Medications Affecting Blood Pressure (general info) Flashcards
What is the suffix to remember ACE inhibitors by?
ril or pril
What is the mechanism of actions for ACE inhibitors?
Blocks the conversion of angiotensin I to angiotensin II which causes vasodilation and excretion of sodium and water but retention of potassium.
What are some adverse effects of ACE inhibitors?
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)
What is angioedema?
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.
How long after the first administration of an ACE inhibitor do we monitor for orthostatic hypotension?
2 hours
What classification of medications should we discontinue 2-3 days before administration of an ACE inhibitor and why?
We should discontinue diuretics 2-3 days before the first dose of an ACE inhibitor because of the increased risk for orthostatic hypotension.
Because of the risk for hyperkalemia with ACE inhibitors, what medications should be avoided while taking them?
Potassium-sparing diuretics
Potassium supplements
What are some patient teaching points for ACE inhibitors?
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
What is the suffix to know ARBs by (angiotensin II receptor blockers)?
tan
What is the mechanism of action for ARBs?
Block the action of angiotensin II and causes vasodilation and excretion of sodium and water
ARBs and ACE inhibitors have the same therapeutic uses, but other than their mechanism of action, how do they differ?
With ARBs there is no dry cough or risk for hyperkalemia.
What are some adverse effects of ARBs?
Angioedema
Orthostatic hypotension
LOOK IN BOOK FOR MORE?
What are some patient teaching points to consider for ARBs?
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)
What is the mechanism of action for aldosterone antagonists?
Blocks aldosterone which supports excretion of sodium and water (retain potassium)
What are some adverse effects of Aldosterone antagonists?
Hyperkalemia
Hyponatremia
Lithium toxicity (because of hyponatremia)
What are some nursing considerations for aldosterone antagonists?
monitor lithium levels
monitor potassium/sodium levels
avoid supplements and other medications that increase potassium
What is the mechanism of action for calcium channel blockers, and the difference between slective and nonselective?
Both of them block calcium channels.
Selective - cause relaxation of arteries (vasodilation)
nonselective - slow the conductivity of the heart and decrease force of contraction
What is a suffix that calcium channel blockers MIGHT have?
pine
What kind of calcium channel blocker would be used for arrhythmias?
nonselective - these would help tachyarrhythmias by slowing the conductivity of the heart.
What are some adverse effects of selective calcium channel blockers?
Reflex tachycardia - vasodilation causes body to increase HR to keep CO up
peripheral edema - vasodilation
Hypotension
What are some adverse effects of nonselective calcium channel blockers?
peripheral edema
hypotension
bradycardia/dysrhythmias
What are some nursing considerations for calcium channel blockers?
monitor heart rate/bp
monitor ECG when giving nonselective IV/always have emergency equipment available
What medications should be avoided when giving nonselective calcium channel blockers?
beta-blockers or any other medications that slow heart rate
How would you administer IV verapamil (nonselective calcium channel blocker)?
slowly (2-3 minutes)
How would you administer IV cardizem (nonselective calcium channel blocker)?
continuous infusion
Why do we avoid giving calcium channel blockers to patients experiencing MI, shock, or heart failure?
Shock - we dont want to decrease CO
Heart failure - peripheral edema could become worse
MI - NOT SURE?
What are some patient teaching points for calcium channel blockers?
Don’t take if pregnant (category C)
Monitor BP
Don’t stop taking until you follow up with physician
avoid grapefruit juice (both)
What is the mechanism of action for alpha 1 adrenergic blockers?
selectively blocks alpha 1 receptors causing venous and arterial vasodilation
also causes smooth muscle relaxation in the prostate and bladder neck
What are some therapeutic uses for calcium channel blockers?
angina
HTN
cardiac arrhythmias
What are some therapeutic uses for alpha 1 adrenergic blockers?
hypertension and BPH
What are some adverse effects of alpha 1 adrenergic blockers?
FIRST DOSE orthostatic hypotension
dizziness - orthostatic hypotension and vasodilation
What are some nursing considerations for alpha 1 adrenergic blockers?
start low and monitor BP for 2 hours after administration (ortho hypotension)
What are some patient teaching points for alpha 1 adrenergic blockers?
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)
What is the mechanism of action for centrally acting alpha 2 agonists?
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.
What are some therapeutic uses for centrally acting alpha 2 agonist?
hypertension and other investigational uses
What are some adverse effects for centrally acting alpha 2 agonists?
drowsiness/sedation - improves with time
dry mouth - improves with time
constipation - goes away with time
rebound hypertension
What are some nursing considerations for centrally acting alpha 2 agonists?
have patient suck on hard cany (dry mouth)
Drink lots of water (constipation)
dont stop suddenly for rebound hypertension (wean 1-2 weeks)
What are some patient teaching points for centrally acting alpha 2 agonists?
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
What does beta 1 control?
increases HR
increases force of muscular contraction in heart
increases rate of conduction
What does beta 2 control?
bronchodilation
increases blood glucose levels
What is the mechanism of action for selective and nonselective beta blockers?
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
What is the suffix to know beta-blockers by?
lol
What are some therapeutic uses for beta-blockers?
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…
What are some adverse affects of selective beta-blockers?
Bradycardia (hold if HR
What are some adverse effects of nonselective beta-blockers?
bronchoconstriction
decreased BG levels
decreased CO
Bradycardia (hold is HR
What are some nursing considerations for beta blockers?
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
Why is hypoglycemia and monitoring BP important (especially in diabetics)?
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.
What medications and conditions should a beta-blocker not be administered for?
AV blocks and bradycardia
if receiving other medications that slow heart rate (nonselective calcium channel blockers) or decrease BP
How should beta blockers be administered IV?
slowly (over 5 minutes)
What are some patient teaching points for beta-blockers?
dont stop abruptly (wean off 1-2 weeks)
watch out for orthostatic hypotension
monitor HR and BP at home
may cause sexual dysfunction
What is the mechanism of action for direct acting vasodilators?
direct vasodilation of arteries and veins to rapidly decrease BP
What units are direct acting vasodilators usually used in?
ICU, ED, surgery, recovery, etc…
mostly critical care units
What medications are also used in hypertensive crisis?
ACE inhibitors and calcium channel blockers
in patients with what conditions should we avoid administering a direct acting vasodilator?
kidney and lever failure (increased wrisk for toxicity)
What are some adverse effects of direct acting vasodilators?
extreme hypotension
thiocyanate toxicity (byproduct of cyanide metabolism) - delirium, psychosis
cyanide poisining (byproduct of metabolism) - HA, drowsiness, dysrhythmias, cardiac arrest possible
What are some nursing considerations for direct acting vasodilators?
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)
What are the main teaching points for HTN medications?
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)
