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NURS 365 - Pharmacology in Nursing > Week 11: Cardiovascular Part 2 > Flashcards

Week 11: Cardiovascular Part 2 Flashcards

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1
Q

Vasodilators

A

drugs that reduce BP by acting directly on vascular smooth muscle and thereby decrease peripheral resistance

can act as anti-hypertensives

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2
Q

2 Kinds of Vasodilators

A
  1. Selective to arterioles (only dilate arterioles - ex: Hydralazine) - Direct Vasodilator
  2. Affect both arterioles and veins (Huge effect on the body - ex Nitroprusside - will oftne need to be titrated)
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3
Q

Selective to arteriole vasodilators will decrease ____

A

afterload

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4
Q

Vasodilators affecting arterioles and veins decrease ___ and ___

A

afterload and preload

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5
Q

The fastest acting antihypertensive type is…

A

vasodilators that affect the arterioles and the veins

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6
Q

How can vasodilators precipitate angina, MI, or CHF?

A

SNS will activate by reflex action which can lead to increased HR, CO, and force of contraction

This means generally there needs to be a combined therapy with something like a beta blocker

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7
Q

What is the prototype direct vasodilator, antihypertensive drug

A

hydralazine (Apresoline)

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8
Q

Action of hydralazine

A

thought to have direct action on blood vessels, to cause arteriolar vasodilation and increase renal blood flow (helps the kidneys)

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9
Q

What is the bonus effect of a vasodilator like hydralazine

A

it also increases renal blood flow which is beneficial for the kidneys

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10
Q

What is the most common route for hydralazine and why is it this important to know?

A

Oral - because it has an extensive first pass

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11
Q

ADRs of hydralazine

A

HYPOTENSION

(Reflex) PALPITATIONS/TACHYCARDIA

Other: HA, Anxiety, Mild Depression, Dry mouth, Unpleasant taste in mouth, NV

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12
Q

What kind of vasodilator is hydralazine

A

direct acting vasodilator

so it is selective to arterioles

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13
Q

Why is there frequent monitoring in the early stages of hydralazine therapy?

A

Because of differences in metabolism, some people metabolize this quicker while others do not so we need to be monitoring the BP response to watch for the effect

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14
Q

Calcium Channel Blockers

A

Type of drug that causes arteriolar dilation, blocks the renin system, AND DECREASES MYOCONTRACTILITY

It inhibits the movement of Ca ions across cell membranes to decrease mechanical contraction of the heart

“Calcium Antagonists”

Does perform some coronary vessel and peripheral artery dilation but focuses on cardiac muscle membranes

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15
Q

Calcium Channel Blocker results and treatment is similar to what other type of drug for antihypertension

A

Beta Blockers (but this works on calcium instead)

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16
Q

Calcium antagonist (Ca Channel Blocker), Antianginal, and Antiarrhythmic (and by result Antihypertensive) Prototype Drug

A

verapamil (Calan, Isoptin)

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17
Q

Action of verapamil

A

produces blockage of calcium channels in blood vessels and in the heart (Dual Effect)

This leads to a multitude of effects where the HR slows and does not beat as strong - similar in some ways to beta blockers

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18
Q

What are the 6 important effects of verapamil’s action

A
  1. Arteriolar Dilation and resultant lowering of BP
  2. Increase in coronary perfusion
  3. Slows SA node causing reduction in heart rate
  4. Decrease in nodal; conduction in AV node
  5. Decrease in force of myocardial contraction
  6. inhibition of renin release
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19
Q

Route of verapamil

A

oral - but there is an extensive 80-90% first pass so there is an IV form for emergencies

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20
Q

ADRs of verapamil

A

BRADYCARDIA
HYPOTENSION
SEVERE TACHYCARDIA (Some Reflex)
CONSTIPATION (HIGHER THAN IN OTHER DRUGS)

Other: Nausea, Discomfort, Dizziness, HA, Flushing, Pruritis

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21
Q

When is verapamil contraindicated

A

In an AV block and conditions of reduced myocardial contractility, severe hypotension, and severe CHF

  • avoid conduction problems, reduced contractility, further drops in BP and worsens heart failure
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22
Q

What could increase calcium channel blocker levels (like verapamil) if taken with the drug

A

Grapefruit Juice (So dont drink it)

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23
Q

Renin-Angiotensin System Antagonists

A

Newer class of drugs - 1980s

Inhibits the action of renin-angiotensin-aldosterone system

Includes ACE Inhibitors and ARBs

can act as antihypertensives

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24
Q

Angiotensin II is a potent ____

A

vasoconstrictor (so if we block it we can open vessels and decrease BP)

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25
Q

ACE Inhibitors

A

Prevent the conversion of angiotensin I to angiotensin II

Inhibits the ACE enzyme, not the angiotensin 2 directly

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26
Q

All ACE Inhibitors end in ____

A

-pril

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27
Q

ARBs

A

Angiotensin Receptor Blockers

Block binding of angiotensin II to receptors

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28
Q

All ARBs end in ____

A

-sartan

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29
Q

Angiotensin II (ACE) Inhibitor Prototype Drug

A

lisinopril (Prinivil, Zestril)

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30
Q

Action of lisinopril

A

Inhibits ACE to prevent angiotensin I –> Angiotensin II conversion

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31
Q

What is the result of lisinopril inhibiting ACE

A
  1. reduced vascular tone and a direct lowering of BP
  2. Decreased aldosterone release and less Na Retention –> Less Na retention means less water retention meaning a DIURETIC EFFECT and decreases BP
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32
Q

Route of lisinopril

A

mostly Oral

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33
Q

ADRs of lisinopril

A
  1. ACE INHIBITOR COUGH - Dry nonproductive cough, chronic - 5-30% get this
  2. HYPOTENSION
  3. POSSIBLE HYPERKALEMIA

Other: Pruritis, Rashes, Dizziness, HA

Rare: Neutropenia, agranulocytosis, hepatotoxicity

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34
Q

Why is there a risk for hyperkalemia with lisinopril

A

because there is less Na retention leading to increased K retention

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35
Q

What could be concerning for a renal impaired patient taking lisinopril

A

the retention of K they cannot rid of

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36
Q

We would never give anyone on an ACE inhibitor what kind of drug alongside it

A

any drug that increases Potassium

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37
Q

What is the Black Box Warning for All Ace Inhibitors like Lisinopril

A

Fatal Injury and death when taking during pregnancy - mainstay of therapy for heart failure

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38
Q

What are the 2 effects ACE Inhibitors can do that is helpful

A
  1. Anti-hypertensive

2. Treatment of heart failure

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39
Q

Why can ACE inhibitors be used for heart failure treatment

A

because it blocks aldosterone and also low sodium retention decreases fluids thus decreasing strain

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40
Q

Angiotensin II Receptor Antagonist (ARB), Antihypertensive Prototype Drug

A

losartan (Cozaar)

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41
Q

What ADR seen in ACE inhibitors is not seen with ARBs

A

the cough

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42
Q

Action of losartan

A

Blocks binding of Angiotensin II to type I receptors in blood vessels and other tissues

Inhibits RAA system better and more selectively than ACE inhibitors

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43
Q

Route of losartan

A

oral

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44
Q

ADRs of losartan

A

HYPOTENSION
DIZZINESS

Other: Insomnia, GI, Muscle Pain and Cramps, Occasionally increased liver enzymes

NOT AND ADR = COUGH

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45
Q

Black Box Warning for ARBs like losartan

A

Do not use in pregnancy because of effects in the RAA system

Same as ACE inhibitor’s black box warning

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46
Q

Maximum effect for losartan is seen when?

A

within 3-6 weeks

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47
Q

Why is losartan sometimes given with a diuretic like HCTZ in the form of the combo drug Hyzaar

A

for a boosted anti hypertensive effects

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48
Q

Things that ACE Inhibitors Do

A

Vasodilation

Decreased blood volume (less sodium retention)

Decreased cardiac and vascular remodeling

Potassium retention

Fetal injury

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49
Q

What is it about ACE Inhibitors that leads to the unique cough

A

ACE inhibitors also prevent the breakdown of BRADYKININ (which is a vasodilator and inflammatory mediator) –> This leads to Vasodilation, Rare Angioedema, and the COUGH

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50
Q

Angina Pectoris

A

a symptom of transient myocardial ischemia perceived as chest pain or discomfort.

Generally precipitated by a condition that increases myocardial oxygen demand or decreases oxygen supply (primarily in diseased vessels – but can be in normal ones if constricted).

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51
Q

3 Classes of Drugs for Angina Pectoris Treatment

A

Nitrates

Beta Blockers

Calcium Channel Blockers

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52
Q

How do nitrates help treat angina

A

reduce O2 demand by reducing preload and afterload

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53
Q

How do beta blockers help treat angina

A

decrease O2 consumption by decreasing heart rate, BP, and myocardial contractility

Blocking Beta 1 causes decreased HR and contractility, also decrease reflex tachycardia caused by other drugs

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54
Q

How do calcium channel blockers help treat angina

A

produce coronary and systemic arterial vasodilation, reduce afterload, HR, and contractility

Have many actions beside anti anginal effects but reduces myocardial O2 consumption

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55
Q

Anti Anginal Prototype Drug

A

Nitroglycerin

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56
Q

Action of Nitroglycerin

A

Relaxes vascular smooth muscle and both arterial and venous vessels BUT works mainly on the venous system in those with CAD - exact mechanism is unknown but peripheral resistance decreases and venous return to the heart is decreases!

Dilating veins decreases preload and BP

Net result: decreased myocardial O2 consumption and angina relief

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57
Q

What is the issue with Nitroglycerin and CAD

A

those with CAD are physically unable to have their vessels dilate with nitroglycerin since they are hardened

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58
Q

Why can nitroglycerin still be helpful despite someone having CAD

A

It cannot dilate the coronary arteries, but it will dilate everything else - like the venous system - so blood can stay in extremities instead of going back into the heart which will decrease preload and work load overall since there is less circulation going to the heart –> results in cardiac demand decreasing

So basically, it opens everything else up beside the coronary vessels

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59
Q

What is the preferred route of absorption for nitroglycerin?

A

Sub-lingual (under tongue and absorbed quickly) very well

Can also be given IV oral and skin

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60
Q

ADRs of Nitroglycerin

A

HA (Dilated vessels in the head causing a pounding HA)

!!REFLEX TACHYCARDIA

!!HYPOTENSION (all the smooth muscles are relaxing)

Other: Dizziness, Syncope, Flushing of skin

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61
Q

Why does BP need to be checked 5 minutes after giving Nitroglycerin

A

drops BP and this can happen fast

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62
Q

What needs to be done when giving nitroglycerin

A

you have to wear gloves because it can absorb through the palms and give a pounding headache for the nurse as well

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63
Q

What is unique about nitroglycerin dosage

A

it is INDIVIDUALIZED

Used to be take 3 tablets then call 911 - but now you take one tablet and if it doesnt help call 911 (dont drive and dont have someone else drive you)

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64
Q

When is nitroglycerin use contraindicated

A

When another drug that causes blood vessel dilation - such as sildenafil (Viagra) - is taken because it can cause life threatening hypotension and cardiac collapse

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65
Q

Nitrate Tolerance

A

Tolerance occurring for nitroglycerin in its topical patch and ointment form

Creating a nitrate free period of 10-12 hours without the patch while they sleep can prevent this

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66
Q

What is important to know about the container nitroglycerin comes in

A

it comes in a brown bottle to protect it from sunlight and moisture so the patient should not eb putting it into pill sorters

67
Q

Usual Causes of Congestive Heart Failure

A

MI
HTN
CAD
Arrhythmias (especially AF)

68
Q

Goals of Congestive Heart Failure Medication Therapy

A

decrease cardiac workload

improve cardiac performance

69
Q

3 Classes of Drugs For Congestive Heart Failure Therapy

A
  1. Diuretics
  2. Vasodilators (Nitrates, Hydralazine and others, ACE inhibitor)
  3. Inotropic Agents
70
Q

digoxin (Lanoxin) increases ____

A

contraction (increased contractility, improve efficiency, decreased HR, better filling)

71
Q

It is important to monitor for ___ depletion with diuretics

A

potassium

72
Q

Diuretics

A

Class of drugs reducing body fluid volume (Helps with HTN, heart failure, cirrhosis, renal disease, increased ICP and increased Intraocular pressure)

Less volume = you have the less work for a failing heart

73
Q

Many Diuretics work to do what

A

decrease reabsorption of sodium and water along the renal tubule - leaves Na in the filtrate to increase loss of fluid instead of having it go back into the bloodstream

74
Q

Degree of diuresis depends on…

A

which part of the tubule is affected - so depending on what area it acts on (areas where it acts on sodium or not) will determine fluid loss and effectiveness

75
Q

Common ADR of Diuretics

A

Electrolyte loss other than sodium!

Particularly POTASISUM - serious one to worry about

76
Q

Thiazide Diuretic

A

Family of diuretic acting on the distal tubule to increase Na, Cl, K, and H2O excretion

ex: HCTZ

ADRs - lyte and fluid losses

77
Q

All thiazide diuretics end in what

A

-thiazide

78
Q

Thiazide Diuretic Prototype Drug

A

HCTZ / Hydrochlorothiazide (Hydrodiuril)

79
Q

Action of Hydrochlorothiazide

A

Inhibition of sodium reabsorption at cortical diluting segment of the nephron, including portions of ascending loop of henle and distal convoluted tubule

exact mechanism unclear

promotes excretion of Na, Cl, and H2O and K is also lost (Washes out many Lytes)

80
Q

ADRs of Hydrochlorothiazide

A

HYPOKALEMIA and other lyte disturbances

Other: Gastric irritation, anorexia, cramping, constipation, juandice, HA, vertigo, paresthesias, Allergic manifestation

81
Q

What type of allergies contraindicated hydrochlorothiazide use

A

sulfur allergies - it is a sulfonamide derivative

82
Q

Thiazide diuretics are only considered mild/moderate diuretics, therefore it is not…

A

used for intense fluid loss or emergency situations

83
Q

Loop Diuretic Prototype Drug

A

furosemide (Lasix)

84
Q

Loop Diuretics

A

Works on the loop of henle to promote excretion of sodium, chloride, potassium and water

Causes a very strong diuretic effect

ADRs r/t fluid and lyte losses - especially K

85
Q

If there is an acute or dangerous fluid overload or pulmonary edema what kind of diuretic is often given

A

loop diuretic (strong fluid loss)

86
Q

Action of furosemide

A

Inhibits active Cl transport in thick portions of the ascending limb of the loop of Henle

Passive sodium transport inhibition occurs

By blocking the ascending portion of the loop of henle, where a lot of Na is reabsorbed, a lot of diuresis occurs

87
Q

Why is furosemide called Lasix

A

it lasts six hours

88
Q

What is important to know about the distribution of furosemide

A

Orally - onset in 30 minute, peaks in 1-2 hours, duration of 6-8 hours

IV - onset in 5 minutes, peaks in 30 , duration 2 hours

89
Q

ADRs of furosemide

A

NVD (From lyte imbalances) - dont lie them down after this

POSTURAL HYPOTENSION

HYPOKALEMIA

Other: Dermatitis, Pruritis, Blurring of vision, ototoxicity, allergies

90
Q

What allergy contraindicates furosemide use

A

sulfur allergy (sulfonamide derivative)

91
Q

In what situations is furosemide contraindicated in?

A

Contraindicated in pregnancy and nursing mothers

States of anuria ( wont make kidneys work and causes more damage)

Hepatic coma (can take too long to rid of toxins)

Electrolyte depletion (already K depleted)

92
Q

Since loop diuretics are more potent than thiazide diuretics they are not ideal for treating ___ but are ideal for ___

A

HTN; CHF

93
Q

What is an important long term thing to consider when taking furosemide

A

it promotes calcium excretion so consider long term bone health

94
Q

Osmotic Diuretic

A

A type of diuretic where a sugar like Mannitol will pull water, like plasma proteins do, from vascular spaces through osmosis and the water and sugar will filter into urine and allow for large diuresis

95
Q

Osmotic Diuresis Prototype Drug

A

Mannitol

96
Q

Action of Mannitol

A

Mannitol pulls water from vascular spaces (Osmosis) and pulls it to the kidneys during excretion - large enough where it wont cross places

Non-electrolytes are filtered by glomerulus, but not significantly reabsorbed or metabolized(stays its own way in and out) The high osmolality also decreases reabsorption of water.

97
Q

Whats important to know about the distribution and excretion of Mannitol

A

Distribution - stays in vascular compartment - does not cross membranes

Excretion: Renal, unchanged

98
Q

ADRs of Mannitol

A

Depends on amount of drug used and its effect on fluid balance

SE: HA, nausea, chills, mild chest pain, lyte imbalances

EXACERBATION OF HEART FAILURE IF A LOT OF FLUID IS DRAGGED TO THE HEART TO PUMP

99
Q

When is Mannitol mostly used

A

Emergent cerebral edema - pulls fluid from brain tissue

not really a cardiac diuretic more of a cerebral effect

100
Q

Contraindications for Mannitol

A

Severe CHF

HTN (lots of fluid in bloodstream)

Chronic Edema (Empties blood stream with edema still in third space - works too fast)

101
Q

Why are filter needles always used with mannitol

A

because it can crystallize

102
Q

A big way to treat heart failure is for drugs to improve ____

A

constractility

103
Q

Cardiac Glycosides

A

group of drugs including digoxin

Strengthens force of myocardial contraction, slows conduction, and slows HR

net effect: increasing CO, and controlling rhythm and rate

104
Q

Cardiac Glycoside Prototype Drug

A

digoxin (Lanoxin)

105
Q

Action of Digoxin (Lanoxin)

A

Alters sodium and potassium transport, also leading to alteration in calcium movement

Indirect actions: intensifies vagus nerve effects - further slows the heart, AND a diuretic effect on the kidney

Some steroidal element similar to sex hormones

106
Q

Effects of the Action of Digoxin

A
    • Inotropic Action
    • Chronotropic Action
    • Dromotropic Action
107
Q

Inotropic

A

strength on contraction

digoxin increases this

108
Q

Chronotropic

A

heart rate

digoxin decreases this

109
Q

Dromotropic

A

conduction velocity

digoxin slows this

110
Q

Digoxin is esp useful in what patient situations

A

HF

A Fib and Flutter (drop in CO)

111
Q

Digoxin effects ___ more than ___ to make the heart more efficient

A

rate more than rhythm (but does affect both)

112
Q

Route of Digoxin

A

oral - variable depending on dissolution

113
Q

Therapeutic Digoxin Blood Levels

A

0.5-2.0 ng/mL

114
Q

ADRs of Digoxin

A

ANOREXIA, NVD, HEADACHE - Might indicate Toxicity

VISUAL DISTURBANCES

GYNECOMASTIA

Other: Weakness, Restlessness, Nervous irritability, Cardiotoxicity, GI, CNS

115
Q

Almost every type of dysrhythmia can be produced by…

A

digoxin toxicity

116
Q

What is the visual disturbances from digoxin like

A

funny yellow green halows and rings around lights

117
Q

What are the 3 Side Effects may indicate Digoxin Toxicity

A

Headache

Anorexia

NVD

118
Q

Digitalizing

A

getting digoxin levels up quickly with a higher dose

it is than maintained with a maintenance dose that is lower

119
Q

Antidote for Digoxin Toxicity

A

Digoxin Immune FAB

120
Q

What vitals are important to check prior to giving digoxin

A

APICAL PULSE RATE and RHYTHM (BP less important here)

121
Q

Why is giving diuretics with digoxin a potential problem

A

Diuretics lead to K loss which can lead to digoxin toxicity

So we need perfect or higher K levels or we have an issue

122
Q

Why is giving antacids with digoxin an issue

A

because antacids interfere with absorption of digoxin

123
Q

____ increases the effects of digoxin even to the point of toxicity

A

Hypokalemia

So we need to monitor lyte levels, especially potassium

124
Q

Cardiac Electrolyte Prototype Drug

A

Potassium

125
Q

Potassium

A

Major positively charged ion in intracellular fluid

can be used for prophylaxis with a diuretic and/or digoxin therapy

should never be IV pushed/bolus

126
Q

Action of Potassium

A

Major positively charged ion that plays an important part in the following:

  1. Muscle Contraction
  2. Conduction of nerve impulses
  3. Enzyme action
  4. Cell membrane function
127
Q

Most common reason for giving potassium is what

A

as prophylaxis from Digoxin or Diuretics

128
Q

Absorption route of potassium

A

Oral, very good

can also give IV somtimes

129
Q

ADRs of Potassium

A

HYPERKALEMIA - with all of its effects especially on cardiac electrical activity

Other: May cause GI Pain, distention, abdominal cramps, diarrhea, weakness, and paralysis

130
Q

What route of potassium is for prophylactic diuretic therapy

A

oral

131
Q

What is important to think about regarding the administration of oral potassium

A

It should be given with a full glass of water

It has an unpleasant taste if liquid or elixir and it may smell like orange soda but the taste is highly unpleasant

132
Q

Dysrhythmias arise from what 2 general causes?

A
  1. Disturbance in automaticity

2. Disturbance in conduction

133
Q

What sort of drugs are used for their antiarrhythmic effects other than Antiarrhythmic agents specifically?

A

beta blockers, calcium channel blockers, digoxin

134
Q

What causes arrhythmias

A

Changes in ion currents through the channels of the myocardial cell membrane are the main cause of cardiac rhythm changes and arrhythmias (Abnormal rhythms)

Any drug used to treat an arrhythmia can also cause arrhythmias! – ex could fix rhythm but then make one too slow for example!!!!!!!!

135
Q

Anti-arrhythmic Class 1A prototype drug

A

Quinidine - Class 1 A

136
Q

Action of Quinidine

A

direct action on cardiac cell membrane

Stabilizes cell membrane by preventing ready movement on Na and K across cellular barrier

Decreases impulse generation, prolongs refractory period of atria and ventricular fibers and decreases conduction

Used for atrial arrhytmias/dysrhythmias

137
Q

Route of Quinidine

A

Oral, good (form intestine - alkaline pH)

138
Q

ADRs of Quinidine

A

NVD - too much can lead to loose stools and quinidine toxicity

CV - effects vary to complete heart block and ventricular disorders including Ventricular Fibrillation

Other: tinnitus, vertigo, visual disturbances, thrombocytopenic purpura, rashes, urticaria, hypotension

139
Q

Most common quinidine ADR is…

A

GI Disturbance (NVD)

140
Q

Most serious quinidine ADR is…

A

cardiac rhythm changes

141
Q

Quinidine is mostly used with what kind of dysrhythmias?

A

Atrial Dysrhythmias - not used too often anymore though

It still has some activity in the ventricles as well though

142
Q

Antiarrhythmic Class 1B Prototype Drug

A

Lidocaine (Xylocaine)

143
Q

Lidocaine is both a _____ and ____ ___

A

anti-arrhythmic and local anesthetic

144
Q

Lidocaine is mostly used with what kind of dysrhytmias?

A

Ventricular Arrhythmias (extra ventricular beats like PVCs)

145
Q

Why is a continuous IV infusion of lidocaine needed

A

because it has a very short half life

146
Q

Most common ADRs of lidocaine are…

A

ones affecting the heart and CNS

147
Q

Action of lidocaine (as an antiarrhythmic)

A

Similar electrophysiologic properties as quinidine - anesthetizes the cell membrane to stop unusually sources impulses

Depresses excessive automaticity of ectopic pacemakers (esp. in HIs-Purkinje fibers)

LITTLE EFFECT ON ATRIA

148
Q

What route is lidocaine given

A

IV usually (continuous) because there is a huge first pass effect and irritation orally

149
Q

How fast is lidocaine distributed

A

Rapidly - onset is in 10-90 seconds, duration of 20 minutes, and half life of 2 hours

150
Q

ADRs of Lidocaine

A

CNS DISTURBANCES: agitation, disorientation, muscle twitching

CV: heart block, hypotension, resp or cardiac arrest occurrence, bradycardia

Other: Drowsiness, Blurred vision, nausea, tinnitus, euphoria, resp depression, mental status changes

151
Q

Lidocaine as an anti-arrhythmic is only given on what units

A

critical care units

152
Q

The drug of choice in treating ventricular dysrhythmias is…

A

lidocaine - it gets in quick and works quick

153
Q

Caution using lidocaine with what kinds of patients

A

Liver Disease (hepatic blood flow affects rate of drug clearance) - so it wont clear well and bad ADRs occur

154
Q

Your patient is taking atorvastatin (Lipitor). Patient teaching should include contacting the provider IMMEDIATELY for…

a. Diarrhea
b. Intermittent headaches
c. Nausea
d. Severe muscle pain

A

D. Severe muscle pain

lots of muscle effects in the ADRs

155
Q

Which symptoms may indicate hyperkalemia?
A. Anorexia, NVD, constipation
B. Irregular pulse, muscle weakness, constipation
C. NVD, weak pulse, cardiac arrhythmias
D. Elevated LDH, muscle cramps

A

Answer: C. nausea, diarrhea, weak pulse, cardiac arrhythmias

Hyperkalemia revs up the GI tract - constipation is more hypokalemia

156
Q

Your patient is prescribed IV furosemide (Lasix). You should administer this medication how fast?

A

over 1-2 minutes

157
Q

Which of the following adverse reactions is associated with ACE inhibitors

a. Bradycardia
b. Cough
c. HTN
d. Ankle edema

A

B. Cough

158
Q

CHF Management includes all of the following except:

A. Diuretics
B. Positive Inotropic Agents
C. ACE Inhibitors
D. Anti-arrhythmic agents

A

D. Anti-Arrhythmic Agents

For general heart failure it is not associated with arrhythmic agents out of these choices

159
Q

Prototype Potassium Sparing Diuretic

A

Spironolactone (Aldactone)

160
Q

Action of Spironolactone

A

Antagonizes aldosterone by binding to the protein that permits K secretion at the distal tubule

Works in the distal tubule to promote sodium and water excretion BUT also reabsorption of potassium!

161
Q

Weakest Diuretic Type

A

potassium sparing - a slow and mild diuresis

162
Q

Route of spironolactone

A

oral

163
Q

ADRs of Spironolactone

A
  1. HYPERKALEMIA
  2. Male Gynecomastia or Female Breast Soreness/Menstrual Irregularities - Steroid Effect

Other: Anorexia, NVD, HA, drowsiness, Ataxia, mental confusion

NO HYPOTENSION SINCE ITS SLOW AND MILD

164
Q

What is common to see alongside spironolactone

A

another diuretic for a synergistic effect while retaining K

NURS 365 - Pharmacology in Nursing (15 decks)

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