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AE1 > PHARM WEEK 3 CARDIOVASCULAR AGENTS PART 1A > Flashcards

PHARM WEEK 3 CARDIOVASCULAR AGENTS PART 1A Flashcards

1
Q

any damage to the ____, _____, and _____ of the heart will affect the heart’s function.

A

myocardium, pericardium and endocardium

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2
Q

The heart will get damaged if not enough ___ is delivered.

A

O2

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3
Q

ekg can detect ___ if symptoms are absent.

A

MI

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4
Q

Vasospasm can limit blood flow to the heart and thus…

A

decreasing O2 and the heart will get hurt :(

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5
Q

Nitrates is an old or new drug.

A

old!

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6
Q

Name 3 facts about sublingual drugs.

A
  1. fast acting because there are a lot of blood vessels under the tongue
  2. effects last only 10 minutes
  3. sublingual meds are kept in brown containers because heat and light can decompose the meds.
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7
Q

Nitroglycerin patch and ointment must be removed after ___ hours

A

12

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8
Q

2nd block means

A

increased PR interval, increased time in communication between SA node and AV node

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9
Q

3rd block means

A

no communication between SA node and the ventricles. This is considered an emergency because the beatings are individualized, no communication between the cells.

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10
Q

Selective Beta 1 blockers affect only the

A

Heart rate

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11
Q

Nonselective Beta 1 blockers affect…

A

both the bronchospasm and heart rate so need to be careful when using this for pts with COPD.

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12
Q

If not enough O2 is delivered to the peripheral vessels, what will happen?

A

intermittent claudication (pain) in legs

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13
Q

____ makes angiotensinogen… goes to the lungs to convert ______ to ________. In the lungs, ACE converts _____ to _______. All acts on adrenal cortex to release aldosterone.

A

Liver, angiotensinogen, angiotensin I, angiotensin I, angiotensin II.

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14
Q

aldosterone increases reabsorption of ___ and ___.

A

sodium and h2o

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15
Q

aldosterone increases ___ ____

A

potassium excretion.

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16
Q

aldosterone increases ___ ____ and also ___

A

blood volume, bp

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17
Q

if aldosterone is not working, what should the nurse do?

A

give pt fluid or vasoconstriction.

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18
Q

what can cause vasoconstriction?

A

norepinephrine

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19
Q

what are some risk factors for htn (4)?

A

african american race, mexican american race and low social-economical income, increase stress

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20
Q

smoking can vasoconstrict via?

A

smoking can increase norepinephrine so it can vasoconstrict.

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21
Q

Secondary htn is caused by:

A

htn due to other disorders (neural, kidney…)

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22
Q

htn pts usually eat diet low in ___ so there is an increase in ___ retention.

A

potassium, sodium

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23
Q

good sources of K+:

A

potatoes, dried molasses, figs

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24
Q

In medical settings, there is a disparity for African Americans and Mexican Americans compared to other races. Please explain.

A

African Americans and Mexican Americans are usually not prescribed htn meds even tho they have htn, so lower outcomes of htn control in these people.

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25
Q

htn education should start when?

A

as early as adolescent years.

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26
Q

Daily K+ needed?

A

4,700 mg

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27
Q

dehydration can cause:

A

metabolic alkalosis

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28
Q

selective and nonselective beta blockers should not be given to ____. Why (2)?

A

Pts with diabetes, because (1) the meds can lower blood sugar and (2) meds will mask the symptoms of hypoglycemia

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29
Q

metoprolol can decrease what?

A

libido, impotence…

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30
Q

selective beta blockers are selective only until ____. Over that dose, it will…

A

a certain dose.

It will affect both Beta 1 and Beta 2 (nonselective)

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31
Q

centrally acting Alpha 2 agonists are used to

A

used to lower bp for people with alcohol and drug withdrawal. It is a symptomatic management, won’t help with the actual addiction. Therefore this med is mostly prescribed in detox centers.

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32
Q

Only ____ meds affect ___ ____, not ___ meds

A

Beta, glucose metabolism, alpha

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33
Q

meds end in -ril or -pril

A

ACE inhibitors

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34
Q

meds end in -lol

A

beta blockers

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35
Q

Pts using ACE inhibitors should be watched out for?

A

hyperkalemia

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36
Q

meds end in -tan

A

ARB; angiotensin receptor blockers

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37
Q

Ca channel blockers block ___ into cells so it can ____ the arterial muscles.

A

Ca, relaxes

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38
Q

meds end in -pine

A

Ca channel blockers

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39
Q

Direct- Acting arteriolar vasodilators are used in ___ ____. Why?

A

severe htn, because they are fast acting.

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40
Q

What is one side effect of Direct- Acting arteriolar vasodilators?

A

hair growth

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41
Q

What is one example of Direct- Acting arteriolar vasodilators?

A

Rogane(spelling?)

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42
Q

Interventions for Direct- Acting arteriolar vasodilators?

A

if pill med, recheck bp after an hour of taking the med

if IV med, recheck bp after 5 to 10 minutes

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43
Q

what is appropriate exercise routine?

A

exercise 5 out of 7 days per week, for at least 30 minutes

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44
Q

what is normal blood sugar level?

A

70 to 100

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45
Q

What is the most commonly prescribed meds of all?

A

antilipidemics Medications.

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46
Q

what is the action of Zetia?

A

it inhibits cholesterol absorption in the lower intestines

** Fatty stool = diarrhea

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47
Q

Nursing interventions for pts taking Atorvastatin (3)

A

check liver function, pregnancy, and if pt drinks

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48
Q

LFT stands for

A

liver function test

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49
Q

Some heart diseases are not related to high ____

A

cholesterol.

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50
Q

The reason for MI is

A

inflammation

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51
Q

Inflammation is due to what?

A

stress

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52
Q

when you are inflamed, your blood becomes ____

A

hypercoagulatable.

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53
Q

what are the three types of cardiovascular agents?

A
  1. Antianginals
  2. Antihypertensives
  3. Antilipidemics & peripheral vasodilators
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54
Q

What is the myocardium?

A

it’s the heart muscle,

surrounding the ventricles and atria. Ventricles have thick walls and atria have thin walls

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55
Q

What is the pericardium?

A

It’s the fibrous covering the heart, to protects the heart from injury

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56
Q

What is the endocardium?

A

It’s the inner lining of the heart chambers. It is a three-layered membrane

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57
Q

Coronary arteries are separated into what 2 structures?

A

Right and Left coronary arteries

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58
Q

Describe Right coronary artery

A

Divides into branches that supply blood to the right atrium and both ventricles of the heart

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59
Q

describe Left coronary artery (3)

A
  1. Divides near its origin
  2. Forms the left circumflex artery and anterior descending artery
  3. Supplies blood to the left atrium and both ventricles of the heart
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60
Q

Blockage of the heart will lead to what?

A

myocardial infarction (MI)

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61
Q

what are the five structures in the heart conduction system?

A
  1. SA node
  2. AV node
  3. Ventricles
  4. Sympathetic NS
  5. Parasympathetic NS
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62
Q

SA node is how many beats per min?

A

60-80

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63
Q

AV node is how many beats per min?

A

40-60

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64
Q

Ventricles are how many beats per min?

A

30-40

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65
Q

what will the sympathetic NS do for the heart conduction system?

A

increase heart rate through epic and norepi

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66
Q

what will the parasympathetic NS do for the heart conduction system?

A

decreases heart rate through acetylcholine

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67
Q

describe the anatomy of the Cardiac Conduction System: Sinus Node.

A

The normal cardiac impulse originates in the sinus node

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68
Q

where is the Sinus node?

A

a structure located in the long, superior portion of the right atrium at its juncture with the superior vena cava.

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69
Q

conduction from the sinus node is thought to occur over what pathways?

A

internodal pathways

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70
Q

what are the three internal pathways?

A
  1. the anterior internodal pathway
  2. the middle internodal pathway
    3 the posterior internodal pathway
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71
Q

describe the anterior internodal pathway.

A

It arises at the cranial end of the sinus node. It divides into branches, one to the left atrium (Bachmann’s bundle) and the other along the right side of the interatrial septum to the AV node.

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72
Q

describe the middle internodal pathway.

A

It arises along the endocardial surface of the sinus node and descends through the interatrial septum to the AV node.

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73
Q

describe the posterior internodal pathway

A

It arises from the caudal end of the sinus node and approaches the AV node at its posterior aspect.

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74
Q

What is the speed of conduction through the atria via the internodal pathways?

A

approximately 1000 mm/s.

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75
Q

where is the AV node?

A

The AV node is located inferiorly in the right atrium, anterior to the ostium of the coronary sinus and above the tricuspid valve

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76
Q

what is the speed of conduction through the AV node?

A

about 200 mm/s

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77
Q

Tell me 3 things about the AV node.

A
  1. It is anatomically a complicated network of fibers. These fibers converge at its lower margin to form a discrete bundle of fibers, the bundle of His (or AV bundle).
  2. This structure penetrates the annulus fibrosis and arrives at the upper margin of the muscular intraventricular septum.
  3. There the bundle of His gives origin to the bundle branches.
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78
Q

where are the bundle branches?

A

The left bundle branch arises as a series of radiations, or fascicles, at right angles to the bundle of His.

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79
Q

What do the bundle branches break up into?

A

Purkinje network

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80
Q

What is the first section of the ventricle to begin depolarization?

A

the midportion of the interventricular septum from the left side, giving rise to the normal Q wave on the 12-lead ECG

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81
Q

Are the walls of the left and right ventricles depolarized simultaneously?

A

Yes

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82
Q

what is the speed of conduction through the ventricular Purkinje network?

A

about 4000 mm/s

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83
Q

what is the speed of conduction through the ventricular muscle?

A

about 400 mm/s

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84
Q

CO =

A

HR x Stroke volume

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85
Q

Stroke volume is determined by?

A

Preload, contractility and afterload

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86
Q

What is preload

A

the blood flow force that stretches the ventricle

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87
Q

what is contractility

A

the force of ventricular contraction

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88
Q

what is afterload

A

the systemic vascular resistance

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89
Q

Pulmonary artery does what?

A

sends deoxygenated blood to the lungs

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90
Q

what does the pulmonary vein do?

A

sends oxygenated blood to left atrium

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91
Q

for the systemic circulation, left ventricle does what?

A

send oxygenated blood into the aorta

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92
Q

general circulation pathway…

A

arteries to arterioles to capillary beds (exchange) to venules to veins and back to the right ventricle with deoxygenated blood

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93
Q

what drug is used to treat angina pectoris?

A

antianginal drugs

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94
Q

what is angina pectoris?

A

Acute cardiac pain caused by inadequate myocardial blood flow.

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95
Q

what can lead to inadequate myocardial blood flow (2)?

A
  1. Plaque or blood clot occlusions

2. Coronary artery spasms

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96
Q

what can cause anginal pain?

A

decrease in myocardial O2 supply

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97
Q

what are some symptoms of angina?

A
  1. Chest tightness or pressure with pain radiating down left arm
  2. Referred jaw or neck pain
  3. May have SOB, diaphoresis, pallor, clammy skin, GI symptoms
  4. Usually lasts a few minutes; may lead to MI
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98
Q

Is it possible for patients to have no symptoms of MI?

A

Yes, silent MIs.

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99
Q

what are 3 types of angina pectoris?

A

Classic (stable), Unstable (pre-infarction) and variant (Prinzmetal, vasopastic)

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100
Q

what is one thing about the classic angina pectoris?

A

Occurs with stress or emotion due to coronary artery narrowing or partial occlusion

101
Q

what is one thing about unstable (pre-infarction) angina pectoris?

A

Occurs frequently over course of a day with ↑ severity due to coronary artery narrowing or partial occlusion

102
Q

what is one thing about variant (prinzmetal, vasospastic) angina pectoris?

A

Occurs with rest, caused by vasospasm (caused by atherosclerotic plaques, or drugs that induced vasospasm)

103
Q

angina drug therapy is to ___ the O2 supply and demand

104
Q

what are the 3 types of antianginal drugs?

A

nitrates, beta-blockers and calcium channel blockers

105
Q

what is the actions of antianginal drugs?

A

Increase myocardial blood flow by increasing O2 supply or decreasing O2 demand

106
Q

what are 2 facts about nitrates?

A
  1. developed in 1840s.

2. first agents used to relieve angina

107
Q

what do nitrates affect?

A

venous blood vessels and coronary arteries

108
Q

what is the action of nitrates?

A

cause generalized vascular and coronary vasodilation to increase blood flow through coronary arteries to myocardial cells, and decrease myocardial ischemia but causes decrease bp

109
Q

increase blood flow to the coronary arteries and decrease the amount of blood that is returned to the heart will do what?

A

decreased preload and decrease peripheral vascular resistance.

110
Q

what are the effects of nitrates on variant (vasospastic) angina?

A

relaxes coronary arteries by decreasing vasospasm and increase O2 supply

111
Q

what are the effects of nitrates on classic (stable) angina?

A

dilates veins by decreasing preload and O2 demand

112
Q

Name one prototype drug of nitrates.

A

nitroglycerin.

113
Q

what are the 4 pharmacodynamics of nitroglycerin?

A
  1. Reduces myocardial oxygen demand
    2.Increases cyclic guanosine monophosphate
    (Smooth muscle relaxation and vasodilation)
  2. Decreases preload
    (Amount of blood in RV at end of diastole)
    4.Decreases afterload
    (Peripheral vascular resistance)
114
Q

what is the nitroglycerin dosage for an adult?

A
  • adult is PO or SL at various dosages.

- SL is most commonly used because it is readily absorbed

115
Q

What is the onset and effects of nitroglycerin?

A

-onset is 1 to 3 min, effects last 10 mins.

116
Q

where should nitroglycerin be kept?

A

SL tabs decompose when exposed to heat or light so must be kept in original container.

117
Q

Other routes of nitroglycerin? other than SL.

A

IV, Topical and PO

118
Q

What is dosage of IV nitroglycerin?

A

dose is usually titrated to relieve angina or manage acute CHF exacerbation

119
Q

What are 3 things about the topical nitroglycerin?

A
  1. Ointment 2%: Apply ½ to two inches chest or thigh
  2. Ointment or patch should be removed after 12 hrs to avoid tolerance (8-12hr nitrate free interval)
  3. Transdermal patch: pre-measured dose to chest or thigh
120
Q

What is one thing about PO nitroglycerin?

A

oral extended release capsule or tablet.

121
Q

Ointment nitroglycerin is used when?

A

in emergency cases, and transdermal patch is the norm (more regulated)

122
Q

What are 4 special nursing considerations for IV Nitroglycerin?

A
  1. dilute in D5W
  2. use glass infusion bottles and non-polyvinyl tubing
  3. do not use plastic IV bags or tubing
  4. Plastic absorbs nitroglycerin
123
Q

What are the most common side effects of nitroglycerin?

A

headache (most common)

decrease bp, dizziness, lightheadedness, Rebound effect of myocardial ischemia if NTG ointment or transdermal patch not tapered over several weeks, reflex tachycardia if NTG given too rapidly

Life threatening: Circulatory collapse

124
Q

Nitroglycerin will have enhanced hypotensive effect if given with what 4 meds/chemical?

A
  1. beta blockers
  2. ca channel blockers
  3. antihypertensives
  4. alcohol
125
Q

IV nitroglycerin may decrease effects of what med?

126
Q

nitroglycerin is contraindicated with what 3 meds?

A
  1. sildenafil (viagra)
  2. tadalafil (Cialis)
  3. Vardenafil (levitra)
    * * these are 2nd to potential for risk of sever hypotension or CV collapse.
127
Q

What does beta blocker do?

A

block the beta 1 and beta 2 receptor sites

128
Q

what are the effects of beta blockers (2)?

A
  1. ↓ effects of sympathetic nervous system by blocking action of catecholamines
    Epinephrine & norepinephrine
  2. ↓ HR & BP
129
Q

what are the uses of beta blockers?

A

Antianginal
Antidysrhythmic
Antihypertensive

130
Q

what are 2 examples of beta blockers?

A

Atenolol (Tenormin)

Propranolol (Inderal)

131
Q

Beta blockers are effective ___? How?

A

antianginals, by decreasing HR, myocardial contractility, O2 consumption, and thus anginal pain

132
Q

What is one thing to be careful when using beta blockers?

A

should not discontinue abruptly. taper over specified number of days to avoid reflex tachycardia and recurrent angina.

133
Q

beta blockers are usually not given if…

A

decreased HR and BP, so check specific parameters

134
Q

beta blockers are effective for?

A

classic angina pectoris

135
Q

what are the contraindications for beta blockers?

A

2nd or 3rd degree AV block (severe conduction disturbances and possible death)

136
Q

what is one nonselective (B1 and B2) prototype of beta blockers?

A

propranolol (inderal)

137
Q

what does propranolol do?

A

decrease HR and BP

138
Q

what are two adverse reactions for propranolol?

A

bronchoconstriction and impotence

139
Q

what should the nurse monitor for the pt taking propranolol?

A

monitor VS closely in early treatment, and assess lungs since it can cause bronchospasm.

140
Q

What are two selective (mostly B1) prototypes of beta blockers?

A

metoprolol (lopressor) and atenolol (tenormin)

141
Q

what are the effects of metoprolol and atenolol?

A

decrease HR and BP

142
Q

What should the nurse monitor for a pt on metoprolol or atenolol?

A

monitor VS closely in early treatment.

143
Q

When was Ca channel blockers introduced?

144
Q

what is the action of Ca channel blockers?

A

Inhibits calcium ion from entering calcium ion channels into vascular smooth muscle and myocardium

145
Q

how does a Ca channel blockers work?

A

Causes relaxation of smooth muscle and coronary vasodilation by ↓ workload & O2 demand and by ↓ afterload, ↓ peripheral vascular resistance

146
Q

what are Ca channel blockers effective for (2)?

A
  1. Classic (stable) angina
    by ↓ O2 demand by relaxing peripheral arterioles
  2. Variant (vasospastic) angina
    by relaxes coronary arteries
147
Q

what are the other uses of Ca channel blockers?

A

some dysrhythmias and htn.

148
Q

By relaxing smooth muscle, what is accomplished?

A

increase delivery of oxygenated blood to the heart.

149
Q

What are 4 long term treatment of angina?

A
  1. Verapamil (Calan)
  2. Nifedipine (Procardia)
  3. Diltiazem (Cardizem)
  4. Amlodipine (Norvasc) **NEWER
150
Q

what should pt on verapamil be cautioned of?

A

bradycardia is a common problem.

151
Q

what should pt on Nifedipine be cautioned of?

A

hypotension can occur, can be profound

152
Q

what is the most potent long term treatment of angina?

A

Nifedipine (Procardia)

153
Q

What do the 4 long term treatment of angina have in common?

A

highly protein bound.

154
Q

what are the side effects of Ca channel blockers?

A

headache, hypotension (> with nifedipine;

155
Q

Why did some pts not want to take Ca Channel blockers?

A

the med can cause peripheral edema, ankle is swollen.

156
Q

What should the nurse assess for, for a pt who is on Ca channel blockers?

A

bp, pulse, ekg periodically (med can prolong PR interval), I & O, daily weight, signs of CHF (peripheral edema, crackles, dyspnea, weight gain, JVD).

If pt is also on digoxin, monitor serum digoxin level for toxicity.

157
Q

What are the 5 nursing pearls of wisdom for antianginals?

A
  1. NTG SL if angina

2. Monitor VS, look for hypotension (withhold drug if systolic BP

158
Q

client teaching for nitroglycerin:

A

take one NTG, call 911 if unrelieved or worsen. Do not discontinue drugs without notifying HCP

159
Q

client teaching for Beta blockers and Ca channel blockers

A

teach pt how to take own pulse, and don’t discontinue without provider approval.

160
Q

what are some nursing interventions for pt with chest pain in the ER

A

history and physical exam, monitor VS, start O2, pain meds (morphin IV, nitro), 12-lead EKG, cardiac biomarkers (troponin, CK MB)

161
Q

what is an appropriate goal for a pt with chest pain in the ER

A

goal is client will be pain free.

162
Q

What med is for peripheral arterial (vascular) disease (PAD, PVD), arteriosclerosis, hyperlipidemia?

A

peripheral vasodilators.

163
Q

what is the goal of peripheral vasodilators?

A

to improve blood flow.

164
Q

What are the 5 classifications of peripheral vasodilators?

A
  1. Alpha-adrenergic antagonists
  2. Direct-acting peripheral vasodilators
  3. hemorrheologic
  4. antiplatelets
  5. selected antihypertensives.
165
Q

what are 2 drugs that promote vasodilation (peripheral vasodilators)?

A
  1. Prazosin (Minipress): Alpha 1 blocker

2. Nifedipine (Procardia): Calcium channel blocker

166
Q

what are some side effects of peripheral vasodilators?

A

Lightheadedness, dizziness, orthostatic hypotension, tachycardia, palpitation, flush, and GI distress

167
Q

what is the most often experienced symptom in patients with PAD?

A

intermittent claudication that goes away at rest.

168
Q

what are some further complications of PAD?

A

lower O2 levels in lower extremities leading to ischemia leading to necrosis and leading to possible amputation

169
Q

what is an example of anti platelet drug?

A

cilostazol (Pletal)

170
Q

what is the action of cilostazol (pletal)

A

direct-acting vasodilator, it inhibits platelet aggregation.

171
Q

what can cilostazol (pletal) treat?

A

intermittent claudication

172
Q

what are some side effects of cilostazol (pletal)?

A

Nausea, vomiting, dizziness, syncope, blood in eye, headache, abdominal pain, abnormal stools, peripheral edema

173
Q

what is an example of hemorrheologic agent?

A

Pentoxifylline (Trental)

174
Q

what are the 5 actions of Pentoxifylline (Trental)?

A
  1. Improves microcirculation and tissue perfusion
  2. Decreases blood viscosity
  3. Improves flexibility of erythrocytes
  4. Inhibits aggregation of platelets and red blood cells
  5. Decreases blood viscosity
175
Q

nursing diagnoses for vasodilators (2)

A

impaired tissue integrity, acute pain

176
Q

assessments for vasodilators

A

check baseline vs, assess signs and symptoms of inadequate blood flow to extremities

177
Q

interventions for vasodilators

A

monitor vs, esp BP and HR

178
Q

evaluation (goal) for vasodilators

A

pt’s blood flow to extremity will improve and pain will be controlled.

179
Q

what 4 cardiac factors influence bp?

A
  1. heart rate
  2. inotropic state
  3. neural- nerves innervates the blood vessels
  4. humoral
180
Q

what 3 renal fluid volume control factors influence bp?

A
  1. Renin-angiotensin
  2. aldosterone
  3. atrial natriuretic factor
181
Q

the factors that influence bp also has an influence on what?

182
Q

what are the 2 types of htn?

A

essential and secondary

183
Q

what is the most common of the 2 types of htn?

A

essential, 90% people affected

184
Q

what is the etiology of essential htn?

185
Q

what are the contributing factors of essential htn?

A
  • Family hx, hyperlipidemia
  • African-American background, Mexican Americans
  • Diabetes, obesity
  • Aging, stress, excessive smoking & alcohol
186
Q

Secondary htn is associated with what (2)?

A
  1. 10% cases related to renal & endocrine disorders

2. sleep apnea -> associated with high blood pressure and hemorrhagic stroke -> CO2 retention -> atherosclerosis

187
Q

how is glucocorticoids related to htn?

A

Glucocorticoids – release stress hormones – produce epinephrine and norepinephrine – blood sugar goes up -> hyperglycemia -> produced atherosclerosis -> diabetes -> increases atherosclerosis -> hypertension

188
Q

how is one’s diet physiological risk factors for htn?

A

diet high in fat and carbs. carbs can affect sympathetic NS.

alcohol, renin secretion leads to increase angiotensin II

189
Q

how is one’s obesity physiological risk factors for htn?

A

obesity causes increased CO, SV, and left ventricular filling. 2/3 of hypertensives are obese.

190
Q

what can decreased htn?

A

normal weight loss and mild to moderate sodium restriction.

191
Q

what is normal htn?

192
Q

what is pre-htn?

A

systolic : 120-139, diastolic: 80-89

193
Q

what is stage 1 htn?

A

systolic 140 - 159 and diastolic 90-99

194
Q

what is stage 2 htn?

A

systolic >160 and diastolic >100

195
Q

what are the african americans cultural variations on antihypertensives?

A
  1. african american get htn at earlier age and have higher mortality than whites.
  2. beta blockers and ACE inhibitors is less effective
  3. alpha 1 blockers and Ca channel blockers are more effective
  4. African americans respond to diuretics as initial mono therapy.
196
Q

what are the asian americans cultural variations on antihypertensives?

A

asians are twice as sensitive to beta-blockers and other antihypertensives than white, so they usually need lower dosage.

197
Q

what are the white americans cultural variations on antihypertensives?

A

whites respond well to all antihypertensive agents.

198
Q

by age 65, the stats for htn in older adults are

A

26% males, 30% females

199
Q

htn in older adults…

A

both sys and dis htn associated with increased CV mortality and morbidity

200
Q

the side effects of antihypertensives for htn in older adults

A

orthostatic hypotension and may need to decrease dose and use another drug.

201
Q

what are some instructions nurses can give to older adults with htn on modifying lifestyle?

A

2Gm Na+ diet, avoid tobacco, lose weight if overweight/obese

202
Q

in order to have healthier older adults, we should…

A

concentrate on adolescent’s health now.

203
Q

what are the benefits of lowering bp?

A

reduction in average percentage of stroke incidence, myocardial infarction and heart failure (as high as 50%).

204
Q

what are the 8 types of antihypertensive drugs?

A
  1. Diuretics
  2. Beta-blockers
  3. Alpha2 agonists
  4. Alpha adrenergic blockers
  5. ACE inhibitors
  6. Angiotensin II receptor antagonists (blockers)
  7. Direct renin inhibitor
  8. Calcium channel blockers
205
Q

what is the action of diuretics?

A

Promote Na+ and water depletion

↓ extracellular fluid volume

206
Q

Diuretics is effective as

A

first line treatment for mild htn

207
Q

what is an example of loop diuretics?

A

Furosemide

208
Q

what are the side effects of Furosemide?

A

nausea, diarrhea, electrolyte imbalances (hypokalemia)

209
Q

what is an example of thiazides (diuretics)?

A

hydrochlorothiaziede

210
Q

what are the side effects of hydrochlorothiazide?

A

hypokalemia, dehydration

211
Q

where do the loop diuretics work on?

A

they work in the loop of henle, water and sodium get excreted here.

212
Q

where do the thiazides work on?

A

Thiazides work in the distal convoluted tubule, so it inhibits Na reabsorption. It can also lose some of the electrolytes like K – some pts may develop hypokalemia – tend to develop metabolic alkalosis

213
Q

one of the causes of alkalosis is?

A

dehydration

214
Q

One treatment of heart failure is using

215
Q

what are diuretics?

A

Diuretics are drugs which eliminate Na and water by acting directly on the kidney

216
Q

what are the two types of beta-adrenergic blockers?

A

beta 1 (selective) beta 2 (non-selective)

217
Q

what are the actions of beta-adrenergic blockers?

A

decrease CO, decrease systemic vascular resistance, decrease HR, contractility and renin release and lowers bp

218
Q

what is one prototype drug of beta-adrenergic blockers?

A

metoprolol (Lopressor)

219
Q

ideally, try one med at a time, if it doesn’t work…

A

add an additional drug

220
Q

selective beta blockers work on ?

A

beta 1 receptors only

221
Q

non-selective beta blockers work on?

A

beta 2 and beta 1 receptors.

222
Q

what is sympatholytics?

A

sympathetic depressants

223
Q

what are 2 examples of Nonselective beta blockers?

A

propranolol (Inderal) and carvedilol (Coreg)

224
Q

what is a contraindication for beta - adrenergic blockers?

A

chronic obstructive pulmonary disease (COPD) because the meds blocks beta 2 effects of bronchodilation -> so it bronchoconstricts -> may experience SOB

225
Q

What are 5 examples of Selective beta blockers?

A 
acebutolol (Sectral)
atenolol (Tenormin)
betaxolol (Kerlone)
bisoprolol (Zebeta) 
metoprolol (Lopressor)
226
Q

what are some contraindications for selective beta blockers?

A

patients with diabetes mellitus when taking beta blockers bc Beta blockers can cause decreased release of glucagon -> will cause hypoglycemia

227
Q

What are the side effects of metoprolol (Lopressor)?

A 
Dizziness
Fatigue, weakness
N/V, diarrhea
Nasal stuffiness
Impotence
Decreased libido
Depression 
Mental changes
Bradycardia/heart block
Thrombocytopenia
Agranulocytosis
228
Q

What are some contraindications for beta-blockers?

A
  • Second or third degree AV block
  • Sinus bradycardia
  • Heart failure (but may be prescribed for early use in chronic HF)
  • Non-cardioselective beta-blockers, e.g., Inderal
229
Q

Beta-blockers should be avoid giving to pts with (4) conditions:

A

Asthma
COPD
CHF
DM

230
Q

The stimulation of alpha 1 adrenoceptors will result in:

A

vasoconstriction, increase peripheral resistance, increase bp, mydriasis(dilation of pupils) , and increased closure of internal sphincter of the bladder

231
Q

The stimulation of alpha 2 adrenoceptors will result in:

A

inhibition of norepinephrine release, inhibitions acetylcholine release and inhibitions insulin release

232
Q

The stimulation of beta 1 adrenoceptors will result in:

A

tachycardia, increased lipolysis, increased myocardial contractility, and increased release of renin

233
Q

The stimulation of beta 2 adrenoceptors will result in:

A

vasodilation of skeletal muscles, slightly decreased peripheral resistance, bronchodilation, increased muscle and liver glycogenolysis, increase release of glucagon, and relaxed uterine smooth muscle.

234
Q

what are the actions of Centrally Acting Alpha2 Agonists?

A

↓ sympathetic activity (brainstem)
↑ Vagus activity
↓ CO, serum epinephrine,
lowers bp
norepinephrine, & renin release
Reduced peripheral vascular resistance and increased vasodilation
Minimal effect on cardiac output & renal blood flow

235
Q

Centrally Acting Alpha2 Agonists are not given with?

A

beta-blockers

236
Q

what is an example of Centrally Acting Alpha2 Agonists?

A

Clonidine (Catapres)

237
Q

Centrally Acting Alpha2 Agonists is a drug of choice for?

A

drug abuse/benzodiazepine withdrawal, etoh withdrawal, cocaine/heroin withdrawal

238
Q

What are the side effects and adverse reactions of Centrally Acting Alpha2 Agonists?

A

Drowsiness
Dry mouth
Dizziness
Bradycardia
Rebound hypertensive crisis if D/C abruptly
If need to stop immediately, prescribe another antihypertensive
Peripheral edema due to Na+ & H2O retention
Methyldopa (treat HTN) shouldn’t be used if impaired liver function
Monitor serum liver enzymes

239
Q

What are the actions of Alpha-Adrenergic Blockers?

A
  • Blocks alpha 1 or alpha 2 receptors
  • Vasodilation & lowers blood pressure
  • Maintain renal blood flow
  • Useful in treating hypertension if lipid abnormalities – can lower LDL
  • Do not affect glucose metabolism or respiratory function
  • Selective alpha1 adrenergic blockers used to ↓ BP & for BPH (benign prostate hypertropy)
240
Q

what is an example drug for Alpha-Adrenergic Blockers?

A

Prazosin HCl (Minipress)- sometimes prescribed for BPH (benign prostate hypertrophy)

241
Q

Pt with benign prostate hypertrophy -> if you block alpha 1, you will be able to…

A

open up internal sphincter of the bladder

242
Q

When taking Alpha-Adrenergic Blockers…

A

Less of orthostatic hypotension if taken at night

243
Q

The antihypertensive drugs that are effective for African-Americans are…

A

alpha1 blockers and calcium channel blockers.

244
Q

What are the contraindications for Alpha-Adrenergic Blockers?

A

renal failure due to sodium and water retention

245
Q

What is Orthostatic hypotension?

A

Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing compared with blood pressure from the sitting or supine position.

246
Q

What are the side effects and adverse reactions for Alpha-Adrenergic Blockers?

A 
ORTHOSTATIC HYPOTENSION
Nausea
Drowsiness
Edema
Weight gain
Impotence
247
Q

What is the drug interactions for Alpha-Adrenergic Blockers?

A

Nitrates: decrease bp

248
Q

What are the first 2 of 5 nursing pearls of wisdom for antianginals?

A
  1. NTG SL if angina

2. Monitor VS, look for hypotension (withhold drug if systolic BP

249
Q

What are the last 3 nursing pearls of wisdom for antianginals

A
  1. Have client sit or lie down when taking nitrate 1st time & always with SL NTG
    Follow special procedures for prescribed route
  2. Do not touch topical NTG with your fingers
  3. Do not place topical nitrate in area of cardioverter-defibrillator paddle placement

AE1 (12 decks)

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