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pharmacology > Pharmacotherapy of HTN > Flashcards

Pharmacotherapy of HTN Flashcards

1
Q

Decrease in BP/blood volume =

A

Angiotensin I –> lungs, angiotensin II -(cough) –> stim. vasocortex and vasoconstricts (inc. BP)…. inc. aldosterone (sex hormones off) = inc. Na+ and water reabsorption.

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2
Q

Decrease in BP/blood volume =

A

Angiotensin I –> lungs, angiotensin II -(cough) –> stim. vasocortex and vasoconstricts (inc. BP)…. inc. aldosterone (sex hormones off) = inc. Na+ and water reabsorption.

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3
Q

Adrenal Glands

A

Sugar
Salt
Sex

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4
Q

JNC Guidelines

A 
BP = <120/<80
*low = <90/<60
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5
Q

HTN MOST IMPORTANT

A

Lifestyle Interventions

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6
Q

First-line treatments

A

4 drugs… someone has been diagnosed, x3 mo’s lifestyle modifications with no change.

These drugs are used alone or in combo (additive properties):

  1. thiazide diuretic
  2. ACE-inhibitor
  3. Angiotensin Receptor Blocker
  4. CCB (Calcium Channel Blocker)
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7
Q

Diuretics used for

A

HF, renal failure, Htn, liver failure, cirrhosis, PE

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8
Q

Pt. receiving HCTZ, nurse has taught the client about the importance of kidney function and evaluates that learning has occurred when client makes which statments?

A

1–Kidneys help by balancing potassium.
3-Kidneys help regulate BP
4-

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9
Q

Diuretics

A
  • Loop diuretics (strongest-closest to tubule)
  • Thiazide diuretics (1st line treatment)
  • Potassium-Sparing diuretics.
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10
Q

Thiazides

A

Most commonly prescribed diuretics.

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11
Q

HCTZ

A

Route: PO (non emergency
Onset: 2 hr
Action: 6-12 hr, half life 45min. (1x per day and not at night)
Indications: **htn, ascites (fluid in abdomen), edema (swelling), HF (dec. preload and dec. cardiac work), nephrotic syndrome (distal tubule).

Mechanisms: Acts on distal tubule to dec. reabsorption of Na+ (causes excretion of Na and water)

Adverse effects:
Hypotension
dizziness
HA, electrolyte imbalances
gout (pain in joints)
blood dyscrasias

Contraindications: Anuria (no urine production), jaundiced neonates (high bili)

Prego: B

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12
Q

The PCP prescribes HCTZ for a client in chronic renal failure. The nurse suspects the client is experiencing an ineffective response to the medication. Which clinical manifestation would be the most sig?

A

Rales or crackles!! (Fluid in lungs)

Not htn d/t

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13
Q

Adrenal Glands

A

Sugar
Salt
Sex

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14
Q

JNC Guidelines

A 
BP = <120/<80
*low = <90/<60
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15
Q

HTN MOST IMPORTANT

A

Lifestyle Interventions

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16
Q

First-line treatments

A

4 drugs… someone has been diagnosed, x3 mo’s lifestyle modifications with no change.

These drugs are used alone or in combo (additive properties):

  1. thiazide diuretic
  2. ACE-inhibitor
  3. Angiotensin Receptor Blocker
  4. CCB (Calcium Channel Blocker)
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17
Q

Diuretics used for

A

HF, renal failure, Htn, liver failure, cirrhosis, PE

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18
Q

Pt. receiving HCTZ, nurse has taught the client about the importance of kidney function and evaluates that learning has occurred when client makes which statments?

A

1–Kidneys help by balancing potassium.
3-Kidneys help regulate BP
4-

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19
Q

Diuretics

A
  • Loop diuretics (strongest-closest to tubule)
  • Thiazide diuretics (1st line treatment)
  • Potassium-Sparing diuretics.
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20
Q

Thiazides

A

Most commonly prescribed diuretics.

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21
Q

Prazosin (Minipress)

A

Route: PO (phentolamine: IV,SQ)
Onset: 2 hrs

Indications: htn (NOT 1st line, vasodilate, dec. afterload), bph, raynauds, pheochromocytoma: benign tumors on adrenal glands.

Mechanisms of action:
Competes with NE at alpha1 receptors on vascular smooth muscle.

Adverse:
orthostatic hypotension, dizzy (dec. bp), drowsiness, fatigue, first dose phenomenon: drop in BP w/ first dose med or inc. in med dose, erectile dysfunction.

Contraindications: hypersensitivity, older adult-renal impairment, CAD

Prego: Cat. C

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22
Q

The PCP prescribes HCTZ for a client in chronic renal failure. The nurse suspects the client is experiencing an ineffective response to the medication. Which clinical manifestation would be the most sig?

A

Rales or crackles!! (Fluid in lungs)

Not htn d/t

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23
Q

Loop Diuretic

A

(Strongest)

Furosemide (Lasix)

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24
Q

Furosemide (Lasix)

A 
Route: IV/IM
Onset: PO-30-60 min, IV: 5 min.
Duration: 6-8 hrs.
Indications: 
acute edema (1st line)
PE (1st line)
HTN

Mechanism: Prevents the reabsorption of Na+ and Cl in the loop of henle.

Adverse:
Hypotension (dec. bp w/ position)
Syncope and tachycardia (thready/weak) (bp dec. and body tries to inc. HR)
Dysrhythmias (hypokalemia w/ other meds )
Nausea and Vomiting
Ototoxicity (hearing loss)
Gout (uric acid in joints)
Metabolic alkalosis

Contraindications:
hypersensitivity/anuria

Prego: C

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25
Q

The nurse is preparing to discharge a client who is prescribed a loop diuretic for the treatment of congestive heart failure. Which foods should the nurse encourage the client to consume to prevent serious adverse effects associated with the medication?

A

Bananas
Oranges
Dates

(want to excrete urine and thus help excrete K+!)

26
Q

Potassium-Sparing Diuretics

A

(weakest) Spironolactone (Aldactone)

27
Q

Spironolactone (Aldactone)

A

Route: PO
Onset: 2-3 days up to 2 weeks
Indications:
-mild htn, HF, nephrotic syndrome, liver disease/cirrhosis.

Mechanism: inhibits the actions of aldosterone in the distal tubule and collecting ducts (excrete Na+ and H2O and hold K+).

Adverse effects:
hyperkalemia, gynecomastia impotence and diminished libido in males, menstrual irregularities, hirsutism, breast tenderness, dec. fertility, blood dyscrasias.

Contraindications:
anuria, hyperkalemia

Prego: D (don’t want to mess w/ hormones when someone is prego)

28
Q

Watch for

A 
Low BP
Low Na
Low Chloride
Low K
hyperglycemia
Low weight
Is&Os
Dehydration
29
Q

Delivery routes for Diuretics

A

PO,IV,IM

30
Q

Main diuretics?

A

HCTZ, furosemide,

31
Q

Alpha 1 - Adrenergic Antagonists

A

Relax sphincters and Vasodilate

Alpha1-Adrenergic Antagonists

32
Q

Prazosin (Minipress)

A

Route: PO (phentolamine: IV,SQ)
Onset: 2 hrs

Indications: htn (NOT 1st line, vasodilate, dec. afterload), bph, raynauds, pheochromocytoma: benign tumors on adrenal glands.

Mechanisms of action:
Competes with NE at alpha1 receptors on vascular smooth muscle.

Adverse:
orthostatic hypotension, dizzy (dec. bp), drowsiness, fatigue, first dose phenomenon: drop in BP w/ first dose med or inc. in med dose, erectile dysfunction.

Contraindications: hypersensitivity, older adult-renal impairment, CAD

Prego: Cat. C

33
Q

Side effects of Alpha adrenergic antagonists

A

Orthostatic hypotension, palpitations, sexual dysfunction, vertigo.

34
Q

Are alpha 1 antagonists 1st line for htn?

A

NO (they include Thiazide, CCB, ACE-inhibitor, ARBs)

35
Q

Beta Adrenergic Antagonists

A

Dec. in HR/contractility/conduction.
AND
Bronchoconstrict and dec. in glucose. (antagonist)

Propanolol (inderal) nonselective.

36
Q

Propanolol (inderal)

A

Route: PO/IV
Indications:
HTN, angina (supply/demand… helps lower demand to dec. work of heart )
Dysrhythmias (dec. conduction)
Migraine prophylaxis (dec. hr and conduction), MI prophylaxis (necrosis d/t dec. supply of O2…)
Essential tremor

Mechanism of Action:
Block beta 1 receptor in the heart and beta 2 in the lungs (dec. HR, contractility)

Adverse Effects:
Bronchospasm
Agranulocytosis: acute low WBC count., Stevens-Johnson syndrome: blisters on skin (risk for infections and dehydration), bradycardia, fatigue and impotence (dec. in CO), rebound tachycardia, myocardial ischemia IF abrupt withdrawal.

Contraindications: cardiogenic shock (dec. BP, dec. HR), severe HF (dec. HR <60), bradycardia, COPD/asthma, caution w/ dm .

37
Q

The nurse would monitor a client beginning drug therapy with propanololfor which life-threatening manifestation of an adverse drug reaction?

A

Bradycardia and Dyspnea

38
Q

Nurse is taking initial hx of a client admitted to the hospital for htn, the PCP has ordered a beta-adrenergic blocker. Which statement by the client does the nurse recognize as most significant?

A

“I have always had problems with my asthma.”

Asthma is a huge issue with beta adrenergic.

39
Q

Beta 1-adrenergic antagonist

A

Metropolol (Lopressor, Toprol)

40
Q

Metropolol (Lopressor, Toprol) Selective

A

Route: PO/IV
Duration: 13-19hrs.
Indications: Htn, chronic stable angina, stable HF, migraine prophylaxis, essential tremor, atrial dysrhythmias, acute MI.

Mech. of A: Selective beta 1 antagonist at receptors in cardiac muscle.

Adverse effects: completes heart block, dizziness, fatigue, bradycardia, agranulocytosis, rebound cardiac excitation.

Contraindications: cardiogenic shock, severe bradycardia, heart block!

Prego: C

41
Q

Beta Blockers

A

Reduce HR/Contraction/Conduction.

Side effects: Bradycardia, hypotension, symptoms of CHF, drowsiness/depression. dec. BP, GI disturbance, CHF, depression

42
Q

CCB!!!

A

-causes muscles to contract (blocking channels and dec. in contractility)

43
Q

Nifedipine (adalat, procardia)

A

(CCB - dihydropyridine)
dec. afterload/dec. contractility by dec. work of heart/dec. SVR

Route: PO
Indications: HTN, Chronic stable angina (provides heart w/ more blood)

M of A: Blocks Calcium channels in vascular smooth muscle, including coronary arteries (vasodilator).

Adverse:
hypotension, dizziness, HA, flushing (d/t dilated arteries), peripheral edema (d/t dilated arteries).

Contraindications: Hypersensitivity.

Prego: C

44
Q

Verapamil (calan, isoptin, verelan)

A

(CCB - non-dyhydropyridine)

Verapamil does a better job at contractility and conduction, not as good at vasodilation.

Route: PO/IV
Indication:
antidysrhythmic, htn, angina (dec. work of heart and dec. contractility and dec. afterload)

M of A: inhibits flow of calcium into cardiac muscle and vascular smooth muscle cells (vasodilation and reduces contractility of myocardium)

Adverse Effects: worsening HF, irregular HR, AV block, peripheral edema (vasodilates)

Contraindications:
AV block, SSS (arrhythmias), severe hypotension.

Prego: Cat. C

45
Q

CCB

A

“very nice drugs”
Dec. Contractility/conductivity/dec. demand for O2.

Side Effects: Dec. bp, bradycardia, may precipitate A-V Block, HA, abdominal discomfort, peripheral edema.

46
Q

ACE inhibitors

A

Angiotensin-converting enzyme inhibitors… Watch for hypotension, fatigue, renal insufficiency, cough.

47
Q

The nurse is caring for a client diagnosed with htn. The client is currently taking a CCB. Which adverse reactions should the nurse monitor for while the client is taking this med??

A 
Myalgia (less Calcium channels...forcing them)
Facial edema (vasodilation)
Sig constipation (Dec. in contractility)
48
Q

Drugs that affect RAAS

A

Angiotensinogen (liver), Renin (kidneys), Angiotensin I (convert in lungs) Angiotensin II, both inc. afterload (constriction) and inc. preload (inc. water and sodium retention)

49
Q

ACE-inhibitor

A

“-PRIL”

Inhibits angiotensin converting enzyme (lungs)

50
Q

Lisinopril (Privinil)

A

dec. production of angiotensin II = dec. aldosterone (excretion of sodium and water and hold onto K) and vasodilation

Route: PO
Indications: HF, HTN (dec. preload/afternolad/svr), acute MI (dec. preload/afterload/BP)

Mechanisms of Action: Binds to and inhibits action of ACE (dec. BP and peripheral resistance, dec. aldosterone)… thus dec. blood volume.

Adverse Effects:
-hepatotoxicity
cough
dizzy
orthostatic hypotension
rash
hyperkalemia
angioedema
blood dyscrasias

Contraindications: Pregnancy, hyperkalemic, angioedema.

Prego: C first, D for 2nd and on!!

51
Q

Which is a priority nursing intervention for a client who is prescribed lisinopril for antihypertensive treatment?

A

Monitor their blood pressure. Watch for hyperkalemia

52
Q

If someone is on a diuretic will they be given another?

A

No, that would cause hypotensive crisis and they can’t lose so much fluid. Give another mechanism of action.

53
Q

If pt. has htn?

A

ACE inhib, ARB, thiazide, CCB

54
Q

What to give pt in emergency w/ acute edema?

A

Loop diuretic!! Furosemide.

55
Q

Pt. with benign prosthetic hyperplasia?

A

Give pt. alpha 1 blocker!

56
Q

Pt. with angina?

A

Give pt. CCB! B/c these will vasodilate.

57
Q

ACE inhibitors

A

Angiotensin-converting enzyme inhibitors… Watch for hypotension, fatigue, renal insufficiency, cough.

58
Q

Angiotensin II Receptor Blocker (ARBS)

A

Blocks adrenal glands and blocks blood receptors.

59
Q

Losartan (Cozaar)

A

ARBS
Route: PO
Indication: htn - first line, stroke prophylaxis, prevention of Type II diabetic neuropathy (vasodilation… )

M of A: Blocks Angiotensin receptors (causing vasodilation, reduced peripheral resistance, dec. BP, prevents aldosterone, promotes water and Na+ excretion by kidneys)

Adverse Effects:
Dizzy, fatigue, angioedema, acute renal failure, hypotension, inc. in K+

Contraindication:
hypersensitivity and prego/lactation

Prego: C (first tri), D @ 2nd and on

60
Q

Pt. with HF and hypertension

A

EITHER ACE-inhibitor or ARBs

61
Q

Nurse knows it is essential to monitor which laboratory values while a client is being treated with ACE inhibitors and ARBS?

A

-electrolyte levels
-liver function
(not BUN/creatinine and not ECG - not lab value)

62
Q

Would anyone ever be put on an ACE inhibitor and ARB at the same time?

A

No, mechanism of action is the same…

pharmacology (22 decks)

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