Antihypertensive

Question 1

Antihypertensive Administration Considerations for Acute Care

Answer 1

• Take BP prior to admin
  > all can cause hypotension
• If dosed once daily, take in AM
• Do not abruptly discontinue
  > esp. adrenergic blocking agents
  > risk for reflex HTN
• IVP meds
  > admin over a minimum of 2mins; tele
• PRN meds require evaluation
  > IVP: recheck BP in 5-10mins
  > PO: recheck BP in 1hr

Question 2

Metoprolol (Toprol) - Class & MOA

Answer 2

• Class: Beta Adrenergic Blocker
• MOA: Block vasoconstriction, dcr HR, dcr cardiac muscle contraction & incr blood flow to kidneys
  > slows HR & lowers BP

Question 3

Metoprolol (Toprol) - Indications & Route

Answer 3

• Indications
  > HTN
  > HF
  > S/P MI
  > A-fib/flutter
• Route
  > maintenance: oral
  > acute HTN or dysrhythmias: IVP

Question 4

Metoprolol (Toprol) - Drug/Drug

Answer 4

• Beta Agonist inhaler
  > albuterol
  > salmeterol

Question 5

Metoprolol (Toprol) - Contra/Cautions

Answer 5

• Bradycardia
• Hypotension
• Masks S/S of hypoglycemia

Question 6

Metoprolol (Toprol) - AEs

Answer 6

• Bradycardia
• Hypotension
• Bronchospasm
• Pulmonary edema
• Weakness
• Fatigue
• Dcrd exercise intolerance
• Alterations in BG

Question 7

Metoprolol (Toprol) - Nursing Considerations

Answer 7

• Monitor hypoglycemia closely in DM; immediate & extended release (XL,XR) prescribed

Question 8

Antihypertensives Assessment

know this!

Answer 8

• Physical assessment w/ focus on cardiovascular, resp, & neuro assessments
• Labs: electrolytes, kidney & liver func
• Assess cardiac rhythm (if on monitor)
• Always assess HR & BP prior to admin in acute care
  > hold parameters

Question 9

Antihypertensive BP Parameters

know this

Answer 9

• High: greater than 180 SBP and/or 110 DBP
• Low: less than 90 SBP and/or 60 DBP
• CALL PCP

Question 10

Antihypertensive HR Parameters

know this

Answer 10

Hold if HR < 60 bpm

Question 11

Antihypertensive Interventions

know this

Answer 11

• Monitor for situation which may lead to dcrd fluid vol
• Reduce risk for falls (orthostatic hypotension)
• Consult w/ prescriber to switch from IV to oral if indicated

Question 12

Antihypertensive PT Education

Answer 12

• Lifestyle change: weight loss, smoking cessation, dcrd alcohol/salt intake
• Medication: dosing, timing, drug specific AE
• Do not abruptly discontinue
• How to assess pulse, BP, & S/S bradycardia or hypotension
• Need for follow up & monitoring

Question 13

Antihypertensive Evaluation

Answer 13

• Therapeutic Response (depends on indication/MOA):
  > BP goal for most pts: SBP < 140mmHg, DBP < 90mmHg
  > HR goal for AFib: < 110bpm
  > caution: drug-drug interaction mult meds tht slow HR
• AEs:
  > bradycardia, hypotension, drug specific
• Teaching; was it effective?