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AE1 > PHARM WEEK 3 CARDIO AGENTS PART 1B > Flashcards

PHARM WEEK 3 CARDIO AGENTS PART 1B Flashcards

1
Q

ACE inhibitors inhibit formation of __ __

A

angiotensin II (vasoconstrictor)

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2
Q

ACE inhibitors block the release of __, which then causes __ ___ and __ __

A

aldosterone

Na+ excretion
K+ retention

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3
Q

ACE inhibitors cause (little/significant) change in cardiac output

choose one

A

little

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4
Q

ACE inhibitors ___ peripheral vascular resistance

A

lower

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5
Q

ACE inhibitors: Uses (5)

A
  1. Primarily used to treat Hypertension
  2. Some also treat heart failure
  3. African-Americans & the elderly do NOT respond well to these alone
  4. Should not be used in pregnancy
  5. Most can be taken with food
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6
Q

Examples of ACE inhibitors:

A
  1. benazepril(Lotensin)
  2. captopril (Capoten)
  3. enalapril maleate
    (Vasotec)
  4. fosinopril (Monopril)
  5. lisinopril (Prinivil, Zestril)
  6. moexipril (Univasc)
  7. perindopril (Aceon)
  8. quinapril (Accupril)
  9. ramipril (Altace)
  10. trandolapril (Mavik)
  11. captopril (Capoten)
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7
Q

-PRIL

A

most likely be an ace inhibitor

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8
Q

-LOL

A

beta blockers

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9
Q

ACE inhibitors: Side effects

A
  1. Constant irritated cough* (can produce hernia, bowel/bladder incontinence)
  2. Hypotension
  3. Nausea
  4. Dizziness
  5. Rash
  6. Taste disturbance
  7. Hyperkalemia
  8. Tachycardia
  9. Impotence
  10. Intestinal angioedema
  11. Agranulocytosis
  12. Anaphylactoid reaction
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10
Q

When taking ACE inhibitors try to avoid __ __ b/c they are made of potassium. Try not to give __ which is potassium sparing.

A

salt substitutes

Aldactone

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11
Q

Angiotensin II Receptor Blockers (ARBs)

How are they similar to ACE inhibitors?

A
  1. Prevent release of aldosterone
  2. Act on renin-angiotensin system
  3. Less effective in treating HTN in African Americans
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12
Q

Angiotensin II Receptor Blockers (ARBs)

Differences from ACE inhibitors?

A
  1. ARBs selectively binds to angiotensin II receptors in the blood vessels to prevent vasoconstriction
  2. ACE inhibitors prevent conversion of angiotensin I to angiotensin II
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13
Q

ARBs cause __ of the blood vessels and decrease the release of __

A

vasodilation

aldosterone

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14
Q

ARBs cause a decrease in __ __

They don’t cause __ __ __ like ACE inhibitors (just occasional __)

A

peripheral resistance

constant irritated cough

cough

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15
Q

ARB prototype

A

Losartan potassium (Cozaar)

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16
Q

Other examples of ARBs

A

Valsartan (Diovan)
Olmesartan (Benicar)
Irbasartan (Avapro)

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17
Q

ARB side effects

A
  1. dizziness
  2. diarrhea
  3. insomnia
  4. occasional cough
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18
Q

-ARTAN =

A

most likely ARB

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19
Q

Direct Renin Inhibitor prototype:

A

aliskiren (Tekturna) - 1st FDA approved direct renin inhibitor to treat HTN

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20
Q

Direct Renin Inhibitor binds with __ therefore decreasing angiotensin I and II, and oldster levels

A

renin

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21
Q

Direct Renin Inhibitor can be used __ or __ with another agent

A

alone; combined

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22
Q

Direct Renin Inhibitors have an additive effect with

A

thiazide or ARB

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23
Q

Calcium Channel Blockers prevents the movement of calcium into __ and __ (__) muscles; interferes with the ability to __ causing __.

A

cardiac; smooth (arterial)

contract; vasodilatation

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24
Q

Calcium channel blockers slow __ __

A

cardiac impulses

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25
Q

Calcium channel blockers are used to treat __ __ and are also used for __ and __

A

chronic HTN

angina & dysrhythmias

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26
Q

Calcium channel blockers are highly __-___

A

protein-bound

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27
Q

Prototype for calcium channel blockers:

A

Amlodipine (Norvasc)

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28
Q

Norvasc - highly protein bound - __ %

A

98%

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29
Q

Norvasc - half life

A

30-60 hours dosed daily

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30
Q

side effects of Amlodipine (Norvasc)

A 
Peripheral edema
Headache
Flushing
Dizziness
Nausea 
Fatigue
Flush, dizziness, 
Ankle edema,
bradycardia
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31
Q

adverse rxns to Amlodipine (Norvasc)

A

Hypotension
Angina
Angioedema
Heart block

Note: Do not take with grape fruit juice due to reduced presystemic clearance of the drug and subsequent increase in bioavailability that could lead to hypotension.

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32
Q

you do not excrete __ __ __ and __ __ AS QUICLY when taken with grapefruit juice

A

calcium channel blockers

beta blockers

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33
Q

If a patient experiences angioedema as an adverse effect of Amlodipine (calcium channel blocker), what should you give and why?

A

give benadryl or epinephrine

may have a risk of airway obstruction d/t edema of the tongue

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34
Q

Direct-Acting Arteriolar Vasodilators causes

A

relaxation of the vascular smooth muscles, mainly the arteries, causing vasodilatation

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35
Q

Direct-Acting Arteriolar Vasodilators are used in __ __ or __ __

A

severe HTN

hypertensive emergencies

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36
Q

Direct-Acting Arteriolar Vasodilators do not block

A

reflex tachycardia due to low BP

37
Q

Direct-Acting Arteriolar Vasodilators can increase your __ __

A

hair growth

38
Q

Direct-Acting Arteriolar Vasodilators can cause __ __ due to low BP

A

reflex tachycardia

39
Q

Examples of Direct-Acting Arteriolar Vasodilators:

A
  1. Hydralazine (Apresoline)
  2. Minoxidil (Loniten)
  3. diozoxide (Hyperstat)
40
Q

Mechanism of action for Direct-Acting Arteriolar Vasodilators:

__ binds to and activates voltage gated __ channels on vascular __ muscle. The result is an efflux of __ and a subsequent hyper polarization of the cell. This prevents calcium-mediated activation and contraction of the smooth muscle resulting in

A

Hydralazine

potassium

smooth

potassium

vasodilation

41
Q

Assessment for antihypertensives:

A
  1. Past and current medications
  2. Assess openness to lifestyle changes
  3. Baseline vital signs, renal (chemistry) like BUN and CREAT & liver function
  4. Baseline & daily weight
  5. Oral intake & urinary output
42
Q

Antihypertensives: Nursing Diagnoses

A
  1. Decreased cardiac output
  2. Knowledge deficit
  3. Noncompliance
  4. Sexual dysfunction
43
Q

According to EBP Guidelines 2014, nurse should initiate antihypertensives for patients 60+, if the systolic blood pressure is __mmHg or > or if the diastolic blood pressure is __mmHg .

The goals are to:

A

150

90

lower SBP to

44
Q

Nursing interventions for antihypertensives:

A
  1. Monitor vital signs
  2. Check lab values for renal & liver function
  3. I&O, daily weight, urinary output
  4. Assess signs & symptoms for adverse reactions
  5. Refer for counseling as needed
45
Q

Nursing interventions for antihypertensives: Monitoring vital signs

If BP systolic 210/120 mmHg what do you do?

A

immediate treatment is warranted!

46
Q

Antihypertensives: Client Education

A
  1. Take drug same time every day
  2. Do not stop abruptly → rebound hypertension
  3. Teach how to take BP & pulse daily
  4. Change positions slowly
  5. Report side effects to health care provider
  6. Schedule F/U appointments for labs & check-ups
47
Q

Dyslipidemia: total cholesterol values

desirable, borderline high, High

A

less than 200, 200-239, greater than 240

48
Q

Dyslipidemia: LDL cholesterol

  1. optimal
  2. near/above optimal
  3. borderline high
  4. high
  5. very high
A
  1. less than 100
  2. 100-129
  3. 130-159
  4. 160-189
  5. greater than 190
49
Q

Dyslipidemia: HDL cholesterol

  1. low
  2. high
A
  1. less than 40

2. greater than 60

50
Q

Dyslipidemia: Triglycerides

  1. goal
  2. borderline high
  3. high
  4. very high
A
  1. less than 150
  2. 150-199
  3. 200-499
  4. greater than 500
51
Q

Blood testing for cholesterol is recommended to begin at age

52
Q

TLC: therapeutic lifestyle changes (5)

A
  1. Diet: Alteration in fatty diets (red meat, egg yolks, high-fat dairy, commercial processed food products, increase soluble fiber; calorie adjustment relative to BMI)
  2. Exercise (avoid sedentary lifestyle), 30 minutes per day until you sweat, 5 out of 7 days
  3. Decrease tobacco (increases HDL), alcohol intake (calories)
  4. Weight reduction
  5. If diabetic, good to excellent sugar control = 70-110
53
Q

Antilipidemics lowers abnormal blood lipid levels like:

  1. )
  2. )
  3. )
A
  1. cholesterol
  2. triglycerides
  3. phospholipids
54
Q

What are drugs that lower lipid levels? (5)

A
  1. Bile-acid sequestrates
  2. Fibrates (fibric aci)
  3. Nicotinic acid
  4. Cholesterol absorption inhibitor
  5. Hepatic 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins)
55
Q

What do Bile-acid sequestrates do?

A

they Reduce LDL cholesterol (LDL-C) levels by binding with bile acids in the intestine

56
Q

What are examples of Bile-acid sequestrates?

A
  1. Cholestyramine (Questran)
  2. colestipol (Colestid)
  3. colesevelam HCl
57
Q

Side effects of Bile-acid sequestrates

A
  1. constipation
  2. flatulence
  3. cramping
58
Q

Fibrates - what do they do?

A

Breaks down lipoprotein from tissues and remove them from plasma. Decrease synthesis of triglycerides

59
Q

Example of a Fibrate

A

Gemifibrozil (Lopid)

60
Q

You should not take __ with Fibrates b/c they:

A

anticoagulants

compete for protein sites

61
Q

Anticoagulant dose should be reduced during antihyperlipidemic therapy and __ __ __ (__) should be monitored

A

international normalized ratio (INR)

62
Q

What does Nicotinic acid (Niacin, vitamin B3)

do?

A

Inhibits release of free fatty acids from adipose tissues, promotes triglyceride removal from plasma and increases HDL

63
Q

side effects of Nicotinic acid (Niacin, vitamin B3):

A
  1. cutaneous flushing
  2. nausea
  3. gout
64
Q

(Large/Small) doses are required for Nicotinic acid (Niacin, vitamin B3)

65
Q

As few as __% of patients can initially tolerate niacin

66
Q

what do Cholesterol Absorption Inhibitors do?

A

Acts on the cells in the small intestine to inhibit cholesterol absorption

67
Q

Cholesterol Absorption Inhibitors should be combined with a __ for optimum effect

68
Q

give an example of a Cholesterol Absorption Inhibitor

A

Ezetimibe (Zetia)

69
Q

Hydroxymethylglutaryl-coenzyme A reductase (HMG-CoA) is the precursor for

A

cholesterol synthesis and controls the last step of cholesterol production

70
Q

HMG CoA Reductase Inhibitors (Statins) decrease cholesterol by :

A

inhibiting the enzyme HMG CoA reductase in cholesterol biosynthesis

71
Q

HMG CoA Reductase Inhibitors (Statins) slightly increase __ and decrease __

72
Q

Examples of HMG CoA Reductase Inhibitors (Statins):

A
  1. Atorvastatin (Lipitor) 2.Fluvastatin (Lescol) 3.Lovastatin (Mevacor)
  2. Pravastatin (Pravachol)
  3. Rosuvastatin (Crestor)
  4. Simvastatin (Zocor)
73
Q

Statins have an ___ effect which decreases atherosclerosis

A

anti-inflammatory

74
Q

the prototype statin drug is

A

atorvastatin (Lipitor)

75
Q

atorovastatin (Lipitor) can be used in children older than

76
Q

Contraindications of atorovastatin (Lipitor) :

A
  1. Active liver disease

2. pregnancy

77
Q

Cautions when using atorvastatin (Lipitor) :

A
  1. Hx of liver disease
  2. Increased alcohol ingestion
  3. Trauma
  4. Severe metabolic endocrine disorders
  5. Uncontrolled seizures
78
Q

side effects of atorvastatin (Lipitor):

A
  1. Headache
  2. Rash
  3. Pruritus
  4. Diarrhea or constipation
  5. Sinusitis
  6. Pharyngitis
  7. Leg cramps (similar to neuropathy)
79
Q

adverse effects of atorovastatin (Lipitor):

A

Rhabdomyolysis – breakdown of myoglobin = kidney damage* (urine is the color of diet coke)
Myalgia
Photosensitivity
Cataracts

*Rare

80
Q

Assessment of Antilipidemics

A
  1. Vital signs
  2. Serum chemistry values
  3. LFTs, CPK, cholesterol, triglycerides
  4. Medical & drug history
  5. Family history
81
Q

atorovastatin (Lipitor) drug interactions:

A
  1. May ↑ digoxin level, oral contraceptives
  2. ↑ effects with macrolide antibiotics, antifungals
  3. ↓ effect with antacids, propranolol

4.High protein-binding

82
Q

According to a study titled, “Plasma HDL cholesterol and risk of myocardial infarction: A Mendelian randomization study”, some genetic mechanisms that raise plasma HDL cholesterol do not seem to lower the risk of __ __. These data challenge the concept that raising HDL will translate into reductions in risk of __ __.

A

myocardial infarction

myocardial infarction

83
Q

Some heart diseases are not related to high cholesterol. Instead it is related to __. When you are __, __ occurs. When __ occurs, your blood becomes __. This can then lead to an __.

A 
stress 
stressed 
inflammation 
inflammation 
hypercoagulable 
MI
84
Q

Nursing diagnoses for Antilipemics (2)

A
  1. Increased lipids in blood

2. Anxiety related to increased cholesterol

85
Q

Planning for Antilipidemics:

What are the optimal levels for total cholesterol, HDL, LDL, triglycerides ?

A

Client’s total cholesterol will be less than 200 mg/dl in 8-12 weeks
HDL will be 45 - 60 mg/dl
LDL will be less than 100 mg/dl
Triglycerides will be less than 150 mg/dl
Client will eat a low fat, low cholesterol diet low in sugars.

86
Q

Nursing interventions for Antilipidemics:

A
  1. Monitor labs
    -Lipid profile, triglycerides (fasting)
    Liver enzymes: ALT, AST, GGT
  2. Observe signs & symptoms GI upset
    -Take with enough water
    -Can take with meals
87
Q

Client Education on Antilipidemics:

A
  1. Have children tested if family history of HLD
  2. Drug compliance
  3. Have tests as ordered
  4. Dietary modification
  5. Benefits of exercise
    What’s the nurse’s role in public health?
88
Q

Nursing interventions for antihypertensives: Monitoring vital signs

If BP systolic is less than 90

89
Q

Nursing interventions for antihypertensives: Monitoring vital signs

If BP systolic is greater than 180/110 mmHg what do you do?

A

depending on the clinical situation and any complications present, treat the patient either immediately or within days

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