Pharm 180: Cardiovascular Medications affecting Blood Pressure
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What is the drug classification for cardio medications that end in "pril" such as:
enalaprilat (Vasotec IV)
ACE Inhibitors (angiotesin-converting enzyme)
What would the nurse include in educating the patient who is taking ACE inhibitors?
To avoid foods that are high in potassium
WHat would a nurse include in her patient teaching to a patient taking ACE inhibitors?
that diuretics, alcohol use and Beta blockers enhance Hypotension
What lab tests would a nurse monitor with a patient taking ACE inhibitors?
CBC + potassium serum levels
What are some of the adverse effects seen with patients taking ACE inhibitors?
- goosey cough,
- chest pain,
- hypotension, neutropenia, agrnulocytosis
What is the main adverse effect seen with patients taking ACE inhibitors?
Where does the action of ACE Inhibitors take place in the body?
in the lungs
WHy is ACE Inhibitors the preferred anti-HTN medication for CHF + Diabetic patients?
It protects the kidneys
What is the expected action of ACE Inhibitors
- produces their effects by blocking the conversion of angiotensin I to angiotensin II (RAS system)
- --inhibits breakdown of bradykinin (vasodilator)
what actions result from the conversion of angiotensin I to angiotensin II is blocked
- -vasodilation of the arterioles
- -excretion of Na + water
- -retention of potassium via in the kidneys
- -reduction in pathological changes in blood + heart (result from presence of angiotensin II and aldosterone)
What are all the therapeutic uses of ACE Inhibitors?
HTN, Heart failure, MI, Diabetic + Non-diabetic nephropathy
Why would a nurse administer ramipril to a patient who may be at high risk for a cardiovascular event?
Can be administered to prevent an MI, stroke or death
What adverse effect would a nurse expect to find in a patient who has just taken their first dose of an ACE inhibitor?
--ace inhibitors act to decrease the patients BP, and increase the pulse rate
What are the adverse effects of ACE Inhibitors?
Cough, Hyperkalemia, Rash, dysgeusia(altered taste), angioedema (swelling of tongue+oral pharynx), neutropenia
What adverse effects would a nurse expect from a patient who is currently taking Captopril?
rash + dysgeusia (altered taste)
Neutropenia is a rare effect but is a serious adverse effect
What intervention would the nurse implement on a patient who is currently taking a diuretic and is about to start taking ACE inhibitor medication?
The nurse would hold the diuretic medication temporarily for 2-3 days from the patient who is about to start taking ACE inhibitor
A patient who is taking other anti-HTN medications concurrently with ACE inhibitors would
increase the hypotensive effects of a ACE inhibitor
What would a nurse instruct the patient who is taking an ACE inhibitor to do?
- --to change positions slowly
- --to lie down if feeling dizzy, lightheaded, or faint feeling.
How long would the nurse monitor the patient's blood pressure who has just taken his first dose of an ACE inhibitor medication?
(start treatment with a low dose)
The patient who started taking an ACE inhibitor to treat her HTN tells the nurse that she has been experiencing a dry cough. What intervention would the nurse do next?
Call the patients doctor to report cough and request to d/c the medication
The patient who started taking captopril to treat her HTN informs the nurse that she has developed a rash and has noticed that her taste has been altered. What intervention would the nurse do next?
the nurse would inform the HCP and would request that the medication be d/c
--patients symptoms would stop once the medication has been d/c
The nurse assesses a patient taking captopril and notices that the patient's tongue and oral pharynx is swollen. What immediate intervention would the nurse do next?
Administer epinephrine shot via subQ + call the HCP and request the medication be stopped.
The nurse who is caring for a patient with renal failure who is currently taking captopril just received lab results showing low neutrophil serum levels, which is a rare serious adverse effect. What should the nurse do?
The nurse should call the HCP and request a D/C order for the medication.
--symptoms will stop as a result
What are the main signs of infection experienced from a patient with renal failure who is taking an ACE inhibitor?
fever + sore throat
(patient is at high risk for developing neutropenia)
Why should a nurse worry about administering an ACE inhibitor to a patient with a history of allergies/angioedema, bilateral renal artery stenosis, or who only have 1 kidney?
ACE inhibitors are contraindicated to those types of problems
What medication is known to contribute to a patients first dose Hypotension?
Diuretics, a nurse should advise patient to temporarily hold the medication for 2-3 days before starting ACE inhibitor treatment
Whys should a patient change or adjust the dosage to other anti-HTN medications if ACE inhibitors are added to her treatment regimen?
Anti-HTN medications may have an additive hypotensive effect
WHat is the rationale behind monitoring a patients lithium serum levels while taking ACE inhibitors?
ACE inhibitors can increase levels of Lithium (Eskalith) and cause toxicity.
What effect does NSAIDS have on a patient who is taking ACE inhibitors concurrently?
It may decrease the anti-HTN effects of the ACE inhibitors and should avoid concurrent use
Which is the only ACE inhibitor that is admin via IV ?
enalapril (Vasotec IV)
ACE inhibitors may be taken by itself or may be used in combination with what other medication?
Hydrochlorothiazide, a thiazide diuretic that blocks reabsorption of salt and chloride + water
works on the early distule tubule in the kidney
When should the nurse advise the patient to take captopril medication ?
1 hour before meals
What is the classification for cardiac medication that end in "sartan"
cardiac meds that end with "sartan" are Angiotensin II Receptor Blockers aka ARBs
Name examples of ARBs aka angiotensin II receptor blockers
- losartan -- Cozaar (prototype)
How does ARBs act on the cardiovascular system?
- By blocking the action or effects of Angiotensin II in the body but allows the conversion of angio II which results in:
- --vasodilation in arterioles
- --excretion of Na + water
- --retention of potassium
What are the 5 therapeutic uses for ARBs?
- Heart Failure
- Prevention of death following M.I.
- Prevention of Stroke
- Delay progression of diabetic nephropathy
What is the major difference between ARBs + ACE inhibitors? (adverse effects)
Cough + hyperkalemia are not adverse effects seen in ARBs
What are the common adverse effects of Valsartan and Losartan medication?
- nasal congestion
What are the adverse effects of a patient who just took her first dose of Losartan?
What type of contraindications are involved with ARBs?
clients who have renal stenosis when present bilaterally or in a single remaining kidney.
Why would a nurse advise a patient currently taking losartan, to adjust anti-HTN medications if ACE inhibitors are added to treatment regimen?
Other Anti-HTN medications may have an additive effect when used with ARBs
Should ARBs be taken by itself or in combination with another drug>
both, can be taken alone or with hydrochlorothiazide, a diuretic.
What is the drug classification for Aldactone (spironolactone) or Inspra (eplerenone) ?
What is the expected action of Aldosterone Antagonists?
reduce blood volume by blocking aldosterone receptors in the kidney, promoting excretion of Na + water.
What are the therapeutic uses for Aldosterone Antagonists ?
HTN + Heart Failure
What are some of the Adverse Effects of Aldosterone Antagonists?
- Hyperkalemia + Hyponatremia
- Flu-like m/f + fatigue, Headache, Mild GI m/f
What patient teaching would the nurse include if the patient who is taking aldosterone antagonist medication and c/o having dizziness?
do not operate machinery or drive until rxn is known
What contraindications does Aldactone have?
- should not be given to patients with:
- --hyperkalemia, kidney impairment, type 2 diabetes with albuminuria (albumin in blood)
what types of medications may increase the risk of hyperkalemia when taken with aldactone? (5)
Verapamil, ACE inhibitors, ARBs, erythromycin + ketoconazole
What supplements would you advise patient not to take with Aldactone ?
Do not take medication with potassium supplements
What is the drug classification for nifedipine (Adalat, Procardia)
--Calcium Channel Blockers
- vermapamil (Calan)
- diltiazem (Cardizem)
- amlodipine (Norvasc)
- nicardipine (Cardene, Cleviprex)
what are the select prototypes for Ca channel blockers?
nifedipine (Adalat), verapamil (Calan), diltiazem(Cardizem)
What is the action of Ca Channel Blockers?
- blocks the Ca influx into the cardiac + smooth muscle cells which results in:
- -Decreased Contractility
- -vasoconstriction (dilates coronary arteries + arterioles)
what is the expected action of verapamil + diltiazem?
- block calcium channels in blood vessels leading to:
- ---------vasodilation of peripheral arterioles and arteries/arterioles of the heart.
- blocks calcium channels in the myocardium, SA node, AV node leading to:
- --------decreased force of contraction, heart rate, and slowing rate of conduction thru AV node.
What is the site of action of Verapamil and Diltiazem?
act on arterioles of the peripheral + heart at therapeutic doses
veins are not significantly affected
what is the site of action of nifedipine (dihydropyramidine)
acts primarily on arterioles in the peripheral + the heart
veins are not significantly affected
what is the expected action of nifedipine?
- blocks calcium channels in blood vessels which -leads to vasodilation of peripheral arterioles +
- -arteries/arterioles of the heart.
what is the expected action of nondihidropyridines (ca channel blocker)
decrease heart rate, contractility, and afterload
Why is verapamil, and diltiazem used alone for anti-anginal effects or with nitrates ?
to block or reduce reflex tachycardia caused by nitrate
Nefidipine is a dihydropyrimidine that is used to treat
Angina Pectoris and HTN
which ca channel blocker is used for: angina pectoris, HTN, and Cardiac dysrhythmias such as atrial fibrillation, atrial flutter, and Systolic ventricular tachycardia?
verapamil and diltiazem aka nondihydropyrimidines
what signs and symptoms would a nurse be worried about in a patient taking verapamil?
acute toxicity resulting in hypotension, bradycardia, AV block, and Ventricular tachydysrhythmias.
Why would the nurse monitor vital signs and ECG for a patient taking diltiazem or verapamil?
patient is at risk for having dysrhythmias where the QRS complex is widened + QT interval is prolonged
A nurse assesses a patient with bradycardia and heart failure. What would the nurse teach the patient to monitor?
- to observe patient for suppression of the cardiac function --> slow pulse rate + activity intolerance
- notify HCP if symptoms occur
- medication may be d/c
A patient who is admitted to the hospital for suppression of cardiac function (bradycardia + heart failure). What intervention should the nurse do for this patient?
monitor the patients ECG, pulse rate, and heart rhythm.
What would the nurse instruct the patient taking Verapamil who c/o feeling light headed and dizziness?
- instruct patient about the signs of postural hypotension which could be minimized by getting up slowly
- sit or lie down if occurs
what would the nurse instruct the patient who is taking diltiazem who c/o peripheral edema
- instruct the patient to observe swelling in the lower extremities
- notify HCP if it occurs
- (diuretic may be prescribed to control edema)
a patient taking nifedipine is on med surge floor and a nurse is performing an assessment and observes that the patient is having reflex tachycardia. What intervention should the nurse implement first?
admin a beta blocker such as metoprolol (lopressor) which will counteract the tachycardia resulting in lowering patients heart rate.
a patient who is showing signs of acute toxicity resulting in hypotension, bradycardia, AV block and Ventricular tachydysrhythmias.
what should be the first intervention that the RN implements?
admin norepineprine, calcium, isoproterenol, lidocaine, and IV fluids
have equipment for cardioversion + cardiac pacer available
What would prompt the nurse that a patient is experiencing acute toxicity?
gastric lavage + cathartic may be indicated
What would the nurse monitor on a patient with orthostatic hypotension + peripheral edema?
monitor the patients BP, edema + weight daily
what complications or adverse effects are involved with Verapamil and Diltiazem?
- Orthostatic Hypotension + Peripheral Edema
- Constipation (verapamil)
- Bradycardia + Heart Failure
- acute toxicity
What complications or adverse effects are involved with nifedipine?
reflex tachycardia, peripheral edema, and acute toxicity
why are verapamil and diltiazem good at decreasing vasospasms in the smooth muscles?
It blocks the vascular smooth muscle cell Calcium influx
Why should a patient who is taking calcium channel blockers stay clear of beta blockers?
it causes cardiac depression
What type of action do dihydropyridines (ca channel blocker)?
vasodilates but has no cardiac-depressant actions
what are the main adverse effects that a nurse should monitor a patient who is taking nondihydropyridines?
- edema--> diltiazem
- constipation --> verapamil
which calcium channel blocker medication causes refelx tachycardia?
its common with dihydropyridines b/c it has no cardiac depressant effects of its own.
Which Calcium channel blocker is the #1 prescibed heart medication?
what other adverse effects would the nurse monitor on a patient taking Ca channel Blockers?
headache, dizziness, bradycardia, orthostatic hypotension
what would the nurse include in her patient teaching on a patient who is being discharged + given a prescription of calcium channel blockers?
to use embolytic support stockings to prevent blood clots + emolisms
--to avoid hot baths or shower b/c it can cause hypotension
what would a nurse advise a client who is taking verapamil and c/o constipation?
to increase fiber and fluid intake
what would a nurse advise a patient taking ca channel blockers to report symptoms of ?
agranulocytosis which includes:
-Rapid onset of fever, chills, jaundice, weakness, or sore throat.
-Mouth sores, Bleeding gums.
what would the nurse teach to patient taking calcium channel blockers regarding orthostatic hypotension?
to rise slowly from sitting or lying position
when is the best time to take Calcium channel blockers?
at bedtime to decrease the chances of the patient experiencing hypotensive effect
what would the nurse advise the patient taking calcium channel blockers not to do when taking the medication?
do not chew or crush sustained release tablets
When administering verapamil via IV to a patient. How should the nurse deliver medication?
slowly over a period of 2 to 3 mins
What would the nurse advise the patient who is taking a calcium channel blocker and c/o angina pectoris?
record pain frequency, intensity, duration, and location
notify HCP if atacks increase in frequency, intensity, and duration
what contraindication involving nifedipine should a nurse assess a patient for before administering the medication?
hold the medication: if patient has history of M.I, unstable angina, aortic stenosis, shock and intestinal obstruction.
what contraindication should the nurse monitor the patient for before administering verapamil?
if patient is has a heart block, digoxin toxicity, severe heart failure, and during lactation.
Which patients should the nurse be cautious about giving calcium channel blockers to?
older adults who may have kidney, liver problems, or mild to moderate heart failure and GERD
what should the nurse advise the patient to avoid while taking nifedipine?
to avoid grape fruit juice b/c it can lead to toxicity
What should the nurse teach the patient about taking verapamil with digoxin?
verapamil can increase digoxin levels above 2 ng/ml increasing the risk of toxicity due to its additive effect which can further intensify AV conduction suppression of the heart
what intervention should the nurse implement with a patient who is taking Verapamil and digoxin concurrently?
monitor v/s for bradycardia, av block (reduced ventricular rate)
monitor digoxin levels to maintain therapeutic levels of .5 - 2 ng/ml
When taking verapamil (Calan) via IV and beta blockers, how long should the nurse allow after administering ca channel blocker?
2 hours, to avoid risk of heart failure, av block and bradycardia.
both calcium channel blockers and digoxin slow the heart rate and decrease the blood pressure
What type of anti-HTN medication ends in "lol"
what is the drug classification for
doxazosin mesylate (Cardura),
alpha1 agonist blockers
which type of patient should the nurse withhold giving prozosin (alpha agonist?
patient who has a hypotension
use caution with patients with angina pectoris, renal insufficiency, and in older adults
What teaching should the nurse include when discussing admin of prozosin?
medication can be given with food
what signs and symptoms would a nurse monitor a patient who is taking prazosin (alpha1 agonist blocker) with other anti-HTN medications?
dizziness, lightheadedness, and faintness
anti-HTN medications can have an addivtive hypotensive effect
patient should lie down if symptoms occur and to change position slowly
when should the nurse administer first dose of prozosin (minipress) to a patient?
at night or bedtime
what intervention would the nurse implement when caring for a patient taking doxazosin mesylate?
- start treatment with low dose
- monitor BP for 2 hours after starting treatment
- instuct patient to avoid activities requiring mental alertness for the first 12-24 hours
which other anti-HTN medications taken with alpha 1 blockers result in either increase or decrease of effect?
beta blockers and calcium channel blockers
which alpha1 blockers cause decrease pressure on urethra?
Hytrin (trazosin) + Cardura (dazosin mesylate)
Which alpha1 blocker is not used for blood pressure mgmt?
which alpha-1 blocker is used to treat BPH?
- Hytrin or trazosin
- Cardura (doxazosin mesylate)
Which alpha-1 blocker is used to treat a patient with an enlarged prostate?
Cardura or doxazosin mesylate
What would the nurse teach regarding the adverse effects of starting (1st dose) treatment with prazosin (alpha1 blocker)?
first dose will cause orthostatic hypotension (syncope) especially at the beginning of therapy
What is the therapeutic uses of Alpha1 Blockers (sympatholytics)?
treats primary HTN
- doxazosin + terazosin can be used
- --decrease m/f of Benign Prostatic Hyperplasia (BPH):
- ------urgency, frequency + dysuria
what is the expected action of the Cardura (doxazosin mesylate)?
- selective alpha1 blockade result in
- ---venous and arterial dilation
- ---smooth muscle relaxation of the prostatic capsule and bladder neck
How does alpha adrenergic act on the brain?
- acts in the cardiovascular centers of the brain to decrease sympathetic outflow.
- leads to decrease cardiac contractility and decreased vasoconstriction
What are the adverse effects of clonidine, alpha agonist ?
dizziness, drowsiness, orthostatic hypotension
What should the nurse advise the patient about abruptly stopping clonidine?
taper in order to prevent severe rebound HTN
What would the nurse include in her patient teaching with a client who is taking clonidine(prn)?
drowsiness effect will diminish over 4-6 week of taking the medication
what should nurse advise patient who is taking prozosin, Hytrin, or Cardura (alpha1 agonist blocker)?
safety measures to minimize the results of orthostatic hypotensive--> dizziness
which alpha agonist is administered as a patch to a patient PRN as needed
What is the drug classification for
doxazosin mesylate (Cardura),
what is the expected action of alpha agonist blockers?
blocks the sympathomimetic-induced vasoconstriction in + at the arterioles
What is the drug classification of
clonidine (Catapres), and methyldopa(Aldamet)
What is the name of the drug classification for alpha2 agonists that act within the CNS?
- Centrally Acting Alpha2 Agonists which include
- clonidine (Catapres), guanfacine HCL (Tenex), and methyldopa (Aldomet)
WHat is the expected action of the (centrally acting) alpha2 agonist
act w/in the CNS to decrease sympathetic outflow that results in decreased stimulation of the adrenergic receptors (alpha+beta) of the heart + peripheral vascular system.
What action does the decrease in sympathetic outflow to the myocardium cause your heart muscle cells to do?
Decrease in your HR (bradycardia) + decrease in your cardiac output (CO) --> Lowers contractility
your increased HR can weaken your cardiac muscle over time + cause your heart to enlarge which ultimately can result in Heart failure
what action does the Decreased sympathetic outflow to the peripheral vasculature cause your blood vessels to do?
vasodilation --> decreased BP
what is the centrally acting Alpha-2 agonists therapeutic uses?
to treat primary HTN (alone, w/diuretic, w/ another anti-HTN agent)
to treat severe cancer pain (parenterally via epidural infusion)
What are the Central acting alpha agonists other 4 uses under investigation?
- migraine headache
- flushing from menopause (older female)
- MGMT of ADHD
- MGMT of s/s from alcohol, tobacco + opioids
What adverse effects would the nurse monitor on a patient who just started taking clonidine (catapress)?
drowsiness + sedation
what teaching would the nurse include with a patient taking Catapress (clonidine)?
to avoid activities that require mental alertness until m/f subside
A patient who has been taking a centrally acting alpha-2 agonist for 1 week called the nurse and c/o dry mouth. What would the nurse advise the patient to do?
- chew gum or suck on hard candy
- sip small amts of water or ice chips
reassure the patient that his symptoms of dry mouth with resolve in 2-4 weeks.
what would the nurse include in his teaching plan for a patient with a doctors order for clonidine (catapress)?
- abruptly stopping the medication could lead to rebound HTN.
- --clonidine should be d/c gradually over 2-4 days
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