Exam 2 Drugs

what are antihypertensive drugs?

work by lowering BP through various mechanisms including:

targeting RAS pathway, vascular smooth muscle, CO, or volume status

what can a decrease in cardiovascular and/or renal morbidity lead to?

stroke

HF

sexual dysfunction

vision loss

MI

kidney dz/failure

what are the classifications of HTN meds?

diuretics

angiotensin-converstin enzyme inhibitors (ACE inhibitors)

angiontensin receptor blockers (ARBs)

adrenergic drugs *beta blockers, alpha-1 blockers, alpha-2 receptor agonists)

calcium channel blockers (CCBs)

vasodilators

what do ACE inhibitors do?

block conversion of angiotensin 1 to angiotensin 2

what are ACE inhibitors indicated for?

first line drugs for HTN

what are nursing considerations for ACE inhibitors?

monitor for anioedema (facial and throat swelling, can cause resp distress)

dry cough

hyperkalemia

what are AE for ACE inhibitors?

dizziness

HA

fatigue

orthostatic hypotension

what are contraindications for ACE inhibitors?

pregnancy (category X) —> fetal abnormalities

what are drug-drug interactions for ACE inhibitors?

NSAIDS —> inhibiting prostaglandins which can also cause vasodilation

lithium

avoid combining with ARBS/ACEs/ARNIs (other RAS drugs)

what patient education should you include for ACE inhibitors?

don’t stop abruptly

report facial swelling

avoid K supplements (salt substitutes have a lot of K)

what drug class is lisinopril?

what is the MOA for lisinopril?

what drug class is captopril?

what is the MOA for captopril?

what drug class is enalapril?

what is the MOA for enalapril?

what are contraindications for ACE inhibitors?

potassium lvl of 5 mEq/L or greater

renal stenosis —> impaired blood flow, don’t want to decrease BP

hx of angioedema

pregnant or lactating women

what are AE for ACE inhibitors?

dry

nonproductive cough

hyperkalemia

angioedema

pregnancy (category x)—> fetal toxicity

what are drug nuances for ACE inhibitors?

can cause hypotension, take at night

what are angiotensin receptor blockers (ARBS)?

selectively block angiotenision II from receptors

blocks vasoconstriction and aldosterone —> no sodium and water retention

no bradykinin impact

what are ACE inhibitors indicated for?

HTN

HFrEF

CKD

what are contraindications for ARBS?

pregnancy (category x)

hyperkalemia

what are AE of ARBS?

hyperkalemia

dizziness

hypotension

what is important patient education for ARBS?

don’t stop abruptly

rise slowly

avoid salt subs containing potassium

report facial swelling

what are examples of ACE inhibitors?

lisinopril

captopril

enalapril

THINK “PRIL” ramipril
quinapril
benazepril

what are examples of ARBS?

losartan

eprosartan

valsartan

irbesartan

THINK “SARTAN”

what is the drug class for losartan?

what is the MOA for losartan?

what do beta blocking drugs do to treat HTN?

block B1 and B2

decrease HR, contractility, BP, and reduce myocardial oxygen needs

who do you not want to give nonselective beta blockers to?

asthmatics

COPD

cause bronchoconstriction

what can beta-blockers mask the symptoms of?

nonselective BB like metoprolol can mask symps of hypoglycemia —> can lower glucose in the liver

what are examples of b-adrenergic blockers?

propranolol

metaprolol

atenolol

THINK “LOL”

what is the drug class for carvedilol?

what is the MOA for carvedilol?

what do alpha-beta and alpha blockers do?

vasodilation

decreased CO

lower SVR

lower HRW

what are examples of alpha-beta blockers?

labetalol

carvedilol

sodium

what do A2 agonists do?

sympatholytic —> paralyze SNS, slow everything down

inhibit norepi

sedation

decreased HR + BP

what are examples of alpha adrenergic blockers?

prazosin

terazosin

phentolamine

what are examples of A2 agonists (central sympatholytics)?

clonidine

methyldopa

what are contraindications for beta blockers?

severe bradycardia

2nd or 3rd degree heart block

severe asthma

what are nursing considerations for beta blockers?

hold for HR <60 + BP <90

what are drug nuances for beta blockers?

propranolol is nonselective BB

lipophilic

what are A2 receptor agonists indicated for?

HTN

sedation

spasticity

what are contraindications for A2 agonists?

severe bradycardia

heart block

cardiogenic shock

sexual dys

what are AE for A2 agonists?

bradycardia

hypotension

sedation dry mouth
rebound hypertension

what are nursing considerations for A2 agonists?

taper slowly

monitor for orthostatic hypotension (first dose syncope)

not usually first line BP meds

what is the MOA for calcium channel blockers?

inhibit calcium into cardiac and vascular smooth muscle cells

leads to vasodilation, reduced myocardial contractility, and decreased HR

what are calcium channel blockers indicated for?

HTN secondary to angina

certain cardiac arrhythmias

what are CA for calcium channel blockers?

severe bradycardia

significant HF

sick sinus syndrome

what are AE for calcium channel blockers?

peripheral edema

dizziness

flushing

liver dysfunction

what are nursing considerations for calcium channel blockers?

avoid grapefruit juice

what does the dihydropyridine class of CCB target?

vascular smooth muscle

what do dihydropyridine CCBs do?

arterial vasodilation

coronary vessel vasodilation

coronary & cerebral vasospasm

what is an example of a dihydropyridine CCB?

amlodipine

what is the drug class for amlodipine?

antianginal

CCB

antihypertensive

what is the MOA for amlodipine?

inhibits calcium ion influx across cell membrane during cardiac depolarization

produces relaxation of coronary and peripheral vascular smooth muscle

what does the phenylalkylamines and benzothiazepine class of CCBs target?

myocardium

phenylalkylamines —> BP + rhythm

benzothiazepine —> rate

what do phenylalkylamines and benzothiazepine class of CCB do?

reduce HR

negative inotrope

what do direct vasodilators do?

act directly on arteriolar and venous smooth muscle

causes relaxation of the muscle and vasodilation

what are direct vasodilators indicated for?

HTN + HTN emergencies (can give during pregnancy)

HF

what are CAs for direct vasodilators?

CAD

what are AEs of direct vasodilators?

reflex tachycardia

HA

dizziness

fluid retention

what is the drug class for sodium nitroprusside?

direct vasodilator

what is the MOA for sodium nitroprusside?

relaxes arterial and venous smooth muscle

acts within sec-min and had half life of 2 min

what is sodium nitroprusside indicated for?

HTN emergencies

ICU drug

what are CA for direct vasodilators?

severe hepatic/renal failure

increased ICP

pregnancy (category x) —> cyanide toxicity

what are AEs of sodium nitroprusside?

cyanide toxicity

severe hypotension

increase ICP

what are nursing considerations for sodium nitroprusside?

protect from light (put in foil)