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Pharmacology - ADRN.114 > perfusion/ cardiac + HTN - part 2 > Flashcards

perfusion/ cardiac + HTN - part 2 Flashcards

1
Q

What does the RAAS system regulate in the body?

A

blood pressure + sodium and water absorption

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2
Q

When BP is low ______ is released from the kidneys into the blood stream. Renin is a key part in the conversion of angiotensin 1 to 2. Angiotensin 2 then __________ the small arteries, which increases BP. This also stimulates ______ + ________ to be released. These 2 hormones is what causes water + sodium ________, which increases BP +blood ________.

A

-renin
-vasoconstricts
- Aldosterone + ADH (vasopressin)
-retention
-volume

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3
Q

Drugs that end in “-pril” like Captopril belong to which drug class?

A

ACE Inhibitors - Angiotensin Converting Enzyme Inhibitors

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4
Q

What is Captopril mainly used to treat?

A

-hypertension
-HF

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5
Q

What are the 4 main side effects of Captopril?

A

hypotension
dry, non productive cough
angioedema
hyperkalemia

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6
Q

if Captopril is taken with NSAIDs, will it become more or less effective?

A

captopril will become less effective

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7
Q

What 3 other drug classes would increase the risk of hypotension if taken with Captopril?

A

antihypertensives
nitrates
diuretics

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8
Q

Drugs that end in “-artan” like Losartan belong to which drug class?

A

ARBs - Angiotensin 2 Receptor Blockers

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9
Q

ARBs are very similar to ACE inhibitors, what is the key difference that makes them the second choice behind ACE inhibitors?

A

ARBs aren’t able to protect against acute cardiac events.

BUT they don’t have the side effects of cough or hyperkalemia

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10
Q

if ARBs are blocking Angiotensin 2 receptors, what is happening in order to bring blood pressure down?

A

vasodilation
sodium + water excretion
potassium retention

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11
Q

What are the 3 things ARBs are used to treat or prevent?

A

-treat HTN + HF
-Prevent stroke

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12
Q

What are the 5 side/ adverse effects of Losartan?

A

angioedema
dizziness
hypotension
headaches
insomnia

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13
Q

if angioedema occurs, what medication is given IV to reverse it?

A

epinephrine

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14
Q

true or false?
ACE Inhibitors and ARBs are both contraindicated in patients who are pregnant or breastfeeding?

A

true

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15
Q

If you’re taking Losartan and also using NSAIDs this will _______ the effectiveness of Losartan.

A

decrease

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16
Q

Digoxin is the ONLY drug in this drug class?

A

digoxin is a CARDIAC GLYCOSIDE

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17
Q

Digoxin is used to treat atrial ______ or _______ and paroxysmal atrial ___________, by reducing the HR and helping the heart pump blood more effectively.

A

-fibrillation or flutter
-tachycardia

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18
Q

Cardiac dysrhythmias is a sign of digoxin toxicity. What are the early signs of digoxin toxicity?

A

-N/V
-fatigue + restlessness
-visual changes

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19
Q

What are the 2 key points in education, when is comes to the patient taking digoxin at home?

A

-take their own pulse
-take it at the same time everyday

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20
Q

if a patient is experiencing digoxin toxicity, what would you give them as the antidote?

A

digoxin immune fab, which are antigen binding fragments that carry the digoxin out of the bloodstream and excrete it through the kidneys

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21
Q

Metoprolol is a betablocker used to treat hypertension, but also an _______ used to treat angina pectoris.

A

antianginal

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22
Q

Metoprolol is going to decrease HR + contractility and decrease release of renin which is going to do what 3 things?

A

-decrease cardiac output

-vasodilate and decrease fluid retention

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23
Q

if you stop taking Metoprolol suddenly it can cause rebound excitation which can cause…..

A

angina and MI

24
Q

Metoprolol can cause HF + decreased cardiac output, so it is important to monitor and report what S+S? (4)

A

bradycardia
SOB
edema
coughing

25
Q

can you crush metoprolol?

A

no

26
Q

what kind of conditions would be contraindicated with Metoprolol? (5)

A

sinus bradycardia
> 1st degree heart block
HF
cardiogenic shock
asthma or COPD

27
Q

Milrinone is a PDE-3 inhibitor used to treat HF by vasodilation and helping the heart pump more effectively. If PDE-3 is inhibited, it is preventing the breakdown of what?

A

cAMP - cyclic adenosine monophosphate

28
Q

What are the 2 things that are continuously monitored during the Iv infusion of Milrinone?

A

vital signs and cardiac rhythm

29
Q

what are the 4 adverse effects of Milrinone?

A

ventricular dysrhythmias
hypokalemia
hypotension
angina

30
Q

if a patient is taking a medication that can increase their potassium, therefor causing hyperkalemia, what conditions do we need to watch for that would, combined, put them at an even higher risk? (4)

A

-kidney impairment
-diabetes
-hypoaldosteronism
-eat a potassium rich diet

31
Q

Sacubitril/ valsartan is a combination drug used to treat HF +HTN. Valsartan vasodilates + increases sodium + fluid excretion. Sacubitril is inhibiting Neprilysin, which also allows vasodilation + excretion of excess fluid + sodium. What is this doing in the body to help w/ HF + HTN?

A

these drugs are reducing afterload + BP, which is helping the heart pump more effectively

32
Q

Normally a patient shouldn’t be taking Sacubitril/ valsartan along with an ACE inhibitor or ARB because it can increase effects and increases the risk of angioedema or an allergic reaction. BUT if this patient does need to take them concurrently, how long do they need to wait in between therapies?

A

36 hours

33
Q

If Sacubitril/ valsartan wasn’t being an effective therapy, you’d monitor for S+S of heart failure. What would you see in your patient?

A

-weight gain/ edema
-JVD
-SOB
-crackles

34
Q

If a patient is on Sacubitril/ valsartan they should avoid _________ supplements due to them increasing the risk of hyperkalemia.

A

potassium

35
Q

Ivabradine is an HCN blocker, that blocks HCN channels in the SA node which makes it less effective. If the SA node is less active, what 2 things are happening?

A

heart rate is lowered and ventricles are filling more effectively

36
Q

There are specific guidelines that need to be met in order for a patient to be put on Ivabradine. What are those 4 guidelines?

A

-EF <35%
-Cardiac rhythm needs to be NSR
-Resting HR >70 bpm
-either already on the max dose of beta blockers or have contraindications to use of beta blockers

37
Q

Why is it so important that Ivabradine is taken 2x a day WITH food?

A

to keep consistent medication levels in the blood

38
Q

Which 2 natural substances should be avoided while taking Ivabradine due to it decreasing its effectiveness?

A

grapefruit juice and St. John’s Wort

39
Q

As a nurse educating a patient on Ivabradine, you tell them to be cautious with driving due to the drug causing ________ ________. They should also notify the provider of any _________, ______ ________ or ______, due to the risk of lethal cardiac rhythms.

A

-visual impairment

-palpitations
-chest pain
-SOB

40
Q

if you take atorvastatin and warfarin together, what are you at an increased risk of due to PT and INR becoming increased?

A

bleeding

41
Q

medications like fibrate, erythromycin and other lipid lowering medications put the at an increased risk of what? if taken with atorvastatin?

A

-myopathy + rhabdo.
-liver/ kidney toxicity/ damage
-increased blood levels of atorvastatin- which increases risk of adverse effects

42
Q

Statins, like atorvastatin, inhibit HMG-CoA reductase in the liver. When that is inhibited, what is being increased and decreased in the body?

A

HDL is being increased

LDL and triglyceride’s are being decreased
(to treat hyperlipidemia)

43
Q

What are the 2 most serious complications/ side effects of Atorvastatin? And what should a patient taking that drug report right away?

A

-myopathy and rhabdo.
-hepatotoxicity

which can lead to kidney damage

The patient should report:
-muscle pain
-jaundice
-Abd pain
-unusual fatigue

44
Q

What 2 of the signs you would assess if a patient was experiencing rhabdomyolysis?

A

muscle pain and elevated creatinine kinase (CK)

45
Q

If you were assessing your patient for signs of liver injury after taking Ezetimibe, what kind of manifestations would you see?

A

-jaundice
-fatigue
-poor appetite
-ABD pain
-dark urine

46
Q

Ezetimibe is a cholesterol absorption inhibitor, this means it is inhibiting the absorption of cholesterol in the ________ _________.

A

small intestine

47
Q

While taking Ezetimibe, your labs need to be monitored. Liver enzymes, CK, kidney function and lipid panels all need to be monitored in order to assess for what adverse effects/ complications?

A

rhabdomyolysis
hepatotoxicity
renal injury

and to assess for effectiveness of the drug

48
Q

How does Nitroglycerin treat and prevent angina? How does it act on the body?

A

-dilates blood vessels to decrease the oxygen demand and cardiac work of the heart

relaxes artery spasms in variant angina

49
Q

What are 4 side effects of Nitroglycerin related to it vasodilating the cardiac arteries?

A

-hypotension
-headache
-tachycardia
-dizziness

50
Q

lidocaine is a class ___ antiarrhythmic that is a _________ channel blocker.

A

Ib; sodium

51
Q

When sodium channels are blocked it is reducing the amount of sodium that’s entering the heart cells. What 3 things are being decreased in the heart to treat these ventricular dysrhythmias?

A

-decreased automaticity
-slowed impulse conduction
-shortened refractory period

slowing the rate of electrical impulses

52
Q

Sodium channel blockers are used to treat ventricular dysrhythmias caused from? (3)

A

MI
cardiac surgery/ procedure
digoxin toxicity

53
Q

what kind of side effects do sodium channel blockers like lidocaine cause?

A

CNS effects
like, confusion, paresthesia, seizures etc.

54
Q

what 2 things will be monitored with basically all kinds of cardiac meds.?

A

vitals and cardiac rhythm

55
Q

does lidocaine be ran in the IV tubing with other medications or does it need its own IV tubing for the infusion?

A

lidocaine needs its own separate tubing

56
Q

-allergy to amide anesthetics
-SVT, bradycardia, heart block
-respiratory depression
-low blood oxygen level
-hypovolemia
-myasthenia gravis
-hx. of malignant hyperthermia

these are all contraindications or cautions for which medication?

A

Lidocaine

-sodium channel blocker

Pharmacology - ADRN.114 (13 decks)

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