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Pharmacology > Cardiovascular Part 1 > Flashcards

Cardiovascular Part 1 Flashcards

1
Q

What is the ACE inhibitor suffix?

A

-pril

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2
Q

Adverse Effects

Angiotensin-Converting Enzyme Inhibitors - captopril

A

Severe hypotension following first dose (most likely in clients taking diuretics, with high BP, or who have hyponatremia)
Dry, nonproductive cough due to increase in bradykinin
Rash and report of metallic taste in mouth
Angioedema (swelling of mouth, throat due to inhibition of kinase II)
Hyperkalemia
Neutropenia (decrease in white blood cells with increased risk of infection)

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3
Q

Contraindications

ACE Inhibitors - captopril

A

Teratogenic effects
Angioedema or allergy to ACE inhibitors
Hypotension
Liver disease with elevated liver enzymes

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4
Q

Interactions

ACE Inhibitors - captopril

A

Potassium diuretics, potassium supplements, or use of salt substitutes increase risk of hyperkalemia
Antihypertensive drugs, diuretics, and nitrates (such as nitroglycerin) increase risk for hypotension
NSAIDs may decrease effectiveness
Food decreases absorption of ACE Inhibitors
ACE Inhibitors may cause lithium toxicity

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5
Q

What is the suffix for Angiotensin II Receptor Blockers (ARBs)?

A

sartan

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6
Q

Expected Pharmacological Action

ARBs - losartan

A

Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II
Selectively blocks the binding of angiotensin II to the AT receptor found in tissues

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7
Q

Client Education

ARBs - losartan

A

Report minor swelling of the mouth, throat to provider; call 911 immediately if severe reaction occurs
Report frequent headaches or insomnia
Do not take losartan if pregnant or breastfeeding
Tell provider if pregnancy is a possibility

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8
Q

Adverse Effects

Aldosterone Antagonist - eplerenone

A

Hyperkalemia

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9
Q

Client Education

Aldosterone Antagonist - eplerenone

A

Do not take potassium supplements, use potassium-containing salt substitutes or drugs which raise potassium levels unless prescribed by the provider
Report palpitations, muscle twitching, weakness, or paresthesia in extremities to provider

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10
Q

Expected Pharmacological Action

Direct Acting Renin Inhibitors - aliskiren

A

Binds to renin at its active site, stopping the cleavage of angiotensin, in turn inhibiting the formation of angiotensin I. This ends the cascade of angiotensin II mediated mechanisms that normally increase the blood pressure

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11
Q

Medication Administration

Direct Acting Renin Inhibitors - aliskiren

A

Available in oral form only
High-fat meals decrease absorption
Give at a consistent time daily before eating
Expect 2 weeks before full effect is seen
Monitor for hypotension at beginning of therapy and after any dose increase

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12
Q

Client Education

Direct Acting Renin Inhibitors - aliskiren

A

Do not take potassium supplements, salt substitutes, or drugs that raise potassium levels unless prescribed by provider
Report palpitations, muscle twitching, weakness, or paresthesia in extremities to provider
Report persistent cough to provider
Report minor swelling of mouth, throat to provider; call 911 immediately if severe reaction occurs
Report GI symptoms to provider
Stop taking aliskiren if pregnant; fetal injury can occur

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13
Q

What is the suffix for vascular Calcium Channel Blockers (CCB)?

A

dipine

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14
Q

Expected Pharmacological Action

Calcium Channel Blockers (CCB) - nifedipine

A

Dihydropyridine CCBs block calcium channel in vascular smooth muscle (VSM) cells of peripheral arterioles, and minimally block calcium channels in cardiac arteries. This results in vasodilation and a lower blood pressure. CCBs indirectly increase heart rate, called reflex tachycardia, because the decrease in blood pressure stimulates the baroreceptor reflex. This increase in heart rate does not occur due to direct effect on the electrical conduction system of the heart

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15
Q

Nursing Interventions

Calcium Channel Blockers (CCB) - nifedipine

A

Give nifedipine along with ordered beta-blocker to prevent reflex tachycardia
Monitor heart rate
Assist with ambulation as needed
Inform client that facial flushing may occur
Monitor for and report edema (a diuretic may be prescribed if edema occurs)
Notify provider and withhold dose for BP below 90mmHg systolic or for prearranged parameter
Advise regular dental care

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16
Q

Adverse Effects

Alpha 1 Blockers - doxazosin

A

Orthostatic hypotension-especially with first dose and with dosage increases
Reflex tachycardia may also occur
Headache or dizziness

17
Q

Client Education

Alpha 1 Blockers - doxazosin

A

Report dizziness, syncope, rapid HR, or palpitations to provider
Take this drug at bedtime
Rise slowly from lying to sitting or standing to prevent injury
Do not perform hazardous activities, such as driving for at least 12 hours following first dose and subsequent dosage increases
Report increase in frequency of headache or dizziness to provider

18
Q

What is the suffix for Beta-Blockers

A

lol

19
Q

Expected Pharmacological Action

Beta Blockers - atenolol

A

Completely blocks stimulation of beta-adrenergic receptor within vascular smooth muscle; produces negative chronotropic activity

20
Q

Adverse Effects

Beta Blockers - atenolol

A

Bradycardia due to blockade of beta1 receptors; may lead to reduced cardiac output
Heart failure (HF) (SOB, edema, coughing at night)
Rebound excitation causing angina pain or MI with sudden withdrawal of betablocker in client with CHD

21
Q

Nursing Interventions

Beta Blockers - atenolol

A

Monitor heart rate and report rate slower than 60 beats/min (or prearranged parameter) to provider
Monitor for signs of heart failure and report to provider
Teach client not to stop taking beta blocker suddenly
On discontinuation, taper dose slowly over 1 to 2 weeks

22
Q

Adverse Effects

Adrenergic Neuron Blockers - reserpine

A

Severe depression and risk for suicide, which can linger after reserpine is discontinued
Bradycardia and orthostatic hypotension
GI symptoms: diarrhea, abdominal cramping

23
Q

Contraindications

Adrenergic Neuron Blockers - reserpine

A 
Previous allergy to alkaloids
Depressive disorders
Peptic ulcer or ulcerative colitis
Cardiac dysrhythmias, or cerebrovascular disease
Older adults
24
Q

Therapeutic Use

Centrally Acting Alpha 2 Adrenergic Agonist - clonidine

A

Treats Hypertension
Severe pain relief (administered by epidural infusion)
ADHD

25
Q

Client Education

Centrally Acting Alpha 2 Adrenergic Agonist - clonidine

A

Take at bedtime to minimize CNS effects
Do not perform hazardous activities, such as driving, until effects are known
Suck hard candies, chew sugarless gum, sip water to minimize dry mouth.
Do not abruptly stop taking clonidine; when discontinued, taper according to instructions

26
Q

Therapeutic Use

Alpha Beta Blockers - carvedilol

A

Treats hypertension
Treats heart failure along with digoxin, ACE inhibitors, and diuretics
Prolongs chance of survival following MI

27
Q

Expected Pharmacologic Action

Direct-Acting Vasodilators - hydralazine

A

Acts by dilating the arterioles, which in turn decrease peripheral resistance, decrease arterial blood pressure without affecting venous pressure, increase heart rate, and increase contractility of the heart

28
Q

Adverse Effects

Direct-Acting Vasodilators - hydralazine

A

Headache, dizziness, weakness and fatigue, reflex tachycardia
A systemic lupus erythematosus (SLE)-like syndrome can occur (face rash, joint pain, fever, nephritis, pericarditis)
Most likely with high doses, fluid retention, edema
Abrupt withdrawal can cause hypertensive crisis and HF

29
Q

Nursing Interventions

Direct-Acting Vasodilators - hydralazine

A

Advise client that headache and tachycardia can occur
Monitor pulse and report tachycardia
A beta blocker can be added to decrease tachycardia; watch for hypotension with additional antihypertensive agent
Monitor for and report signs of facial rash, joint pain, or fatigue to provider (hydralazine will be discontinued)
Monitor for edema, crackles in the lungs; can be combined with a diuretic to minimize this effect
Taper hydralazine slowly when discontinued

30
Q

Adverse Effects

HMG-CoA Reductase Inhibitors (Statins) - atorvastatin

A

Myopathy (pain in muscles, which can progress to rhabdomyolysis [breakdown of muscle protein causing kidney damage])
Hepatotoxicity

31
Q

Medication Administration

HMG-CoA Reductase Inhibitors (Statins) - atorvastatin

A

Available orally only

For greatest effectiveness, take in the evening with or without food

32
Q

Client Education

HMG-CoA Reductase Inhibitors (Statins) - atorvastatin

A

Report muscle pain to the provider
Report abdominal pain, jaundice, and fatigue to provider
Comply with periodic liver function testing

33
Q

Therapeutic Use

Fibrates - gemfibrozil

A

Reduces high levels of plasma triglycerides

Increases HDL cholesterol

34
Q

Adverse Effects

Fibrates - gemfibrozil

A

GI symptoms: nausea, abdominal pain, diarrhea

Gallstones, myopathy, liver toxicity

35
Q

Interactions

Fibrates - gemfibrozil

A

Statin antilipemic greatly increase risk for myopathy

Warfarin with fibrates increases risk for bleeding

36
Q

Therapeutic Use

Nitrates - nitroglycerin

A

Treatment and prophylaxis of angina pectoris, rapid-acting forms (only transmucosal tablets, translingual spray and sublingual tablets treat an angina attack)
Longer acting forms such as regular tablets, immediate release or sustained release tablets/capsules are used to prevent attacks from occurring
IV nitroglycerin is used for severe unstable angina attacks and to control blood pressure preoperatively and to treat heart failure after acute MI

37
Q

Medication Administration

Nitrates - nitroglycerin

A 
Oral extended-release capsules
Sublingual tablet
Translingual spray
Topical ointment
Transdermal patch 
Intravenous

Pharmacology (9 decks)

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