NR 508 Final Exam study guide (1) 2020 (A GUARANTEED)

NR 508 Final Exam study guide (1) 2020 (A GUARANTEED) Cardiovascular management: Know Initial treatment choices for HTN Ace inhibitors and ARBs Know first line treatment options for HTN for African Americans without ...

NR 508 Final Exam study guide (1) 2020 (A GUARANTEED) Cardiovascular management: Know Initial treatment choices for HTN Ace inhibitors and ARBs Know first line treatment options for HTN for African Americans without renal impairment. Thiazides First line option for HTN for anyone with chronic kidney disease ACEIs or ARBs, appropriate diuretic therapy, and dietary salt restriction make up the foundation for the treatment of HTN in CKD. Lisinapril and Furosomide. IN most instances, the hypertensive CKD patient requires multiple drugs to reach goal blood pressure. Multiple antihypertensive drug combinations are possible in the CKD patient. One combination of note is that of an agent that blocks the effects of the renin-angiotensin system given together with a loop diuretic and any of several other drug classes. Diuretics: types, uses side effects, names; preferred diuretic with renal impairment; side effect of post diuretic sodium retention; recognition that some diuretics are sulfa derivatives (carbonic anhydrase inhibitors, loop diuretics, thiazides, but NOT ethacrynic acid); management of edema Thiazide diuretics increases amount of urine produced by reducing sodium re-absorbtion in the kidney. Another effect they have is to widen the blood vessels which also helps reduce blood pressure. bendroflumethiazide , chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide, metolazone. Loop diuretics are powerful diuretics that work in a part of the kidney called the loop of Henle where they reduce sodium, chloride and potassium reabsorption. This increases the amount of urine produced which helps reduce blood pressure and also helps remove any extra fluid that has been accumulating around the body (odema) or the lungs. Furosemide (Lasix), Bumetanide (Bumex), Torsemide (Demadex), Chlorothiazide (Diuril) Potassium sparing diuretics are weaker diuretics that have their effect by increasing the amount of water and sodium that passes through the kidneys to increase urine volume. Because there is no increase in the amount of potassium that is passed through the kidney sometimes you may end up with higher potassium levels. Examples are Eplerenone (Inspra), Triamterene (Dyrenium), Spironolactone (Aldactone), Amiloride (Midamorgeneric), Spironolactone(CaroSpir) SE= Acne, Alopecia, Ascites, Edema, Gender Dysphoria, Heart Failure, HTN, Hirsutism, Hypokalemia, Primary Hyperaldosteronism, Primary Hyperaldosteronism DiagnosisCarbonic anhydrase inhibitors are weaker diuretics that act by increasing the amount bicarbonate, sodium, potassium and water excreted from the kidney. Carbonic anhydrase inhibitors are also used to reduce fluid levels in the eye and is sometimes used off-label for altitude sickness. An example is Acetazolamide SE= side effects of diuretics may include changes in potassium, sodium, calcium or magnesium blood levels, changes in heartbeat, you may have dizziness, headache, tiredness, dry mouth, gastric upset, gout, increase sugar levels or muscles cramps. Related medical conditions: Edema, Congestive heart failure, Hypertension (high blood pressure), Ascites. CHF drugs including diuretic choices Angiotensin-Converting Enzyme (ACE) Inhibitors ACE inhibitors are a good choice for people who have had a heart attack, because the medicine helps reduce the workload on the heart, diabetes, help protect the kidneys small amounts of protein in your urine (microalbuminuria), an early sign of kidney damage, prevent a heart attack or stroke. SE= Hives, Irregular heartbeats (this could be caused by too much potassium in your blood), Dizziness or lightheadedness or fainting, Dry cough, Headache. Don’t take with nonsteroidal antiinflammatory drugs (NSAIDs), antacids, potassium supplements, certain diuretics, and lithium. Captopril (Capoten) Enalapril (Vasotec) Fosinopril (Monopril) Lisinopril (Prinivil, Zestril) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Angiotensin II Receptor Blockers (or Inhibitors) ARBs or Angiotensin-2 Receptor Antagonists) have had a heart attack, have coronary artery disease, have high blood pressure that hasn’t responded well to ACE inhibitors, have had many side effects from ACE inhibitors. SE= headache, fainting, dizziness, nasal congestion, diarrhea, back pain, leg pain, arrhythmia, Candesartan (Atacand), Eprosartan mesylate (Teveten), Irbesarten (Avapro), Losartin potassium, (Cozaar), Telmisartan (Micardis), Valsartan (Diovan) Angiotensin-Receptor Neprilysin Inhibitors (ARNIs) Sacubitril/valsartan