Exam 2 topic 6 antihypertensive drugs Flashcards

Question

Focus nursing goals for antihypertensive therapy on educating patient, family, and/or caregiver about the critical importance of adequate management to prevent end organ damage. Goals must include?

Answer 1

- Making sure pt understands the nature of the disease, its symptoms & Tx - importance of adhering to Tx regimen - come to terms w/diagnosis as well as w/fact that there is no cure for the disease & Tx will be lifelong - emphasize influence of chronic illness & importance of nonpharmacologic therapy, stress reduction, follow-up care plan - plan for ongoing assessment of BP, weight, diet, exercise, smoking habits, alcohol intake, compliance w/therapy, & sexual function

Answer 2

``` Pressure (blood) monitor Rise slowly to reduce orthostatic hypotension Eating must be considered (diet) Stay on medications Skipping or stopping is a no-no Undesirable responses Remind to exercise, no alcohol Eliminate smoking; educate ```

Answer 3

Abruptly stop taking the medication. Inform pt's that any abrupt withdrawal is a serious concern because of risk for REBOUND HYPERTENSION (sudden & very high elevation of BP) -this places pt at risk for a cerebrovascular accident or other cerebral or cardiac AE's

Answer 4

Rebound hypertension (with abrupt withdrawal), and prevention of this through patient education is critical to pt safety

Answer 5

Their BP & pulse rate at home or have these parameters measured by a family member (NOT ones in grocery stores)

Answer 6

First-dose syncope, so, to avoid injury, advise patients to remain supine for the first dose of the drug - may take 4-6 weeks to take full effect. Educate about this delay - pt needs continuous monitoring for dizziness, syncope, edema & other AE's (SOB, exacerbation) - Diuretics are adjunctive therapy to minimize AE's of edema, may lead to more dizziness & electrolyte problems

Answer 7

Central, so AE's are often more pronounced (e.g hypotension, sedation, bradycardia, edema)

Answer 8

Careful adherence to drug regimen is critical to pt safety. - pt's taking beta blockers may experience an exacerbation of respiratory diseases such as asthma, bronchospasm, and COPD (because of increased bronchoconstriction due to beta 2 blocking) or an exacerbation of heart failure (because of drugs negative inotropic effects, i.e. decreased contractility due to beta 1 blocking) - provide clear and concise instructions about reporting AE's & instructions for taking BP & pulse rates - if beta 1 blocker causes SOB, most likely due to edema and/or exacerbation of heart failure - any dizziness, postural hypotension, edema, constipation, or sexual dysfunction needs to be reported to the prescriber immediately

Answer 9

Antihypertensives, because research studies have documented differences in responses to antihypertensives among different racial & ethnic groups

Answer 10

Adhere to both their pharmacologic and nonpharmacologic Tx regimens -monitor for AE's & toxic effects to identify potentially life-threatening complications

Answer 11

Collecting data and monitoring patients for evidence of controlled BP. - BP must maintained at values lower than parameters established by JNC or below the levels for prehypertension (120-139/80-89). If pt has diabetes mellitus or kidney disease, BP is lower - measure BP at periodic intervals - pt education about self-monitoring important - prescriber will measure fundus of the eye (changes in fundus are more reliable indicator of long-term effectiveness of Tx than blood pressure readings because changes in vasculature of the eye caused by high BP) - continually monitor pt for development of end-organ damage - Counsel and constantly monitor male pt's for complaints of sexual dysfunction

Answer 12

They are at a high risk for rebound hypertension & possible stroke or other complications

Answer 13

Improvement in BP & in the disease process - return to a normal baseline level of BP w/improved energy levels and decreased s/s of HTN (less edema, improved breath sounds, no abnormal heart sounds, capillary refill <5 seconds, less SOB) - monitor AE

Answer 14

- take as ordered - adherence to regimen/diet - pt monitor stress levels & use biofeedback, imaginary massage - avoid smoking, excessive alcohol intake/exercise, hot climates, saunas, hot tubs, hot environment (heat precipitates vasodilation & leads to worsening hypotension) - frequent lab tests - keep out of reach of children (extreme toxicity). Transdermal patches check on, dont let fall off) - medical alert bracelet (house, car, etc.) - record BP/daily weights in journal. (Weights done morning before breakfast, at same time, same amount of clothing). Report an increase in weight by 2 lbs or more over a 24-hr period or 5lbs in a week - educate to inform all health care providers (dentists, surgeon) of taking antihypertensives - careful purposeful, & cautious changing of positions encouraged due to AE of postural hypotension and associated risk for dizziness, lightheadedness, and possible fainting and falls - keep adequate supply of medications on hand - schedule periodic eye exam (Q6 months) - w/successful therapy conditions will improve, but NEVER stop abruptly. Life-long therapy - saliva substitutes, use of sugar-free hard candy/gum and forcing fluids helps with dry mouth - forcing fluids and increasing dietary fiber may help w/preventing constipation - sexual dysfunction - may lead to depression and to report any change in emotional status to the prescriber

Answer 15

- first-dose syncope, avoid conditions/situations/drugs that would exacerbate this - careful w/driving or anything involving alertness - report dizziness, palpitations, orthostatic hypotension - centrally acting alpha blockers affect sexual dysfunction inform pt of these AE's, report if problematic - transdermal patches of clonidine are applied to non-hairy areas, rotate sites. Clean off residual w/lukewarm water & thoroughly dry area

Answer 16

- move & change position slowly to avoid dizziness, fainting, and falls - report pulse rate lower than 60 beats/min, dizziness, or systolic BP of 90 or lower - prolonged sitting/standing & excessive physical exercise may lead to exacerbation of hypotensive effects, so counsel pt to avoid these activities or counteract them w/healthy practices such as pumping the feet up and down while sitting - heat may exacerbate hypotensive effects. Avoid saunaus, hot tubs, excessive heat, syncope (fainting) may result

Answer 17

Amount of blood ejected from the left ventricle and is measured in liters/min

Answer 18

Diuretics, alpha blockers, centrally acting alpha blockers, beta blockers, ACE inhibitors, vasodilators, CCBs, and ARBs

Answer 19

ACE inhibitors

Answer 20

Angina, dysrhythmias, HTN to help reduce BP by causing smooth muscle relaxation and dilation of blood vessels. If calcium is not present, the smooth muscle of the blood vessels cannot contract

Answer 21

Determining whether the patient has any underlying causes of HTN such as renal or liver dysfunction, a stressful lifestyle, Cushing's disease, Addison's disease, renal artery stenosis, peripheral vascular disease, or pheochromocytoma

Answer 22

History of MI or chronic renal disease. Cautious use is recommended in pt's with renal insufficiency or glaucoma. Drugs that interact with antihypertensives drugs include other antihypertensive drugs, anesthetics, and diuretics

Answer 23

Consume a diet low in fat, make any other necessary modifications in their diet (decrease intake of sodium and increase fiber intake), engage in regular supervised exercise, and reduce the amount of stress in lives

Answer 24

- safe and efficacious & often used as first-line drugs in Tx of both heart failure and HTN - ALL ACE inhibitors have detrimental effects on the unborn fetus and neonate - classified as pregnancy category C in first trimester & pregnancy category D in 2nd or third trimester. Only used in pregnant if there are no safer alternatives

Answer 25

- Shortest half life so dosed more frequently. This is a drawback for pt's w/history of nonadherence - on the other hand it may be best to start with this drug in a pt who is critically ill, so if problems were to arise they will be short lived - Both Captopril and Enalapril can be dosed multiple times a day - Captorpil and Lisinopril are the ONLY two ACE inhibitors that are NOT prodrugs. This characteristic is important advantage in treating a pt w/liver dysfunction - minimizing or preventing left ventricular dilation and dysfunction (Ventricular remodeling) that can arise in acute period after an MI and thereby improve pt's survival - also reduce risk for heart failure

Answer 26

Drug that is inactive in its administered form and must be metabolized to its active form in the body, generally by the liver, to be effective

Answer 27

- Both Captorpil and Enalapril can be dosed mult. X/day - ONLY ACE inhibitor available in oral and parenteral forms - parenteral form: active drug, offers the hemodynamic benefit of inhibiting ACE activity in an acutely ill pt who can't tolerate oral medications. Doesn't require cardiac monitoring - oral form differs from captopril in that it is a prodrug, pt must have functioning liver - improve chance of survival after MI and reduces incidence of heart failure

Answer 28

Inhibit angiotensin-converting enzyme (responsible for converting angiotensin I, formed through action of renin, to angiotensin 2). AII is a potent vasoconstrictor & induces aldosterone secretion by adrenal glands. Aldosterone stimulates sodium and water resorption, which raises BP. Together these processes are referred to as the renin-angiotensin-aldosterone system. By inhibiting this process, BP is lowered.

Answer 29

Cardiovascular and renal - Cardiovascular effects: due to their ability to reduce BP by decreasing systemic vascular resistance (SVR). Do this by preventing breakdown of vasodilating substance bradykinin and substance P, and preventing formation of AII. These combined effects decrease afterload, or the resistance against which the left ventricle must pump to eject volume of blood during contraction - beneficial in Tx of heart failure: prevent sodium and water resorption by inhibiting aldosterone secretion. This eases diuresis, which decreases blood volume and return to the heart. This in turn decreases preload, or the left ventricular end-diastolic volume, & work required of heart

Answer 30

Antihypertensives and adjunctive drugs for Tx of heart failure - used alone or combination w/other drugs such as diuretics in Tx of HTN or heart failure - can stop progression of left ventricular hypertrophy (seen after MI), known as ventricular remodeling (cardioprotective effect) - decrease morbidity & mortality in pt's w/heart failure - drugs of choice for hypertensive pt's w/heart failure - have protective effect on the kidneys, they reduce glomerular filtration pressure. So good for diabetic pt's - reduce proteinuria, standard therapy for diabetic pt's to prevent the progression of diabetic nephropathy

Answer 31

- known drug allergy, previous reaction to angioedema (larygeal swelling) to an ACE inhibitor - pt's w/baseline potassium level of 5 mEq/L or higher may not be suitable candidates because they can promote hyperkalemia - lactating women, children, pt's w/bilateral renal artery stenosis

Answer 32

Major CNS effects include: fatigue, dizziness, mood changes, HA - Dry nonproductive cough that is reversible with discontinuation of the therapy - first-dose hypotensive effect can cause significant decline in BP - loss of taste, hyperkalemia, angioedema, renal impairment - in pt's w/severe heart failure whose renal function may depend on the activity of the renin-angiotensin-aldosterone system, Tx w/Ace inhibitors promote potassium resorption in the kidney, so serum potassium levels must be monitored regularly, especially w/concurrent therapy w/potassium-sparing diuretics

Answer 33

Most pronounced symptom is HYPOTENSION - tx is symptomatic and supportive and includes administration of IV fluids to expand blood volume - hemodialysis is effective for the removal of captopril and lisinopril

Answer 34

NSAIDs such as ibuprofen can reduce the antihypertensive effect of ACE inhibitors - use of NSAIDs and ACE inhibitors may predispose pt to development of acute renal failure - concurrent use of ACE inhibitors and other antihypertensive or diuretics can have hypotensive effects - giving lithium and ACE inhibitors together can result in lithium toxicity - potassium supplements and potassium-sparing diuretics, when administered w/ACE inhibitors may result in hyperkalemia - monitor serum potassium levels

Answer 35

- Assess BP, apical pulse rate, and respiratory status (because AE of dry, hacking, chronic cough) - take BP readings immediately before initial and subsequent doses of drug so extreme fluctuations id'd early - assess serum potassium, sodium, chloride levels - tests of baseline cardiac functioning - due to potential AE's of neutropenia, assess CBC BEFORE and DURING therapy

Answer 36

- Goals focused on education about importance of adequate management to prevent end-organ damage - Tx lifelong - Don't abruptly stop taking medications>rebound hypertension

Answer 37

- take as prescribed - contact prescriber if angioedema occurs - wean off drug to avoid rebound HTN - monitor serum sodium/potassium levels during therapy - serum potassium levels increase as AE resulting in hyperkalemia - Impaired taste=AE can last 2-3months - takes several weeks to see therapeutic effects - DON'T take potassium supplements

Answer 38

- known drug allergy - pregnancy - lactation - use w/caution in older adults and in patients w/renal dysfunction - BP & apical pulse rate assessed BEFORE & DURING drug therapy

Answer 39

Chest pain, fatigue, hypoglycemia, diarrhea, UTI, anemia, weakness -hyperkalemia & cough less likely to occur than with the ACE Inhibitors

Answer 40

Overdose may manifest as hypotension and tachycardia; bradycardia occurs less often -Tx is symptomatic and supportive, includes administration of IV fluids to expand the blood volume

Answer 41

- NSAIDs - lithium - rifampin - potassium supplements and potassium-sparing diuretics * can promote hyperkalemia, especially when taken concurrently with potassium supplements (happens less frequently than with ACE) - monitoring of serum potassium level is necessary for all patients

Answer 42

- Beneficial in patients w/HTN & heart failure - contraindicated in pt's who are hypertensive to any component of this product - use w/caution in pt's w/renal artery stenosis - breastfeeding women DON'T take because it can cause serious AEs on nursing infant

Answer 43

Several indications and have many beneficial effects and relatively few AEs - primary use for tx of HTN and angina - effectiveness in Tx HTN related to ability to cause smooth muscle relaxation by blocking the binding of calcium to its receptors, thereby prevents contraction - due to their effectiveness/safety they are added to list of first-line drugs for HTN - also effective antidysrhythmics - sometimes used in Tx of Raynaud's disease and migraine HA - used in combination w/other drugs

Answer 44

Most commonly used for HTN

Answer 45

Accelerate the rate of urine formation via a variety of mechanisms. The result is the removal of sodium and water from the body. -first-line drugs in Tx of HTN

Answer 46

- Cause direct arteriolar dilation, which decreases peripheral vascular resistance - reduce extracellular fluid volume, plasma volume, & cardiac output, which accounts for decrease in BP

Answer 47

-relatively low coast and favorable safety profile

Answer 48

Metabolic adverse effects that can result from excessive fluid and electrolyte loss. Usually dose related & controllable with dosage titration (careful adjustment)

Answer 49

Kidney, they exert their effect in the nephron

Answer 50

Loop diuretics, followed by mannitol, metolazone (a thiazide-like diuretic), the thiazides, and the potassium-sparing diuretics

Answer 51

Where they work in the nephron to inhibit sodium and water resorption -the more sodium and water they inhibit from resorption, the greater the amount of diuresis and therefore the greater the potency

Answer 52

Chemical derivatives of sulfonamide antibiotics - Inhibit activity of the enzyme carbonic anhydrase, found in the kidneys, eyes, and other parts of the body - work at the location of the carbonic anhydrase enzyme system along the nephron, primarily proximal tubule

Answer 53

Carbonic anhydrase system in the kidney is located distal to glomerulus in the proximal tubules, where 2/3 of all sodium and water is resorbed into blood - in proximal tubules, there is an active transport system that exchanges sodium for hydrogen ions. For sodium and water to be resorbed back into blood, hydrogen must be exchanged, w/out hydrogen this can't occur, & sodium/water will be eliminated w/urine - carbonic anhydrase makes hydrogen ions available for this exchange. When its actions are inhibited, little sodium and water can be resorbed into blood and they are eliminated w/urine - CAIs reduce formation of hydrogen and bicarbonate ions from carbon dioxide and water through noncompetitive, reversible inhibition of carbonic anhydrase activity - results in reduction in the availability of the ions, mainly hydrogen, for use by active transport systems - reduction in the formation of bicarbonate and hydrogen ions can have effects on other body parts

Answer 54

Respiratory and metabolic acidosis. Both respiratory and metabolic acidosis can increase oxygenation during hypoxia by increasing ventilation, cerebral blood flow, & dislocation of oxygen from oxyhemoglobin -These actions beneficial to pt -

Answer 55

Elevation of blood glucose level and glycosuria in diabetic pt's. May be due in part to CAI-enhanced potassium loss through urine

Answer 56

- Tx of glaucoma, edema, high-altitude sickness - used as adjunct drugs in long-term management of open-angle glaucoma that CAN'T be controlled by topical miotic drugs or epinephrine derivatives alone - When CAIs given, an increase in outflow of aqueous humor results - also for short term in conjunction w/miotics to lower intraocular pressure in preparation for ocular surgery and as an adjunct in Tx of secondary glaucoma

Answer 57

- Manage edema secondary to heart failure that has become resistant to other diuretics - as a class, CAIs less potent diuretics than loop diuretics or thiazides, & because of metabolic acidosis they induce, their effectiveness diminishes in 2-4 days - effective in both the prevention and Tx of the symptoms of high-altitude sickness (HA, nausea, SOB, dizziness, drowsiness, and fatigue)

Answer 58

- known drug allergy - hyponatremia, hypokalemia - severe renal or hepatic dysfunction - adrenal gland insufficiency - cirrhosis

Answer 59

- Metabolic abnormalities such as acidosis and hypokalemia - drowsiness - anorexia - paresthesias - hematuria - urticaria - photosensitivity - melena (blood in stool)

Answer 60

Since they can cause hypokalemia, an increase in digoxin toxicity may occur when combined w/digoxin - use w/corticosteroids may cause hypokalemia - effects of amphetamines, carbamazepine, cyclosporine, phenytoin, & quinidine may be increased when taken concurrently w/CAIs

Answer 61

250-500 mg/day, may be given orally or IV

Answer 62

- Contraindicated in pt's w/hypersensitivity to is as well as in those w/significant liver or kidney dysfunction, low serum potassium or sodium levels, acidosis, or adrenal gland failure - oral and parenteral forms - pregnancy category C

Answer 63

- Baseline breath/heart sounds, neurologic status, skin turgor (for edema), moisture levels of mucus membranes, capillary refill - vital signs, weights, I&O measurements (because fluid volume levels & electrolyte concentrations are affected by them) - assess postural BP (lying, standing, sitting) BEFORE & DURING drug therapy because of diuretic-induced fluid volume loss possibly precipitating postural or orthostatic hypotension - postural or orthostatic hypotension=drop in BP of 20 mm Hg or more upon standing - assess specific lab values associated w/renal and hepatic functioning (BUN, Creatinine level, ALP/AST, LDH for hepatic function) - Serum electrolyte levels BEFORE & DURING therapy - obtain/document serum potassium, sodium, chloride, Mg, Calcium, uric acid, creatinine levels - ABGs

Answer 64

- Close assessment of sodium & potassium levels - DON'T give to pt's w/history of renal or liver dysfunction - as w/any diuretic resulting in potassium loss (excluding potassium sparing diuretic), if these drugs are given concurrently w/digoxin, there is an increased risk for digoxin toxicity because of the hypokalemia

Answer 65

- Measure/record BP, pulse rate, I&O, daily weights during therapy - Changes from initial baseline assessment that alert you to possible problems w/drug therapy include: presence of dizziness, fainting, lightheadedness on standing or changing positions, weakness, fatigue, tremor, muscle cramping, changes in mental status, or cold, clammy skin - diuretic therapy may precipitate cardiac irregularities or palpitations; therefore monitor HR and rhythm - fluid loss from action of diuretic may lead to AE of constipation, so preventive measures needed, such as increased I&O of fluids and fiber and/or use of natural bulk-forming products - give as directed - dosing & timing of drugs important to enhance therapeutic effects & minimize AEs - if taken in late afternoon or evening may lead to nocturia & subsequent loss of sleep, usually scheduled for morning - safety concerns exist with nocturia because of possible confusion and dizziness

Answer 66

Resolution of or reduction in edema, fluid volume overload, heart failure, HTN, or return to normal intraocular pressures

Answer 67

- Monitor pt for occurrence of AEs (hypotension, electrolyte imbalance, metabolic acidosis, drowsiness, hypokalemia, tachycardia, hyperkalemia - hypokalemia may manifest by anorexia, nausea, lethargy, muscle weakness, mental confusion, hypotension

Answer 68

Nutritional Intake and fluid volume and eat potassium-rich foods, except when contraindicated or when potassium-sparing diuretics are used. -Foods high in potassium include bananas, oranges, apricots, dates, raisins, broccli, green beans, potatoes, tomatoes, meats, fish, wheat bread, legumes

Answer 69

Symptoms that patient presents and the serum levels. Normal serum potassium levels are 3.5-5 mEq/L

Answer 70

At the beginning of and during therapy w/diuretics. These tests may include measurement of electrolytes, uric acid, blood gases

Answer 71

Slowly and to rise slowly after sitting or lying to prevent dizziness and possible fainting (syncope)

Answer 72

Dehydration and minimize constipation. Increased consumption of fiber may also help with constipation

Answer 73

Excessive dizziness, syncope, weakness, or muscle aches, need to be reported immediately to the prescriber

Answer 74

- Alpha 2 receptor is located in the post ganglionic sympathetic nerve endings - when stimulated, it INHIBITS the release of norepineprine thus leading to a decrease in BP - Thus A2 Receptors LOWER BP

Exam 2 topic 6 antihypertensive drugs Flashcards

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