Pharmacology Exam Part 2 Flashcards
Blood Pressure Review
Blood Pressure(BP) = CO x SVR(systemic vascular resistance)
Hypertension = BP greater than or equal to 130/80
Lifestyle changes
Lose extra weight and watch your waistline
Exercise regularly
Eat a healthy diet
Reduce salt and sodium in your diet
Limit alcohol
Quit smoking
Get a good night’s sleep
Ease stress
Track your blood pressure at home and get regular checkups
Control your cholesterol and blood sugar
Treatment Threshold
The threshold for starting antihypertensive medications has been lowered to 130/80 mmHg for adults with cardiovascular disease (CVD) or a higher risk of CVD (e.g., diabetes, chronic kidney disease)
The four stages based on BP measurements
Normal = 120/80
Prehypertension = 120-129?80mmHg
Stage 1 Hypertension = 130-139/80-89mmHg
Stage 2 Hypertension = Greater than or equal to 140/90mmHg
Secondary Hypertentsion
The elevation of BP by an identifiable cause. Can be treated if there is a known cause.
Primary hypertension
No identifiable cause
Complications of Hypertension
Difficulty breathing
Inflammation in the lower extremities
Weight gain
Chest pain
Excessive fatigue
Palpitations
CKD
AKI
Choroidopathy
Retinopathy
Optic neuropathy
What applies to all hypertensive drugs?
All lower BP; potential side effects of dizziness, postural hypotension, rebound hypertension if stopped abrupt; Interactions: anything else that would lower BP such as alcohol, cold medications, or taking more than one type of BP lowering medication; All have different dosing and amount of mg does not equal potency between classes.
Nursing considerations for all hypertensive drugs
Assess for contraindications
Assess for conditions that require cautions
Educate patients on not missing doses of meds
Instruct patients to check BP and HR daily, keep a jornal, and when to call a health provider
Instruct patients that these drugs should not be stopped abruptly
IV forms(medication that can lower BP) require extreme caution, IV pump and constant monitoring
Remind patients that medication is only part of therapy to treat HTN
Instruct patients to avoid smoking and foods high in sodium
Teach patients to change positions slowly to avoid postural hypotension
Antihypertensive Drugs Side Effects and Elderly Considerations
General Side Effects: Dizziness, fatigue, orthostatic hypotension, bradycardia.
Elderly Considerations: Increased risk of falls due to hypotension and slower metabolism of drugs.
Alpha 2 Receptor Agonists
Action: stimulate alpha-2 adrenergic receptors in the nervous system which results in decreased peripheral vascular resistance.
Adverse Effects: Rebound HTN
Caution: Cirrhosis
Example Drugs:
Clonidine: oral or patch
Dry mouth Rebound hypertension if abruptly stopped or not taken
Methyldopa: oral or IV
Adverse effects specific to this drug is a positive combs test and hemolytic anemia. Hepatotoxicity can occur
Adrenergic Neuron Blocker
Action: prevent the release of norepinephrine and epinephrine from adrenergic nerve endings. A decrease occurs in both cardiac output and peripheral vascular resistance.
Adverse Effects: Bradycardia, Orthostatic Hypotension (peripherally)
Caution: Depression
Example Drugs: Reserpine is the only one available at this time
USED AS A LAST RESORT
Alpha Adrenergic Blocker (Alpha 1 blocker)
Action: block alpha1 adrenergic receptors and result in vasodilation and decreased BP.
Adverse Effects: impotence, orthostatic hypotension
Caution: Hepatic Disease and Geriatric Patients
Example Drugs: Doxazosin
Take the first dose at bedtime due to the high risk of the first dose causing OH.
Beta Blocker
Action: block beta 1 & 2 receptor sites resulting in decreased HR and BP
Can be cardio selective (block only beta 1) or nonselective (block beta 1 & 2)
Adverse Effects: bradycardia, masking of hypoglycemia
Caution: COPD and asthma
Example Drugs: Tenormin (atenolol) Lopressor and Toprol (metoprolol)
Beta1 blocks heart Beta2 blocks lungs (1 heart, 2 lungs) Nonselective blocks both
Uses: Hypertension, arrhythmias, heart failure.
Patient Education: Take as prescribed, avoid sudden withdrawal, monitor pulse.
Contraindications: Asthma, bradycardia, heart block.
Vitals to Monitor: Blood pressure and heart rate; if HR <60 bpm, withhold and notify provider
Dual acting Alpha and Beta Blocking Agents
Action: have both alpha1 and beta 1&2 effects.
Adverse Effects: bradycardia, dizziness, hypotension
Caution: children under 18, diabetes mellitus, renal and hepatic disorders, peripheral vascular disease
Example Drugs: carvedilol labetalol
Works on Alpha 1 and Beta 1 and 2
Furosemide (Lasix)
Side Effects: Hypokalemia, dehydration, hypotension.
Labs to Monitor: Potassium, kidney function (BUN, creatinine).
Uses: Edema, heart failure, hypertension. More potent than other diuretics like thiazides.
ACE Inhibitors
Uses: Hypertension, heart failure, post-MI.
Labs to Monitor: Potassium, renal function.
Side Effects: Dry cough, hyperkalemia, angioedema.
MOA: Lowers BP by stopping the switch between Angiotensin I and Angiotensin II.
Adverse Effects: Angioedema, Hyperkalemia, Bone marrow suppression, FIRST DOSE hypotension-Worse with Diuretic, Dry Cough, hyperkalemia, anorexia
Considerations: Not as effective on African Americans; May be prevention for diabetes, renal, and liver disorders; BLACK BOX WARNING (DO NOT USE IF PREGNANT); NSAIDS can reduce effectiveness
Ends in pril
Lanoxin (Digoxin)
Toxicity Signs: Nausea, vomiting, visual disturbances (halos), bradycardia.
Vitals to Monitor: Apical pulse for 1 full minute before administering; hold if <60 bpm.
Primary indication is heart failure
Also used to treat supraventricular dysrhythmias, tachyarrhythmias, atrial fibrillation, atrial flutter
Inactive against ventricular dysrhythmias
MOA: Increase myocardial contractility, decreases HR, slows conduction through heart by inhibiting the Na+ K+ pump, which increases cellular calcium, causing muscle fibers to contract. Result, increased CO.
Adverse effect:
Cardiotoxicity (risk increased by hypokalemia)
Arrhythmias, bradycardia, EKG changes
Fatigue, HA, weakness, blurred vision, yellow or green vision, anorexia, nausea/vomiting, diarrhea, gynecomastia, thrombocytopenia
Nursing interventions:
Monitor electroytes, renal &liver function, EKG
Monitor apical pulse for 1 minute prior to administration.
Pulse should be at least 60 bpm
Monitor I&O and daily weight (excreted via kidneys)
Assess for peripheral edema, jugular distention, cough/SOB; auscultate lungs for rales/crackles
Therapeutic Digoxin range: 0.5-2 ng/mL
Quinidine can increase plasma levels of Digoxin
Digibind is antidote
Do not give with ventricular fibrillation, ventricular tachycardia, & digoxin toxicity
Dig improves symptoms but does not increase longevity
Nitroglycerin
Forms: Sublingual (tablet, spray), transdermal patches.
Vitals: Monitor blood pressure; can cause significant hypotension.
Patient Education: Sit or lie down before use; rotate patch sites.
Nitrates Antianginal Drugs:
Action: Vasodilation by relaxing smooth muscles. Dilates coronary arteries.
Indications: Prevention and treatment of angina
Forms:
Rapid-acting forms
Used to treat acute anginal attacks (Sublingual tablets/sprays; IV infusion)
Long-acting forms
Used to PREVENT anginal episodes. PO pills
Trade name/generic names:
Nitrobid (Nitroglycerin) both rapid and long acting
Isordil (Isosorbide dinitrate) both rapid and long acting
Imdur (Isosorbide mononitrate) primarily long acting
Side effects: headache, hypotension, reflex tachycardia
Contraindications: anemia, closed angle glaucoma, severe head injury, severe hypotension, use of ED drugs
Potassium-Sparing Diuretics
(spironolactone) 1-5%
Definition: Diuretics that don’t cause potassium loss (e.g., spironolactone).
Patient Education: Avoid high potassium foods and salt substitutes.
MOA: Acts in the Renal to promote sodium and water
Drugs: Aldactrone (Spironolactone)
Adverse Effect: Severe Hyperkalemia, dry mouth, photosensitivity
Considerations: Effective after 48 Hours, Weaker than Thiazide
Loop Diuretics
(Furosemide: Thick segment ascending loop of henles’ loop 20%)
Furosemide(lasix)
Bumex (bumetanide)
Other name: Water pill
MOA: Act in the loop of Henle prevents by inhibiting and excreting sodium in the bloodstream.
Adverse Effects: Hypotension, Otoxic, Hypokalemia
Considerations: Don’t amd at bedtime; Think about potassium supplementation; Bumex for severe hypervolemia
Thiazide Diuretics
(Early distal convoluted tubule 10%)
MOA: Acts in the distal tubules to promote excretion of sodium, Chloride, and water
Drugs: HydroDiuril (hydrochlorothiazide called HCTZ)
Adverse effect: Impotence; decreased libido; electrolyte imbalances; thrombocytopenia Considerations: Not effective when urine flow is scant (unlike loop diuretics)
Osmotic Diuretics
(Mannitol/ osmitrol: Proximal convoluted tubules 65%)
MOA: Promotes diuresis by creating osmotic force within lumen of the nephron
MED: Mannitol (Osmitrol)
Adverse effects: Edema; Pulmonary Edema; Heart failure
Considerations: Dosing is complex and is based on indication IV only
Statins
Instructions: Take in the evening, with or without food. Understand the why!
Side Effects: Muscle pain (rhabdomyolysis), liver toxicity.
Labs to Monitor: Liver enzymes, lipid levels.
Action: inhibits the enzyme HMG CoA reductase so less cholesterol is produced. Most effective drugs for lowering LDL. Reduction of LDL cholesterol. Elevation of HDL cholesterol. Reduction of triglyceride levels. Nonlipid beneficial cardiovascular actions. Promote plaque stability. Reduce the risk for cardiovascular (CV) events. Increased bone formation.
Suffix: statin
Trade name/generic name: there are many statins, we will focus on the first: Lipitor (atorvastatin)
Pregnancy category: X
Indications: hyperlipidemia
Cautions: liver disease, alcohol use
Labs: Must check LFTs and lipid profile before therapy and 6-8 weeks after starting therapy
ARBs
This Blocks Angiotensin II from stimulating the bodily actions that increase blood pressure.
Adverse Effects: Renal Failure; Hyperkalemia; Increased Cancer Risk; Angioedema
Considerations: Not as effective on African Americans; BLACK BOX WARNING (DO NOT USE IF PREGNANT)
Suffix-sartan
Calcium Channel Blockers
The calcium channel is an essential part of the contractions of muscles such as in the smooth (in the arteries and veins) and heart. MOA: Blocks the influx of calcium in the cardiac muscle cells, slowing the pulse, and blocks the binding of Calcium receptors in smooth muscles causing vasodilation. DO NOT take grapefruit juice with this. Nursing Interventions: Monitoring EKGs; assess BP and pulse; monitor LFTs, renal function, CBC, glucose level, & K+
Suffix: most end in ipine ar amil
Vasodilators
MOA: Directly acts to cause relaxation of smooth muscle which results in vasodialation of vessels
Indications: HTN(not used first line, used in urgent HTN situations)
Contraindications: CHF
Adverse effects: Fluid retention leading to CHF, tachycardia, rebound HTN with sudden withdrawal.
Hydralazine (apresoline)
MOA: Selective dilution of Arterioles.
Indications: Hypertensive crisis-(DBP >120 mmhg), angina, HF
Considerations: Greater Risk of reflex tachycardia Fluid retention
Sodium Nitroprusside
MOA: dilution of BOTH veins and Arterioles
Indications: Hypertensive Emergencies; Severe HTN
Adverse Effects: Excessive hypotension, Cyanide Poisoning
RAAS – pathway (#11)
In response to low blood pressure, the RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM is activated.
The juxtaglomerular cells located in the wall of the afferent (incoming) arteriole of the glomerulus releases RENIN.
RENIN cleaves (converts) ANGIOTENSINOGEN (produced in the liver) to ANGIOTENSIN I (an inactive peptide). This is rate limiting step in this cascade.
ANGIOTENSIN I in converted to ANGIOTENSIN II by ANGIOTENSIN CONVERTING ENZYME (ACE). The majority of ANGIOTENSIN CONVERTING ENZYME (ACE) is found in lung’s vascular endothelial cells
ANGIOTENSIN II has FOUR major effects:
Produces arteriolar vasoconstriction
Increases absorption of sodium and water in the proximal tubules
Stimulates release by adrenal cortex of ALDOSTERONE which causes reabsorption of sodium and water in the distal tubules
Stimulates release of ADH with absorption of water in the collecting tubules
- Retention of sodium by the kidney is associated with loss of potassium by the kidney.
Angiotensin 2: 4 actions
Produces arteriolar vasoconstriction
Increases absorption of sodium and water in the proximal tubules
Stimulates release by adrenal cortex of ALDOSTERONE which causes reabsorption of sodium and water in the distal tubules
Stimulates release of ADH with absorption of water in the collecting tubules
