Pharm Exam 2

What can fluid volume overload lead to?

Altered cognitive status, impaired gas exhange, cardiac complications, intestinal malabsorption, and reduced renal function

Why is identification of the underlying cause of fluid volume overload important?

It is necessary to restore fluid balance

What is the normal range of potassium?

3.5 to 5.0 mEq/L

Potassium Sparing Diuretic Medications

Spiroonolactone, Eplerenone, Amiloride, Triamterene (SEAT)

Effect on Potassium: Potassium-Wasting Diuretics

Cause Potassium Loss → Hypokalemia

Effect on Potassium: Potassium-Sparing Diuretics

Retain Potassium → Hyperkalemia

Main action of Potassium Wasting Diuretics

Increase sodium and water excretion, potassium is lost in urine

Main Action of Potassium Sparing Diuretics

Increase sodium and water excretion while preventing potassium loss

What should a nurse watch out for when a patient is on a potassium warsting diuretic?

Low potassium levels

What should a nurse watch out for when a patient is on a potassium sparing diuretic?

High Potassium Levels

Common use of potassium wasting diuretics?

Edema, Hypertension, Heart Failure

Common use of potassium sparing diuretics?

Heart Failure, Resistant hypertension, prevention of hypokalemia

Are Loop Diuretics Potassium wasting or sparing?

Potassium Wasting

Are thiazides potassium wasting or postassium sparing?

Potassium Wasting

Loop Diuretic Medications

Furosemide (Lasix), Bumetanide

Thiazide Medications

Hydrochlorothiazide, Chlorthalidone

Are aldosterone antagonists potassium wasting or potassium sparing?

Potassium Sparing

Are epithelial sodium channel blockers potassium wasting or potassium sparing?

Potassium Sparing

Aldosterone Antatgonists Medications

Spironolactone, Eplerenone

Epithelial Sodium Channel Blocker Medications

Amiloride, Triamterene

Signs of Hypokalemia

Muscle Weakness, Fatigue, Weakness, Nausea/Vomiting, Muscle Cramps

Signs of Hyperkalemia

Muscle Twitching, Paresthesia

Why can you combine potassium sparing and potassium wasting diuretics?

To balance potassium levels while maximizing fluid removal

What is a common medication combination in heart failure?

Furosemide (wasting) and Spironolactone (sparing)- Helps remove excess fluid while reducing the risk of severe hypokalemia from furosemide alone

Loop Diuretics

Act on ascending loop of henle to remove excess fluid and are often used for heart failure or kidney disease

What is the strongest/most potent diuretic?

Loop Diuretics

Why are loop diuretics reserved for patients with fluid and electrolyte accumulation disorders like CHF and kidney disease?

Potassium levels can decrease rapidly and result in adverse effects like cardiac arrhythmias

Method of Action for Furosemide (Lasix)

Blocks reabsorption of Na, Cl, and water in the ascending loof of henle, causing rapid diuresis

Side effects of Furosemide

Dehydration, hypotension, ototoxicity, hypokalemia

Client education for furosemide

Consume food high in potassium

Foods that are high in potassium?

Bananas, dark leafy greens, potatoes

Why should furosemide be administered slowly?

Rapid administration can casue ototoxicity

If furosemide is rx for acute pulmonary edema, how should it be administered?

At a rate of 20mg/min

If furosemide is rx at 40mg IV bolus, how should it be administered?

Undiluted over 2 minutes IV bolus

Ototoxicity

Vertigo, ringing, buzzing, sense of fullness in the ears

When should furosemide be administered?

In the morning to avoid nocturia

Method of Action of Thiazide

Inhibit sodium reabsorption in the distal tubules of the kidney, promoting sodium and water excretion

Thiazides

Commonly used to manage hypertension by reducing blood volume and relaxing blood vessels

Why are thiazides the preferred first line treatment for hypertension?

They promote sodium and water excretion through the kidneys while also lowering the risk for heart disease and stroke

Method of action of Hydrochlorothiazide

Blocks reabsorption of Na and Cl, and prevent the reabsorption of water at the distal convoluted tubule

What disorder is lithium used for?

Bipolar disorder

True or False: Hydrochlorothiazide causes ototoxic events?

False

Which medications have the weakest diuretic effect?

Potassium-Sparing Diuretics

Method of action for Spironolactone

Blocks aldosterone, promoting exretion of sodium and water in the late distal portion of the nephron

Side effects of Spironolactone

Hyperkalemia, Gynecomastia, Impotence, Hirsutism

Client education for spironolactone

Avoid salt substitutes containing potassium

Why should Spironolactone not be used with ACE’s and ARBS?

It can cause hyperkalemia

Osmotic Diuretics

Used for conditions such as brain swelling- create an osmotic gradient that draws water out of body tissues and into urine

Method of Action of Mannitol

Decreases the intracranial pressure and intraocular pressure, treats cerebral edema

How should mannitol be administered?

IV

Which body system plays in hypertension?

Sympathetic Nervous System

Hypertension

Retention of sodium and water leads to increased blood volume, which directly raises blood pressure

First Line Hypertension Agents

ACE Inhibitors, ARBs, Calcium channel blockers, Thiazide diuretics

Why should ACEs & ARBs not be put together?

They increase potassium in the body

Angiotensin-Converting Enzyme Inhibitors (ACE) Medications

Captopril, Enalapril, Lisinopril, Ramipril, Benazepril

Purpose of ACE Inhibitors

Reduces production of angiotensin II by blocking the conversion of angiotensin I to angiotensin II; Increases levels of bradykinin

When ACE inhibitors block angiotensin converting enzymes and leads to a reduction to angiotensin II levels, it leads to what?

Promotion of excretion of excess sodium and water, decreasing blood volume and blood pressure AND prevents structural changes to the heart and blood vessels

When ACE inhibitors increase the levels of bradykinin, it leads to…?

Vasodilation, which improves circulation

Kidney Protective or Cardio Protective: Angiotensin-Converting Enzyme Inhibitors

Both

Complications of ACE Inhibitors

First does orthostatic hypotension, Cough, Hyperkalemia, Rash and altered taste, Angioedema, Neutropenia

Angioedema

Swelling of the tongue and pharynx

True or False: It is okay to use ACE Inhibitors in pregnancy/lactation?

False

Why are ACE Inhibitors less effective in African American/Black Patients?

They carry a higher risk of angioedema

Which Medication class can decrease the antihypertensive effect of ACE Inhibitors?

NSAIDs

First Dose Hypertension

Sudden drop in blood pressure after the first dose of medication

Orthostatic Hypotension

Drop in blood pressure when moving from lying/sitting to standing

Therapeutic level of lithium

0.6-1.2meg/L

When should blood pressure be monitored after the first dose of an ACE Inhibitor?

At least 2 hours

True or False: ACE Inhibitors can be given in combination with hydrochlorothizaide to take care of blood pressure and hyperkalemia at the same time?

True

Angiotensin II Receptor Blockers (ARBs) Medications

Losartan, Valsartan, Irbesartan, Candesartan, Olmesartan, Telmisartan

Purpose of Angiotensin II receptor blockers

Bind to and Block the angiotensin II type 1 receptors found on the smooth muscles of blood vessels

ARBs help blood vessels relax and widen, making it easier for the heart to pump blood and lower blood pressure which leads to…?

Prevent thickening of the heart muscle and lowers the risk of stroke

Kidney Protective or Cardioprotective: Angiotensin II receptor blockers

Both

Therapeutic uses of ARBs

Lowers BP, Relaxes blood vessels, Protects Kidneys

Complications of ARBs

Angioedema, Fetal Injury, Hypotension, Dizziness, Lightheadness

How do you treat severe effects of Angioedema from the use of ARBs?

SUBQ Injection of epinephrine

If a client is of childbearing age while taking any ARBs, what should be used to minimize fetal injury?

Contraception

True or False: Angiotensin II Receptor Blockers CANNOT be used in pregnancy/lactation?

True

Contraindications with Angiotensin II Receptor Blockers include all of the following EXCEPT:

Hypertensive Patients

Do we give ACEs and ARBs if a patients heart rate is below 60?

Yes because they lower the blood pressure; They do not lower the heart rate

Therapeutic uses of Aldosterone Antagonists

Lower blood pressure, relax blood vessels, reduce fluid buildup

Client education for aldosterone antagonists

Tell client to maintain a low-sodium diet as too much sodium can cause the body to retain water and increase BP more

To determine if a cardiovascular medication efficacy as well as the potential for side effects of medication, when should the nurse assess client vitals?

45 to 1 hour after medication administration

ECG/EKG

Medical test that records the electrical activity of the heart

Gastric Lavage

Medical Procedure that involves washing out the contents of the stomach. Used to remove harmful substances that have been ingested

Cathartic

Strong Laxative- rapid evacuation of the bowel

What is the first line of medication for hypertensive African American patients?

Calcium Channel Blockers

Dihydrophyridines Calcium Channel Blocker Medications

Nifedipine, Amlodipine, Nicardipine, Felodipine

Non-Dihydropyridines Calcium Channel Blockers

Verapamil and Diltiazem

Purpose of Calcium Channel Blockers

Relaxes the blood vessels and takes the strain off the heart

Purpose of Dihydropyridine Calcium Channel Blockers

Primarily cause vasodilation and lower blood pressure by relaxing the blood vessels

Purpose of Non-Dihydropyridine Calcium Channel Blockers

Not only relax blood vessels, but also slow down the eletrical activity in the heart

All of the following Dihydropyridine calcium channel blockers can help with angina EXCEPT:

Felodipine

Which Calcium Channel Blockers help with cardiac dysrhythmias?

Verapamil and Diltiazem

Complications of Dihydropyridine calcium channel blockers

Reflex Tachycardia, Acute Toxicity, Orthostatic hypotension and peripheral edema

Complications of Non-Dihydropyridine calcium channel blockers

Orthostatic Hypotension & Peripherial Edema, Constipation, Suppresion of Cardiac Function, Dysrhythmias

Ingestion of grapefruit juce can lead to toxicity in which medication?

Nifedipine

Verapamil can increase toxicity levels of which medication?

Digoxin

Direct Acting Vasodilator Medications

Hydralazine

Mechanism of action for hydralazine

Vasodilators function by widening or preventing the narrowing of blood vessels, thereby enhancing blood flow to different organs