pharm 2 cardiovascular week 1

What are the main functions of the cardiovascular system?

The heart acts as the pump, blood vessels are the roads, and blood carries what tissues need to survive.

What two factors determine blood pressure?

Cardiac output and vascular resistance.

What determines cardiac output (CO)?

Heart rate × stroke volume.

What is heart rate?

How fast the heart beats.

What is stroke volume?

How much blood the heart pumps with each beat.

What is preload?

The blood returning to and stretching the heart before it contracts; related to volume.

What is afterload?

The resistance the heart pumps against.

What is contractility?

How forcefully the heart muscle squeezes with each beat.

What are the four mechanisms cardiovascular drugs affect?

Heart rate, contractility, blood volume, and vessel diameter.

What are four common reasons patients need cardiovascular medications?

Hypertension, heart failure, angina, and arrhythmias.

What are the main goals of cardiovascular medications?

Improve oxygen delivery, reduce the heart's workload, and prevent complications or organ damage.

What are the five major classes of blood pressure medications covered in the slides?

ACE inhibitors, ARBs, beta blockers, calcium channel blockers (CCBs), and diuretics.

What does ACE inhibitor stand for?

Angiotensin-converting enzyme inhibitor.

What hormone system do ACE inhibitors and ARBs affect?

The renin-angiotensin-aldosterone system (RAAS).

When are ACE inhibitors used?

Hypertension, heart failure, diabetic kidney protection, and after a heart attack.

How do ACE inhibitors work?

They block the enzyme that creates angiotensin II, helping vessels stay relaxed and allowing the kidneys to release more sodium and water.

How do ACE inhibitors affect blood pressure?

Vasodilation and reduced blood volume lower blood pressure.

How do ACE inhibitors affect preload and afterload?

They decrease preload by reducing fluid volume and decrease afterload by reducing resistance.

What are common ACE inhibitors?

Lisinopril, enalapril, captopril, and ramipril.

What drug-name ending identifies ACE inhibitors?

-pril.

What is a common ACE inhibitor side effect?

A persistent dry cough.

What serious electrolyte problem can ACE inhibitors cause?

Hyperkalemia (high potassium).

What labs should be monitored with ACE inhibitors?

Potassium, BUN, and creatinine; also assess blood pressure.

What should the nurse assess before giving an ACE inhibitor?

Blood pressure; if it is too low, hold the medication and notify the provider according to orders/policy.

What is angioedema?

Swelling of the face, lips, tongue, or throat; it can obstruct the airway and is a medical emergency.

What should the nurse do if a patient taking lisinopril develops lip or tongue swelling?

Stop the drug and get emergency help/notify the provider immediately; prioritize airway safety. The slides state the patient should never receive the medication again.

What patient teaching is important for ACE inhibitors?

Do not take potassium supplements or potassium-containing salt substitutes unless the provider approves; rise slowly; report facial, lip, tongue, or throat swelling immediately; do not stop suddenly without talking to the provider.

What does ARB stand for?

Angiotensin II receptor blocker.

How do ARBs differ from ACE inhibitors?

ACE inhibitors prevent angiotensin II formation; ARBs block angiotensin II receptors. ARBs cause less cough.

When are ARBs used?

Hypertension, heart failure, as an alternative when ACE inhibitors cause cough, and diabetic kidney protection.

How do ARBs work?

Angiotensin II is still made, but ARBs block its receptors, preventing vasoconstriction; vessels relax and kidneys release sodium and water.

What are common ARBs?

Losartan, valsartan, and irbesartan.

What drug-name ending identifies ARBs?

-sartan.

What should be monitored with ARBs?

Blood pressure, potassium, and kidney function; monitor for orthostatic hypotension.

Why must ARBs be avoided during pregnancy?

They can harm the developing baby.

What is orthostatic hypotension?

A drop in blood pressure when changing position that can cause dizziness or lightheadedness.

What should a patient do if dizzy when getting out of bed?

Sit on the edge of the bed, wait 1–2 minutes, then stand slowly; keep the call light nearby and use fall precautions as appropriate.

What are the priority nursing actions for dizziness on losartan?

Assess blood pressure lying and standing, teach the patient to sit first and wait 1–2 minutes before standing, ensure the call light is within reach, and consider fall precautions.

How do beta blockers work?

They block beta-adrenergic receptors that respond to epinephrine/adrenaline and norepinephrine, slowing the heart and reducing contraction force and workload.

When are beta blockers used?

Hypertension, angina, heart failure, arrhythmias, and after a heart attack.

What effects do beta blockers have on the heart and blood pressure?

They slow heart rate, weaken contractions, reduce oxygen demand, and lower blood pressure.

What are common beta blockers listed in the slides?

Metoprolol, atenolol, carvedilol, and propranolol.

What drug-name ending is common for beta blockers?

Many end in -olol.

What must the nurse check before every beta blocker dose?

Heart rate and blood pressure.

What is the general heart-rate hold parameter for beta blockers in the lecture?

Hold if heart rate is below 60 beats/minute, or if systolic blood pressure is below ordered parameters; notify the provider.

What should the nurse do if a patient's HR is 52 before metoprolol, even if the patient feels fine?

Hold the medication and notify the provider; the heart rate is too low and the medication could slow it further.

How can beta blockers affect patients with diabetes?

They can mask hypoglycemia symptoms such as shakiness and rapid heartbeat; teach patients to check glucose regularly.

Why should nonselective beta blockers be used cautiously in asthma or respiratory problems?

They can cause bronchospasm and worsen breathing problems.

Why should beta blockers not be stopped abruptly?

Sudden stopping can cause rebound hypertension or even a heart attack; taper gradually as directed.

What is the main action of calcium channel blockers (CCBs)?

They block calcium from entering heart and blood-vessel smooth-muscle cells, reducing contraction and allowing relaxation.

How do CCBs affect blood vessels?

They relax and widen vessels (vasodilation), reducing resistance and blood pressure.

What are CCBs used for?

Hypertension, angina, certain arrhythmias, and vasospastic disorders.

What are the three CCB examples in the slides?

Amlodipine, diltiazem, and verapamil.

What does the ending -dipine suggest?

A calcium channel blocker that mainly affects blood vessels, such as amlodipine.

Which CCBs can significantly slow heart rate, so the pulse needs checking?

Diltiazem and verapamil.

What common side effect is associated with amlodipine?

Peripheral edema, especially ankle and foot swelling.

What common side effect is associated with verapamil?

Constipation because it slows gut motility.

What should be monitored before giving CCBs?

Blood pressure and heart rate; diltiazem and verapamil can slow the heart rate.

What food/drink instruction do the slides give for CCBs?

Avoid grapefruit juice because it can block the enzyme that breaks down CCBs and cause dangerous drug levels.

What should the nurse do for new bilateral ankle edema on amlodipine?

Document it, measure and record the extent, notify the provider for awareness, reassure that it is common, teach leg elevation when resting, and monitor for worsening.

Does mild amlodipine-related ankle edema automatically mean heart failure or drug allergy?

No. The slides describe it as an expected side effect; it usually does not require stopping the medication unless severe or bothersome.

What are diuretics also called, and what do they do?

Water pills; they increase urine production and help remove sodium and water.

How do diuretics lower blood pressure?

They reduce sodium and water reabsorption, so more sodium and water leave in urine, lowering blood volume, preload, and blood pressure.

When are diuretics used?

Hypertension, heart failure, edema, and pulmonary congestion.

What are the three main types of diuretics?

Loop, thiazide, and potassium-sparing diuretics.

What is an example of a loop diuretic and what is notable about it?

Furosemide (Lasix); it is the strongest type and is used for severe fluid overload and heart failure.

What is an example of a thiazide diuretic and what is it often used for?

Hydrochlorothiazide (HCTZ); it is often a first choice for hypertension and long-term blood pressure control.

What is an example of a potassium-sparing diuretic and what does it do?

Spironolactone; it keeps potassium in the body and is often used in heart failure.

Which diuretic in the slides can cause potassium loss?

Furosemide (Lasix), a loop diuretic.

What is a key risk of spironolactone?

Hyperkalemia because it retains potassium.

What labs/electrolytes should be monitored with diuretics?

Potassium, sodium, and magnesium; monitor kidney function as clinically ordered.

How should daily weights be taken for a patient receiving diuretics?

At the same time each day, on the same scale, and in the same clothing.

What daily weight change should be reported according to the slides?

A gain or loss of 2 or more pounds in 24 hours.

Why are daily weights important in heart failure/diuretic therapy?

They are a key indicator of fluid status and help show whether the diuretic is working.

Why track intake and output with diuretics?

To assess fluid balance and whether the diuretic is working effectively.

When should diuretics preferably be given?

Early in the day, before 4 PM if possible, to reduce nighttime urination.

What signs of dehydration should be monitored with diuretics?

Dry mucous membranes, poor skin turgor, and dizziness.

A patient taking furosemide has potassium 3.0 mEq/L. What is the problem and priority action in the slides?

Hypokalemia. Hold furosemide and notify the provider immediately; low potassium can cause life-threatening arrhythmias and may need replacement.

What are nitrates used for?

Primarily angina; they relieve chest pain by improving oxygen supply and reducing the heart's oxygen demand.

How do nitrates work?

They dilate veins more than arteries, reduce preload, dilate coronary arteries, improve blood flow to heart muscle, and decrease oxygen demand.

What are the nitrate medications/forms listed in the slides?

Sublingual nitroglycerin for acute chest pain, nitroglycerin patch for long-acting prevention, and isosorbide mononitrate for long-acting oral prevention.

How quickly does sublingual nitroglycerin work according to the slides?

About 1–3 minutes.

What repeat schedule for sublingual nitroglycerin is listed in the slides?

It may be repeated every 5 minutes for up to 3 doses, following the prescribed instructions.

Why must blood pressure be checked before giving nitroglycerin?

Nitrates cause vasodilation and can significantly lower blood pressure.

At what systolic blood pressure do the slides say not to give nitrates?

Do not give if systolic blood pressure is below 90 mmHg; notify the provider.

A patient has BP 88/56 and an order for sublingual nitroglycerin. What should the nurse do?

Do not administer it; notify the provider immediately because it may cause dangerous hypotension, shock, or cardiac arrest.

What is a common nitrate side effect and why does it occur?

Headache due to vasodilation in the brain; the slides say it often improves with continued use and acetaminophen may help.

Why is a nitrate-free period needed with long-acting nitrates?

To prevent tolerance, when the medication stops working as well; the slides specify 10–12 hours without the drug daily.

Which medications must never be combined with nitrates according to the slides?

ED medications such as sildenafil (Viagra) and tadalafil (Cialis), because the combination can cause severe, life-threatening hypotension.

What are the main goals of heart failure medications?

Improve cardiac output, reduce fluid overload, decrease cardiac workload, and prevent disease progression.

Which drug classes are listed for heart failure treatment?

ACE inhibitors, ARBs, beta blockers, diuretics, and vasodilators.

How do ACE inhibitors help in heart failure according to the slides?

Reduce afterload and protect the heart from remodeling.

How do ARBs help in heart failure according to the slides?

Provide benefits similar to ACE inhibitors and can be an alternative when ACE inhibitors are not tolerated.

How do beta blockers help in heart failure according to the slides?

Protect the heart from stress hormones and improve long-term survival.

How do diuretics help in heart failure according to the slides?

Remove excess fluid and reduce pulmonary congestion and edema.

How do vasodilators help in heart failure according to the slides?

Reduce preload and afterload to ease the heart's workload.

What are the core nursing responsibilities for cardiovascular medications?

Check vital signs first, monitor labs such as electrolytes and kidney function, recognize adverse effects early, teach safety and side effects, and support medication adherence.

What should be assessed before administering any cardiovascular medication?

Current vital signs—especially heart rate and blood pressure—and relevant labs and ordered hold parameters.

What is the NCLEX priority when a medication causes an emergency side effect?

Prioritize safety and ABCs (airway, breathing, circulation) before comfort.

Which cardiovascular drug adverse effect threatens the airway?

Angioedema, such as swelling of the face, lips, tongue, or throat.