Pharmacology Exam 4 Flashcards
Make at least a 75 using these poorly made cards!! Love it go slay!!!!!!
What are examples of a few ACE inhibitors?
Captopril
Benazepril
Enalapril
Lisinopril
Ramipril
What 4 main classes of medications treat hypertension (HTN)?
Renin-angiotension Aldosterone System Suppressants (RAAS)
Calcium Channel Blockers
Sympatholytic (Antiadrenergics)
Directly acting Vasodilators
What disease process do ACE inhibitors treat?
Hypertension (HTN)
Heart Failure
Post-MI
used lightly/in low doses in patients with renal impairment (diabetic nephropathy)
What patient teaching would we provide to a patient taking Captopril?
-take with food
What is the risk of abruptly stopping an ACE inhibitor?`
Rebound hypertension
What nursing interventions do you implement to a patient prescribed an ACE inhibitor (captopril, lisinopril, benazepril, enalapril, ramipril)?
Check the patient’s blood pressure before AND after administration of medication. DO NOT GIVE when the patient is hypotensive (BP systolic less than 90)
What is the rule of thumb when giving an ACE inhibitor?
start LOW, go SLOW
Your patient is prescribed an ACE inhibitor for hypertension. The patient states they have never taken an ACE inhibitor before for hypertension. Which mg do you give?
A. 10mg daily
B. 20mg daily
C. 30mg daily
D. 40mg daily
A. 10mg (go low, go slow rule)
What are some adverse effects of taking ACE inhibitors?
Hyperkalemia
Angioedema and lip swelling
Dry, non-productive cough is NORMAL
hypotension
-metallic taste in the mouth
These symptoms would indicate a change in meds may be needed.
A patient taking an ACE inhibitor should report which symptom to their provider/nurse?
a. dry mouth
b. constipation
c. muscle twitching
d. dizziness
c. muscle twitching
What patient education would a nurse provide to a patient taking an ACE inhibitor?
-this is a daily maintenance medication. Do not stop taking the medication, even if you have achieved a lower blood pressure and you feel better.
-be slow when getting up due to risk of orthostatic hypotension
Would we allow a pregnant patient to take Benazapril?
NO (ACE inhibitors are teratogenic)
What is important to know with African American populations and ACE inhibitors?
ACE inhibitors are less effective in African American populations; they also have a higher risk of developing angioedema (allergic reaction).
What labs do we check with patients taking ACE inhibitors?
CBC
BNP
Potassium levels in blood (risk of hyperkalemia)
What types of medications are typically paired with ACE inhibitors?
Thiazide diuretics (such as hydrochlorothiazide)
What are examples of a few Angiotension II Receptor Blockers?
Losartan
Irbesartan
Valsartan
Telmisartan
What are some indications for Angiotension II Recepto Blockers?
Heart failure
hypertension
diabetic nephropathy
Patient teaching for Angiotension II Receptor Blockers?
-this is a daily maintenance drug. DO NOT STOP ABRUPTLY
-it takes 3-6 weeks to establish a therapeutic effect for hypertension
Nursing interventions when administering an Angiotension II Receptor Blocker?
-check BP before and after giving the med.
Side effects of Angiotension II Receptor Blockers?
-risk of angioedema (similar to ACE inhibitor)
-dizziness/hypotension
-heartburn/diarrhea,
-CNS effect of headache/insomnia
Would we give an ARB (Angiotension II Recepto Blocker) to a pregnant female?
NO. It can cause fetal death.
What types of medications are typically paired with ARBs? (Angiotension II Receptor Blockers)
Diuretics, typically thiazides
Provide a prime example of an Aldosterone Antagonist, also known as a potassium-sparing diuretic that can be given for hypertension at times.
Spironolactone
Is Spironolactone commonly paired with additional antihypertensives?
Yes
How long does it take for Spironolactone to be effective for Hypertension?
up to 4 weeks
Side effects of Aldosterone Antagonist (Spironolactone)
Hyperkalemia, because it is a potassium-sparing medication.
Patient education for Spironolactone?
do not eat potassium-rich foods due to the cardiac risks of hyperkalemia
NOTE: KNOW THE THERAPEUTIC POTASSIUM RANGE OF 3.5-5.0
Select all that apply. Patients taking Spironolactone must report which side effects?
dizziness
muscle weakness
muscle twitching
palpitations
nausea and vomiting
headache
muscle twitching
muscle weakness
palpitations
Provide an example of a Direct Renin Inhibitor (DRI); they aren’t used often; only know that it EXISTS
Aliskiren -only drug on the market
Provide a few examples of calcium channel blockers
Nifedipine (Prototype)
Amlodipine
Felodipine
Nicardipine
Verapamil
Diltiazem
What 2 calcium channel blockers are oftentimes used for treating arrythmias such as atrial fibrillation, atrial flutter, and SVT (fast, atrial rhythm disorders)?
Verapamil
Diltiazem
Can we give Nifedipine to a pregnant female?
Yes, this calcium channel blocker is safe for pregnancy
Indications for calcium channel blockers?
dysrhythmias
angina
hypertension
What patient education would we provide for patients taking calcium channel blcokers?
LIFESTYLE MATTERS; educate on the importance of exercise 30 minutes a day for 5 days a week, a healthy diet, and to avoid GRAPEFRUIT juice. discoloration of the teeth may occur so be sure to have good dental hygeine
Select all that apply. Patients taking calcium channel blockers such as Nifedipine must report the following symptoms?
palpitations
discoloration of the teeth
fatigue
peripheral edema
PERIPHERAL EDEMA; discoloration of the teeth is a normal finding when taking this med. palpitations occur with Amlodipine.
What nursing interventions should be used when administering Amlodipine (calcium channel blocker)?
check BP and PULSE BEFORE and AFTER giving the medication, remembering that calcium channel blockers affect both BP and heart rate
What is an adverse effect of Nifedipine?
REFLEX TACHYCARDIA
What is an adverse effect of Amlodipine?
PERIPHERAL EDEMA
Which drugs are first-line treatments of hypertension in African American patients?
CALCIUM CHANNEL BLOCKERS
Sympatholytic (Anti-adrenergics) are also known as BETA BLOCKERS.
Provide a few examples of beta blockers that are SELECTIVE
Beta-1 blockers are known to be selective. This means they only affect the heart.
-Metoprolol
-Atenolol
Sympatholytic (Anti-adrenergics) are also known as BETA BLOCKERS.
Provide a few examples of beta blockers that are NON-SELECTIVE
Beta-1 and Beta-2 blockers are known to be non-selective. This means they affect the heart and lungs. This also means you do not want to give these medications to patients with asthma.
Which class of beta blockers can we give to a patient with asthma?
Beta-1 blockers, such as metoprolol and atenolol
The doctor prescribes Propranolol to a patient with a history of asthma. Is this safe or not safe?
NOT SAFE. propranolol is a non-selective beta blocker that is not safe because it may affect lung function.
The doctor prescribes Atenolol for a patient with a history of asthma. Is this safe or not safe?
SAFE; it is selective and only affects the heart.
Indications of beta blockers?
HTN, MI, CHF, tachycardia general or from hyperthyroidism, migraines as preventative therapy, glaucoma
Administration of beta blockers?
PO and IV
Patient education regarding beta blockers?
-do not stop taking abruptly due to risk of CHF, angina, or MI!!!!!
-beta blockers may cause fatigue, do not move positions slowly due to risk of orthostatic hypotension, do not operate a vehicle until effects are known because of fatigue.
Adverse effects of beta blockers?
bradycardia
Nursing interventions when administering a beta blocker?
check HR before and after, have a parameter of HR 60 or above to give the med.
Provide some examples of Alpha-Adrenergic Blockers
Doxazosin
Terazosin
What are some indications of Alpha-Adrenergic Blockers
HTN, and BPH (decreasing benign prostatic hyperplasia, also known as enlarged prostate)
Explain the first dose phenomenon.
Occurring with ONLY THE FIRST DOSE, a patient may experience orthostatic hypotension, palpitations, dizziness, and syncope. This typically relieves after the medication dosage has increased or the med. has been given for the second time.
Provide some examples of Alpha-2 Agonists
Clonidine
Transdermal Administration of Alpha-2 Agonists (Clonidine)
Reapply the transdermal patch every 7 days. Be sure to apply to a clean area that is without hair to the torso or upper arm, be sure to rotate sites of administration.
What is an adverse effect of Alpha-2 Agonists?
-First dose effect (orthostatic hypotension, palpitations, dizziness, and syncope first time given)
What are some adverse effects of Alpha Adrenergic Blockers?
First dose effect (orthostatic hypotension, palpitations, dizziness, and syncope first time given)
What is a hypertensive crisis?
-a medical emergency
-a BP of 180/120
-sudden, may cause MI or stroke
-associated with headache, chest pain, SOB, NA/VOM, and vertigo
What is the tx of a hypertensive crisis?
directly acting vasodilators such as
-Nitroprusside
-Nitroglycerin
(administer both slowly to avoid overdose)
What is the antidote for a patient in overdose from Nitroprusside?
Thiosulfate
What is the action of Nitroglycerin and Nitroprusside in a HTN crisis?
They rapidly dilate the anteries and veins, helping to rapidly reduce the blood pressure.
What is the S/S of nitroprusside and nitroglycerin overdose?
evidence of cyanide poisoning
Provide an example of a potassium-wasting diuretic
(thiazides) hydrochlorithiazide
What are the indications for a potassium-wasting diuretic?
They are a first line treatment for hypertension, and are commonly used with other antihypertensives, such as Lisinopril or Valsartan.
-mild to moderate edema for patient’s with liver ascites, kidney disease, and CHF.
-decreases urine production in diabetes insipidus patients.
What are some side effects of potassium-wasting diuretics?
dehydration, hypokalemia, hyponatremia, hypercalcemia, hyperuricemia, and hyperglycemia
What are some nursing interventions for potassium-wasting diuretics?
take BP, check electrolytes, daily weights at same times
Patient education regarding diuretic use?
do not take after 2pm because of nocturia, try to take it in the morning
-take daily weights at the same time with the same types of clothing on
-keep a record of daily weights
-take potassium-rich foods
Can a pregnant female take a potassium-wasting diuretic?
NO
provide examples of potassium-rich foods
(think dark, leafy greens)
spinach
avocado
bananas
kale
beans
potatoes
squash
watermelon
What is an example of a potassium-sparing diuretic?
Spironolactone
What are the indications for a potassium-sparing diuretic?
HTN, edema,
-used in patients for ACNE, weight loss
What is the therapeutic effect time for potassium-sparing diuretic (spironolactone)
12-48 hours, not for acute use of flash pulmonary edema
do patients taking spironolactone require potassium supplementation?
no, because spironolactone is potassium-sparing
What is a side effect unique to Spironolactone that is not harmful but is strange?
blue urine
Adverse effects of taking spironolactone?
hyperkalemia, endocrine effects (deepening voices in males), impotence, and menstrual irregularities.
Give an example of a Loop Diuretic
FUROSEMIDE
What are the indications for a loop diuretic (Lasix/Furosemide)?
flash pulmonary edema, fluid overload, rapid SOB, CHF exacerbation; rapid diuresis.
-can be given IV push for rapid diuresis
-do not give at bedtime for nocturia risk
Adverse effects of loop diuretics?
tinnitus (ototoxicity)
hypokalemia
hypotension due to fluid loss
dehydration
hyponatremia
risk for hypocalcemia
hyperglycemia
hyperuricemia
Med. Admin. note for loop diuretic (how fast do we give it)?
Give the medication slowly
Dr. Martin mentions 1mg per 1 minute in the video and said to double check, but i didn’t because I’m lazy hehehe (typically there is a protocol for hospitals)
Can a pregnant female have a loop diuretic such as Lasix?
NO
What lab values do we continue to monitor for patients receiving loop diuretics?
Routine BMPs (calcium, magnesium, potassium (basic metabolic panel))
uric acid
lipids (renal and hydration)
What do we monitor in our patient assessment for patients receiving loop diuretics
baseline blood pressures
orthostatic blood pressures
monitor for edema
daily weights, same clothes each day, same time each day
input and output
If the patient mentions they have ringing in the ears and takes Furosemide, what do you do?
Stop med and notify provider immediately!!!
Give an example of a cardiac glycoside
Digoxin
What are some indications for Digoxin, a cardiac glycoside
-2nd line tx of heart failure
-treatment of dysrhythmias, such as atrial fibrillation
What do we remember when administering Digoxin
Check the apical pulse for one full minute before administration with parameters of HR; notify provider and record if the HR is too low to give (<60)
A patient forgot to take their digoxin dose for the day, what do you tell them to do?
Do not double up on the medication, wait until the next dose.
What is the therapeutic level of Digoxin?
0.8-2ng/mL
Digoxin level of 1.3
Is it toxic or non-toxic
Non-toxic, it is normal
(0.8-2)
Digoxin level of 3
Is it toxic or non-toxic
Toxic
(0.8-2)
If the patient is taking both digoxin and hydrochlorothiazide, what is the patient at risk for?
hypokalemia
increased risk of dysrhythmias
If the patient is taking both digoxin and an ACE inhibitor or ARBs, what is the patient at risk for?
increased risk for hypokalemia which creates increased risk for dysrhythmias
reduced effects of digoxin
Nursing implications for Digoxin?
-monitor potassium level
-monitor digoxin level
What do we give in a digoxin overdose?
activated charcoal, antidote is Digibind
