Pharm exam #2 expanded

What is Lisinopril?

An Angiotensin Converting Enzyme Inhibitor.

What are the therapeutic uses of Lisinopril?

Hypertension (HTN), Heart Failure (HF), post-myocardial infarction (post-MI), nephropathy, diabetic retinopathy.

What should patients do if they experience angioedema while taking Lisinopril?

Seek treatment ASAP and never take it again.

What should be closely monitored in patients taking Lisinopril, especially those with heart failure?

Renal function.

What class of medication is Losartan?

Angiotensin Receptor Blocker (ARB)

What are the therapeutic uses of Losartan?

Hypertension (HTN), Heart Failure (HF), post-myocardial infarction (post-MI), nephropathy, diabetic retinopathy

What should patients do if they experience angioedema while taking Losartan?

Seek treatment ASAP and never take it again

What should be closely monitored in patients taking Losartan, especially those with heart failure?

Renal function

What is the mechanism of action (MOA) of Losartan?

Directly blocks angiotensin II receptor

What are Eplerenone and Spironolactone?

Aldosterone Antagonists

What are the therapeutic uses of Eplerenone and Spironolactone?

Hypertension (HTN) and Heart Failure (HF)

What type of medication are Eplerenone and Spironolactone?

Potassium Sparing Diuretics

What are some potential side effects of Eplerenone and Spironolactone?

Hyperkalemia, increased serum creatinine (SrCr), angioedema

What are some steroid receptor-mediated side effects of Eplerenone and Spironolactone?

Hirsutism, gynecomastia, impotence, menstrual irregularities

What should patients be educated about when taking Eplerenone and Spironolactone?

Never use with potassium supplements and avoid potassium-containing foods; caution with drug-drug interactions (DDIs)

What is the mechanism of action (MOA) of Eplerenone and Spironolactone?

Antagonize effects of aldosterone at the collecting tubule

What does aldosterone cause in the body?

Increased reabsorption of sodium (Na) and water (H2O); potassium (K) excretion

What type of medication is Verapamil?

Non-dihydropyridines CCB

What conditions is Verapamil used to treat?

Hypertension (HTN), angina, dysrhythmias

What are common adverse effects (AEs) of Verapamil?

Constipation, dizziness, flushing, headache (HA), partial or complete AV block

What should be avoided while taking Verapamil?

Grapefruit juice

What is the mechanism of action (MOA) of Verapamil?

Blocks calcium channels in the blood vessels and heart

In which conditions should Verapamil never be used?

Sick sinus syndrome or 2nd or 3rd degree heart block

What are some drug interactions with Verapamil?

Grapefruit juice, beta-blockers (BB), Digoxin

What type of medication is Nifedipine?

Dihydropyridine calcium channel blocker (CCB)

What conditions is Nifedipine used to treat?

Hypertension (HTN) and angina

What are common adverse effects (AEs) of Nifedipine?

Reflex tachycardia, flushing, headache, dizziness, peripheral edema, gingival hyperplasia

What should you never do with immediate-release (IR) Nifedipine products?

Never administer IR products for hypertension

What is a critical instruction regarding extended-release Nifedipine products?

Do not crush extended-release products as it could be deadly

What should patients be warned about when taking Nifedipine?

Peripheral edema

What is the mechanism of action (MOA) of Nifedipine?

Blocks calcium channels in the blood vessels with little to no effect on the heart

What is the mechanism of action (MOA) of Hydrochlorothiazide?.

Block sodium reabsorption in the distal convoluted tubule

What are the therapeutic uses of Hydrochlorothiazide?

Hypertension (first line) and heart failure (mild volume overload).

What are the common adverse effects (AEs) of Hydrochlorothiazide?

Hypokalemia, hyponatremia, hypochloremia, dehydration, hyperglycemia, hyperuricemia.

What is a nursing implication for administering Hydrochlorothiazide?

Give once daily in the morning to prevent nocturia.

What should patients be educated about to minimize hypokalemia while taking Hydrochlorothiazide?

Eat potassium-rich foods (like bananas and citrus) or take a potassium supplement.

What is Hydralazine classified as?

Direct Vasodilator

What conditions is Hydralazine used to treat?

Hypertension (HTN), Heart Failure (HF) with a nitrate, hypertensive crisis (IV form)

What are the common adverse effects (AEs) of Hydralazine?

Reflex tachycardia, fluid retention, SLE-like syndrome, hypotension

What symptoms of hypotension should patients be educated about when taking Hydralazine?

Dizziness, lightheadedness

How can patients minimize the risk of hypotension when taking Hydralazine?

By avoiding abrupt transitions from seated to upright position

What is the mechanism of action (MOA) of Hydralazine?

Directly dilates arterioles

What is Sodium Nitroprusside used for?

Hypertensive emergency

What class of medication is Sodium Nitroprusside?

Direct Vasodilators

What are the adverse effects of Sodium Nitroprusside?

Hypotension, cyanide poisoning, thiocyanate toxicity

What type of monitoring is required when using Sodium Nitroprusside?

Continuous EKG monitoring (arterial line, central line, real time cardiac monitoring)

What is the mechanism of action of Sodium Nitroprusside?

Directly dilates venous and arterioles

What type of drug is Nitroglycerin?

Organic Nitrates

What types of angina is Nitroglycerin used to treat?

Stable, unstable, and variant angina

What is the mechanism of action of Nitroglycerin?

Vasodilator

What is a common adverse effect of Nitroglycerin?

Headache

What is another adverse effect of Nitroglycerin?

Orthostatic hypotension

What is a potential adverse effect related to heart rate when using Nitroglycerin?

Reflex tachycardia

What is a concern regarding tolerance when using Nitroglycerin?

Tolerance can develop with prolonged use

What is required for cardiac monitoring when administering Nitroglycerin IV?

Requires cardiac monitoring with IV administration

What special equipment is needed for IV Nitroglycerin?

Requires special non-permeable tubing

How should Nitroglycerin pills be stored?

In original container

What should a patient do when taking Nitroglycerin spray or sublingual dose?

Lie down, give pill, wait 5 min, and repeat up to 2 times

What should a patient do if there is no relief after the first dose of Nitroglycerin?

Call 911

Where should a Nitroglycerin patch be placed?

On a hairless site

When should a Nitroglycerin patch be applied?

After showering in the morning

What should patients notify their prescriber about regarding Nitroglycerin?

If the frequency of sublingual NTG is increasing

What types of drugs can interact with Nitroglycerin?

Hypotensive drugs (beta blockers, CCB) and Phosphodiesterase type 5 inhibitors (Viagra)

What is Lidocaine classified as?

Antidysrhythmic, Class 1B

What types of arrhythmias is Lidocaine used for?

Ventricular arrhythmias

What is one of the uses of Lidocaine besides treating arrhythmias?

Local anesthetic

What are some dose-related adverse effects of Lidocaine?

Convulsions, confusion, agitation, psychosis, paresthesias, slurred speech

What respiratory adverse effects can occur with Lidocaine?

Respiratory depression and arrest

What cardiovascular adverse effects can occur with Lidocaine?

Bradycardia, heart block, hypotension, cardiac arrest

What are two contraindications for using Lidocaine?

AV block, bradycardia

What should be monitored when administering Lidocaine?

Hemodynamic monitoring, Apical pulse

What should be looked for during Lidocaine treatment?

Prolongation of PR interval or QRS

What is the mechanism of action of Lidocaine?

Depresses Phase 0 and weakens Phase 4 depolarization by blocking sodium channels

What is the onset time for IV bolus of Lidocaine?

45 - 90 seconds

What is the duration of action for IV bolus of Lidocaine?

10 - 20 minutes

What is important to remember about the therapeutic index of Lidocaine?

It has a narrow therapeutic index; obtain levels

What should be done when giving Lidocaine IV?

Give with repeated boluses and switch to oral anti-arrhythmics ASAP

What drug interaction should be noted with Lidocaine?

Quinidine/Lidocaine interaction

What is Propranolol classified as?

Antidysrhythmics Beta Blocker

What class of antidysrhythmics is Propranolol?

Class 2

What types of arrhythmias is Propranolol used to treat?

Supraventricular arrhythmias and Ventricular tachycardias

What are some adverse effects of Propranolol?

Heart failure, AV block, sinus arrest, and constriction of bronchial vessels

What nursing implications are associated with Propranolol?

IV - hemodynamic monitoring, EKG; Monitor respiratory system

What is the mechanism of action (MOA) of Propranolol?

Depresses Phase 4; Beta blockers (non-selective); blockade of Beta 1 receptors attenuates sympathetic stimulation of the heart; suppresses excessive SA node firing; slows ventricular rate

Which drug increases the level of Propranolol?

Lidocaine

Which other drug increases the level of Propranolol?

Quinidine

What test interference does Propranolol cause?

Masks symptoms of blood glucose changes

What class of drugs does Amiodarone belong to?

Class III: Potassium Channel Blockers

What types of dysrhythmias is Amiodarone used to treat?

Supraventricular and ventricular dysrhythmias

What is the half-life range of Amiodarone?

25-110 days

What are common adverse effects of Amiodarone?

Malaise, lethargy, GI issues (nausea, vomiting, diarrhea), thyroid issues, photosensitivity

What percentage of patients experience malaise and lethargy as adverse effects of Amiodarone?

15-40%

What percentage of patients experience gastrointestinal issues when taking Amiodarone?

25%

What life-threatening adverse effect is associated with Amiodarone?

Pulmonary toxicity (cough, dyspnea, test findings)

What is the mortality rate associated with pulmonary toxicity from Amiodarone?

10%

What lab tests are important when monitoring patients on Amiodarone?

T3, T4, ALT, AST, electrolytes, serum protein levels

What is the mechanism of action of Amiodarone?

Prolongs Phase 3 repolarization, prolongs ERP, blocks K+, Na+, Ca+ channels, and beta-receptors

What is a key consideration for administering Amiodarone?

Use a loading dose and give via IV pump/central line

What is Amiodarone's effect on the heart's oxygen demand?

It decreases O2 demand of the heart

What is the pregnancy category of Amiodarone?

Category D