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Nursing Care of the Adult > Hypertensive Drugs- Chapter 33 > Flashcards

Hypertensive Drugs- Chapter 33 Flashcards

Learn the nursing considerations and side effects of the hypertensive drugs.

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1
Q

Side effects associated with Fenoldopam, a direct vasodilator?

A

Tachycardia, angina, headache, nausea, flushing.

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2
Q

Nursing Considerations for Fenoldopam?

A

IV use only for hypertensive crisis in hospitalized patients.

Use cautiously in patients with glaucoma.

Patient should remain supine for 1 hr after administration

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3
Q

Side effects associated with hydralazine, a direct vasodilator?

A

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

Hemolytic anemia, vasculitis, and rapidly progressive glomerulonephritis. .

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4
Q

Nursing Considerations for Hydralazine?

A

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.

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5
Q

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

A

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.

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6
Q

Nursing Considerations for Minoxidill?

A

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

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7
Q

Nitroglycerin - what adverse effects should be expected?

A

Hypotension, headache, vomiting, flushing.

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8
Q

Nursing Considerations for Nitroglycerin? (a direct vasodilator) ?

A

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

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

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9
Q

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

A

Acute hypotension, nausea, vomiting, muscle twitching.

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

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10
Q

Nursing considerations for a patient taking Sodium Nitroprusside?

A

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).

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11
Q

Trimethaphan, a Ganglionic Blocker - What side effects?

A

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

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12
Q

Nursing Considerations for Tripethaphan?

A

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

Administered by continuous IV infusion with pump or control device,

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13
Q

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)

A

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

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14
Q

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

A

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.

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15
Q

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

A

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

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16
Q

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)

A

Hyperkalemia

Decreased Renal Function

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17
Q

Nursing Considerations for Angiotensin II receptor blockers?

(candesartan (Atacand)

eprosartan (Teveten)

irbesartan (Avapro)

losartan (Cozaar)

olmesartan (Benicar)

tasosartan (Verdia)

telmisartan (Micardis)

valsartan (Diovan)

A

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.

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18
Q

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

A

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

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19
Q

Nursing Considerations for Alisken, a Renin Inhibitor?

A

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

Not to be used in pregnancy.

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20
Q

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)

A

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

21
Q

What are the Nursing Considerations for Calcium Channel Blockers?

A

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.

22
Q

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))

A

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.

23
Q

Nursing Considerations for Thiazide diuretics?

A

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.

24
Q

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

ethacrynic acid (Edecrin)

furosemide (Lasix)

torsemide (Demadex))

A

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.

25
Q

Nursing Considerations for Loop Diuretics?

A

Monitor for orthostatic hypotension and electrolyte abnormalities.

Loop diuretics remain effective despite renal insufficiency. Diuretic effect of drug increases at higher doses.

26
Q

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

A

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

27
Q

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

A

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.

28
Q

Side effects for Aldosterone Receptor Blockers?

(Spironolactone, or Eplerenone)?

A

Same as amiloride and triamterene.

May cause gynecomastia, erectile dysfunction, decreased libido, menstrual irregularities.

29
Q

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

A

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.

30
Q

What side effects should you expect for Central-Acting α-Adrenergic Antagonists

clonidine (Catapres)?

(also guanabenz, guanfacine)

A

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

31
Q

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

A

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.

32
Q

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

A

Symptomatic bradycardia in patients with conduction disorder.

Patch may cause pruritus, redness, or darkening of skin.

33
Q

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

A

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

34
Q

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

A

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

35
Q

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

A

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

36
Q

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

A

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

37
Q

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

A

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.

38
Q

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

A

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

39
Q

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

A

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.

40
Q

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

A

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.

41
Q

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

A

Reduced resistance to the outflow of urine in benign prostatic hyperplasia.

Taking drug at bedtime reduces risks associated with orthostatic hypotension.

42
Q

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

A

Acute, prolonged hypotension, cardiac dysrhythmias, tachycardia, weakness, flushing.

Abdominal pain, nausea, and exacerbation of peptic ulcer.

43
Q

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

A

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.

44
Q

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)

A

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

45
Q

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)

A

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.

46
Q

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

A

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

47
Q

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

A

Hypotension, bradycardia, orthostatic hypotension, dizziness, fatigue, nausea, vomiting, dyspepsia, paresthesia, nasal stuffiness, erectile dysfunction, edema.

Hepatic toxicity.- Lebetalol causes Hepatic Toxicity.!)

48
Q

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

A

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).

Nursing Care of the Adult (1 decks)

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