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

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.