Week 11: Antihypertensive Drugs (15 questions)

Question 1

Adrenergic

Clonidine

Used for what?
Used as what treatment?
***How to stop taking it? and why?
Adverse effect? 3

Answer 1

Mild to moderate HTN

*Used in conjunction and w/ other anti-HTN meds

**DO NOT STOP ABRUPTLY
**May lead to SEVERE REBOUND HTN

*Drowsiness,
sexual dysfunction
dry mouth

Question 2

Clonidine: Nursing Considerations

check what before giving?
Hold if?
Transdermal patch:
Apply when?
Apply where?
Avoid what sites?

Answer 2

check BP and HR before administering

Hold medication and call provider if SBP < 90
DBP < 60
HR <60

-Remove old patch first
-Applied every 7 days
-May be applied to any hairless site
(Absorption is greater when placed on chest or upper arm)
-Rotate sites; avoids sites that are cut or have callus

Question 3

Adrenergic Drugs: α1 Blockers (-osin)

Doxazosin

What happens with first dose?
Asses for?
Advise male client to?

Answer 3

First-dose orthostatic hypotension

Assess for first-dose orthostatic hypotension and syncope (30 min-2 hrs after initial dose

notify doctor if an erection lasts more than 4 hours (can lead to permanent impotence)

Question 4

Adrenergic Drugs: Beta-Blockers
(-lol)

1. β1-selective (cardio-selective) Blocker?
2. Non-selective beta + alpha1 blockers
   (dual-action α1b-blocker)?
3. Non-selective beta-blockers?

Answer 4

1. Nebivolol (Bystolic)
2. carvedilol
3. Propranolol

Question 5

β1-selective (cardio-selective) Blockers

Nebivolol (Bystolic)

Indication?
Less what than other hypertension meds?
Can be used for patients with?

Answer 5

Indication: HTN (and HF)

Less sexual dysfunction than other meds that treat HTN

Cardio-selective beta blockers can be used for patients with asthma

Question 6

Dual-action Alpha1 and Beta Blockers

CARvedilol (Coreg, Coreg-CR)

Treats what?
Adverse effect?***

Answer 6

Treats HTN and mild to moderate HF

**BRADYCARDIA

Widely used drug, well-tolerated

Question 7

Beta-Blockers (lols): Nursing Considerations

Monitor what?
Hold if?
What to do if u want to stop taking?
May mask?

Answer 7

Monitor BP and HR (apical pulse)

Hold medication and call provider if SBP < 90
DBP < 60
HR <60

DO NOT STOP ABRUPTLY, it must be tapered down over 1-2 weeks

May mask symptoms of hypoglycemia

Question 8

ACE and ARBS cause???

Answer 8

HYPERKALEMIA

Question 9

ACE-Inhibitor causes vaso…and?

Can’t give ACE-Inhibitor if what lab is high?**

Black Box Warning for?

ACE-Inhibitor: Adverse Effect? rare but fatal?

Answer 9

Systemic Vasodilation and lower BP

***Baseline potassium level of 5 mEq/L or higher

Fetal toxicity

***ANGIOEDEMA, rare but potentially fatal

Question 10

ACE-I: what can it cause?
what labs need to be monitored?

May decrease?
Can also cause?

Answer 10

HYPERKALEMIA,
potassium levels need to be monitored

May decrease serum sodium levels

RENAL IMPAIRMENT

Question 11

ACE-I: Interactions? 4

Answer 11

NSAIDs

Concurrent use w/ anti hypertensives, diuretics

Lithium

Potassium supplements and potassium-sparing diuretics:

Question 12

ACE-I:

Captopril? half life?

Enalapril?
available in?

Both meds do what?

Answer 12

Captopril: Shortest half-life of all the ACE-I so must be given multiple times a day

Only ACE inhibitor available in both PO and IV

Both meds improve chances of survival after an MI , reduce the
incidence of HF

Question 13

ACE-I: Client Education

Change positions?
What is expected when on this med?
Avoid what?

Answer 13

change positions slowly to minimize orthostatic hypotension

A chronic dry cough is an expected effect of this medication**

Avoid salt substitutes containing potassium

Question 14

Angiotensin II Receptor Blockers (ARBs) - sartan

does not cause?
should not be used in?
Interactions? 4

Answer 14

Well-tolerated
Do not cause a dry cough

should NOT be used in pregnancy

• NSAIDs
• Lithium
• Rifampin
• Potassium supplements

Question 15

ARBs: Losartan

Used for?
Caution in clients with?
Don’t use if?
Avoid what? and do what?

Answer 15

Used for hypertension and HF

renal or hepatic dysfunction

Don’t use in pregnancy or breastfeeding

avoid salt substitutes containing potassium

change positions slowly to avoid orthostatic hypotension

Question 16

Direct Renin Inhibitors:

Aliskiren

block what?
Contraindication?

Answer 16

Block renin and cause vasodilation

use of ACE-Is or ARBs
in clients w/ DM or moderate to severe renal impairment

Question 17

Calcium Channel Blockers (CCB):

Amlodipine

Used for?
Adverse effects? 3

Answer 17

Chronic stable angina

hypotension
bradycardia
peripheral edema

Question 18

Diuretics

Treatment for?

What’s the most common diuretic for hypertension?

Answer 18

First-line treatment of hypertension

Thiazide diuretics are the most common diuretics for HTN

Question 19

Vasodilators

IV hydralazine and sodium nitroprusside

Used for?
Adverse effects?

Answer 19

hypertensive emergencies!!!!
> 180/120 mm Hg!!!

Orthostatic hypotension
Tachycardia

Question 20

Vasodilators: Sodium Nitroprusside

Contraindication? 2

Answer 20

Hypotension
Bradycardia

Question 21

Vasodilators: Nursing Considerations

Hydralazine IV push?

Sodium nitroprusside?
Prepared solution is what color?

Answer 21

IV: may need to be placed on cardiac monitoring

SN: Wrap infusion in aluminum foil to protect from light

Prepared solution has a slight brownish tint

Question 22

Treprostinil (Tyvaso)

Used to treat?

Answer 22

Pulmonary artery hypertension

Question 23

Sildenafil & Tadalafil?

Used for?
Also used for?

Answer 23

Commonly used for erectile dysfunction

pulmonary hypertension**

Question 24

What drugs can be used in Pregnancy & HTN:

Mild to Moderate HTN?
Severe HTN / HTN Emergencies

Answer 24

Mild to Moderate HTN
* Labetalol
* Nifedipine (ER only)
* Thiazide diuretics

Severe HTN / HTN Emergencies
* IV Hydralazine

Question 25

What foods are high in Potassium

Answer 25

Banana, orange, avocado, dry fruit, winter squash