Advanced Pharmacology (Maryville NURS 615- Exam V) Latest Update 2022

Advanced Pharmacology (Maryville NURS 615- Exam V) Latest Update 2022 What assessments should be made before prescribing any antihypertensive agent? - ANS-BP, RF, and head to toe assessment. Assess diet, sodium intake, electrolytes, and potassium levels. Prior to prescribing any antihypertensives, creatinine and BUN levels should be evaluated. Confirmation of elevated BP at 3 different times. Children over 3 years old should be assessed at least once at every visit-preferred method for children is by auscultation, the correct measurement requires using a cuff that is appropriate to the child's upper arm. 12 lead EKG. UA, albumin, albumin/creatinine ratio. Diabetics or those with renal disease should have the albumin/creatinine ratio annually. The presence of albuminuria, micro albuminuria even in the setting of normal GFR is associated with increased cardiovascular risk. Blood sugar, hct, serum calcium, and lipid profile. Why are ACE inhibitors the drug of choice in diabetic patients with hypertension? - ANS-ACE-Is will improve insulin sensitivity, as well as reduce the effects of DM on the kidneys. Protect the kidneys, watch for renal function, any creatinine 2.5 requires dose reduction. Prevents diabetic nephropathy or slow its progression. Reduce albuminuria and BP. ACEIs and ARBs should be used to treat the HTN. Renal protection, reduces the conversion of AT II and improve the insulin sensitivity. What is the drug of choice to improve symptoms for patients taking propranolol? - ANSIpratropium What is the most common adverse effect of an ACE inhibitor? - ANS-Dry, hacking cough in some patients. Can switch to an angiotensin blocker which won't cause cough. Reduce dose with either of these if Cr 2.5. Most are associated with hypotension, dizziness, HA, fatigue, orthostatic hypotension, tachyphylaxis. What is the action of an ACE inhibitor? - ANS-Decreases angiotensin II and aldosterone. Vasodilatation on the venous and arterial sides of the heart. Blocks the RAAS system leads to rennin acts on angiotensinogen to angiotensin I to angiotensin II through ACE. Angiotensin II stimulates aldosterone causing sodium and water while losing potassium via the kidney. ACE is also involved in the inactivation of bradykinin a vasodilator. Bradykin is what causes the cough (irritating the lungs). What is the action of an Angiotensin Receptor Blocker? - ANS-Blocks the angiotensin II receptor to leading to increasing vascular tone and stimulating vascular smooth muscle contraction. One of the greatest advantages: doesn't produce the dry, hacking cough that ACE-Is do. Similar to ACE-I except to bradykinin activity (no cough), lowers BP, decreases vascular resistance, decreases pulmonary cap wedge pressure, decreases HR, increases cardiac index. Continues...