ACE Inhibitors
A 65-year-old male patient is prescribed an ACE inhibitor for the treatment of hypertension. Which medication below is an ACE inhibitor?*
A. Metoprolol
B. Benazepril
C. Losartan
D. Amlodipine
What is B (Benazepril)?
ACE Inhibitors end in -PRIL!
A physician writes a new medication order for a patient who has cardiovascular disease. The medication is an angiotensin II receptor blocker (ARB). What new medication on the patient's scheduled medication list is an ARB?*
A. Metoprolol
B. Losartan
C. Lisinopril
D. Nicardipine
What is B (Losartan)?
Angiotensin II Receptor Blockers end in -SARTAN
Your patient is taking Verapamil. When helping the patient make a lunch selection, the nurse should encourage the patient to choose items that are?
a. low in calcium
b. high in fiber
c. low in potassium
d. high in sodium
What is B?
Verapamil can cause constipation. The patient should choose to eat foods that are high in fiber to help prevent this side effect.
A patient is admitted with a dysrhythmia. The physician prescribes Propranolol. Which statement by the patient requires the nurse to hold the ordered dose and notify the physician for further orders?*
A. "I use an inhaler at home for asthma."
B. "My heart feels like it is racing, and I feel very weak."
C. "I had caffeine this morning with breakfast."
D. "I smoke 2 packs of cigarettes per day."
What is A?
Using propranolol together with albuterol may reduce the benefits of both medications, since they have opposing effects in the body. In addition, propranolol can sometimes cause narrowing of the airways, which may worsen your breathing problems or trigger severe asthmatic attacks.
Fill in the blanks: Angiotensin II causes ___________ of the vessels and triggers the release of ____________.*
A. vasodilation; anti-diuretic hormone (ADH)
B. vasodilation; aldosterone
C. vasoconstriction; aldosterone
D. vasoconstriction; anti-diuretic hormone (ADH)
What is C (vasoconstriction; aldosterone)?
Angiotensin causes vasoconstriction, raising BP levels due to the increase release of aldosterone. Therefore, ACE Inhibitors are taken to lower BP levels and inhibit the renin-angiotensin-aldosterone system.
You're teaching a patient about how angiotensin II receptor blockers (ARBs) work. Which statement below BEST describes how these medications work on the body?*
A. "They prevent Angiotensin II Type I Receptors from binding with Angiotensin II."
B. "These medications prevent the activation of Angiotensin II Type II Receptors from binding with Angiotensin II."
C. "They inhibit angiotensin-converting-enzyme (ACE) from converting an Angiotensin I to Angiotensin II."
D. "These medications prevent Angiotensin II Type I Receptors from binding with angiotensin-converting-enzyme (ACE)."
What is A?
Angiotensin II Receptor Blockers prevent angiotensin II type I receptors from binding with angiotensin II.
So veins & arteries can relax
Which expected side effect of calcium channel blockers should the nurse report to the provider immediately?
a. headache
b. light-headedness
c. heart dysthymias
d. bradycardia
C
Perfusion is a higher concern than headache and lightheadedness.
With Calcium channel blockers you can see reflex tachycardia.
At 1000 your patient is scheduled to take a dose of Atenolol. What finding below would require you to hold the scheduled dose and notify the physician?*
A. The patient's heart rate is 120 beats per minute.
B. The patient's blood pressure is 102/76.
C. The patient has swelling in lower extremities, dyspnea, and crackles in lung fields.
What is C?
Beta Blockers can cause pulmonary effects, therefore if patient is experiencing shortness of breath and crackles in the lungs, then the medication should be stopped immediately.
Which patient below would MOST benefit from an ACE Inhibitor?*
A. A 50-year-old female with systolic dysfunction heart failure.
B. A 48-year-old male with severe renal failure.
C. A 35-year-old female with chronic hepatitis.
D. A 54-year-old male with hypovolemic shock.
What is A?
ACE Inhibitors improve signs and symptoms of heart failure.
Before administering a new prescription of Angiotensin II Receptor Blockers (ARBs) the nurse should check the clients:
A. Temperature
B. Sodium level
C. Kidney function
D. Height
What is C
Check BUN and creatinine before administration; ask about liver disease!
Check BP & HR - not temp
Can cause hyperkalemia not sodium changes
Monitor for increased weight and I &O - not height
A patient is prescribed a calcium channel blocker and Digoxin. Which findings would require the nurse to hold further doses of these medications and to immediately notify the physician? Select all that apply:
a. The patient reports seeing yellow-greenish halos & is vomiting.
b. The patient reports flushing & has enlargement of the gums.
c. The patient's heart rate is regular & 80 beats per minute.
d. The patient's Digoxin level is 3ng/mL.
What is A and D?
Calcium channel blockers can increase Digoxin level. Therefore, the patient's Digoxin levels should be monitored closely. A normal Digoxin level is 0.5-2 ng/mL. Signs and symptoms of Digoxin Toxicity is nausea, vomiting, vision changes (seeing yellowish/green halos, blurred vision etc. Option B is an expected side effect from calcium channel blockers and option C is normal.
A patient is prescribed Metoprolol. Which statement by the patient requires the nurse to re-educate the patient on how to take the medication properly?*
A. "After I stop taking this medication I will let my physician know."
B. "I take this medication with my breakfast every morning."
C. "I will change positions slowly while I'm taking this medication."
D. "While I'm taking this medication I will monitor my heart rate."
What is A?
Abrupt withdrawal of a beta-blocking drug can cause rebound hypertension. These drugs should not be withdrawn abruptly, but should be tapered over 1 to 2 weeks. Antacids should not be taken with beta blockers because they may decrease absorption.
You're providing discharge instructions to a patient that will be taking an ACE Inhibitor at home. Which statements by the patient demonstrate they understood your discharge instructions? Select all that apply:*
A. "If I feel unwell, it is okay that I miss a dose."
B. "I will avoid using salt substitutes that contain potassium."
C. "I will make sure I incorporate a high amount of potatoes, bananas, oranges, and tomatoes into my diet while taking this medication".
D. "I will regularly check my blood pressure and pulse rate while taking this medication and report any significant changes to my doctor.
What is B and D?
ACE Inhibitors already cause potassium levels to increase, therefore adding more potassium to the body can be harmful. They also are responsible for managing BP, therefore it is important to monitor these levels.
A patient is taking an Angiotensin II Receptor Blocker (ARB). What finding below is an adverse side effect of this medication and should be reported to the physician?*
A. BUN 10
B. Creatinine 1 mg/dL
C. Potassium 8.6 mEq/L
D. ALT 20 U/L
What is C?
Angiotensin II Receptor Blockers increase potassium in the body. A normal potassium level is 3.5 mEq/L to 5 mEq/L. A level of 8.6 mEq/L is important to report because high potassium levels can cause further cardiac issues.
Which type of calcium channel blockers below are considered non-dihydropyridines and can provide anti-arrhythmic effects? Select all that apply:*
A. Nifedipine
B. Diltiazem
C. Amlodipine
D. Verapamil
What is B and D?
Calcium Channel blockers ending in "dipine" are known as the dihydropyridines, and they are more vascular selective. Therefore, the others are anti-dihydropyridines and can have anti-arrhythmic effects.
Adrenergic blockade at the alpha-adrenergic receptors leads to which of the following effects? (select all that apply)
a. Vasodilation
b. Decreased blood pressure
c. Increased blood pressure
d. Constriction of pupil
e. Tachycardia
What is A, B, and D?
Vasodilation
Decreased blood pressure
Constriction of pupil
A patient states they are experiencing an annoying, persistent dry cough that started once they begin taking an ACE Inhibitor. The patient is not experiencing any other signs and symptoms. As the nurse, your response is?*
A. Tell the patient to immediately stop taking the medication and seek medical treatment.
B. Reassure the patient this is a harmless side effect of this medication and to not abruptly stop taking the medication.
C. Recommend the patient start taking the medication at night to decrease the coughing.
D. Reassure the patient that the cough will disappear within 6 months of taking the medication.
What is B?
ACE Inhibitors have the tendency to cause a dry cough side effect due to the breakdown of bradykinins, which is not abnormal to see in a patient taking this medication.
A patient who developed a dry, persistent cough while taking an ACE Inhibitor is switched to an angiotensin II receptor blocker (ARB). The patient reports the cough is now gone, but asks you to explain how this medication helped alleviate the cough. What is the correct response?*
A. "ARBs prevent ACE (angiotensin-converting-enzyme) from breaking down bradykinin so a dry, persistent cough is less likely."
B. "ARBs increase ACE (angiotensin-converting-enzyme) which helps decrease bradykinin levels and helps alleviate the cough."
C. "ARBs do not inhibit ACE (angiotensin-converting-enzyme), which is a substance that inactivates bradykinin by breaking it down; therefore, a cough is not likely with this medication."
D. "ARBs prevent Angiotensin II Type I receptor sites from activating bradykinin in the lungs."
What is C?
Your patient is prescribed a calcium channel blocker. As the nurse you know that these medication works to block calcium channels in what areas of the body? Select all that apply:*
A. Vagal nerve cells
B. Vascular smooth muscle
C. Cardiac nodal tissue
D. Peripheral nervous cells
E. Cardiac myocytes
B. Vascular smooth muscle
C. Cardiac nodal tissue
E. Cardiac myocytes
Inhibits transport of calcium into myocardial & vascular smooth muscle, Systemic vasodilation, Decrease BP, Decreases angina
A patient has a new prescription for a beta blocker as part of treatment for hypertension. The nurse is reviewing the patient's current medications and notes is concerned regarding reactions to which medication?
a. thyroid hormone supplement
b. antibiotic for a sinus infection
c. oral hypoglycemic for type 2 diabetes mellitus
d. oral contraceptive
What is C?
In insulin-dependent diabetics, beta-blockers can prolong, enhance, or alter the symptoms of hypoglycemia, while hyperglycemia appears to be the major risk in noninsulin-dependent diabetics. beta-blockers can potentially increase blood glucose concentrations and antagonize the action of oral hypoglycemic drugs.