NURP-424- Exam 3 Study
Set @ 2024
Factors that Affect BP - Answer - Cardiac output
- Peripheral resistance
- Heart rate
- Filling pressure
- Contractility
- Arteriolar tone
- Blood volume
- Venous tone
Blood Pressure Medicine Action - Answer Reduce blood pressure by lowering cardiac
output and peripheral resistance
ACE Inhibitors (-prils) - Answer - 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 - Answer - 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 & Conraindications - Answer - 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 aliskern
- Caution in renal and hepatic impairment
- Limited data for < 6 y.o. for HTN treatment. Approved for > 6 y.o.
ACE Inhibitor Adverse Effects - Answer - Dry cough
- Hypotension
- Hyperkalemia
- Skin rash
- Altered taste
- Dizziness
- HA
- Fatigue
ARBs (-sartans) - Answer - Indications: HTN, hypertensive proteinuric 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 - Answer - Avoid in bilateral renal artery stenosis
- Avoid in idiopathic and hereditary angioedema
- Avoid concurrent use of ACE-I with ARB or aliskern
- Caution with other medications that cause hyperkalemia
- Caution in renal and hepatic impairment
- Approved for > 6 y.o.
ARBs Adverse Drug Effects - Answer - Dizziness
, - Hypotension
- Hyperkalemia
- Fatigue
- URI
The initial dose for an angiotensin II receptor blocker (ARB) may need to be lower in
which of these? - Answer 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.
The action of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor
blockers (ARBs), and direct renin inhibitors on the renin-angiotensin-aldosterone (RAA)
system lowers blood pressure and reduces the adverse effects of which disease on the
kidney? - Answer The action of ACEIs, ARBs, and direct renin inhibitors on the RAA
system lowers blood pressure and reduces the adverse effects of diabetes on the
kidney.
Calcium Channel Blockers (Dihydropyridines) - Answer - Nifedipine (Procardia) or
Amlodipine (Norvasc)
- Indications: HTN and angina
- Pharmacodynamics: inhibit calcium ions from crossing the cell membrane, resulting in
a marked decrease in transmembrane calcium content and prolonged vascular smooth
muscle relaxation
- Increase myocardial oxygen supply and decrease peripheral vascular resistance
- More potent vasodilator and do not suppress the conduction of the SA or AV node
- More beneficial to the African American community
Calcium Channel Blockers (Dihydropyridines) - Caution and Contraindications - Answer
- Avoid in patients with significant peripheral edema
- Avoid in unstable angina
- Caution in hepatic impairment
- Nifedipine can be used in pregnancy and lactation
- Approved in pediatric > 6 y.o.
Calcium Channel Blockers (Dihydropyridines) - Adverse Drug Effects - Answer -
Flushing
- Dizziness
Set @ 2024
Factors that Affect BP - Answer - Cardiac output
- Peripheral resistance
- Heart rate
- Filling pressure
- Contractility
- Arteriolar tone
- Blood volume
- Venous tone
Blood Pressure Medicine Action - Answer Reduce blood pressure by lowering cardiac
output and peripheral resistance
ACE Inhibitors (-prils) - Answer - 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 - Answer - 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 & Conraindications - Answer - 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 aliskern
- Caution in renal and hepatic impairment
- Limited data for < 6 y.o. for HTN treatment. Approved for > 6 y.o.
ACE Inhibitor Adverse Effects - Answer - Dry cough
- Hypotension
- Hyperkalemia
- Skin rash
- Altered taste
- Dizziness
- HA
- Fatigue
ARBs (-sartans) - Answer - Indications: HTN, hypertensive proteinuric 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 - Answer - Avoid in bilateral renal artery stenosis
- Avoid in idiopathic and hereditary angioedema
- Avoid concurrent use of ACE-I with ARB or aliskern
- Caution with other medications that cause hyperkalemia
- Caution in renal and hepatic impairment
- Approved for > 6 y.o.
ARBs Adverse Drug Effects - Answer - Dizziness
, - Hypotension
- Hyperkalemia
- Fatigue
- URI
The initial dose for an angiotensin II receptor blocker (ARB) may need to be lower in
which of these? - Answer 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.
The action of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor
blockers (ARBs), and direct renin inhibitors on the renin-angiotensin-aldosterone (RAA)
system lowers blood pressure and reduces the adverse effects of which disease on the
kidney? - Answer The action of ACEIs, ARBs, and direct renin inhibitors on the RAA
system lowers blood pressure and reduces the adverse effects of diabetes on the
kidney.
Calcium Channel Blockers (Dihydropyridines) - Answer - Nifedipine (Procardia) or
Amlodipine (Norvasc)
- Indications: HTN and angina
- Pharmacodynamics: inhibit calcium ions from crossing the cell membrane, resulting in
a marked decrease in transmembrane calcium content and prolonged vascular smooth
muscle relaxation
- Increase myocardial oxygen supply and decrease peripheral vascular resistance
- More potent vasodilator and do not suppress the conduction of the SA or AV node
- More beneficial to the African American community
Calcium Channel Blockers (Dihydropyridines) - Caution and Contraindications - Answer
- Avoid in patients with significant peripheral edema
- Avoid in unstable angina
- Caution in hepatic impairment
- Nifedipine can be used in pregnancy and lactation
- Approved in pediatric > 6 y.o.
Calcium Channel Blockers (Dihydropyridines) - Adverse Drug Effects - Answer -
Flushing
- Dizziness
