poop but small

• where do angiotensin converting enzymes take effect


  in the lungs
• what pregnancy category are ACEI's and ARBs

  category D in 2nd and 3rd trimester
• when should you hold ACEIs and ARBS

  if pt is hypotensive or showing signs of hypotension or if they are hyperkalemic
• what is the RAAS

  the renin angiotensin aldosterone system
• what type of toxicity occurs wih ACEIs

  hepatotoxicity because they are synthesized in the liver
• what is the first line of treatment for primary vs secondary hypertension

  primary - diuretics

  secondary - ACEIs
• how do ACEIs work

  they block the conversion of angiotensin I to angiotensin II in the lungs, it results in decrease in BP and HR, decreases aldosterone secretion to reduce blood volume
• what causes most of the adverse effects associated with ACEIs

  the accumulation of bradykinin (because ACEIs break down bradykinin causing it to build up)
• what are indications for use of ACEIs

  -slow progression of heart failure

  -lower mortality of recent acute MI

  -prophylaxis of cardiac events

  -prevent or delay progression of renal disease and retinopathy of diabetics
• when are ACEIs contraindicated

  -hyperkalemia

  -angioedema

  -pregnancy

  -serious renal impairment
• what drug interaction should you be concerned with for ACEIs

  -potassium sparing diuretics because combined they can cause hyperkalemia (watch lab work regularly)

  -decreased antihypertensive and worsened renal impairment with NSAIDS

  - synergistic hypotensive actions with other antihypertensives
• what is angioedema

  rapid swelling of throat, face, larynx, tongue that can lead to airway obstruction
• what is a black box warning for ACEIs

  major congenital defects
• what is the last name o ACEIs


  "pril"
• what is the last name of ARBS

  "sartans"
• what is the prototype drug for ACEIs

  lisinopril (Prinivil)
• what is the mechanism of action for lisinopril

  -binds to and inhibits action of ACE

  -decreases serum angiotensin II and reduces aldosterone which results in less sodium and water retention which lowers blood volume and therefore BP
• what are adverse effects of lisinopril

  -dry persistant cough (due to action being in lungs)

  -headache

  -dizziness

  -orthostatic hypotension

  serious

  - angioedema

  -agranulocytosis

  -hepatotoxicity

  -hyperkalemia
• what are nursing considerations for lisinopril

  - check renal labs and potassium levels for hyperkalemia

  -monitor BP before admin and 30mins to an hour after
• when are ARBS used instead of ACEIs

  -liver impairment because you dont need to worry about hepatotoxicity
• what are ARBS used for

  -HTN

  -heart failure

  -treat MI

  -prophylaxis of CVA
• what adverse effects are avoided when ARBs are used instead of ACEIs

  -dry cough

  -angioedema is less common
• what is the prottype drug for ARBS

  -losartan (Cozaar)
• what is losartan used for

  -HTN

  -CVA prophylaxis

  -prevention of diabetic neuropathy

  -off label use for heart failure
• what is the mechanism of action of losartan

  selectuvely blocks angiotensin AT1 receptors resulting in decreased BP (inhibits effects of angiotensin II)
• what are drug interactions of losartan

  -decreased antihypertensive action with NSAIDS

  -additive hypotensive with other antihypertensies

  -hyperkalemia with potassium sparing diuretics

  -additive hypotensive effect with alcohol
• what are the 4 types of lipid disorders

  -hyperlipidemia

  -hypercholesterolemia

  -dislipidemia

  -hypertriglyceridemia
• what are the 3 main things to remember about statins

  1. avoid grapefruit juice

  2. watch liver

  3. stop if myopathies occur (rhabdomyolysis, muscle aches)
• what is rhabdomyolysis

  the breakdown of muscle tissue releases muscle fiber contents into the blood. these substances can cause kidney damage *rare but adverse effect of statins
• what is atorvastatin

  a antihyperlipidemic

  -a HMG-CoA inhibitor
• what is a serious adverse effect of statins (atorvastatin)

  rhabdomyolysis
• what are considerations for atorvastatin

  -obtain baseline lipid values

  -monitor LDL

  -assess for signs of myopathies

  -observe for signs of digoxin toxicity

  -watch for hepatoxicity (because it has major effects on liver)
• what is patient education for atorvastatin

  -report signs and symptoms of myopathies

  -no alcohol

  -no grapefruit juice
• what is the last name of statins

  statin
• what is cholestyramine

  bile acid sequestrant (type of antihyperlipidemic)
• what is an adverse effect of cholestyramine (bile acid sequestrant)

  GI obstruction because drug causes lipids to bulk up and defecate them out
• whhat are considerations for cholestyramine

  -completely disolve powder before admin

  -increase fluid intake

  -assess for signs of hypoprothrominbinemia

  -monitor lab tests for therapeutic effectiveness

  -consult prescriber if vitamins A B and folic acid are necessary
• what is important patient education for cholestyramine

  -increase fluid intake (so that lipids do not bulk in wrong place and cause GI obstruction)

  -consult HCP if necessary to take vitamin A, D and folic acid

  -disolve powder completely before admin
• what is niacin used for

  decrease LDL and triglycerides
• What is gemfibrozil?

  a fibric acid agent (fibrate) (a antihyperlipidemic agent)