypotension; not recommended for use in patients with cerebrovascular or coronary insufficiency or in older adults. Advise patient to rise slowly and wear support stockings.

Question 38

Side effects for Guanadral sulfate and Resperpine, Peripheral acting alpha adrenergic antagonists?

Answer 38

Similar to guanethidine. Sedation and inability to concentrate, depression, nasal stuffiness.

Question 39

Nursing Consideraitons for Guanethidine and Resperpine, Peripheral-Acting Alpha Adrenergic Antagonists?

Answer 39

Must be given twice daily. Contraindicated in patients with history of depression. Monitor mood and mental status regularly. Advise patient to avoid barbiturates, alcohol, and opioids.

Question 40

What side effects can be expected for Alpha-1 Adrenergic Blockers - Doxazosin, Prazosin, Terazosin?

Answer 40

Variable amount of orthostatic hypotension depending on the plasma volume. May see profound orthostatic hypotension with syncope within 90 min after initial dose. Retention of salt and water.

Question 41

Nursing Considerations for for Alpha-1 Adrenergic Blockers - Doxazosin, Prazosin, Terazosin?

Answer 41

Reduced resistance to the outflow of urine in benign prostatic hyperplasia. Taking drug at bedtime reduces risks associated with orthostatic hypotension.

Question 42

Side effects for Phentolamine, an Alpha-1 Adrenergic Blocker?

Answer 42

Acute, prolonged hypotension, cardiac dysrhythmias, tachycardia, weakness, flushing. Abdominal pain, nausea, and exacerbation of peptic ulcer.

Question 43

Nursing Considerations for Phentolamine, an Alpha-1 Adrenergic Blocker?

Answer 43

Used in short-term management of pheochromocytoma. Also used locally to prevent necrosis of skin and subcutaneous tissue after extravasation of adrenergic drug. No oral formulation.

Question 44

What side effects should you monitor for in a patient taking a Beta-Adrenergic Blocker, ending in "lol" ? ex. acebutolol (Sectral) atenolol (Tenormin) betaxolol (Kerlone) bisoprolol (Zebeta) carteolol (Cartrol) metoprolol (Lopressor) nadolol (Corgard) nebivolol (Bystolic) penbutolol (Levatol) pindolol (Visken) propranolol (Inderal) timolol (Blocadren)

Answer 44

Hypotension, bronchospasm, atrioventricular conduction block, impaired peripheral circulation. Nightmares, depression, erectile dysfunction, weakness, reduced exercise capacity. May induce or exacerbate heart failure in susceptible patients. Sudden withdrawal of β-adrenergic blockers may cause rebound hypertension and exacerbate symptoms of ischemic heart disease

Question 45

What are the Nursing Considerations for a patient taking a Beta-Adrenergic Blocker, ending in "lol" ? ex. acebutolol (Sectral) atenolol (Tenormin) betaxolol (Kerlone) bisoprolol (Zebeta) carteolol (Cartrol) metoprolol (Lopressor) nadolol (Corgard) nebivolol (Bystolic) penbutolol (Levatol) pindolol (Visken) propranolol (Inderal) timolol (Blocadren)

Answer 45

β-Adrenergic blockers vary in lipid solubility, selectivity, and presence of partial sympathomimetic effect, which explains different therapeutic and side effect profiles of specific agents. Monitor pulse and BP regularly. Use with caution in patients with diabetes mellitus because drug may depress the tachycardia associated with hypoglycemia. Nonselective agents may cause bronchospasm, especially in patients with a history of asthma.

Question 46

What Nursing Considerations are there for a patient taking esmolol (Brevibloc), a Beta-Adrenergic Blocker?

Answer 46

IV administration; rapid onset and very short duration of action.

Question 47

What are the side effects that the nurse should monitor for when her patient is taking Carvedilol and Labetalol - Beta Adrenergic Blockers???

Answer 47

Hypotension, bradycardia, orthostatic hypotension, dizziness, fatigue, nausea, vomiting, dyspepsia, paresthesia, nasal stuffiness, erectile dysfunction, edema. Hepatic toxicity.- Lebetalol causes Hepatic Toxicity.!)

Question 48

Nursing considerations for Carvedilol and Labetalol - Beta Adrenergic Blockers???

Answer 48

Same as β-adrenergic blockers. IV form available for hypertensive crisis in hospitalized patients. Patients must be kept supine during IV administration. Assess patient tolerance of upright position (severe orthostatic hypotension) before allowing upright activities (e.g., commode).