Pharm 3

What are the two major determinants of blood pressure?

Cardiac output and peripheral vascular resistance

What is the prototype for ACE inhibitors?

Lisinopril

What is the prototype for ARBs?

Valsartan

What is the prototype for calcium channel blockers?

Amlodipine

What is the prototype for beta blockers?

Metoprolol

What is the prototype for diuretics?

Hydrochlorothiazide

What is the prototype for direct vasodilators?

Hydralazine

What are the main clinical manifestations of heart failure?

Dyspnea, fatigue, exercise intolerance, fluid retention, low cardiac output

What should be monitored when administering antihypertensives?

Blood pressure and heart rate

How do ACE inhibitors manage hypertension and heart failure?

Block angiotensin I → II, decrease vasoconstriction, decrease aldosterone, decrease preload, decrease workload of heart

Why are ACE inhibitors recommended for hypertension and diabetes with kidney damage?

They slow progression of albuminuria and protect kidneys

Do ACE inhibitors cause a persistent dry cough?

True

What is angioedema?

Swelling of lips, eyelids, tongue, throat; potentially fatal

Can ACE inhibitors be given in severe renal impairment?

Use cautiously; may be contraindicated in severe cases

What electrolyte should be monitored with ACE inhibitors?

Potassium

Do ARBs cause dry cough like ACE inhibitors?

No (less likely)

Are ACE inhibitors and ARBs teratogenic?

True

How do calcium channel blockers manage hypertension and angina?

Block calcium → relax smooth muscle → vasodilation → lower BP, decrease HR and contractility

What is the contraindication for administering calcium channel blockers?

SBP < 90 or HR < 50

Where are beta 1 receptors mainly located?

Heart

What effect do beta 1 receptor stimulants have?

Increased contractility and heart rate

What is the effect of alpha 1 stimulation?

Vasoconstriction → increases BP

What is the effect of alpha 2 stimulation?

Vasodilation → decreases BP

What are clonidine and methyldopa?

Alpha 2 agonists that decrease BP

What do doxazosin, prazosin, and terazosin do?

Alpha 1 blockers that cause vasodilation and lower BP

What do beta blockers end in?

-olol (e.g., metoprolol)

What do selective beta blockers affect?

The heart only (Beta 1)

What do nonselective beta blockers affect?

Beta 1 and Beta 2; avoid in asthma

How do beta blockers help heart failure?

Decreasing morbidity and mortality, preventing ventricular remodeling

What should be monitored when administering beta blockers?

Heart rate and blood pressure

Do beta blockers cause sexual dysfunction?

True

What are the three major types of diuretics?

Loop (Furosemide), Thiazide (HCTZ), Potassium-sparing (Spironolactone)

What diuretic is used for mild heart failure?

Thiazide

What diuretic is used for severe edema?

Loop (Furosemide) because it is powerful

What is a common adverse effect of loop diuretics?

Hypokalemia

What other adverse effects can loop diuretics cause?

Hyponatremia, dehydration, hypotension, ototoxicity, hyperglycemia

How can ototoxicity of IV Lasix be prevented?

Administer slowly

What should not be given if potassium is high?

Potassium-sparing diuretics

What is the drug of choice for hypertensive emergencies?

Nitroprusside

What is a cardiac glycoside?

Digoxin

How does digoxin treat heart failure?

Positive inotropic effect (stronger contraction)

What electrolyte imbalance increases digoxin toxicity?

Hypokalemia

What are the signs of digoxin toxicity?

Nausea, vomiting, fatigue, yellow vision, halos, bradycardia

What is the antidote for digoxin?

Digoxin Immune Fab

What nursing considerations are important for digoxin?

Check apical pulse for 1 minute, hold if HR < 60, monitor levels, potassium, and renal function

What is a phosphodiesterase inhibitor?

Milrinone, used short-term in acute heart failure

Can Milrinone be given with nitroglycerine?

False

What are two disorders of coronary artery disease?

Angina and myocardial infarction (MI)

Is nitroglycerin the first drug for coronary artery disease?

True

What are the routes of nitroglycerin?

Sublingual, IV, oral, topical, transdermal

What are the rapid-acting routes for nitroglycerin?

Sublingual and IV

What instructions should be given for acute chest pain?

Take SL tablet, if not relieved after 5 minutes call 911, may repeat up to 3 doses 5 minutes apart

What should be done when applying a nitro patch?

Remove old patch, apply to clean, hairless area, rotate sites, remove at bedtime for 8 hours

What are common adverse effects of nitrates?

Headache, hypotension, tolerance

How does aspirin help coronary artery disease?

Reduces mortality during MI and prevents clot formation

What nursing considerations are important for aspirin?

Monitor for bleeding, dark stool, epistaxis

What are desirable lipid levels?

Low LDL, high HDL, normal total cholesterol

What is the first-line drug for hyperlipidemia?

Statins (Atorvastatin)

When is the usual time to take statins?

Evening or bedtime

What are significant adverse effects of statins?

Myopathy, rhabdomyolysis, liver toxicity

What lab tests should be monitored with statins?

Liver function tests

Why is myopathy serious?

Can lead to rhabdomyolysis → acute renal failure

What are the contraindications of statins?

Pregnancy and active liver disease

What is the newest goal of dysrhythmia drug therapy?

Prevent symptoms, relieve symptoms, prolong survival.

What are the common classes of antidysrhythmic drugs?

Class I - Sodium channel blockers, Class II - Beta blockers, Class III - Potassium channel blockers, Class IV - Calcium channel blockers, Other: Digoxin, Adenosine, Atropine.

What are the indications of Sodium Channel Blockers (Quinidine)?

Atrial fibrillation, atrial flutter, SVT, ventricular tachycardia, PVCs, prevention of ventricular fibrillation.

Why does Quinidine have a black box warning?

It can cause pro-dysrhythmias (new or worsening arrhythmias).

What are the nursing considerations for Quinidine?

Monitor ECG, blood pressure, avoid grapefruit, monitor digoxin levels, watch for hypotension and hepatotoxicity.

What is the main use of Lidocaine (Class IB)?

Drug of choice for severe ventricular dysrhythmias.

What are the nursing considerations for Lidocaine?

IV only, loading dose then infusion, monitor BP and ECG, watch for CNS toxicity, not used longer than 24 hours.

Which beta blocker is used for dysrhythmias?

Propranolol.

What are the indications for Propranolol?

Atrial flutter, atrial fibrillation, SVT.

What are the nursing considerations for Propranolol?

Monitor HR and BP, hold if HR < 60, do not stop abruptly, monitor for bronchospasm, may mask hypoglycemia.

What is a Class III potassium channel blocker?

Amiodarone.

What are the adverse effects of Amiodarone?

Pulmonary toxicity, hepatotoxicity, thyroid dysfunction, visual disturbances, dysrhythmias.

What are the nursing considerations for Amiodarone?

Baseline chest X-ray, monitor liver enzymes, monitor thyroid, monitor ECG, long half-life.

Is Diltiazem used for tachydysrhythmia?

True.

Is Diltiazem contraindicated in liver and renal impairment?

True.

What are the nursing considerations for Adenosine?

Rapid IV push, flush immediately, continuous ECG monitoring, short half-life, temporary bradycardia or asystole expected.

Is Atropine used for bradycardia?

True.

What are nonpharmacological therapies for dysrhythmia?

Valsalva maneuver, carotid massage, defibrillation, pacemaker, radiofrequency ablation.

What are the types of shock?

Cardiogenic, hypovolemic, septic, anaphylactic, neurogenic.

What are the signs and symptoms of shock?

Hypotension, tachycardia, cool clammy skin, decreased urine output, altered LOC.

What is the main goal of shock drug therapy?

Raise blood pressure to maintain perfusion of brain, kidneys, heart.

What are common drugs to treat shock?

Norepinephrine (Levophed), dopamine, dobutamine, epinephrine, phenylephrine.

What are the main adverse effects of Levophed?

Extravasation injury, limb ischemia, decreased organ perfusion, dysrhythmias, hypertensive crisis and vision problems.