Quiz 5 Diuretics & Antihypertensives

ACE inhibitors

-pril MOA: prevent formation of Angiotensin II, which is a powerful vasoconstrictor and stimulator of aldosterone --> works in LUNGS common complaint of DRY COUGH indication: htn (esp. in Pts @ risk for renal disease) drug effects 1. vasodilation (decrs afterload) 2. excretion of Na+ and H2O (decrs preload) 3. renal protective captopril (Capoten)

consequences of htn

if left untreated: stroke HF RF CAD, PVD

ARB reactions

Similar to ACE I except for cough (do not interfere with bradykinin) Hypotension Angioedema Hyperkalemia

ARBs (angiotensin II receptor blockers)

-sartan MOA: blcok binding of angiotensin II to receptors, which blocks vasoconstriction and aldosterone formation indication: antihypertensive for those who can't tolerate ACEI due to cough!!! drug effect: vasodilation of arterioles & veins decreases afterload losartan (Cozarr)

CCB Pt education

1. change positions slowly 2. avoid hazardous activities while dizzy 3. incrs fluid & fiber intake to prevent constipation unless otherwise instructed by provider nurse: monitor VS

drug classes that treat htn

1. diuretics 2. drugs that supress RAAS: ACE inhibitors and ARBs 3. antiadrenergic drugs: beta blockers, alpha/beta blockers 4. calcium channel blockers (CCB) 5. direct-acting vasodilators

4 categories of diuretic drugs

1. loop diuretics 2. thiazide diuretics 3. osmotic diuretics 4. postassium-sparing diuretics

kidney functions (3)

1. maintenance of extracellular volume & composition 2. maintenance of acid-base balance 3. cleansing of ECF, excretion of metabolic wastes and foreign substances

A patient is taking enalapril. The nurse understands that patients taking this type of drug for heart failure needs to be monitored carefully for a. Hyperkalemia b. Hypertension c. Hypokalemia d. Hypernatremia

A

A patient is taking gentamicin (Garamycin) and furosemide (Lasix). The nurse should counsel this patient to report which adverse effect? a. Ringing in the ears b. Headaches c. Urinary retention d. Frequent nocturia

A

The nurse is caring for a patient admitted with chronic obstructive pulmonary disease (COPD), angina and hypertension. While administering the prescribed daily dose of propranolol 80 mg PO, the nurse assesses the patient carefully. Which adverse effect is this patient at risk for, given the patient's health history? a. Bronchospasm b. Tachycardia c. Nausea and vomiting d. Sleep apnea

A

While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk for the development of hypertension is a. Excessive sodium and alcohol consumption b. A consumption of a high protein diet c. Low calcium diet d. A family history of hypertension

A

When providing teaching to a client taking verapamil (Calan) for control of hypertension, which of the following should the nurse include? a)Increase the amount of dietary fiber in the diet b)Drink at least one glass of grapefruit juice each day c)Decrease the amount of calcium in the diet d)Withhold food for 1 hr after the medication is taken

A Constipation is a side effect of verapamil. Increasing dietary fiber can help prevent constipation. Clients should avoid drinking grapefruit juice when taking verapamil because concurrent use can lead to toxicity. There is no restriction on calcium intake when taking verapamil. There is no restriction regarding food intake after taking verapamil.

Which of the following are adverse effects of ACE inhibitors? (MARK ALL THAT APPLY) a. Hyperkalemia b. Neutropenia (low WBC's) c. First dose hypertension d. Cough

A, C, D

A nurse is teaching a patient who will begin taking verapamil (Calan) for hypertension about the drug's side effects. Which statements made by the patient indicates understanding of the teaching? a. I may experience a rapid heart rate as a result of taking this drug b. I may become constipated so I should increase fluids and fiber c. I may have swelling of my hands and feet, but this will subside d. I may need to increase my digoxin dose while taking this drug

B

A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally and the potassium level is 6 meq/L. what diuretic agent ordered by the prescriber should the nurse question? a. Bumetanide (Bumex) b. Spiranolactone (Aldactone) c. Hydrochlorothiazide (HydroDiuril) d. Furosemide (Lasix)

B

A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic and a beta blocker for... the clinic for evaluation. As part of the ongoing assessment of the patient, the nurse will expect the provider to request a. Maximal exercise capacity b. Serum electrolyte levels c. Complete blood count d. Ejection fraction

B

A client has a new prescription for spironolactone (Aldactone). Which of the following laboratory values should the nurse recognize as a reason to hold the morning dose of this medication and notify the provider? a)Serum sodium 148 mEq/L b)Serum potassium 5.2 mEq/L c)Serum creatinine 1.2 mg/dL d)Serum chloride 106 mEq/L

B The nurse should not administer spironolactone, a potassium-sparing diuretic, if the serum potassium is higher than 5.0 mEq/L. A serum sodium of 148 mEq/L is elevated, but this would not be a contraindication to giving the medication. The serum creatinine and serum chloride levels are within expected reference ranges.

1. The nurse admits a 73 year old male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication? a. Metoprolol (Lopressor) b. Hydralazine c. Bumetanide (Bumex) d. Spironolactone (Aldactone)

C

A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol (Osmitrol). The nurse knows that this is given to a. Restore extracellular fluid b. Redue renal perfusion c. Reduce intracranial pressure d. Reduce peripheral edema

C

A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats per minute, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. The nurse will contact the provider to request an order for which medications? a. ACE inhibitor b. Digoxin (Lanoxin) c. Furosemide (Lasix) d. Spiranolactone (Aldactone)

C

loop diuretic CI and adverse effects

CI: ESRD, anuria a/e: severe dehydration, hypotension, hypokalemia, ototoxicity (ringing in ears), hyperglycemia, hyperuricemia interactions: Digoxin

A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching? a. Beta blockers decrease heart rate and contractility b. Beta blockers decrease peripheral vascular resistance c. Beta blockers decrease the release of renin d. Beta blockers block the actions of angiotensin II

D

A patient is taking a vasodilator that relaxes smooth muscles in veins. To help minimize drug side effects, the nurse... patient will: a. Warn the patient about the possibility of bradycardia b. Tell the patient to report shortness of breath c. Encourage the patient to increase fluid intake d. Caution the patient not to get up abruptly

D

A provider has ordered captopril (Capoten) for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril (Vasotec) in the past. Which action by the nurse is correct? a. Administer the captopril and monitor for adverse effects b. Request an order to administer fosinopril instead of captopril c. Reassure the patient that this is not a serious side effect d. Hold the dose and notify the provider

D

potassium-sparing diuretics

MOA: blocks action of aldosterone in distal nephrone; preventss aldosterone from exchanging K+ for Na+ counteractss potassium-wasting effect of more powerful diuretics - little diuresis effect indications: freq. combined w/ thiazide & loop diuretics (htn, HF management, etc) spironolactone (Aldactone)

Thiazide diuretics

MOA: blocks reabsorp. of Na+/Cl- in early segment of DCT - retention of Na+ in nephron causes H2O retention --> 10% of filtered NaCl is reabsorbed indication: HTN hydrochlorothiazide (HydroDiuril, HCTZ)

Calcium Channel Blockers (CCB)

MOA: prevents influx of Ca2+ across cell membrane of vascular smooth muscle drug effects: dilation of peripheral & coronary arteries & arterioles = decrs afterload indicationL hypertension, angina, cardiac dysrhythmias 1. diiltiazem (Cardizem) 2. nifedipine (Procardia) 3. verapamil (Calan)

osmotic diuretics

MOA: promotes diuresis by creating osmotic force w/in nephron that inhibits passive reabsorp. of H2O - little effect on electrolytes greater amnt of mannitol in nephron = greater the diuresis (5-25%) indications: 1. cerebral edema --> reduce ICP 2. prevention of RF Mannitol (Osmitrol) IV only --> only given inpatient!! very potent, only used for short period of time

direct acting vasodilators

MOA: works directly on arteriolar and venous muscles to cause relaxation - won't affect heart or lower HR = good for Pt with low HR indication: managing htn emergencies caution: BP must be brought down SLOWLY hydralazine (Apresoline) short half-life

htn and CKD

Treatment of hypertension in patients with chronic kidney disease (CKD) should include an ACE inhibitor (ACEI) or an angiotensin receptor blocker (ARB) to improve kidney outcomes ACEI or ARB

Angioedema is a serious adverse effect of ACE inhibitors and ARBs. Which of the following are true of angioedema? (MARK ALL THAT APPLY) a. Once this occurs, the patient should never take this drug again b. Life-threatening c. Peripheral edema, especially in the lower extremities d. Swelling of the tongue and oral pharynx

a, b, d

potassium sparing diuretics a/e and interactions

a/e 1. hyperkalemia if used ALONE 2. gynecomastia 3. menstrual irregularities interactions ACE inhibitors, ARBs --> both are potassium-sparing blood pressure meds! can cause dangerous hyperkalemia

Non-dihydropyridines

blood vessels ex. Nifepidine indications: angina pectoris, htn

osmotic diuretics a/e

can precipitate CHF/pulmonary edema

beta blockers

decrease HR and BP drug effects: decreased cardiac output indications: HTN drug effect: decrsed CO cardioselective (beta1) metoprolol (Lopressor) atenolol (Tenormin) nonselective: propranolol (Inderal)

alpha1/beta blockers

decreases HR and BP Labetalol (Trandate)

beta blocker a/e

dizziness bradycardia, heart block mask s/s of hypoglycemia bronchoconstriction constipation

CCB a/e

dizziness hypotension constipation peripheral edema

direct acting vasodilators a/e

dizziness hypotension dysrhythmias

diuretics

drugs that increase urine output

3 kidney processes

filtration reabsorption active secretion

Dihydropyridines

heart & BVs ex. Verapamil (Calan) Dilitilazem (Cardizem) indications: angina pectoris, htn, cardiac dysrhythmias (Afib, Aflutter, SVT)

nursing implicatioons

1. remind pts that med is oly part of therapy; encourage to quit smoking, lose weight, exercise, decrease sodium intake 2. educate about importance of adherence despite lack of symptoms --> htn is silent killer 3. teach to keep journal of BP 4. teach pt to change positions slowly to avoid syncope fr. postural hypotension 5. if Pts are experiencing srs a/e or dose should be changed, contact HCP 6. male patients - impotence is expected effect! this may influence compliance w/ therapy 7. male pts may not be aware that impotence is expected affect and this may impact compliance w/ drug therapy 8. moitor for a/e and toxic effects 9. monitor for therapeutic effects BP < 140/90 for Pts < 60 y/o and those with comorbidities

CCB effects

1. vascular smooth muscle - vasodilation 2. myocardium - decreased contractile force 3. SA node: reduced HR 4. AV node: decrs velocity of conduction thru AV node

A nurse is caring for a client prescribed hydrochlorothiazide (Hydrodiuril) for a client with hypertension. Which of the following instructions should the nurse include in the client's teaching? a)"Your diet should include foods high in potassium." b)"Take the medication right before bedtime." c)"You may notice some swelling in your feet." d)"Avoid drinking liquids early in the morning."

A Rationale: Clients who take hydrochlorothiazide are at risk for potassium loss. Eating foods high in potassium (bananas, cantaloupe, white potatoes) can help prevent this. Diuretics should be taken early in the morning and usually no later than 1400. Clients should notice decreased swelling. Clients need adequate fluid intake to promote urine output. Fluids are best taken in the morning.

Propranolol (Inderal) is contraindicated for a client who has which of the following conditions? a)Asthma b)Diabetes c)Angina d)Dementia

A Rationale: Propranolol is a nonselective beta-adrenergic blocker and blocks both beta1 and beta 2 receptors. Blockade of beta2 receptors in the lungs causes bronchoconstriction, so it is contraindicated in clients with asthma. Use propranolol cautiously with clients who have diabetes, but it is not contraindicated. Propranolol can be used to treat angina. It is not contraindicated in dementia.

For which of the following side effects should a client taking furosemide (Lasix) for hypertension be assessed? a)Visual disturbances b)Hearing loss c)Tremors d)Restlessness

B Rationale: Furosemide is ototoxic and may cause hearing loss. Visual disturbances, tremors and restlessness are not side effects of furosemide.

thiazide diuretics CI and a/e

CI: low GFR. RF a/e: dehydration, hypotension, hypokalemia, hyperglycemia, hyperuricemia

ACE inhibitor CI and a/e

CI: previous rxn of angioedema a/e dry cough hypotension, syncope (esp @ 1st dose) angioedema - can be delayed (ex. after 2 years) hyperkalemia

1. A nurse is reviewing a patient's medications before administration. Which drug to drug interaction will most concerning for a patient with a history of heart failure and a potassium level of 5.5 meq/L? a. Furosemide (Lasix) and enalapril (Vasotec) b. Metoprolol (Lopressor) and furosemide (Lasix) c. Amlodipine (Norvasc) and spironolactone (Aldactone) d. Captopril (Capoten) and spironolactone (Aldactone)

D

diuretics (thiazide) for htn

incrs UP by blocking reabsorp of NaCL in early distule tubule, which prevents reabsorp of H2O reduction of blood volume (preload) and arterial resistance (afterload) indication: 1st-line antihypertensive hydrochlorothiazide (HydroDiuril, HCTZ)

loop diuretic & thiazide diuretic nursing implications

monitor 1. fluid volume status 2. VS 3. labs (esp. K+)

loop diuretics

-ide MOA: acts in thick segment of ascending loop of henle to block reabsorp. of NaCl --> 20% of filtered NaCl is absorbed = profound diuresis - most effective diuretic!! indication: edema assoc. w/ CHF furosemide (Lasix)

loop diuretic & thiazide diuretic Pt education

1. monitor weight & BP 2. change positions slowly 3. eat potassium rich foods (potatoes, tomatoes, bananas, spinach, dried fruit, citrus fruits) 4. take early in day - so they don't wake up to pee frequently @ night