Test 2 Anti Hypertensives Flashcards
1
Q
nifedipine: nursing implications
A
- inform pts about signs of edema
- administer with a beta blocker to prevent reflex tachycardia
- check BP, pulse, liver & kidney fcn before starting
- monitor the serum levels of K+ if given with digoxin
2
Q
valsartan: SEs
A
- **do not cause significant hyperkalemia like ACE inhibitors
- **lower incidence of cough than ACE inhibitors b/c do not cause accumulation of bradykinin in the lungs
- dizziness
3
Q
valsartan:ADRs
A
- angioedema
- fetal harm (during 2nd and 3rd trimester)
- renal failure
- in pts with bilateral renal A stenosis
4
Q
lisinopril: nursing implications
A
- contraindicated in pts with bilateral renal stenosis
- check BP after first hour on drug
- take at bedtime if taking drug at home
- shouldn’t take with NSAIDs b/c it will neutralize ACE, so will not lower BP like you want
- monitor potassium
5
Q
lisinopril: SEs
A
- first dose hypoTN: b/c lower Ang II–>vasodilation
- hyperkalemia: b/c inhibition of Ang II–>inhibition of aldosterone
- dizziness
6
Q
lisinopril: MOA
A
- reduce levels of AngII thru inhibition of ACE
- dilate blood vessels
- reduce blood volume
- prevent/reverse pathologic changes in the heart and blood vessels administered by Ang II and aldosterone
- lower glomerular filtration pressure and cause slow development of renal injury
- inc levels of bradykinin thru inhibition of kinase II
- causes vasodilation
- potassium sparing
7
Q
lisinopril: ADRs
A
- renal failure, b/c Ang II will normally maintain glomerular filtration, so when we inhibit ACE and Ang II falls, then no urine production
- fetal injury: hypoTN, hyperkalemia, skull hypoplasia, oliguria
- during 2nd and 3rd trimester
- angioedema: edema of tongue, glottis, lips, eyes, pharynx
-
cough: persistent, dry, nonproductive
- when ACE gets degraded, you get bradykinin and if it builds up, then causes cough
8
Q
amlodipine: SEs
A
- peripheral and facial edema
- flushing
- dizziness
- headache
- eczematous rash
- hypotension
9
Q
amlodipine: class
A
- dihydropyridone: calcium channel blocker (but only minimally in the heart unlike verapamil and diltizem)
10
Q
nifedipine: MOA
A
- blocks calcium channels in vascular SM, so it causes vasodilation in the peripheral arterioles–>lowers arterial pressure
- calcium channel blcoakde in arteries and arterioles of heart inc coronary perfusion
- activates baroreceptor reflex, so causes sympathetic stimulation of the heart, and contractile force/HR increase
- only occurs with the immediate release formulation
11
Q
nifedipine: indications
A
- angina pectoris
- usually combined with a beta blocker to prevent reflex stimulation of the heart
- when it acts on coronary vessels
-
essential HTN
- only use SR formulation, b/c immediate release has been associated with an inc risk of MI
- when it acts systemically
12
Q
amlodipine: indications
A
- essential HTN
- angina pectoris
13
Q
amlodipine: MOA
A
- selective blockade of Ca channels in blood vessles w/ minimal effects on the heart
14
Q
difference b/c nifedipine and amlodipine
A
- amlodipine causes little reflex tachycardia
- amlodipine has a very long half life
- so, effective at only once a day dosing
15
Q
nifedipine: SE
A
- flushing
- dizziness
- headache
- peripheral edema
- gingival hyperplasia
- chronic eczematous rash
- **causes minimal blockage of Ca channels in the heart, so is not likely to exacerbate AV heart block, HF, bradycardia, or sick sinus syndrome, so nifedipine is preferred to verapamil for these pts
