HTN & HLD drug matrix

Question 1

hydrochlorothiazide MOA

Answer 1

works on distal convoluted tubule to inhibit resorption of Na/K+/Cl -> results in decreased cardiac output and increased water loss
also decreases PVR

Question 2

hydrochlorothiazide side effects

Answer 2

hypokalemia + lyte abnormalities
-orthostatic hypotension
-hyperuricemia
-may worsen renal insufficiency
-can elevate levels of glucose, cholesterol & tags

Question 3

hydrochlorothiazide nursing considerations

Answer 3

-watch out for pt’s w/ gout
-give K+ sups & encourage K+ rich foods (potatoes, spinach, kale, beans, tomatoes, banana, avocado)

Question 4

Furosemide MOA

Answer 4

inhibit the kidney’s ability to reabsorb Na in the loop henle -> more Na in urine which water will follow and increase urine output
water pills

Question 5

Furosemide side effects

Answer 5

hypokalemia + lyte abnormalities
-dehydration
-hypotension
-ototoxicity

Question 6

Furosemide nursing consideration

Answer 6

-monitor K+ levels (usually give a sup)

Question 7

Spironolactone MOA

Answer 7

block the action of aldosterone -> K+ retention & excretion of Na & H2O

Question 8

Spironolactone side effects

Answer 8

-hyperkalemia
-endocrine effects (deepened voice, period and erectile, hirsutism)

Question 9

Spironolactone nursing considerations

Answer 9

-usually given w/ other diuretics
-only given PO

Question 10

metoprolol/propranolol/carvedilol MOA

Answer 10

-increases nitric oxide = vasodilation
-blocks stimulation of beta 1 receptors = decreases HR and contractility

Question 11

metoprolol/propranolol/carvedilol side effects

Answer 11

bradycardia
hypotension
-fatigue/lethargy

Question 12

metoprolol/propranolol/carvedilol nursing considerations

Answer 12

-can mask hypoglycemia
-wean when discontinuing to avoid rebound HTN
-hold & call if HR <60 or systolic is <100

Question 13

propranolol/carvedilol additional nursing considerations

Answer 13

do not give to pt’s w/ lung conditions or asthma d/t blocking of beta 2 receptors in the lungs

Question 14

clonidine MOA

Answer 14

decrease sympathetic outflow resulting in decreased stimulation of adrenergic receptors (alpha & beta)

Question 15

clonidine side effects

Answer 15

-drowsiness (give at night, v common)
-rebound HTN
-may worsen pre existing liver disease

Question 16

clonidine nursing consideration

Answer 16

wean when discontinuing

Question 17

doxazosin MOA

Answer 17

selective alpha 1 blockage (directly blocks SNS & decreases PVR) -> venous & arterial dilation

Question 18

doxazosin side effects

Answer 18

-hypotension
-dizzinesss

Question 19

doxazosin nursing considerations

Answer 19

only use after other meds have failed

Question 20

captopril/lisinopril MOA

Answer 20

blocks ACE -> inhibits angiotensin 2 & aldosterone secretion (vasodilation & less water retention)

Question 21

captopril/lisinopril side effects

Answer 21

dry, non productive cough
angioedema w/ racial disparity
-first dose hypotension
-dizziness
-rash

Question 22

captopril/lisinopril nursing considerations

Answer 22

do not give to pregnant women
-renal insufficiency so use caution w/ renal disease
-hyperK+ risk (esp on K+ sups)
-often give w/ thiazide diuretics

Question 23

captopril additional nursing consideration

Answer 23

can cause neutropenia -> monitor WBC

Question 24

losartan MOA

Answer 24

blocks the action of angiotensin 2 after it is formed

Question 25

losartan side effects

Answer 25

**usually well tolerated** -angioedema w/o racial disparities

Question 26

losartan nursing considerations

Answer 26

-do not give to pregnant women **requires contraception use** -use cautiously w/ renal pts

Question 27

aliskiren MOA

Answer 27

direct inhibition of renin (induces vasodilation, decrease blood volume & SNS and inhibitors cardiac & vascular hypertrophy)

Question 28

aliskiren side effects

Answer 28

**well tolerated** -GI discomfort -hyperK+ when given w/ ACE (esp in DM pts)

Question 29

aliskiren nursing considerations

Answer 29

-do not give to pregnant women -takes several weeks to see full effect due to half life

Question 30

nifedipine/nicardipine MOA

Answer 30

blocks calcium access to cells causing a decrease in contractility & conductivity of heart (vasodilation of smooth muscles & peripheral arterials)

Question 31

nifedipine/nicardipine side effects

Answer 31

**peripheral edema** **orthostatic hypotension** -bradycardia -headache -abdominal discomfort -AV block

Question 32

nifedipine/nicardipine nursing considerations

Answer 32

**best for elderly and African Americans** -can give diuretics for peripheral edema

Question 33

hydralazine MOA

Answer 33

vasodilator works directly on arterial and venous smooth muscles causing relaxation (decreases systemic & peripheral resistance)

Question 34

hydralazine side effects

Answer 34

-hypotension -dizziness, headache, tachycardia, edema, dyspnea, GI upset

Question 35

hydralazine nursing considerations

Answer 35

can be given with isosorbide to treat heart failure in African Americans

Question 36

what drug class can you not give to pregnant women

Answer 36

-ACE -ARBs -Renin inhibitors

Question 37

what drug classes do you need to watch for renal pts

Answer 37

-ACEs -ARBs -Thiazide Diuretics

Question 38

statins MOA

Answer 38

inhibits HMG-CoA reductase -> less cholesterol is produced & more LDL receptors are produced to pull cholesterol out of the blood (also stabilizes plaque & decreases inflammation)

Question 39

statins effect on levels

Answer 39

LDL: 21-63% decrease HDL: 5-22% increase TAGs: 6-43 decrease

Question 40

statins side effects

Answer 40

myopathy -> rhabdomyolysis (breakdown of muscle fibers & acute kidney failure) -hepatotoxicity

Question 41

statin nursing considerations

Answer 41

-2 wks to take effect -take w/ food -avoid drugs & alcohol

Question 42

additional nursing considerations for simvastatin & rosuvastatin

Answer 42

take at night d/t short half life since chol is highest at night

Question 43

ezetimibe MOA

Answer 43

blocks absorption of cholesterol in the jejunum (dietary chol)

Question 44

ezetimibe nursing considerations

Answer 44

-not as effective as statins d/t dietary chol -take w/ statin -2nd line

Question 45

nursing considerations before giving HLD meds

Answer 45

-fasting lipid panel -ALT levels -CK levels (rhabdo) -consider secondary causes

Question 46

what are other meds to treat HLD

Answer 46

-bile acid sequestrants -niacin -fibric acid derivative -fish oil

Question 47

what drugs have a risk of hyperkalemia

Answer 47

-potassium sparing diuretics -ACEs -Renin Inhibitors