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Chapter 22: Antihypertensive Drugs Test, ACE inhibitors, Pharmacology for Nurses

The key terms in this Pharmacology course Anti-hypertensive Drugs, Diuretics, Nonsteroidal, ACE inhibitors, Hypertension, Patient, Captopril, Nurse, Liver, Sexual Function, Proteinuria, , Antihypertensive, Angiotensin-Converting Enzyme, Nonsteroidal Anti-inflammatory Drugs, Diagnosis of Hypertension, Diagnosis of Hypertension, JNC-8 Guidelines.

The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class?



Nonsteroidal anti-inflammatory drugs

Calcium channel blockers

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce the antihypertensive effect of ACE inhibitors. In addition, the use of NSAIDs and ACE inhibitors may also predispose patients to the development of acute renal failure.

The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential human needs statement for the patient taking antihypertensive medications?

Altered GI elimination (diarrhea)

Need for effective perception

Altered urinary elimination (urge incontinence)

Altered sexual function

Altered sexual function is a potential human needs statement related to possible adverse effects of antihypertensive drug therapy. The other human needs statements are not appropriate.

The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a newly diagnosed hypertensive African-American patient would most likely include which drug or drug classes?

Vasodilators alone

ACE inhibitors alone

Calcium channel blockers with thiazide diuretics

Beta blockers with thiazide diuretics

According to the JNC-8 guidelines, calcium channel blockers and thiazide diuretics are recommended as first-line therapy for management of hypertension in African-American patients. The other drugs are not recommended as first-line drugs for this group.

During a follow-up visit, the health care provider examines the fundus of the patient’s eye. Afterward, the patient asks the nurse, “Why is he looking at my eyes when I have high blood pressure? It does not make sense to me!” What is the best response by the nurse?

“We must watch for increased intraocular pressure.”

“The provider is assessing for visual changes that may occur with drug therapy.”

“The provider is making sure the treatment is effective over the long term.”

“We need to monitor for drug toxicity.”

The physician would examine the fundus of a patient’s eyes during antihypertensive therapy because it is a more reliable indicator than blood pressure readings of the long-term effectiveness of treatment.

A patient with severe liver disease is receiving the angiotensin-converting enzyme (ACE) inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this patient is which characteristic?

Captopril does not need to be metabolized by the liver before becoming active because it is not a prodrug.

Captopril rarely causes first-dose hypotensive effects.

Captopril has little effect on electrolyte levels.

Captopril is a prodrug and is metabolized by the liver before becoming active.

A prodrug relies on a functioning liver to be converted to its active form. Captopril is not a prodrug, and therefore it would be safer for the patient with liver dysfunction.

A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the main reason for prescribing this class of drug for this patient?

Cardioprotective effects

Renal protective effects

Reduces blood pressure

Promotes fluid output

ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This is one reason that they are among the cardiovascular drugs of choice for diabetic patients. The other drugs do not have this effect.