What are the primary antihypertensive agents? (5)
- Diuretics
- Beta Blockers
- Ca2+ channel blockers
- ACE Inhibitors
- Angiotensin II blockers (ARBS)
What should assess before administering Atenolol or Metoprolol?
Assess HR and BP
Sam is due for his Atenolol, but you checked his BP and HR and both are low. What is your nursing action?
Hold the atenolol
Sean is a new admit and has a prescription for Lasix, what is the best way to know the medication is working properly?
- Check his weight daily
2. Measure his input and output
What is the purpose of digoxin?
to treat HF by increasing contractility
When should you hold the prescription of digoxin?
if serum digoxin is higher than 1.8 ng/ml
While giving digoxin what is your concern?
digoxin toxicity
What are the signs and symptoms of digoxin toxicity?
- N/V
- Fatigue
- Anorexia
- Visual disturbance like seeing halos or blurring
What is the drug of choice for HTN?
hydrochlorothiazide
What kind of drug is hydrochlorothiazide?
thizade diuretic
What is your pt. teaching for thiazide?
since potassium levels decrease, advise patient to increase potassium-rich foods (shellfish, bananas, avocado, spinach)
When is the best time for a patient to take their diuretic?
daily in the morning
What does ACE inhibitor stand for?
it is angiotension-converting enzyme inhibitor
What is the MOA for ACE inhibitors?
prevents the conversion of Angiotensin I to Angiotension II, this lowers peripheral resistance and a decrease in fluid volume
What are ACE inhibitors such lisinopril, catopril, used for?
to decrease BP, and reduce blood volume
If taking lisinopril, should I encourage an increased in potassium-rich foods as part of my teaching?
No, decrease potassium because hyperkalemia is an adverse effect
If an elderly patients have HTN why are they given combination pills?
older people do not like taking taking a lot of pills
What is an example of a combination drug for HTN?
tenoritic= diuretic + B blocker
What is my concern with tenoritic?
it causes hypotension
If an older patient is taking tenoritic, what is your major concern? What is your nursing intervention?
my major concern is the pt is at risk for falls. I intervene by dangling feet prior to ambulation and having the pt get up slowly
What is Angina?
acute chest pain due to insufficient O2 to myocardium
What group of meds are given to treat angina?
Nitrates
What is the prototype for Nitrates?
nitroglycerin
What is the MOA for nitrates?
relax both arterial and venous smooth muscle; dilate coronary arteries.
** Decrease venous return which promotes dilation**
If Sara, has a nitroglycerin patch, how do I prevent tolerance?
remove the patch for 6-8 hours
If Sara is taking nitroglycerin and develops a headache which i s a common adverse effect, what can type of analgesic can I administer?
acetaminophen (Tylenol)
If Sean is taking nitrogylcerin and now wants to Viagra, do we recommend the physician he gets Viagra?
No, nitrates and viagra can not be used concurrently
What type of tachycardia do nitrates cause?
reflex tachycardia
Do nitrates cause bradycardia?
no
What is the MOA of statins?
interfere with the synthesis of cholesterol
If Lee is taking Lipitor during what SI/Sx should he call the MD?
when his skin begins to turn yellow (jaundice) liver failure
During pt teaching you teach Lee to report rhabdomyolysis, he ask you to what it is?
muscle or joint pain as result from lipitor
Kevin is beginning to take amlodipine, what is your pt teaching?
he is taking a calcium channel blocker so he can not drink grapefruit juice
What are the reasons a patient is taking an ACE inhibitor?
- HTN
- reduce diabetic neuropathy
- HF
- after an MI to reduce a re occurrence
- angina
Do ACE inhibitors fix dysrhythmias?
no
If Kevin’s Cr levels are below 6 should I give him an lisinopril?
no
What is another name for vitamin B3?
Niacin
Why would a patient be given Niacin?
decreases VLDL & LDL levels (antihyperlipidemia)
What are some side effects of taking Niacin?
- flushing
- hot flashes
- nausea
- xs gas
- diarrhea
More seriously - hepatotoxicity
- gout
If patient is experiencing flushing from taking Niacin, what can be given?
pt can take aspirin 30 mins prior
What are the side effects of Lasix?
- hyperurcemia
- hypoklaemia
- hyperglycemia
- dehydration
- dry mouth
- thirst
- weight loss
- headache - hypotension
- dizziness
- fainting
What is the MOA of Beta blockers?
decrease HR and contractility
What type of pts is a beta blocker contraindicated?
asthma pt.
What type of diuretic is Lasix?
loop
What is the MOA of Lasix?
acts on the loop of Henle preventing the reabsorption of Na+ and Cl-
Why are pts given diuretics?
- HF
- HTN
- edema
- pulmonary edema
- increase urine flow
When is the best time for a pt to take their statin?
take in the evening or at night
What type of drugs can be given with statins?
bile acid-binding resins (Sequestrants)
What is the MOA for sequestrants?
bind with bile acids to increase excretion of cholesterol in stool
What is the prototype drug for bile-acid resins?
Questran
What is the adverse effect of Questran?
GI problems (constipation and bloating)
Which 2 diseases are the most responsible for kidney failure?
diabetes and HTN
What is the antidote for heparin?
protamine sulfate
What is histamine?
chemical mediator of inflammatory response; responsible for allergy SX
What type of med is given for allergic rhinitis?
decongestants (relievers) and antihistamine (preventers)
What is the prototype drug for Antihistamines?
Benadryl
What are some side effects of Benadryl?
drowsiness, anticholinergic
What is your pt teaching for benadryl?
avoid ETHOL
no operating heavy machinery (ie driving)
What is a common type of decongestant?
Sudafed
If my pt has hypertension and I want to give him a decongestant, can I give him Sudafed?
NO
If all meds for asthma are not working for my pt, what is my last resort?
theophylline
Why is Theophylliine not typically prescribed?
narrow margin of safety (5-20 mcg/ml serum)
What is your favorite thing that is incorporated with Theophylline?
caffeine
What is type of med that inhibits coughing?
Antitussives
What do some antitussives consist of?
some consist of narcotics
If an antitussive has a narcotic, what do we know will be a side effect?
constipation
What is the MOA of antitussive?
blocks the cough reflex in the medulla
If Susan is using an MDI inhaler and you hear whistling is that okay?
No, there should be no whistling sound. they could mean she does not have her lips fully around the inhaler
When a pt with asthma is using an inhaler, how do we know it is effective?
lung sounds are clear
What type of med is used to dissolve clots?
thrombolytics
What does it mean when a drug is positive inotropic? negative?
if positive they increase heart contractility and if negative they decrease heart contractility
What does it mean when a drug is positive chronotropic? negative?
if they are positive that means it increases heart rate and if negative they decrease the heart rate
Is digoxin negative or positive inotrope? chronotrope?
positive for inotropic drug and negative for chronotropic
What is an example for a negative inotrope drug? `
metroprolol
What is a positive chronotropic drug?
dopamine
How do we know digoxin is working on a pt?
the pt become active