pharm exam 2

What formula determines blood pressure?

Blood Pressure = Cardiac Output x Systemic Vascular Resistance

What formula determines cardiac output?

Cardiac Output = Heart Rate x Stroke Volume

What is the main goal of diuretic therapy?

To decrease fluid volume in the body, lower hypertension, and decrease edema.

What does the term "inotropic" mean?

Refers to drugs that increase the force of myocardial contraction.

What does the term "chronotropic" mean?

Refers to drugs that increase the heart rate.

What does the term "dromotropic" mean?

Refers to drugs that accelerate cardiac conduction.

What is the primary physiological cause of angina?

Decreased blood supply to the heart that is inadequate to meet myocardial oxygen demand, resulting in pain.

What four physiological factors increase the heart muscle's oxygen demand?

Heart rate, myocardial contractility, afterload, and preload.

What distinguishes stable angina from unstable and vasospastic angina?

Stable: caused by fixed atherosclerosis, triggered by exertion, relieved by rest.

Unstable: caused by CAD, gets progressively worse, precedes MI.

Vasospastic: spasms in smooth muscle, occurs at rest.

How do ACE Inhibitors help treat heart failure?

They cause diuresis, which decreases blood volume and preload, reducing cardiac workload.

How do Angiotensin II Receptor Blockers (ARBs) treat heart failure?

They block Angiotensin II binding, lowering systemic vascular resistance (afterload) and decreasing preload to lower blood pressure.

How do Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) support heart failure treatment?

They combine an ARB with a neprilysin inhibitor to lower systemic vascular resistance, preload, and afterload, decreasing overall blood volume and cardiac workload.

How do Beta Blockers like Metoprolol lower myocardial oxygen demand to relieve angina?

They block Beta-1 receptors to decrease heart rate and contractility, reducing the heart's workload.

At what heart rate threshold should a nurse withhold Metoprolol?

Do not administer if the heart rate is less than 60 bpm.

What dietary interaction must be avoided with Calcium Channel Blockers like Diltiazem?

Grapefruit juice.

What time of day should Thiazide and Loop diuretics be administered?

Strictly in the morning to prevent sleep disruption/nocturia.

What electrolyte imbalance is a major risk with Furosemide, and what foods help correct it?

Hypokalemia; managed by eating potassium-rich foods like bananas, spinach, yogurt, fish, and baked potatoes.

What is the therapeutic blood level range for Digoxin?

0.5–2 ng/mL.

What are the classic signs of Digoxin toxicity, and what triggers it?

Nausea, vomiting, and visual halos (blurry/yellow vision); triggered/worsened by low potassium or magnesium levels.

What is the antidote for severe Digoxin toxicity?

Digoxin immune fab (administered IV).

Describe the underlying pathophysiology of asthma.

The lung airways narrow due to bronchospasms, bronchial mucosal inflammation, and mucosal edema, obstructing airflow while alveoli remain open.

Describe the underlying pathophysiology of COPD.

Alveoli become inflamed, causing wall destruction and enlarged air spaces that reduce gas exchange surface area; air enters easily but is highly difficult to exhale.

What does "beta-adrenergic" mean in respiratory pharmacology?

It refers to drugs or mechanisms that stimulate adrenergic receptors to mimic sympathetic nervous system activity and dilate the bronchioles.

What is the purpose of using a "spacer" with a metered-dose inhaler (MDI)?

It gives the patient more time to inhale and ensures the medication reaches deep into the airways rather than trapping in the mouth.

How do corticosteroids help Beta-2 agonist inhalers perform more effectively?

They act as anti-inflammatory agents to clean out the gunk in the lungs, allowing the bronchodilator to penetrate deeper.

How long does it take for inhaled corticosteroids like Beclomethasone or Fluticasone to achieve therapeutic effects?

2 to 3 weeks.

What essential oral care instruction must be taught to patients using inhaled glucocorticoids?

Rinse the mouth and spit out water after every dose to prevent oral candidiasis (thrush).

Why must systemic glucocorticoids like Prednisone never be stopped abruptly?

Abrupt discontinuation can lead to acute adrenocortical insufficiency; doses must be tapered down.

Why must blood glucose be monitored closely in patients taking glucocorticoids?

Corticosteroids can cause marked hyperglycemia.

Categorize these medications into Acute vs. Long-term control: Albuterol, Fluticasone, Prednisone, Ipratropium.

Acute (Rescue): Albuterol, Ipratropium. Long-Term (Maintenance): Fluticasone, Prednisone.

Why should H1-blockers (antihistamines) like Diphenhydramine be given before an allergic reaction peaks?

They compete for unoccupied H1 receptors to prevent histamine binding; they cannot displace histamine that is already bound.

What is the difference between the mechanisms of the antitussive Dextromethorphan and the expectorant Guaifenesin?

Dextromethorphan: Suppresses the medullary cough reflex to stop a dry, non-productive cough.

Guaifenesin: Thins respiratory secretions and reduces mucus viscosity to make a productive cough more efficient.

what is the MOA of captopril

Inhibits ACE in lungs, stopping RAAS, decreasing SVR, causing diuresis.

Indications: HTN, heart failure adjunctive treatment.

Contraindications: Pregnancy, lactation, history of angioedema, allergy, hypotension.

Adverse Effects: Dry cough, hyperkalemia, angioedema, hypotension, orthostatic hypotension, nephrotoxicity.

Nursing: Monitor BP, renal function, electrolytes; take before meals; report dry cough, rash, or metallic taste; change positions slowly.

what is the MOA of losartan

Blocks binding of angiotensin II to its receptor to lower SVR.

Indications: Hypertension, heart failure.

Contraindications: Pregnancy, ARB allergy, children under 6 (or over 6 with low creatinine clearance).

Adverse Effects: Fatigue, chest pain (cough less likely than ACE).

Nursing: Monitor BP, kidney function, potassium; report face/throat swelling; change positions slowly; consult on NSAID use.

what is the MOA of diltiazem

Blocks calcium binding to relax smooth muscle, dilate coronary/peripheral arteries, decrease SVR, and lower HR/contractility.

Indications: HTN, angina, dysrhythmias, cerebral artery spasms, heart failure.

Contraindications: Serious heart blocks, sick sinus syndrome, cardiogenic shock, systolic BP <90 mmHg.

Adverse Effects: Hypotension, tachy/bradycardia, constipation, nausea, rash.

Nursing: Give with food; monitor vitals; hold if HR <60 bpm; change positions slowly; avoid grapefruit juice.

what is the MOA for doxazosin

Alpha 1 receptor antagonist that dilates vessels by blocking adrenergic hormone binding (norepinephrine).

Indications: Hypertension, BPH.

Adverse Effects: Orthostatic hypotension, tachycardia, vertigo, sexual dysfunction.

Nursing: Watch for first-dose syncope; take at bedtime; monitor for BP drop >20mmHg systolic when standing; rise slowly; report frequent headaches or nasal congestion.

what is the MOA of metoprolol

Antagonist at beta-adrenergic receptors; blocks adrenaline/epinephrine to slow HR, reduce contractility, and lower workload.

Indications: Angina, MI, dysrhythmias, HTN, heart failure.

Contraindications: Asthma patients (rebound risk).

Adverse Effects: Bradycardia, decreased CO, HF, SOB, edema, coughing flat, rebound excitation.

Nursing: High alert drug; hold if HR <60 bpm; move positions slowly; never discontinue abruptly (rebound HTN risk).

what is the MOA of hydrochlorothiazide

Inhibits resorption of Na, K, and Cl, causing water loss at the distal convoluted tubule.

Indications: Essential hypertension, heart failure, edema, diabetes insipidus.

Adverse Effects: Hyponatremia, hypochloremia, dehydration, hypokalemia, hyperglycemia, hyperuricemia.

Nursing: Administer in the morning; monitor serum electrolytes periodically; check for dysrhythmias if hypokalemic; monitor blood glucose; eat potassium-rich foods.

what is the MOA of Furosemide

Blocks reabsorption of water and sodium in the ascending loop of Henle.

Indications: Pulmonary edema, edematous states, hypertension, liver impairment/ascites.

Adverse Effects: Hypokalemia, hypotension, ototoxicity, dehydration.

Interactions: Digoxin, black licorice, ototoxic drugs, NSAIDs.

Nursing: Monitor potassium, I&Os, and daily weights; empty Foley before giving; encourage potassium-rich foods.

what is the MOA of Spironolactone (Potassium-Sparing Diuretic / Aldosterone Antagonist)

Blocks aldosterone action, increasing sodium/water excretion while conserving potassium.

Indications: Hypertension, HF, edematous states, acne in women, PCOS, premenstrual syndrome.

Adverse Effects: Hyperkalemia, drop in BP.

Nursing: Check BP; monitor serum potassium levels (normal 3.5–5); monitor for cardiac dysrhythmias.

what is the MOA for digoxin

Positive inotropic (stronger contraction),

negative chronotropic (slower HR),

negative dromotropic (slowed conduction);

improves coronary perfusion.

Indications: Systolic heart failure, atrial fibrillation.

Contraindications: Uncontrolled ventricular dysrhythmias, AV block, severe heart disease, digoxin toxicity.

Adverse Effects: Brady/tachycardia, headache, fatigue, confusion, visual halos (blurry/yellow vision).

Nursing: Index 0.5–2 ng/mL; low K/Mg increases toxicity risk; check apical pulse for 1 full minute, hold if <60 bpm; antidote is Digoxin immune fab IV.

what is the MOA of atorvastatin

Decreases liver cholesterol production; increases hepatic LDL receptors.

Indications: High cholesterol.

Contraindications: Pregnancy, liver disease.

Adverse Effects: Headache, dizziness, fatigue, constipation, diarrhea, nausea, myalgias, rhabdomyolysis.

Nursing: Avoid grapefruit juice; crucial to report signs of myopathy (unexplained muscle pain) immediately due to rhabdomyolysis risk.

what is the MOA of Nitroglycerin (Antianginal / Nitrate)

Dilates all blood vessels/coronary arteries, reduces preload and myocardial oxygen demand, lowers BP.

Indications: All types of angina.

Contraindications: Nitrophosphodiesterase 5 inhibitors (Viagra), anemia, increased ICP, hypovolemia.

Adverse Effects: Headache (COMMON), reflex tachycardia, tolerance.

Nursing: Assess BP and ED med use; if pain occurs: sit, take 1 SL tablet; if no relief in 5 min, call 911 and take 2nd tablet; max 3 tablets 5 min apart. Store in dark, airtight glass bottle (potency lost 3 months after opening). Remove patches for 10-12 hours daily.

what is the MOA of albuterol

Dilates bronchioles by stimulating Beta 2 adrenergic receptors in the lungs.

Indications: Asthma, COPD (first-line rescue drug).

Adverse Effects: Tachycardia, tremor, paradoxical bronchospasm.

Nursing: Assess lung sounds, rate, quality, work of breathing, O2 sat, and HR; teach proper rescue inhaler and spacer usage.

what is the MOA for ipratropium

Induces bronchodilation by blocking muscarinic receptors in airway smooth muscle.

Indications: COPD, acute asthma attacks.

Contraindications: Glaucoma, prostatic hyperplasia, bladder neck obstruction, urinary retention.

Adverse Effects: Increased IOP with angle-closure glaucoma, paradoxical bronchospasm.

Nursing: Monitor urinary elimination; encourage routine eye exams; provide water or hard candy for dry mouth.

what is the MOA of Theophylline (Xanthine Derivative)

Causes bronchodilation by increasing cAMP to cause smooth muscle relaxation.

Indications: Asthma, COPD (not first choice).

Contraindications: Smoking tobacco/marijuana, seizure disorders, peptic ulcer disease.

Adverse Effects: Nausea, vomiting, tachycardia, palpitations, hyperglycemia; toxicity causes dysrhythmias and seizures.

Nursing: Monitor blood levels; minimize caffeine; maintenance use only.

what is the MOA of beclomethasone

Prevents release of leukotrienes, prostaglandins, and histamine; decreases airway inflammation/edema.

Indications: Long-term asthma management, post-exacerbation manifestations.