68 terms

calcium channel blockers, beta blockers, ace inhibitors, antianginal drugs,Cardiotonics

calcium channel blockers beta blockers ACE inhibitors Antianginal Drugs:Description
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Prehypertension:
120-139/80-89 (no drug therapy indicated)
Hypertension: Stage 1:
140-159/90/99 (Thiazide diuretics with possible combo antihypertensive)
Hypertension: Stage 2
greater than 160/ greater than 100 (Two drug combo)
Hypertensive emergencies require
immediate blood pressure reduction with parenteral antihypertensive drugs to limit damage to target organs.
Beta Blockers: (3)
metoprolol (Lopressor)
propranolol (Inderal)
atenolol (Tenorim)
Beta Blockers Actions: (4)
Decreased heart Rate
•Decreased rate of conduction
•Decreased myocardial contractility
•Results in decreased workload of the heart which decreases the oxygen demands
Beta Blockers 2 main uses
angina
hypertension
beta blockers other uses
cardiac dysrhythmias
myocardial infarction
heart failure
when should you hold beta blocker meds and contact PCP
if pulse is below 60bpm
or BP systolic below 90mm Hg
if pt on beta blockers is symptomatic(nausea, vomiting, loss of consciousness) the nurse would consider admin. what to restore heart rate
atropine
beta blocker doses should be started low and titrate may take
1-3 months for beneficial effects to occur
observe for these signs of worsening heart failure in a pt. taking beta blockers
SOB
edema
fatigue
pts. with what should not be admin. beta blockers
AV block or sinus bradycardia
when antihypertensive meds. are abruptly discontinued what may occur
Rebound myocardium excitation: rebound hypertension
avoid beta blockers in pts with
asthma, bronchospasm, and heart failure
a pt. with asthma should only be admin. what kind of beta blocker
a beta1 selective agent
beta blockers can mask symptoms of
low blood glucose levels
asians need a (smaller) or (larger) dose of beta blockers
smaller
Beta blockers are the drugs of first choice for patients
younger than 50 years of age with high-renin hypertension, tachycardia, angina pectoris, myocardial infarction, or left ventricular hypertrophy
Calcium Channel Blockers: (4)
amlodipine (Norvasc)
diltiazem (Cardizem)
verapamil (Calan)
nicardipine (Cardene)
Calcium Channel Blockers: actions
•Blocking of calcium channels in blood vessels leads to vasodilation of arteries(nifedipine)
•Vasodilation and decreased force of contraction, decreased heart rate, slowed rate of conduction through the AV node. (verapamil)
Calcium Channel Blockers: uses
Angina
Hypertension
calcium channel blockers for cardiac dysrhythmias (a-fib, a-flutter)
verapamil (Calan) and diltiazem (Cardizem)
monitor pt on Calcium Channel Blockers: for
increased heart rate
swelling in the lower extremities
a fall in systolic pressure by 10mm Hg-orthostatic hypotension
constipation
dysrhythmias
bradycardia or heart failure
Calcium Channel Blockers: contraindicated in pts. with
heart block, hypotension,bradycardia,aortic stenosis, or severe heart failure
-Calcium channel blockers are safe and effective for HTN if they are given as
sustained-release or extended-release preparations
Calcium Channel Blockers:These medications should not be given with
grapefruit juice it increases the concentration of the the drug and can lead to toxicity. (verapamil)
The drug of choice to treat HTN in the African American population
calcium channel blockers
Verapamil produces gastric irritation. The nurse should instruct the patient to
open the capsules and sprinkle the contents over food to prevent gastric irritation. Verapamil capsules should not be chewed, crushed, or powdered before use.
________ calcium channel blocker should be taken along with food and not before food.
Verapamil
ACE Inhibitors- (3)
lisinopril (Prinivil)
enalapril (Vasotec)
captopril (Capoten)
ACE Inhibitors action
Angiotensin-converting enzyme inhibitors (ACEIs) act primarily for suppress the rennin-angiotensin-aldosterone system.
Block angiotensin II resulting in:
Vasodilation (mostly arteriole)
Excretion of sodium and water, and retention of potassium
ACE Inhibitors uses
Heart Failure
HTN
MI
Diabetic and non-diabetic nephropathy
•If client is taking a diuretic it should be stopped for 2-3 days before starting
ACE Inhibitors
first dose orthostatic hypotension with ace inhibitors
start treatment with a low dose
monitor for BP for two hours after starting tx
change position slowly
: Notify PCP if experience what with ACE Inhibitors
a dry hacking cough and it is likely another medication will be chosen
A persistent cough develops in approximately ____% to ____% of clients on ________ and may lead to stopping of the drug
10 to 20
ACE Inhibitors
with what drug group
•Monitor potassium levels to maintain normal range 3.0-5.0 meals.
•Client should take Potassium supplements
Rash and dysgeusia (altered taste)
ACE Inhibitors
Watch for swelling of what with ACE Inhibitors
Angioedema
•Swelling of tongue and oral pharynx
•May need to give epinephrine if becomes severe
what is rare but can occur with captopril (Capoten)
Neutropenia
ACE Inhibitors preg. catagory-
Beware these medication are Pregnancy category D 2nd and 3rd trimester and can cause fetal injury-It would be important to know when the patient's LMP occurred and that the patient is not pregnant
ACE Inhibitors contraindicated in pt with
a history of angioedema and renal impairment
-what reduce the antihypertensive effect of ACE inhibitors.
NSAIDS
The administration of NSAIDs, like ibuprofen (Motrin), to a client receiving an ACEI, like lisinopril (Prinivil) can result in .
decreased hypotensive effects of ACEIs resulting in increased blood pressure
Diuretics contribute to _______ in pts taking ACE Inhibitors (Thiazides are the first choice of diuretic)
first-dose hypotension
when on ACE Inhibitors what increases the risk of hyperkalemia
Potassium supplements
angina is
The body's response to a lack of oxygen in the heart muscle is pain
Antianginal Drugs:
nitrates
nitroglycerin
nitrates
relax the smooth muscle of blood vessels, increase the lumen of the artery or arteriole, and increase the amount of blood flowing through the vessel.
Nitroglycerin Uses:
Pain of acute anginal attack
Prevent angina attacks (prophylaxis)
Treat chronic stable angina pectoris
Nitroglycerin Adverse Reactions:
•CNS reactions: headache, dizziness, weakness, and restlessness
•Hypotension
•Flushing
•Rash
Nitroglycerin Contraindicated:
•Head trauma
•Early MI
•Closed-angle glaucoma
•Cerebral Hemorrhage (increase cerebral edema)
•Severe anemia
Nitroglycerin Interactions:
•Calcium Channel blockers increase in orthostatic hypotension
•Alcohol severe hypotension and cardiovascular collapse
•Sildenafil (Viagra) may cause severe hypotension
The transdermal nitroglycerin patch should be applied every day for
10 to 12 hours
Know how to administer sublingual nitro. !
!
Cardiotonics
improve the efficiency and improve the contraction of the heart muscle
Digoxin (Digitek): Uses:
Heart Failure
Atrial fibrillation
Digoxin (Digitek): action
Increased force of contraction, slow conduction through AV node.
Digoxin (Digitek): adverse reactions
vision changes (yellow/green halo around objects)
digitalis toxicity
nausea, anorexia
•Digitalis Toxicity• : Signs of toxicity include
•potentially life-threatening heart rhythm disturbances, ranging from very slow to rapid ventricular rhythms. Other side effects include nausea, vomiting, loss of appetite, abdominal discomfort, blurred vision, and mental changes.
•Therapeutic digoxin levels range from
•0.5 ng/mL to 2.0 ng/mL
Digoxin (Digitek): Contraindications/Precaution:
•Heart arrhythmia's
•Renal impairment
what increases the effect of digoxin and increases the risk for digoxin toxicity.
hypokalemia
digoxin call PCP and hold if
pulse less than 60 and BP less than 90
•Taking Digoxin (Digitek): with high-fiber meals will
•decrease the absorption of the drug.
•Digoxin may be less effective if combined with
•thyroid hormones
•The dose of digoxin may need to be decreased if it is combined with either of these drugs alone
verapamil.
amiodarone.
erythromycin.
________is used as the antidote to digoxin toxicity.
* Digoxin immune fab