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pharm > Beta Blockers, Antianginals, Ace Inhibitors, ARBs > Flashcards

Beta Blockers, Antianginals, Ace Inhibitors, ARBs Flashcards

1
Q

What are selective beta blockers vs non-selective

A

Cardio selective only block beta 1 receptors in heart, while non-selective block both beta 1 and 2

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2
Q

What is the difference between beta 1 receptors and beta 2 receptors

A

Beta 1 receptors are found in the heart (and kidneys) so their blockage causes cardiovascular effects, while beta 2 receptors are found in the lungs so their blockage causes bronchial effects as well as inhibition of glycogenolysis

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3
Q

Is propranolol selective or nonselective

A

Non selective

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4
Q

Propranolol indications

A

Angina, Hypertension, Cardiac Dysrhythmias, MI, Migraine Prophylaxis, Stage fright, Hypothyroidism, pheochromocytoma, glaucoma

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5
Q

What VS are important to observe before administering Propranolol

A

BP and HR

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6
Q

What are the 3 objectives of antianginal therapy

A
  • Minimize the frequency and duration of attacks and intensity of pain
  • Improve patient’s functional capacity with as few side effects as possible
  • Prevent or delay MI, decrease morbidity and mortality
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7
Q

What are the 3 types of angina

A
  • Chronic Stable Angina: chronically narrowed arteries due to atherosclerosis, causes pain with increased demand
  • Variant Angina: due to vasospasm, heart doesn’t get enough blood and causes pain
  • unstable angina: like chronic angina, but clot causes total block of artery, leading to medical emergency
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8
Q

Which preparations of nitroglycerin are and aren’t affected by the the first pass effect

A
  • first pass: oral
  • No first pass: sublingual, translingual,transdermal, topical, IV
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9
Q

Which preparations of Nitroglycerin are rapid and brief, vs slow and long

A

Rapid and Brief: Sublingual, translingual, and IV
Slow and Long: Oral, transdermal, topical

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10
Q

What are the indications of rapid forms of nitroglycerin vs slower and longer lasting

A

Rapid: terminate ongoing angina, acute treatment, HF with MI or perioperative HTN
Slow: prophylaxis, long term protection

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11
Q

What is an important nursing consideration for antianginals regarding vitals

A

Decreases BP so ensure vitals are taken beforehand and mobilize patient slowly

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12
Q

What are the side effects of antianginals

A

Headache, orthostatic Hypotension, reflexive tachycardia, contact dermatitis, Tolerance

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13
Q

What is reflexive tachycardia caused by nitroglycerin

A

Because of the rapid vasodilation. BP is lowered by decreasing venous return and dilating arteries. This can activate baroreceptor reflex, causing sympathetic stimulation of the heart resulting in increased HR and contractile force (cardiac demand) which negates the purpose of the nitro in the first place.

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14
Q

What 3 things trigger the RAAS cycle

A

Low Na, Low water, High K+

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15
Q

Ace Inhibitors MOA

A

Inhibit the conversion of A1->A2 in the lungs by ACE

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16
Q

What are the Side effects of Ace inhibitors

A

Cough, angioedema, hypotension, lung hyperplasia, Hyperkalemia, renal failure, Anuria, teratogenic

17
Q

What are important assessments to complete before administering Ace inhibitors

A

BP, K+, Na+

18
Q

Why is it important to monitor potassium when giving Ace inhibitors

A

Can cause a buildup due to increased retention in the kidneys which can cause heart problems

19
Q

What do ace inhibitors interact with

A

Other antihypertensives, lithium, NSAIDs, Diuretics, potassium increasing agents

20
Q

Why is it important for patients using ACE inhibitors to start with a low dose, temporarily discontinue diuretics and monitor BP for first 2 hours after initial therapy

A

First dose hypotension

21
Q

What is the difference between aces and arbs

A

Aces prevent A2 from forming, while ARBs block its effects, meaning ARBs pose less of a risk for cough and hyperkalemia

22
Q

What ARB provides the most diverse range of treatment

A

Telmisartan

23
Q

Which ACE inhibitor provides the most diverse range of treatment

A

Ramipril

24
Q

What are the indications for the main ACE inhibitors

A

Ramipril (Everything)
Captopril (DN, MI)
Enalapril (RN, MI)
Trandopril (MI, HF)
Lisinopril (Acute MI)
Perindopril (LVD, MI)

25
Q

What are the indications of the main ARBs

A

Telmisartan (prevention)
Losartan (DN, CVA)
Valsartan (HF, MI)
Irbesartan (DN)
Candesartan (HF)

26
Q

What are the adverse effects of ARBs

A

Angioedema, teratogenic, renal failure

27
Q

What do ARBs interact with

A

Antihypertensives

28
Q

What are contraindications for Beta Blockers

A

Nonselectives shouldn’t be given to asthmatics, diabetics, pts with a history of anaphylaxis, or pts with cardiac or respiratory disorders

29
Q

What are side effects of beta 1 blockades

A

Bradycardia, rebound cardiac excitement, AV heart block, HF, decrease output

30
Q

What do beta blockers interact with

A

Calcium channel blockers and insulin

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