Pharm. Fall 2010 Chap 43

Front 1

Alpha-adrenergic blockers

Back 1

Block the alpha-adrenergic receptors, thus causing vasodilation and decrease in blood pressure

Front 2

Beta-adrenergic blockers

Back 2

Block beta1 receptors, causing a decrease in heart rate and blood pressure

Front 3

Calcium channel blockers

Back 3

Decrease calcium level and promote vasodilation

Front 4

Angiotensin-converting enzyme (ACE) inhibitors

Back 4

Inhibit angiotensin-converting enzyme, which blocks the release of aldosterone

Front 5

Angiotensin II receptor blockers (ARBs)

Back 5

Block the angiotensin II receptor, causing a decrease in peripheral resistance and vasodilation

Front 6

The hormones atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are released by the _____________ of the heart when the volume (decreases/ overloads) within the heart chambers. ( fill in the blank and choose the correct answer)

Back 6

Atrium; overload

Front 7

Four cases of essential hypertension are:

Back 7

Obesity, aging, family history, hyperlipidemia, etc.

Front 8

Nonpharmacologic measures to decrease blood pressure include: (at least 4)

Back 8

Relaxation techniques, salt restriction, weight reduction, exercise, decrease alcohol use

Front 9

When hypertension cannot be controlled by nonpharmacologic means, antihypertensive drugs may be prescribed. Three of the sympatholytic groups are:

Back 9

Sympatholytics:
centrally-acting, peripherally-acting, alpha1 blocker, alpha-beta blocker

Front 10

Three additional categories of antihypertensives in addition to the sympatholytics are:

Back 10

Beta blocker, calcium blocker, angiotensin antagonist (ACE inhibitors), diuretics

Front 11

The Joint National committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) uses three classifications for defining elevated systolic blood pressure (SBP):

Back 11

Prehypertension, state I and stage II

Front 12

The most common antihypertensive agent for treating state I hypertension is the _______.

Back 12

diuretic

Front 13

Thiazide diuretics may be combined with other antihypertensive agents such as ____ and _____.

Back 13

Beta blockers and ACE inhibitors, also A-II inhibitors

Front 14

Many antihypertensive drugs can cause fluid retention. To decrease body fluid, what drug group is often administered with antihypertensive drugs?

Back 14

diuretics

Front 15

ACE inhibitors may be combined with the antihypertensive agent ______.

Back 15

Calcium blockers

Front 16

A client with a blood pressure of 182/ 105 mm Hg has what state of hypertension according to JNC-7?

Back 16

Stage II

Front 17

Beta-adrenergic blockers reduce cardiac output by diminishing the sympathetic nervous system response. With continued use of beta blockers, vascular resistance is (increased/ diminished) and blood pressure is (lowered/ increased). Choose the correct answer

Back 17

Diminished; lowered

Front 18

The cultural group that does not respond well to beta blockers or ACE inhibitors.

Back 18

African- American

Front 19

Atenolol and metoprolol are examples of (cardioselective/ noncardioselective) antihypertensive drugs. Choose the correct answer.

Back 19

cardioselective

Front 20

The generic names for beta blockers end with which four letters?

Back 20

olol

Front 21

The alpha blockers are useful in treating hypertensive clients with lipid abnormalities. The effects they have on lipoproteins include _________ and _____________-.

Back 21

Decreases very- low- density lipoprotein (VLDL) and LDL; increases high- density lipoprotein (HDL)

Front 22

Two direct-acting arteriolar vasodilators for treating acute hypertensive emergencies are _______ and _______.

Back 22

Prazosin, doxazosin, terazosin

Front 23

Two direct-acting arteriolar vasodilators for treating acute hypertension emergencies are: (2)

Back 23

Diazoxide and nitroprusside

Front 24

The newest group of antihypertensive drugs that are prescribed when clients cannot take ACE inhibitors is _______.

Back 24

Angiotensin II receptor antagonists (A-II blockers)

Front 25

A frequent side effect of ACE inhibitors is _______.

Back 25

coughing

Front 26

Explain the Nursing intervention:

Monitor vital signs

Back 26

Baseline vital signs for future comparison should first be taken. Blood pressure should be closely monitored to determine the effectiveness of the drug

Front 27

Explain the Nursing intervention:

Monitor WBC, BUN, serum creatinine, protein, potassium, and blood glucose levels

Back 27

BUN, serum creatinine, protein, and potassium levels may be increased when taking an ACE inhibitor. If a client with diabetes mellitus is taking an oral antidiabetic agent, hypoglycemia might result. WBC count should be monitored because neutropenia might occur

Front 28

Explain the Nursing intervention:

Inform client that dizziness and lightheadedness may occur during the first week

Back 28

ACE inhibitors are usually potent antihypertensive agents and may cause hypotension wen the drug is first started. If dizziness persists, health care provider should be notified

Front 29

Explain the Nursing intervention:

Instruct the client not to discontinue ACE inhibitor abruptly without notifying health care provider

Back 29

Rebound hypertension could result

Front 30

Explain the Nursing intervention:

Instruct the client to report bruising, petechiae, and/ or bleeding.

Back 30

Severe adverse reaction of ACE inhibitors is petechiae or bleeding

Front 31

Explain the Nursing intervention:

Instruct the client to take the drug 20 minutes to 1 hour before meals.

Back 31

Food could decrease one third of the drug absorption

Front 32

What category of antihypertensive does the generic drug belong to?

Captopril

Back 32

Angiotensin antagonist (ACE inhibitor)

Front 33

What category of antihypertensive does the generic drug belong to?

Verapamil

Back 33

Calcium blocker

Front 34

What category of antihypertensive does the generic drug belong to?

Prazosin

Back 34

Selective alpha blocker

Front 35

What category of antihypertensive does the generic drug belong to?

Methyldopa

Back 35

Centrally acting sympatholytic

Front 36

What category of antihypertensive does the generic drug belong to?

Hydralazine

Back 36

Direct- acting vasodilator

Front 37

What category of antihypertensive does the generic drug belong to?

candesartan

Back 37

Angiotensin II receptor antagonist (A-II blocker)

Front 38

The JNC-7 developed new guidelines for determining hypertension. The category for prehypertension is:

Back 38

130/ 139 Hg/ 80 – 89 mm Hg

Front 39

Another name for the cardioselective beta-adrenergic blocker is:

Back 39

Beta blocker agent

Front 40

The nonselective alpha-adrenergic blockers are useful for:

Back 40

Treating sever hypertension caused by adrenal medulla tumor

Front 41

Direct-action vasodilators used to treat hypertension act on:

Back 41

Smooth muscles of the blood vessels

Front 42

With use of direct-acting vasodilators, sodium and water are retained, and peripheral edema occurs. A drug category that is given to avoid fluid retention is:

Back 42

Diuretics

Front 43

Which of the following is NOT an action of A-II blockers (ARBs)?

a) Blocks angiotensin II
b) Increases sodium retention
c) Causes vasodilation
d) Decreases peripheral resistance

Back 43

b) Increases sodium retention

Front 44

An angiotensin receptor blocker (ARB) can be combined with the thiazide diuretic HydroDIURIL. The purpose of combining these two drugs is to:

Back 44

Enhance the antihypertensive effect by promoting sodium and water loss

Front 45

Angiotensin II receptor blockers (ARBs or A-II blockers) may be prescribed for hypertensive clients instead of an ACE inhibitor. A common side effect of ACE inhibitors is:

Back 45

Coughing

Front 46

The use of ACE inhibitors is NOT effective for treating hypertension in the African-American population. This is because African-Americans:

Back 46

Are susceptible to low-renin hypertension

Front 47

ACE inhibitors can be effective for treating hypertension in African-Americans if the ACE inhibitor is given with which other drug?

Back 47

Diuretic

Front 48

Herb-drug interactions may not occur if the client is taking certain herb supplements. An herb history should be obtained. Use of ma huang or Ephedra with an antihypertensive drug may:

Back 48

Decrease or counteract the effects of the antihypertensive drug

Front 49

Captopril is from which group of antihypertensives?

Back 49

Angiotensin antagonist (ACE inhibitor)

Front 50

The action of captopril is to:

Back 50

Inhibit angiotensin II (a vasoconstrictor).

Front 51

The protein-binding power of captopril is:

Back 51

Low protein-bound

Front 52

Situation:
D.D., age 59, has essential hypertension. He is taking captopril 25 mg t.i.d. D.D. tells the health care provider that he feels fine, his blood pressure is within normal range, and he feels he does not need the drug.

If D.D. takes captopril with a highly protein-bound drug, what might occur?

Back 52

There is no drug displacement, because captopril is not highly protein-bound

Front 53

Situation:
D.D., age 59, has essential hypertension. He is taking captopril 25 mg t.i.d. D.D. tells the health care provider that he feels fine, his blood pressure is within normal range, and he feels he does not need the drug.

What drug interaction could occur if D.D. takes captopril with nitrates, diuretics, or adrenergic blockers?

Back 53

Hypotensive reaction

Front 54

Captopril may not be as effective with which of the following group(s) of people.

Back 54

Elderly

Front 55

Situation:
D.D., age 59, has essential hypertension. He is taking captopril 25 mg t.i.d. D.D. tells the health care provider that he feels fine, his blood pressure is within normal range, and he feels he does not need the drug.

If D.D. takes captopril with a potassium-sparing diuretic, what might occur?

Back 55

Hyperkalemia

Front 56

Situation:
D.D., age 59, has essential hypertension. He is taking captopril 25 mg t.i.d. D.D. tells the health care provider that he feels fine, his blood pressure is within normal range, and he feels he does not need the drug.

D.D. states that he wishes to stop taking the drug. How might the nurse respond?

Back 56

“Captopril is controlling your blood pressure and should not be stopped until you discuss this with the health care provider.”

Front 57

Situation:
D.D., age 59, has essential hypertension. He is taking captopril 25 mg t.i.d. D.D. tells the health care provider that he feels fine, his blood pressure is within normal range, and he feels he does not need the drug.

D.D.’s antihypertensive drug was change to nifedipine (Procardia) 10 mg t.i.d. What type of antihypertensive drug is nifedipine?

Back 57

Calcium blocker

Front 58

The protein-binding power of nifedipine (Procardia) is:

Back 58

Highly protein-bound

Front 59

Situation:
D.D., age 59, has essential hypertension. He is taking captopril 25 mg t.i.d. D.D. tells the health care provider that he feels fine, his blood pressure is within normal range, and he feels he does not need the drug.

Side effects that D.D. may encounter with the use of nifedipine include all of the following EXCEPT:
a) Dizziness
b) Lightheadedness
c) Headache
d) Increased blood pressure

Back 59

d) Increased blood pressure

Front 60

Amlodipine (Norvasc) is what type of drug?

Back 60

Calcium channel blocker

Front 61

Norvasc promotes:

Back 61

Vasodilation

Front 62

Norvasc:
(protein-binding?)

Back 62

Is highly protein-bound

Front 63

Situation:
J.R. is taking amlodipine (Norvasc) 10 mg daily. He is 77 years old. His blood pressure before Norvasc was 168/ 88 mm Hg and now is 136/ 76 mm Hg.

J.R. complains of swelling in his ankles. The nurse should tell J.R. that:

Back 63

Swelling may occur with Norvasc. Call the health care provider to determine if the drug should be changed or another drug should be added

Front 64

Zebeta is classified as a/an:

Back 64

Beta blocker

Front 65

Procardia is classified as a/an:

Back 65

Calcium blocker

Front 66

Pindolol is classified as a/an:

Back 66

Calcium blocker

Front 67

The advantage(s) of beta-adrenergic blockers for their antihypertensive effect is/ are the following: select all that apply
a) Increase serum electrolyte levels
b) Minimize hypoglycemic effect
c) Maintain renal blood flow
d) Help prevent bronchoconstriction
e) Can be abruptly discontinued without causing rebound symptoms
f) Prevent hypolipidemia

Back 67

b) Minimize hypoglycemic effect
c) Maintain renal blood flow
d) Help prevent bronchoconstriction

Front 68

68) The angiotensin receptor blocker (ARB) has gained popularity for treating hypertension. Example(s) of ARB agents is/ are: select all that apply
a) Irbesartan (Avapro)
b) Losartan potassium (Cozaar)
c) Valsartan (Diovan)
d) Metoprolol (Lopressor)

Back 68

a) Irbesartan (Avapro)
b) Losartan potassium (Cozaar)
c) Valsartan (Diovan)

Front 69

A new antihypertensive agent/ group, the direct renin inhibitors, has been approved by the FDA for treatment of hypertension. Indicate the correct responses.
a) It is effective for treating severe hypertension
b) It can be combined with another antihypertensive drug such as an ARB
c) It can cause hypokalemia when taken as a monotherapy drug
d) Aliskiren (Tekturna) is an example of a direct renin inhibitor
e) Telmisartan (Micardis) is an example of a direct renin inhibitor
f) Diazoxide (Hyperstat) is an example of a direct renin inhibitor.

Back 69

b) It can be combined with another antihypertensive drug such as an ARB
d) Aliskiren (Tekturna) is an example of a direct renin inhibitor

Front 70

S.H., 82 years old, has essential hypertension. He is taking atenolol (Tenormin) 25 mg, daily, and hydrochlorothiazide 25 mg, daily. His vital signs are BP 138/ 88 mm Hg, P 74 beats/ min, R 22 breaths/ min. He lives by himself and has a care person who is with him for 4 hours in the morning and 4 hours in the evening. The care person assists S.H. with his medication and food.

What type of antihypertensive agent is atenolol (Tenormin)? Is the drug dosing for S.H. within normal range?

Back 70

Beta blocker. It is within normal-low range

Front 71

What is the pharmacologic action of atenolol (Tenormin)?

Back 71

Atenolol blocks the beta1-adrenergic receptors in the cardiac tissue

Front 72

S.H., 82 years old, has essential hypertension. He is taking atenolol (Tenormin) 25 mg, daily, and hydrochlorothiazide 25 mg, daily. His vital signs are BP 138/ 88 mm Hg, P 74 beats/ min, R 22 breaths/ min. He lives by himself and has a care person who is with him for 4 hours in the morning and 4 hours in the evening. The care person assists S.H. with his medication and food.

From what drug group is hydrochlorothiazide? Why would this drug be ordered for S.H.?

Back 72

It is a diuretic. It complements the atenolol and helps lower S.H.’s blood pressure by decreasing fluid volume

Front 73

What type of electrolyte imbalance may occur with the use of hydrochlorothiazide? Why?

Back 73

Potassium, sodium, and magnesium imbalance can result. Hydrochlorothiazide is a potassium-wasting diuretic.

Front 74

S.H., 82 years old, has essential hypertension. He is taking atenolol (Tenormin) 25 mg, daily, and hydrochlorothiazide 25 mg, daily. His vital signs are BP 138/ 88 mm Hg, P 74 beats/ min, R 22 breaths/ min. He lives by himself and has a care person who is with him for 4 hours in the morning and 4 hours in the evening. The care person assists S.H. with his medication and food.

With his blood pressure within normal range, should the drug be discontinued or the drug dose reduced?

Back 74

S.H.’s blood pressure should be closely monitored. His medications should not be discontinued because his blood pressure is not extremely low, nor was there a large blood pressure drop. The health care provider will adjust drug dose as needed

Front 75

S.H., 82 years old, has essential hypertension. He is taking atenolol (Tenormin) 25 mg, daily, and hydrochlorothiazide 25 mg, daily. His vital signs are BP 138/ 88 mm Hg, P 74 beats/ min, R 22 breaths/ min. He lives by himself and has a care person who is with him for 4 hours in the morning and 4 hours in the evening. The care person assists S.H. with his medication and food.

What important client teaching points should the nurse discuss with S.H.’s care person?

Back 75

Client teaching: the importance drug compliance and taking drugs at specified times; eating foods rich in potassium and proper nutrition; checking S.H.’s blood pressure; proper nutrition; checking S.H.’s blood pressure; proper rest; exercise if appropriate

Front 76

What are the similarities and differences between atenolol and amlodipine?

Back 76

Atenolol is a beta blocker and amlodipine is a calcium channel blocker. Both drugs lower blood pressure. Amlodipine can also cause sodium and fluid retention

Front 77

What are some of the side effects of atenolol?

Back 77

Side effects: dizziness, headache, slow heart rate, diaphoresis, cold extremities, fatigue, constipation/ diarrhea

Front 78

S.H., 82 years old, has essential hypertension. He is taking atenolol (Tenormin) 25 mg, daily, and hydrochlorothiazide 25 mg, daily. His vital signs are BP 138/ 88 mm Hg, P 74 beats/ min, R 22 breaths/ min. He lives by himself and has a care person who is with him for 4 hours in the morning and 4 hours in the evening. The care person assists S.H. with his medication and food.

What laboratory tests should be monitored?

Back 78

Serum electrolytes should be checked periodically, and also the liver enzymes