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Explain the RAAS system.
- Kidney makes Renin.
- Renin makes Angio I.
- Angio I becomes Angio II by ACE (lungs)
- Angio II is a vasoconstrictor; adrenal secretes aldosterone;
Aldosterone retains Na+/H2O--> increases fluid --> BP.
Name the exemplars (antihypertensives) and action for ACE/ARBs, BB, Ca+ channel blocker, and Diuretics (thiazide, loop, and K+ sparing)
ACE: captoril (inhibits AI-->AII by inhibiting ACE = decrease); contains Alpha 1/Alpha 2
ARBs: losartan (blocks AII from binding to its receptors on blood vessels)
BB: metoprolol (B1 & B2); selective only for B1; Non-selective for both B1 & B2.
Ca++: diltiazem; inhibits movement of Ca++ into muscles-->decreases contraction-->decreases BP.
- Thiazide: HCTZ; blocks Cl- pump in distal tubule excreting Cl- & Na+.
- Loop: furosemide; works in loop of Henle to inhibit reabsorption of Na+ & Cl-.
- K+ sparing: triamterene; weak when used alone, promotes Na+ & H2O excretion in distal tubule while retaining K+.
What are the Uses for metoprolol and diltiazem that are similar? different?
Both are used for HTN & angina.
Metoprolol is also used for controlled CHF.
diltiazem is also used for arrhythmias.
Which antihypertensive is AKA "beta blues" and why?
What are other SFX of this drug?
metoprolol; side effect of depression is common.
SFX: fatigue, impotence, diarrhea, hypoglycemia.
What is an important nursing action prior to administering metoprolol?
Check the HR (apical) if <50, hold medication and contact prescriber.
Metoprolol is selective to only which BB?
Where is this BB located?
What non-selective actions work on which BBs?
Selective only to B1.
Located in the heart.
Non-selective acts on B1 & B2. B2 receptors are located in the vascular and bronchial tree.
Why must you "taper off" antihypertensives?
Stopping the drug abruptly may cause "rebound hypertension".
What side effect of diltiazem should prompt you to tell Pts to increase fluids, fruit, and fiber?
What class of drug is diltiazem in and what is its action?
Ca++ channel blockers (CCBs). CBB prevent calcium from binding to receptors in the heart and BV walls, and vasodilation, resulting in lower blood pressure.
What are the drug-food interactions w/ diltiazem? Why?
Pt should not have grapefruit juice as this may increase effects and cause toxicity.
What are some other side effects of diltiazem?
headache, hyptension, p. edema.
What exemplar is our ACE inhibitor?
What is its action?
Action: inhibits ACE = no Angio II = Na+/H2O excreted & vasodilation = decreased BV = decreased BP.
What is captoPRIL and losARtan used for that are similar? (no major diff).
What are their contraindications that are similar? (no major diff).
HTN, CHF, diabetic neuropathy.
What is an expected side effect of captoPRIL?
What are other side effects?
a persistent dry cough.
rash, hypotension, dizziness, dyspnea
What is a similar adverse reaction with captoPRIL & losARton?
What are two other major adverse effects of losARtan?
Similar in both: angioedema.
2 major AFX: hyperKalemia, hypoglycemia.
Why should captoPRIL not be given with food?
Food decreases drug effects, therefore, take 1 hour before or 2 hours after meal.
What should you monitor (2) and assess (1) in Pts taking captoPRIL?
Monitor Pt for at least 2 hrs until BP stabilizes; electrolyte imbalance.
Assess blood reports for hyperKalemia, hypoNAtremia, & neutropenia.
What exemplar is our ARBs?
What is its action?
Action: Angio II receptor blockrs bind with Angio II receptors in vascular smooth muscle & adrenal cortex = no vasoconstriction & aldosterone = no retention of Na+/H2O = decreased BP.
What food (electrolyte) should the Pt avoid while taking this losARtan, why? What should be assessed?
What should you monitor with this Pt that's similar with captoPRIL?
What should you asses in this Pt?
K+. At risk for increase of K+ = cardiac emergency. Assess blood reports for hyperKalemia.
Monitor for hypotension w/ large doses or repeated use.
Which of the diuretics interact with captoPRIL and losARtan?
Triamterene is a K+ sparing diuretic and captoPRIL and losARtan reabsorb K+ which may put Pt at risk for hyperKalemia.