Cardiovascular Flashcards

Question

Side effects of CCBs Why should the patient on CCB not take grapefruit juice or eat grapefruit?

Answer 1

Calcium channel blockers are associated with several side effects due to their vasodilatory and cardiovascular effects. Common side effects include headache, which results from increased blood flow to the brain, and hypotension, more frequently observed with dihydropyridines like nifedipine and less common with non-dihydropyridines like diltiazem. Other effects include dizziness, flushing of the skin, and reflex tachycardia, which occurs as a compensatory response to the drop in blood pressure. Additionally, peripheral edema may occur due to fluid retention in the lower extremities caused by vasodilation. Because of their broad applications, CCBs are commonly used to treat hypertension, chest pain (angina), and heart rhythm disorders, but they do come with some side effects. Common ones include headaches, dizziness, low blood pressure, skin flushing, and leg swelling (peripheral edema). One thing to watch out for with dihydropyridines like nifedipine is reflex tachycardia, where the heart speeds up in response to the drop in blood pressure. Also, patients should avoid grapefruit, as it can interfere with drug metabolism and lead to stronger effects than intended. (Grapefruit (juice, fruit) has flavanoid and nonflavanoid (furanocoumarins) components that interferes with enterocyte cytochrome P450 3A4 (CYP3A4 for short) activity. CYP3A4 is involved in the bioinactivation of CCB). CYP3A4 is located in epithelial cells (enterocytes) lining the small intestines and colon, and in the parenchymal cells of the liver (hepatocytes). Consuming grapefruit (Seville oranges, limes and pomelos/ˈpɑː.mə.loʊz/ too) can significantly increase the amount of oral CCB in the serum, increasing its effect, leading to potential toxicity. Similar effect is seen in taking grapefruit with statins, amiodarone, warfarin, and many others.)

Answer 2

When using nitroglycerin, patients should take one tablet at the onset of chest pain. If the pain persists or worsens after five minutes, they must call 911 immediately. They can take up to three doses, each spaced five minutes apart, but only if medical help has been contacted. To maintain the medication's effectiveness, nitroglycerin pills should be stored away from direct sunlight, which can degrade the drug. For beta blockers and calcium channel blockers, patients should be taught how to monitor their own pulse and be aware of side effects like dizziness or faintness, which could indicate low blood pressure (hypotension). It is critical to notify the healthcare provider if these symptoms occur. Additionally, patients should never stop taking any antianginal medication without first consulting their provider to avoid potential complications or worsening of their condition.

Answer 3

Block adrenergic stimulation of heart depress myocardial excitability and contractility decrease conduction velocity in cardiac tissue increase myocardial recovery time(repolarization) suppress automaticity(spontaneous depolarization to initiate beats) Most antidysrhythmics are also proarrhythmic and vasodilator Give medications as schedule Monitor HR and BP Monitor ECG(prolonged QT), liver(AST/ALT) and renal function(creat.) monitor drug levels of procainamide for s/s of toxicity like seizure avoid alcohol, caffeine, tobacco, monitor for orthostatic hypotension

Answer 4

Aspirin is an antiplatelet medication that works by inhibiting platelet aggregation. Its mechanism of action involves blocking the enzyme cyclooxygenase (COX), which is essential for the synthesis of thromboxane A2 (TxA2), a chemical required for platelet activation and clot formation. Aspirin is used in various conditions to reduce the risk of clot-related complications. In acute myocardial infarction (MI), patients are advised to bite and chew aspirin to ensure rapid absorption and effect. It is also used for both treatment and prophylaxis of cerebrovascular accidents (CVA), especially within 24-48 hours of a stroke, and for coronary artery disease (CAD) prophylaxis. Aspirin can also be administered as a suppository in situations where oral intake is not feasible, such as when the patient is vomiting or unconscious. Common side effects include tinnitus (ringing in the ears) and an increased risk of bleeding, particularly in those prone to gastrointestinal bleeding. It is not recommended for children with viral infections due to its association with Reye's syndrome, a rare but serious condition. Adverse reactions can include nausea, dyspepsia, heartburn, gastrointestinal bleeding, toxicity, hypersensitivity reactions, and anaphylactoid reactions. Aspirin has no specific antidote, and its effects cannot be reversed immediately. To reduce bleeding risks, it should be discontinued one week before surgery. Despite its short half-life of 20 minutes, aspirin has long-lasting effects on platelets. It is rapidly absorbed in the gastrointestinal tract, with an onset of action within 5-30 minutes, reaching peak antiplatelet activity within 25 minutes to 2 hours and lasting for 3-6 hours. Precautions include avoiding concurrent use with NSAIDs, as this combination increases the risk of bleeding. Additionally, aspirin should be used cautiously in patients over 70 years old (as per Beers Criteria) due to heightened bleeding risks and uncertain benefits for primary prevention of cardiovascular events.

Answer 5

Heparin is derived from pork and should not be administered to clients who are allergic to pork products. Intravenous heparin dosing is based on weight and institution-specific protocols.

Answer 6

When the SNS is activated, your heart rate (HR) and stroke volume (SV) go up, pumping more blood to keep up with the body's energy demands. Your bronchioles expand, making it easier to breathe, and blood flow to your muscles and heart increases (β₂-mediated vasodilation) so you're ready to run or fight. At the same time, blood vessels in your skin, digestive tract, and kidneys tighten up (α₁-mediated vasoconstriction) to redirect blood to where it’s needed most. Even your spleen squeezes out extra blood, giving your circulation a boost. Your eyes adjust too—your upper eyelids lift, your pupils widen, and your eyeballs slightly protrude to sharpen your vision and expand your field of view. To fuel this high-energy state, your liver pumps out more glucose (from glycogenolysis and gluconeogenesis), making sure your brain and muscles have quick access to energy. Meanwhile, your digestive system slows down, your GI walls relax, and your sphincters tighten up, putting digestion on hold. The same thing happens to your bladder—the bladder wall relaxes, but the internal sphincter contracts, preventing any inconvenient pit stops. To supercharge this whole response, your adrenal medulla releases epinephrine (Epi) and norepinephrine (NE), flooding your bloodstream with even more of these powerful messengers. On top of that, your kidneys release renin, triggering the RAAS system, which leads to aldosterone secretion—helping your body hold onto sodium (Na⁺) and water to keep blood pressure up. Almost all blood vessels constrict (α₁ effect), except for the ones going to your heart and skeletal muscles (β₂ effect), which widen to make sure they get plenty of oxygen and nutrients. In short, your body goes into high-performance mode, pushing oxygen, blood, and energy toward the heart, muscles, and brain, while putting digestion and urine production on the back burner until the danger has passed.

Answer 7

Norepinephrine (NE) is primarily released from sympathetic nerve endings and works locally to increase blood pressure by constricting blood vessels and raising heart rate. A small amount of NE is also released from the adrenal medulla, but its main role is as a neurotransmitter in the sympathetic nervous system. Epinephrine (E), on the other hand, is mainly secreted by the adrenal medulla and enters the bloodstream, affecting the whole body. It increases heart rate and blood pressure but has an additional effect—it relaxes the airways (bronchodilation), making breathing easier. This is why norepinephrine is mainly used to treat low blood pressure (shock), while epinephrine is used for severe allergic reactions (anaphylaxis) to open up the airways. Epinephrine acts on β₂ receptors, leading to bronchodilation, which improves oxygen delivery. At the same time, it also stimulates β₁ receptors, increasing heart rate and cardiac output (CO). Norepinephrine primarily acts on α₁ receptors, causing vasoconstriction, which raises blood pressure (BP). This makes it especially useful for treating hypotensive shock. The adrenal medulla secretes epinephrine and norepinephrine, while the adrenal cortex secretes aldosterone, cortisol, and androgens.

Answer 8

The Renin-Angiotensin-Aldosterone System (RAAS) is the body's way of regulating blood pressure and fluid balance. It all starts when there’s a drop in blood pressure or blood volume—this can happen due to dehydration, blood loss, or even heart failure. When the body senses this drop, the Juxtaglomerular cells release renin, an enzyme that kicks off the RAAS cascade. Renin then acts on angiotensinogen, a protein made by the liver, converting it into angiotensin I. But angiotensin I itself isn’t very active—it needs to be converted into something more powerful. That’s where ACE (angiotensin-converting enzyme) comes in. ACE is mainly found in the lungs, and its job is to convert angiotensin I into angiotensin II, which is the real player in blood pressure control. Angiotensin II has three major effects: ✅ Vasoconstriction – It makes blood vessels narrow, which increases blood pressure. This helps maintain circulation when blood volume is low. ✅ Direct Action on Renal Tubules – Angiotensin II directly stimulates the proximal tubules in the kidney to reabsorb sodium (Na⁺) and water (H₂O), helping to increase blood volume and blood pressure even before aldosterone is involved. ✅ Aldosterone Release – Angiotensin II acts on the adrenal cortex, telling them to release aldosterone. Aldosterone then signals the distal tubules and collecting duct to retain sodium (Na⁺) and water (H₂O), while excreting potassium (K⁺). By holding on to more fluid, blood volume increases, and blood pressure goes up. So, in simple terms, the RAAS system is designed to keep blood pressure stable by tightening blood vessels and increasing fluid retention. However, when overactivated—like in chronic hypertension—it can actually lead to high blood pressure, fluid overload, and even heart failure. That’s why medications like ACE inhibitors, ARBs, and direct renin inhibitors are used to block different parts of the RAAS system and lower blood pressure.

Answer 9

ACE inhibitors, like lisinopril, work by blocking the angiotensin-converting enzyme (ACE), which is mainly found in the lungs. Normally, ACE converts angiotensin I into angiotensin II, a powerful vasoconstrictor. Angiotensin II also acts on the adrenal glands to stimulate aldosterone release, which causes sodium and water retention. By blocking ACE, these drugs lower blood pressure and reduce fluid overload, making them useful for hypertension (HTN) and heart failure (HF). One key thing to remember is that ACE inhibitors do not affect heart rate, so they are not antiarrhythmic drugs.

Answer 10

Now, let’s talk about side effects. One of the most serious is angioedema, which causes deep tissue swelling, often in the face, lips, and throat. The biggest danger? Airway obstruction. If the swelling blocks the airway, the patient could have trouble breathing, which is a medical emergency. Another classic side effect is the dry cough, caused by bradykinin buildup in the lungs—since ACE normally helps break bradykinin down, blocking it leads to irritation. Other side effects include hyperkalemia (too much potassium, which can affect the heart). This happens because ACE inhibitors reduce aldosterone levels, and aldosterone normally acts on the kidneys to increase sodium (Na⁺) reabsorption and potassium (K⁺) excretion. Without enough aldosterone, the body retains more potassium instead of excreting it through urine, leading to higher potassium levels in the blood. Lastly, ACE inhibitors can also cause agranulocytosis/neutropenia, meaning fewer white blood cells and a higher risk of infection.

Answer 11

When prescribing ACE inhibitors, there are a few key things to keep in mind. They should never be used in pregnancy, as they can cause serious harm to the baby, especially in pregnancy-induced hypertension. Also, elderly patients don’t respond well to ACE inhibitors alone, so they’re usually given with other antihypertensives. Lastly, that bradykinin buildup I mentioned doesn’t just cause a cough—it can also trigger an anaphylaxis-like reaction, leading to severe inflammation and swelling. If a patient develops significant swelling or breathing issues, we need to stop the drug immediately and treat the reaction. The nurse should prepare patients for CBC, pregnancy test and Comprehensive metabolic panel test to assess electrolyte levels.

Answer 12

ARBs, or Angiotensin II Receptor Blockers, like losartan, work by blocking angiotensin II from binding to its receptors. Normally, angiotensin II causes blood vessels to tighten and triggers aldosterone release, which makes the body hold on to sodium and water, raising blood pressure. But when we block those receptors, blood vessels stay relaxed, and less aldosterone is released, which helps lower blood pressure. That’s why ARBs are mainly used to treat hypertension (HTN).

Answer 13

Now, let’s talk about side effects. The most common ones with ARBs are dizziness, diarrhea, and insomnia. But one big advantage of ARBs over ACE inhibitors is that they don’t cause that annoying dry cough. That’s because ACE inhibitors mess with bradykinin, which leads to the cough, but ARBs work differently—they just block angiotensin II from acting, without affecting bradykinin. So, if a patient can’t tolerate ACE inhibitors because of the cough, ARBs are a good alternative.

Answer 14

When we prescribe ARBs, there are a few things to keep in mind. They’re generally better tolerated than ACE inhibitors, especially for people who get that persistent cough with ACE-Is. That being said, some patients may feel dizzy or have trouble sleeping, so it’s something to watch for. Since ARBs block angiotensin II at the receptor level, they’re a great option for lowering blood pressure while avoiding some of the side effects that come with ACE inhibitors.

Answer 15

Direct renin inhibitors, like aliskiren, work at the very beginning of the RAAS (Renin-Angiotensin-Aldosterone System) cascade. Normally, the kidneys release renin, which acts on angiotensinogen from the liver to form angiotensin I. Then, ACE converts it into angiotensin II, which causes vasoconstriction and stimulates aldosterone release. But when we block renin, we stop this whole chain reaction—less angiotensin I, less angiotensin II, and less aldosterone. This leads to lower blood pressure, which is why these drugs are used for mild to moderate hypertension (HTN).

Answer 16

Now, when it comes to side effects, hypotension is a big one because these drugs lower blood pressure. Some patients may also get peripheral edema (swelling in the legs), diarrhea, or hyperkalemia—which happens because less aldosterone means the kidneys don’t get rid of potassium as efficiently. Another major concern is heart failure (HF) in some cases. And one of the most serious but rare side effects is Stevens-Johnson syndrome (SJS). Stevens-Johnson syndrome usually starts off like the flu—fever, body aches, maybe a sore throat. But then, the skin reaction kicks in: painful blisters, peeling skin, and raw, exposed areas, especially on the mucous membranes. It gets so bad that some patients end up in burn units or ICUs because of how much skin they lose. Since it affects the mouth and throat, it hurts to eat and drink, which can lead to malnutrition and dehydration. If caught early and treated properly, patients can start recovering in about 2 to 3 weeks.

Answer 17

Hydralazine is a direct-acting vasodilator that works by relaxing the smooth muscles of arteries, leading to vasodilation and lowering blood pressure. It is mainly used for severe hypertension or hypertensive emergencies when immediate blood pressure control is needed. However, because it directly dilates arteries, the body may try to compensate by increasing heart rate, leading to tachycardia and palpitations. Other side effects include headache, dizziness, edema, nasal congestion, GI bleeding, and even excessive hair growth. A key adverse reaction to watch for is lupus-like symptoms, which can cause muscle and joint pain, fever, and rash. Because of its strong vasodilatory effects, hydralazine is usually given with a beta-blocker to control the reflex tachycardia. It’s an effective drug for short-term blood pressure management, but long-term use requires monitoring for side effects. (Lupus-like symptoms refer to drug-induced lupus (DIL), which happens when certain medications—like hydralazine, procainamide, and isoniazid—cause lupus-like reactions. Unlike systemic lupus erythematosus (SLE), DIL is not an autoimmune disease and usually goes away after stopping the drug. Symptoms include swollen joint, swollen lymph node, chest pain and fatigue. Blood tests show positive ANA but usually negative dsDNA, which helps differentiate it from real lupus. Treatment is simple—stop the drug, and symptoms typically resolve within weeks to months. NSAIDs can help with joint pain, and steroids are rarely needed) One key difference between hydralazine and nitroglycerin is where they work. Hydralazine primarily acts on peripheral arteries, reducing afterload, making it useful for hypertension. In contrast, nitroglycerin mainly works on peripheral veins and coronary arteries, reducing preload, which makes it more effective for conditions like angina and heart failure.

Answer 18

Adrenergic receptors, also known as adrenoreceptors, are named because they respond to adrenaline (epinephrine) and noradrenaline (norepinephrine), which are released by the adrenal gland and the sympathetic nervous system. These receptors play a key role in regulating blood pressure, heart rate, and airway function as part of the body's "fight or flight" response. There are four main types of adrenergic receptors: α₁, α₂, β₁, and β₂.

Answer 19

α₁ receptors are found in peripheral blood vessels, causing vasoconstriction, leading to an increase in blood pressure (↑BP). Drugs like norepinephrine and phenylephrine activate α₁ receptors to raise blood pressure in hypotensive states. α₂ receptors are mainly located in the central nervous system (CNS) and work by inhibiting the sympathetic nervous system, which results in vasodilation and lower blood pressure (↓BP). A common α₂ agonist is clonidine, which is used to treat hypertension. β₁ receptors are primarily found in the heart and are responsible for increasing heart rate and contractility, improving cardiac output. Drugs like dopamine and dobutamine target β₁ receptors to enhance heart function in conditions like heart failure. β₂ receptors are located in the lungs and blood vessels, where they promote bronchodilation and vasodilation, making breathing easier. Albuterol, a β₂ agonist, is commonly used to treat asthma by opening up the airways.

Answer 20

Clonidine is an alpha-2 agonist that works by reducing sympathetic activity in the central nervous system. This leads to a decrease in heart rate (HR) and blood pressure (BP), lowering cardiac output (CO). It also reduces levels of epinephrine, norepinephrine, and renin, causing vasodilation and lowering peripheral vascular resistance (PVR). Since clonidine affects fluid balance and heart function, it has some notable adverse reactions. Peripheral edema can occur due to sodium and water retention. It may also cause bradycardia, dizziness, and even heart block, especially when used with digoxin, calcium channel blockers (CCBs), or beta-blockers. A serious concern is rebound hypertensive crisis if the drug is abruptly discontinued, so it must be tapered off gradually. One major consideration is that clonidine should never be given with beta-blockers, as this can intensify bradycardia and lead to dangerous drops in heart rate. Additionally, liver enzymes should be monitored in patients on long-term therapy.

Answer 21

Prazosin is an alpha₁ blocker that works by blocking alpha₁-adrenergic receptors, leading to vasodilation and a decrease in blood pressure (BP). It is primarily used to treat hypertension (HTN) but is also effective for benign prostatic hyperplasia (BPH) because it relaxes the bladder sphincter, allowing for improved urine flow. While it is beneficial in lowering BP and easing urinary symptoms, it comes with some side effects, including orthostatic hypotension, dizziness, syncope (sudden loss of consciousness), and impotence. Because of the risk of a sudden drop in BP, nurses should always check the patient’s blood pressure before administering the medication. Patients should also be monitored for orthostatic hypotension, especially when changing positions, to prevent dizziness and falls. If the drug is being used for BPH, the nurse should also assess the patient’s urinary symptoms to ensure improved urine flow and relief from urinary retention. Since alpha₁ blockers cause vasodilation, careful monitoring is needed to prevent excessive hypotension and related complications. Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, which commonly happens in older men. As the prostate grows, it can press against the urethra, making it harder for urine to pass. Symptoms include： Difficulty starting urination (hesitancy) Weak urine stream Frequent urination, especially at night (nocturia) Feeling like the bladder is not completely empty Urgency to urinate

Answer 22

Carvedilol is a combined alpha₁ and non-selective beta blocker, meaning it blocks both alpha₁ and beta receptors to lower blood pressure. By blocking alpha₁ receptors, it causes vasodilation, which helps reduce blood pressure. At the same time, beta blockade slows the heart rate and decreases cardiac output, reducing the workload on the heart. Because of this dual action, carvedilol can be used alone or in combination with other antihypertensive agents, such as thiazide or loop diuretics, to improve blood pressure control. However, because it lowers both blood pressure and heart rate, common side effects include hypotension and bradycardia. More serious contraindications include heart failure, heart block, cardiogenic shock, and severe bradycardia, as excessive suppression of heart function can be dangerous. A major concern with beta blockers, including carvedilol, is their effect on the lungs. Even cardioselective beta blockers should not be used in patients with a history of obstructive airway diseases, such as asthma or COPD, because blocking β₂ receptors can lead to bronchoconstriction, making it harder to breathe. Since carvedilol is a non-selective beta blocker, it poses an even higher risk for respiratory complications in these patients.

Answer 23

Patients taking antihypertensive medications should be educated on proper use and potential risks. It is important to take the medication at the same time every day to maintain stable blood pressure control. Stopping the medication abruptly can lead to rebound hypertension, which can be dangerous. This is especially true for beta blockers, which should never be stopped before surgery, even if the patient is NPO, to prevent sudden blood pressure spikes and heart complications. Patients should be taught how to check their blood pressure (BP) and pulse daily and to change positions slowly to avoid dizziness from orthostatic hypotension. Any side effects should be reported, and regular follow-ups, including lab tests and eye exams, should be scheduled to monitor for any long-term effects. Certain over-the-counter cold and cough medications should be avoided, as they can raise blood pressure or interfere with antihypertensive drugs. Reducing alcohol intake is also recommended, as alcohol can worsen hypotension. Patients should be aware that some antihypertensive medications may cause sexual side effects, such as impotence in men. Finally, stress management is crucial, as stress can contribute to high blood pressure and reduce the effectiveness of treatment. No extra salt lose weight avoid tobacco

Answer 24

Inotropes/ˈaɪ.nəˌtroʊps/ are medications that increase the force of heart contractions, making them useful in the management of heart failure and shock. Two commonly used inotropes are dopamine and dobutamine, both of which act on beta-adrenergic receptors to improve heart function. Dopamine is a beta-adrenergic agonist that increases both heart rate and blood pressure, making it particularly useful in hypotension and shock. Dobutamine, on the other hand, is a sympathomimetic drug with beta-adrenergic activity, meaning it enhances the force of myocardial contraction (positive inotropic effect) and increases heart rate (positive chronotropic effect), helping to improve cardiac output. These medications are primarily used in conditions such as heart failure, hypotension, and shock states to improve perfusion and maintain blood pressure. However, when used in shock, it is essential to administer fluids first to ensure adequate blood volume before giving inotropes, as these medications work best when there is enough circulating fluid to support increased cardiac output. Common side effects of inotropes include tachycardia, premature ventricular contractions (PVCs), angina, nausea, vomiting, piloerection and hypertension. More serious adverse reactions include ventricular tachycardia (V-tach), ventricular fibrillation (V-fib), and myocardial infarction (MI), so patients receiving these medications must be closely monitored for dysrhythmias and cardiac complications. Piloerection is the medical term for "goosebumps" or "gooseflesh"—when the tiny muscles at the base of hair follicles contract, causing the hairs on your skin to stand up.