Cv Drugs Nursing2007
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Transcript of Cv Drugs Nursing2007
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Cardiovascular Drugs
Unit 7
Nursing Pharmacology
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Electrical Activity of the HeartWhat are the 2 nodes of the heart that generate
electrical impulses???
What mineral is needed for this to occur???
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Normal Heart Rates per Age Infants:
Toddler: Preschoolers:
School-age:
Adolescents:Adult:
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Terms to KnowBradycardia
Tachycardia Systole
Diastole
Loading dose
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More Terms to Know Positive inotropic effect
Negative inotropic effect Positive chronotropic effect
Negative chronotropic effect
Positive dromotropic effectNegative dromotropic effect
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More Terms to Understand Parasympathetic Nervous System (cholinergic)
vagus stimulation = neurotransmitter acetylcholine
= Slows the heart by inhibiting impulse formation
Sympathetic Nervous System (adrenergic)when
stimulated = neurotransmitter norepinephrine =increase in heart rate by promoting impulseformation
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What is Congestive Heart Failure??
(CHF) 3 things happen:
1. Cardiac distention result from inability ofventricles to pump all blood
2. Cardiac hypertrophyfrom prolonged
stretching
3. Sodium and water retentionpartly due to
decreased blood to kidneys
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S/S of CHFWeight gain
Edema Shortness of breath
Pulmonary congestion
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Cardiac Glycosides Primary use???
Method of action???
Common DrugsDigoxin (Lanoxin), Digitoxin
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S/S of Digoxin Toxicity 1. GI distressdiarrhea, excessive salivation,
abdominal pain
2. Neurologicalrestlessness, irritability., HA,
weakness, lethargy, drowsiness, confusion, visual
disturbancesblurred or colored vision, halo
vision, amblyopic, diplopia
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More s/s of toxicity 3. Cardiac effectcardiac arrhythmiasextra
beats, bradycardia, AV block, bigeminy
What are risk factors for toxicity???
AB
C
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Action to Take if Digoxin ToxicMonitor blood levels of drug
--Digoxin 0.5-2 ng/ml Therapeutic
--Digitoxin 14-26 ng/ml Therapeutic
If too high???
1. Stop/hold drug 2. If life threatening = digoxin immune fab
(Digibind)
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Other Nursing Implications for
Cardiac Glycosides 1. Give it with meals to decrease GI problems
2. Assess apical pulse for 1 minutes before
givingnote rate and rhythm
3. If pulse less than 60 beats per min., 90 in infant,
70 in children/adolescences = DO NOT GIVE
4. Call MD for bradycardia and tachycardia.
5. Report any irregular rhythmespecially if new.
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Implications continued 6. Assess and report toxicity: HA, visual
disturbances, anorexia, disorientation, weight
gainweight pt. every day 7. If on potassium-losing diuretics = increases
chance of toxicity
8. Monitor potassium level closelyreportabnormals to MD
9. Encourage food high in potassium
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Implication continued 10. Teach patienttake pulse before taking med,
what to do with findings for HR, what to do if miss
medication dose, action of med, importance of
follow-up with MD
11. Monitor drug levels as ordered by MD
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Inamrinone Lactate (Inocor) &
Milrinone Lactate (Primacor)Method of action???
1. Positive inotropic effect
2. Direct relaxant effect on vascular smooth
muscle
Uses?? Short term for CHF
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Side EffectsLeast likely to cause arrhythmiasInamrinone
Ventricular arrhythmias more likely--Milrinone
1. Thrombocytopenia
2. Drug fever
3. GI disturbances
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Administration of Inocor/Primacor 1. IV route
2. Chemical reaction with dextrose solutionsdo
not dilute
3. With Lasix = precipitate immediately forms
4. Protect ampules from light 5. If diluted = use within 24 hours
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Antiarrhythmic DrugsWhat is happening in the heart to cause
arrhythmias???
Treatments for arrhythmias??
--No treatment for some --Cardioversion --Pacemakers
--Drugs therapy
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Major Groups of AntiarrhythmicsGroup 1Sodium Channel Blockers
Group 2Beta-adrenergic Blockers
Group 3Potassium Channel Blockers
Group 4Calcium Channel Blockers
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Antiarrhythmic Agents quinidine (Duraquin, Cardioquin) Group 1
procainamide (Procan) Group 1 --Common routes????
amiodarone (Cordarone) Group 3
verapamil (Calan) Group 4
lidocaine (Xylocaine) Group 1
propranolol (Inderol) Group 2
atenolol (Tenormin) Group 2
diltiazem (Cardizem) Group 4
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Antiarrhythmic Agents continuedMechanism of action??
1. Decrease automaticity of cardiac tissues from
the SA node
2. Alter the rate of conduction of electrical
impulses
3. Alter the refractory period of cardiac muscle
between consecutive contractions
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Nursing Implications for
Antiarrhythmic Agents 1. Monitor the apical pulse for 1 minute before
administration
2. Record rate and rhythm of heart beat
3. Patient should be supine when IV dose is given
to prevent postural hypotension
4. If receiving lidocaine, tocainide, procainamide
= question if any allergies to local anesthetics
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Nursing Implication continued 5. If drug causes GI irritation = give with meals
6. Assess vital signs after administration
7. Assess for any S/S of toxicity
--Dizziness, HA, dyspnea, chest pain, edema,
hypotension, bradycardia, etc. --Know the specific medication you are giving
look it up!!!!
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Cardiac Stimulants (Sympathomimetic
Agents)When would we need to use a cardiac stimulant???
Mechanism of action???
--Adrenergic or sympathomimetic drugs mimic theaction of norepinephrine (the sympathetic nervousstimulation)----MAY CAUSE:
1. Vasoconstriction of peripheral vessels 2. Vasodilation of vessels in skeletal muscles
3. Increased HR (Positive chronotropic effect)
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Mechanism of Action continued 4. Increase in the force of contraction of the heart
(Positive inotropic effect)
5. Increased rate of glycogenolysis in the liver &
skeletal muscles
6. Stimulation of the CNS
***Not all drugs produce the effects to the same
degree***
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Examples of Action of Specific Drugs If drug works at alpha-adrenergic receptors =
profound vasoconstriction of peripheral vessels, no
real effect of heart/respiratory systems
If drug works at beta-adrenergic receptors =
increase heart rate and force of contraction along
with bronchodilation, but no real effect onperipheral blood vessels
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Examples of DrugsDobutamine (Dobutrex)
Dopamine (Intropin)
Ephedrine
Epinephrine (Adrenalin)
Isoproterenol (Isupril) Phenylephrine (Neosynephrine)
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Common Side Effects 1Nervousness and restlessness
2Sweating
3Hypertension
4Tachycardia and palpitations
5Hyperglycemia 6N/V
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Nursing Implications for
Sympathomimetic Agents 1. Assess vital signs and condition continuously
2. IV line is to be patentwatch for tissue
necrosis
3. Keep track of the names and dosages of drugs
administered during an emergency
4. Record
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Nursing Implications continued 5. Assess for CNS stimulation, HA, palpitations,
tremors, elevated blood sugars, abnormal lung
sounds
6. Be aware of the many drug interactions
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NitratesUsed for angina therapy
Actions (Theories): ***Vasodilators***
1Improve the delivery of O2 to ischemic tissue
by increasing coronary blood flow
2Cause favorable redistribution of blood flow 3Reduce the O2 consumption by coronary blood
vessels
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Examples of Nitrates nitroglycerine (Nitrostat, Nitro-Bid, NTG)
nitroglycerine SR tabs
isosorbide dinitrate (Isorbid)
isosorbide mononitrate (Imdur)
Routes??? (7)
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Side Effects of Nitrates 1HA
2Postural hypotension
3Dizziness
4Weakness
5Syncope 6Increase in introcular &/or intracranial pressure
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Other Drugs (Non-Nitrates) Used for
AnginaBeta-adrenergic blocker (propranolol, nadolol)
--Decrease HR & contractility = decreased
myocardial O2 demand
Calcium channel blocker (nifedipine, diltiazem,verapamil)
--Vasodilator = more blood to heart
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Nursing Implications for Nitrates and
Others for Angina 1. Assess the frequency, nature, precipitants of
angina
2. Teach patient to modify life styles
3. Assess the effectiveness of the drugs and for
side effects
4. Monitor vital signs, especially BP and HR
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Other Nursing Implications 5. Give medications while sitting or lying
6. Use Nitro cautiously in patients with glaucoma
7. Follow routes carefully (eg: SL = do not
swallow)
8. Nitro needs to be protected from heat, light,
should feel stinging sensation if working, get new
every 3 months
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Implications continued 9. IV Nitrodilute in IV solution, no other drugs
in the same lines, use Glass IV bottles and IV
tubing from manufacturer
10. If severe hypotension = elevate legs for 2-3
minutesif does not work slow rate and call MD
11. Teach patient to follow-up with MD, carry ID
card with information
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Implications continued 12. When beta-adrenergic blocking agent also
ordered ---give beta blocker first
13. Hold the drugs if BP lower than 90mmHG for
adult or HR less than 60 beats/min. Notify MD.
14. Assess BP and HR frequently
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Myocardial Infarction (MI)What is happening???
Reasons for MI??
1. Decrease flow of O2 to heart muscle
-- thrombus formation, embolism 2. Increased demand for O2 by myocardium
--Stress, heavy exertion, abrupt increase in BP
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Treatment of MIGoal???
1. AspirinWhy?? 7. Calcium Channel
2. NitroglycerinWhy?? BlockerWhy??
3. IV MorphineWhy??
4. Beta-BlockerWhy?? 5. ACE inhibitorWhy??
6. LidocaineWhy??
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Peripheral VasodilatorsUsed to treat???
1. Obstructive disorders (arteriosclerosis)
2. Vasospastic disorders (Raynauds)Mostly
effective with this type***
Some Drugs: Posicor, cilostazol, nylidrin
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Nursing Implications for Peripheral
Vasodilators 1. Assess the disease process, skin for color, hair,
lesions, pulses, temperature, turgor, auscultate for
arterial sounds
2. Watch for hypotensionlight headedness,
dizzy = lie down until effect passes
3. Educateno smoking, care of feet, effects of
meds, safety
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ThromboemboliHow does the body form a clot???
1. There is injury to the wall of a blood vessel
2. Activation of many different clotting factors
3. Formation of a fibrin clot
4. These clots can break loose and travel todifferent areas of the body causing more problems
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Anticoagulants 2 Purposes:
1. Prevent the formation of a thrombus
2. Inhibit the extension of the existing ones
Problems: 1. Many drug interactions
2. If not properly controlled, hemorrhagic risk
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Drug Groups the Affecting Blood
Clotting 1. Anticoagulants
2. Thrombolytic agents
3. alteplase, anistreplase
4. Hemostatic agents
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Heparin **MOST COMMON anticoagulants used**
Action = interfere with the conversion of
prothrombin to thrombin = prevents the conversion
of fibrinogen to fibrin = inhibits clots
Routes???
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Heparin continuedLab test measured by??
--Partial thromboplastin time (PTT)Therapeutic
1.5-2x normal range
Contraindicated in which type of patients??? (6)
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Heparin continuedWhat would you treat an overdose with???
--Protamine sulfate = combines with heparin to
form a stable complex with no anticoagulant action
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Oral Anticoagulantswarfarin (Coumadin) used most frequently
Method of action??
--1. Interferes with the synthesis of vitamin K
dependent clotting factors (II, VII, IX, X) in the
liver
Takes 12-24 hours to see any effect after
administered
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Coumadin continuedLab test used to measure drug???
--Prothrombin time (PT) = want it 1.5-2 x normal
value to be therapeutic level of drug
--INRInternational Normalized Ratio
Many drug interactions
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Coumadin continued If overdose: Vitamin K (phytonadione)
--Also blood transfusion if needed
Need frequent lab tests as inpatient and outpatient
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Antiplatelet Agents (Anticoagulants)Action:
--Used to inhibit the aggregation of platelets
Drugs: dipyridamole (Persantine), sulfinpyrazone
(Anturane), ticlopidine (Ticlid), abciximab
(ReoPro), chopidogrel bisulfate (Plavix),
acetylsalicylic acid (ASA, Aspirin)
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Nursing Implications for
Anticoagulants 1. Assess for S/S of bleeding: #1 SIDE FFECT*
--Hematuria --Tarry stools --Excessive vaginal
bleeding --Abdominal, flank, or joint pain --HA
--Changes in neuro status --Hematomas or
ecchymotic areas --Vomiting blood (coffee
ground) --Bleeding from nose/gums/IV
sites/dressing, etc. --Weak, rapid pulse --Restless
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Nursing Implications continued 2. Nurse need to be familiar with the drugs being
used and treatment goal of MD
3. Make sure is into fat layer, short needle (5/8
inch), could use TB syringe, do NOT aspirate,
rotate sites, prefer abdominal area, do NOT
rub/massage after injection
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Nursing Implications continued 4. IVUse IV pump for steady rate, only hang a
portion of drug for several hour time period-
WHY??, do not mix/give with other drugs in sameline
5. Avoid IM injections = risk for hematomas
6. Avoid trauma, shaving = electric razor, soft
bristle toothbrush, assistance with ambulation
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Nursing Implications continued 7. Caution/Avoid use of aspirin products, alcohol,
NSAIDs
8. Use Tylenol for HA, aches/pains
9. Keep diet consistentdo not add/change meds
10. Keep follow-up appt. with MD
11. Teach proper dosageif need 7.5 mgyou
only have 5 mg tabswhat do you do???
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Thrombolytic AgentsAction?? 2-6 hour window for use????
1. Convert the substance plasminogen to the
enzyme fibrinolysin = dissolves the fibrin clots
Drugs: urokinase (Abbokinase), streptokinase
(Streptase), TPA (tissue plasminogen activator)
Used for which type of patients???
Side Effects???
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Nursing Implications for
Thrombolysis 1. Assess patient for MIsevere pain, high
anxiety, location, nature, duration of pain, VS,
color, respiratory function, evidence of shockcold, clammy skin
2. After drug givenwatch for bleeding
cerebral, GI, pericardial. Assess VS, neuro status,visual signs of bleeding
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Nursing Implication continued 3. Apply pressure for 20-30 minutes on all
puncture sites during and after drug received
4. Assess urine for blood and hemoccult stool
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DiureticsAction???
Which type of patient would need these drugs???
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How does the Body Balance H2O and
NA??? 1. Maintained by the reabsorption of sodium along
the entire length of the nephron:
A. Proximal tubule = 70-80% reabsorbed
B. Ascending loop of Henle = 10-20 % reabsorbed
C. Distal tubule = 5% reabsorbedthis is
dependent on the concentration of the hormone
aldosterone
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Why is Potassium Imbalance a Big
Concern????Low Level = Hypokalemia:
*** Serious, life-threatening problems***
1. Potassium is needed for the neurotransmitters to
conduct impulse to the muscleslike heart, etc.
= cardiac arrhythmias, muscle weakness, lethargy,
paresthesias, hyporeflexia, altered mental status
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Treatment for Hypokalemia 1. Supplement with potassium chloride
--Come in tablets, capsules, liquids, effervescent
solutions, IV
Also can take in a food =fruits, vegetables,
almonds, peanuts, molasses, wheat germ
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Problems with High Levels of
Potassium???Hyperkalemia = ***Serious, life-threatening
problems***
Signs: Cardiac arrhythmias, muscle spasms,
muscle weakness to paralysis
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Hyponatremia Signs/symptoms:
Confusion, lethargy, muscle excitability,
convulsions, coma
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Thiazide DiureticsAction: Distal tubule = inhibits sodium and
chloride reabsorption along with chloride and
potassium from the Loop of Henle
Side effects???? (7)
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Common Agents chlorothiazide (Diuril)
hydrochlorothiazide (HydroDIURIL)
metolazone (Diulo, Zaroxolyn)
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Loop DiureticsMost potent diuretics
Site of action????
Remains effectiveeven with impaired
glomerular filtration ratesgood for young and
old
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Common Agentsbumetanide (Bumex)
ethacrynic acid (Edecrin)
furosemide (Lasix)
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Potassium-Sparing Diuretics Site of action???
**Not real potent diuretic**
What could happen the potassium level for thispatent????
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Common Agents amiloride (Midamor)
spironolactone (Aldactone)
triamterene (Dyrenium)
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Osmotic Diuretics Site of action???
Common agents: glycerin (Osmoglyn), mannital
(Osmitrol)
Uses? To treat intracranial pressure, Acute renal
failure, intraocular and intraspinal fluid pressure
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Combination Potassium-Sparing &
HCTZHCTZ = hydrochlorothiazide
Purpose of combining these drugs???
Common drugs: Aldactazide = spirolactone &HCTZ, Dyazide and Maxide = triamterene &
HCTZ
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HypertensionDefinedas sustained elevated arterial blood
pressure** Greater than or equal to 140/90* *
Possible causes???
Complications???
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Hypertension continuedRisk factors??? (7)
Mechanisms the control of blood pressure:
***CO x SVR = BP***
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Treatment for Hypertension 1. Life styleLike what changes???
**Add in medication:
2. Diuretics (Review earlier slides)
3. Centrally acting anti adrenergic agents
4. Peripherally acting anti adrenergic agents 5. Beta-adrenergic blockers
6. Vasodilators (Review earlier slides)
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Treatment continued 6. Angiotensin-Converting Enzyme (ACE)
Inhibitor
7. Aniotensin II Antagonists
8. Calcium Channel Blocking Agents
9. Combination ProductsWHY??
10. Agents used to treat Hypertensive
Emergencies
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Central Acting Antiadrenergic Agents **Potent antihypertensive but sedation biggest side
effect
Common agents: methyldopa (Aldomet), clonidine
(Catapres), guanfacine HCL (Tenex)
Action?? Block the sympathetic nervous system =
dilation of per ipheral blood vessels and reduced
HR
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Peripherally Acting Antiadrenergic
AgentsAction?? Works similar to Central Acting but
side effects = dizziness, weakness, syncope D/T
hypotensionCommon agents: prazocin (Minipress), terazosin
(Hytrin), doxazosin (Cardura)
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Beta-Adrenergic Blocking AgentsAction: Block the sympathetic nervous system
stimulation = decreased HR, decreased force of
contraction, & bronchoconstriction (Who shouldnot get this drug??)
Common agents: propranolol (Inderal), nadolol,perbutolol, timolol, pindolol, carteolol, labetalol,atenolol (Tenormin), metoprolol (Lopressor)
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Angiotensin-Converting EnzymeAction???
1. Are antagonists of the renin-angiotensin system
2. Interferes with the conversion of angiotension 1
from turning to angiotension 2 (which is a very
strong vasoconstrictor) = vasodilation = decreased
BP
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Common ACE Inhibitorsbenazepril (Lotensin), captopril (Capoten),
enalapril (Vasotec), fosinopril (Monopril),
lisinopril (Prinivil, Zestril), Quinapril (Accupril),ramipril (Altace)
One Unique Side Effect for this Class: Cough in15% on patients
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Angiotensin II AntagonistsAction???
1. Blocks the binding of angiotensin II on its
receptors = reduction in aldosterone concentrationsin the blood = less NA and H2O retention =
decreased BP
Common drugs: losartan (Cozaar), valsartan(Diovan), irbesartan, (Avapro)
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Calcium Channel Blocking AgentsAction???
1. Prevent Calcium across the cell membrane =
smooth muscle relaxation = vasodilation 2. Decreases myocardial contractility = decreases
workload of heart = decreases CO
Common drugs: diltiazem (Cardizem), nifedipine(Procardia), verapamil (Calan), amlodipine(Norvasc)
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Nursing Implications for Hypertension 1. Assess blood pressure and other vitals correctly
2. Teaching about disease, complications,
treatments, life-style changes needed, importanceof follow-up with MD
3. Teach on sodium-restricted dietread food
labels, not to add salt to cooking, watch processedfoods
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Nursing Implications continued 4. Assess fluid and electrolyte balance = daily
weight, I & O, s/s of potassium and sodium
problems 5. Assess for other side effects: orthostatic
hypotension, hyperglycemia, increased uric level
levels, dizziness, lightheadness, HA
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Nursing Implication continued 6. Teach patients to avoid heavy meals, exercise
of meals, highly stressful situations, avoid
straining at stool, safety to prevent falls/injuries
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Agents to Treat Hypertensive
EmergenciesBP is so high = permanent bodily damage or death
All IV route
Common drugs: diazoxide (Hyperstat), sodium
nitroprusside (Nitropress, Nipride), trimethaphan
camsylate (Arfonad)
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Time to Study All This!!!