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Pharmacology > Medications Affecting Blood Pressure (general info) > Flashcards

Medications Affecting Blood Pressure (general info) Flashcards

1
Q

What is the suffix to remember ACE inhibitors by?

A

ril or pril

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2
Q

What is the mechanism of actions for ACE inhibitors?

A

Blocks the conversion of angiotensin I to angiotensin II which causes vasodilation and excretion of sodium and water but retention of potassium.

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3
Q

What are some adverse effects of ACE inhibitors?

A

FIRST DOSE orthostatic hypotension

Dry cough (very common) caused by inhibition of kinase and the subsequent increase of bradykinins (inflammatory response, not really adverse but may decrease adherence) SUCK ON HARD CANDY

Hyperkalemia

Rash (stop medication) MAY OR MAY NOT BE HYPERSENSITIVITY

angioedema - emergent but rare

neutropenia - emergent but rare (monitor WBC)

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4
Q

What is angioedema?

A

A life-threatening condition caused by an allergic reaction that causes sudden swelling of the tongue and the upper airway. This causes difficulty breathing and requires notification of the rapid response team.

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5
Q

How long after the first administration of an ACE inhibitor do we monitor for orthostatic hypotension?

A

2 hours

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6
Q

What classification of medications should we discontinue 2-3 days before administration of an ACE inhibitor and why?

A

We should discontinue diuretics 2-3 days before the first dose of an ACE inhibitor because of the increased risk for orthostatic hypotension.

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7
Q

Because of the risk for hyperkalemia with ACE inhibitors, what medications should be avoided while taking them?

A

Potassium-sparing diuretics

Potassium supplements

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8
Q

What are some patient teaching points for ACE inhibitors?

A

Take pills one hour before meals on an empty stomach for the best absorption

Don’t take if pregnant (category D)

Look for adverse effects - cough, orthostatic hypotention, infections, rash, signs of hyperkalemia

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9
Q

What is the suffix to know ARBs by (angiotensin II receptor blockers)?

A

tan

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10
Q

What is the mechanism of action for ARBs?

A

Block the action of angiotensin II and causes vasodilation and excretion of sodium and water

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11
Q

ARBs and ACE inhibitors have the same therapeutic uses, but other than their mechanism of action, how do they differ?

A

With ARBs there is no dry cough or risk for hyperkalemia.

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12
Q

What are some adverse effects of ARBs?

A

Angioedema

Orthostatic hypotension

LOOK IN BOOK FOR MORE?

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13
Q

What are some patient teaching points to consider for ARBs?

A

Lifestyle modifications

Administration techniques (give with food)

Don’t take if pregnant (category D)

Look for adverse effects and ways to avoid them (mainly orthostatic hypotension)

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14
Q

What is the mechanism of action for aldosterone antagonists?

A

Blocks aldosterone which supports excretion of sodium and water (retain potassium)

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15
Q

What are some adverse effects of Aldosterone antagonists?

A

Hyperkalemia

Hyponatremia

Lithium toxicity (because of hyponatremia)

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16
Q

What are some nursing considerations for aldosterone antagonists?

A

monitor lithium levels

monitor potassium/sodium levels

avoid supplements and other medications that increase potassium

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17
Q

What is the mechanism of action for calcium channel blockers, and the difference between slective and nonselective?

A

Both of them block calcium channels.

Selective - cause relaxation of arteries (vasodilation)

nonselective - slow the conductivity of the heart and decrease force of contraction

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18
Q

What is a suffix that calcium channel blockers MIGHT have?

A

pine

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19
Q

What kind of calcium channel blocker would be used for arrhythmias?

A

nonselective - these would help tachyarrhythmias by slowing the conductivity of the heart.

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20
Q

What are some adverse effects of selective calcium channel blockers?

A

Reflex tachycardia - vasodilation causes body to increase HR to keep CO up

peripheral edema - vasodilation

Hypotension

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21
Q

What are some adverse effects of nonselective calcium channel blockers?

A

peripheral edema

hypotension

bradycardia/dysrhythmias

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22
Q

What are some nursing considerations for calcium channel blockers?

A

monitor heart rate/bp

monitor ECG when giving nonselective IV/always have emergency equipment available

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23
Q

What medications should be avoided when giving nonselective calcium channel blockers?

A

beta-blockers or any other medications that slow heart rate

24
Q

How would you administer IV verapamil (nonselective calcium channel blocker)?

A

slowly (2-3 minutes)

25
Q

How would you administer IV cardizem (nonselective calcium channel blocker)?

A

continuous infusion

26
Q

Why do we avoid giving calcium channel blockers to patients experiencing MI, shock, or heart failure?

A

Shock - we dont want to decrease CO

Heart failure - peripheral edema could become worse

MI - NOT SURE?

27
Q

What are some patient teaching points for calcium channel blockers?

A

Don’t take if pregnant (category C)

Monitor BP

Don’t stop taking until you follow up with physician

avoid grapefruit juice (both)

28
Q

What is the mechanism of action for alpha 1 adrenergic blockers?

A

selectively blocks alpha 1 receptors causing venous and arterial vasodilation

also causes smooth muscle relaxation in the prostate and bladder neck

29
Q

What are some therapeutic uses for calcium channel blockers?

A

angina

HTN

cardiac arrhythmias

30
Q

What are some therapeutic uses for alpha 1 adrenergic blockers?

A

hypertension and BPH

31
Q

What are some adverse effects of alpha 1 adrenergic blockers?

A

FIRST DOSE orthostatic hypotension

dizziness - orthostatic hypotension and vasodilation

32
Q

What are some nursing considerations for alpha 1 adrenergic blockers?

A

start low and monitor BP for 2 hours after administration (ortho hypotension)

33
Q

What are some patient teaching points for alpha 1 adrenergic blockers?

A

be careful driving or doing anything that requires mental alertness (dizziness)

avoid in pregnancy (category D)

advise how to manage orthostatic hypotension

take first dose before bed (so first dose orthostatic hypotension isnt a bigdeal while sleeping in bed all night)

34
Q

What is the mechanism of action for centrally acting alpha 2 agonists?

A

acts within the CNS to decrease stimulation of adrenergic receptors (alpha 2 and beta) of heart and peripheral vascular system causing lowered BP and HR.

35
Q

What are some therapeutic uses for centrally acting alpha 2 agonist?

A

hypertension and other investigational uses

36
Q

What are some adverse effects for centrally acting alpha 2 agonists?

A

drowsiness/sedation - improves with time

dry mouth - improves with time

constipation - goes away with time

rebound hypertension

37
Q

What are some nursing considerations for centrally acting alpha 2 agonists?

A

have patient suck on hard cany (dry mouth)

Drink lots of water (constipation)

dont stop suddenly for rebound hypertension (wean 1-2 weeks)

38
Q

What are some patient teaching points for centrally acting alpha 2 agonists?

A

avoid driving and other activities with the sedation/drowsiness

suck on hard candy for dry mouth

drink lots of water for constipation

remove old patch before applying new patch to dry, clean, hairless skin

avoid taking with alcohol and other medications that cause drowsiness

39
Q

What does beta 1 control?

A

increases HR

increases force of muscular contraction in heart

increases rate of conduction

40
Q

What does beta 2 control?

A

bronchodilation

increases blood glucose levels

41
Q

What is the mechanism of action for selective and nonselective beta blockers?

A

selective - block beta 1 which causes a decrease in heart rate, decrease in myocardial contractility, and decreases rate of conduction

nonselective - blocks beta 1 and 2 so same actions as selective but also causes brochcoconstriction and decreased BG levels

42
Q

What is the suffix to know beta-blockers by?

A

lol

43
Q

What are some therapeutic uses for beta-blockers?

A

HTN

tachyarrhythmias

heart failure - decreased work of heart preserves tissue for longer

MI - decrease work for heart during MI to preserve tissue

cardiomyopathy - corag is used to strengthen left ventricle (may cause hair loss)

others…

44
Q

What are some adverse affects of selective beta-blockers?

A

Bradycardia (hold if HR

45
Q

What are some adverse effects of nonselective beta-blockers?

A

bronchoconstriction

decreased BG levels

decreased CO

Bradycardia (hold is HR

46
Q

What are some nursing considerations for beta blockers?

A

monitor HR

observe for signs of heart failure

monitor BP

monitor BG

monitor respiratory status (nonselective)

use nonselectives very cautiously in people with pulmonary disorders

47
Q

Why is hypoglycemia and monitoring BP important (especially in diabetics)?

A

Beta 1 being block masks the symptoms of hypoglycemia, so thats an issue right there. But if beta 2 is als being blocked then hypoglycemia may be induced.

48
Q

What medications and conditions should a beta-blocker not be administered for?

A

AV blocks and bradycardia

if receiving other medications that slow heart rate (nonselective calcium channel blockers) or decrease BP

49
Q

How should beta blockers be administered IV?

A

slowly (over 5 minutes)

50
Q

What are some patient teaching points for beta-blockers?

A

dont stop abruptly (wean off 1-2 weeks)

watch out for orthostatic hypotension

monitor HR and BP at home

may cause sexual dysfunction

51
Q

What is the mechanism of action for direct acting vasodilators?

A

direct vasodilation of arteries and veins to rapidly decrease BP

52
Q

What units are direct acting vasodilators usually used in?

A

ICU, ED, surgery, recovery, etc…

mostly critical care units

53
Q

What medications are also used in hypertensive crisis?

A

ACE inhibitors and calcium channel blockers

54
Q

in patients with what conditions should we avoid administering a direct acting vasodilator?

A

kidney and lever failure (increased wrisk for toxicity)

55
Q

What are some adverse effects of direct acting vasodilators?

A

extreme hypotension

thiocyanate toxicity (byproduct of cyanide metabolism) - delirium, psychosis

cyanide poisining (byproduct of metabolism) - HA, drowsiness, dysrhythmias, cardiac arrest possible

56
Q

What are some nursing considerations for direct acting vasodilators?

A

do not give rapidly (extreme hypotension) - IV .3-4mcg/kg/min on infusion pump

constant monitoring of ECG and BP during infusion

Maintain patient on bedrest

Avoid use for longer than 3 days (thiocyanate and cyanide poisoning)

Protect medication from light because light breaks it down (throw away is discolored, and dont hang for longer than 24 hours in light)

57
Q

What are the main teaching points for HTN medications?

A

teach lifestyle changes

manage orthostatic BP

monitor BP/HR when applicable

Dont stop medications suddenly

keep appointments

dont take in pregnancy or avoid pregnancy (discuss risk/benefits with physician)

Pharmacology (13 decks)

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