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Question

Hydromorphone

Answer 1

A

Class: Antianginal, Antihypertensive (Calcium Channel Blocker)

Indications: Hypertension (ER only), Angina, Off-label: Migraine prevention

-Action: Blocks calcium entry → relaxes vessels → ↓ BP & angina

Pharmacokinetics:
-Half-life: 2–5 hrs
- PO: Onset: 20 mins; Peak: n/a; Duration: 6-8 hr
- PO-ER: Onset: n/a; Peak: 6hrs; Duration: 24 hr

Key Side Effects: Edema, dizziness, flushing, severe: hypotension, HF, Stevens-Johnson syndrome

Interactions:
- ↑ toxic: Grapefruit, ketoconazole, cimetidine
- ↓ Effect: Rifampin, phenytoin, St. John’s wort (avoid)
- Risk: Additive hypotension with alcohol, beta-blockers

Contraindications: SBP <90 mmHg, heart block without pacemaker, grapefruit juice

Nursing Tips: Monitor BP, HR, HF signs; don’t crush ER tablets

Patient Advice: Take regularly, avoid grapefruit, change positions slowly (prevent dizziness), report chest pain or rash

Effect: ↓ BP, ↓ angina attacks

Answer 2

A

Class: Anti-inflammatory (Steroidal), Immune Modifier (Corticosteroid)

Indications: Inflammatory, allergic, hematologic, autoimmune, neoplastic disorders

Action: Suppresses inflammation & immune response; replaces cortisol in deficiency

Pharmacokinetics:
- Half-life: 3.4–3.8 hrs (plasma), 18–36 hrs (tissue)
- PO: Onset: hrs; Peak: n/a; Duration: 1.25–1.5 days

Key Side Effects:
- Common: Weight gain, hyperglycemia, fluid retention, mood changes
- Severe: Infections, adrenal suppression, Cushingoid features, GI bleeding, thromboembolism

Interactions:
- ↑ Risk: NSAIDs (GI issues), fluoroquinolones (tendon rupture)
- ↓ Effect: Rifampin, phenytoin, phenobarbital
- Avoid: Live vaccines, grapefruit juice

Contraindications: Active infections (unless treated), systemic fungal infections

Nursing Tips: Monitor for infection, BP, blood sugar, adrenal suppression signs

Patient Advice:
- Take with food, in the morning
- Do NOT stop suddenly → risk of adrenal crisis
- Report signs of infection, GI bleeding, mood changes

Effect: ↓ Inflammation, ↓ immune response, symptom control

Answer 3

A

Class: Antihypertensive (ACE Inhibitor)

Indications: Hypertension, Heart Failure, Asymptomatic LV dysfunction, Off-label: Proteinuria

Action: Blocks ACE → ↓ angiotensin II → vasodilation, ↓ BP, ↓ aldosterone

Pharmacokinetics:
- Half-life:
+ Enalapril (Adults: 2 hr; Adults with HF: 3.4–5.8 hr)
+ Enalaprilat (35–38 hrs)
- PO: Onset: 1hr ; Peak: 4-8hrs; Duration: 12-24hrs
- IV: Onset: 15mins ; Peak: 1-4 hrs; Duration: 4-6 hrs

Key Side Effects:
- Common: Cough, dizziness, fatigue, hypotension
- Severe: ANGIOEDEMA, hyperkalemia, renal impairment

Interactions:
- ↑ Risk: Angioedema (sacubitril), hyperkalemia (K+ supplements, spironolactone), lithium toxicity
- ↓ Effect: NSAIDs, COX-2 inhibitors
- Avoid: Potassium-rich foods, salt substitutes, natural licorice

Contraindications:
History of angioedema, pregnancy, severe renal impairment, concurrent use with aliskiren or sacubitril

Nursing Tips:
- Monitor BP, renal function, electrolytes (K+, creatinine)
- Watch for angioedema (swelling of face, lips, tongue)
- Hold if SBP <90 mmHg

Patient Advice:
- Take at the same time daily
- Report persistent cough, swelling, or difficulty breathing
- Avoid potassium supplements & salt substitutes

Effect: ↓ BP, improved heart failure symptoms, ↓ heart failure progression

Answer 4

A

Class: Antihypertensive (Peripherally Acting Antiadrenergic)

Indications: Hypertension (IR only), Benign Prostatic Hyperplasia (BPH)

Action: Blocks α1-receptors → dilates arteries & veins → ↓ BP, ↑ urine flow

Pharmacokinetics:
- Half-life: 22 hrs
- PO: Onset: 1-2 hrs; Peak: 2-6hrs; Duration: 24hr
- PO-XL: Onset: 5wk; Peak: n/a; Duration: n/a

Key Side Effects:
- Common: Dizziness, headache, fatigue, orthostatic hypotension
- Severe: First-dose hypotension, arrhythmias, priapism

Interactions:
- ↑ Risk: Hypotension with sildenafil, nitrates, alcohol
- ↓ Effect: NSAIDs, estrogens, sympathomimetics

Contraindications:
- Hypersensitivity
- Use Cautiously In: Hepatic impairment, elderly (↑ fall risk), cataract surgery (floppy iris syndrome)

Nursing Tips:
- Monitor BP & pulse, especially after 1st dose & dose changes
- Watch for orthostatic hypotension & edema

Patient Advice:
- Take at bedtime (reduces risk of fainting)
- Change positions slowly to avoid dizziness
- Report prolonged erections (>4 hrs)

Effect: ↓ BP, ↓ urinary symptoms in BPH

Answer 5

A

Class: Antianginal, Antihypertensive (Beta Blocker)

Indications: Hypertension, Angina, Post-MI, Heart Failure (off-label: Arrhythmias, Migraines, Anxiety)

Action: Blocks β1-receptors → ↓ HR, BP, myocardial oxygen demand

Pharmacokinetics:
- Half-life: 3–7 hrs
- PO; onset: 15mins; peak: n/a; duration: 6-12hrs
- PO-ER; onset: n/a; peak: 6-12hrs; duration: 24 hr
- IV; onset: immediate; peak: 20 mins; duration: 5-8hrs

Key Side Effects:
- Common: Fatigue, dizziness, bradycardia, hypotension
- Severe: Heart block, HF, bronchospasm, PULMONARY EDEMA

Interactions:
- ↑ Risk: Bradycardia (digoxin, verapamil), hypotension (antihypertensives, alcohol)
- ↓ Effect: Beta-agonists (dopamine), insulin (masks hypoglycemia)
- Avoid: Abrupt discontinuation (risk of arrhythmias, MI)

Contraindications:
- Uncompensated HF, bradycardia, heart block, cardiogenic shock
- Use Cautiously In: Asthma, diabetes, liver/renal impairment, elderly

Nursing Tips:
- Monitor BP, HR (hold if HR <50 bpm), ECG
Assess for HF signs (edema, SOB, weight gain)

Patient Advice:
- Take with food, same time daily
- Don’t stop abruptly
- Report slow HR, dizziness, breathing issues

Effect: ↓ BP, ↓ angina attacks, ↑ survival post-MI, ↓ HF symptoms

Answer 6

A

Class: Antiplatelet, Antipyretic, Non-opioid Analgesic (Salicylate, NSAID)

Indications: Pain, Fever, Inflammation (RA, OA), MI & Stroke Prevention (off-label: Kawasaki disease)

Action: Inhibits prostaglandin synthesis (↓ pain, inflammation, fever) & platelet aggregation

Pharmacokinetics:
- Half-life: 2–3 hrs (low dose), 15–30 hrs (high dose)
- PO; Onset: 5–30 min; Peak 1–3 hr; Duration: 3–6 hr

Key Side Effects:
- Common: GI upset, nausea, dyspepsia, tinnitus
- Severe: GI BLEEDING, HYPERSENSITIVITY (anaphylaxis), Reye’s syndrome (pediatrics), HEPATOTOXICITY

Interactions:
- ↑ Bleeding Risk: Warfarin, heparin, clopidogrel, NSAIDs
- ↓ Effect: ACE inhibitors, diuretics
- Avoid: Alcohol, other NSAIDs, antacids (affects absorption)

Contraindications:
Bleeding disorders, aspirin allergy, children with viral infections (Reye’s syndrome risk), pregnancy (3rd trimester)

Nursing Tips:
- Monitor for GI bleeding, tinnitus (toxicity sign), allergic reactions
- Use lowest effective dose, take with food to reduce GI upset

Patient Advice:
- Take with water, sit upright for 15–30 mins after
- Avoid alcohol (↑ GI risk)
- Report unusual bleeding, ringing in ears, black stools

Effect: ↓ Pain, fever, inflammation, ↓ risk of MI & stroke

Answer 7

A

Class: Antihypertensive (ACE Inhibitor)

Indications: Hypertension, Heart Failure, Post-MI (reduces mortality)

Action: Blocks ACE → ↓ angiotensin II → vasodilation → ↓ BP, ↓ aldosterone

Pharmacokinetics:
- Half-life: 12 hrs (prolonged in renal impairment)
- PO; ONSET 1 hr; PEAK 6 hr; DURATION 24 hr

Key Side Effects:
- Common: Dizziness, headache, fatigue, cough
- Severe: ANGIOEDEMA, hypotension, hyperkalemia, renal impairment

Interactions:
- ↑ Risk: Angioedema (sacubitril), hyperkalemia (K+ supplements, spironolactone)
- ↓ Effect: NSAIDs (may blunt antihypertensive effect)
- Avoid: Potassium-rich foods, salt substitutes

Contraindications:
History of angioedema, pregnancy, concurrent use with sacubitril/valsartan, severe renal impairment

Nursing Tips:
- Monitor BP, renal function, electrolytes (K+, creatinine)
- Watch for angioedema (swelling of face, lips, tongue)
- Hold if SBP <90 mmHg

Patient Advice:
- Take at the same time daily
- Change positions slowly to prevent dizziness
- Report persistent cough, swelling, or breathing difficulties

Answer 8

A

Class: Vasodilator (Combination of Nitrate & Arterial Vasodilator)

Indications: Heart Failure with reduced ejection fraction (specifically in Black patients)

Action:
- Isosorbide Dinitrate: Dilates veins → ↓ preload
- Hydralazine: Dilates arteries → ↓ afterload

Therapeutic Effect: Improved survival, ↓ HF symptoms, ↑ time to hospitalization

Pharmacokinetics:
- Half-life: 2 hrs
- hydralazine (PO); onset 45 min , peak 2 hr, duration 2–4 hr
- isosorbide (PO); onset 15–40 min; peak n/a; duration 4 hr

Key Side Effects:
- Common: Headache, dizziness, orthostatic hypotension
- Severe: Drug-induced lupus (hydralazine), hypotension, syncope

Interactions:
- Severe Hypotension: PDE-5 inhibitors (sildenafil, tadalafil) – contraindicated
- ↑ Risk of Hypotension: Other antihypertensives, alcohol
- Caution with: Beta-blockers (affects heart rate), MAO inhibitors

Contraindications:
- Hypersensitivity to components
- Concurrent use with PDE-5 inhibitors or riociguat

Nursing Tips:
- Monitor BP & HR, watch for orthostatic hypotension
- Assess for lupus-like symptoms (joint pain, fever)
- Hold if SBP <90 mmHg

Patient Advice:
- Take regularly, even if feeling well
- Change positions slowly to prevent dizziness
- Avoid alcohol & ED meds (risk of severe hypotension)
- Headache may occur but usually improves with time

Effect: ↑ Survival, ↓ HF symptoms, ↑ exercise tolerance

Answer 9

A

Class: Antiarrhythmic, Inotropic (Digitalis Glycoside)

Indications: Heart Failure (HF), Atrial Fibrillation/Flutter, Paroxysmal Atrial Tachycardia

Action:
- ↑ Myocardial contraction (positive inotropic effect)
- ↓ Heart rate (negative chronotropic effect)
- Prolongs AV node refractory period

Pharmacokinetics:
- Half-life: 36–48 hrs (prolonged in renal impairment)
- PO, onset 30–120 min; peak 2–8 hr, duration 2–4 days
IM, onset 30 min; peak 4–6 hr; duration 2–4 days
- IV, onset 5–30 min, peak 1–4 hr, duration 2–4 days

Key Side Effects:
- Common: Fatigue, weakness, nausea, vomiting, blurred/yellow vision
- Severe: ARRHYTHMIAS, bradycardia, heart block

Signs of Toxicity:
- GI: Anorexia, nausea, vomiting
- Neuro: Vision changes (yellow/green halos), confusion
- Cardiac: Bradycardia, arrhythmias

Therapeutic Range: 0.5–2 ng/mL (toxicity risk ↑ >2 ng/mL)

Interactions:
- ↑ Toxicity Risk: Hypokalemia (diuretics), amiodarone, quinidine, verapamil
- ↓ Effect: St. John’s wort, antacids, high-fiber meals
- Avoid: Licorice, aloe (↑ K+ loss), beta-blockers (↑ bradycardia risk)

Contraindications:
Ventricular arrhythmias, heart block (without pacemaker), digoxin toxicity

Nursing Tips:
- Check apical pulse for 1 min before dose
- Hold if <60 bpm (adults), <70 bpm (children), <90 bpm (infants)
- Monitor K+, Mg2+, Ca2+ levels (imbalances ↑ toxicity risk)
- Adjust dose in renal impairment

Patient Advice:
- Take at the same time daily
- Learn to check pulse before each dose
- Report signs of toxicity (nausea, vision changes, slow pulse)
- Avoid sudden discontinuation

Effect: ↓ HF symptoms, ↑ cardiac output, controlled HR in AFib/flutter

Answer 10

A

Class: Loop Diuretic

Indications:
Edema (HF, renal/hepatic impairment)
Hypertension (PO)
Off-label: Hypercalcemia, ascites

Action:
Inhibits sodium & chloride reabsorption in the loop of Henle → ↑ excretion of water, Na⁺, K⁺, Cl⁻, Mg²⁺, Ca²⁺ → ↓ fluid overload & BP

Pharmacokinetics:
- Half-life: 30–120 min (↑ in renal impairment)
- PO, onset 30–60 min; peak 1–2 hr; duration 6–8 hr
- IV, onset 5 min, peak 30 min; peak 2 hr

Adverse Effects:
- Common: Dizziness, dehydration, electrolyte imbalances (hypokalemia, hyponatremia)
- Severe: Hypotension, ototoxicity, renal impairment, SJS/TEN, agranulocytosis

Electrolyte Imbalances to Watch:
-↓ Na⁺, K⁺, Ca²⁺, Mg²⁺ → Risk of arrhythmias, cramps
- ↑ Glucose, uric acid → Risk of hyperglycemia, gout

Drug Interactions:
- ↑ Risk of Toxicity: Digoxin (hypokalemia), lithium, aminoglycosides (ototoxicity), corticosteroids (electrolyte imbalance)
- ↓ Effect: NSAIDs, sucralfate, cholestyramine
- Risk: Additive hypotension with antihypertensives, alcohol

Contraindications:
Anuria, severe electrolyte depletion, hepatic coma, sulfa allergy (cross-sensitivity risk)

Nursing Tips:
- Monitor BP, HR, I&O, daily weight, electrolytes, renal function
- Assess for dehydration, orthostatic hypotension, hearing changes
- Administer in the morning to prevent nocturia

Patient Advice:
- Take early in the day, with food if GI upset
- Change positions slowly to prevent dizziness
- Report weight gain >3 lbs/day, muscle cramps, weakness, rash
- Eat potassium-rich foods unless contraindicated

Effect:
- Mobilization of excess fluid (↓ edema, clear lungs)
- ↓ BP

Answer 11

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