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semester 3 > pharmacy test 2 > Flashcards

pharmacy test 2 Flashcards

1
Q

what classification of antihypertensive drugs is found to be more effective in Caucasian patients than African American?

A

beta blockers and ACE inhibitors

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2
Q

what classification of antihypertensive drugs is found to be more effective in African American patients than Caucasian?

A

calcium channel blockers

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3
Q

what does the parasympathetic nervous system stimulate?

A

stimulates smooth muscles, cardiac muscles, glands

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4
Q

what does the sympathetic nervous system stimulate?

A

stimulates heart, blood vessels, skeletal muscles

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5
Q

Acetylcholine

A

chief neurotransmitter of parasympathetic nervous system

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6
Q

Norepinephrine

A

a neurotransmitter of the sympathetic nervous system

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7
Q

Clonidine and methyldopa

A

Peripheral Alpha 1 Blockers
Decreases norepinephrine production
Stimulates alpha2-adrenergic receptors, thus reducing renin activity in the kidneys
= result in decreased BP
not typically first line

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8
Q

Propranolol, metoprolol, and atenolol

A

Beta Blockers
Reduction of the heart rate through beta1 receptor blockade
Cause reduced secretion of renin
= results in decreased BP

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9
Q

Labetalol and carvedilol

A

Duel-Action Alpha 1 and Beta Blockers
Dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade)

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10
Q

Adrenergic Drugs Indications

A

hypertension, glaucoma, benign prostatic hyperplasia (BPH), management of severe heart failure

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11
Q

doxazosin, prazosin, and terazosin (adrenergics) are used to treat

A

benign prostatic hyperplasia (BPH)

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12
Q

Adrenergic Drugs Contraindications

A

Acute HF, MOAIs, peptic ulcers, severe liver/kidney disease and asthma (with beta blockers)

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13
Q

Why aren’t adrenergic drugs used to treat acute heart failure?

A

They have a negative ionotropic effect. Used to treat heart failure, but not in the acute / exacerbation phases

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14
Q

Adrenergic drugs side effects

A

Bradycardia with reflex tachycardia, dry mouth, drowsiness, sedation, constipation, depression, edema, sexual dysfunction (affects compliance), headaches, sleep disturbances, nausea, rash, abrupt discontinuation can lead to rebound hypotension
high instance of orthostatic hypotension
first-dose syncope

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15
Q

Adrenergic drug interactions

A

Can cause additive CNS depression with alcohol, benzodiazepines, opioids

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16
Q

Clonidine (Catapres)

A

Used primarily for hypertension, management of opioid withdrawal (blocks sympathetic nervous system activity)
Oral and topical patch

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17
Q

Alpha1 Blockers

A

Doxazosin (Cardura)
Prazosin (Minipress)
Tamsulosin (Flomax)* - symptomatic hypertension only
Terazosin (Hytrin)

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18
Q

Doxazosin (Cardura)

A

Alpha1 Blocker
Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels

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19
Q

Carvedilol (Coreg)

A

Dual-Action Alpha1 and Beta Receptor Blocker
widely used and well tolerated
Uses: hypertension, mild to moderate HF in conjunction with digoxin, diuretics, and ACE inhibitors
Contraindications: cardiogenic shock, severe bradycardia or HF, bronchospastic conditions such as asthma, and various cardiac problems involving the conduction system

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20
Q

Nebivolol (Bystolic)

A

beta receptor blocker
uses: hypertension and HF
Action: blocks beta1 receptors and produces vasodilatation, which results in a decrease in SVR
causes limp dick disease

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21
Q

Angiotensin-Converting Enzyme (ACE) Inhibitors

A

Often used as first line drug for heart failure and hypertension
can be used with thiazide diuretic and calcium channel blockers

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22
Q

ACE inhibitor naming convention

A

ends in -pril

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23
Q

which blood pressure medication is cardioprotective?

A

ace inhibitors
they decrease the SVR

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24
Q

ace inhibitors are the hypertension rug of choice for

A

heart failure, kidney disease and diabetic patients

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25
Q

why would ace inhibitors be used in patients for kidney disease

A

they reduce glomerular filtration pressure

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26
Q

ace inhibitor indications

A

Hypertension
HF (either alone or in combination with diuretics or other drugs)
Slow progression of left ventricular hypertrophy after myocardial infarction (MI) (cardioprotective)
Renal protective effects in patients with diabetes

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27
Q

ace inhibitor adverse reactions

A

Fatigue
Dizziness
Headache
Mood changes
Impaired taste
Possible hyperkalemia
Dry, nonproductive cough, which reverses when therapy is stopped
Angioedema (facial swelling): rare but potentially fatal
first dose hypotension

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28
Q

ace inhibitor and lab values

A

can cause kidney failure leading to a high creatinine
can cause hyperkalemia

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29
Q

Captopril (Capoten)

A

oral ace inhibitor
Prevention of ventricular remodeling after MI; reduce the risk of HF after MI, but it must be taken 2-4 times a day

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30
Q

Enalapril (Vasotec)

A

oral and parenteral ace inhibitor
metabolized by the liver

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31
Q

Angiotensin II Receptor Blockers (ARB)

A

Well tolerated
Do not cause a dry cough that is common with ACE inhibitors

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32
Q

Angiotensin II Receptor Blockers (ARB) naming convention

A

-sartin
Losartan (Cozaar), Eprosartan (Teveten), Valsartan (Diovan), Irbesartan (Avapro), Candesartan (Atacand), Olmesartan (Benicar), Telmisartan (Micardis), Azilsartan (Edarbi)

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33
Q

arbs vs ace

A

arbs seem to be equally effective in treating hypertension and are better tolerated because lack of cough
arbs have a lower post MI mortality rate
not clear if they are cardioprotective in cases of heart failure or protect the kidneys in cases of diabetes

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34
Q

ARB side effects

A

Chest pain, fatigue, hypoglycemia, diarrhea, urinary tract infection, anemia, weakness
Hyperkalemia and cough are less likely to occur than with the ACE inhibitors.

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35
Q

Losartan (Cozaar)

A

ARB
indications: HTN, HF
use with caution in renal patients
contraindicated in pregnancy and breastfeeding

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36
Q

Calcium Channel Blockers

A

indications: HTN and angina, dysrhythmias, migraine headaches, Raynaud’s disease
Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction

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37
Q

Diuretics

A

decreases plasma and extracellular secretions to reduce blood pressure. Decreases workload of the heart

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38
Q

Vasodilators Examples

A

Diazoxide (Hyperstat)
Hydralazine (Apresoline)
Minoxidil (Rogaine) - For hair regrowth
Nitroprusside (Nitropress)

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39
Q

what is used in htn emergencies?

A

Sodium nitroprusside and IV diazoxide

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40
Q

Hydralazine (Apresoline)

A

vasodilator
Orally: routine cases of essential hypertension
Injectable: hypertensive emergencies
BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients

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41
Q

Sodium Nitroprusside (Nitropress)

A

vasodilator
Used in the intensive care setting for severe hypertensive emergencies; titrated to effect by IV infusion
contraindications: known hypersensitivity to the drug, severe HF, and known inadequate cerebral perfusion

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42
Q

Hydralazine: Adverse Effects

A

dizziness, headache, anxiety, tachycardia, edema, dyspnea, nausea, vomiting, diarrhea, hepatitis, systemic lupus erythematosus, vitamin B6 deficiency, and rash

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43
Q

Minoxidil: Adverse Effects

A

T-wave electrocardiographic changes, pericardial effusion or tamponade, angina, breast tenderness, rash, and thrombocytopenia

44
Q

Sodium nitroprusside: adverse effects

A

bradycardia, decreased platelet aggregation, rash, hypothyroidism, hypotension, methemoglobinemia, and (rarely) cyanide toxicity

45
Q

Eplerenone (Inspra)

A

selective angiotensin blocker
Reduces BP by blocking the actions of aldosterone at its corresponding receptors in the kidney, heart, blood vessels, and brain
Indications: routine treatment of hypertension and for post-MI HF

46
Q

Bosentan (Tracleer)

A

Specifically indicated only for the treatment of pulmonary artery hypertension in patients with moderate to severe HF
Action: blocks receptors of the hormone endothelin

47
Q

Sildenafil and Tadalafil

A

for erectile dysfunction
Also used for pulmonary hypertension but with different trade names
Sildenafil: Revatio
Tadalafil: Adcirca

48
Q

Treprostinil (Remodulin)

A

for pulmonary artery hypertension

49
Q

most potent diuretic?

A

loop

50
Q

Carbonic Anhydrase Inhibitors (CAIs)

A

helps body produce hydrogen to excrete bicarbonate
acetazolamide (Diamox) – most commonly used
methazolamide
dichlorphenamide

51
Q

Carbonic Anhydrase Inhibitors: Indications

A

not useful for hypertension
glaucoma, edema, altitude sickness and when other diuretics are not working

52
Q

Carbonic Anhydrase Inhibitors: Adverse Effects

A

can induce respiratory and metabolic acidosis, high glucose in diabetic patients, hypokalemia, drowsiness, anorexia, paresthesia’s, hematuria, urticaria, photosensitivity, melena (blood in the stool)

53
Q

Carbonic Anhydrase Inhibitors: Interactions

A

may lead to dig toxicity
corticosteroids may cause hypokalemia
Increased effects of amphetamines, carbamazepine, cyclosporine, phenytoin, and quinidine with concurrent use of CAIs

54
Q

loop diuretics

A

Bumetanide (Bumex)
Ethacrynic acid (Edecrin)
Furosemide (Lasix)
Torsemide (Demadex)
sulfa drug allergy can occur, but its rare

55
Q

not obvious reason for loop diuretics

A

Increase renal excretion of calcium in patients with hypercalcemia

56
Q

s/s hypokalemia

A

muscle spasms, muscle weakness, hypotension, excessive thirst, excessive urination, arrythmia

57
Q

loop diuretic interactions

A

Digitalis toxicity precipitated by hypokalemia
Lithium toxicity precipitated by hyponatremia
Can potentiate hypotensive effects for patient treated with antihypertensive agents
NSAIDS reduce diuretic effects
On steroids, potentiate hypokalemia

58
Q

osmotic diuretics

A

Mannitol (Osmitrol) - Most used osmotic diuretic
Urea
Organic acids
Glucose

59
Q

osmotic diuretics nursing implications

A

use a filter needle because it can crystalize at room temperature

60
Q

Osmotic Diuretics: Indications

A

helps to prevent kidney damage during acute renal failure caused by hypovolemic shock
sodium retention, water excretion
reduces intraocular pressure, ICP from cerebral edema but doesn’t do shit for peripheral edema

61
Q

Osmotic Diuretics: Adverse Effects

A

Convulsions, thrombophlebitis, pulmonary congestion/edema
Fluid & electrolyte imbalance

62
Q

Potassium-Sparing Diuretics

A

spironolactone (Aldactone) (prototype drug)
triamterene (Dyrenium)
amiloride (midamor)
weak when used alone, used in heart failure

63
Q

Spironolactone and triamterene (dyrenium) indications

A

Hyperaldosteronism, hypertension, reversing the potassium loss caused by potassium-losing drugs and certain cases of heart failure

64
Q

Amiloride (midamor) indications

A

heart failure

65
Q

what to do if K sparing diuretics spare too much and you get hyperkalemia?

A

If detected, may DC medication, limit dietary intake or administer insulin to pump back into the cell depending on severity/symptoms

66
Q

what is dangerous about salt subsitutes?

A

usually made of potassium and can lead to hyperkalemia

67
Q

thiazide diuretics

A

Hydrochlorothiazide (Esidrix, HydroDIURIL) HCTZ
Chlorothiazide (Diuril)

68
Q

thiazide-like diuretics

A

Metolazone (Mykrox, Zaroxolyn)
Chlorthalidone (Hydone, Thalitone)
Indapamide (Lozol)

69
Q

Thiazide and Thiazide-like Diuretics: Indications

A

Hypertension ( most prescribed drugs )
Edematous states (chronic-peripheral)
Idiopathic hypercalciuria – most common cause of kidney stones
Heart failure due to diastolic dysfunction
Adjunct drugs in treatment of edema related to HF, hepatic cirrhosis, corticosteroid or estrogen therapy
Promote diuresis if renal function not impaired

70
Q

Thiazide and Thiazide-like Diuretics: Adverse Effects

A

hypokalemia - watch for dig tox
Dehydration/hypovolemia
Hyponatremia
Hyperglycemia in diabetics
Increased lipids esp. triglyderides, LDL
Hyperuricemia( even at low dose)
Azotemia (in renal patient)

71
Q

potassium rich foods

A

Dried apricots, potatoes, banana, carrot, prune juice, dried beans, legumes, whole grains, citrus, cruciferous vegies

72
Q

nursing implications for diuretics

A

Rapid diuretic – loop
For patients on Lasix – potassium supplement and tele monitor
Lasix – may cause photosensitivity

73
Q

Nitrates/Nitrites Mechanism of Action and Drug Effects

A

Cause vasodilation due to relaxation of smooth muscles
Potent dilating effect on coronary arteries
Result: oxygen to ischemic myocardial tissue
Used for prevention and treatment of angina depending on form

74
Q

long acting nitrates indications

A

Used to PREVENT anginal episodes
Ointment, patch

75
Q

nitrate contraindications

A

Severe anemia
Closed-angle glaucoma
Hypotension
Severe head injury
Use of the erectile dysfunction drugs sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) - could dangerously lower BP

76
Q

Nitroglycerin

A

for angina
IV form used for BP control in perioperative hypertension, treatment of HF, ischemic pain, pulmonary edema associated with acute MI, and hypertensive emergencies

77
Q

nitroglycerine nursing implications

A

do not chew sublingual form. it might burn. don’t spit it out
Storage: no moisture, light, room temp; non-transparent container. Air-tight no light. 3 month shelf life
sit down when you take it
do not take with viagra

78
Q

Nitroglycerin: IV Indications

A

BP control in perioperative hypertension
treatment of HF, ischemic pain
pulmonary edema associated with acute MI
hypertensive emergencies
NON PVC TUBING AND BAG

79
Q

Nitrates: Adverse Effects

A

Headaches- usually, diminish in intensity and frequency with continued use
Profound and/or postural hypotension
Reflex Tachycardia
Skin irritation with topical application
Tolerance may develop! (have a nitrate free-period, take it off at night)

80
Q

Isosorbide

A

Used for:
Mitigation in # of acute attacks
Prophylaxis in situations that may provoke angina
Long-term prophylaxis of angina

81
Q

beta blockers for angina

A

atenolol (Tenormin)
metoprolol (Lopressor)
propranolol (Inderal)
nadolol (Corgard)

82
Q

calcium channel blockers for angina

A

verapamil (Calan, Isoptin)
diltiazem (Cardizem) – effective for angina and afib
nifedipine (Procardia)
amlodipine (Norvasc) – good for angina and hypertension

83
Q

calcium channel blockers side effects

A

Constipation is a common side effect. – high fiber, stool softener, plenty of water unless contraindicated

84
Q

Angiotensin Receptor-Neprilysin Inhibitors (ARNI)

A

Valsartan/sacubitril (Entresto)
Blocks the degradation of vasoactive peptides by inhibiting the neprilysin enzyme
Common adverse effects: hypotension, hyperkalemia, increased serum creatinine

85
Q

Nesiritide (Natrecor)

A

last stitch effort drug, used in ICU
Synthetic version of human B-type natriuretic peptide
vasodilates arteries and veins
side effects: hypotension, dysrhythmia, headache, abdominal pain, insomnia

86
Q

Milrinone

A

Only available phosphodiesterase inhibitor - injection
Adverse effects: cardiac dysrhythmias, headache, hypokalemia, tremor, thrombocytopenia, and elevated liver enzyme levels
additive effect for diuretics and dig

87
Q

digoxin

A

Positive inotropic effect (force of contraction)
Negative chronotropic effect (rate of heartbeat)
Negative dromotropic effect (conduction of electrical impulses)
makes heart beat more effectively and slower

88
Q

digoxin nursing implications

A

monitor K and dig level
listen to apical heart rate for one minute
watch for halo vision, n/v/d

89
Q

digoxin therapeutic level

A

0.5-2.0 ng/mL

90
Q

digibind

A

antidote to digoxin, however its only used for emergencies
that includes dig overdose, severe sinus bradycardia not responding to other treatment and potassium over 5

91
Q

Vaughn Williams classification

A
  1. Some – sodium channel blockers
  2. Block –beta blockers
  3. Potassium – potassium channel blockers
  4. Channels – calcium channel blockers
92
Q

Antidysrhythmics: Adverse Effects

A

ALL antidysrhythmics can cause dysrhythmias!
Hypersensitivity reactions
Nausea, vomiting, and diarrhea
Dizziness
Headache and blurred vision
Prolongation of the QT interval

93
Q

Procainamide (Pronestyl)

A

CLASS 1A
Uses: atrial and ventricular tachydysrhythmias
Significant adverse effects: include ventricular dysrhythmias, blood disorders, systemic lupus erythematosus (SLE)–like syndrome, nausea, vomiting, diarrhea, fever, leukopenia, maculopapular rash, flushing, and torsades de pointes resulting from prolongation of the QT interval
Contraindications: known hypersensitivity, heart block, and SLE

94
Q

Quinidine (Quinidex)

A

class 1a
Significant adverse effects: cardiac asystole and ventricular ectopic beats
Others: cinchonism (tinnitus, loss of hearing, blurring vision, GI upset)
Black box warning: can cause torsades de pointes

95
Q

Lidocaine (Xylocaine)

A

class 1b
Significant adverse effects: twitching, convulsions, confusion, respiratory depression or arrest, hypotension, bradycardia, and dysrhythmias
Contraindications: hypersensitive, severe SA or atrioventricular (AV) intraventricular block, or Stokes-Adams or Wolff-Parkinson-White syndrome

96
Q

Flecainide (Tambocor)

A

class 1c
Negative inotropic effect and depresses left ventricular function
Adverse effects: dizziness, visual disturbances, and dyspnea
Contraindications: hypersensitivity, cardiogenic shock, second- or third-degree AV block, and non–life-threatening dysrhythmias

97
Q

Propafenone (Rythmol)

A

1c
Use: life-threatening ventricular dysrhythmias, atrial fibrillation
Most common reported adverse reaction: dizziness
Others: metallic taste,

98
Q

Atenolol (Tenormin)

A

class 2
Check blood pressure and apical pulse. Hold for bradycardia

99
Q

Esmolol (Brevibloc)

A

Ultrashort-acting beta blocker
Use: acute treatment of supraventricular tachydysrhythmias; hypertension; post-MI tachydysrhythmias

100
Q

Amiodarone (Cordarone, Pacerone)

A

class 3
Uses: one of the most effective antidysrhythmic drugs for controlling supraventricular and ventricular dysrhythmias
Can turn your skin blue, or a greyish blue tone – mostly happens in sun exposed areas

101
Q

Ibutilide (Corvert)

A

class 3 used for afib

102
Q

Diltiazem (Cardizem, Others)

A

Class IV
Temporary control of a rapid ventricular response in patients with atrial fibrillation or flutter and PSVT
Contraindications: hypersensitivity, acute myocardial infarction, pulmonary congestion, Wolff-Parkinson-White syndrome, severe hypotension, cardiogenic shock, sick sinus syndrome, or second- or third-degree AV block

103
Q

Verapamil (Calan)

A

Class IV
Inhibits calcium ion influx across the slow calcium channels in cardiac conduction time
Results in dramatic effects on the AV node

104
Q

Adenosine (Adenocard)

A

has a D. brings heart rate down
Slows conduction through the AV node
Used to convert PSVT to sinus rhythm
Very short half-life—less than 10 seconds
Only administered as fast intravenous (IV) push
May cause asystole for a few seconds
Other adverse effects are minimal.

105
Q

lidocaine nursing implications

A

Solutions of lidocaine that contain epinephrine should not be given IV; they are to be used ONLY as local anesthetics. Pull the RIGHT lidocaine

106
Q

hold digoxin for what heart rate

A

below 60

semester 3 (9 decks)

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