Pharm Chapter 23

Front 1

What is a normal blood pressure?

Back 1

<120 / <80

Front 2

What are the numbers for prehypertension?

Is lifestyle modification needed?

Is medication needed?

Back 2

120-139 / 80-89

Yes.

No, unless compelling indications need treated.

Front 3

What are the numbers for Stage 1 hypertension?

Are lifestyle modifications needed?

Is medication needed, if so what kinds?

Back 3

140-159 / 90-99

Yes.

Yes. Usually Thiazide diuretics. Or others include: ACEI, ARB, BB, CCB or combination. Compelling indications should be treated.

Front 4

What are the numbers for Stage 2 HTN?

Is lifestyle change needed?

Is medication needed? If so, what kinds?

Back 4

>=160 / >=100

Yes.

Two-drug combinatin for most. Thiazide diuretic and ACEI, ARB, BB, or CCB.

Front 5

What is the average BP for children ages 1-5?

Back 5

90s / 60s

Front 6

What is the normal BP for age 10? boys and girls?

Back 6

103 / 60s

Front 7

What is the average BP for Men ages 20-44?

Back 7

120s / <80

Front 8

What is the average BP for women ages 20-24?

Back 8

116/72

Front 9

What is the average BP for women ages 30-44?

Back 9

120s / 70s

Front 10

What is the average BP for Men and Women ages 50-54?

Back 10

130s / 80s

Front 11

What is the average BP for Men 60+?

Back 11

140s / 80s

Front 12

What is the average BP for Women ages 60-64?

Back 12

140s / 80s.

Front 13

What is the average BP for Women ages 70+?

Back 13

150s / 80s.

Front 14

What is the Thiazide Diuretic Prototype?

What are the 2 other common meds in this group?

Back 14

hydrochlorothiazide (Hydrodiuril)

Most end in -Thiazide.

indapamide (Lozol), metalazone (Diulo)

Front 15

How do thiazide diuretics work in the body?

Back 15

Blocks the reabsorption of sodium and chloride, and prevents the reabsorption of water.

Front 16

What are the 2 reasons thiazide diuretics are used?

Back 16

1. HTN.
2. Edema due to mild-moderate heart failure, liver, and kidney disease.

Front 17

What are the 3 common adverse effects of thiazide diuretics?

Back 17

1. Dehydration.
2. Hypokalemia.
3. Hyperglycemia.

Front 18

When a patient is taking a thiazide diuretic, what 5 things should the nurse watch for?

Back 18

1. s/s of Dehydration.
2. ECG changes.
3. K+ levels.
4. s/s of Hypokalemia.
5. Monitor Glucose levels.

Front 19

What 3 types of clients should not use thiazide diuretics?

Back 19

1. Preganant or lactation women.
2. Anuria.
3. Hypersensitivity to sulfa or thiazides.

Front 20

When should thiazide diuretics be used with caution?

Back 20

Decreased renal function. They may not be effective.

Front 21

What 3 medications interact with thiazide diuretics?

Back 21

1. Digoxin.
2. Antihypertensives.
3. Lithium.

Front 22

If a thiazide diuretic is working approperiately, what 3 things should the nurse see?

Back 22

1. Decrease in BP.
2. Decrease in edema.
3. Increase in urine output.

Front 23

What is the latest time of day that you would want to give a thiazide diuretic?

Back 23

1400.

Front 24

What 4 things should the nurse document before giving a thiazide diuretic?

Back 24

1. Baseline vitals and Orthostactic BP.
2. Weight
3. Electrolyte data.
4. Location and extent of edema.

Front 25

Is there an issue of ototoxicity with the use of thiazide diuretics?

Back 25

NO.

Front 26

What are normal K+ levels?

Back 26

3.0-5.0

Front 27

What 2 things should the nurse tell the patient about their diet when taking a thiazide diuretic?

Back 27

Increase potassium, and maintain adequate fluid intake unless contraindicated.

Front 28

Can you take thiazide diuretics with food?

Back 28

YES.

Front 29

Does the client need to take a thiazide diuretic at the same time every day?

Back 29

No. Alternating the time can decrease the chance of an electrolyte imbalance.

Front 30

If you have someone in an emergent HF, should a thiazide diuretic be used?

Back 30

NO.

Front 31

With what lab and value would a thiazide diuretic NOT work?

Back 31

Creatinine clearance of less than 30 mL/min.

Front 32

How long does it take to see the maxium antihypertensive effect of a thiazide diuretic?

Back 32

2-4 weeks.

Front 33

Can metolazone be used for children?

Back 33

NO.

Front 35

What class of antiarrhythmic drugs are CCB?

Back 35

Class IV.

Front 36

What 6 things do CCB do in the body?

Back 36

1. Intracelllar calcium remains below stimulating level.
2. Dialates cornary arteries. Veins not effected.
3. Increases Mycardial oxygen delivery.
4. Slows conduction through AV and SA Nodes.
5. Decreases afterload due to dialation.
6. Decreases conductivity, decreasing heart rate.

Front 37

What 3 things are CCBs used to treat?

Back 37

1. Vasospastic angina (at rest agina).
2. Chronic stable angina.
3. Hypertension.

Front 38

What is the prototype seclective CCB?

How can you remember them?

What are the other 2 CCBs?

Back 38

Nifedipine (Procardia)

All end in -Pine.

diltiazem (Cardizem)
verapamil (Calan)

Front 39

When should diltiazem be given?

Back 39

ACHS

Front 40

When should verapamil be given?

Back 40

With food to prevent GI upset.

Front 41

What 2 things should the nurse assess before giving a CCB?

Back 41

1. BP- Hold if less than 90/60.
2. ECG.

Front 42

What are the 3 contraindications of CCBs?

Back 42

1. Sick Sinus Syndrome, unless pacemaker is in place.
2. Any heart Blocks.
3. BP less than 90/60.

Front 43

What are the 6 drug interactions of CCBs?

Back 43

1. BB.
2. Digoxin.
3. Quinidine.
4. Cimetidine.
5. Cyclosporine.
6. Furosemide is incompatible in IV solution.

Front 44

What are the 4 common side effects of CCBs?

Back 44

1. H/A.
2. Fatigue.
3. Constipation.
4. Orthostatic Hypotension.

Front 45

What 5 labs should be checked when taking a thiazide diuretic?

Back 45

1. Glucose.
2. Cholesterol.
3. Bilirubin.
4. Triglyceride.
5. Electrolytes.

Front 46

What food or supplement should clients taking a thiazide diuretic stay away from?

Back 46

Ginkgo biloba.

Front 47

What 5 labs should be checked with CCBs?

Back 47

1. alkaline phosphatase.
2. LDH.
3. CPK.
4. AST.
5. ALT.

Front 48

What food should be avoided when taking a CCB?

Back 48

Grapefruit.

Front 49

How is a overdose of a CCB treated?

Back 49

Fluid and a vasopressor.

Front 50

What patient should not get a CCB?

Back 50

Current MI or s/p MI of <2 weeks.

Front 51

What herbal supplement should not be used when taking a CCB?

Back 51

Melatonin.

Front 52

What 2 CCBs are used to treat dysrhythmias?

Back 52

1. verapamil.
2. diltiazem.

Front 53

What are 3 adverse effects of nifedipine?

Back 53

1. Reflex tachycardia.
2. Peripheral edema.
3. Acute toxicity.

Front 54

What are 7 adverse effects of verapamil and diltiazem?

Back 54

1. Orthostatic Hypotension.
2. Peripheral edema.
3. Constipation.
4. Bradycardia.
5. HF.
6. Dysrhythmias.
7. Acute toxicity.

Front 55

How long should it take to administer an IV CCB?

Back 55

2 to 3 minutes.

Front 56

What is the difference between selective and nonselective CCBs?

Back 56

Selective is for Blood vessels only. Nonselective is for both blood vessels and heart.

Front 57

Define Reflex Tachycardia

Back 57

A increase in the heart rate caused by the drop in the blood pressure from the medication action.

Front 58

What is the prototype ACEI?

How can you remember them?

Back 58

Enalapril

All end in -Pril.

Front 59

What is the most important thing about starting enalapril?

Back 59

There is a possiblility of first-dose hypotension.

Front 60

What are 3 life-threatening affects of ACEIs?

Back 60

1. Angioedema.
2. Neutropenia.
3. Agranuloctosis.

Front 61

Define angioedema.

Back 61

An allergic reaction that causes large welts that appear under the skin, especially near the eyes and lips.

Front 62

What are the 4 drug-drug interactions of ACEIs?

Back 62

1. Potassium supplements.
2. Lithium.
3. NSAIDS.
4. Thiazide diuretics.

Front 63

What 6 labs may show an increase when taking ACEIs?

Back 63

1. Potassium.
2. Creatinine.
3. ALT.
4. BUN.
5. Alkaline phosphatase.
6. AST.

Front 64

What 5 things should the nurse assess before/when someone is on a diuretic?

Back 64

1. Medical History.
2. Baseline vitals.
3. Breath sounds.
4. Lower limb edema.
5. Obtain labs.

Front 65

What should the nurse remind the paitent that is taking a diuretic?

Back 65

They may cause photosensitivity.

Front 66

What 5 things should the nurse assess when a patient is taking a CCB?

Back 66

1. Health History.
2. Baseline ECG and V/S.
3. Assess neurological status and LOC.
4. Breath chest sounds.
5. Assess for Edema. Note character and level.

Front 67

How can you remember what 4 CCBs are selective?

Back 67

FANN-- felodipine, amlodipine, nicardipine, and nifedipine.

Front 68

What is paradoxical chest pain and what causes it?

Back 68

Paradoxical chest pain is an increase in angina symptoms due to severe hypotension due to medications that have been given.

Front 69

If a client takes a medication that decreases mycardial contractility, it increases the chance of what?

Back 69

Heart Failure.

Front 70

How can you remember ACEI?

Back 70

They all end in -Pril.

Front 71

How can you remember the Angiotensin II receptor blockers, or ARBS?

Back 71

They all end in -Sartan.

Front 72

What 4 things should the nurse assess when a patient takes an ACEI?

Back 72

1. Health history.
2. Baseline vitals and ECG.
3. Neuro status and LOC.
4. Needed Labs.

Front 73

What should the patient report when taking an ACEI?

Back 73

A dry cough.

Front 74

What 4 patients taking an ACEI are at risk for the development of hyperkalemia?

Back 74

1. Lowered aldosterone levels.
2. CHF patients.
3. Impaired kidney function.
4. Diabetes.

Front 75

When are ACEI contraindicated?

Back 75

During pregnancy and lacation.

Front 76

What should be avoided when taking ACEI?

Back 76

High potassium foods, salt substitutes, and sports drinks.

Front 77

What is the major difference in ARBS and ACEI?

Back 77

ARBS do not cause the cough and hyperkalemia like ACEIs do.

Front 78

What 4 conditions are ARBs used to treat?

Back 78

1. HTN.
2. Heart failure and mortality after MI.
3. Stroke prevention.
4. Delays progression of diabetic neuropathy.

Front 79

What are the 2 adverse effects of ARBs?

Back 79

1. Angioedema.
2. Fetal Injury.

Front 80

For what 2 reasons are ARBs contraindicated?

Back 80

1. Pregnancy.
2. Renal stenosis.

Front 81

What is the one drug-drug interaction of ARBs?

How should that be handled?

Back 81

Antihypertensive medications may have an additive effect when used with ARBs.

A lower dose may be needed.

Front 82

Can ARBs be taken with food?

Back 82

Yes. They can be taken with or without food.

Front 83

What 3 things would the nurse see to know that the ARB is working?

Back 83

1. Decrease in BP.
2. Imporvement of HF by ability to perform ADLs, breath sounds, and absence of edema.
3. Imporvement in renal function AMB decreae in proteinuria.

Front 84

What 6 things should a client be taught when taking an ARB?

Back 84

1. Do not stop taking med.
2. Avoid salt substitutes.
3. Tell physician about possible pregnancy.
4. Use alternative birth control methods.
5. Report side effects.
6. Change positions slowly to prevent hypotension.

Front 85

How can you remember the beta-adrenergic antagonists?

Back 85

They all end in -Olol.

Front 86

How can you remember the Alpha-1 Andrenergic Antagonists?

Back 86

They all end in -Osin.

Front 87

What are the 3 alpha-2 Adrenergic Agonists?

Back 87

1. Clonidine (Catapres).
2. guanabenz (Wytensin).
3. methyldopa (Aldomet).

Front 88

What are the two centrally acting Alpha-1 and BB?

Back 88

1. carteolol (Cartrol, Ocupress).
2. labetalol (Trandate, Normadyne).

Front 89

What are the 3 peripherally acting Adrenergic Neuron Blockers?

Back 89

1. guanadrel (Hylorel).
2. guanethidine (Ismelin).
3. reserpine (Serpasil).

Front 90

What subclass of adrenergic antagonists are used as first-line drugs for HTN?

Back 90

Beta-blockers.

Front 91

Are alpha blockers ever used alone to treat HTN?

Back 91

No. less effective in treat CV issues than diuretics.

Front 92

Beta-blockers sshould be used cautiously with what 2 people?

Back 92

1. Asthma.
2. Heart Failure.

Front 93

When is methyldopa (aldomet) usually used?

Back 93

HTN for pregnant or lactating women.

Front 94

Before the nurse gives an adrenerrgic antagonist, what 2 things should she check?

Back 94

1. BP. Hold if less than 90/60.
2. Pulse. Hold if less than 60.

Front 95

Beside v/s and BP, what else should be checked when the patient is taking an adrenercgic blocker?

Back 95

Glucose. The s/s of hypoglycemia may be masked when taking that medication.

Front 96

Nitroprusside (Nitropress) is metabolized into what?

Back 96

cyanide.

Front 97

When are direct vasodilators used?

Back 97

To treat hypertensive crisis.

Front 98

When is there a hypertensive crisis?

Back 98

When the diastolic pressure is greater than 120 and there are s/s of organ issues.

Front 99

What is the prototype direct vasodilator?

What are the names of the other 3 direct vasodilators?

Back 99

hydralazine (Apresoline).

1. diazoside (Hyperstat IV).
2. minoxidil (Loniten).
3. nitroprusside (Nitropress).

Front 100

For what 5 reasons are direct vasodilators contraindicated?

Back 100

1. Angina.
2. Rheumatic heart disease.
3. MI.
4. Tachycardia.
5. Lupus.

Front 101

What are the 6 adverse affects of direct vasodilators?

Back 101

1. Reflex tachycardia.
2. Lupus-Like Syndrome.
3. Stevens-Johnson Syndrome.
4. Agranulocytosis.
5. Cardiac Arrhythmias.
6. Shock.

Front 102

What lab may not be accurate when using a direct vasodilator?

Back 102

Coombs Test.

Front 103

How often should v/s be monitored when a person is taking a direct vasodilator?

Back 103

Every 5-15 minutes.