NRS 325 Perfusion Meds

names: ACEIs

enalapril, lisinopril

names: ARBs

losartan, valsartan

which drugs are RAAS suppressants

ACEIs and ARBs

what are the goals of ACEIs and ARBs

lower blood pressure, treat CHF symptoms, reduce risk of MI and stroke, slow progression of diabetic neuropathy

what is assessed before and after giving ACEIs and ARBs

BP

who are ACEIs and ARBs contraindicated in

pregnant, history of angioedema, renal artery stenosis

who is monitored closely while on ACEIs and ARBs

dehydrated

what can occur with lisinopril when first given

first dose hypotension

what is a side effect of enalapril

dry, irritating, nonproductive cough

what side effects can occur on ACEIs and ARBs

hyperkalemia and angioedema

how is lisinopril administered

initial low does then increased

how can you tell if RAAS suppressants are working

lower BP, decreased CHF symptoms, better kidney function

what are potential drug interactions for RAAS suppressants

other BP meds, drugs that raise K+, lithium, NSAIDs

how can you tell if ACEIs and ARBs are helping heart failure symptoms

less dyspnea, cyanosis, JVD, edema

how can first dose hypotension be minimized with lisinopril

withdraw diuretics 2-3 days before, use low initial dosing, monitor BP for 2 hrs, lie down if occurs

what should patients avoid while on RAAS suppressants

potassium supplements

what happens with agonists of alpha-1 receptors

vasoconstriction

what happens with beta-1 agonists

increased HR

what happens with beta-2 receptors agonists

bronchodilation

what happens with alpha-1 antagonists

vasodilation

what happens with beta-1 antagonists

lower HR

what happens with beta-2 antagonists

bronchoconstriction

name: beta 1 and 2 blockers

propranolol

name: beta 1 blocker

metoprolol

what beta blocker is cardioselective

metoprolol

beta blocker goals

treat high BP, treat heart failure symptoms, treat angina pectoris, treat dysrhythmias

what are the precautions for propranolol

lung disease

how do beta blockers treat heart failure symptoms

slow HR which allows LV to fill fully and decreases heart work load

how do beta blockers treat angina pectoris

vasodilation of coronary arteries

how do beta blockers treat dysrhythmias

slow HR

what should be assessed before/after giving beta blockers

BP and HR

who are beta blockers contraindicated in

HR and BP too low

who are beta blockers given to with extra precaution

diabetics

what is important education for a diabetic patient on beta blockers

tachycardia will not be a sign of hypoglycemia

what is important general education for patients on beta blockers

they cannot be stopped abruptly

what can be present in a patient with hyperkalemia

palpitations, changes in perfusion, dysrhythmia

what should be watched for with patients on beta blockers that could be a side effect on their heart

potassium levels and supplements

what does the nurse do if angioedema is present in a pt on beta blockers

hold and call provider

how do you tell if beta blockers are working

BP is lower, HR is lower, pain is improved

interactions that occur with beta blockers

other meds that lower BP, calcium channel blockers, insulin

what is the name of the alpha blocker that is used in BPH

tamsulosin

what is the name of the alpha blocker that is used in HTN

prazosin

what does tamsulosin doe

dilate the prostate

what does prazosin doe

dilate vessels

what would you do if a female is on tamsulosin

call provider and question

what should you asses before and after giving alpha blockers

HR and BP

what patients are not given alpha blockers

previous allergy

side effects of alpha blockers

hypotension, orthostatic hypotension, vertigo, palpitations, sexual dysfunction

what is important education about alpha blockers

do not go off med without telling provider

how do you evaluate is tamsulosin is working

less difficulty emptying bladder and less nocturia

drug interactions for alpha blockers

other meds that lower BP

what are the names of the calcium channel blockers that treat HTN and angina

amlodipine and nifedipine

what are the names of the calcium channel blockers that treat HTN, angina, and dysrhythmias

diltiazem and verapamil

how do amlodipine and nifedipine work

cause vasodilation in peripheral vasculature to decrease HTN and angina

how does diltiazem and verapamil work

vasodilation in coronary arteries and slow conduction in heart to decrease oxygen demands

what occurs when calcium channel blockers block the calcium access to cells

decreases contractility and conductivity to decrease the oxygen demand of the heart

what do calcium channel blockers do in the heart and arteries

slow SA node signal which lowers HR so LV can fill completely and dilate arteries

what are the side effects of calcium channel blockers

lowered BP, bradycardia, precipitate AV block, headache, constipation, nausea, peripheral edema, cardiosuppression

what dysrhythmia does diltiazem treat

tachydysrhythmia

what is assessed before and after giving verapamil

BP and HR

what are the contraindications for calcium channel blockers

HR and BP already too low

what is the precaution for calcium channel blockers

heart failure

what side effect is especially present with verapamil

constipation

what side effect is especially present with amlodipine

peripheral edema

how are calcium channel blockers given

PO or IV slowly

what do you look for with cardio suppression secondary to calcium channel blockers

perfusion, crackles in lungs, dyspnea, fatigue, edema

what is a nursing intervention for giving amlodipine

compression and elevation of limbs

what is evaluated after giving a calcium channel blocker

lower BP, lower HR, pain improved

what interactions occur with calcium channel blockers

grapefruit juice, digoxin, beta blockers

what is the goal of nitrates

reduce frequency and intensity of anginal attacks

how do nitrates work

vasodilation in the veins to lower preload and decrease how hard the heart has to work

how do nitrates decrease angina intensity and frequency

vasodilation in the veins allows for less work for the heart which decreases the need for oxygen

what what causes angina

low O2 in heart

what is a consideration for nitrates for the nurse

wear gloves

what should be assessed before and after nitrates

BP and HR

what is a vital question to ask a pt starting nitrates

do you take sildenafil (viagra)

what is a contraindication for nitrates

sildenafil (viagra)

what is a precaution for those on nitrates

BP lowering meds or low BP

side effects with nitrates

headache, orthostatic hypotension, reflex tachycardia, tolerance

How do statins work

decrease cholesterol synthesis by blocking the cholesterol production in the liver

names of the lipid lowering medications

atorvastatin, simvastatin, lovastatin

was to reduce heart attacks and strokes for individuals at risk of a cardiac event

heart-healthy diet, exercise, statin therapy

what do statins treat

high cholesterol, reduce risk of MI or stroke

what is assessed before giving a statin

liver function, CK level, cholesterol panel

why is liver function assess on lovastatin

metabolized by and act on the liver

why is CK assessed on atorvastatin

causes myopathy and rnhabdomylosis

who is contraindicated for statins

viral or alcoholic hepatitis, pregnant

who is a statin used in caution with

liver disease, alcoholics

what is monitored for while on statins

hepatotoxicity, myopathy, rhabdomylosis

what other meds should a patient not be on while on statins

macrolides, HIV meds, anti fungal

when is lovastatin taken

PO evening meal

what is the evaluation for statins

lowered LDL, higher HDL

what other medication might a patient on nitrates take

beta blocker to lower HR

how do you prevent tolerance for pt on nitrates

have 10-12 hrs a day without

what is education for storing nitrates

keep accessible, out of heat, check expiration date

how do you evaluate the effectiveness of nitrates

chest pain improved

what are the interactions for nitrates

sildenafil, other BP lowering drugs, alcohol

how long should a pt keep nitro-dur on

10-14 hrs

how does digoxin work

inhibits Na+K+ATPase in order to increase force of contraction and decrease HR

what happens to O2 demand of heart on digoxin

increases