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Flashcards in Ch 20 Meds Affecting BP Deck (43)
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Name the 10 MEDS used to treat BP

1. Thiazide diuretics ( often the 1st, med given for HTN)
2. Angiotensin converting enzymes ( ACE) inhibitors
3. Angiotensin II receptor blockers ( ARB's)
4. Aldosterone antagonists
5. Direct renin inhibitors
6. Calcium channel blockers ( CCB)
7. Centrally acting alpha2 agonists
8. Alpha adrenergic blockers
9. Beta adrenergic blockers
10. Vasodilators


What is the prototype drug of ACE inhibitors and other drugs in that class?

captopril ( Capoten)
enalapril ( Vasotec)
Enalaprilat ( Vasotec intravenous)
fosinopril ( Monopril)
Lisinopril ( Prinivil)
ramipril ( Altace)
moexipril ( Univasc)


What are actions of ACE inhibitors

It is used for hypertension, HF, MI, diabetic and nondiabetic neuropathy
For clients at high risk for cardiovascular event, ramipril may be used to prevent MI, stroke, or death.
ACE inhibitors block the conversion of angiotensin I to angiotensin II leading to vasodilation, excretion of sodium and water, and retention of K+ by action of the kidneys


What are potential complications of ACE INHIBITORS?

1st dose orthostatic hypotension
Cough, in which the med should be discontinued.
Hyperkalemia (monitor K+ levels to maintain at a levels within 3.5 to 5
Advise client to avoid use of salt substitutes)
Rash and dysgeusia ( altered taste) primarily with captopril


What category are ACE INHIBITORS

Pregnancy category D


Ace inhibitors are contraindicated in who

Clients who have history of allergy angioedema to ace inhibitors, in bilateral renal artery stenosis, or who have a single kidney
Use cautiously in ppl who have renal impairment and collagen vascular diseas because they are at risk of developing neutropenia monitor closely for signs of infection


What class of drugs can contribute to first dose hypertension?



What med interaction can cause an additive hypotensive effect

Other hypotensive meds


What drug can increase the risk of hyperkalemia in combination of ACE INHIBITORS

Potassium supplements and potassium sparing diuretics


What increases the levels of lithium carbonate ( Eskalith)



The use of what drug may decrease the antihypertensive effects ACE INHIBITORS



All ACE INHIBITORS are administered PO except what drug

enalaprilat which is the only ACE INHIBITOR FOR IV USE


What 2 ace inhibitors should be taken one hrs before meals

Captopril and moexipril


What are ARB's

Angiotensin II receptor blockers;
Used for hypertension
HF and prevention of mortality following MI
stroke prevention
Delay progression of diabetic neuropathy


What is the major difference between ARBs and ACE INHIBITORS

is that cough and hyperkalemia are not adverse effects of ARBs


What pregnancy category are ARBs

can cause angioedema ( instruct clients to observe for skin wheels, swelling of the tongue and notify provider)
Can cause fetal injury ( advise of risk during second and third trimester)


ARBS are contraindicated in ppl who what?

In ppl who have 1 kidney
Ppl with renal stenosis


What are aldosterone antagonists

Meds that treat hypertension and HF


Name drugs of the class aldosterone antagonists

eplerenone (Inspira)
spironolactone ( Aldactone)


What does aldosterone agonists do

It antagonizes blood volume by blocking aldosterone receptors in the kidney thus promoting excretion of sodium and water


What are adverse effects of aldosterone agonists

Hyperkalemia hyponatremia

Monitor serum k+ levels
Advise client to not use k+ supplements or slat substitutes

Flulike manifestations


Aldosterone agonists are contraindicated in who

Ppl with high k+ levels, kidney impairment, and type 2 diabetes
Use cautiously in liver impairment


Med food interactions of aldosterone antagonists

Verapamil, ace inhibitors, ARBs, erythromycin and ketoconazole can increase risk of hyperkalemia lithium toxicity may occur if taken concurrently.
Do not administer with K+ supplements


Direct renin inhibitors aliskiren ( Tekturna)

Inhibits production of angiotensin I
Relieves hypertension


Adverse effects of direct renin inhibitors

Allergic reactions, angioedema
Diarrhea- dose related often seen in females and older adults


Contraindications of direct renin inhibitors

Pregnancy category C ;D during 2&3rd trimesters
Clients who have hyperkalemia

Asthma other respiratory disorders, history of angioedema, diabetes, older adults.


Med food interactions of direct renin inhibitors

Decreases serum levels of furosemide, furosemide dosage may need to be increased.

Increased effects of other hypertensive meds
Atorvastatin ( Lipitor) and ketoconazole increase levels of aliskiren, monitor for hypotension if used concurrently)


What should the nurse instruct the client about regarding direct renin inhibitors

High fat meals interfere with absorption
Take at the same time daily away from foods high in fat

Avail alone or in combination


Name Calcium channel blockers

Nifedipine ( Adalat, Procardia)
Verapamil ( Calan)
Dilatizem ( Cardizem)

Other MEDS;
amlodipine (Norvasc)
Felodipine (Plendil)
Nicardipine ( Cardene, cleviprex)


The calcium channel blocker nifedipine does what

It blocks calcium channels in blood vessels which leads to vasodilation of peripheral arterioles and arteries/ aterioles of the heart.
It acts primarily on the arterioles the veins are not significantly affected