Chapter 47

Question 1

What does the Renin-Angiotensin-Aldosterone System do?

Answer 1

It tries to raise BP by constricting vessels & holding onto water

Question 2

When the RAAS activates, what does it cause? (3)

Answer 2

1. Renin release from kidneys
2. Angiotensin II formation –> raises BP through vasoconstriction
3. Aldosterone release –> retains sodium & water

Question 3

NITROPRUSSIDE
-What is the drug class?

Answer 3

Direct vasodilator/antihypertensive agent

Question 4

NITROPRUSSIDE: Therapeutic Use
-What is this used for?

Answer 4

Lowering BP RAPIDLY in hypertensive emergencies

Question 5

NITROPRUSSIDE: Therapeutic Use
-When does BP return to pretreatment levels?

Answer 5

Minutes after stopping infusion

Question 6

NITROPRUSSIDE: Mechanism of Action
-What does it do
-What does this activate?
-What will this cause?

Answer 6

-It breaks down to release nitric oxide
-guanylate cyclase
-vasodilation of arterioles & veins

Question 7

NITROPRUSSIDE: Pharmacokinetics
-What is the route?

Answer 7

IV

Question 8

NITROPRUSSIDE: Adverse Effects
-What are the 4 major adverse effects?

Answer 8

1. Excessive hypotension
2. Cyanide poisoning
3. Thiocyanate toxicity
4. Retention of sodium & water

Question 9

NITROPRUSSIDE: Adverse Effects
-What does a drop in BP cause?

Answer 9

Headache, palpitations, N/V, & sweating

Question 10

NITROPRUSSIDE: Adverse Effects
-Who does risk of cyanide poisoning increase in?

Answer 10

Patients with liver disease

Question 11

NITROPRUSSIDE: Adverse Effects
-What can thiocyanate toxicity cause? (3)

Answer 11

1. Disorientation
2. Psychotic behavior
3. Delirium

Question 12

NITROPRUSSIDE: Drug Interactions
-What can prevent excessive fluid retention during treatment?

Answer 12

Furosemide

Question 13

ARBs
-What kinds of medications are these?

Answer 13

Angiotensin II receptor blockers

Question 14

ARBs: Therapeutic Use
-What are these used for? (4)

Answer 14

1. HTN
2. HF
3. Diabetic neuropathy
4. MI & stroke prevention

Question 15

ARBs: Mechanism of Action
-What do these block?

Answer 15

-Access of angiotensin II to its receptors

Question 16

ARBs: Mechanism of Action
-What is the result when angiotensin II is blocked? (4)

Answer 16

1. Arteries & veins dilate
2. Prevents pathologic changes in heart structure
3. Decreases aldosterone release
4. Increases sodium & water excretion

Question 17

ARBs: Pharmacokinetics
-What is the route?
-Taken with or without food?

Answer 17

-PO
-Either or

Question 18

ARBs: Adverse Effects
-What are the 3?

Answer 18

1. Angioedema
2. Fetal harm (2nd & 3rd trimester)
3. Renal failure

Question 19

ARBs: Adverse Effects
-Who does renal failure occur in?

Answer 19

Patients with bilateral renal artery stenosis

Question 20

ARBs: Drug Interactions
-When may this require dose reduction?

Answer 20

When given with other antihypertensive drugs

Question 21

ARBs: Nursing Interventions
-What will you monitor?
-What will you assess for?

Answer 21

-BP
-Angioedema –> facial swelling

Question 22

NIFEDIPINE
-What is the drug class?

Answer 22

CCB

Question 23

NIFEDIPINE
-What kind of CCB is this?
-What does it act primarily on?

Answer 23

-Dihydropyridine
-Blood vessels

Question 24

NIFEDIPINE: Therapeutic Uses
-What is this used for? (2)

Answer 24

1. HTN
2. Angina pectoris

Question 25

**NIFEDIPINE**: *Mechanism of Action* -What does this block? -Why does it do this?

Answer 25

-Calcium channels in vascular smooth muscle -To cause vasodilation

Question 26

**NIFEDIPINE**: *Pharmacokinetics* -Absorption and route?

Answer 26

Well absorbed orally

Question 27

**NIFEDIPINE**: *Adverse Effects* -What are the 3 adverse effects?

Answer 27

1. Vasodilation: flushing, peripheral edema, headaches, dizziness 2. Gingival hyperplasia 3. Reflex tachycardia

Question 28

**NIFEDIPINE**: *Adverse Effects* -Does reflex tachycardia occur with instant relase (IR) or slow release (SR)?

Answer 28

IR

Question 29

**NIFEDIPINE**: *Drug Interactions* -What can nifedipine be combined with to prevent reflex tachycardia?

Answer 29

Beta blockers