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NRS 255 > Anti-hypertensive and BPH drugs > Flashcards

Anti-hypertensive and BPH drugs Flashcards

Exam 3

1
Q

Diuretics

A

Indications: hypertension, heart failure, renal failure, liver failure/cirrhosis, pulmonary edema

MOA: reduce blood volume, lowering BP

AE: dehydration, lowering BP too much, hyponatremia, hypokalemia, nocturne

Types of diuretics: thiazides, potassium-sparing, loop diuretics, osmotic diuretics

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2
Q

Thiazides

A

Most common diuretic for hypertension

Hydrochlorothiazide (Microzide)

Metolazone (Zaroxolyn)

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3
Q

Potassium-sparing

A

Not as effective as others at diuresis

Risk for hyperkalemia with renal impairment, use of ACE-I

Cannot use salt substitutes

Triamterene (Dyrenium)

Spironolacton (Aldactone)

Amiloride (Midamor)

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4
Q

Loop diuretics

A

usually not used for hypertension

Furosemide (Lasix)

Bumetanide (Bumex)

Torsemide (Demadex)

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5
Q

Hydrochlorothiazide (Microzide)

A

MOA: Blocks sodium reabsorption at distal tubule, results in less water reabsorption and increased diuresis

Class: antihypertensive, Thiazide diuretic

Indications: hypertension, edema

Preg class: B

Precautions: diabetes, hypovolemia, hypotension

Patient/family teaching: avoid prolonged exposure to sun and sunscreen due to potential photosensitivity, DO NOT breast feed

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6
Q

Intermediate-acting thiazides

A

Metolazone (Zaroxolyn)

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7
Q

Spironolactone (Aldactone)

A

MOA: inhibits action of aldosterone in distal tubule and collecting ducts of nephron; sodium, chloride, and water excretion are increased; body retains potassium

Class: antihypertensive, potassium sparing diuretic

Preg class: D

Drug interactions: can cause hyperkalemia with potassium supplements, ACE inhibitors, ARB; additive hypotensive results with other antihypertensives

potassium-sparing diuretics have low effectiveness but can help prevent hypokalemia

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8
Q

Other potassium-sparing drugs

A

Amiloride (Midamor)

Triamterene (Dyrenium)

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9
Q

Furosemide (Lasix)

A

MOA: Blocks sodium reabsorption at the loop of henle

Indications: edema, heart failure, hypertension, pulmonary edema

Class: antihypertensive, loop diuretic

Preg class: C

Nursing responsibilities: administer early in day, cannot give IV furosemide faster than 10mg/min

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10
Q

Other loop diuretics

A

Bumetanide (Bumex): acites, peripheral edema

Torsemide (Demadex): twice as potent

Ethacrynic acid (Edecrin): cause most severe hearing loss, not used much anymore

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11
Q

Mannitol (Osmitrol)

A

MOA: raise osmolality of intravascular space pulling fluids from extravascular to intravascular space

Rarely first choice drug

Indications: increased intracranial pressure (head injuries), high intraocular pressure, renal failure

Precautions: high ICP

Class: osmotic diuretic

Preg class: C

AE: electrolyte imbalances, CHF, pulmonary edema, hypovolemia, dehydration, fatigue, nausea, vomiting, dizziness, convulsions, tachycardia

Nursing responsibilities: avoid extravasation, be alert to rebound increase ICP (headache & dizziness)

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12
Q

Acetazolamide (Diamox)

A

MOA: block carbonic anhydrase at proximal tubule to inhibit reabsorption of sodium and bicarbonate

Weak diuretic effect, used as adjunct therapy when loop diuretics cause alkalosis

AE: Hypokalemia, acidosis

Indications: edema, anticoagulation agent, altitude sickness

Class: carbonic anhydrase inhibitor

Preg: C

Patient/family teaching: maintain adequate fluid intake; immediately report numbness, tingling, burning, drowsiness, visual problems, sore throat or mouth, unusual bleeding, fever, ad skin or urinary problems

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13
Q

Nursing Responsibilities for Diuretic Therapy

A

complete health history

baseline and periodic determination of serum electrolytes

Measure BP before therapy and at regular intervals

Assess for signs of fluid/electrolyte retention

Monitor I&O

Monitor for therapeutic effectiveness

monitor adverse effects

ensure ready access to bathroom (Safety precautions)

monitor weight, report swelling

obtain baseline and periodic determinations of pH, blood gases, urinalysis, CBC (Diamox)

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14
Q

Patient-family teaching for diuretic therapy

A

monitor BP regularly

learn symptoms of potassium imbalances

weigh daily and report gains/losses

slow position changes

diet rich in potassium for potassium wasting diuretics, limit potassium for potassium sparing diuretics

avoid exposure to sun

report changes in hearing

DO NOT breast-feed

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15
Q

Adverse effects of diuretic therapy

A 
hypotension
dizziness
fainting (syncope)
headache
electrolyte imbalances (hyperkalemia)
dysrhythmias
gout attacks
parasthesia
fatigue
tachycardia
nausea/vomiting
ototoxicity
metabolic alkalosis (Lasix)
metabolic acidosis (Diamox)

Serious Effects:
blood dyscrasias
life-threatening cardiac dysrhythmias

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16
Q

Nifedipine (Adalat CC, Procardia XL)

A

MOA: Selectively blocks calcium channels in vascular smooth muscle; decreases the amount of calcium available for muscle contraction

Class: antihypertensive, calcium channel blocker

Preg: C

indications: hypertension, angina, off-lable uses include hypertensive mergence, persistent hiccups, premature labor contractions, prevent migraines

Contraindications: hypersensitivity to drug or drug class, immediate-release form - acute MI/cardiogenic shock

precautions: bradycardia, CHF, preexisting hypotension, hepatic impairment

drug interactions: additive effect with other antohypertensive drugs, increased risk of CHF with beta-adrenergic blocker, syncope/drop in BP with alcohol

17
Q

Verapamil (Calan, Isoptin, Verelan)

A

MOA: inhibits flow of calcium ions into cardiac muscle cells, causes vasodilation of peripheral arterioles and reduces contractability of myocardium

Class: anithypertensive, calcium channel blocer

Preg: C

Indications: antidysrhythmic, antihypertensive, angina, off-lable uses include migraine prophylaxis

AE: flushed skin, headache, dizziness, light-headedness, peripheral edema, CONSTIPATION, serious hypotension

Serious AE: CHF, bradycardia, reflex tachycardia, AV block

Nursing Responsibilities: Complete health history, monitor BP before and 30mins to 1hr after, withhold drug if systolic BP < 90, establish baseline vitals and lab values, monitor for edema, keep patient in recumbent positions for at least 1 hour after, monitor effectiveness, monitor for heart block or bradycardia with digoxin use, I&O, monitor ECG continuously, Check BP shortly before next dose

Patient-family teaching: take w/food and full glass of water, monitor BP, do not stop taking meds, take radial pulse before each dose, do not eat grapefruit or drink grapefruit juice, decrease intake of caffeinated beverages

18
Q

Drugs Similar to Nifedipine

A

Amlodipine (Norvasc), Verapamil, Diltiazem

19
Q

Diltiazem (Cardizem, Dilacor, Tazia XR, Tiazac)

A

treatment of atrial dysrhythmias and HTN, angina

off label uses migraine prophylaxis

NRS 255 (2 decks)

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