Med For Hypertensive Crisis-ATI Pharm

Question 1

Meds

Answer 1

Prototype=nitroprusside(centrally-acting vasodilator)

• nitroglycerin(vasodilator)
• nicardipine(CCB)
• clevidipine(CCB)
• Enalaprilat(ACE inhibitor)
• Esmolol(BB)

Question 2

Expected Pharm action

Answer 2

Direct vasodilation of arteries and veins resulting in rapid reduction of BP(decreased pre and after load)

Question 3

Therapeutic uses

Answer 3

Hypertensive crisis

Question 4

Complications

Answer 4

1-excessive hypotension=administer med slowly,keep pt supine
2-cyanide poisoning/thiocyanate toxicity
3-bradycardia/tachycardia/ECG changes

Question 5

Cyanide poisoning/thiocyanate toxicity

Answer 5

• Nitroprusside only
• Headache/drowsiness;can lead to cardiac arrest
• Pts w/ liver dysfunction are at increased risk
• Risk is reduced by administering med for no longer than 3 days, at a rate of 5mcg/kg/min or less. Avoid prolonged use
• manifestations include weakness,disorientation,and delirium.
• administer thiosulfate to counteract/reverse effects
• monitor plasma levels if used for more than 3 days;level should be maintained at less than 10mg/dL

Question 6

Contraindications/precautions

Answer 6

Pregnancy risk cat C

• contraindicated in pts who have heart failure w/ reduced peripheral vascular resistance, and AV shunt
• use cautiously in pts who have liver/kidney disease,hypothyroidism,hypovolemia,or fluid and electrolyte imbalances, and in older adults

Question 7

Interactions

Answer 7

Do not administer nitroprusside in the same infusion as any other medication

Question 8

Nursing Admin

Answer 8

1-prepare med by adding to dilute the for IV infusion
2-note color of solution, should be light brown, discard if it isn’t
3-protect IV container and tubing from light
4-discard med after 24 hr
5-monitor vital signs and ECG continuously

Question 9

Nursing Evaluation of med effectiveness

Answer 9

1-decrease in BP/maintenance of normotensive BP
2-improvement of heart failure such as ability to perform activities of daily living, improved breath sounds, and absence of edema