Term
Angiotension (Ag) converting enzyme inhibitors
(ACE inhibitors) |
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Definition
Action: Completely blocks the Ag I converting enzyme, Prevents the production of Ag II which is a powerful vasoconstrictor, decreases vascular tone, Absence of aldosterone release leads to excretion of fluid, Renal protective in diabetics
SE: Hyperkalemia, Dry cough (occurs in about 1/3 of patients), Angioedema
DDDrug-drug Interactions: additive effect with other antihypertensives, NSAIDs (non-steroidal anti-inflammatory drug) antagonize (reduce ACE) effects
EEEducation: Full effects not seen for several weeks, taste impairment disappears 2-3 weeks, cough not indicative of lung disease, don't use: renal artery stenosis, K supplements, and w/ pregnancy (no blood to fetus) |
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Term
Captopril or Capoten
(ACE inhibitor)
HTN- Hypertension
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Definition
Indications
–Essential HTN with normal renal function
–Often used with a thiazide or loop diuretic
§counteracts K retention of ACE
–for CHF it's used with digoxin and diuretics
–Diabetes-for renal protection via protect nephron
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Term
Captopril or Capoten, Lisinopril, Enalapril
ACE Inhibitors |
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Definition
Indication
-mangement of HF
-L & C reduce risk of death or HF deve post MI
-E slow progession of L venticular dysfunction to overt HF
Absorption: absorb after oral administration
Distribution: cross placenta, E & C enter breast milk, L small penetration CNS
Metabolism & Excretion: usually metabolized by liver excreted by kidney
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Term
Angiotensin II Receptor Blockers (ARBs)
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Definition
-Similar & more specific than ACE so can be used to replace or w/ ACE
-Action: blocks action Ag II, Vasodilatation via smooth muscle relaxation, Reduce salt and water volume via decrease release aldoesterone
-Less SE than ACE but can increase risk cancer, doesn't retain K as much as ACE
-same DM renal protection as ACE
-Drug Interactions: Additive w/ other antihypertension drugs
-Prep, dosage, and administration: administer PO
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Term
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Definition
ADME
A:well absorb
D:cross the placenta
M & E: activated in liver via metabolism and excreted via urine |
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Term
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Definition
Action:selective and nonselective agents (negative chronotrope, inotrope, & dromotrope), lower CO leads low BP,
Indications:Chronic angina, HTN, treat cardiac dysrhythmias, prevent 2nd MI, vascular HA, tremors, anxiety, pregnancy
SE:bradycardia, fatigue, drowsiness, depression, impotence, cold hands and feet, can make CHF worse used cardioselective
ADME: some are highly lipid soluble while others are more water soluble, large distribution
Education: don’t alter drug regimen, consistently take w/ or w/out food, no OTC decongestants & cough & cold meds with pseudoephedrine/phenylprine, how to avoid orthostatic hypotension, weight & diet management, if pulse < 45 then don't take, monitor for signs of depression, should be on one post MI |
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Term
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Definition
-B1 receptor on heart stimulate increase HR
ACTION
-cardioselective
–Decreases HR, conduction, contractility, and cardiac output
–Inhibits renin release by the kidney
–Reduces myocardial oxygen demand
–Decreases peripheral vascular resistance which lowers BP |
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Term
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Definition
Action (blockade of beta2)
–Bronchoconstriction
§Patients with asthma, CHF, emphysema at risk
–Should use cardioselective agent
–Masks symptoms of acute hypoglycemia and hyperthyroidism
§Ok to use if not brittle DM (diabetes mellitus) |
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Term
Propranolol
(Beta Blocker) |
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Definition
Action (non-selective of either receptors)
-Decreases cardiac contractility (negative inotropic effect) which drops arterial pressure and inhibits renin release
-lower HR & BP, supress arrhythmias
-Useful in HTN with tachycardia, angina
-More selective beta blockers can help avoid most significant SE of propranolol
§So more likely to see atenolol or metoprolol in clinical |
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Term
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Definition
–Synergistic effect with other antihypertensives
–Reduces renal blood flow
–Orthostatic hypotension
–May impair sexual function
–Psychiatric disturbances (nightmares)--most common in early use, lessens over time
–Overdose: severe hypotension, CV collapse |
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Term
Methyldopa similar to Clonidine
(Central-acting Sympatholytics) |
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Definition
Action:Decreases sympathetic outflow from brain to periphery, generalized decrease in sympathetic tone (alpha2 receptors)—lowers CO, HR, peripheral resistance
Dif: no change in CO for M
Indication:Used in moderate hypertension
Dif: moderate-severe in M
SE: Same as general ones plus high risk for rebound HTN if drug abruptly withdrawn
Drug-drug interaction:Use with beta blocker counteracts effects and can lead to severe hypertension, additive hypotension
OD:Severe hypotension, Can affect alpha1 receptors and lead to severe hypertensive crisis
NOTE: Class drug methyldopa (Aldomet) preference drug in pregnancy cause has longer history of usage w/ lilo SE
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Term
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Definition
nMajor site of action is the kidney nephron
nAll interfere w/ reabsorption in the tubules of the kidney
nNa is so prevalent in dietary intake that must monitor K since it'll flunctuate the most
naffect Ca, glucose, and uric acid
nThose block Na reabsorption from tubules produce more water loss
–Proximal & loop drugs more powerful than distal drugs in reducing fluid
nAltering renal function can lead to risk for hypovolemia, acid-base dysfunction, electrolyte abnormalities |
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Term
Acetazolamide (Diamox)
(Proximal Tubule Diuretics) |
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Definition
Action :inhibits carbonic anhydrase, prevent reabsorption of bicarbonate ions resulting in increased tubular oncotic (osmotic) diuresis
Indications: glaucoma, altitude sickness, management of seizure disorders, produces an alkaline urine which helps increase excretion of drugs that are weak acids
Contraindications: Allergy to sulfonamides
Drug-drug interaction: Amphetamines
Special consideration: Older adults are susceptible to excessive diuresis but rapid water loss may cause hypotension. Diabetics will have a rise in blood sugar levels. May cause kidney stones
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Term
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Definition
Administered: IV agents for cerebral edema (toxic), PO agents for glaucoma
SE: GI sx, dry mouth, HA, polyuria, weakness, dizziness, rash, vision disturbances
Contraindications: Renal or cardiac dysfunction, Intracranial bleeding
Nursing Implications:
-Crystallization is common—need to warm, have IV linen filter, filter needles
-Use an catheter to measure hourly urine output (get I & O)
–Effect lasts about 6-8 hours
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Term
Mannitol
Osmotic Diuretic |
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Definition
SE: Edema, fluid and electrolyte imbalance
Action: potent osmotic
–Stays inside tubule
–Large size pulls water and solutes into tubular fluid (chemically inert)
–Kidneys reabsorb less Na, Cl, and water in an effort to equalize the concentration, but not significant shifts of electrolytes |
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Term
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Definition
-most effective diuretic cause produce most loss of electrolyte and fluid
-act on loop of Henele |
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Term
Furosemide (Lasix)
LOOP Diuretic |
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Definition
Action:Inhibit reabsorption of Na and chloride in the ascending loop of Henle, Similar to thiazides but more intense
ADME: Fast acting, massive fluid absorp, effect w/in 5 min via IV, can use w/ low GFR, increase urine output & Ca excretion
Indications:Significant edema (CHF, cirrhosis, renal disease), Hypertension
Drug-drug interactions: Digoxin & lithium (increase risk of ototoxicity (toxicity to ear), NSAIDs antagonize diuretic effects
OD: Hypovolemia, hypotension, electrolyte imbalances
Education: Postural hypotension, Dietary counseling: foods rich in potassium, need K supplements, avoid sun, alert to hearing loss |
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Term
Thiazides
(LOOP Diuretic) |
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Definition
Action: Inhibits Na and Cl reabsorp in early distal tubule; increase serum levels of Ca, Glu, and uric acid; reduces plasma and extracellular fluid; decrease peripheral resistance, moderate increases in urine output & can't use when urine flow scant, inhibits release insulin, increase in cholesterol and TG levels
Indications:Essential hypertension, Chronic edema (CHF, cirrhosis, renal failure), treatment of hypercalciuria and stone formation
SE: Hyponatremia and hypovolemia, Polyuria, Hypokalemia, Cardiac dysrhythmia, increased risk of digitalis toxicity
Contraindications: Renal disease, gout, unstable diabetes, hyperlipidemia, Pregnant women
Drug-drug interactions: Drugs that affect electrolytes or minerals like Digoxin (K shifting impacts this)
OD: Chronic excess can lead to hypokalemia
Education: Supplement K in diet, monitor BP & lipid levels, may make patients feel tired so drink more non-sugar, non-caffeine fluids |
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Term
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Definition
-adrenal hormone act on all adrenergic receptors cept dopamine & only one act on Beta 2 receptors
-prep body for flight or fight response
-made in adrenal as norepinephrine & converted to epinephrine via enzyme
-stored in vessels be4 released into blood
-metabolized by liver
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Term
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Definition
-Action:muscarinic antagonist, blocks activation PSN increasing HR, decrease secretion, relax bronchi and GI tract, mild CNS excitation
-ADME: dose dependent due diff sensitivity of receptors at diff locations, orally, injection, and topical, elimination by urine and liver
-Therapeutic uses: antiarrhythmics (brachycardia)
-SE: dry mouth, blurred vision, photophobia, urinary retention, constipation, anhidrosis (inhibit sweatiing), tachycardia
-Drug Interactions: Additive effect w/ other muscarinic antagonist like anithistimines |
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Term
Spironolactone
Potassium-sparing Diuretics |
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Definition
Action: Block aldosterone in distal tubule, promotes Na and H2O excretion, low potency, similar to thiazides cept K remain in system
Indications: Prevention & treatment of hypokalemia, hypertension & edema especially in liver failure & adrenal disease issues, use in combo with HCTZ counteract K loss
SE: like other diuretics (but K goes up), hypernatremia and hypoyolemia,
-gynecomastia, menstrual irregularities, impotence, hirsuitism cause like steroid hormone |
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Term
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Definition
Control K levels
– Oral agents—KCl in liquids, powders, effervescent tablets (taste bad so take w/ H2O or meal), potassium-sparing diuretics
– IV potassium supplement
SE:
-KCL more toxic NaCl cause it irritates the GI tract causing abdominal discomfort, nausea, vomiting, and diarrhea.
-Solid formulations produce high local conc of K lead to severe intestinal injury |
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