NCLEX - PHARMACOLOGY ACE Inhibitors [-pril]

PHARMACOLOGY ACE Inhibitors [-pril] • Commonly Used: Captopril, Enalapril, Fosinopril, Moexipril, Perindopril ◦ Lisinopril ▪ 20-40 mg/day ▪ Can cause HA, dizziness, fatigue, tachy ...

PHARMACOLOGY ACE Inhibitors [-pril] • Commonly Used: Captopril, Enalapril, Fosinopril, Moexipril, Perindopril ◦ Lisinopril ▪ 20-40 mg/day ▪ Can cause HA, dizziness, fatigue, tachy ▪ Notify if taking diuretic!! • Action: Any group of antihypertensive drugs that relax arteries and promote renal excretion of salt and water by inhibiting the activity of an angiotensin converting enzyme. • Indications: ◦ Treat- HTN, CHF ◦ Lower risk of stroke and heart attack • Side Effects: ◦ Postural hypotension (‘head rush’; ‘dizzy spell’) ◦ Fatigue ◦ Loss of appetite ◦ N/V; diarrhea ◦ HyperK ◦ Insomnia ◦ Could exacerbate non-productive cough ◦ Angioedema ◦ Difference between ACE inhibitors and ARBs cough and hyperkalemia are not S/E’s of ARBs • Nursing Considerations/Education: ◦ Meds cause retention of K+ Hence, monitor electrolytes (watch for ↑K) ◦ Elderly clients at highest risk for postural hypotension ◦ DO NOT abruptly discontinue meds rebound hypertension can occur ◦ Monitor BP frequently ▪ If take BP and is low, elevate pts legs by adjusting the bed and placing in Trendelenburg position ◦ Notify MD  if dizziness persists • Interactions/Contraindications ◦ Drug-Food ▪ Absorption ↓ if taken with food: Wait at least one hour after taking meds before eating ◦ Drug-Drug ▪ If pt taking diuretics, notify MD if on Lisinopril ◦ Contraindications ▪ If pt has impaired renal function  be cautious • Desirable Outcomes ◦ BP WNL ◦ Improved survival rates for pts suffering from acute MI ◦ ↓ workload on cardiovascular system ◦ ↓ or absence of chest pain Alpha Blockers [-zosin] • Commonly Used: Alfuzosin, Prazosin, Tamsulosin, Doxazosin, Silodosin, Terazosin, Reserpine (Serpasil) • Action: Help relax certain muscles and help small blood vessels remain open. Work by keeping norepinephrine from tightening muscles in the walls of smaller arteries and veins. • Indications: ◦ Treat- HTN, BPH, Raynaud’s Disease, Pheochromocytoma (Adrenal gland tumors) • Side Effects: ◦ Expected: nausea, drowsiness, nasal congestion, wt. gain, edema ◦ Orthostatic hypotension, and sodium & water retention may occur • Nursing Considerations/Education: ◦ Monitor: fluid retention, edema, BP ◦ When rising from bed, breathe slowly for a few minutes and rise slowly to avoid OH ◦ Typically NOT preferred as first tx option for high BP ▪ If BP difficult to control, alpha blockers may need to be combined with other drugs like diuretics • Interactions/Contraindications ◦ Drug-Drug ▪ Avoid OTC meds ◦ Drug-Food ▪ Prazosin (Minipress) best time to take initial dose @ bedtime ▪ Decrease salt intake ▪ + foods include: banana, oatmeal ◦ Contraindications ▪ Tamsulosin should not be prescribed to pts with coronary atherosclerosis • Desirable Outcomes ◦ Renal blood flow of pt will be correctly maintained ◦ Reduction in symptoms of BPH (noticeable) ◦ BP will be decreased within 15 minutes following oral administration in hypertensive pts Angiotension II Inhibitors-ARBS [-sartan] • Commonly Used: Candesartan, Eprosartan, Irbesartan, Losartan, Olmesartan, Telmisartan, Valsartan ◦ Brand names include- Diovan, Micardis, Benicar, Cozaar, Avapro, Teveten, Atacand • Action: Block action of angiotensin II, allowing the blood vessels to widen, thus making it easier for the heart to pump blood • Indications: Treats- HTN, CHF, Kidney Failure in Diabetes, Chronic Kidney Diseases, Scleroderma • Side Effects: Expected- HA, Dizziness, lightheadedness, nasal congestion, vomiting & diarrhea, back & leg pain, Hyperkalemia, Angioedema, Dry Cough • Nursing Considerations/Education ◦ Notify MD if edema occurs ◦ Do not stop taking drugs until DR is consulted ◦ Change positions slowly ◦ Watch for hypotension (may be reduction in fluid volume through excessive perspiration, dehydration, vomiting, & diarrhea) ◦ Have blood drawn for potassium levels • Interactions/Contraindications ◦ Drug/Drug ◦ Drug/Food ◦ Contraindications ▪ PREGNANCY CATEGORY D-not to be taken by preg moms or if breastfeeding ▪ Caution in pts with hypovolemia, hepatic, or renal dysfunction ▪ Hold Telmisartan if menstruation delayed • Desirable Outcomes ◦ Prevention and treatment of diabetic neuropathy ◦ Decrease in sodium & potassium retention ◦ Decrease in hearts workload ◦ Improvement in pts unable to tolerate ACE inhibitors Antianginals [-nitrate] • Commonly Used: Erythrityl Tetranitrate (Cardilate); Isosorbide Mononitrate (Imdur, Monoket); Isosorbide Dinitrate (Iso-Bid, Isordil, Isotrate, Sorbitrate); Nitroglycerine (NTG, Nitrostat, Nitrolingual); Nitroglycerine ointment 2% (Nitro-Bid, Nitrol, Nitrodisc, Transderm-Nito) • Action: Relax smooth muscle, producing vasodilator effect on the peripheral veins and arteries with more prominent effects on the veins. • Indications: Treats- Angina ◦ Controls- Perioperative BP • Side Effects: HA, blurred vision & dry mouth; Postural hypotension; syncope; reflex tachycardia • Nursing Considerations/Education: ◦ Sublingual Nitroglycerine ▪ Given for immediate response ▪ Can give clients 3 doses in every five minute intervals ▪ Avoid abrupt changes in posture ◦ Nitroglycerine patch ▪ Remove before defibrillation or cardioversion ▪ Prevent tolerance to nitrates: 12 hour “no nitrate” period ◦ Purpose of transdermal patch prevent chest pain, and allow pts to maintain ADL’s ◦ Topical application is used for sustained protection against angina attacks ▪ Avoid contact with skin ◦ Report to MD: continuous headaches, blurred vision, or dried mouth ◦ Keep medicine a tightly closed, dark glass container to ensure potency • Interactions/Contraindications ◦ Drug/Drug ◦ Drug/Food ◦ Contraindications ▪ Limit Alcohol: it will potentiate postural hypotension • Desirable Outcomes ◦ Prevention of chest pains (d/t coronary artery disease) ◦ Acute relief of an attack of angina pectoris