Antihypertensive Meds

Question 1

What is the Mechanism of Action of Thiazide Diuretics?(Chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide, metolazone)

Answer 1

Inhibits NaCl reabsorption in the distal convoluted tubule.
Increases the excretion of Na+ and Cl-
Initial decrease in ECF
Sustained decrease in SVR
Lowers BP moderately in 2-4 weeks

Question 2

What is the Mechanism of Action for Loop Diuretics? (Bumetanide, Furosemide, Torsemide)

Answer 2

Inhibits NaCL reabsorption in the ascending limb of the loop of Henle.
Increases excretion of Na+ and Cl-
More potent than Thiazides, but shorter duration of action
Less effective for hypertension

Question 3

What are the nursing considerations for Thizaide Diuretics?

Answer 3

Monitor for orthostatic hypotension, hypokalemia, and alkalosis
May potentiate cardiotoxins of Digoxin
NSAIDs can decrease diuretic and antihypertensive effects of thiazides
Advise patients to supplement with potassium rich foods.

Question 4

What are the nursing considerations for Loop Diuretics?

Answer 4

Monitor for orthostatic hypotension and electrolyte abnormalities
Loop diuretics remain effective despite renal insufficiency
Diuretic effect of drug increases at higher doses

Question 5

What is the mechanism of action for potassium-sparing diuretics? (Amiloride, Triamterene)

Answer 5

Reduce K+ and Na+ exchange in the distal and collecting tubules.
Reduce the excretion of K+, H+, Ca2+, Mg2+

Question 6

What are the nursing considerations for potassium-sparing diuretics?

Answer 6

Monitor for orthostatic hypotension and electrolyte abnormalities
Contraindicated in patients with renal failure
Use with caution in patients also using ACE inhibitors or angiotensin II blockers.
Avoid K+ supplements and K+ rich foods

Question 7

What is the mechanism of action for Aldosterone Receptor Blockers? (Spironolactone, Eplerenone)

Answer 7

Inhibit the Na+ retaining and K+ excreting effects of aldosterone in the distal and collecting tubules

Question 8

What are the nursing considerations for Aldosterone Receptor Blockers?

Answer 8

Monitor for orthostatic hypotension and electrolyte abnormalities
Do not combine with K+ sparing diuretics or K+ supplements
Use with caution in patients also using ACE inhibitors or angiotensin II blockers.
Also classified as K+ sparing diuretics

Question 9

What is the mechanism of action of central acting alpha adrenergic agonists? (Clonidine, methyldopa, guanfacine)

Answer 9

Reduces sympathetic outflow from the CNS

Question 10

What are the nursing considerations for Central Acting Alpha Adrenergic Agonists?

Answer 10

Sudden discontinuation can cause withdrawal syndrome
Causes dry mouth
Increases sedation effects of alcohol and sedatives
Instruct patient about daytime sedation and avoidance of hazardous activities
Educate patient to take at night before bed

Question 11

What is the Mechanism of Action of Peripheral Acting Alpha Adrenergic Agonists? (Reserpine)

Answer 11

Depletes central and peripheral stores of norepinephrine resulting in peripheral vasodilation decreasing SVR and BP

Question 12

What are nursing considerations for Peripheral Acting Alpha Adrenergic Agonists?

Answer 12

Must be given BID
Contraindicated in patients with history of depression
Monitor mood and mental status regularly
Advise patient to avoid barbiturate, alcohol and opiates

Question 13

What class of drugs do Central Acting Alpha Adrenergic Agonists and Peripheral Acting Alpha Adrenergic Agonists fall under?

Answer 13

Adrenergic inhibitors

Question 14

What is the mechanism of action of Alpha I Adrenergic Blockers? (Doxazosin, prazosin, terazosin, phentolamine)

Answer 14

Block alpha-I adrenergic effects, producing peripheral vasodilation (decrease in SVR and BP)
Beneficial Effects on lipid profile
Phentolamine- blocks alpha-I adrenergic receptors, resulting in peripheral vasodilation (decreases SVR and BP)

Question 15

What are nursing considerations of Alpha I Adrenergic Blockers?

Answer 15

Block alpha-I adrenergic effects, producing peripheral vasodilation (decrease in SVR and BP)
Beneficial Effects on lipid profile
Phentolamine- blocks alpha-I adrenergic receptors, resulting in peripheral vasodilation(decreases SVR and BP

Question 16

What is the mechanism of action for CARDIOSELECTIVE Beta-1 Adrenergic blockers? (Acebutolol, atenolol, betaxolol, bisoprolol, esmolol, metoprolol, nebivolol)

Answer 16

Cardioselective agents block Beta-I adrenergic receptors
Reduce BP by blocking Beta-adrenergic effects
Decrease CO and reduce sympathetic vasoconstrictor tone
Decrease renin in the kidneys

Question 17

What are the nursing considerations for CARDIOSELECTIVE Beta Blockers?

Answer 17

Monitor PUlse and BP regularly
Use cautiously in patients with diabetes
Drug of choice in patient with a history of MI or HF
Less effective BP reduction in African American patients
Cardioselective agents lose cardioselectivity at higher doses

Question 18

What is the mechanism of action of NON-CARDIOSELECTIVE Beta Blockers? (Nadolol, pindolol, propranolol)

Answer 18

Non Selective agents block B-I and Beta adrenergic receptors
Reduce BP by blocking B-I and B-II adrenergic effects

Question 19

What are the nursing considerations for NON-CARDIOSELECTIVE Beta Blockers?

Answer 19

Monitor PUlse and BP regularly
Use cautiously in patients with diabetes
Drug of choice in patient with a history of MI or HF
Less effective BP reduction in African American patients
Cardioselective agents lose cardioselectivity at higher doses
May cause bronchospasm especially in patients with a history of asthma

Question 20

What is the mechanism of action for mixed alpha and beta blockers? (Carvedilol, labetalol)

Answer 20

Alpha-1, Beta-I, and Beta-II adrenergic blocking properties producing peripheral vasodilation and decreased heart rate.
Reduce CO, SVR, and BP

Question 21

What are the nursing considerations for mixed alpha and beta blockers?

Answer 21

Monitor Pulse and BP regularly
Use cautiously in patients with diabetes
Drug of choice in patient with a history of MI or HF
Less effective BP reduction in African American patients
Cardioselective agents lose cardioselectivity at higher doses
IV available for hypertensive crisis, however, patient must remain supine during administration

Question 22

What is the mechanism of action of Fenoldopam?

Answer 22

Activates dopamine receptors, resulting in systemic and renal vasodilation

Question 23

What are the nursing considerations for Fenoldopam?

Answer 23

IV use only for hypertensive crisis in hospitalized patients.
Use cautiously in patients with glaucoma
Patient should remain flat for 1 hour after administration

Question 24

What is the mechanism of action for Hydralazine and minoxidil?

Answer 24

Reduces SVR and BP by direct arterial vasodilation

Question 25

What are the nursing considerations for hydralazine and minoxidil?

Answer 25

V use for hypertensive crisis in hospital patient BID oral dosage Contraindicated in patients with CAD Reserved for treatment of severe hypertension associated with renal failure and resistant to other therapy (Minoxidil)

Question 26

What is the mechanism of action for Na+ Nitroprusside?

Answer 26

Direct vasodilation reduces SVR and BP

Question 27

What class of drugs do Fenoldopam, Hydralazine, Minoxidil, and Na+ Nitroprusside fall under?

Answer 27

Direct vasodilators

Question 28

What is the mechanism of action for Angiotensin-Converting-Enzyme Inhibitors? (ACE) (-pril)

Answer 28

Inhibit ACE and reduce conversion of angiotensin I to angiotensin II Inhibits AII vasoconstriction

Question 29

What are the nursing considerations for ACE inhibitors?

Answer 29

Aspirin and NSAIDs may reduce drug effectiveness Addition of diuretic enhances drug effect Should not be used with K+sparing diuretics Can cause increase in serum creatinine Inhibits breakdown of bradykinin which may cause a dry, hacking cough*** Captopril may be given PO for hypotensive crisis

Question 30

What is the mechanism of action for Angiotensin II Receptor Blockers? (ARBS) (-sartan)

Answer 30

Prevents action of Angiotensin II and produces vasodilation and increased Na+ and H2O excretion

Question 31

What are the nursing considerations for ARBS?

Answer 31

Full effect on BP may not be seen for 3-6 weeks*** Do not affect bradykinin levels: alternative for ACE Inhibitors Should not be used with ACE Inhibitor in patients with kidney disease

Question 32

What is the mechanism of action for non-Dihydropyridines calcium channel blockers?

Answer 32

nhibit movement of Ca2+ across cell membrane resulting in vasodilation Cardioselective resulting in decrease in HR and slowing of AV conduction (verapamil)

Question 33

What calcium channel blockers are non-dihydropyridines (myocardial selective)?

Answer 33

Diltiazem ER, Verapamil intermediate release, Verapamil Long-acting, Verapamil timed-release

Question 34

What are the nursing considerations for non-dihydropyridines Calcium channel blockers?

Answer 34

Use with caution in patients with HF Serum concentration and toxicity of certain calcium channel blockers may be increased by grapefruit juice; avoid concurrent use Used for SVT Avoid in patients with 2nd or 3rd degree AV heart block or left ventricular systolic dysfunction

Question 35

What is the mechanism of action for dihydropyridines (vascular selective) calcium channel blockers?

Answer 35

Cause vascular smooth muscle relaxation resulting in decreased SVR and arterial BP

Question 36

What calcium channel blockers are dihydropyridines (vascular selective)?

Answer 36

Amlodipine, clevidipine, felodipine, isradipine, nicardipine sustained release, nifedipine long acting, nisoldipine

Question 37

What are the nursing considerations for dihydropyridine calcium channel blockers?

Answer 37

More potent peripheral vasodilators Clevidipine is for IV use only Use of sublingual short-acting nifedipine in hypertensive emergencies in unsafe and not effective Serious adverse events such as CVA and MI have been reported IV nicardipine is available for hypertensive crisis in hospitalized patients and the peripheral IV infusion site needs to changed q12h