Test 3: Antihypertensive Drugs

Question 1

Captopril, ACE Inhibitors

Answer 1

a. Expected used: Heart failure and hypertension, MI, left ventricular, diabetic nephropathy
b. Action: block the enzyme that normally converts angiotensin I to the potent vasoconstrictor angiotensin II.
c. Adverse effect: persistent cough, angioedema
d. Teaching:

Question 2

losartan (Cozaar), ARBs

Answer 2

Block angiotensin II from binding to its receptor so BP stays low

Question 3

Name adverse side effect and contraindications of Losartan

Answer 3

b. Adverse effect: hypo/hyperkalemia, hyperglycemia
c. Contraindication: BLACK BOX-Pregnancy(Death to fetus)
d. Adverse reaction: Avoid -grapefruit juice-licorice-salt substitute and OTC products, St Johns Wort. Notify provider of edema. Position change slowly.

Question 4

amlodipine (Norvasc), Calcium channel blockers. Expected action:

Answer 4

inhibits the influx of calcium ions across cardiac and smooth muscle during depolarization, resulting in relaxation and vasodilation.

b. Adverse effect: edema
d. Adverse reaction: Monitor daily pulses and hold if under 60 bpm and contact provider. Change position slowly, avoid grapefruit juice, OTC cold medication. Don’t stop abruptly, full glass of water, don’t crush.

Question 5

doxazosin mesylate

Answer 5

Class: Alpha-1 Adrenergic Blockers

a. Expected action: Block vasoconstriction in blood vessels, venous and arterial dilation.
b. Adverse effect: Orthostatic hypotension
c. Contraindication:
d. Teaching reaction: Take at bedtime, Viagra will increase hypotension. Avoid changing position quickly. Can have first dose syncope (stay recumbent for 90 minutes). Monitor BP, weight, BUN/Creatinine.

Question 6

clonidine (Catapres)

Answer 6

Class: Alpha 2 Agonists

a. Expected action: Decreased sympathetic stimulation, bradycardia, decreased cardiac output, vasodilation of peripheral blood vessels
b. Adverse effect: lightheadedness, hyperglycemia
c. Contraindication:
d. Teaching reaction: Take at bed time, Avoid changing positions quickly, Monitor for fluid retention

Question 7

atenolol (Tenormin)

Answer 7

Class: Beta-Adrenergic Blockers

a. Expected action: Decrease cardiac output/contractility, suppress reflex tachycardia
b. Adverse effect:
c. Contraindication
d. Teaching reaction: Monitor heart rate daily-hold under 60, take at bedtime, do not stop abruptly, antacids decrease absorption, may mask hypoglycemia. Limit alcohol, smoking, and sodium intake.

Question 8

carvedilol (Coreg)

Answer 8

Class: Alpha/Beta adrenergic blockers

a. Expected action: Vasodilation, decrease heart rate and contractility
b. Adverse effect:
c. Contraindication:
d. Teaching: Report dizziness, check pulse daily, lying to standing position carefully. Hyperglycemia and digoxin toxicity, Do not stop abruptly, Take with food, can be crushed.

Question 9

8. nitroglycerin

Answer 9

Class: Nitrates

a. Expected action: vasodilation, increase heart rate and contractility
b. Adverse effect:
c. Contraindication
d. Teaching: orthostatic BP, taper dose, MAOI 14 days–Take at onset of pain-every 5 minutes not more then 3 doses- Go to ER. Renew supply every 3 months. Protect from light. Wet tablet with saliva before under tongue.

Question 10

norepinephrine (Levophed)

Answer 10

Class: Treatment for hypovolemia and shock-Andrenergic

a. Expected action: Potent peripheral vasoconstriction
b. Adverse effect:
c. Contraindication: cardiac dysrhythmias, angina, hypertension, hyperthyroid, Cerebrovascular Disease, increase IOP, allergy to sulfites
d. Teaching: Infuse with Dextrose. Monitor I/O & BP. Protect from light.

Question 11

digoxin (Lanoxin)

Answer 11

Class: Cardiac glycosides

a. Expected action: cardiotonic (positive inotropic) effect that improves the contractility and pumping ability of the heart by inhibiting sodium, potassium, and adenosine triphosphatase. Decrease HR by stimulating vagus nerve and blocking AV node.
b. Adverse effect: PVC’s, N& V, anorexia = toxicity. Vision changes (yellow–green halos and problems with color perception), blurred vision, and mental changes, HA. bradycardia, dysrhythmia. Hypokalemia
c. Contraindication: Narrow therapeutic window
d. Teaching: Monitor for toxicity.- Know BOX 30.1-Box 30.5. Apical pulse 1 minute-Digibind for toxicity, monitor K+. DO not crush or chew capsule. Avoid OTC meds. Eat sodium restricted and potassium rich diet. With or without food. Don’t stop abruptly. KNOW LABS.

Question 12

furosemide (Lasix)

Answer 12

Class: Loop Diuretics

a. Expected action: inhibit sodium and chloride reabsorption in the ascending limb of the loop of Henle. Increase excretion of H2O and K+
b. Adverse effect:
c. Contraindication: sulfonamides, pregnancy, anuria, electrolyte imbalance, gout, DM. liver, myocardial infarction (MI)
d. Teaching: Give IV slowly(4mg/min) to prevent ototoxicity. Diuresis in 5-10 minutes. Monitor blood sugar, BP, vertigo. Take with food. Tablets can be crushed. Take early in day. Weigh daily. Encourage potassium diet. Monitor BP & I/O.

Question 13

hydrochlorothiazide (HCTZ) (Microzide)

Answer 13

Class: Thiazide-Like Diuretics

a. Expected action: decrease reabsorption of sodium, water, chloride, and bicarbonate in the distal convoluted tubule. Increase excretion of H2O sodium and K+
b. Adverse effect:
c. Contraindication
d. Teaching: Monitor for electrolyte-cardiac. Takes 2 hours- works for 6-12 hours. Monitor blood sugar, BP, vertigo. Take with food. Tablets can be crushed. Take early in day. Weigh daily. Encourage potassium diet. Monitor BP / I & O

Question 14

spironolactone (Aldactone)

Answer 14

Class: Potassium-Sparing Diuretics

a. Expected use: heart failure, ascites (liver disease), hypokalemia, and hypertension, primary and secondary hyperaldosteronism. Acne
b. Expected action: inhibits mineralocorticoid receptors and blocks the effects of aldosterone, a hormone secreted by the adrenal cortex, in the renal tubules. Increase sodium excretion, low H2O excretion
c. Adverse effect:
d. Contraindication: renal insufficiency-first trimester of pregnancy(anti-andronergic)
e. Teaching: Take with food. Weight daily, avoid K+ Take in AM. Diuresis 24-48 hours. Avoid salt substitutes containing K+ Monitor BP & I/O.

Question 15

mannitol (Osmitrol)

Answer 15

Class: Osmotic Diuretics

a. Use: increase intracranial pressure
b. Expected action: rapid diuresis by increasing osmotic pressure (solute load increase) water will be pulled from extravascular sites
c. Adverse effect:
d. Contraindication
e. Teaching: Monitor for BP, ICP neuro changes, I & O and electrolytes.

Question 16

atorvastatin calcium (Lipitor)

Answer 16

Class: HMG-CoA Reductase Inhibitors Statins

a. Used: hypercholesterolemia and reducing cardiovascular events. Reduction of LDL
b. Expected action: inhibit an enzyme (HMG-CoA reductase) required for hepatic synthesis of cholesterol. Increase HDL, lower LDL and triglycerides
c. Adverse effect: hepatic(LFT)
d. Contraindication
e. Teaching: Monitor LFT, Take at bed-time(enzyme at night), jaundice, report muscle pain(myopathies). Avoid grapefruit. Take with food absorption is decreased by 30% without.

Question 17

ACE inhibitor

Answer 17

end in pril e.g. lisinopril

a. Main side effect is ACE:
i. A: avoid in pregnant women
ii. A: angioedema
iii. C: cough
iv. E: electrolyte imbalance (low sodium and high potassium)

Question 18

26. ARBS: losartan

Answer 18

a. Decrease load on the heart and more relaxation of the BP.
b. Make you pee
c. Kill fetus
d. No grapefruit juice

Question 19

beta blockers

Answer 19

end in lol e.g betalol

a. low HR, cannot give if HR is 60 or less, or low BP
b. 4 B’s:
i. Bradycardia (60 or less)
ii. Bottom out BP (80/60)
iii. Breathing problem (COPD, Asthma)
iv. Blood sugar masking (diabetic)

Question 20

Calcium channel blocker

Answer 20

calm the heart = low BP and HR, control BP

a. Nephedipine, Cardizem and Verapamil
b. Block the movement of calcium
c. Never give when BP is low or less than 60
d. We hold the drug for:
e. Low BP (below 100), low HR (below 60)
f. Change position slowly
g. Bad headache
i. Neg. Chronotropic
ii. Neg. inotropic (less force)
iii. Neg Dromotropic (less beats)

Question 21

Diuretics

Answer 21

3D’s:

a. Decrease BP
b. Drain fluid (urinate)
c. Decrease reabsorption of sodium in the kidney = less sodium
i. K+ wasting – furosemide and HTC
ii. K+ sparing – spironolactone (avoid salt substitute)
1. Avoid potassium rich food
d. Dehydrate (dried body)

Question 22

Dilators

Answer 22

Vasodilates, relieve pressure

a. Decrease BP
b. Dilates vessels
c. Decrease vascular resistance
i. Nitroglycerin (pillow)
1. Rest and relax heart