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Exam 4 Brainshark Notes
Antihypertensives
Beta blockers – end in “lol” (e.g propranolol)
- Assess blood pressure and pulse (apical for 1 minute)
- hold for SBP <100 and pulse <
- Can cause orthostatic hypotension (safety considerations!)
- Can cause bronchospasms (careful with asthma or wheezing pts)
- Can cause drowsiness/sedation
- Can cause sexual dysfunction Impotence
- Educate on not stopping abruptly and s/s of heart failure!
Alpha Blockers –
used primarily for hypertension
- assess for blood pressure
Peripherally acting alpha 1 blockers – used primarily for BPH (“zosin” meds)
- evaluate effectiveness by ability to urinate
- assess blood pressure
ACE inhibitors – end in “pril”*** SAFETY***Slowly getting up
- given for hypertension and as renal protection for diabetic patients. Also given for heart failure.
- A/R = dry, non-productive cough, hyperkalemia, angioedema
- N/I = it’s teratogenic! So not for pregnant women
- assess blood pressure, potassium, and renal function
- I need to drink at least 4 quarts of water daily. -Give the medication one hour before meal Give Tylnol if there is any pain. Angiotensin II receptor blockers – end in “artan”
- A/R = teratogenic, hypotension, Upper respiratory infection
- N/I = assess blood pressure (no effect on pulse)
Calcium Channel Blockers – ones ending in “pine” are for HTN
- Diltiazem – given for atrial fibrillation, stable chronic angina, HTN
- check baseline renal and liver function
- assess blood pressure and pulse
- no grapefruit juice
Diuretics – hydrochlorothiazide – given for HTN (hypertension)
- check electrolytes especially magnesium , check bp
- cross sensitivity with sulfa meds
Vasodilators – hydralazine – given for HTN
- can cause B6 deficiencies
- nitroprusside – given in ICU for HTN crisis
- can cause hypotension (must watch bp)
Antianginals
Nitrates – Nurse implication = assess bp (decreases), causes vasodilation (so avoid alcohol, extreme
heat)
- Nitroglycerin – routes = IV - pump, glass bottle, special filter tubing (check bp!) = SL – teach them how to administer and that they may feel a burning sensation = topical – take patch off at night, wear gloves if ointment
- Adverse reaction = headache (can take Tylenol) & hypotension
- contraindicated with ED meds-rectal disfunction
- Isosorbide = oral - is a controller taken daily! Nitro is a reliever except for the nitro patch which is a controller.
Nitroglycerin teaching – if anginal pain occurs:
- stop activity and sit, take a sublingual tablet
- if no relief in 5 minutes, call 911 and take second tablet
- if no relief in 5 minutes, take a third sublingual tablet
- do not try to drive to the hospital Nitroglycerin -adverse effect low blood pressure Nitroglycerin immediate effect- headache ?Nitroglycerin-take 3 tablet, 5 minutes, call 911 after first dose
Heart Failure meds
Nesiritide and milrinone – both IV meds, have to be on a pump
- assess bp
- Milrinone – can cause ventricular arrhythmias
Digoxin – given for heart failure and atrial fibrillation
- assess apical pulse for 1 min. Blood pressure
- hold pulse for < 60 seconds
- assess potassium levels (hypokalemia can lead to digoxin toxicity)
- TR for digoxin = 0.5 – 2ng/mL
Anticoagulants
- do not break existing clots! Only used to prevent formation of new clots for people at risk of stroke, PE, or DVT.
- all carry an increased risk for bleed
Warfarin – only oral
- teratogenic – pt is given heparin sq instead
- lab check is PT/INR (TR = 2-3 seconds)
- reversal is vitamin K or fresh frozen plasma (for quicker reversal) (spinach)
- monitor foods high in vitamin K (tomatoes, dark leafy green vegetables, mayo, organ meats) anticoagulation
- full therapeutic effect takes several days – first dose changes blood levels in 48hrs
- stop meds 1 week before invasive procedures b/c of long half-life of warfarin
You cant take Ecotrin (enteric-coated aspirin) with Warfin Warfarin- administer therapeutic (normal) range 2.0 – 3. Warfarin therapy-prothrombin time/INR Warfarin therapy – client need further instruction when he takes aspirin 4 times a day Warfarin with INR 3.
Heparin – monitored by activated partial thromboplastin times (aPTTs) (➔Piriority assessment for
Heparin)
- parenteral (IV or sq – only given in abdomen, do not aspirate)
- short half-life (1-2 hours)
- effects reversed by protamine sulfate(== heparin antidote)
- aPTTs TR = 50 - 80 seconds, also assess platelets, hct, and hgb (will show volume loss) -©?aptt level of 30.
- A/R = bleeding, heparin-induced thrombocytopenia (HITS)=decrease in platelets by 50% of their baseline
Enoxaparin – low molecular weight heparin
- only given sq (subcutaneously)
- has an air bubble that you need to inject into pt © allow time for the client to demonstrate injection
- protamine sulfate is antidote for excessive anticoagulation with enoxaparin -A syringe that has a small ⅝-inch needle is used to administer the injection."
Thrombolytics - TPA-medication - tissue plasminogen activator, Clot busters! For existing clots.
- educate clients on risk for bleed priority
- no venipuncture for 24 hours or invasive procedure or any other meds effecting coagulation
- t-PA (super clot buster) given IV
Antifibrinolytics
- Given for hemophilia (promotes coagulation)
- gives pt whatever clotting factor they’re missing
- A/R = related to transfusion reactions of the factor they’re missing
Antihyperlipidemic meds
HMG-CoA inhibitors – end in “statin”
- assess liver and cholesterol levels
- give in evening (that’s when liver makes cholesterol)
- A/R = rhabdomyolysis (check creatinine kinase levels - bipriduct of skeletcal muscle product), liver damage
Bile Acid Sequestrants – cholestyramine – dry powder (must mix with water)
- give hour before meals or 4-6 hours after
- all drugs must be taken 1 hour before or 4-6 hours after the administration of bile acid sequestrants
- high doses of bile acid sequestrant decrease the absorption of fat-soluble vitamins A D K E
- do not give with GI obstructions (it stops absorption of cholesterol)
Niacin – vitamin B3 – can cause flushing (take with low dose aspirin)
- turns urine bright yellow Fibric Acid Derivatives – primarily affect triglycerides
- watch liver and kidney function
- cannot take with HMG-CoA reductase inhibitors
Herbal meds for hyperlipidemia = garlic & omega 3s (both increase risk for bleeding. They interact with anticoagulants)
Diuretics
Thiazide diuretics – end in “thiazide”
- given primarily for HTN
- watch magnesium, potassium, and sodium
- assess blood pressure
- no black licorice (increases hypokalemia) ** Hypokalemia, hyperglycemia, sulfa allergy
Loop diuretics – end in “emide” (e.g furosemide?)
- 60 years or older: systolic blood pressure (SBP) of greater than 150 mm Hg or diastolic blood pressure (DBP) greater than 90 mm Hg
- Younger than 60 years and those who have chronic kidney disease or diabetes: SBP greater than 140 and DBP greater than 90 Steps To Treat Hypertension Step 1: Lifestyle modifications are instituted Step 2: If the measures in step 1 are not sufficient, drug therapy is added Step 3: If the client’s response is inadequate, drug dose or class may be changed or another drug added Step 4: Includes all of the above measures with the addition of more antihypertensive agents until blood pressure is controlled
Adrenergic Medications: Beta Blockers
- High incidence of orthostatic hypotension
- Most common o Bradycardia with reflex tachycardia o Dry mouth o Drowsiness , sedation o Constipation o Depression o Edema o Sexual dysfunction
Beta blockers
o Reduce BP by reducing heart rate through beta1 blockade o Cause reduced secretion of renin o Long-term use causes reduced peripheral vascular resistance o End in “lol” o © Metoprolol: assess apical pulse for one minute
Adrenergic Medications: Alpha Blockers
- Used to treat hypertension o Treatment of hypertension, either alone or with other drugs o Usually used after other drugs have failed because of adverse effects Clonidine is useful in the management of withdrawal symptoms in opioid-dependent persons
Peripherally Acting Alpha1 Blockers
Doxazosin, prazosin, and tamsulosin- “zosin” or “losin” Block alpha1-adrenergic receptors
When alpha1-adrenergic receptors are blocked, BP is decreased. Dilate arteries and veins Alpha1 blockers also increase urinary flow rates and decrease outflow obstruction by preventing smooth muscle contractions in the bladder neck and urethra. Tamsulosin is not used to control BP but is indicated solely for symptomatic control of BPH.
ACE Inhibitors
- End in “pril”
- Indications o Hypertension o HF (either alone or in combination with diuretics or other drugs) o Slow progression of left ventricular hypertrophy after myocardial infarction (MI) (cardioprotective) o Renal protective effects in clients with diabetes ACE Inhibitors: Adverse Effects
- Fatigue
- Dizziness
- Headache
- Mood changes
- Impaired taste
- Possible hyperkalemia
- Dry, nonproductive cough, which reverses when therapy is stopped
- Angioedema: rare but potentially fatal
- Teratogenic- do not use in pregnant women
- Note: First-dose hypotensive effect may occur.
Angiotensin II Receptor Blockers
o Also referred to as angiotensin II blockers or ARBs o Well tolerated o Do not cause a dry cough o End in “artan” o Allow angiotensin I to be converted to angiotensin II, but block the receptors that receive angiotensin II o Block vasoconstriction and release of aldosterone o © Valsartan: asses blood pressure
Antihypertensive Drugs 22
- A patient has a new order for the adrenergic drug doxazosin (Cardura). When providing education about this drug, the nurse will include which instructions? a. "Weigh yourself daily, and report any weight loss to your prescriber."
The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a newly diagnosed hypertensive African-American patient would most likely include which drug or drug classes? a. Vasodilators alone b. ACE inhibitors alone c. Calcium channel blockers with thiazide diuretics d. Beta blockers with thiazide diuretics ANS: C The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential nursing diagnosis for the patient taking antihypertensive medications? a. Diarrhea b. Sexual dysfunction c. Urge urinary incontinence d. Impaired memory ANS: B A patient's blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside (Nipride) drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long? a. 10 minutes b. 30 minutes c. 1 hour d. 24 hours ANS: A
A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. Which answer by the nurse is the correct response?
a. "This therapy will take about 3 months." b. "This therapy will take about a year." c. "This therapy will go on until your symptoms disappear." d. "Therapy for high blood pressure is usually lifelong." ANS: D
A patient who has been taking antihypertensive drugs for a few months complains of having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?
a. Beta blockers b. Angiotensin-converting enzyme (ACE) inhibitors c. Angiotensin II receptor blockers (ARBs) d. Calcium channel blockers ANS: B
A pregnant woman is experiencing hypertension. The nurse knows that which drug is commonly used for a pregnant patient who is experiencing hypertension? a. Mannitol (Osmitrol) b. Enalapril (Vasotec) c. Hydrochlorothiazide (HydroDIURIL) d. Methyldopa (Aldomet) ANS: D A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the main reason for prescribing this class of drug for this patient? a. Cardioprotective effects b. Renal protective effects c. Reduces blood pressure d. Promotes fluid output ANS: B The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class? a. Calcium channel blockers b. Diuretics c. Nonsteroidal anti-inflammatory drugs d. Nitrates ANS: C An older adult patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug? a. Dry mouth b. Restlessness c. Constipation d. Hypotension ANS: D When teaching a patient about antihypertensive drug therapy, which statements by the nurse are correct? (Select all that apply.) a. "You need to have your blood pressure checked once a week and keep track of the readings." b. "If you notice that the symptoms have gone away, you should be able to stop taking the drug." c. "An exercise program may be helpful in treating hypertension, but let's check with your doctor first." d. "If you experience severe side effects, stop the medicine and let us know at your next office visit." e. "Most over-the-counter decongestants are compatible with antihypertensive drugs." f. "Please continue taking the medication, even if you are feeling better."
The nurse is assessing the patient's knowledge regarding drug therapy prescribed for the treatment of hypertension. Which statement by the patient indicates the need for further teaching by the nurse? A. "I will move slowly from a sitting to standing position." B. "Blood pressure drugs can cause changes in sexual functioning."
The nurse is conducting a community education program. When explaining different medication regimens to treat hypertension, it would be accurate to state that African Americans probably respond best to which combination of medications? A. Diuretics and calcium channel blockers B. ACE inhibitors and diuretics C. Diuretics and beta blockers D. ACE inhibitors and beta blockers
What is the classification of carvedilol (Coreg)? A. Beta blocker B. ACE inhibitor C. Alpha2 blocker D. Dual-action alpha1 and beta receptor blocker
When administering nitroprusside (Nipride) by continuous intravenous infusion, the nurse monitors for which symptom of drug toxicity? A. Wheezing B. Hypotension C. Fever D. Hyperglycemia
A patient who is prescribed tamsulosin (Flomax) does not have a history of hypertension. The nurse knows this medication is also used for what condition? A. Migraine headache B. Pulmonary emboli C. Subarachnoid hemorrhage D. Benign prostatic hyperplasia (BPH)
ACE inhibitors and ARBs both work to decrease blood pressure by which action? A. Enhance sodium and water resorption B. Increase the breakdown of bradykinin C. Prevent the formation of angiotensin II D. Prevent aldosterone secretion
When teaching a patient about a new prescription for carvedilol (Coreg), the nurse explains that this medication reduces blood pressure by which action? (Select all that apply.) A. Decreases heart rate B. Promotes excretion of sodium C. Relaxes muscle tone D. Peripheral vasodilation E. Increases urine output A + D
4 stages based on BP
**1. normal
- prehypertension
- stage one hypertension
- stage two hypertension**
drug categories
**1. adrenergic
- angiotensin converting enzyme (ACE) inhibitors
- angiotensin II receptor blockers (ARBs)
- calcium channel blockers (CCBs)
- diuretics
- vasodilators**
MOA of adrenergic (alpha II receptor agonists)
**1. stimulate alpha II receptors in brain
- decrease sympathetic outflow
- decrease norepi. production
- stimulate alpha II receptors thus reducing renin activity in kidneys
- decreased BP**
MOA of alpha blockers
**1. block alpha I receptors
- result: decreased BP**
MOA of beta blockers
**1. reduce BP through beta I blockade
- cause reduced secretion of renin
- reduced peripheral vascular resistance
- result: decreased BP**
MOA of dual-action alpha I + beta receptor blockers
**1. vasodilation (alpha I blockade)
- reduction of HR (beta I blockade)
- result: decreased BP**
MOA of ACE inhibitors
**1. inhibit ACE, which is responsible for converting angiotensin I --> angiotensin II
- angiotensin II is a potent vasoconstrictor + causes aldosterone secretion from the adrenals**
MOA of ACE inhibitors cont'd
**1. aldosterone stimulates water + sodium resorption
- result: increased blood volume, increased preload + increased BP**
D. “Avoid taking these medications with grapefruit juice.”
A client asks how to apply transdermal nitroglycerin. What is the nurse’s best response? A. “Always apply the transdermal patch over the area of your chest where your heart is.” B. “Keep the previous patch on for one full day so you always have 2 patches on at a time.” C. “Apply the patch to hairless areas of the body.” D. “First apply Vaseline to your body, then apply the transdermal patch.”
A client is receiving digoxin 0.25 mg/day as part of treatment for HF. The nurse assesses the client before medication administration. Which assessment finding would be of most concern? A. Apical heart rate of 58 beats/min B. Ankle edema +1 bilaterally C. Serum potassium level of 2.9 mEq/L D. Serum digoxin level of 0.8 ng/mL
The nurse is preparing to administer a first dose of an ACE inhibitor medication to a patient who is also being treated with lithium. What result should the nurse anticipate that from the interaction of the two drugs? A) Toxic level of lithium B) Decreased level of lithium C) Toxic level of the ACE inhibitor D) Decreased level of the ACE inhibitor
A patient has developed toxicity while receiving lisinopril. What action should the nurse expect to implement? A) Administer aspirin. B) Insert a Foley catheter. C) Send the patient for hemodialysis. D) Administer potassium chloride intravenously.
The health care provider prescribes a sodium nitroprusside intravenous infusion to manage a patient's blood pressure of 230/120 mm Hg. Which action(s) should the nurse implement before starting the infusion? A) Evaluate the electrocardiogram. B) Perform a neurologic assessment. C) Assess oxygenation and ventilation. D) Obtain an intravenous infusion pump. E) Draw baseline serum electrolyte levels. F) Assess the patient for peripheral edema.
A patient with heart failure and hypertension is being treated with a positive inotrope and an angiotensin-converting enzyme (ACE) inhibitor. Despite pharmacotherapy, the patient develops pulmonary edema. The patient is adherent to pharmacologic and nonpharmacologic management of the
disease processes. Which action should the nurse take if the patient refuses to take additional medication? A) Instruct the patient to reduce dietary sodium. B) Ask the patient to perform a 24-hour dietary recall. C) Suggest the patient drink diuretic beverages such as tea. D) Collaborate with the health care provider to find a combination ACE inhibitor and diuretic. The nurse demonstrates knowledge of use of calcium-channel blockers (CCBs) for management of hypertension by making which statement to the patient? A) "CCBs promote excretion of water." B) "CCBs block reabsorption of sodium." C) "CCBs increase blood return to heart." D) "CCBs relax vascular smooth muscle."
The nurse is caring for a patient with hypertension who is prescribed a clonidine transdermal patch. What should the nurse teach this patient? A) "Change the patch daily at the same time." B) "Remove the patch before taking a shower or bath." C) "Get up slowly from a sitting to a standing position." D) "Do not take other antihypertensive medications while using this patch."
Which effect indicates that a patient is experiencing an adverse effect of enalapril? A) Persistent dry mouth B) A dry, hacking cough C) Serum potassium of 4.2 mEq/L D) Serum sodium of 147 mEq/L A middle-aged male patient started antihypertensive drug therapy 3 months ago and is in the health care provider's office for a follow-up visit. While the nurse is taking his blood pressure, he informs the nurse that he has had some problems with erectile dysfunction. Which would be the most appropriate response by the nurse? A) "Don't worry. Eventually, tolerance will develop." B) "The physician can work with you on changing the dose or medications." C) "Sexual dysfunction happens with this therapy, and you will learn to accept it." D) "This is an unusual occurrence, but it is important to stay on your medications." When giving antihypertensive medications, the nurse should plan to administer a first dose at bedtime for which drug? B) Doxazosin
The nurse administers clonidine. What finding indicates the medication is therapeutic? C) Blood pressure decrease from 150/100 mm Hg to 110/70 mm Hg
A patient with coronary artery disease and diabetes mellitus has resistant hypertension despite therapy with benazepril. Which antihypertensive agent should the nurse avoid administering to this patient?
D) Diazoxide F) Hydralazine A nurse is caring for a patient who is taking an angiotensin-converting enzyme inhibitor and develops a dry, uncomfortable, nonproductive cough that has persisted for several weeks. What is the nurse's priority action? A) Call the health care provider to switch the medication. What assessment finding indicates a patient is having an adverse effect of adrenergic drug therapy for hypertension? A) Heart rate of 40 beats/min The nurse administers lisinopril to a hypertensive patient with heart failure. Which parameter should the nurse evaluate to determine the therapeutic effectiveness of lisinopril in this patient? B) Breath sounds The nurse is administering minoxidil to a patient. What should the nurse anticipate administering if toxicity is suspected? B) Intravenous fluids What should the nurse teach the patient to ensure patient understanding of pharmacologic therapy for hypertension? D) "Blood pressure is a product of cardiac output and vascular resistance." A patient with hypertension receives ramipril and consequently develops a potassium level of 5. mEq/liter. Which medication when administered concurrently with ramipril can improve the patient's metabolic condition? D) Hydrochlorothiazide
The nurse is administering amlodipine. What assessment finding requires immediate action? D) Blood pressure of 80/60 mm Hg The nurse is caring for an adult male patient who is hypertensive and is being treated with transdermal clonidine patches. Which is the most appropriate site for the patient to use in applying the patches? D) Upper arm The health care provider's prescription reads: Administer hydralazine 1.25 mg/kg/day. The child weighs 22 pounds. How many mg/day should the nurse plan to administer? Round your answer to the nearest tenth. 12.5 mg/day Which comment by the patient indicates understanding about the use of enalapril for treatment of hypertension? D) "If I develop a chronic cough, I need to notify my health care provider."
The nurse is caring for several patients who are all being treated for hypertension. Which patient will the nurse assess first? D) A patient who has stopped taking a beta blocker because of cost
The nurse is teaching the patient why hypertension must be treated. What information should be included in the teaching plan? A) "Hypertension is a risk factor for stroke." D) "Hypertension is a risk factor for heart failure."
E) "Hypertension is a risk factor for cardiovascular disease."
The nurse administers candesartan to a patient. Which patient assessment finding should the nurse use as a clinical indicator of therapeutic effectiveness of the medication? D) Blood pressure of 120/72 mm Hg A patient is prescribed a nonselective beta blocker. What nursing intervention is a priority for this patient? A) Respiratory assessment When teaching a patient about the drug atenolol, what information should the nurse include in the teaching plan? B) "Do not stop the medication abruptly." A patient taking adrenergic drugs for hypertension is being given discharge teaching about the therapy. What information should be included in this teaching plan? D) "Do not drink alcohol when using this therapy." Which is an appropriate nursing intervention for a patient who is taking hydrochlorothiazide? A) Encourage intake of foods rich in potassium. A patient receiving the adrenergic medication clonidine reports experiencing constipation. What should be included in the plan of care for this patient? C) Increase the amount of fruits and vegetables in the diet. D) Inform the patient that this is a common adverse effect of the medication. E) Discuss incorporation of psyllium-based products in the plan of care with the health care provider. A patient has been receiving a sodium nitroprusside infusion for the last 4 days for management of severe hypertension. Based on the duration of therapy, what is most essential for the nurse to evaluate? A) The serum cyanide level A patient has a new prescription for an angiotensin-converting enzyme (ACE) inhibitor. During a review of the patient's list of current medications, which medication(s) should alert the nurse for a possible interaction with this new prescription? B) Spironolactone, 25 mg by mouth daily C) Ibuprofen, 400 mg by mouth twice daily E) Potassium chloride, 20 mEq by mouth daily A community health nurse is providing education on clonidine to an elderly patient during a home visit. Which adverse effect should be emphasized as most concerning to this patient? C) Hypotension A patient is receiving transdermal clonidine. What information does the nurse need to include in the teaching plan? B) "Remove the old patch before applying the new patch." The nurse is caring for a patient who is hypertensive and has liver dysfunction. The nurse should anticipate that the patient will most likely be placed on which antihypertensive drug? D) Captopril The nurse is reviewing a medication history for a patient taking captopril. The nurse should contact the health care provider if the patient is also taking which medication? B) Spironolactone A patient taking methyldopa is found to have liver disease. What is the best action by the nurse? B) Notify the health care provider.
