ACEI & ARBs & HTN

Question 1

What is the first-line agents in treatment of HTN and heart failure?

Answer 1

ACE inhibitors

Question 2

What do ACE inhibitors do?

Answer 2

block conversion of angiotension 1 to angiotension 2.

Question 3

Where does the action of ACE inhibitors work and what is a potential side effect because of this location?

Answer 3

occurs in lungs, a cough

Question 4

What is the result of ACE inhibitors?

Answer 4

-Results in decrease of BP and PR.
-Decrease in aldosterone secretion reduce blood volume.

Question 5

What do ACEI break down?

Answer 5

bradykinin, similar to histamine

Question 6

in regards to ACE inhibitors

What does the accumulation of bradykinin do?

Answer 6

causes several of the adverse effects of ACE inhibitors.

This is because ACEI’s break down bradykinin

Question 7

4 things

Indications of ACE inhibitors

Answer 7

• Slow progression of HF
• Lower mortality of recent acute MI
• Prophalaxis for adverse cardiac events
• Prevent or delay progression of renal disease and retinopathy of diabetics

Question 8

ACE inhibitors have a low incidence of?

Answer 8

serious adverse effects

Question 9

When are ACE inhibitors contraindicated

Answer 9

-hyperkalemia

Question 10

What is the most serious adverse effect of ACE inhibitors?

Answer 10

-Angioedema!!
(rapid swelling of throat, face, larynx, tongue that can lead to airway obstruction)

Question 11

ACE inhibitors should be cautiously used when concurrently used with what other type of medication?

Answer 11

Potassium sparing diuretics

Spironolactone, Amiloride, Eplerenone, Triamterene

Question 12

What should be checked regularly when on ACE inhibitors

Answer 12

Watch potassium levels
(check lab work regularly)

Question 13

What is the black box warning for ACE inhibitors?

Answer 13

ACE inhibitors have a black box warning as they have a large risk of major congenital defects

Question 14

What off-label use are ACE inhibitors sometimes used for?

Answer 14

preventing new-onset of type 2 diabetes.

Question 15

Lisinopril
Therapeutic classification?
Pharmacologic classification?

(Prinivil, Zestril)

Answer 15

Therapeutic classification:
-Antihypertensive
Pharmacologic classification:
-ACE inhibitor

Question 16

Lisinopril therapeutic effects and uses

Answer 16

-HF
-HTN
-Acute MI

Question 17

Lisinopril mechanism of action

Answer 17

• Binds to and inhibits action of ACE.
• Decrease in serum angiotensin 2 reduces aldosterone, which results in less sodium and water retention.

Question 18

Lisinopril
Adverse effects?
Serious adverse effects?

Answer 18

Adverse effects:
- persistent cough
-HA
-Dizziness
-Orthostatic/ postural hypoTN
-hyperkalemia
Serious adverse effects:
-Angioedema
-Agranulocytosis
-Hepatotoxicity

Question 19

What considerations should the nurse take before administering Lisinopril?

Answer 19

-Check renal labs and potassium levels for hyperkalemia.
-Monitor BP before administration and 30min to 1hr after.

Question 20

In what conditions is Lisinopril contrainindicated?

Answer 20

-pregnancy (cat D)
-angioedema
-hyperkalemia
-serious renal impairment

Question 21

What is the treatment of overdose for Lisinopril?

Answer 21

-normal saline or vasopressor
-hemodialysis

Question 22

What drug interactions should the nurse be aware of when administering Lisinopril?

Answer 22

-NSAIDS= decreased anti-hypertensive activity and worsened renal disease.
**- Diuretics and other hypotensives= **Synergistic hypotensive action.
-Potassium supplements and potassium-sparing diuretics= Hyperkalemia

Question 23

Lisinopril pregnancy category?

Answer 23

First trimester: category C
Second trimester: category D

Question 24

What is the family ending name for ACE inhibitors?

Answer 24

• PRIL

Question 25

ARBS indications

Answer 25

- same as for ACE inhibitors. - treat HTN and HF. - some approval to treat MI and prophylaxis of CVA.

Question 26

unlike ACE inhibitors, what adverse reactions are less common in ARBS

Answer 26

Cough and angioedema, hypotension is less likely.

Question 27

Losartan (Cozaar) Therapeutic classification? Pharmacologic classification?

Answer 27

Therapeutic classification **-Antihypertensive** Pharmacologic classification **-Angiotensin II receptor blocker**

Question 28

Losartan therapeutic effects and uses

Answer 28

-HTN -CVA prophylaxis -Prevention of diabetic nephropathy -Off-label use for heart failure

Question 29

Losartan mechanism of action and what does it prevent

Answer 29

- Selectively blocks angiotensin AT1 receptors, resulting in decreased BP. - Blockade prevents cardiac remodeling and deterioration of renal function in patients with diabetes.

Question 30

Losartan drug interactions

Answer 30

**NSAIDs=** Decreased antihypertensive activity **Diuretics and other hypotensives=** Additive hypotensive action **Potassium supplements, potassium-sparing diuretics=** Hyperkalemia **Alcohol=** Additive hypotensive effect

Question 31

Losartan treatment of overdose

Answer 31

-Normal saline or vasopressor -Drug is not removed by hemodialysis.

Question 32

ARB's family last name ending?

Answer 32

- SARTAN

Question 33

what organs are damaged by HTN

Answer 33

-Heart -Eyes -Brain -Kidneys

Question 34

What things should the nurse watch for when considering the damage caused by HTN?

Answer 34

**Heart**: hypertrophy, MI, HF (rapid weight gain 5lbs/2-3days, SOB, BLE edema) **Eyes**: blindness (frequent eye checks) **Brain**: stroke (access FAST criteria) **Kidneys**: Kidney failure, (watch for protein in urine, micro & macro-albuminuria)

Question 35

What is the first line treatment option for HTN?

Answer 35

**Thiazide diuretics: such as Hydrochlorothiazide** Potassium-sparing diuretics, such as Triamterene, spironolactone are sometimes used too.

Question 36

What pharmacological therapy is often used to control HTN

Answer 36

multi-drug therapy

Question 37

what do diuretics do?

Answer 37

decrease blood volume = decrease blood pressure

Question 38

diuretics: adverse effects

Answer 38

-dehydration -hyponatremia -hypokalemia (less with K sparing) -Nocturia (if taken too late) -Orthostatic hypoTN

Question 39

What diuretics are typically not used for HTN?

Answer 39

Loop (high-ceiling) diuretics, for example Furosemide, bumetanide

Question 40

ACE inhibitors increase the effectiveness of what other medication

Answer 40

diuretics

Question 41

What do ACE inhibitors help to protect?

Answer 41

the kidney's

Question 42

How do ACE inhibitors acheive vasodilation

Answer 42

by reducing angiotensin 2 and decreasing aldosterone effects.

Question 43

Are ARBS or ACEI's more expensive?

Answer 43

ARBS are more expensive

Question 44

At higher doses beta blockers may cause adverse effects including

Answer 44

-fatigue, activity intolerance -erectile dysfunction -masks symptoms of hypoglycemia -clinical depression

Question 45

Nonspecific beta blockers should be used cautiously with what type of patients?

Answer 45

asthma or heart failure

Question 46

direct acting vasodilators do what to arterial smooth muscle? Can you name any examples of these drugs?

Answer 46

directly relax arterial smooth muscle which decreases resistance and afterload. | hydralazine, diazoxide, nitroprusside

Question 47

what affect does isosorbide dinitrate (long-acting nitrate) have on the heart

Answer 47

decrease preload

Question 48

adverse effects of vasodilators and how can this be minimized?

Answer 48

-reflex tachycardia and hypotension -fluid retention Beta blockers and diuretics can minimize this.

Question 49

**hydralazine (Apresoline)** Therapeutic classification? Pharmacologic classification?

Answer 49

Therapeutic classification: **Antihypertensive** Pharmacologic classification: **Direct vasodilator**

Question 50

Therapeutic effects and uses of hydralazine?

Answer 50

-Moderate to severe HTN -Hypertensive emergencies -Acute heart failure

Question 51

Mechanism of action of Hydralazine?

Answer 51

-causes peripheral vasodilation -decrease PVR, HR, CO -decreases afterload

Question 52

Hydralazine are selective towards?

Answer 52

arterioles

Question 53

What considerations should the nurse take when administering Hydralazine?

Answer 53

-hx and px -monitor lab tests for antinuclear antibody titer before and during therapy -monitor I&O -watch for adverse effects (palpitations/CP) -assess for rapid drop in BP and subsequent tachycardia