Week 8 - Cardiovascular

Question 1

• ACE inhibitors “prils”: Captropils, lisinopril
• ARB (Angiotensin 2-Receptor Blocker) “tans”: Losartan
• Beta blockers “Olols”: Metoprolol, atenolol
• Calcium channel blockers: Nifedipine

Answer 1

All classifications and medications for HTN

Question 2

• ↓ BP
• Postural hypotension
• Hyperkalemia
• bradycardia

Answer 2

Generalized adverse reactions for all HTN meds

Question 3

• Vasodilation of arteries = ↓ afterload
• Slow progression of neuropathy
• ADR: Chronic dry cough - notify MD to change med; Hyperkalemia (blocks Na reabsorption, so K stays in the system) - numbness, tingling, muscle cramps, paresthesias in extremities; angioedema - given antihistamines/steroids, allergy rx
• Pt ed: monitor BP (after 1st dose) -> can cause ↓ BP; monitor w asthma/COPD; notify MD if any new onset of dry cough
• Blood pressure drop, monitor BP

Answer 3

ACE-inhibitor: captopril

Question 4

• Blocks calcium - relax vessels, ↓ heart contractility (force), ↓ hr & bp
• ADR: hypotension (s/s fatigue) / Bradycardia - monitor EKG, notify provider < 50
• Pt ed: monitor edema; no grapefruit -> cause toxicity of drug in system; s/s of hypotension and bradycardia (very fatigue)
• NC: hold doses if HR/BP lower; monitor elderlies and renal failures pts w >1 anti-hypertensive meds
• Blood pressure drop & HR
• Don’t give to Brady patients

Answer 4

Calcium Channel Blocker: nifedipine

Question 5

What to check for before administrating beta blockers?

Answer 5

check pulse is more than 60bpm

Question 6

• Cardio selective
• Vasodilation in coronary arteries help w angina (Chest pain); ↓ force of heartbeat -> ↓ <3 workload = Gets more blood flow & O2 AND ↓ contractility = ↓ hard work
• Pt edu: s/s new HF (sob, orthopnea, peripheral edema due to low contractility); masks hypoglycemia sx (no tachy) so monitor BG closely
• NC: contra for HF pts
• Blood pressure drop & HR

Answer 6

Beta1 Adrenergic Blocker: atenolol

Question 7

• Noncardio selective - heart & lungs (Respiratory pts)
• SE: nausea & abdominal pain/constipation
• Pt educ: watch s/s of HF (↓ HR = ↓ CO); Don’t stop abruptly; Respiratory issue (coughs, SOB or exacerbation of COPD/Asthma) -> causes bronchoconstriction
• NC: contra in already atrial arrhythmia (slow HR)
• Monitor BG

Answer 7

Beta1 Adrenergic Blocker: propranolol

Question 8

• ↓ cholesterol = ↓LDL -> ↑ HDL
• SE: Liver pain, myopathy (muscle pain)
• Pt educ: take @ night (fat/cholesterol production @ night), no alcohol, no grapefruit (can inc toxicity), take consistently same time, continue w/ heart healthy diet and lifestyle

Answer 8

HMG-CoA Reductase Inhibitor: atorvastatin

Question 9

• ↓ triglycerides lvl, ↑ cholesterol synthesis into bile (galbladder)
• SE: cholelithiasis (gallbladder pro due to excess bile causing stones) pain in RUQ
• PT edu: lipid lab test, diet exercise, 2-3 mos for effects on blood lvls
• NC: No warfarin = ↑ bleeding, dec effective of gemfi; leads to pancreatitis (↑ triglycerides lvl); rhabdomyolysis (↑ CK lvls)
• HEPATOTOXICITY (JAUNDICE, ABD PAIN, ANOREXIA)

Answer 9

Fibrates: gemfibrozil
- Gemfibrozil: Gallblader & triGlyceride

Question 10

• Anti-angina
• Vasodilates veins including coronary = dec angina, acute onset HTN, and coronary artery spasm
• Dosing: sublingual tablet/spray, IV, topical (NO sq/im)
• Given: 0.5 mg SL Q5mins x3
• SE: hypotension (hold med); HA and syncope (dizziness) - normal sx
• Pt educ: monitor BP (before & after med); remove patch @ night (cont. exposure = build up tolerance) and nitrate free period dec tolerance to med
• NC: Not used for right sided MI/HF; don’t touch topical med, look for irritation/breakdown at topical site; very sensitive to light and moisture; best place on the chest
• Check BP first!

Answer 10

Nitrates: nitroglycerin