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352 Exam 4

Terms in this set (86)

Work by stimulating sympathetic nervous system
Alpha
• Nasal congestion
• Local anesthesia
• ↑ BP (vasoconstriction), ↓ HR (baroreceptors)
• Mydriasis (pupil dilation)
• Reduction of CO
• Relief of severe pain
Beta
• Increased contractility
• Increased CO
• CPR-epinephrine
• Bronchodilation
• Delay preterm labor
Agonists
Blocking of alpha and beta effects
Alpha
--↓ BP (vasodilation), ↑ HR
--BPH (reduced prostate)
Beta
--↓contractility
--↑strength of contraction
--↓CO
--Migraine prophylaxis
--Glaucoma
Antagonists
Indications/Therapeutic use
Heart failure
↑BP
AMI
Dysrhythmia
Adverse effects
Bradycardia
Decreased atrioventricular (AV) conduction
Reduction of contractility
Asthmatic effects possible with some beta blockers - NOT metoprolol
Use with caution in patients with diabetes - effects beta cells of pancreas
Side Effects
Insomnia
Depression
Bizarre dreams
Sexual dysfunction
Metoprolol (Lopressor) BETA BLOCKER
Available forms
-IV push
-Oral
-Inhaled (for respiratory)
Contraindications
-Verapamil (↑cardiac depression), Digoxin (↓HR), Insulin (decreased effectiveness), cocaine (↑ BP, ↓HR)
Nursing Implications
-Monitor HR, BP
-Take BP/HR before administering drug - hold HR < 60 or SBP < 90
-Monitor blood glucose levels
-Monitor BUN/Creatinine, potassium, LFTs
-Monitor I/O, daily weight for increased fluid retention
-Reduce dosage over 1-2 weeks before discontinuing
Evaluation of Effectiveness
-BP and HR
-Increased activity tolerance
Metoprolol (Lopressor) BETA BLOCKER
ACE inhibitors Prototype
Lisinopril (Prinivil)
Beta blocker prototype
Metoprolol (Lopressor)
Action/effect: ↓ BP by inhibiting the conversion of Angiotensen I to Angiotensin II results in vasodilation and increased excretion of intravascular fluid
Therapeutic Uses
• Hypertension
• Heart Failure
• Myocardial Infarction
• Diabetic & Non-diabetic neuropathy
• Prevention of AMI, CVA, and death in high risk cardiovascular clients
Lisinopril (Prinivil) Ace Inhibitor
Evaluation of Effectiveness & Nursing considerations
• Monitor BP, HR, orthostatic BP
• Teach to change positions slowly
• Monitor for peripheral edema and angio edema
• Monitor Na and K levels, WBC for neutropenia, BUN/creatinine
• Small frequent meals-give 1 hour prior to meal or 2 hours after meal to increase absorption
Lisinopril (Prinivil) Ace Inhibitor
Angiotensin-Converting
Enzyme Inhibitors
Adverse effects
First-dose hypotension most likely with
-Severely hypertensive patients
-Patients taking diuretics
-Volume depleted patients
-Fetal injury
-2nd and 3rd Trimester injury
-Angioedema
-Tongue, glottis, and pharynx edema
-Hyperkalemia
Lisinopril (Prinivil) Ace Inhibitor
Drug interactions
- Diuretics
- Antihypertensive agents
- Drugs that raise potassium levels
- Lithium (can cause toxicity)
- Nonsteroidal anti-inflammatory drugs
Lisinopril (Prinivil) Ace Inhibitor
Angiotensin II Receptor Blockers (ARB's)
Irbesartan (Avapro)
• Newer class, Well tolerated
• Do not cause a dry cough
• Hyperkalemia much less likely to occur
• Most common
- losartan (Cozaar, Hyzaar)
- Irbesartan (Avapro)
Angiotensin II Receptor Blockers (ARB's)
Therapeutic Uses
- Hypertension, heart failure, myocardial infarction
- Diabetic nephropathy
- If unable to tolerate ACE inhibitors: protection against MI, stroke, and death from cardiovascular (CV) causes in high-risk patients
- Migraine headache
- May prevent development of diabetic retinopathy
Angiotensin II Receptor Blockers: Irbesartan (Avapro)
Adverse effects
• Dizziness, HA, hypotension, ↑HR, impaired renal function, hyperkalemia, chest pain
Drug interactions/contraindications
• Digoxin levels ↑, ↑warfarin concentrations
Nursing implications
• Monitor VS (orthostatic especially), renal/hepatic labs, potassium
• assess edema
Angiotensin II Receptor Blockers: Irbesartan (Avapro)
Calcium Channel Blockers
Diltiazem (Cardizem)
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