Question

4. What adverse effects should the nurse teach the patient, taking beta blockers, to report to the prescriber immediately? Angiotensin-converting Enzyme inhibitors (ACE Inhibitors or ACEI): 1. How do ACE inhibitors work? 2. Why is the patient's potassium (K) level important when taking this class of medications? 3. Who should not take ACE inhibitors? 4. List the drugs that should not be taken with ACE Inhibitors or require close monitoring when doing so? 5. How is ACEI overdose/toxicity managed? Angiotensin II Receptor Blockers (ARBs): 1. How does the action of this class of drug differ from ACEI? 2. What the usual contraindications for use of this class of drugs? 3. What are the common adverse effects of this class?

Answer 1

4. Beta blockers also known as beta adrenoceptor antagonist, which are effectively used in patients with chronic stable angina. they decrease the heart rate and contractility.

The common adverse effects of beta blockers are dizziness, weakness,drowsiness or fatigue, cold hands and feet,dry mouth, skin, or eyes,headache,upset stomach, diarrhea or constipation, muscle cramps.

The serious adverse effects includes heart failure, myocardial infarction,ventricular arrhythmia, thyrotoxicosis, anaphylaxis, systemic lupus erythematosus, pulmonary embolism and withdrawal symptoms.IT can cause shortness of breath in astmatic patient due to bronchospasm, impotence or sexual dysfunction,

The nurse should teach the patient to observe for

sudden shortness of breath,worsening of chest pain or irregular heart beats or palpitation which may be symptoms of pulmonary and cardiac adverse effects.

excessive sweating, heat intolerance, increased bowel movements, tremor (usually fine shaking), nervousness, agitation, anxiety which may be symptoms of thyrotoxicosis

frequent headaches ,joint pain and swelling, development of rash on cheek and nose, excessive hair lose and anemia which are the symptoms of systemic lupus erythematosus.

rash, itching,swelling,dizziness,trouble breathing which may be an allergic reaction to the drug.

Thus, the nurse should teach the patient to watch for these effects and also not to withdraw the drug suddenly becaude it may cause fatal effects.

Angiotensin converting enzyme inhibitors

1) ACE Inhibitor reduces blood pressure by vasodilation ( by reducing peripheral vascular resistance). ACE ( Angiotensin converting enzyme) catalyses the conversation of Angiotensin I to Angiotensin II, a potent vasoconstrictor. By inhibiting this conversation reaction ACEI causes vasodilation there by reduction in blood pressure.

2) ACEI causes retention of potassium levels in the body. Angiotensin II decreases the secretion of aldosterone and decreases it's level in the blood. Aldosterone enhances the excretion of potassium from the blood through kidney. Once aldosterone level is supposed by ACEI, potassium excretion by kidney will be reduced there by increase potassium level in the blood leads other cardiovascular complications such as arrhythmia.

3) ACE Inhibitors are contraindicated for the following
Pregnant women- It can cause teratogenic effect
People with end stage kidney disease- It can worsen the kidney function
People have allergy to ACE Inhibitors- may be end up with life-threatening problems.

4. Drugs that should take with ACEI or need close monitoring
Should not co administrator with
Sacubitril - a neprilysin inhibitor ( may increases the risk of angioedema)
Aliskiren - increases the risk of hyperkalemia, hypotension and renal impatient
Drug need close monitoring
NSAIDs such aspirin, ibuprofen, and naproxen can cause retention of sodium and water and decreases effects of ACE inhibitor- BP monitoring required.

5. Toxicity management include

Supportive: Patient may have hypotension correct hypotension and maintain BP
Patient may have hyperkalemia- Manage with insulin, potassium binder or hemodialysis
Decontamination: with activated charcoal
Antidote: Angiotensin infusion and
Continues monitoring of patient

Angiotensin II receptor blockers(ARB_s)

1)Angiotensin converting enzyme inhibitors (ACEI) prevent the convertion of Angiotensin I to Angiotensin II by inhibiting the enzyme responsible for it, but Angiotensin II receptor blockers(ARB_s) block the angiotensin II to bind the receptors of blood vessels; Although, both cause vasodilation and reduce blood pressure.

2)Contraindications

Pregnancy

Concomitant aliskiren use in diabetic patients

Hypersensitivity to drug

Bilateral renal artery stenosis

Hypercalemia

3)The common advers effects include

cardiovascular effects like chest pain,palpitations, atrial fibrilation,edema, syncope

central nervous effects like fatige, headache, sleep dissorders, depression, migraine

Dermatological effects like pruritis, rash, utricaria, skin photo sensitivity

Endocrine and metabolic effects hypercalemia, hypoglycemia

Gastrointestinal effects like constipation or diarrhea, abdominal pain