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A. Pharm II > EXAM 4 > Flashcards

EXAM 4 Flashcards

1
Q

ACE inhibitor.

Used to tx HF, HTN and acute MI:

A

lisinopril (Prinivil)

MA: Prevents the conversion of angiotensin I to angiotensin II (Inhibits the action of ACE). This reduces the levels of aldosterone which leads to less sodium and water retention.

This reduces the blood pressure (since less volume).

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2
Q

What class of drug is lisinopril?

A

It’s an ACE inhibitor.

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3
Q

What does ACE stand for and what does it do?

A

Angiotensin Converting Enzyme

ACE, is a central component of the renin-angiotensin system (RAS), which controls blood pressure by regulating the volume of fluids in the body. It converts the hormone angiotensin I to the active vasoconstrictor angiotensin II.

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4
Q

Name the adverse effects of lisinopril:

A
  • Angioedema, cough
  • Fetal injury and death (BLACK BOX)
  • HA, dizziness, orthostatic hypotension
  • Rash
  • Hyperkalema (small %) from the sodium leaving the body and consequential diffusion-shift of the K in the blood.
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5
Q

What class of drugs are the following:

Benzapril
Captopril
Enalapril
Ramipril

A

Other ACE inhibitors.

Recognizable by their -pril endings.

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6
Q

How do Angiotensin II receptor blockers work?

A

They block the actions of angiotensin II AT the receptor

  • These have the same pharmacological effects as ACE inhibitors

– These are prescribed for those who cannot tolerate the adverse effects of the ACE inhibitors.

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7
Q

What is losartan used for?

A

losartan (Cozaar) is used to tx:

  • HTN
  • Stroke prophylaxis
  • Diabetic nephropathy
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8
Q

What class of drug is losartan (Cozaar)?

What is the mechanism of action?

A

Angiotensin II Receptor Blocker (ARB)

MA: Blocks receptor site for angiotensin II (AT1)

This reduces the BP, PREVENTS cardiac remodeling, and PREVENTS renal deterioration.

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9
Q

What are the adverse effects of losartan (Cozaar)?

A

HA, dizziness

Fetal toxicity and death (BLACK BOX)

May increase LITHIUM levels!!!

Hyperkalemia

Angioedema is rare but still possible.

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10
Q

This CCB is a dihydropyridine and is used for HTN and angina:

What are some unique adverse effects of this drug?

A

Nifedipine (Adalat CC, Procardia)

Unique adverse effects:
* Flushing

  • Increased digoxin levels (contraindicated)
  • Alcohol perpetuates effects (contraindication)

Other common AE’s: hypotension, HA, dizziness (r/t drop in BP)

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11
Q

Which kind of drugs end in -diprine?

A

Dihydropyridine CCBs (Calcium Channel Blockers)

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12
Q

Name the two nondihydropyridines:

A
  1. Verapamil (Calan): Tx for HTN but very important for angina and dysrhthmias
  2. Dilitazem (Cardizem): HTN and angina
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13
Q

Which medication causes an increase in digoxin levels by 45%?

A

nifidepine.

A dihydropyridine CCB for HTN and angina.

nifidepine is also contraindicated with alcohol users because they both vasodilate and cause a dire drop in BP

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14
Q

When should patients taking thiazides be monitored for K, glucose, and lipids?

A

All pts should be monitored for K because thiazides do not spare K, and can lead to hypokalemia which causes dysrhythmias… they can also increase their K intake or it may be prescribed.

Thiazides may also cause hyperglycemia so if a patient has diabetes this needs to be closely monitored.

Lipids may also be increased by thiazides so if a patient has an existing hyperlipidemia, use with caution.

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15
Q

This nonhydropyridine is useful for the tx of HTN and angina:

A

dilitazem (Cardizem)

verapamil (Calan) is also useful for the tx of HTN and angina but also dysrhythmias.

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16
Q

How do CCBs work?

A

Blockade of calcium channels in the vascular smooth muscle AND cardiac muscle (myocardium).

This decreases BP, contractility, and conduction.

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17
Q

Which drug is contraindicated for lupus?

A

hydralazine (Apresoline). 2nd line, direct-acting vasodilator.

Exacerbates lupus like symptoms.

Also contraindicated or used with caution with:

  • Renal impairment (bc it’s excreted through kidneys).
  • Other HTN medications (dire hypotension can result)
  • MAOi’s combined with hydralazine can lead to an INCREASE in BP.
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18
Q

This dihydropyridine CCB blocks the calcium channels in the vascular smooth muscle, including the coronary arteries:

A

nifedipine (Adalat CC, Procardia)

Tx: HTN and angina

Through the dilation of arterials, this decreases the BP and the oxygen demand on the heart. These also decrease the afterload (wall stress) of the heart.

This drug does NOT affect the conductivity of the heart unless in toxic levels.

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19
Q

What are dihydropyridines useful for Tx?

A

They are the most smooth muscle selective. Because of their high vascular selectivity they are used primarily to reduce systemic vascular resistance and arterial pressure (hypertension).

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20
Q

What class of drugs end in -dipine?

A

Dihydropyridine CCBS:

nifedipine
amlodipine
clevidipine
felodipine

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21
Q

Which drug has adverse effects of HA, flushed skin, dizziness, lightheadedness, peripheral edema, and high doses reflex tachycardia or bradycardia?

A

The nondihydropyridine CCBs:

verapamil (Calan)
dilitazem (Cardizem)

The HA, flushed skin, dizziness, and peripheral edema are from the vasodilation. The reflex tachycardia is the body’s compensatory measure from the drop of BP. The bradycardia may be from the reduced contractility and conduction. (these last two are from high doses)

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22
Q

Which drugs are contraindicated in patients with HF, or AV block?

A

Nondihydropyridine CCBs:

verapamil and dilitazem

These two drugs have myocardial affects whereas the other CCBs do not. These can exacerbate HF symptoms as well as slow conduction conditions.

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23
Q

Which drug is Rx’d if the patient can’t handle the adverse effects of the ACE inhibitors?

A

ARBs

Angiotensin Receptor Blockers like losartan.

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24
Q

Which drug is used to treat HTN, prophylactic tx of stroke, prevents cardiac remodeling and tx diabetic nephropathy?

A

Losartan

Black box warning for pregnancy.

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25
Q

Which drug is amplified by alcohol in that it increases the affect of hypotension and grapefruit juice inhibits metabolism?

A

nifedipine.

nifedipine is a di-CCB which dilates arterioles and coronary arteries… alcohol also dilates. The combo can lead to extensive, dangerous depression of BP.

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26
Q

Which drug is used to tx HTN by blocking the sympathetic nervous system activation to decrease BP, HR, CO?

A

Prazosin (Minipress). Second-line adrenergic antagonists

Adverse Effects (AE):
Hypotension
Bradycardia

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27
Q

This 2nd-line adrenergic antagonist is a non-specific beta blocker:

A

propanolol (Inderal).

this is all you need to know.

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28
Q

This 2nd-line adrenergic antagonist is a specific beta blocker:

A

metoprolol (Lopressor).

this is all you need to know.

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29
Q

This 2nd line drug is used to tx moderate to severe HTN by reducing blood pressure by direct vasodilation:

A

Hydralazine (Apresoline). Direct acting vasodilator (not veins, so no ortho. hypo.)

Directly relaxes the smooth muscle of arterioles - immediate effect.

Decreases afterload (wall stress).

Selective for ARTERIOLES not veins.
(contraindicated for lupus, MAOi, and caution with renal impairment)

30
Q

Which 2nd line drug is used to tx severe HTN that is unresponsive to other txs?

A

minoxidil (Loniten). Direct-acting vasodilator.

This is through the direct relaxation of smooth muscle arterioles - selective for arterioles.

Adverse effects: More toxic than hydralazine, causes hypertrichosis (abnormal amt of hair growth).

Topical form - Rogaine - hair growth for men.

31
Q

Which drug is used to tx HTN crisis (diastolic >120)?

A

nitroprusside sodium (Nitropress). Direct-acting vasodilator.

Dilates BOTH arteries and veins.

AE: Severe risk of hypotension… leading to lack of perfusion to organs (close monitoring).

32
Q

What special consideration is needed regarding the use of nitroprusside?

A

72 hr window.

Build up of metabolite thiocyanate poisoning (decreased BP, blurred vision, lethargy, acidosis)

BLACK BOX: ischemic injury and death.

33
Q

Which drug is used solely to tx HF?

A

digoxin (Lanoxin). Cardiac glycoside.

MA: inhibits Na, K ATPase pump, Na accumulates, Ca goes into cell, positive ionotropic agent. Increases contractility and CO.

AE: dysrhythmias - ventricular. Many drug interactions. Visual disturbances.

Definition: an agent or medication, or its side effects, which may effectuate either to strengthen (positive) or weaken (negative) the force of a functional system (usually the contractility of the heart).

34
Q

What things should be considered/monitored with digoxin?

A

Potassium levels.

Hypokalemia = dig induced dysrhythmias.
Hyperkalemia = can decrease dig effect

Narrow safety range.

35
Q

First line diuretic:

A

Furosemide (Lasix). Loop diuretic.

Most effective.

MA: blocks Na+, Cl-, K+ re absorption by blocking symporter protein in the loop of Henle.

AE: 
Electrolyte imbalance
Fluid loss = dehydration
Ototoxicity
Hyperglycemia

Contraindications/Monitor:
Increased blood sugar = diabetics BG
Hyperuricemia from drug can cause an exacerbation of gout.

Hyperuricemia: an excess of uric acid in the blood. Uric acid passes through the liver, and enters your bloodstream. Most of it is excreted (removed from your body) in your urine, or passes through your intestines to regulate “normal” levels.

36
Q

First line choice for tx of moderate to severe HTN, fluid retention, or renal failure:

A

Furosemide (Lasix). Loop diuretic.

AE: 
Electrolyte imbalances
Dehydration
Ototoxicity 
Hyperglycemia 
Hyperuricemia
37
Q

Which first line diuretic is used for mild to moderate HTN or edema:

A

HCTZ (Microzide). Thiazides diuretics.

MA:
In distal tubule.
10% Na+ reabsorbed normally = less diuresis.

AE:
Loss of K, Na, Cl
No ototoxicity

Monitor/Contraindications:
Diabetics need to check BG (like furosemide)
Increased Uric acid = gout (like furosemide)

38
Q

Name a potassium-sparing diuretic used for txing HTN and edema:

A

spironolactone (Aldactone). Potassium-sparing diuretic.

MA:
Inhibits aldosterone actions in the distal tubule/collecting ducts. The Na is excreted but the K is retained.

Onset of action is 2 days.

39
Q

spironolactone’s adverse effects:

A

Hyperkalemia

Endocrine effects:
Gynecomastia (man boobs)
Impotence
Hirsutism (unwanted male-pattern hair growth on a woman’s face, chest, and back.)

Should NOT be used during pregnancy (teratogenic effects in lab animals - tumors).

40
Q

Muscle weakness, tiredness, tingling sensations (parathesias), or nausea. A slow heartbeat (bradycardia) and weak pulse are more serious symptoms, since these may signal an effect on the electrical activity of the heart. These are signs of what condition?

A

Hyperkalemia

A possible adverse effect of spironolactone.

41
Q

This osmotic diuretic is used to tx renal failure and oliguria:

A

mannitol (Osmitrol). Osmotic diuretic.

MA:
Increases osmolality (solute concentration) and draws water out in proximal tubule.

AE:
Electrolyte and fluid imbalances… all electrolytes are excreted.

Monitor/contra:
Not good to use with HF… severe overload of fluid to blood circulation.

42
Q

This diuretic is used to tx mild fluid retention:

A

acetazolamide (Diamox). Carbonic anyhdrase inhibitor.

MA:
Inhibits carbonic anyhdrase enzyme (forms and reabsorbs HCO3). Inhibits reabsorption of HCO3. Without HCO3 Na absorption can’t occur in the proximal tube.

No adverse effects or monitoring/contraindications are listed.

43
Q

Which diuretic is possibly teratogenic and contraindicated for pregnancy?

A

spironolactone (Aldactone). Potassium-sparing diuretic.

MA:
Inhibits adolsterone actions in distal tubule/collecting ducts… Na excreted, K retained.

Onset of action is 2 days.

44
Q

Which two diuretics should be monitored for BG and hyperuricemia?

A

furosemide (Lasix). Loop diuretic.
and
HCTZ (Microzide). Thiazide diuretic.

45
Q

Which two diuretics are used to treat renal failure?

A

furosemide (Lasix)
and
mannitol (Osmitrol)

46
Q

Which diuretic is contraindicated for HF?

A

mannitol (Osmitrol). Osmotic diuretic.

May produce a sever overload of fluid to blood circulation.

47
Q

Which diuretic has an onset of 2 days?

A

spironolactone (Aldactone). K-sparing diuretic.

Used to Tx HTN and edema.

Works in distal convoluted tubule and collecting ducts of nephron.

48
Q

What percentage of cardiac output goes to our kidneys?

A

25%

Each kidney has 1 million nephrons

49
Q

What does blocking aldosterone do?

A

Causes Na to be excreted.

Aldosterone causes the re-absorption of Na in the kidney. By blocking it, Na remains in the filtrate (urine).

50
Q

If K is reabsorbed, then what happens to Na?

A

Na is excreted.

If Na is re-absorbed, then K is excreted.

They switch places.

51
Q

What do we call a generalized massive edema?

A

Anasarca.

52
Q

What characteristic of a diuretic makes it the most effective?

A

It’s ability to block the re-absorption of Na.

53
Q

What are the 3 ways diuretics get rid of excess fluids?

A
  1. Blocking the re-absorption of Na and Cl (furosemide [loop], HCTZ [thiazide], and acetazolamide [carbonic anhydrase inhibitor]).
  2. Blocking aldosterone (spironolactone).
  3. Osmotic pressure changes (mannitol).
54
Q

How does acetazolamide, which is a carbonic anhydrase inhibitor, prevent the absorption of Na in the proximal tubule?

A

Carbonic anhydrase enzyme: a family of enzymes that catalyze the rapid interconversion of carbon dioxide and water to bicarbonate and protons…

If this enzyme is not able to form (catalyze) bicarbonate, then this prevents the re-absorption of Na in the proximal tubule.

55
Q

Which class of diuretic inhibits the action of aldosterone?

A

Potassium-sparing.

This occurs in the distal tubule and collecting ducts.

spironolactone.

56
Q

Which diuretic is used to tx renal failure and moderate to severe HTN?

A

furosemide.

Patients with chronic renal failure retain Na+ and H2O, and they retain K- and acid. This disordered homeostasis results in hypertension, edema, hyperkalemia and acidosis.

57
Q

Which diuretic is used to tx mild to moderate HTN or edema?

A

HCTZ (Microzide). Thiazides.

Largest and most commonly Rx’d.

This diuretic blocks a different symporter protein and in a different location than the loop diuretics. Works in the early segment of the distal conv. tubule (where only 10% of Na is normally absorbed).

Not a good choice for those with renal impairment (bc diuresis is slower… use a loop instead).

58
Q

Which other diuretic, besides furosemide, is used to tx renal failure?

A

mannitol (Osmitrol). Osmotic diuretic.

Given IV… creates a force that draws H2O N2 the filtrate (urine), causing diuresis.

Rarely the first drug of choice.

AE:
Electrolyte imbalance
Dehydration

59
Q

Which diuretic is rarely Rx’d?

A

acetazolamide (Diamox). Carbonic anhydrase inhibitor.

Only produces a mile diuresis.

MA:
Inhibits carbonic anhydrase enzyme that is important for acid-base balance in the proximal tubule, causing Na to be excreted (because no bicarb there to assist the Na).

60
Q

What is hypertrichosis and which diuretic has this as an adverse effect?

A

Hirsutism.

The unwanted “manly” hair on a woman’s face, chest and back.

AE of spironolactone, because this drug also binds with progesterone and androgen receptors.

61
Q

Teaching topics regarding diuretics:

A

WEIGHT : report any gain.

GI : Take Rx with food/milk

AVOID exercise in hot weather and prolonged standing (dehydration).

ORTHOSTATIC hypotension : dizzy, weak, falls

62
Q

Nursing Considerations for diuretics:

A
  • Give in the morning.
  • Problems with fluid and Na loss : replenish PRN (Pro Re Nata = “as the circumstances arises”).
  • Potassium imbalance - supplements
  • Restrict intake of K+ rich foods if taking spironolactone:
    Bananas, Nuts, Potatoes, Citrus.
63
Q

MI, mitral stenosis, diabetes, coronary artery disease and chronic HTN may all cause what condition?

A

Heart Failure.

All produce a weakening of the myocardium.

Mitral stenosis: a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart.

64
Q

Congestive heart failure is referring to which type of HF?

A

Left-sided HF. CHF.

Characterized by pulmonary edema, and ventricular hypertrophy (compensating).

65
Q

Blood pooling in the veins, edema, and engorgement of the organs are all signs of what health condition?

A

Right-sided HF.

Particularly engorgement of the liver.

The right side of the heart is too weak to keep up with the flow and it starts to backup. Generally caused by congestive HF.

66
Q

What do we call the end diastolic volume that stretches the right or left ventricle of the heart to its greatest dimensions under variable physiologic demand?

A

Preload.

67
Q

The stress in the wall of the left ventricle during ejection. In other words, it is the end load against which the heart contracts to eject blood. This is readily broken into components: one factor is the aortic pressure the left ventricular muscle must overcome to eject blood.

A

Afterload.

68
Q

An inotrope is an agent that alters the force or energy of muscular contractions. What does a positive inotrope mean?

A

Positively inotropic agents increase the strength of muscular contraction.

Negatively inotropic agents weaken the force of muscular contractions.

69
Q

Which drug toxicity may manifest as abdominal pain, anorexia, N/V, visual disturbances, bradycardia, and other arrhythmias?

A

Digoxin toxicity

May need to DC the drug, talk to provider… also Digibind may be needed if severe.

70
Q

Which drug has a therapeutic range of 0.5 - 2 ng/mL?

A

digoxin.

> 2 = toxicity:
abdominal pain, anorexia, N/V, visual disturbances, bradycardia, and other arrhythmias.

LONG half life of 1 and 1/2 days!

HOLD if HR is <60!

Monitor Potassium: Hypo- can lead to a digoxin-induced dysrhythmia. Hyper- can reduce the effects of digoxin.

71
Q

If the patient has HF and the diuretic, ACE inhibitor, beta adrenergic antagonist, and vasodilator does not effectively treat, then what is added?

A

A cardiac glycoside. Digoxin (Lanoxin)

72
Q

What HF drug does not prolong life but does reduce symptoms, increases exercise tolerance, and decreases hospitalizations?

A

Digoxin. Cardiac glycosides.

MA:
Inhibits the Na/K ATPase. This is an important enzyme that pumps Na ions out of myocardial cells in exchange for K ions. The Na ions build up and Ca ions are released from storage to activate myocardial contraction.

A. Pharm II (7 decks)

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