Blood Pressure Agents Flashcards
(140 cards)
1
Q
What is BP determined by?
A
HR, Stroke Volume (amount of blood pumped out of the ventricle with each heartbeat), Total Peripheral Resistance (restistance of the muscular arteries to the blood being pumped through), Baroreceptors, Renin-angiotensin-aldosterone system
2
Q
What is stroke volume determined by?
A
Total amount of blood in the vascular system, so if you have a low blood volume you would also have a low stroke volume. This may happen with dehydration or vomiting.
3
Q
What may increase stroke volume?
A
Things that cause fluid retention. These may be things such as heart failure, renal failure.
4
Q
Increased stroke volume decreases blood pressure.
TRUE/FALSE
A
FALSE.
Increased stroke volume increases blood pressure.
5
Q
What risks are related to Hypertension?
A
Coronary Artery Disease - there is a thickening of the heart muscle due to the heart having to work harder.
6
Q
Why is enlargement of the heart/hypertrophy associated with coronary artery disease a problem?
A
The heart muscles is enlarged due to the heart having to work harder to overcome vascular resistance, these enlarged muscles gets in the way of adequate contraction which will eventually make the heart weaker, resulting in heart failure.
7
Q
The higher peripheral resistance, the higher the blood pressure.
TRUE/FALSE
A
TRUE.
The more resistance in the arteries, the harder the heart have to pump to circulate the blood. This increases blood pressure.
8
Q
What receptor in the aorta can sense blood pressure changes?
A
Baroreceptors. Baroreceptors will then send a message to the brain to either vasodilate or vasoconstrict to maintain normal BP.
9
Q
What does RAAS stand for?
A
Renin angiotensin aldosterone system
10
Q
Explain the RAAS.
A
Its a system in the kidney that help to regulate BP through fluid retention and vasoconstriction. The kidney releases renin when blood profusion to the kidney is inadequate. The renin notrifies the liver to release angiotensinogen which is converted into angiotensin I which is converted into angiotensin II in the lungs. Angiotensin II causes vasoconstriction in the vessels and to stimulate the adrenal gland to release aldosterone which will cause sodium and water retention.
11
Q
What happens when a person has coronary artery disease?
A
The heart walls gets ticker. There is increased pressure generated by the muscle on contraction and there is an increased workload on the heart.
12
Q
What can happen in Hypertension remain untreated?
A
CAD and risk of Cardiac death, Stroke, Renal failure, Loss of vision
13
Q
What BP range is considered Stage 1 hypertension?
A
systolic: 130-139 Diastolic: 80-89
14
Q
What BP range is considered Stage 2 Hypertension?
A
Systolic over 140 Diastolic over 90
15
Q
What are some risk factures that might cause Hypertension?
A
Stress, Chronic Kidney Disease, Insulin Resistance, Increased age, Cigarette smoking, Alcohol use, Obesity, Decreased physical activity, Diabetes, High-salt diet, Sleep Apnea, Genetic predisposition
16
Q
What lifespan considerations should be taken into account when considering giving children BP medication?
A
Drug therapy should be used with caution after lifestyle changes have been attempted first. (weight loss, increased activity)
HTN is most likely to be secondary and start in childhood (high BP related to another disease or disorder)
Different drug classes may be used. Follow up appointments are needed to monitor BP and adverse effects. If the patient is using diuretics to lower BP, then glucose and electrolyte levels should be monitored.
17
Q
What lifespan considerations should be taken into account when considering giving adults BP medication?
A
Proper education - side effects to be reported asap.
Safety precautions should be put in place such as situations that may cause dehydration.
Education related to drug-drug interactions.
Education r/t lifestyle modifications.
Caution in pregnancy and lactation - ACE/ABR/Renin inhibitors (work on the RAAS) are a cat X only. Labetalol should be used if absolutely necessary.
Drugs may enter breastmilk.
18
Q
What lifespan considerations should be taken into account when considering giving older adults BP medication?
A
Older adults are more susceptible to toxic effects and underlying conditions may effect drug metabolism & excretion.
Drug-drug interactions incl. herbal therapies.
Drugs that are extended or sustained release should not be cut, crushed or chewed because this may lead to a toxic dose.
There may be an increased fall risk and risk of dehydration.
Patients should have their BP evaluated in an institutional setting - should be taken immediately before administration.
19
Q
What is the 1st step out of the 4 steps to treat Hypertension?
A
Step 1. Lifestyle Modifications - weight reduction, smoking cessation, meditation of alcohol intake, reduction of dietary salt, increase in aerobic physical activity.
20
Q
What is the 2nd step out of the 4 steps to treat Hypertension?
A
Inadequate response - drug therapy is added
21
Q
What is the 3rd step out of the 4 steps to treat Hypertension?
A
Inadequate response - consider change in drug dose or class or addition of another drug for combined effect.
22
Q
What is the 4th step out of the 4 steps to treat Hypertension?
A
Inadequate response - Second or third agent or diuretic is added if not already prescribed.
23
Q
What are some types of Antihypertensive Agents that we must know?
A
Drugs affecting the RAAS : ACE inhibitors, Angiotensin II Receptor Blockers, Renin Inhibitors.
Calcium Channel Blockers
Vasodilators
Diuretics
Sympathetic Nervous System Blockers: Beta Blockers - (selective/nonselective), Alpha-adrenergic Blockers (nonselective & alpha1-blockers)
Alpha- and Beta - blockers (aka nonselective adrenergic blocking agents)
Alpha2-agonist
24
Q
What are some antihypertensive agents that affect the RAAS?
A
Angiotensin-Converting Enzyme Inhibitors (ACEI or ACE inhibitors)
Angiotensin II Receptor Blockers (ARBs)
Renin Inhibitors
25
What are the suffix(es) and potential outliers for ACE inhibitors?
"-pril"
Benazepril
Captopril
Enalapril
Lisinopril
Ramipril
26
What does ACE inhibitors do?
They block the ACE from converting angiotensin I to angiotensin II in the RAAS. This action blocks aldosterone leading to vasodilation, sodium and water excretion and a small increase in serum potassium.
27
Why would we give a patient ACE Inhibitors?
Treat hypertension - drugs block aldosterone leading to vasodilation, sodium & water excretion & small increase in potassium.
Decreases stimulation of angiotensin receptors in the renal artery, may lead to less damage in the renal artery.
Protective agent for the kidneys, and often used for diabetics to protect against diabetic nephropathy/kidney disease
CHF & left ventricular dysfunction w/ other medication to prevent/reverse remodeling of the heart in heart failure due to decreased resistance and therefore decrease in cardiac workload.
28
When should we absolutely not give a patient ACE inhibitors?
If they have an allergy to the drug or pregnancy.
29
Which patients should we avoid giving ACE inhibitors to?
Patients with impaired renal function because the drug reduces renal blood flow which may impair the kidneys further.
30
Which patients should we be cautious with giving ACE inhibitors to?
Patients with acute/unstable CHF - need to be aware in changes in hemodynamics that could worsen heart failure. If heart is unstable then these drugs are not a good choice.
31
What are some drug-drug interactions that we need to be aware of with patients that are taking/are prescribed ACE inhibitors?
Allopurinol - due to increased risk of hypersensitivity reactions.
Other RAAS drugs - serious adverse effects
NSAIDS - decreases effects of ACE inhibitors.
32
What are some adverse Effects r/t vasodilation & alterations in blood
flow a patient can experience when they are taking Captopril?
Captopril is an ACE inhibitor and the patient may experience adverse effects such as :
Hypotension
Renal insufficiency
Dizziness
Fatigue
Reflex tachycardia - BP goes down, then brain stimulates heart to increase heart rate to get more blood flow.
33
What are some adverse effects that a patient may experience when taking Lisinopril?
Lisinopril is an ACE inhibitor and the patient may experience adverse effects such as:
Pancytopenia - from depression of bone marrow which leads to decrease in WBCs, RBCs and paltelets.
GI irritation - nausea, vomiting, diarrhea and abdominal pain.
Rash
Hyperkalemia - due to slight increase in potassium.
Cough - happens to about 30% of patients, reason not known. but may be due to increase in bradykinin.
34
What nursing assessment should you do prior to administering Captopril to a patient?
Captopril is an ACE inhibitor.
Labs : CBC prior & periodically throughout treatment due to the risk for Pancytopenia.
35
What nursing implementation should be made when administering Benazepril?
Benazepril is an ACE inhibitor and patient should be educated regarding cough that might be one of the side effects of the drug.
36
What are the suffix(ex), names and potential outliers for Angiotensin II Receptor Blockers (ARBs)?
“-sartan”
* Candesartan
* Irbesartan
* Losartan
* Olmesartan
* Telmisartan
* Valsartan
37
How does Losartan work?
Losartan is an Angiotensin II blocker and they are all Angiotensin II receptor antagonists that blocks angiotensin II from binding with the receptors on the vascular smooth muscle and in the adrenal cortex.
They :
* prevent vasoconstriction
* prevent release of aldosterone
38
Why would you give a patient Valsartan?
Valsartan is an Angiotensin II Receptor blocker and we would give these drugs to patients that suffer from HTN, CHF and for Diabetic Nephropathy prevention (Same indications as ACE)
39
Would you give Irbesartan to a pregnant woman?
No, Irbesartan is a Angiotensin II receptor blocker and are classified as a category X. Pregnancy is an absolute contraindication and there is a Black Box Warning.
40
What patient conditions should we be cautious of when prescribing Telmisartan?
Telmisartan is an Angiotensin II receptor blocker and we should be cautious with administering these drugs to patients why have hepatic dysfunction, renal dysfunction and are hypovolemic.
41
What are some adverse reactions that are seen when giving patients Olmesartan?
Olmesartan is a Angiotensin II receptor blocker and may have the following side effects:
* CNS: Headache, dizziness, syncope, weakness
* CV: hypotension
* GI complaints - nausea, vomiting, diarrhea or abdominal pain.
* Skin: rash
* Hyperkalemia
* Renal damage
42
What are some drug-drug interactions to be mindful of when giving a patient Candesartan?
Candesartan is an Angiotensin II receptor blocker and they can react with
NSAIDs - decreases the effect of ARBs
Other RAAS drugs - increased adverse effects.
43
What nursing assessment should be done prior to giving a patient Angiotensin II receptor blockers?
We should be assessing for existing liver impairments and should order labs for liver function.
44
What are the suffix(ex), names and potential outliers for Renin Inhibitors?
Aliskiren - Came out in early 2000's
45
How does Aliskiren work?
Inhibits renin which inhibits the RAAS
Decreased BP
Decreased aldosterone
Decreased sodium reabsorption
Aliskiren is a Renin inhibiter.
46
Why would we administer Aliskiren to a patient?
To treat Hypertension
Aliskiren is a Renin inhibiter.
47
Can we give Aliskiren to a pregnant woman?
No, pregnancy is an absolute contraindication.
Aliskiren is a Renin inhibiter.
48
What are some adverse reactions to Aliskiren?
Hyperkalemia
Diarrhea
Aliskiren is a Renin inhibiter.
49
What are some drug-drug interactions to be aware of with Aliskiren?
Other RAAS drugs - increase ina dverse effects.
Aliskiren is a Renin inhibiter.
50
For all the drug classes and categories affecting the RAAS, what should we assess for?
ACE Inhibitors, ARBs and Renin Inhibitors.
History
* Allergy, pregnancy
* Impaired kidney function, salt/volume depletion, heart failure
Physical
* Baseline physical: cardiac, respiratory, abdominal, skin
* Vitals and weight(due to changes in in fluid volume)
Labs: renal function tests, electrolytes, pregnancy test
51
For all the drug classes and categories affecting the RAAS, what nursing diagnosis would we make?
Altered tissue perfusion r/t changes in cardiac output.
Altered skin integrity - r/t dermatological effects such as rash.
Impaired comfort - r/t adverse effect such as GI and rash.
Electrolyte imbalance risk due to action of RAAS.
Knowledge deficit regarding drug therapy.
52
For all the drug classes and categories affecting the RAAS, what nursing implementations would we be prepared to make?
Encourage lifestyle changes
Educate on use of barrier contraceptives in women of childbearing age.
Comfort and safety measures - giving food with drugs if GI effect occur.
Monitor the patient carefully in any situation that might lead to a drop in fluid volume (hot environment, diarrhea, vomiting)
Provide thorough patient teaching
53
What are the suffix(ex), names and potential outliers for Calcium Channel Blockers?
“-dipine”
* Amlodipine
* Felodipine
* Nifedipine
Outliers are (very dairy):
* Diltiazem
* Verapamil
54
How does Calcium Channel blockers work?
By inhibiting movement of calcium ions across the cell membrane of cardiac and arterial muscles, depressing the impulse which leads to slowed conduction, decreased myocardial contractility, and relaxes and dilated arteries.
Decreases BP, cardiac workload and myocardial oxygen consumption.
55
Why would we give Diltiazem to a patient?
Diltiazem is a calcium channel blocker and we give these medications to a patient to treat hypertension, angina and arrythmias.
56
What are some relative contraindications that we should be aware of when thinking of prescribing Felodipine to a patient?
Felodipine is a calcium channel blocker and should be avoided in patients with renal or hepatic dysfunction due to the effect on metabolism and excretion and patients with heart block or sinus syndrome due to the patient having a low heart rate with these conditions and calcium channel blockers lowering the heart rate and slow conduction.
57
Which patients/ patient condition should we be cautious of prescribing Nifedipine to?
Nifedipine is a calcium channel blocker and we should be cautious of prescribing these medications to patients with coronary heart failure.
58
What are some adverse reactions that we should be aware of when a patient is prescribed Verapamil
Verapamil is a calcium channel blocker and with these drugs we might see side effects such as:
*Effects on cardiac output - dizziness, light headedness, fatigue, headache.
* CNS - bradycardia, hypotension,
* CV - peripheral edema, heart block.
* Other :
GI - nausea
Skin - flushing, rash
59
What are some drug-drug interactions that might Diltiazem react with?
Diltiazem is a calcium channel blocker and might react with:
Cyclosporine & Diltiazem taken together may lead to toxicity of the cyclosporine.
60
What food might Felodipine react with?
Grapefruit due to increased risk of toxicity.
Felodipine is a calcium channel blocker.
61
Before prescribing Amlodipine to a patient, what are some things we should assess first?
Amlodipine is a calcium channel blocker and before giving any of these drugs we should assess for
History:
Allergy
Heart block, sick sinus syndrome, heart failure
Liver and kidney impairment
Physical:
Skin, respiratory, cardiac, neuro, abdominal
Vitals, ECG, pain
Labs: liver and renal function tests
62
Before administering Felodipine to a patient, what are some nursing diagnosis that we would make?
Altered cardiac output risk r/t hypotension
and vasodilation.
Injury risk r/t CNS & cardiovascular effect.
Total body altered tissue perfusion r/t hypotension or changes in cardiac output.
Knowledge deficit
Felodipine is a calcium channel blocker.
63
When administering Diltiazem to a patient, what are some nursing interventions that we should be prepared for?
Monitor the patient's blood pressure, cardiac rhythm, and cardiac output.
Comfort measures and safety measures such as small meals with GI effect, or adequate fluid intake with risk of hypotension, caution with standing up and changing position due to risk of orthostatic hypotension.
Provide thorough patient teaching.
64
What are the suffix(ex), names and potential outliers for Vasodilators?
All independent names :
* Hydralazine
* Minoxidil
* Nitroprusside
* Nitroglycerin
65
what does Nitroglycerine do?
Nitroglycerine is a vasodilator and these drugs acts directly on vascular smooth muscle to cause muscle relaxation which leads to vasodilation and decrease in BP.
Also results in decreased peripheral
vascular resistance which increases
cardiac output.
66
Why would you give Hydralazine to a patient?
Vasodilators are given to patients who suffer from severe hypertension and drugs have been ineffective,
* Refractory hypertension (BP spikes for no apparent cause in someone with previously controlled BP)
* Hypertensive emergencies (exceeds 180/120)
* Malignant hypertension (hypertensive emergency with organ damage).
67
What patient conditions should we be cautious of when considering prescribing vasodilators to a patient?
Conditions exacerbated by decreased BP such as :
Peripheral vascular disease, CAD,
heart failure, cerebral insufficiency (decreased blood flow to the brain), or
tachycardia
68
What are some adverse effects that may be seen in patients taking Minoxidil?
Minoxidil is a vasodilator and we may see adverse reactions such as :
CNS and CV changes - r/t BP changes - dizziness and reflexive tachycardia.
Skin - abnormal hair growth.
GI upset - diarrhea, vomiting.
Cyanide toxicity with nitroprusside - due to Nitroprusside metabolizing to cyanide. This is manifested by a pink/cherry-red skin, headache, dizziness, dyspnea & vomiting
69
Before prescribing Nitroprusside to a patient, what are some things we should assess first?
Nitroprusside is a vasodilator and for these drugs we should assess:
History:
Allergy, CV dysfunction
Physical:
Skin, cardiac, respiratory, abdominal
Vitals, ECG, weight
Labs: renal and hepatic function
70
Before administering Hydralazine to a patient, what are some nursing diagnosis that we would make?
Hydralazine is a vasodilator and we could anticipate altered tissue perfusion, altered skin integrity, impaired comfort and knowledge deficit.
71
When administering Nitroglycerin to a patient, what are some nursing interventions that we should be prepared for?
With vasodilators we should make implementations such as encourage lifestyle changes (decrease stress, increase physical activity),
Monitor BP closely ( to evaluate for effectiveness)
Monitor patient carefully in any situation
that might lead to a drop in fluid volume - to detect excessive hypotension.
Comfort and safety measures
Provide thorough patient teaching
72
Why would we give a patient that suffers from hypertension diuretics?
Because diuretics increase the excretion of sodium and water from the kidney which lowers BP.
Fluid retention often impact BP.
73
Which diuretics should we remember for this exam?
Thiazide and thiazide-like diuretics
* Chlorothiazide
* chlorthalidone
* hydrochlorothiazide
Potassium-sparing diuretics
* spironolactone
* triamterene
74
What are the suffix(ex), names and potential outliers for Sympathetic nervous system blockers : Beta -Blockers?
“-olol”
* Atenolol
* Metoprolol
* Propranolol - Nonselective
75
What are non-selective beta blockers?
They block all the receptors in the sympathetic nervous system and therefor have more adverse effects.
76
What are selective beta receptor blockers?
Newer drugs that only block the beta receptors in the heart which produces less adverse reactions.
High doses, may however effect beta receptors outside of the heart (loses their selectivity with higher doses)
77
What are the different types of Sympathetic Nervous System Blockers?
Beta-Blockers
* Selective/ Nonselective
Alpha-Adrenergic Blockers
* Nonselective
* Alpha1-blockers
Alpha- and Beta- Blockers
* a.k.a. Nonselective Adrenergic Blocking Agents
* Alpha2-Agonist
78
What does Metoprolol do?
Beta-Blockers block the adrenergic beta receptors in the heart decreasing heart rate and cardiac muscle contraction decreasing cardiac workload.
Vasodilates which increases blood flow to the kidneys & leads to a decrease in the release of renin which stops the RAAS.
79
Why would we give a patient Atenolol?
Atenolol is a beta-blocker and we would give these drugs to treat HTN, Angina, Tachyarrhythmias, migraine headache, MI, glaucoma, heart failure and hyperthyroidism.
80
In which patients should we avoid giving Beta-blockers?
Patients with acute/unstable heart failure, bradycardia and heart block - will be exacerbated by cardiac suppressing effect.
Patients with bronchospasm, COPD, acute asthma - due to the constricting effect when we block the SNS.
81
Which patient conditions should we exhibit caution when giving Propranolol?
Propranolol is a beta-blocker and we should show caution with patients who have renal and hepatic dysfunction and patients with diabetes because the drugs block the signs and symptoms of altered blood glucose so high or low blood glucose could go unnoticed.
82
What adverse reactions may be seen when a patient is taking Atenolol?
Atenolol is a beta-blocker and adverse effects may be :
* CNS: HA, fatigue, dizziness, depression, sleep issues, disorientation, memory loss.
* CV: bradycardia, hypotension.
* Resp: Bronchospasm, dyspnea, pulmonary edema.
* GI: nausea, vomiting, diarrhea, gastric pain.
* GU: decreased libido and impotence due to decreased blood flow to the penis.
* Alterations in blood glucose levels.
83
What drug-drug interactions do we need to be aware of with beta-blockers?
* Clonidine - risk of increased hypertensive effect when used together, however if used together and one drug discontinued, there is a risk of severe hypertension response( beta blocker should first be discontinued for a several days, then clonidine if both drugs needs to be discontinued)
* NSAIDs - decrease effect of beta blockers.
* Insulin/hypoglycemic agents
84
What nursing assessments should be done prior to prescribing beta-blockers to a patient?
Assess for history or lung conditions and diabetes.
85
What nursing implementations should be anticipated prior to prescribing Propranolol to a patient?
Propranolol is a beta blocker and with these drugs we should take apical pulse prior to administering and hold if below 60 bpm.
Do not abruptly stop medication because the heart becomes sensitized to catecholamine - drugs needs to be tapered off over 1 to 2 weeks.
Patients with diabetes should monitor blood glucose closely.
86
What is the drug class that we need to remember for Sympathetic Nervous System Blockers
Alpha-adrenergic blocker (non-selective)?
Phentolamine (IM or IV only)
87
How does Phentolamine work?
By blocking Alpha1 receptors which vasodilates and results in decreased BP.
It also blocks Alpha recpetors2 which prevents norepinephrine feedback loop resulting in increase in reflex tachycardia.
88
Why would we administer Phentolamine to a patient?
For diagnosis and management of pheochromocytoma episodes.
Pheochromocytoma is a benign tumor in the adrenal gland which results in too many hormones and often increases BP, sweating, rapid heartbeat and headaches.
They are not very useful for hypertension because they have a lot of adverse effects.
89
In which patients should we avoid Phentolamine if possible?
Patients with CAD and MI- may exacerbate these conditions.
90
Are there any drug-drug interactions with Phentolamine , and if so what are they?
Yes, alcohol because alcohol is a vasodilator and taken the two together may increase hypotension.
91
What are some adverse reactions that may be seen in a patient taking Phentolamine ?
Usually are primary action adverse effects such as :
CV
* Hypotension
* Angina; MI
* Arrhythmia
* Increased reflex tachycardia
* Flushing from vasodilation
CNS - usually in response to hypotension
* Cerebral vascular accident /Stroke
* Headache
* Weakness
* Dizziness
92
What are the suffix(ex), names and potential outliers for Sympathetic nervous system blockers :
Alpha1- blockers?
“-azosin”
* Doxazosin
* Prazosin
* Terazosin
93
How does Terazosin work on the body?
* Blocks alpha1-receptor sites which inhibits norepinephrine at the sites, decreases vascular tone resulting in vasodilation and decreases blood pressure
Terazosin is a Alpha 1 - blocker
94
Why would you give Doxazosin to a patient?
Doxazosin is a Alpha 1 - blocker and you would give these drugs to patients that suffer from Hypertension.
95
What conditions should we be cautious of when thinking of administering Prazosin to a patient?
Prazosin is a Alpha - 1 blocker and we should exhibit caution when administering these drugs to patients who suffer from heart or renal failure or hepatic impairment.
96
What are some adverse reactions to Terazosin?
Terazosin is an Alpha-1 blocker and the adverse effects are related to the SNS blocking effect so we might see adverse reactions on the
CNS - headaches, weakness, dizziness, fatigue.
CV - arrythmias, hypotension, edema, heart failure and angina
GU - Priapism (prolonged erection).
Skin - flushing.
97
What are some adverse reactions to Alpha-1 blockers?
Drugs that are used for erectile dysfunction due to an increase on anti-hypertensive effect which can result in dangerously low BP.
98
What are the suffix(ex), names and potential outliers for Sympathetic Nervous System Blockers:
Alpha- and Beta- blockers
(Nonselective Adrenergic Blocking Agents)?
Carvedilol
Labetalol
99
How does Carvedilol work on the body?
By blocking norepinephrine at all alpha and beta receptors in the SNS. This lowers BP and HR, increases renal perfusion which decreases renin.
Carvedilol is a alpha & beta blocker.
99
Why would we give Carvedilol to a patient?
We give alpha and beta blockers to treat Hypertension.
100
What are some relative contraindications to Labetalol?
* Heart block
* Bradycardia
* Liver disease
Labetalol is an alpha & beta blocker.
101
In which patients should we exhibit caution when prescribing alpha & beta blockers?
* Lung disease/bronchospasm
* Diabetes
102
What are some adverse reactions to Carvedilol?
Carvedilol is and alpha & beta blocker and adverse reactions such as :
*CNS - fatigue, dizziness, insomnia.
* Cardiovascular - stroke, hypertension, arrythmias, heart failure
* Respiratory - bronchospasm, pulmonary edema.
* Hypoglycemia
* Skin: Rash
* GI/GU issues - nausea, vomiting, diarrhea, abdominal pain. Decrease in libido and impotence due to decreased blood flow.
* Liver failure may be seen.
103
What are some drug-drug interactions to Labetalol?
Labetalol is an alpha & beta blocker and may interact with antidiabetic agents - may increase effectiveness of antidiabetic agent which could result in hypoglycemia.
104
What are the suffix(ex), names and potential outliers for Sympathetic Nervous System
Blocker Alpha2-agonist?
Clonidine
105
How does Clonidine work on the body?
Stimulates the alpha2 receptors
in the CNS and inhibits the CV centers, leading to a decrease in sympathetic outflow from
the CNS resulting in a drop in BP.
There is a drop in norepinephrine especially.
106
Why would we give Clonidine to a patient?
To treat HTN, and oral and transdermal formulations.
Clonidine is an Alpha 2 - agonist.
107
What are some patient conditions where we should avoid giving Alpha-2 agonists?
Narrow angle glaucoma - this condition may be worsened by arterial constriction.
Severe HTN - due to potential for vasoconstriction.
Hypotension - make worse
Bradycardia - make worse
108
In what patient conditions should we show caution when giving a patient Clonidine?
Clonidine is an Alpha-2 agonist and we should be careful with giving a patient this drug is they suffer from
* CV disease - could be aggravated by the vascular effect of the drug.
* Diabetes - due to glucose elevating effect due to sympathetic stimulation.
* Hyperthyroidism due to thyroid stimulating effect of the drug.
* Renal/hepatic impairment
109
What are some adverse effects of Clonidine?
CNS - Bad dreams, drowsiness, headache, fatigue, anxiety, restlessness
CV - extreme hypotension, bradycardia - this is due to the decreased sympathetic outflow from the CNS.
GU - decreased urinary output, urinary retention.
110
What are some drug-drug interactions to Clonidine?
Clonidine is an Alpha-2 agonist and may react with:
* Beta-blockers - causes hypertension.
* Adrenergic-antagonists - loses effectiveness - counteracts
* CNS depressants/alcohol -decreases SNS outflow.
111
What should we assess for when giving Sympathetic Nervous system blockers?
* History
* Contraindications and cautions
* Physical
* CNS, cardiac/perfusion,
respiratory, abdominal, urinary
* Vitals and ECG
* Labs: electrolytes, renal and
hepatic function, glucose
112
What are some nursing diagnosis which can be made before giving a patient Sympathetic Nervous system blockers?
* Impaired comfort due to CNS,GI/GU, skin
* Altered tissue perfusion - r/t CV effect
* Altered cardiac output - r/t CV effect
* Altered breathing pattern (drugs that affect Beta 2 receptors)
* Injury risk r/t CNS and CV effect
* Activity intolerance r/t suppression of sympathetic nervous system.
* Altered sensory perception r/t CNS effect
* Knowledge deficit
113
What nursing implementations should be made when giving a patient Sympathetic Nervous system blockers?
Take apical pulse prior to administering and hold if below 60 bpm
* Prepare medication carefully - small errors = serious effect
* Monitor blood pressure regularly incl before admin.
* Do not abruptly stop medication
* Encourage patient to make lifestyle modifications
* Change position slowly
* Safety and comfort measures
* Patients with diabetes should monitor blood glucose closely
* Do not crush extended release formulations
* Patient teaching
* Consult a healthcare professional before taking any OTC medication or herbal/alternative therapies
* Emphasize importance of follow-up exam
114
What is Hypotension?
Blood pressure becomes too low
* When the heart muscle is damaged and unable to pump effectively
* With severe blood or fluid loss, when volume drops dramatically
* When there is extreme stress and the body’s levels of norepinephrine are
depleted, leaving the body unable to respond to stimuli to raise BP.
115
What is a drug category that we use to treat hypotension?
Vasopressors .
They are also called Sympathetic adrenergic agonists /Sympathomimetics/ Alpha- and Beta - adrenergic agonists.
116
What are some drug classes that are Vasopressors and that we need to know?
* Dobutamine
* Dopamine
* Epinephrine
* Norepinephrine
117
How does Epinephrine work on the body?
Epinephrine is a Vasopressor and work by stimulating all the adrenergic receptors/SNS. There will be an increase in heart rate and myocardial contractility. Bronchodilation and rate/depth of breathing increases.
118
Why would we give a patient Dopamine?
Dopamine is a vasopressor and we would give these drugs for patients suffering from acute life threatening hypotensive states such as shock and heart failure. Patients in anaphylaxis and for patients experiencing bronchospasms and Acute asthma attacks.
119
When should you absolutely not give a patient vasopressors?
When they have an allergy or Pheochromocytoma (tumor in adrenal gland) (absolute contraindications) which would result in an overload of catecholamine which may cause death.
120
When should we do our best to avoid giving vasopressors?
When patients are suffering from hypovolemia (relative contraindication) because fluid replacement should be the first treatment.
121
When should we be cautious with giving a patient Norepinephrine?
Norepinephrine is a vasopressor and we should exhibit caution in patients suffering from tachycardia - Could result in deadly arrythmia. Hypertension and diseases that limits blood flow.
122
are there any drug-drug interactions that we should be aware of with Dobutamine, and if so, which ones?
Yes. Dobutamine is a vasopressor and we shouldn't give these drugs to any patient that are taking any other drugs that increases their heart rate or blood pressure.
123
What should we assess for before administering dopamine?
Dopamine is a vasopressor and we should look for any contraindications or cautions before giving patients these drugs.
We should also do a physical exam of the Respiratory, cardiac/perfusion, abdominal and skin.
Check weight and vitals
Labs for kidney and liver function
124
what nursing diagnoses can be made prior to giving a patient Epinephrine?
Epinephrine is a vasopressor and so we can anticipate effects such as altered tissue perfusion and altered sensory perception and impaired comfort.
We can also anticipate a patient knowledge deficit of the drug regimen.
125
What nursing implementations should we be prepared to make when giving a patient Norepinephrine?
Norepinephrine is a vasopressor and we should be prepared to monitor BP and HR.
Provide safety and comfort measures and provide patient teachings.
126
A person who has a BP of 118/84 would be considered to have what kind of BP?
Stage 1 hypertension due to diastolic being over 80.
127
Explain why chronic dehydration results in hypertension.
Dehydration decreases blood flow to the kidneys may activate the RAAS. When body cells lack water, the brains ends a signal to the pituitary gland to release vasopressin ( a chemical that causes vasoconstriction) This causes BP to increase which further leads to HTN.
When you're dehydrate the kidneys also reduces urine formation which causes the capillaries in heart and brain to constrict which results in high BP. This may lead to kidney damage and disease.
128
Which are the 3 drug classes that affect the RAAS?
ACE inhibitors, Angiotensin II Receptor Blockers (ARBs) , Renin Inhibitors.
129
What does ACE stand for?
Angiotensin converting enzyme.
130
The nurse just administered an ACE inhibitor to her patient. Before ambulating the patient for the first time after administration, the nurse should monitor for what possible side effect?
Hypotension
ACE inhibitors prevent vasoconstriction and lower blood pressure, placing the client at greater risk for postural (orthostatic) hypotension. Angiotensin II acts as a potent vasoconstrictor that, when inhibited, can reduce blood pressure by dilating vessels and decreasing aldosterone secretion
131
Which SNS blockers do not have reflex tachycardia as one of their adverse effects?
Alpha 1 blockers, and Alpha & Beta blockers
132
What would decrease stroke volume?
Low blood volume. high blood volume would increase stroke volume.
133
Would dehydration or vomiting cause high or low stroke volume?
Low stroke volume because blood volume would drop.
134
Heart failure and renal failure causes fluid retention, what would that do to our stroke volume and blood pressure?
Increase stroke volume and would also increase blood pressure.
135
Where are the baroreceptors located?
In the aorta.
136
Where is the RAAS system located?
In the kidneys
137
Which organ secretes angiotensinogen?
The liver
138
If we have to use blood pressure medication in pregnancy which one would we use?
Labetalol - Beta Blocker.
139
What happens to the the bronchi when we block the SNS?
The SNS dilates the bronchi, however when we block the SNS this may lead to bronchoconstriction which is not good for patients with COPD or Asthma.
