NURP 424 Exam 3 Questions And Answers With
Verified Study Solutions
Factors that Affect BP - Cardiac output
- Peripheral resistance
- Heart rate
- Filling pressure
- Contractility
- Arteriolar tone
- Blood volume
- Venous tone
Blood Pressure Medicine Action Reduce blood pressure by lowering cardiac output and
peripheral resistance
ACE Inhibitors (-prils) - Block conversion of angiotensin I to angiotensin II which inhibits
aldosterone and in return lowers BP by:
- Decreasing output of the sympathetic nervous system
- Increasing vasodilation of vascular smooth muscle
- Decreasing retention of sodium and water (by decreasing aldosterone in the system)
- Inhibit the degradation of bradykinin (anti-inflammatory mediator - the cause of the cough and
angioedema) and increase the synthesis of vasodilating prostaglandins
ACE Inhibitor Indications - HTN: less SE in Caucasian decent
- Hypertensive proteinuric diabetes: helps with renal protection and prevention of nephropathy
,- Angina and ischemic heart disease: decreases peripheral vascular resistance which decrease cardiac
output; decrease the thickening of the ventricular walls which leads to less O2 demand
- Post-MI: reduce morbidity and mortality by reducing myocardial injury and preventing ventricular
remodeling
- HF: reduce remodeling of the heart due to HTN
ACE Inhibitor Caution & Contraindications - Avoid in bilateral renal artery stenosis
- Avoid in idiopathic and hereditary angioedema
- Avoid in pregnancy and lactation
- Avoid concurrent use of ACE-I with ARB or Alis kern
- Caution in renal and hepatic impairment
- Limited data for < 6 y.o. for HTN treatment. Approved for > 6 y.o.
ACE Inhibitor Adverse Effects - Dry cough
- Hypotension
- Hyperkalemia
- Skin rash
- Altered taste
- Dizziness
- HA
- Fatigue
, ARBs (-sartans) - Indications: HTN, hypertensive proteinuria diabetes, angina and ischemic heart
disease, post-MI, HF
- Pharmacodynamics: block angiotensin II receptors and reduce the levels of aldosterone secretion
which reduces the retention of sodium and water
- No effect on bradykinin so less likely to develop a cough or angioedema
ARBs Caution & Contraindications - Avoid in bilateral renal artery stenosis
- Avoid in idiopathic and hereditary angioedema
- Avoid concurrent use of ACE-I with ARB or Alis kern
- Caution with other medications that cause hyperkalemia
- Caution in renal and hepatic impairment
- Approved for > 6 y.o.
ARBs Adverse Drug Effects - Dizziness
- Hypotension
- Hyperkalemia
- Fatigue
- URI
The initial dose for an angiotensin II receptor blocker (ARB) may need to be lower in which of
these? For patients on ARBs, no change in dosage is required based on renal impairment;
however, initial ARB doses may be lower for patients with impaired hepatic function. Liver function
tests should be performed prior to initiating therapy and the dose may be increased as tolerated.
Verified Study Solutions
Factors that Affect BP - Cardiac output
- Peripheral resistance
- Heart rate
- Filling pressure
- Contractility
- Arteriolar tone
- Blood volume
- Venous tone
Blood Pressure Medicine Action Reduce blood pressure by lowering cardiac output and
peripheral resistance
ACE Inhibitors (-prils) - Block conversion of angiotensin I to angiotensin II which inhibits
aldosterone and in return lowers BP by:
- Decreasing output of the sympathetic nervous system
- Increasing vasodilation of vascular smooth muscle
- Decreasing retention of sodium and water (by decreasing aldosterone in the system)
- Inhibit the degradation of bradykinin (anti-inflammatory mediator - the cause of the cough and
angioedema) and increase the synthesis of vasodilating prostaglandins
ACE Inhibitor Indications - HTN: less SE in Caucasian decent
- Hypertensive proteinuric diabetes: helps with renal protection and prevention of nephropathy
,- Angina and ischemic heart disease: decreases peripheral vascular resistance which decrease cardiac
output; decrease the thickening of the ventricular walls which leads to less O2 demand
- Post-MI: reduce morbidity and mortality by reducing myocardial injury and preventing ventricular
remodeling
- HF: reduce remodeling of the heart due to HTN
ACE Inhibitor Caution & Contraindications - Avoid in bilateral renal artery stenosis
- Avoid in idiopathic and hereditary angioedema
- Avoid in pregnancy and lactation
- Avoid concurrent use of ACE-I with ARB or Alis kern
- Caution in renal and hepatic impairment
- Limited data for < 6 y.o. for HTN treatment. Approved for > 6 y.o.
ACE Inhibitor Adverse Effects - Dry cough
- Hypotension
- Hyperkalemia
- Skin rash
- Altered taste
- Dizziness
- HA
- Fatigue
, ARBs (-sartans) - Indications: HTN, hypertensive proteinuria diabetes, angina and ischemic heart
disease, post-MI, HF
- Pharmacodynamics: block angiotensin II receptors and reduce the levels of aldosterone secretion
which reduces the retention of sodium and water
- No effect on bradykinin so less likely to develop a cough or angioedema
ARBs Caution & Contraindications - Avoid in bilateral renal artery stenosis
- Avoid in idiopathic and hereditary angioedema
- Avoid concurrent use of ACE-I with ARB or Alis kern
- Caution with other medications that cause hyperkalemia
- Caution in renal and hepatic impairment
- Approved for > 6 y.o.
ARBs Adverse Drug Effects - Dizziness
- Hypotension
- Hyperkalemia
- Fatigue
- URI
The initial dose for an angiotensin II receptor blocker (ARB) may need to be lower in which of
these? For patients on ARBs, no change in dosage is required based on renal impairment;
however, initial ARB doses may be lower for patients with impaired hepatic function. Liver function
tests should be performed prior to initiating therapy and the dose may be increased as tolerated.
