CCB's , Vasodilators, RAAS drugs

A patient who is taking furosemide [Lasix] and digoxin will begin taking captopril [Capoten]. The nurse is providing information about the drug. Which statement by the patient indicates a need for further teaching?

• “I will need to have blood tests done every 2 weeks for a few months.”

• “I should take this medication on a full stomach.”

• “I should stop taking the Lasix about a week before starting the Capoten.”

• “I can use acetaminophen for analgesia if needed.”

Answer explanation

Most oral formulations of ACE inhibitors may be given without regard for meals; captopril and moexipril, however, should be given 1 hour before meals. Nonsteroidal anti-inflammatory medications should be avoided; acetaminophen is not contraindicated. Patients taking diuretics should stop taking them 1 week before starting an ACE inhibitor to minimize the risk of hypotension. A WBC with differential should be evaluated at baseline and, after treatment starts, every 2 weeks for several months to monitor for neutropenia.

. A female patient who is not taking any other medications is prescribed aliskiren [Tekturna], a direct renin inhibitor (DRI). The nurse reviews medication information with the patient. Which statement by the patient indicates understanding of the teaching?

• “I should restrict my potassium intake while taking this drug.”

• “I should take this medication 1 hour before sitting down to a meal.”

• “If I take this drug with a high-fat meal, it will be more effective.”

• “If I get pregnant, I should stop taking this drug by the second trimester.”

Answer explanation

DRIs should be taken on an empty stomach to improve their bioavailability. Patients should not take this drug when pregnant and should stop immediately upon finding out they are pregnant. Dosing with a high-fat meal reduces the drug’s bioavailability. DRIs rarely cause hyperkalemia when taken alone.

. A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do?

• Request an order for a diuretic to counter the side effects of the ACE inhibitor.

• Report the presence of a dry cough to theprescriber.

• Make sure the patient takes a potassiumsupplement.

• Instruct the patient not to get up without assistance.

Answer explanation

Severe hypotension can result with the first dose of an ACE inhibitor. The patient should be discouraged from getting up without assistance. Potassium supplements are contraindicated. A dry cough is an expected side effect that eventually may cause a patient to discontinue the drug; however, it is not a contraindication to treatment. Diuretics can exacerbate hypotension and should be discontinued temporarily when a patient starts an ACE inhibitor.

A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct?

• Reassure the patient that this is not a serious side effect

• Request an order to administer fosinopril instead of captopril.

• Hold the dose and notify the provider.

• Administer the captopril and monitor for adverse effects.

Answer explanation

Angioedema is a potentially life-threatening reaction to ACE inhibitors. If a patient has exhibited this reaction with any ACE inhibitor, he or she should not receive ACE inhibitors again. The nurse should hold the medication and notify the provider. Fosinopril is an ACE inhibitor and should not be given.

A patient who has been taking an antihypertensive medication for several years is recovering from a myocardial infarction. The prescriber changes the patient’s medication to an ACE inhibitor. The patient asks the nurse why a new drug is necessary. What is the nurse’s response?

• “ACE inhibitors regulate electrolytes that affect the cardiac rhythm.”

• “ACE inhibitors increase venous return to the heart, improving cardiac output.”

• “ACE inhibitors can prevent or reverse pathologic changes in the heart’s structure.”

• “ACE inhibitors help lower LDL cholesterol and raise HDL cholesterol.”

Answer explanation

ACE inhibitors have many advantages over other antihypertensive medications, the most important of which is their ability to prevent or reverse pathologic changes in the heart and reduce the risk of cardiac mortality caused by hypertension. They are useful in patients with high low- density lipoprotein (LDL) or low high-density lipoprotein (HDL) cholesterol, but they do not directly affect this comorbidity. They reduce venous return to the heart, thereby reducing right heart size. They do not alter serum electrolyte levels.

A female patient who begins taking spironolactone [Aldactone] as an adjunct to furosemide [Lasix] complains that her voice is deepening. What will the nurse do?

• Teach the patient to report any associated cough, which may indicate a more severe side

  effect.

• Report this side effect to the provider and request another medication for this patient.

• Contact the provider to obtain an order for a complete blood count (CBC) and liver function tests.

• Explain that this drug binds with receptors for steroid hormones, causing this effect.

Answer explanation

Spironolactone binds with receptors for aldosterone and with other steroid hormones, causing side effects such as gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice. There is no indication for a CBC or for liver function tests in this patient with this side effect. Deepening of the voice is not an indication for withdrawal of the drug. This side effect is not associated with cough

A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient?

• The patient should stop taking the medication and contact her provider immediately.

• The patient’s prescriber probably will change her medication to an ARB.

• The fetus must be monitored closely while the patient is taking this drug.

• The fetus most likely will have serious congenital defects.

Answer explanation

ACE inhibitors are known to cause serious fetal injury during the second and third trimesters of pregnancy. Whether injury occurs earlier in pregnancy is unknown, and the incidence probably is low. However, women should be counseled to stop taking the drug if they become pregnant, and they should not take it if they are contemplating becoming pregnant. Women who take ACE inhibitors in the first trimester should be counseled that the risk to the fetus is probably low. Women should stop taking the drug when pregnant. ARBs carry the same risk as ACE inhibitors

A nurse is teaching a patient who will begin taking verapamil [Calan] for hypertension about the drug’s side effects. Which statement by the patient indicates understanding of the teaching?

• “I may need to increase my digoxin dose while taking this drug.”

• “I may have swelling of my hands and feet, but this will subside.”

• “I may experience a rapid heart rate as a result of taking this drug.”

• “I may become constipated, so I should increase fluids and fiber.”

Answer explanation

Constipation is common with verapamil and can be minimized by increasing dietary fiber and fluids. Verapamil lowers the heart rate. Peripheral edema may occur secondary to vasodilation, and patients should notify their prescriber if this occurs, because the prescriber may use diuretics to treat the condition. Verapamil and digoxin have similar cardiac effects; also, verapamil may increase plasma levels of digoxin by as much as 60%, so digoxin doses may need to be reduced

A patient begins taking nifedipine [Procardia], along with metoprolol, to treat hypertension. The nurse understands that metoprolol is used to:

• prevent constipation.

• prevent reflex tachycardia.

• minimize gingival hyperplasia.

• reduce flushing.

Answer explanation

Beta blockers are combined with nifedipine to prevent reflex tachycardia. Beta blockers do not reduce flushing, minimize gingival hyperplasia, or prevent constipation. Beta blockers canreduce the adverse cardiac effects of nifedipine.

Which medications are most likely to cause postural hypotension? Select all that apply.

• Losartan [Cozaar]

• Captopril [Capoten]

• Prazosin [Minipress]

• Diltiazem [Cardizem]

• Minoxidil