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\- Renin Converts Angiotensinogen to Angiotensin I Renin acts on a protein called angiotensinogen, which is produced by the liver and constantly present in the blood. Renin breakdown angiotensinogen, converting it into angiotensin I, which is relatively inactive. \- Angiotensin I is Converted to...

\- Renin Converts Angiotensinogen to Angiotensin I Renin acts on a protein called angiotensinogen, which is produced by the liver and constantly present in the blood. Renin breakdown angiotensinogen, converting it into angiotensin I, which is relatively inactive. \- Angiotensin I is Converted to Angiotensin II Angiotensin I is then converted into angiotensin II, primarily in the lungs, by the enzyme angiotensin- converting enzyme (ACE). Angiotensin II is the most active form and plays several crucial roles. \- Aldosterone Secretion: It stimulates the adrenal glands to release aldosterone. \- Antidiuretic Hormone (ADH) Release: Angiotensin II also stimulates the release of ADH (alsocalled vasopressin) \- Aldosterone's Role: increase sodium reabsorbption, excrete potassium \- Ace Inhibitor (ANGIOTENSIN-CONVERTING ENZYME): 1\. Blocks ACE from converting angiotensin I to angiotensin II, leading to a decrease in blood pressure, a Decrease in Aldosterone production, and an increase in serum potassium levels along with sodium and fluid loss 2\. It inhibits the breakdown of BRADYKININ leading to vasodilation and Side Effect of Persistent Dry cough 3\. These medications improve cardiac output by reducing preload and afterload \- Side effects of ACE INHIBITOR 1\. Orthostatic hypotension or Postural hypotension 2\. When ACE inhibitors are used with potassium-sparing diuretics, potassium supplements, or potassium-containing salt substitutes, hyperkalemia may occur \- Nursing Consideration for ACE inhibitors Advise client to avoid potassium rich food \- Angiotensin II Receptor Blockers (ARBs): ARBs work by blocking the effects of angiotensin II 1\. blocking the action of angiotensin II 2\. By blocking these receptors, ARBs prevent the vasoconstrictive effects of angiotensin II adverse effect: increased serum potassium: check serum potassium nursing consideration: rebound hypertension \- Calcium Channel Blockers \* Decrease BP, cardiac work load, and myocardial oxygen consumption nursing consideration: 1\. Monitor VS (BP and Heart rate): CHECK for severe Hypotension and HR below 60 bpm 2\. Monitor for reflex tachycardia 3\. Educate not to take together with grapefruit juice \- beta adrenergic antagonists Action: 1\. Exerts its action by blocking the effects of the neurotransmitters epinephrine and norepinephrine at beta adrenergic receptors. 2\. Symphathetic Nervous System Response: Increase in BP/HR, increase strength of contractility, bronchodilation and increase glucose levels nursing interventions: 1\. Withhold the medication if the pulse or BP is not within the prescribed parameters. 2\. Assess for respiratory distress and for signs of wheezing and dyspnea. \- vasodilators side effects: Reflex Tachycardia caused by vasodilation and the drop in BP: To prevent reflex tachycardia the patient may be prescribed beta-adrenergic blocker, such as propranolol. \- Nursing Considerations for Sodium nitroprusside: When administering, solution must be covered by a dark bag provided by the manufacturer and is stable for 24 hours. \- Types of DIURETICS: \- 1. Thiazide and thiazide-like diuretics: chlorothiazide (Diuril), hydrochlorothiazide (HydroDIURIL), methyclothiazide (generic), chlorthalidone (generic), indapamide (generic), and metolazone Zaroxolyn) They are less effective at producing diuresis than the loop diuretics \- 2. Potassium-sparing diuretics: act on the distal tubule to promote sodium and water excretion and potassium retention Interventions: 1\. Monitor for a potassium level greater than 5.1 mEq/L, which indicates hyperkalemia. 2\. In men, Spironolactone can cause gynecomastia, impotence, and diminished libido. \- Loop diuretics/POTASSIUM WASTING diuretics: are highly potent drugs. \* Increase the excretion of water, sodium chloride and potassium. \* Resulting to increased urine production \* more potent than thiazide diuretics, causing rapid diuresis Nursing interventions: 1\. Monitor weight. (WEIGH at the same time each morning, after voiding and before eating, wearing similar clothing, and use the same scale. 2\. Instruct the client to eat foods high in potassium. WOF: decrease in serum potassium level. 3\. Administer IV furosemide (Lasix) slowly because hearing loss can occur if injected rapidly. \- Nitrates: Help restore the appropriate supply-and-demand ratio in oxygen delivery to the myocardium when rest is not enough. Drug to drug interactions: Sildenafil OR Viagra shouldn't be taken within 24 hours of nitrates because of possible enhanced hypotensive effects. Nursing consideration for Nitrates: Sublingual Medication: \- Withhold the dose and notify the prescriber if the patient's heart rate is less than 60 beats/minute or his systolic blood pressure drops below 90 mm Hg, or follow the prescriber's ordered parameters for withholding the medication. \- Instruct the client to take one tablet for pain and repeat every 5 minutes, for a total of three doses. Transdermal Patch: \- Instruct the client to apply the patch to a hairless area, using a new patch and different site each day. AGENTS FOR TREATING HEART FAILURE Drugs for heart failure: Digoxin (a cardiac glycoside) - exerts a positive inotropic action on the heart. That is, the drug increases the force of ventricular contraction and can thereby increase cardiac output. Toxicity: Anorexia = early signs of digoxin toxicity Nursing care: 1\. Assess for signs of impending Digoxin toxicity (e.g., anorexia, nausea, vomiting, dysrhythmias, xanthopsia = visual changes such as seeing halos around lights) 2\. Monitor for hypokalemia, which potentiates the effects of digitalis; electrocardiogram (ECG) will indicate depressed T waves with hypokalemia (digoxin toxicity) 3\. Digoxin---monitor blood level during therapy (therapeutic serum level: 0.5 to 2.0 ng/mL)