CV Concepts Flashcards
(49 cards)
1
Q
first line drugs
A
- Diuretics
- Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin II receptor blockers (ARBs)
- Calcium channel blockers
- Beta-adrenergic antagonists/blockers
2
Q
second line drugs
A
- Alpha1-adrenergic antagonists
- Alpha2-adrenergic agonists
- Direct-acting vasodilators
3
Q
Centrally acting alpha2 receptor agonists characteristics
A
- Stimulate alpha2-adrenergic receptors in the brain
- TX of HTN
- Decrease sympathetic outflow from the CNS
- Decrease norepinephrine production
- Stimulate alpha2-adrenergic receptors, thus reducing renin activity in the kidneys
- Result in decreased blood pressure
- Primary alpha 2 action: Vasodilation, Constrict pupils, v CNS, v HR, contractility
- used after other drugs failed because of adverse effects
4
Q
Centrally acting alpha2 receptor agonists examples
A
- clonidine (Catapres) (Oral or transdermal)
- methyldopa (Aldomet) Can be used for hypertension in pregnancy
5
Q
Peripheral alpha1 blockers/antagonists: example and characteristics
A
- doxazosin (Cardura)
- terazosin (Hytrin)
- prazosin (Minipress)
- Block alpha1-adrenergic receptors
- reflexive tachycardia and first dose phenomenon
6
Q
Beta blockers: examples and characteristics
A
- nebivolol (Bystolic)
- propranolol (Inderal)
- atenolol (Tenormin)
- others
- Reduce BP by reducing heart rate and contractility through beta1 blockade
- Cause reduced secretion of renin
- Long-term use causes reduced peripheral vascular resistance
- Non selective beta blockers can cause bronchoconstriction
- can worsen HF by lowering cardiac output too much, so must be started on lower target dose
7
Q
adrenergic drugs: Dual-action alpha1 and beta receptor blockers: examples and characteristics
A
- carvedilol (Coreg)
- labetalol
- nonselective
- Reduce heart rate (beta1 receptor blockade)
- Cause vasodilation (alpha1 receptor blockade)
- Result in decreased blood pressure
8
Q
Adrenergic Drugs: Adverse Effects
A
- High incidence of orthostatic hypotension
- Most common: Bradycardia or reflex tachycardia, Dry mouth, Drowsiness, sedation, fatigue, Constipation, Depression, Edema, Sexual dysfunction (impotence)
- Other: Headaches, Sleep disturbances, Nausea, Rash
9
Q
List of ACE inhibitors:
A
- captopril (Capoten)
- benazepril (Lotensin)
- enalapril (Vasotec)
- fosinopril (Monopril)
- lisinopril (Prinivil)
- moexipril (Univasc)
- quinapril (Accupril)
FLEM CQB + -pril
10
Q
ACE Inhibitors: Mechanism of Action and characteristics
A
- Block angiotensin-converting enzyme, thus preventing the formation of angiotensin II (which is a potent vasoconstrictor)
- Result in decreased systemic vascular resistance (afterload), vasodilation, and therefore decreased blood pressure
- Also results in a decrease in aldosterone secretion which reduces blood volume***, causes excretion of sodium and retention of potassium
- May be combined with a thiazide diuretic or calcium channel blocker
11
Q
ACE Inhibitors: Indications
A
- Hypertension
- HF (either alone or in combination with diuretics or other drugs) (Slows progression of heart failure)
- Slow progression of left ventricular hypertrophy after MI (cardioprotective***) (Lowers mortality after acute MI)
- prevent MI and protect heart during MI
- Renal protective effects in patients with diabetes (Neuropathy effect also)
- Prevent or delays progression of retinopathy in diabetic patients
12
Q
ACE Inhibitors: special consideration for Captopril and Lisinopril
A
- ***they are NOT prodrugs (Prodrugs are inactive in their administered form and must be metabolized in the liver to an active form so as to be effective)
- Captopril and lisinopril can be used if a patient has liver dysfunction, unlike other ACE inhibitors that are prodrugs
13
Q
ACE Inhibitors: Adverse Effects
A
- Fatigue
- Dizziness
- Headache
- Mood changes
- Impaired taste
- ***Possible hyperkalemia (more likely with ACE than ARB)
- Dry, nonproductive cough, which reverses when therapy is stopped
- Angioedema: rare but potentially fatal
NOTE: First-dose hypotensive effect may occur
- ***Pregnancy category C (first trimester)
- ***Pregnancy category D (second and third trimesters)
14
Q
ACE Inhibitors Prototype Drug: Lisinopril (Prinivil, Zestril): nursing responsibilities
A
- Complete health history
- Monitor BP before administration and 30 min to 1 hour after
- Keep patient in supine position if hypotension occurs
- Evaluate effect of drug
Teach patient and family:
- Immediately report any swelling
- Proper diet (careful K intake)
- Take BP
- Take missed dose as soon as remembered (pneumonic to remember)
- Make position changes slowly
- Drink 6 to 8 glasses of water daily
15
Q
Angiotensin II Receptor Blockers (ARBs): characteristics
A
- Well tolerated
- Do not cause a dry cough
Mechanism of action:
- Allow angiotensin I to be converted to angiotensin II, but block the receptors that receive angiotensin II
- Block vasoconstriction and release of aldosterone so result is vasodilation, elimination of sodium and water and the retention of potassium
16
Q
Angiotensin II Receptor Blockers (ARBs): list of drugs
A
- losartan (Cozaar)
- eprosartan (Teveten)
- valsartan (Diovan)
- irbesartan (Avapro)
- candesartan (Atacand)
- olmesartan (Benicar)
- telmisartan (Micardis)
- azilsartan (Edarbi)
LEVICOTA + -sartan
17
Q
Angiotensin II Receptor Blockers (ARBs): indications
A
- Hypertension
- Adjunctive drugs for the treatment of HF
- May be used alone or with other drugs such as diuretics
- Prevention of diabetic nephropathy
- Heart failure
18
Q
Angiotensin II Receptor Blockers (ARBs): Adverse Effects
A
- Upper respiratory infections
- Headache
- May cause occasional dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue
- Hyperkalemia much LESS likely to occur
19
Q
Angiotensin II Receptor Blockers (ARBs): PT teaching and nursing responsibilities
A
- Monitor BP regularly
- Immediately report any swelling
- Proper diet
- Report vomiting, diarrhea, heavy sweating
- Take missed dose as soon as remembered
- Make position changes slowly
- Drink 6 to 8 glasses of water daily
- Baseline vital signs and labs (BMP, CBC, liver and renal function tests)
- Monitor for hypotension
- Evaluate effects of drug and adverse effects
20
Q
Direct Renin Inhibitor: examples and characteristics
A
- aliskiren (Tekturna)
- Indication: hypertension
- MOA: inhibits the release of renin and prevents the activation of the RAAS.
21
Q
Calcium Channel Blockers: Mechanism of Action
A
- Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction
Results in:
- Decreased peripheral smooth muscle tone
- Decreased systemic vascular resistance
- Decreased blood pressure
22
Q
Calcium Channel Blockade: effects on vascular smooth muscle, coronary arteries, SVR, myocardium, and conduction
A
Effects on vascular smooth muscle
- Prevents contraction of peripheral arterioles (Vasodilation, Fall in BP)
Afterload reduced
- Lower myocardial oxygen demand and less workload for heart
Dilation of coronary arteries
- More blood flow to heart
Effects on myocardium
- Reduces force of myocardial contraction (negative inotropic effect)
Effects on cardiac conduction
- Negative chronotropic effect
- SA node generates fewer action potentials
- Slows automaticity
- Decreases HR
23
Q
Calcium Channel Blockers: Arteriole selective drugs (dihydropyridines) examples
A
- Relax arterial smooth muscle
- Treat hypertension and angina
- Nifedipine (Procardia, Adalat)
- amlodipine (Norvasc)
AVND (A Very Nice Drug), -dipine
24
Q
Calcium Channel Blockers: Nonselective drugs (non-dihydropyridines) examples
A
- Relax arterial smooth muscle
- Decrease myocardial contractility and heart rate better
- Treat hypertension and coronary artery disease
- Verapamil (Calan)
- diltiazem (Cardizem)
AVND (A Very Nice Drug)
25
Other calcium channel blockers: list
- Felodipine (Plendil)
- Isradipine (DynaCirc)
- Nicardipine (Cardene)
- Nimodipine (Nimotop)
FINN + -dipine
26
Calcium Channel Blockers: Indications
- Angina
- Hypertension
- Tachycardia
- Migraine headaches
- Raynaud’s disease
- Vasospasms
27
Calcium Channel Blockers: Adverse Effects
| AVND only
Diltiazem and Verapamil (non-dihydropyridine non-selective):
- Bradycardia
- CHF
- Hypotension
- Constipation
Amlodipine and Nifedipine (dihydropyridine, selective):
- Rebound tachycardia (from the drop in BP)
- Hypotension
- Edema
- Hepatic impairment
28
Calcium Channel Blockers: drug interactions
- Elevates blood levels of **digoxin
- Additive hypotension or bradycardia with other antihypertensive drugs
- Risk of myopathy increases significantly with **statins
- **Carbamazepine serum concentration may increase (Antiseizure med, narrow therapeutic index)
- Grapefruit juice may increase levels
Important to know especially for Ca drugs
29
Calcium Channel Blockers: nursing responsibilities and PT/family teaching
Nursing responsibilities
- Monitor for heart block or bradycardia with digoxin use
- Monitor intake and output
- Monitor ECG
- Check BP and HR before and after administration
Patient/family teaching
- Take with food and full glass of water
- Monitor BP, drinking alcohol could cause BP to decrease
- Do not stop taking medication without consent of HCP, should be discontinued gradually if stop drug
- Take radial pulse before each dose
- Do not eat grapefruit or drink grapefruit juice
- Decrease intake of caffeinated beverages
30
Diuretics: action and characteristics
- Decrease plasma and extracellular fluid volumes
v blood volume
Results:
- Decreased preload
- Decreased cardiac output
- Decreased total peripheral resistance
Overall effect
- Decreased workload of the heart and decreased blood pressure
MOA
- Reduce blood volume, lowering pressure
31
Diuretics general : indications
- Hypertension
- Heart failure
- Renal failure (some work for a while then not as much)
- Liver failure/cirrhosis
- Pulmonary edema (lungs fill up)
32
Diuretics general: adverse effects
- Dehydration (daily weight)
- Lowering the blood pressure too much
- Hyponatremia
- Hypokalemia (less with potassium-sparing diuretics)
- Nocturia (if taken too late in the day)
33
Thiazide diuretics: examples
- Most common diuretic for hypertension.
- Chlorthalidone (Thalitone)
- Hydrochlorothiazide (Microzide) (HCTZ)
- Metolazone (Zaroxolyn) is a thiazide-like diuretic, intermediate acting
CHM + -one + -thiazide
34
Thiazide diuretics: action and characteristics
Mechanism of action
- Acts on distal tubule to decrease reabsorption of sodium
- Results in less water reabsorption, increased diuresis
- Block Na+ reabsorption at distal tubule
- Not effective in renal failure
Indications
- Hypertension
- Edema
- Therapeutic classification: Antihypertensive
- Pharmacologic classification: Thiazide-type diuretic
35
Thiazide Diuretics: nursing implications
Pregnancy category B
Precautions
- Diabetes (thiazides can cause hyperglycemia)
Nursing Implications
- Teach patient to avoid prolonged exposure to sun and sunscreen due to potential for photosensitivity
- Thiazides can cause hypercalcemia, hyperuricemia, hyperglycemia, GOUT attacks
36
Potassium-sparing diuretics: examples
- Triamterene (Dyrenium)
- Spironolactone (Aldactone)
- amiloride (Midamor)
- Eplerenone (Inspra)
- Not as effective as others at diuresis
- Risk of hyperkalemia with renal impairment AND use of ACE-I
- Cannot use salt substitutes
SEAT + -ide + -one + -ene
37
Potassium-Sparing Diuretics: Spironolactone (Aldactone) characteristics
Mechanism of action
- Inhibits action of aldosterone in distal tubule and collecting ducts of nephron
- Sodium, chloride, and water excretion are increased
- Body retains potassium
- prevent cardiac remodeling
Therapeutic classification
- Antihypertensive
Pharmacologic classification
- Potassium-sparing diuretic/***aldosterone antagonist
38
Potassium-Sparing Diuretics: Spironolactone (Aldactone) considerations
- Pregnancy category D
Drug interactions
- Can cause hyperkalemia with potassium supplements, ACE inhibitors, ARB
- Additive hypotensive results with other anti-hypertensives
- Cannot use salt substitutes
39
Loop diuretic: examples
- Furosemide (Lasix)
- Bumetanide (Bumex)
- torsemide (Demadex)
- ethacrynic acid (Edecrin)
Usually not used for HTN, potent diuretics
Only used for renal failure for a while?
BEFT + -semide + -tanide
40
Loop Diuretics: characteristics and indications
- Powerful High doses effective even with renal failure
- Block Na+ reabsorption at loop of Henle
Indications
- Edema
- Heart failure
- Hypertension
- Pulmonary edema
41
Loop Diuretics: nursing responsibilities
- Administer early in day
- ***Cannot give IV furosemide faster the 10 mg/min
- ***Ethacrynic acid is the most likely to cause ototoxicity
- Torsemide is twice as potent
- Must monitor patient for hypokalemia
- Teach patient foods high in potassium
- Monitor fluid balance status
- Can cause metabolic alkalosis (furosemide)
- Can cause ototoxicity
42
Osmotic Diuretic: examples and characteristics
- Mannitol (Osmitrol)
- ***Raise osmolality of intravascular space pulling fluids from the extravascular space to the intravascular space
- Rarely drugs of first choice
Indications
- Increased intracranial pressure
- High intraocular pressure
- Renal failure
- May cause fluid/electrolyte imbalance
43
Osmotic Diuretic: adverse effects
- Electrolyte imbalances
- CHF
- Pulmonary edema
- Hypovolemia
- Dehydration
- Fatigue
- Nausea
- Vomiting
- Dizziness
- Convulsions
- Tachycardia
44
Carbonic Anhydrase Inhibitors: examples and characteristics
- Acetazolamide (Diamox)
- Block carbonic anhydrase at proximal tubule to inhibit reabsorption of Na+ and HCO3
- Can then absorb H ions (different from other diuretics which can make you alkalotic)
- Weak diuretic effect
- Used as adjunctive therapy when loop diuretics cause alkalosis
- Therapeutic classification: Drug for edema, anti-glaucoma agent
45
Carbonic Anhydrase Inhibitors: adverse effects
Adverse effects
- Hypokalemia
- Metabolic Acidosis (other diuretics can make you alkalotic)
46
Vasodilators: examples
- diazoxide (Hyperstat)
- hydralazine HCl (Apresoline)
- minoxidil (Loniten)
- sodium nitroprusside (Nipride, Nitropress) – break down to light, hard on kidneys
SMDH
47
Vasodilators: Mechanism of Action
- Directly relax arteriolar and/or venous smooth muscle
Results in:
- Decreased systemic vascular response
- Decreased afterload
- Peripheral vasodilation
48
Vasodilators: Indications
- Treatment of hypertension
- May be used in combination with other drugs
- Sodium nitroprusside and intravenous diazoxide are reserved for the management of hypertensive emergencies
49
Vasodilators: Adverse effects and Serious Adverse effects
Adverse effects
- Headache
- Tachycardia
- Palpitations
- Flushing
- Nausea
- Diarrhea
- Orthostatic hypotension
- Edema
Serious adverse effects
- Blood dyscrasias
- Thiocyanate toxicity with Nitroprusside
- Indications include changes in mental status, hyper-reflexia, muscle cramps, vomiting, seizures, tinnitus
