Pharm study guide 2 Flashcards
ACE inhibitors - adverse effects (Ace ventura makes me swell and cough)
Swelling of the tongue, lips, face and throat. dry, non productive cough that is reversible with discontinuation of the therapy
who is not suitable for ACE inhibitors? (Ace ventura doesn’t mix with potassium)
Patients with a baseline potassium level of 5mEq/L or higher may not be suitable candidates for ACE inhibitor therapy, because these drugs can promote hyperkalemia.
A first dose hypotensive effect can cause a significant decrease in blood pressure with (Ace is significant)
ACE Inhibitors
Other adverse effects of ACE Inhibitors include (Ace cupcakes make kalema hyper and puffy)
a loss of taste, hyperkalemia, angio edema and renal impairment.
ACE Inhibitors and ARB’s appear to be
equally effective for the treatment of hypertension. Both are well tolerated.
The advantage of ARB’s over ACE Inhibitors is (no cough from arby’s)
that it does not cause a dry cough.
Calcium Channel Blockers may be used to treat (Calcium channel blockers HAD worked)
angina, dysrhythmias, and hypertension
what determines the regulation of arterial blood pressure?
Cardiac output and systemic vascular resistance
Weight reduction and restricted salt intake can be tried first before
being placed on medications for borderline hypertensive patients
what to give in a hypertensive emergency? (Arby’s in an emergency)
Angiotensin receptor blockers (ARB’s) are potent vasodilators bc they decrease systemic vascular resistance (SVR) and decrease pulmonary vascular resistance (PVR).
ARB’s - what action? (it’s in the name)
ARB’s will block angiotensin II from binding to its receptors on the muscles surrounding blood vessels. As a result, blood vessels enlarge (dilate) and blood pressure is reduced.
According to current hypertension management guidelines, initial anti-hypertensive drug therapy for a newly diagnosed hypertensive patient would most likely include
Thiazide diuretics
Comprehensive therapy for high blood pressure very often is
life-long.
How often to check BP if you have HTN?
Blood pressure checked once a week and keep track of the readings is highly suggested.
adverse effect for older pts - prazosin (Minipres®)
prazosin (Minipres®) for hypertension. One adverse effect is of most concern for the older adult patient taking this class of drug is Orthostatic hypotension
A patient diagnosed with “elevated blood pressure” has a reading of
120-129 and less than 80
Digoxin-immune Fab (Digibind®) is a
antidote to digoxin toxicity.
Digoxin-immune Fab (Digibind®) MOA
will bind to circulating digoxin and facilitate therapeutic serum concentration.
Digoxin Therapeutic levels are (Selene absolutely cannot dig)
0.5 - 2.0 nanograms/ml.
early and late signs of dig toxicity
early stages with anorexia and late stage of visual changes.
what increase dig toxicity?
Low potassium or magnesium levels can increase digoxin toxicity
A patient has received an IV dose of adenosine (Adenocard) , and almost immediately (Aden is dead)
the heart monitor shows asystole which is to be expected. It is designed to do so to reset the rhythm.
adenosine adminstration (A den next to my heart)
The medication should be given as close to central circulation as possible
adenosine half-life?
It has an extremely short half-life
Amiodarone half life
Amiodarone: has an extremely long half-life,
Amiodarone side effects for how long after discontinuation? (Amor for months)
months after discontinuation
what labs for amiodarone (Amor, check your TFT and vision)
Check PFT, LFT, TFT and visual changes while on medication
amiodarone - what to avoid? (Amor, don’t drink caffeine)
Avoid beverages that contain caffeine to patients on antidysrhythmic medications because caffeine acts as an irritant to cardiac neuromuscular function and could aggravate an arrhythmia
stable angina
Classic, or chronic stable, angina is triggered by either exertion or stress and subsides within 15 minutes with either rest or drug therapy
NGT patch
The patch may be worn while swimming, but if it does come off, it should be replaced after the old site is cleansed.
NTG preventative?
Can be also used to prevent occurrence of anginal discomfortw
when to use NTG sublingual
In sublingual forms, the medication should be taken at the first sign of chest pain, not delayed until the pain is severe
NTG sit or lie down?
The patient should sit or lie down and take one sublingual tablet
NTG - if patient calls 911, can you take more?
The patient can take one more tablet while awaiting emergency care and may take a third tablet 5 minutes later, but no more than a total of three tablets
if angina pain that does not respond to nitroglycerin may indicate
a myocardial infarction
Patient education about the use of sublingual nitroglycerin should include:
Sit down for a few minutes after taking the sublingual nitroglycerin to avoid fainting.
calcium channel blockers - help to reduce blood pressure by
causing smooth muscle relaxation and dilation of blood vessels.
A patient has a new prescription for an ACE inhibitor. During a review of the patient’s list of current medications, which would cause concern for a possible interaction with this new prescription?
NSAIDs and potassium
These drugs are used in the management of hypertensive emergencies
vasodilators
A patient is being treated for a hypertensive emergency. The nurse expects which drug to be used? (nitro if you’re pressed in an emergency)
Sodium nitroprusside (nitro press)
The nurse is obtaining a drug history on the patient being treated for hypertension. The prescriber has chosen the angiotensin receptor blocker losartan (Avapro) to treat the patient’s hypertension. Which drug is of most concern?
ibuprofen
Given the nurses knowledge of the side effects of alpha blockers which instruction should the nurse provide to the patient with a new order for an alpha blocker to treat hypertension?
change position slowly
During a follow-up visit, the health care provider examines the fundus of the patient’s eye. Afterward, the patient asks the nurse, “Why is he looking at my eyes when I have high blood pressure? It does not make sense to me!” What is the best response by the nurse?
“The provider is making sure the treatment is effective over the long term.”
The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a newly diagnosed hypertensive African-American patient would most likely include which drug or drug classes? (Thia and calcium)
Calcium channel blockers with thiazide diuretics
dont mix ACE with (same)
NSAIDs
Amiodarone (Cordarone) is the drug of choice for
(Amor, it’s a vent)
ventricular dysrhythmias according to the Advanced Cardiac Life Support guidelines. The other drugs are not used for acute ventricular dysrhythmias.
The nurse is preparing to administer adenosine (Adenocard) to a patient who is experiencing an acute episode of paroxysmal supraventricular tachycardia. When giving this medication, which is important to remember? (Aden dies a little)
Asystole may occur for a few seconds after administration.
A patient has been started on therapy of a continuous infusion of lidocaine after receiving a loading dose of the drug. The nurse will monitor the patient for which adverse effect? (Lidocaine makes me convulse at the dentist)
convulsions
A patient is experiencing a rapid dysrhythmia, and the nurse is preparing to administer adensoine (Adenocard). Which is the correct administration technique for this drug?
fast IV push
Mr. N. has a life-threatening ventricular tachycardia that has been resistant to treatment. What drug will the nurse expect to be used and what precautions are necessary with this drug? (Amor has vtach)
amorodione
digoxin dosing range
The normal therapeutic drug level of digoxin is between 0.5 and 2 ng/mL.
ACE inhibitors - side effects (ACE)
A - angio edema, C = hacking cough, E = electrolyte imbalances - low sodium, high potassium
ACE and ARBs lower what, and not what? (Ace ventura and Arby’s are only good for my BP)
Lower BP, NOT HR
ACE and ARBs block what?
the RAAS system
ACE man chills
pril = chill
ARBs - tan at Arbys
end in tan - losartan
sartans and aces spare the
potassium - avoid leafy greens
beta blockers - low HR LOL - double Ls (think metropolol)
ends in LOL
beta blockers side effects - the 4 Bs
bradycardia, breathing problems (bc they block beta 2 in the lungs - never give to asthma or COPD), Bad for HF, Blood sugar masking (beta blockers hide symptoms of low blood sugar)
calcium channel blockers - end in (pine, zem, amil for calcium)
dipine (depine declines the BP), zem (zem is zen yoga, relax BP and HR), amil (amil -calm and chill)
digoxin (digs for a deeper contraction)
JUST lowers HR, not BP. No orthostatic hypotension.
Digoxin, digs for a deeper contraction.
creatinine levels
over 1.3, no pee pee, kidney injury
digoxin cautions - ATP (can you dig at the ATP)
apical pulse, toxicity, and low potassium
vasodilators (nitro, hydro and hair vasodilate)
nitro is a pillow for the heart and hydralazine minoxodil
A first dose hypotensive effect can cause a significant decrease in blood pressure with
ACE Inhibitors.
Calcium Channel Blockers may be used to treat (Calcium treats HAD syndrome)
angina, dysrhythmias, and hypertension
calcium channel blockers MOA
help to reduce blood pressure by causing smooth muscle relaxation and dilation of blood vessel
arbs can also cause (low blood sugar at Arbys)
hypoglycemia
diltizam interactions
interacts with grapefruit juice
Amiodarone contraindicated with (amor, you can’t go to war and dig)
dixogin, warafarin or bradycardia
adenosine used for (Aden is a svelt wolf)
SVT and wolf
Digoxin class (glide into these digs)
gycloside
digoxin used for (digging for fibs and flutters)
aFib, aflutter and HF
digoxin given
slowly over 5 min
diabetes - what meds for HTN? (not arbs this time) (Diabetic aces)
ACE
ACE MOA
Dilate arteries and veins by blocking angiotensin II formation and inhibiting bradykinin metabolism. This vasodilation reduces arterial pressure, preload and afterload on the heart
Beta Blockers MOA
Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. Beta blockers cause the heart to beat more slowly and with less force, which lowers blood pressure
CCB MOA
By blocking calcium, calcium channel blockers allow blood vessels to relax and open.
Drugs of choice in treating hypertension in patients with diabetes mellitus or heart failure (diabetics are ACES)
ACE
