Pharm - Exam 4 - Textbook Notes

Front 1

Nephrotoxic Drugs

Ch. 30

Back 1

-amnioglycosides
-amphotericin B
-ACE inhibitors
-cisplatin/carboplatin
-cyclosporine/tacrolimus
-foscarnet
-NSAIDs
-pentamidine
-radiographic contrast agents

Front 2

Goal of diuretic therapy:

Ch. 30

Back 2

reduction of extracellular fluid volume to reverse abnormal fluid retention by the body

Front 3

Conditions where excretion of excess fluid in the body is desirable (reasons for diuretic use):

Back 3

-hypertension
-heart failure
-kidney failure
-liver failure or cirrhosis
-pulmonary edema

Front 4

BP Classification:

Normal

Back 4

SBP: <120
DBP: <80

Front 5

BP Classification:

Prehypertension

Back 5

SBP: 120-139
DBP: 80-89

Treatment: Lifestyle modification, no antihypertensive drug indicated

Front 6

BP Classification:

Stage 1 hypertension

Back 6

SBP: 140-159
DBP: 90-99

treatment: lifestyle modification, thiazide-type diuretics for most

Front 7

BP Classification:

Stage 2 hypertension

Back 7

SBP: >_160
DBP: >_ 100

treatment: lifestyle modification, two-drug combination for most (usually thiazide-type diuretic and ACEI, ARB, BB, or CCB)

Front 8

BP goal for those with chronic kidney disease or diabetes:

Back 8

<130/80 mmHg

Front 9

Three factors affecting blood pressure:

Back 9

-cardiac output
-blood volume
-peripheral resistance

Front 10

Blood volume

Back 10

fluid loss
-dehydration
fluid retention
-aldosterone
-ADH

Front 11

Peripheral resistance/diameter of arterioles

Back 11

-sympathetic nervous system activity
-renin/angiotensin II
-increase in blood viscosity

Front 12

Cardiac output

Back 12

stroke volume
-preload
-contractility
-afterload
heart rate
-sympathetic nervous system
-parasympathetic nervous system
-epinephrine

Front 13

primary/idiopathic/essential hypertension

Back 13

hypertension having no identifiable cause - accounts for 90% of cases

Front 14

secondary hypertension

Back 14

hypertension with a specific cause identified - accounts for 10% of cases

Front 15

Diseases associated with hypertension:

Back 15

Cushing's syndrome, hyperthyroidism, chronic renal impairment, pheochromocytoma, arteriosclerosis

Front 16

Drugs associated with hypertension:

Back 16

corticosteroids, estrogen, erythropoietin, sibutramine

Front 17

Four target organs most often affected by prolonged or improperly controlled hypertension:

Back 17

heart
brain
kidneys
retina

Front 18

One of the most serious consequences of chronic hypertension:

Back 18

heart failure due to excessive cardiac workload

Front 19

Conditions that are particularly susceptible to long-term consequences of hypertension:

Back 19

-chronic kidney disease
-diabetes

Front 20

Effects of chronic HTN:

Back 20

-damage to blood vessels supplying blood and oxygen to the brain can result in TIAs and cerebral vascular accidents or strokes.
-damage to arteries in kidneys, leading to a progressive loss of renal fx.
-vessels in retina can rupture or become occluded, resulting in visual impairment or blindness

Front 21

Nonpharmacologic methods for controlling hypertension:

Back 21

-limit intake of alcohol
-restrict salt consumption
-reduce intake of saturated fat and cholesterol and increase consumption of fresh fruits and vegetables
-increase aerobic physical activity
-DISCONTINUE use of tobacco products
-explore measures for dealing with stress
-maintain optimum weight

Front 22

Goal of antihypertensive therapy:

Back 22

reduce the morbidity and mortality associated with chronic HTN

Front 23

primary antihypertensive agents:

Back 23

-diuretics
-ACE inhibitors
-ARB
-Beta-adrenergic blockers
-Calcium channel blockers

Front 24

Mechanism of action of antihypertensive drugs:

Alpha2 agonists

Back 24

Decreases sympathetic impulses from the CNS to the heart and arterioles.

--> Vasodilation

Front 25

Mechanism of action of antihypertensive drugs:

Alpha1 blockers

Back 25

Inhibit sympathetic activation in arterioles.

--> Vasodilation

Front 26

Mechanism of action of antihypertensive drugs:

Direct vasodilators

Back 26

Act on smooth muscle of arterioles.

--> Vasodilation

Front 27

Mechanism of action of antihypertensive drugs:

Calcium channel blockers

Back 27

Block calcium ion channels in arterial smooth muscle.

--> Vasodilation

Front 28

Mechanism of action of antihypertensive drugs:

Angiotensin-receptor blockers (ARB)

Back 28

prevent angiotensin II from reaching its receptors

--> Vasodilation

Front 29

Mechanism of action of antihypertensive drugs:

ACE inhibitors

Back 29

Block formation of angiotensin II

--> Vasodilation

Blocks aldosterone secretion

--> Decreasing fluid volume

Front 30

Mechanism of action of antihypertensive drugs:

Diuretics

Back 30

Increase urine output

--> Decrease fluid volume

Front 31

Mechanism of action of antihypertensive drugs:

Beta blockers

Back 31

Decrease heart rate and myocardial contractility

--> Reduces cardiac output

Front 32

Initial antihypertensive drugs for mild to moderate HTN:

Back 32

thiazides

Front 33

Compelling conditions

Back 33

conditions that may benefit from a second drug in place of a diuretic or in combination with.

heart failure, post-myocardial infarction, high risk for coronary artery disease, diabetes, chronic kidney disease, recurrent stroke prevention

Front 34

Advantages of prescribing two antihypertensives concurrently:

Back 34

Lower doses of each may be used = fewer side effects --> better client compliance

Front 35

Result of prescribing two antihypertensives concurrently:

Back 35

results in additive or synergistic blood pressure reduction

Front 36

Alternative antihypertensive drugs:

Back 36

-alpha1 adrenergic antagonist
-alpha2 adrenergic agonist
-direct-acting vasodilators
-peripheral adrenergic antagonists

Cause more side effects and are only prescribed when first-line agents do not produce satisfactory response.

Front 37

Important client teaching goals:

Back 37

-teaching the importance of treating the disease to avoid long-term consequences.
-teaching to report drug side effects promptly so that dosage can be adjusted or changed and treatment may continue uninterrupted.

Front 38

Primary adverse effect for loop and thiazide diuretics:

Back 38

potassium loss/ hypokalemia

Front 39

Concurrent use of potassium-sparing diuretic with ACEI or ARB significantly increases the potential for:

Back 39

hyperkalemia

Front 40

Use of loop diuretics in HTN:

Back 40

-Very effective at relieving HTN because of greater diuresis.
-Not ideal because of their ability to remove large amounts of fluid in a short period of time.
-Risk for hypokalemia and dehydration.
-Higher toxicity
-Reserved only for more serious cases of HTN; primary use CHF

Front 41

Patient on spironolactone develops hypokalemia --> nurse action?

Back 41

HOLD and notify physician prior to administration

Front 42

For clients taking potassium-wasting diuretics:

Back 42

-eat foods high in K, such as bananas, apricots, kidney beans, sweet potatoes, peanut butter, avocados

Front 43

For clients taking potassium-sparing diuretics:

Back 43

-avoid foods high in K
-consult with nurse before using mineral/vitamin supplementation or electrolyte-fortified drinks