HTN & Congestive Heart Failure Flashcards
(69 cards)
1
Q
ACE Inhibitors Meds
A
Captopril (PO)
2
Q
Captopril Use
A
HTN, heart failure, DM nephropathy, MI
3
Q
Captopril MOA
A
- reduce levels of angiotensin II
- increase levels of bradykinin
4
Q
Captopril adverse effects
A
- hyperkalemia
- hypotension/orthostatic
- teratogen
- heart attack
- cough
- angioedema
- reduced neutrophils + granulocytes
- renal failure in pts. w/bilateral renal aa stenosis
5
Q
Captopril interactions
A
- diuretics, antihypertensives (hypotension)
- drugs that raise K+ (hyperkalemia)
- lithium accumulation
- NSAIDs
- taken w/digoxin can increase risk of hyperkalemia
6
Q
Captopril implications
A
- take first dose @bedtime to prevent orthostatic HOTN
- educate on cough - notify prescriber
- contraindicated w/pregnant + renal artery stenosis
- monitor K, CBC, urine for protein
7
Q
Angiotensin II Receptor Blockers (ARBs) meds
A
Irbesartan, Losartan
8
Q
ARBs use
A
HTN, HF, DM nephropathy
9
Q
ARBs MOA
A
block vasoconstriction effects of angiotensin II
10
Q
ARBs adverse effects
A
angioedema, renal failure, fetal injury
11
Q
ARBs implications
A
don’t cause cough or hyperkalemia
12
Q
Direct Renin Inhibitors med
A
Aliskiren
13
Q
Aliskiren use
A
HTN
14
Q
Aliskiren MOA
A
binds to renin and inhibits conversion of angiotensinogen into angiotensin I
15
Q
Aliskiren adverse effects
A
angioedema, cough, hyperkalemia, teratogenic, diarrhea
16
Q
Aliskiren implications
A
avoid high fat meals with administration - affects absorption
17
Q
Aldosterone antagonist meds
A
Eplerenone, spironolactone
18
Q
Eplerenone, spironolactone use
A
HTN, HF
19
Q
Eplerenone, spironolactone MOA
A
selective blockage of aldosterone receptors
20
Q
Eplerenone, spironolactone adverse effects
A
- hyperkalemia
- drug binding w/receptors for other steroid hormones can cause gynecomastia, menstrual irregularities, impotence, hirsutism, deepening of voice
21
Q
Eplerenone, spironolactone implications
A
- monitor potassium
- do not use in patients with renal disease or type 2 DM
22
Q
Calcium channel blockers
A
lower BP and contractility
23
Q
CCB use
A
HTN, angina pectoris, cardiac dysrhythmias
24
Q
Verapamil, diltiazem work primarily on
A
arterioles and heart
25
Verapamil, diltiazem MOA
- prevent calcium ions from entering heart mm cells and blood vessels
- vasodilation, reduced arterial pressure, increased coronary perfusion
- reduced force and HR
26
Verapamil, diltiazem adverse effects
- constipation
- bradycardia or AV block
- result of vasodilation: dizzy, flushing, headache, peripheral edema
27
Verapamil, diltiazem implications
- s/s of toxicity: severe hypotension, bradycardia, AV block, ventricular tachydysrhythmias
- antidote is IV calcium gluconate
- check HR and BP before giving
28
Amlodipine class
Dihydropyridines family of CCB
29
Amlodipine MOA
- blocks calcium channels in vascular smooth mm tissue
- lowers BP, increase HR and contractility
30
Amlodipine adverse effects
result of vasodilation: dizzy, flushing, headache, peripheral edema
31
Amlodipine implications
peripheral edema is most common side effect of vasodilation
32
Hydralazine use
essential HTN, HTN crisis, HF
32
Hydralazine is a
vasodilator
33
Hydralazine MOA
selective dilation of arterioles
34
Hydralazine adverse effects
postural hypotension, reflex tachycardia, expansion of blood volume, systemic lupus erythematosus-like syndrome
35
Hydralazine implications
- symptoms may last 6months-year
- stop drug if systemic lupus erythematous like syndrome occurs
36
Nitroprusside is a
direct acting vasodilator
37
Nitroprusside use
drug of choice for HTN crisis - potent and fast
38
Nitroprusside MOA
causes venous and arteriolar dilation by increasing blood flow to the heart
39
Nitroprusside adverse effects
excessive hypotension, cyanide poisoning
40
Nitroprusside implications
- monitor for thiocyanate toxicity by drawing cyanide levels
- must check BP frequently
41
Propranolol, metoprolol Use
MI, angina, HTN, hypertrophic cardiomyopathy, supraventricular arrythmias
42
Propranolol, metoprolol adverse effects
- hypotension, bradycardia, palpitations, hypoglycemia
- non selective: n/v, bronchospasm, impotence
43
Propranolol, metoprolol implications
- avoid in asthma and COPD patients
- monitor BP
44
Clonidine Use
HTN
45
Clonidine MOA
vasodilation, lower BP and CO
46
Clonidine adverse effects
rebound hypertension, dry mouth, sedation
47
Clonidine implications
monitor BP
48
Nursing implications for ACE Inhibitors, ARBs, and Renin inhibitors
- monitor BP closely for 2 hours after 1st dose
- obtain WBC Q2weeks for first 3 months and monitor for neutropenia (mainly w/captopril)
- target BP <140/90
- instruct to lie down if hypotensive
- warn about cough and to contact prescriber if present
- avoid K supplements unless prescribed
- warn woman of childbearing age
- angioedema - if occurs, stop ACE inhibitors and NEVER take again
- withdraw diuretics 1 week prior to starting ACE inhibitors
- minimize NSAID use - decrease effectiveness
49
Nursing implications for CCB
- if baseline BP & HR to low, withhold med, document, and notify MD
- contraindicated in pts with severe hypotension, sick sinus syndrome, and 2nd-3rd degree heart block
- use with caution if taking digoxin or beta blockers
- teach to self-monitor BP with goal of 140/90
- inform about signs of heart block (slow HR, SOB, weight gain)
- watch for ankle swelling
- increase dietary fluid and fiber
- swallow sustained-released tablets whole
50
Nursing implications for BB
- report signs of resp distress
- check pulse daily
- monitor BP regularly
- warn about masked hypoglycemia
- do not stop drug abruptly
- take oral forms with meals for better absorption
- antacids, barbiturates, anti-inflammatories, and rifampin can decrease effectiveness of BB
51
Drugs to treat CHF
captopril, losartan, diuretics, propranolol, metoprolol, digoxin
52
Thiazide diuretics
hydrochlorothiazide, moderate diuresis
53
Loop diuretics
furosemide, profound diuresis, promote fluid loss even when GFR is low
54
Potassium sparing diuretics
spironolactone, scant diuresis
55
Diuretics MOA
promote excretion of water and electrolytes by the kidneys
56
Diuretics adverse effects
- hypotension
- hyperkalemia (potassium-spring)
- hypokalemia (loop and thiazide)
- dysrhythmias when used with digoxin
57
Diuretics implications
monitor potassium, take in the morning
58
Digoxin class
Cardiac glycoside
59
Digoxin MOA
increase contractility, decrease HR
60
Digoxin Use
CHF, atrial tachycardia, atrial fibrillation
61
Digoxin adverse effects
cardiac dysrhythmias, halos around eyes, n/v, bradycardia, hypokalemia
62
Digoxin interactions
- diuretics promote loss of potassium - increased risk of dysrhythmias and toxicity
- ACE inhibitors/ARBs can increase potassium and decrease therapeutic responses to digoxin
63
Digoxin contraindications
- second or third degree heart block
- caution with renal disease, hypothyroidism, hypokalemia
64
Digoxin ranges
- normal potassium: 3.5-5
- therapeutic range: 0.5-2
- >2 is toxic
65
Draw levels of digoxin
immediately before 1st dose or 4-10 hrs after it
66
Signs of digoxin toxicity
- anorexia, n/v, halos around eyes, bradycardia, heart block, dysrhythmias
- hold medication and notify prescriber if concerned about toxicity
- low potassium increases risk of toxicity
67
If BPM is <60, digoxin
should be withheld, notify physician
68
Digoxin patient education
- avoid OTC
- eat foods high in potassium
- fresh and dry fruits, vegetables, potatoes
