bosentan – n. 波生坦
Tracleer – n. 全可利
endothelin – n. 内皮素
ambrisentan – n. 安立生坦
Letairis – n. 【奥】乐泰利司
treprostinil – n. 曲前列尼尔
Remodulin – n. 瑞莫杜林
ETA –endothelin A 内皮素A
ETB -- endothelin B 内皮素B
sildenafil – n. 西地那非
Revatio – n. 瑞万托
cGMP -- cyclic guanosine monophosphate
cGMP – 环鸟苷一磷酸
Tadalafil – n. 他达拉非
Adcirca – n. 【奥】阿德舍卡
epoprostenol – n. 依前列醇
Flolan – n. 佛罗兰
prostaglandin – n. 前列腺素
Iloprost – n. 伊洛前列素
Ventavis – n. 万他维 注：带“【奥】”标记者为奥医临时用名，只为方便学员复习记忆，不得作为临床诊疗依据！
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——————RN/ISPN Review ——————
Treatment of Pulmonary Arterial Hypertension 肺动脉高血压的治疗
In late 2001, bosentan (Tracleer) became the first endothelin receptor antagonist to be approved for use in the treatment of pulmonary arterial hypertension. Since that time, ambrisentan (Letairis) and treprostinil (Remodulin) and other endothelin receptor antagonists have also been approved. These drugs specifically block receptor sites for endothelin (ETA and ETB) in the endothelium and vascular smooth muscles.
In 2005, sildenafil, a drug known for the treatment of erectile dysfunction, was approved for the treatment of pulmonary arterial hypertension. Revatio is an oral drug, with 20 mg given three times a day. The doses should be at least 4 to 6 hours apart. Revatio inhibits cyclic guanosine monophosphate (cGMP); this allows nitrous oxide in the blood vessel to cause smooth muscle relaxation and decreases vessel pressure. Tadalafil (Adcirca), another drug used for erectile dysfunction, has also been approved for the treatment of pulmonary arterial hypertension. It is given orally at a dose of 40 mg once a day. Women may be concerned that they have been ordered a drug used for treating erectile dysfunction, and the use needs to be explained to them.
Epoprostenol (Flolan) was the next drug approved for this disorder. It is a prostaglandin that causes blood vessel dilation and relieves the pressure in the pulmonary vessels. It is given through a central venous line as a continuous infusion through a portable infusion pump. The usual maintenance dose after 6 months of continuous therapy is 20 to 40 ng/kg/min. The patient and family need extensive teaching on the maintenance and use of the infusion pump. Infection is a serious problem. Headache and muscle aches are the most commonly reported adverse effects.
Iloprost (Ventavis) is an inhaled synthetic prostacyclin that directly dilates the pulmonary vascular bed, reducing pressure in the pulmonary vascular system, increasing gas exchange, and easing the signs and symptoms of pulmonary arterial hypertension. It is inhaled using a special delivery device six to nine times a day while awake. Patients report dizziness and syncope after using the drug and are encouraged to change position slowly. They should not ingest the drug or get it on their skin. It is a pregnancy category C drug and can be used in pregnancy if the benefit clearly outweighs the potential risk to the fetus.
1. Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient?
A. Obtain a BP reading in each arm and average the results.
B. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.
C. Have the patient sit in a chair with the feet flat on the floor.
D. Assist the patient to the supine position for BP measurements. 2. Which assessment finding for a patient who is receiving furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider?
A. Blood glucose level of 180 mg/dL
B. Blood potassium level of 3.0 mEq/L
C. Early morning BP reading of 164/96 mm Hg
D. Orthostatic systolic BP decrease of 12 mm Hg
奥医教育“在线自测”题库
ISPN/RN复习练习、效果检验一站完成。
答案 Answer
1. C. Have the patient sit in a chair with the feet flat on the floor Rationale: The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, but the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second. 2. B. Blood potassium level of 3.0 mEq/L Rationale: Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic.
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