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43 Cards in this Set
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Nephrotoxic Drugs
Ch. 30 |
-amnioglycosides
-amphotericin B -ACE inhibitors -cisplatin/carboplatin -cyclosporine/tacrolimus -foscarnet -NSAIDs -pentamidine -radiographic contrast agents |
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Goal of diuretic therapy:
Ch. 30 |
reduction of extracellular fluid volume to reverse abnormal fluid retention by the body
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Conditions where excretion of excess fluid in the body is desirable (reasons for diuretic use):
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-hypertension
-heart failure -kidney failure -liver failure or cirrhosis -pulmonary edema |
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BP Classification:
Normal |
SBP: <120
DBP: <80 |
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BP Classification:
Prehypertension |
SBP: 120-139
DBP: 80-89 Treatment: Lifestyle modification, no antihypertensive drug indicated |
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BP Classification:
Stage 1 hypertension |
SBP: 140-159
DBP: 90-99 treatment: lifestyle modification, thiazide-type diuretics for most |
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BP Classification:
Stage 2 hypertension |
SBP: >_160
DBP: >_ 100 treatment: lifestyle modification, two-drug combination for most (usually thiazide-type diuretic and ACEI, ARB, BB, or CCB) |
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BP goal for those with chronic kidney disease or diabetes:
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<130/80 mmHg
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Three factors affecting blood pressure:
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-cardiac output
-blood volume -peripheral resistance |
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Blood volume
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fluid loss
-dehydration fluid retention -aldosterone -ADH |
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Peripheral resistance/diameter of arterioles
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-sympathetic nervous system activity
-renin/angiotensin II -increase in blood viscosity |
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Cardiac output
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stroke volume
-preload -contractility -afterload heart rate -sympathetic nervous system -parasympathetic nervous system -epinephrine |
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primary/idiopathic/essential hypertension
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hypertension having no identifiable cause - accounts for 90% of cases
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secondary hypertension
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hypertension with a specific cause identified - accounts for 10% of cases
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Diseases associated with hypertension:
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Cushing's syndrome, hyperthyroidism, chronic renal impairment, pheochromocytoma, arteriosclerosis
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Drugs associated with hypertension:
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corticosteroids, estrogen, erythropoietin, sibutramine
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Four target organs most often affected by prolonged or improperly controlled hypertension:
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heart
brain kidneys retina |
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One of the most serious consequences of chronic hypertension:
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heart failure due to excessive cardiac workload
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Conditions that are particularly susceptible to long-term consequences of hypertension:
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-chronic kidney disease
-diabetes |
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Effects of chronic HTN:
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-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 |
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Nonpharmacologic methods for controlling hypertension:
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-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 |
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Goal of antihypertensive therapy:
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reduce the morbidity and mortality associated with chronic HTN
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primary antihypertensive agents:
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-diuretics
-ACE inhibitors -ARB -Beta-adrenergic blockers -Calcium channel blockers |
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Mechanism of action of antihypertensive drugs:
Alpha2 agonists |
Decreases sympathetic impulses from the CNS to the heart and arterioles.
--> Vasodilation |
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Mechanism of action of antihypertensive drugs:
Alpha1 blockers |
Inhibit sympathetic activation in arterioles.
--> Vasodilation |
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Mechanism of action of antihypertensive drugs:
Direct vasodilators |
Act on smooth muscle of arterioles.
--> Vasodilation |
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Mechanism of action of antihypertensive drugs:
Calcium channel blockers |
Block calcium ion channels in arterial smooth muscle.
--> Vasodilation |
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Mechanism of action of antihypertensive drugs:
Angiotensin-receptor blockers (ARB) |
prevent angiotensin II from reaching its receptors
--> Vasodilation |
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Mechanism of action of antihypertensive drugs:
ACE inhibitors |
Block formation of angiotensin II
--> Vasodilation Blocks aldosterone secretion --> Decreasing fluid volume |
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Mechanism of action of antihypertensive drugs:
Diuretics |
Increase urine output
--> Decrease fluid volume |
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Mechanism of action of antihypertensive drugs:
Beta blockers |
Decrease heart rate and myocardial contractility
--> Reduces cardiac output |
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Initial antihypertensive drugs for mild to moderate HTN:
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thiazides
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Compelling conditions
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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 |
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Advantages of prescribing two antihypertensives concurrently:
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Lower doses of each may be used = fewer side effects --> better client compliance
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Result of prescribing two antihypertensives concurrently:
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results in additive or synergistic blood pressure reduction
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Alternative antihypertensive drugs:
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-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. |
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Important client teaching goals:
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-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. |
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Primary adverse effect for loop and thiazide diuretics:
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potassium loss/ hypokalemia
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Concurrent use of potassium-sparing diuretic with ACEI or ARB significantly increases the potential for:
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hyperkalemia
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Use of loop diuretics in HTN:
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-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 |
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Patient on spironolactone develops hypokalemia --> nurse action?
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HOLD and notify physician prior to administration
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For clients taking potassium-wasting diuretics:
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-eat foods high in K, such as bananas, apricots, kidney beans, sweet potatoes, peanut butter, avocados
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For clients taking potassium-sparing diuretics:
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-avoid foods high in K
-consult with nurse before using mineral/vitamin supplementation or electrolyte-fortified drinks |