Quiz 5

Question 1

ACEI MOA

Answer 1

Blocks the conversion of angiotensin I to angiotensin II (potent vasoconstrictor and stimulator of aldosterone) through inhibition of ACE. Also prevents breakdown of bradykinins which leads to vasodilation.

Question 2

ACEI Drug Effects

Answer 2

Vasodilation (↓ afterload); excretion of sodium and water (↓ preload), and renal protective

Question 3

Examples of ACEI

Answer 3

Those medications ending in “pril”: captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil),

Question 4

ACEI Indications

Answer 4

Hypertension (especially those with renal disease)

Question 5

ACEI Contraindications

Answer 5

Previous reaction of angioedema (swelling of lips and mouth)–>potential airway blockage

Question 6

ACEI Adverse Effects

Answer 6

ACE= Angioedema, cough, extra potassium (hyperkalemia)

+First dose syncope

Question 7

ARBs MOA

Answer 7

Block binding of angiotensin II to angiotensin II receptors which prevents vasoconstriction and aldosterone formation

Question 8

ARBs Drug Effects

Answer 8

Vasodilation of arterioles (↓ afterload), excretion of sodium and water (↓ preload)

Question 9

Examples of ARBs

Answer 9

Those medications ending in “sartan”: losartan (Cozaar), valsartan (Diovan), olmesartan (Benicar)

Question 10

ARBs Indications

Answer 10

Antihypertensive for those who can not tolerate ACEI due to cough

Question 11

ARBs Adverse Effects

Answer 11

Similar to ACE I except for cough 
	(does not interfere with bradykinin)
Hypotension
Angioedema 
Hyperkalemia

Question 12

CCB MOA

Answer 12

Prevents influx of calcium ion across cell membrane of vascular smooth muscle

Question 13

CCB Drug Effects

Answer 13

Dilation of peripheral and coronary arteries and arterioles (↓ afterload)

Question 14

Examples of CCBs

Answer 14

Those medications ending in “pine”: amlodipine (Norvasc), diltiazem (Cardizem), Nicardipine (Cardene), Nifedipine (Procardia), Verapamil (Calan)

Question 15

CCB Indications

Answer 15

HTN, angina

Question 16

CCB Adverse Effects

Answer 16

Don't: Dizziness (4%)
Have: Hypotension (4%)
Common: Constipation (9%)
Pizza: Peripheral edema (2%)
Sticks: Suppression of cardiac function

Question 17

CCB Nursing Implications

Answer 17

Monitor blood pressure and heart rate

Question 18

CCB Patient Education

Answer 18

Change positions slowly
Avoid hazardous activities while dizzy
Increase fluid and fiber intake to prevent constipation unless otherwise instructed by provider.

Question 19

Consequences of untreated HTN

Answer 19

Save: Stroke
Ham: Heart failure
Eggs: End stage renal failure
Cantaloupe: Coronary artery disease
Properly: Peripheral vascular disease

Question 20

Pre-hypertension Ranges

Answer 20

120-139/80-89

Question 21

Hypertension Stage I

Answer 21

140-159/90-99

Question 22

Hypertension Stage II

Answer 22

> 160/>100

Question 23

Blood Pressure Definition

Answer 23

Blood pressure is the product of cardiac output and peripheral vascular resistance
BP = CO x PVR

Question 24

S&S of hypokalemia

Answer 24

Weakness, fatigue, constipation, and muscle cramping, dysrhythmias

Question 25

End organ damage

Answer 25

Refers to damage occurring in major organs fed by the circulatory system (heart, kidneys, brain, eyes) which can sustain damage due to uncontrolled hypertension, hypotension, or hypovolemia.

Question 26

Thiazide Diuretics MOA

Answer 26

Increases urine output by blocking the reabsorption of Na+ and Cl- in the early distal tubule which prevents reabsorption of water

Question 27

Thiazide Diuretic Drug Effects

Answer 27

Reduction of blood volume (preload) and reduction of arterial resistance (afterload)

Question 28

Examples of Thiazide Diuretics

Answer 28

hydrochlorothiazide (HydroDiuril, HCTZ), chlorothiazide (Diuril)

Question 29

Thiazide Diuretic Indications

Answer 29

First-line antihypertensive

Question 30

Thiazide Diuretic Contraindications

Answer 30

Renal failure, renal insufficiency

Question 31

Thiazide Diuretic Adverse Effects

Answer 31

``` Dehydration Hypokalemia Hypergylcemia Hyperuricemia *(D Triple H!) ```

Question 32

Thiazide Diuretic Nursing Implications

Answer 32

Monitor fluid volume status Monitor blood pressure Monitor electrolytes (especially K+)

Question 33

Thiazide Diuretics Patient Education

Answer 33

Monitor weight and blood pressure Change positions slowly Eat potassium rich foods and report S/S of hypokalemia Diabetic patients monitor for ↑ in glucose Take early in the day to avoid nocturia

Question 34

Beta Blockers MOA

Answer 34

Prevent sympathetic stimulation of beta receptors in the heart which decreases heart rate (negative chronotropic), myocardial contractility (negative inotropic), and rate of conduction through AV node (negative dromotropic)

Question 35

Beta Blockers Drug Effects

Answer 35

Decreased cardiac output

Question 36

Types of Beta Blockers

Answer 36

Cardioselective (Beta1) ie.) metoprolol (Lopressor) Nonselective (Beta1 & Beta2) ie.) propranolol (Inderal)

Question 37

Beta Blockers Indications

Answer 37

HTN

Question 38

Beta Blockers Contraindications

Answer 38

Bradycardia, AV block, asthma

Question 39

Beta Blockers Adverse Effects

Answer 39

Dizziness (10%) Bradycardia (3%), AV block Mask signs/symptoms of hypogylcemia in diabetics Bronchoconstriction (3%) Rebound myocardium excitation (black box warning) *Busy bees: bradycardia, blood sugar, bronchoconstriction, black box

Question 40

Beta Blockers Patient Education

Answer 40

- Change positions slowly, avoid time in hot tubs or saunas which result in vasodilation - Monitor glucose closely if diabetic - Do not stop abruptly (black box warning)

Question 41

Alpha1/Beta Blockers MOA

Answer 41

Alpha 1 blockade promotes dilation of arterioles (↓ afterload) and veins (↓ preload). Beta1 blockade reduces heart rate and contractility (decreased CO). In addition, blockade of beta1 receptors on juxtaglomerular cells suppresses release of renin

Question 42

Examples of Alpha1/Beta Blockers

Answer 42

carvedilol (Coreg) | labetalol (Trandate)

Question 43

Vasodilators MOA

Answer 43

Direct vasodilation of arteries and veins resulting in rapid reduction of blood pressure (↓preload and ↓ afterload)

Question 44

Vasodilators Indications

Answer 44

Hypertensive crisis

Question 45

Vasodilators Adverse Effects

Answer 45

Excessive hypotension (keep patient in supine position), monitor EKG, avoid prolonged use due to cyanide poisoning (black box)

Question 46

Examples of Vasodilators

Answer 46

Nitroprusside (Nitropress) I.V. only

Question 47

Vasodilators Nursing Implications/Patient Education

Answer 47

Impotence in males may occur, postural hypotension may occur (orthostatic hypotension)

Question 48

Lifestyle modifications to lower BP

Answer 48

- Weight reduction - DASH eating plan - Dietary sodium restriction - Aerobic activity - Moderation of alcohol consumption

Question 49

HTN Medications used to treat CKD

Answer 49

ACEI, ARBs

Question 50

First Dose Syncope Definition and Precautions

Answer 50

Sudden drop in BP when changing positions (lying to standing). Advise patient to change positions slowly

Question 51

Angioedema Definition and Treatment

Answer 51

Swelling of tongue and oropharynx Severe cases may cause airway obstruction: Histamine blockers, steroids, and, in those with severe symptoms, epinephrine (HOW YOU'D Tx ALLERGIC REACTION)