Diuretics, Blood Pressure and Heart Failure Medications

What is the prototype for ACE inhibitor?

lisinsopril

What suffix is associated with ACE inhibitors?

-pril

What is important to monitor with ACE inhibitors?

Potassium levels & BP

What is the normal range for Potassium?

3.5 - 5.0

Angioedema, Dry cough, Hyperkalemia are major side effects of which drug?

ACE inhibitors

What should be avoided when taking ACE inhibitors?

salt substitutes

During administration, what is a adverse effect to monitor with ACE inhibitors?

first dose orthostatic hypotension

Which medication stops the conversion of angiotensin II to II?

ACE Inhibitors

Hypertension, Heart Failure, MI and Nephropathy are indications for which medication?

ACE Inhibitors

What is the prototype Angiotensin II Receptor Blocker (ARB)?

losartan

What suffix is associated with ARBs?

-sartan

Which medication blocks the action of angiotensin II? What does it lead to?

ARBs; Vasodilation

Hypertension, Diabetic Nephropathy and intolerance to ACE inhibitors are indications of which medication?

ARBs

Hypotension, Dizziness, Angioedema and GI upset are major adverse effects for which medication?

ARBs

Which medication has a drug interaction with other antihypertensive medications?

ARBs

Which medication is fetal toxic and should be avoided in pregnant patients?

ARBs

What should be monitored with ARBs?

BP

What is the prototype Beta Blocker?

metroprolol

What suffixes are associated with Beta Blockers?

-olol, -lol

Which medication blocks beta I receptors needed for the sympathic nervous system?

Beta Blockers

Hypertension, Angina, Tachydysrhythmias, Heart Failure and MI are indications of which medication?

Beta Blockers

Bradycardia, Brocosonstriction, Fatigue, and Hypotension are major adverse effects of which medication?

Beta Blockers

What should we monitor with Beta Blockers?

• Blood Glucose

• BP

• HR

We hold a medication when HR is less than …

60

We hold a medication when systolic BP is less than …

100

Bradycardia, Bronchitis, Asthma and COPD are contraindicated for which medication?

Beta Blockers

Why is it important to use caution with Beta Blockers and diabetic patients?

Can mask signs of hypoglycemia

If a patient has new edema, crackles in lungs, rapid weight gain, new JVD and is metoprolol, what is the priority action?

question the provider’s orders

Which medication decreases resistance, decreases workload and decreases cardiac output?

Beta Blockers

What are indications for Hypertensive medications

ACE inhibitors

Which medication increases MI survival in acute patients?

ACE inhibitors

Which medications lower BP but not HR?

ACE inhibitors & ARBs

What are the prototypes for Calcium Channel Blockers?

verapamil, nifedipine, diltiazem

What are the suffixes associated with Calcium Channel blockers?

-dipine, -zem, -amil

Which medication blocks calcium movement in the heart and blood vessels? What does it lead to?

Calcium Channel Blockers; vasodilation and decreased HR

Which medication decreases cardiac workload, increases oxygen delivery to the heart and relaxes vessels?

Calcium Channel Blockers

Hypertension, Angina and Pre-term labor are indications for which medication?

Calcium Channel Blockers

Peripheral edema, hypotension, dizziness and constipation are major adverse effects of which medication?

Calcium Channel Blockers

What patient teaching is common with all antihypertensive medications?

Change positions slowly

What indication is common with all antihypertensive medications?

Hypertension

What adverse effects are common with all hypertensive medications?

Hypotension & orthostatic hypotension

What should be monitored for Calcium Channel Blockers?

HR & BP

When taking calcium channel blockers, what should be avoided and why?

Grapefruit juice; can lead to drug toxicity

What is a patient teaching specific to Calcium Channel blockers?

Increase high fiber foods because of constipation

Which adverse effect is considered “normal” with Calcium Channel blockers?

Headache

Cardioselective Beta 1 blockers affect the…

Heart

Nonselective Beta 2 blockers affect the…

Lungs

For all hypertension medications, what labs should be monitored?

Electrolytes (sodium, potassium, chloride, bicarbonate)

What symptoms should be reported and what do they indicate?

• muscle cramping

• weakness

• rapid heartbeat / tachycardia

• dizziness

Indicates electrolyte imbalance

What is considered an emergency and should be reported immediately when taking ACE Inhibitors?

Swelling of the face, mouth, eyes or throat (angioedema)

What is an important patient teaching about taking hypertensive medications?

Do not stop taking suddenly, medication should be tapered off

What happens if an antihypertensive medication is stopped abruptly

Rebound Hypertension

What is the prototype Cardiac Glycoside

Digoxin

What is the suffix associated with Cardiac glycosides?

-oxin

Which medication increases sodium and calcium leading to increased contractility?

Digoxin

Which medication decreases HR, decreases BP, increases cardiac function and increases blood flow?

Digoxin

Hypertension, Heart Failure and Cardiac arrhythmias (a-fib) are indications for which medication?

Digoxin

What is the primary indication for Digoxin?

Heart Failure

What is the therapeutic range for Digoxin?

0.5 - 2.0

What are signs of Digoxin toxicity?

• blurry vision

• halos

• color changes

• nausea

• vomiting

• dizziness

What increases the risk for Digoxin toxicity?

• Renal Failure

• Elderly patients

• Hypokalemia

• Potassium-Wasting Diuretics

Dysrhythmias, dizziness, GI upset, worsening edema, rash and vision changes are indications of which medication?

Digoxin

What labs should be monitored with Digoxin?

• Therapeutic Range

• Sodium

• Calcium

• Potassium

• Kidney function (Creatinine)

What labs monitior kidney function?

BUN & Creatinine

What does a creatinine of over 1.3 indicate?

kidney distress/injury

What is the normal range for Creatinine?

0.6 - 1.2

What is important to monitor in heart failure patients taking Digoxin?

Fluid status and daily weight

How is fluid status monitored?

Strict I&Os

What is the priority intervention before giving Digoxin?

Assess BP + apical pulse for 1 full min. (HR)

Where is the apical pulse located?

Left Midclavicular @ the 5th intercostal (IC) space

What patient teaching is important when taking Digoxin?

Know the signs of toxicity and report immediately

Ventricular fibrillation (v-fib) and acute MI are contraindications of what medication? Why?

Digoxin; alter heart’s contraction and blood flow

What is the antidote for Digoxin toxicity?

Digoxin immune fab

What are indications for Diuretics?

• Heart failure

• Edema

• Hypertension

• Chronic Kidney Disease (CKD)

When should you teach the patient to take diuretics?

In the morning

What are common adverse effects of Diuretics?

• fluid & electrolyte disturbances

• dehydration

• orthostatic hypotension

• potassium & sodium imbalances

What patient teaching should be taught for all diuretics?

• Slow position changes

• Increase risk for sunburn, use sunblock

• Low Sodium Diet

• Avoid OTC medications

What should the nurse monitor for a patient taking diuretics?

• daily weights

• I&Os

• Potassium levels

What drugs should be avoided when taking diuretics?

• Cough & flu medications

• Antiacids

• Acetominophen

• NSAIDs

What adverse effects occur when Furosemide is pushed too fast via IV?

• ototoxicity / tinnitus

• hypotension

What are the long term risks associated with Diuretics?

• Nephrotoxicity

• Hypokalemia

What is the prototype Loop Diuretic?

furosemide

What are the suffixes associated with Loop Diuretics?

-mide, -nide

Acute or Worsening Heart Failure and Renal failure are indications of which medication?

Loop Diuretics

Hypokalamia, Ototoxcity, Dehydration, Electrolyte imbalances and orthostatic hypotension are adverse effects of which medication?

Loop Diuretics

What are foods high in Potassium and what are their potassium amount (g)?

• avocado - 201g

• spinach - 180g

• beans - 179g

• potato - 173g

• banana - 118g

What food has the highest potassium content?

avocado - 201g

Which medication inhibits reabsorption of sodium and chloride in 3 parts of the kidney?

Loop Diuretics

Which medication inhibits reabsorption of sodium and chloride in 2 parts of the kidney?

Thiazide Diuretics

What should be avoided when taking Potassium-Wasting Diuretics?

Licorice Root

Hypertension, Ascites, Edema and Heart Failure are indications for which medication?

Thiazide diuretics

What labs should be monitored when taking Thiazide diuretics?

• Uric acid

• blood glucose

• potassium & electrolytes

Hypokalemia, dehydration, hypouricemia and hyperglycemia are indications of which medication?

Thizaide diuretics

What is the prototype Thiazide diuretic?

hydrochlorothiazide

What is the suffix associated with Thiazide diuretics?

-thiazide

Gout and sulfa allergy are contraindations for which medication?

Thiazide diuretics

Hyperkalemia, Gynecomastia and other endocrine effects are adverse effects of which medication?

Potassium-Sparing diuretics

Which medications are interacted with Potassium-Sparing diuretics? Why?

ACE inhibitors and ARBs; they increase potassium

What is the prototype Potassium-sparing diuretic?

spironolactone?

What should the nurse teach their patient to avoid when taking spironolactone?

• potassium supplements

• foods high in potassium

• salt substitutes