Pharmacology Exam Review: Cardiovascular and Urinary Medications

Vocabulary terms and clinical definitions for cardiovascular, respiratory, urinary, and hematological pharmacology from the lecture notes.

Hydrochlorothiazide (Microzide)

A thiazide diuretic that lowers BP and treats fluid overload. Adverse effects include low $K^+$, low $Na^+$, high glucose, gout, and sun sensitivity. Nursing focus: Give in AM, monitor for hypokalemia ($K^+ < 3.5$) indicated by leg cramps or muscle spasms.

Captopril / Lisinopril (Capoten/Zestril)

ACE inhibitors used for hypertension and heart failure. Key side effects include a serious persistent dry cough, high $K^+$, low BP, and angioedema. Pregnancy is contraindicated. Monitor renal function and teach patients to report facial/tongue swelling.

Losartan / Valsartan (Cozaar/Diovan)

Angiotensin II Receptor Blockers (ARBs) used for hypertension and heart failure. Unlike ACE inhibitors, they do not cause a cough or angioedema. Monitor for high $K^+$ and low BP; avoid salt substitutes and potassium supplements.

Aliskiren (Tekturna)

A direct renin inhibitor that blocks renin at the very top of the RAAS pathway. Side effects include high $K^+$, dizziness, and low BP. It should never be combined with ACE inhibitors or ARBs due to increased renal and hyperkalemia risk.

Nifedipine (Procardia XL)

A dihydropyridine calcium channel blocker used for hypertension and chest pain. Key exam clue: reflex tachycardia. Also causes ankle edema, flushing, and headache. Edema results from vasodilation, not fluid. Avoid grapefruit juice.

Verapamil / Diltiazem (Calan/Cardizem)

Non-dihydropyridine calcium channel blockers used for hypertension, arrhythmias, and chest pain. They cause low HR (bradycardia), low BP, and constipation. Check apical pulse before administration and hold if $< 60$. Avoid combining with beta blockers or digoxin.

Metoprolol (Lopressor/Toprol XL)

A beta-1 selective blocker used for hypertension, chest pain, and heart failure. It masks low blood sugar signs in diabetics and should be tapered. Check pulse before dosing and hold if $< 60$.

Propranolol (Inderal)

A nonselective beta blocker that blocks both beta-1 and beta-2 receptors. Avoid in patients with asthma or COPD because it can cause bronchospasm (wheezing and SOB). Used for hypertension, arrhythmias, and migraine prevention.

Sodium Nitroprusside (Nitropress)

A direct vasodilator used in hypertensive emergencies. It carries a risk of cyanide toxicity (metabolized by the liver, cleared by kidneys). Antidote: sodium thiosulfate or hydroxocobalamin. Requires continuous BP monitoring and protection from light.

Epinephrine (Adrenalin)

An adrenergic agonist/vasopressor used for cardiac arrest, anaphylaxis, and asthma. Adverse effects include fast HR, hyperglycemia, and anxiety. During CPR, administered every $2$ minutes. IM in the thigh for anaphylaxis.

Dopamine

A vasopressor used for shock and low cardiac output. Its effect changes with dosage: low doses affect renal function, while high doses cause vasoconstriction. Titrate by weight-based dose and monitor ECG, BP, and urine output.

Sacubitril / Valsartan (Entresto)

An ARNI (Angiotensin Receptor-Neprilysin Inhibitor) combo drug used for heart failure. Serious angioedema risk if combined with ACE inhibitors; requires a 36-hour washout period when switching.

Digoxin (Lanoxin)

A cardiac glycoside for heart failure and atrial fibrillation. Toxicity signs include yellow/green halos, N/V, and anorexia; course range is $0.5$ to $2.0$ (or $0.6$ to $1.2$). Check apical pulse for $1$ full minute; hold if $< 60$. Antidote: Digibind.

Furosemide (Lasix)

A loop diuretic used for fluid overload and heart failure. Side effects include low $K^+$, low $Na^+$, hearing damage (ototoxicity), and gout. Give IV doses slowly and monitor hearing/potassium closely.

Spironolactone (Aldactone)

A potassium-sparing diuretic that raises potassium. Adverse effects include high $K^+$, breast enlargement in men (gynecomastia), and menstrual changes. Avoid potassium supplements and salt substitutes.

Mannitol (Osmitrol)

An osmotic diuretic used for brain swelling and increased intracranial pressure. Use a filter needle for IV administration due to crystallization risk. Monitor neuro status and fluid balance; can briefly worsen heart failure.

Nitroglycerin (Nitrostat/Nitro-Dur)

An organic nitrate used for angina. Causes headache, low BP, and reflex tachycardia. NEVER combine with erectile dysfunction drugs due to life-threatening low BP risk. May repeat every $5$ min up to $3$ doses.

Atorvastatin (Lipitor)

A statin used for high cholesterol. Serious side effects include rhabdomyolysis (muscle pain and dark urine) and liver damage. Avoid grapefruit juice; never use in pregnancy.

Colesevelam (Welchol)

A bile acid sequestrant for high cholesterol. It blocks the absorption of other oral drugs and fat-soluble vitamins (A, D, E, K). Take other medications $1$ hour before or $4$ to $6$ hours after this drug.

Lidocaine (Xylocaine)

A Class IB antiarrhythmic for life-threatening ventricular arrhythmias. Early toxicity signs include perioral tingling, numbness, hand tremors, and drowsiness, which can progress to seizures or cardiac arrest.

Flecainide (Tambocor)

A Class IC antiarrhythmic that can be proarrhythmic (worsen arrhythmias). Watch the EKG specifically for a wide QRS complex. Avoid use in patients with structural heart disease.

Amiodarone (Cordarone/Pacerone)

A Class III antiarrhythmic used for serious ventricular arrhythmias. Adverse effects include lung scarring, thyroid problems, liver damage, and blue-gray skin. Avoid grapefruit juice; requires baseline chest x-rays and routine organ monitoring.

Adenosine (Adenocard)

An emergency drug used to stop SVT. It causes a brief expected pause in the heartbeat (asystole for a few seconds). Give as a rapid IV push immediately followed by a saline flush.

Atropine (Atropen)

An anticholinergic drug used for symptomatic bradycardia. It speeds up the heart rate. Side effects include dry mouth, blurred vision, urinary retention, and tachycardia.

Heparin (Unfractionated)

An anticoagulant that prevents and treats blood clots. Monitor aPTT and platelet count. If Heparin-Induced Thrombocytopenia (HIT) develops, switch to Argatroban. Antidote: Protamine sulfate.

Warfarin (Coumadin)

A vitamin K antagonist for long-term clot prevention. Monitored by INR (target $2.0$ to $3.0$). Many interactions: Vitamin K-rich foods (spinach, kale) lower its effect; amiodarone raises its level. Antidote: Vitamin K.

Dabigatran (Pradaxa)

An oral direct thrombin inhibitor used to prevent blood clots. It does not require routine INR monitoring. Antidote: Idarucizumab (Praxbind).

Argatroban

An IV direct thrombin inhibitor used for clot prevention specifically when heparin cannot be used due to a history of Heparin-Induced Thrombocytopenia (HIT).

Alteplase (Activase/tPA)

A thrombolytic drug that breaks up (dissolves) existing clots in stroke, PE, or MI. Carries a major bleeding risk, particularly in the brain. Strict time window and inclusion criteria for administration.