Exam 1 PathoPharm 2026

What are cardio selective drugs?

target beta-1 receptors

safer for use in lung conditions

What are cardio non-selective drugs?

affect both beta-1 and beta-2 receptors

cause bronchoconstriction

Metoprolol: therapeutic classification

antianginal, antihypertensive

Metoprolol: pharmacologic class

cardio selective beta-1 blocker

Metoprolol: indications

labeled: HF, angina, MI, HTN

off-label: arrhythmias

Metoprolol: action

selectively inhibits beta-adrenergic receptors

Metoprolol: therapeutic effects

reduce HR, lower BP, reduce contractility

reduces heart's workload and oxygen demand

Metoprolol: side effects

bradycardia, bronchospasm, hypotension, CNS disturbance, masks symptoms of hypoglycemia

Metoprolol: contraindications

heart block, bradycardia, hypotension or decompensated HF

Metoprolol: patient education

monitor HR and BP at home

monitor glucose if diabetic

monitor for changes in respiratory system

avoid sudden changes in position (orthostatic BP)

Metoprolol: nursing considerations

monitor BP and HR

hold if HR < 60

monitor for signs of bronchospasm

slow position changes

what are the non selective beta and alpha adrenergic blockers?

-lol

use of carvedilol

management of chronic HTN and HF

use of labetolol

management of acute and chronic HTN and HTN during pregnancy

what is the only safe HTN med for pregnancy?

labetolol

non selective beta blockers side effects

bradycardia, hypotension, CNS disturbance, masks symptoms of hypoglycemia

high risk for bronchospasm

amiodarone: therapeutic class

antiarrhythmic

amiodarone: pharmacologic class

antiarrhythmic, class iii

amiodarone: indications

labeled: arrhythmias (life threatening like Vfib, Vtach)

off label: arrhythmias (Afib, Aflutter, SVT)

amiodarone: action

alpha- and beta- blocking properties, slows sodium, potassium, and calcium channels = prolongs repolarization = slows HR

amiodarone: therapeutic effects

restoration and maintenance of normal heart rhythm (NSR)

slows down electric signals, controls HR

lowers cardiac workload

amiodarone: significant side effects

bradycardia, hypotension, liver toxicity, arrhythmias, pulmonary toxicity, thyroid effects

amiodarone: common side effects

nausea, vomiting, epithelial keratopathy

amiodarone: contraindications

allergy to iodine, heart block, bradycardia, cardiogenic shock

amiodarone: black box warnings

only be used in life threatening arrhythmias, pulmonary toxicity, liver toxicity, can cause worsening arrhythmias (initiate in clinical setting with tele monitoring)

amiodarone: patient education

avoid grapefruit juice

limit iodine intake to < 150mcg/day

take consistently

amiodarone: nursing considerations

monitor BP and HR, requires loading dose in the hospital, cardiac monitoring with emergency equipment nearby, monitor liver and thyroid labs

clonidine: therapeutic classification

antihypertensive

clonidine: pharmacologic class

alpha 2-adrenergic agonist

clonidine: indications

HTN (not 1st line)

clonidine: action

stimulates alpha-2 adrenergic receptors in CNS to reduce SNS action (turns off fight or flight response)

clonidine: therapeutic effects

decrease in peripheral resistance, HR, and BP

clonidine: significant side effects

bradycardia, hypotension, withdrawal with abrupt discontinuation (rebound HTN, flushing, HA, insomnia)

clonidine: common side effects

dermatitis with patches, abdominal pain, xerostoma, dizziness, drowsiness, fatigue, HA

clonidine: contraindications

CNS depression (drowsy or sleepy), hypotension, caution with renal impairment

clonidine: patient education

monitor BP and HR, 3D's (dizziness, drowsiness, dry mouth), medication doses 2-3 times daily

clonidine: nursing considerations

monitor HR and BP, monitor mental status

2 types of calcium channel blockers

DHP and non-DHP

what are DHP drugs

vascular selective vasodilators

work in the periphery - more likely to cause peripheral edema

what are non DHP drugs

cardiac selective, slows HR, more likely to cause bradycardia

amlodipine: therapeutic class

antianginal agend, antihypertensive

amlodipine: pharmacological class

calcium channel blocker, DHP

amlodipine: indications

chronic stable angina, chronic HTN

amlodipine: action

inhibits calcium ions from entering cardiac cells; acts on vascular smooth muscles to produce peripheral arterial vasodilation

amlodipine: therapeutic effects

relaxation of the coronary vascular smooth muscle and coronary vasodilation (artery), increases myocardial oxygen delivery in patients with vasospastic angina, reduces peripheral vascular resistance and blood pressure

amlodipine: side effects

peripheral edema

amlodipine: contraindications

hypotension, HF with reduced ejection fracture

amlodipine: patient education

monitor BP and peripheral edema, slow position changes to avoid orthostatic hypotension

amlodipine: nursing considerations

monitor BP and HR, monitor for peripheral edema, slow position changes to avoid orthostatic hypotension, not used in acute situations - more for chronic management

diltiazem: therapeutic class

antianginal agent, antiarrhythmic agend, antihypertensive

diltiazem: pharmacologic class

class IV antiarrhythmic, calcium channel blocker non DHP

diltiazem: indications

labeled: HTN, arrhythmias, angina

off-label: arrhythmias

diltiazem: action

inhibits calcium ion entering cardiac cell during depolarization

diltiazem: therapeutic effects

coronary vasodilation lowers BP, heart muscle contracts less forcefully and decreases workload, and slows electrical signals in heart and reduces HR = increased oxygen delivery

diltiazem: side effects

significant: bradycardia, severe hypersensitivity skin conditions, skin hyperpigmentation

diltiazem: contraindications

heart blocks, hypotension, acute MI, pulmonary congestion, cardiogenic shock, concurrent use with beta-blockers or calcium channel blockers

diltiazem: patient education

maintain consistent intake of grapefruit juice

slow position changes

diltiazem: nursing considerations

monitor BP and HR, monitor liver function, slow position changes, IV often used in acute situations

verapamil: therapeutic class

antianginal agent, antiarrhythmic agent, antihypertensive

verapamil: pharmacologic class

class IV antiarrhythmic, calcium channel blocker, non DHP

verapamil: indications

angina and arrhythmias

verapamil: action

inhibits calcium ion entering cardiac cells

verapamil: therapeutic effect

coronary vasodilation (lowers BP), heart muscle contracts less forcefully (reduce workload), slows electrical signals in heart (reduced HR) = increased oxygen delivery

verapamil: side effects

can worsen left side HR, bradycardia

verapamil: contraindications

left side HF, hypotension, cardiogenic shock, heart blocks, concurrent use with beta-blockers or other calcium channel blockers, caution in liver and renal dysfunction

verapamil: patient education

maintain consistent intake of grapefruit juice, interaction with alcohol, slow position changes

verapamil: nursing considerations

monitor BP and HR, monitor liver and renal function, IV often used in acute situations, slow position changes

1st line treatment for chronic HTN

amlodipine

what do vasodilators do?

medications that widen blood vessels by relaxing smooth muscle to help improve blood flow and oxygen delivery to the heart

nitroglycerin: therapeutic classification

antianginal

nitroglycerin: pharmacologic class

vasodilator (nitrate)

nitroglycerin: action

relaxation of smooth muscle that caused vasodilation and relaxes coronary arteries, decreasing preload and afterload

leads to increased cardiac output and decreased BP

nitroglycerin: indications

treatment of stable and unstable angina

nitroglycerin: indications for rapid-acting forms

acute anginal attacks

nitroglycerin: indications for long-acting forms

prevent anginal episodes

nitroglycerin: contraindications

hypotension, severe head injury, use of erectile dysfunction drugs (other vasodilator)

nitroglycerin: common adverse effects

headaches, reflex tachycardia, postural/orthostatic hypotension, skin irritation with topical application

nitroglycerin: major interactions

alcohol, beta blockers, CCBs, erectile-dysfunction drugs

nitroglycerin: administration routes

oral capsules, chewable tablets

sublingual, intravenous, transdermal patches, translingual spray - bypass liver and first pass effect (fast acting)

nitroglycerin: assessment during use

baseline vitals and frequency and severity of angina

nitroglycerin: patient teaching

never chew or swallow sublingual form, keep a journal of attacks, alcohol and time in hot bath can lead to fainting, preserve potency by keeping in original container

nitroglycerin: sublingual form important information

you should feel a burning sensation, it indicates that medication is still potent

what is hypertension?

sustained state of higher-than-normal BP that can lead to blood vessel damage, atherosclerosis, and damage to small vessels in end organs

what are anti-hypertensives?

medications that work to alter normal reflexes that control BP

hydralazine: therapeutic class

antihypertensive

hydralazine: pharmacologic class

vasodilator (direct acting)

hydralazine: action

vasodilation of arterioles, decreases peripheral vascular resistance

decreases afterload (preload is not affected)

usually used in ICU

hydralazine: indications

hypertensive emergency and HTN

hydralazine: contraindications

coronary artery disease, severe tachycardia, heart failure with high cardiac output

hydralazine: serious adverse side effects

hydralazine-induced lupus-like syndrome

hydralazine: common adverse effects

hypotension, worsening angina, tachycardia, dizziness, HA, anxiety

hydralazine: administration

IV or oral tablet

hydralazine: assessment during use

baseline vitals, history of heart disease, reflex tachycardia, severe hypotension, worsening angina, assess response

hydralazine: patient and family teaching

report lupus-like symptoms, edema, weight gain, headache or dizziness

sodium nitroprusside: therapeutic class

antihypertensive

sodium nitroprusside: pharmacologic class

vasodilator

sodium nitroprusside: action

direct action on veins and arteries to promote peripheral vasodilation

decreases preload and afterload to rapidly decrease BP

sodium nitroprusside: indications

HTN crisis, controlled HTN to reduce bleeding during surgery, management of acute decompensated HF

sodium nitroprusside: contraindications

compensatory hypertension, known inadequate cerebral circulation, heart failure with reduced peripheral vascular resistance

avoid in pregnancy

sodium nitroprusside: serious adverse effects

cyanide toxicity, methemoglobinemia, excessive hypotension (leads to organ ischemia)