Pharm II Unit 9 Blood Pressure Drugs

What are the 3 drug classes for Blood Pressure?
Hypertensive crisis
Vasopressors
Direct-acting inotropic
What is the prototype drug for hypertensive crisis?
Nitroprusside (Nitropress)
What are the pharmacodynamics of nitroprusside (Nitropress)? (4)
• Relaxes vascular smooth muscle
• Dilates peripheral arteries and veins
• Reduces preload and afterload
• Moderate doses induce renal vasodilation
What is the pharmcokinetics of nitroprusside (Nitropress)?
• IV at approx. 2 µg/kg/minute
What are the uses for nitroprusside (Nitropress)? (3)
• Lower BP in acute hypertensive crisis
• Reduce bleeding during surgery
• Acute CHF
What are teh contraindications for nitroprusside (Nitropress)? (2)
• Compensatory HTN from aortic coarctation or arteriovenous shunting
• Inadequate cerebral circulation in surgery
What is the common adverse effect for nitroprusside (Nitropress)?
• Hypotension from rapid infusion
What are the serious adverse effects of nitroprusside (Nitropress)? (3)
• Cyanide poisoning: converted in erythrocytes
• Methemoglobinemia: blood appears chocolate brown and does not change color upon exposure to air
• Increased ICP
What are the nursing interventions for nitroprusside (Nitropress)? (8)
• Administer the infusion via volumetric infusion pump in the ICU
• Need invasive monitoring arterial lines and Swan-gantz lines for accurate BP and CO
• Take BP q5 min at start-up and q15 during to monitor for cyanide poisoning
• Draw blood thiocyanate levels q72 hrs
• Report S/S of poisoning: profound hypotension, metabolic acidosis, dyspnea, HA, LOC, ataxia, vomiting
• Start infusion slow and slowly increase; once max infusion rate achieved DO NOT continue for >10 minutes or >10 µg/kg/min
• Protect diluted bag from light: wrap in opaque sleeve.
• Color should be brownish. Discard if green blue or red or if particulate appears
What is the prototype drug for Vasopressors?
dopamine (Intropin)
What are the pharmacodynamics of dopamine (Intropin)? (3)
• Stimulates Beta & Alpha to increase CO, BP, and renal perfusion
• Constricts veins, dilates arteries
• + inotrope, + chronotrope
What is the pharmacokinetic use of dopamine (Intropin)?
• IV, acts in 5 minutes
What are the uses for dopamine (Intropin)? (2)
• Hypotension from shock
• Septic shock when hypotension is not corrected after volume resuscitation
What are the contraindications for dopamine (Intropin)? (2)
• Ventricular dysrhythmias: V fib
• Pheochromocytoma
What are the common adverse effects of dopamine (Intropin)? (3)
• N/V, HA
• Palpitations, Ectopic Beats
• Dyspnea, angina
What are the serious adverse effects of dopamine (Intropin)? (4)
• Ventricular dysrhythmias
• Increased pulmonary shunting
• Decrease splanchnic perfusion
• Increase pulmonary wedge pressure
What are the nursing interventions for dopamine (Intropin)? (9)
• Complete physical assessment and focused cardiac assessment prior to administration
• Need invasive monitoring arterial lines and Swan-gantz lines
• Watch the pt electrolytes to make sure adequate renal perfusion (Creatinine and K+)
• Blood gases to detect acidosis as this will decrease effectiveness of dopamine
• Use in a dedicated central line d/t numerous incompatibilities
• Extravasation may occur and cause sloughing
• Correct hypovolemia prior to administration
• Monitor BP, UO, CO, PWP
• Antidote: SQ injection of phentolamine
What is the prototype drug for Direct-acting inotropic drugs?
dobutamine (Dobutrex)
What are the pharmacodynamics of dobutamine (Dobutrex)? (3)
• No effect on renal perfusion
• Increase HR w/ less decrease in peripheral vascular resistance
• No norepinephrine release
What is the pharmacokinetic use of dobutamine (Dobutrex)?
• IV, acts in 1-2 minutes
What is the use for dobutamine (Dobutrex)?
• Adults w/ cardiac decomposition due to decreased contractibility from organic heart disease or cardiac surgery
What are the contraindications for dobutamine (Dobutrex)? (2)
• Hypersensitivity: Sulfite allergies
• Ventricular fibrillation or uncorrected tachycardia
What are the common adverse effects of dobutamine (Dobutrex)? (2)
• Ventricular ectopic activity
• N, HA, SOB, palpitations
What are the serious adverse effects of dobutamine (Dobutrex)? (2)
• Anaphylactic Reaction
• Increase of 30 bpm and systolic BP of 50 mmHg leading to tachycardia
What are the nursing interventions for dobutamine (Dobutrex)? (6)
• Monitor ECG, HR, BP, Cardiac output, and pulmonary wedge pressure continuously
• Caution should be used to prevent infiltration at injection site
• Hypovolemia should be corrected before administrating drug w/ plasma expanders
• Complete physical assessment and focused cardiac assessment prior to administration
• Hypersensitivity Rxn: skin rash, fever, eosinophilia, and bronchospasm
• Digitalis preparation prior to admin in patients with a fib w/ rapid ventricular response d/t ↑ AV conduction

Who was sentenced to death in a controversial criminal trial? c. Nicola Sacco The trial and execution of Nicola Sacco and Bartolomeo Vanzetti: d. demonstrated how the Red Scare extended into the 1920s. WE WILL WRITE A CUSTOM ESSAY SAMPLE …

Palpate bony landmarks of the pelvis a. Pubic symphysis b. Pubic crest – attachment for rectus abdominis c. Pubic tubercle – attachment for inguinal ligament d. ASIS e. PSIS – dimples f. Ischial tuberosity g. Crest of ilium h. Tubercle …

What is a symptom of bacterial pharyngitis? Fever Fever is a symptom of bacterial pharyngitis; other symptoms are an elevated white blood count (WBC), abrupt onset, headache, sore throat, abdominal discomfort, enlargement of tonsils, and firm cervical lymph nodes. p …

Esophageal rings is defined as a concentric, smooth, thin (axial length of 0.3-0.5 cm) extension of normal esophageal tissue consisting of 3 anatomic layers of mucosa, submucosa, and muscle. Found in the distal esophagus Esophageal A ring it is located …

David from ajethno:

Hi there, would you like to get such a paper? How about receiving a customized one? Check it out https://goo.gl/chNgQy