Drugs for HTN, HF, Dyslipidemia

Question 1

atorvastatin therapeutic class

Answer 1

dyslipidemia, lipid-lowering medication

Question 2

atorvastatin pharmacologic class

Answer 2

HMG-CoA reductase inhibitor, needed for biosynthesis of cholesterol in liver

Question 3

atorvastatin action

Answer 3

strongly decrease LDL cholesterol, decrease triglycerides, increase HDL cholesterol, actions only occur when actively taking medication (must stay on for life to decrease cholesterol) slows progression of CAD and reduces mortality

Question 4

atorvastatin side effects

Answer 4

headache, GI cramping, diarrhea, constipation; possible liver damage in small number of patients.

Question 5

atorvastatin adverse effects

Answer 5

rhabdomyolysis (muscle breakdown), increase digoxin levels, grapefruit juice inhibits metabolism of drug

Question 6

atorvastatin contraindications

Answer 6

pregnancy category X - teratogenic (abnormality causing factor in birth)

Question 7

atorvastatin other

Answer 7

give @ night (liver makes cholesterol at night); PO only with food to reduce GI distress

Question 8

cholestyramine therapeutic class

Answer 8

anti-hyperlipidemic

Question 9

cholestyramine pharmacologic class

Answer 9

bile acid sequestrant (collector)

Question 10

cholestyramine action

Answer 10

binds with bile acids in an insoluble complex that is excreted in feces; drug is NOT absorbed in small intestine; liver makes more LDL receptors and causes a drop in LDL cholesterol

Question 11

cholestyramine side effects

Answer 11

gas, bloating, constipation, nausea

Question 12

cholestyramine contraindications

Answer 12

taking with food could impair absorption; patients with gall bladder issues

Question 13

cholestyramine other

Answer 13

comes in powder; give other drugs either 2 hours before or 4 hours after

Question 14

gemfibrozil therapeutic class

Answer 14

anti-hyperlipidemic

Question 15

gemfibrozil pharmacologic class

Answer 15

fibric acid drug

Question 16

gemfibrozil actions

Answer 16

increase lipoprotein lipase which increases breakdown and elimination of triglyceride; increases HDL and decrease VLDL by 50%

Question 17

gemfibrozil side effects

Answer 17

GI issues, nausea, diarrhea, abdominal pain, dyspepsia (pain in upper middle stomach region)

Question 18

gemfibrozil contraindications

Answer 18

don’t use if hepatic impairment is present

Question 19

gemfibrozil other

Answer 19

may increase likelihood of gallstones, affect liver function; may increase effect of anticoagulant medications; may increase risk of myopathy & rhabdomyolysis with statin.

Question 20

hydrochlorothiazide therapeutic class

Answer 20

diuretic

Question 21

hydrochlorothiazide pharmacologic class

Answer 21

thiazide, potassium-wasting diuretic

Question 22

hydrochlorothiazide action

Answer 22

reduce blood volume through excretion of water and potassium, reducing blood volume, and blood pressure.

Question 23

hydrochlorothiazide side effect

Answer 23

hypokalemia, hyponatremia, hypotension, dizziness, dehydration

Question 24

hydrochlorothiazide patient consideration

Answer 24

observe for hypokalemia (what signs/symptoms would patient have?); increase potassium containing food; do NOT give to patients who don’t make urine (anuresis)

Question 25

furosemide therapeutic class

Answer 25

diuretic, antihypertensive

Question 26

furosemide pharmacologic class

Answer 26

loop diuretic, potent potassium-wasting diuretic

Question 27

furosemide action

Answer 27

works in loop of Henle to promote excretion of sodium and water thereby reducing blood vessel; causes potassium-wasting. When given IV, produces rapid diuresis

Question 28

furosemide side effect

Answer 28

hypokalemia (check serum K-levels before administer); orthostatic hypotension, dizziness, fainting, ototoxicity (rare but permanent) and nephrotoxicity, hyperglycemia

Question 29

furosemide nursing considerations

Answer 29

monitor intake/output, K+ levels, blood glucose, causes of hearing changes or losses. Use cautiously with other drugs that deplete potassium.

Question 30

spironolactone therapeutic class

Answer 30

antihypertensive, reduces edema

Question 31

spironolactone pharmacologic class

Answer 31

potassium-sparing diuretic, aldosterone antagonist

Question 32

spironolactone action

Answer 32

inhibits aldosterone (secreted by adrenal cortex) which increases water and sodium excretion (RAAS). Commonly used to treat HTN along with other anti-HTN drugs, slows the progression of heart failure

Question 33

spironolactone side effects

Answer 33

hyperkalemia (especially taken with ACE inhibitors or ARBs)

Question 34

spironolactone nursing considerations

Answer 34

give with food to increase absorption of drug; do NOT give K+ supplements or use salt-substitute; warn male patients about gynecomastia which resolves when drug discontinued.

Question 35

lisinopril therapeutic class

Answer 35

drug for HTN and HF

Question 36

lisinopril pharmacologic class

Answer 36

ACE inhibitor

Question 37

lisinopril action

Answer 37

inhibits ACE which is responsible for converting angiotensin I to angiotensin II which ultimately blocks effects of aldosterone

Question 38

lisinopril side effects

Answer 38

well-tolerated, but be alert for cough (possible switch to an ARB) or Angioedema (1% of patients); patients must report coughing, swelling, tongue fullness, difficulty breathing/talking; hyperkalemia (use cautiously in pts. receiving potassium-sparing diuretics); hypotension; often used concurrently with thiazide diuretics

Question 39

losartan therapeutic class

Answer 39

drug for HTN

Question 40

losartan pharmacologic class

Answer 40

angiotensin II receptor blocker

Question 41

losartan actions

Answer 41

vasodilation and reduced blood volume (due to its effects on blocking aldosterone release)

Question 42

losartan side effects

Answer 42

hypoglycemia, dizziness, stuffy nose, fatigue, hypotension

Question 43

losartan BBW

Answer 43

do NOT use in pregnancy! Causes fetal injury/death = Teratogen!

Question 44

losartan nursing considerations

Answer 44

when given with potassium sparing diuretics — increased risk for hyperkalemia

Question 45

metoprolol therapeutic class

Answer 45

drug for HTN and HF

Question 46

metoprolol pharmacologic class

Answer 46

beta-adrenergic blocker (beta blocker) — selective for B1 (affecting heart by decreasing HR)

Question 47

metoprolol actions

Answer 47

reduces sympathetic stimulation of the heart thus decreasing cardiac workload *preferred for patients with respiratory disease (due to cardio-selective B1 action)

Question 48

metoprolol side effects

Answer 48

hypotension, bradycardia, may enhance hypoglycemic affects of insulin/oral diabetic drugs — watch for hypoglycemia

Question 49

metoprolol BBW

Answer 49

acute withdrawal from drug may make angina worse or cause myocardial infarction

Question 50

metoprolol contraindications

Answer 50

heart block, cardiogenic shock, hypotension, overt cardiac failure

Question 51

nifedipine therapeutic class

Answer 51

drug for HTN

Question 52

nifedipine pharmacologic class

Answer 52

calcium channel blocker

Question 53

nifedipine actions

Answer 53

blocks calcium channels in myocardial and vascular smooth muscle including coronary arteries which results in coronary artery dilation, less oxygen consumption by heart an increase in CO and a fall in BP

Question 54

nifedipine side effects

Answer 54

dizziness, hypotension, headache

Question 55

nifedipine nursing considerations

Answer 55

well-tolerated, give cautiously with other antihypertensive medications, it increases serum levels of digoxin which can lead to bradycardia and dig toxicity. do not take with grapefruit juice. avoid alcohol potentiates vasodilating action

Question 56

digoxin therapeutic class

Answer 56

drug for HF

Question 57

digoxin pharmacologic class

Answer 57

cardiac glycoside

Question 58

digoxin actions

Answer 58

increases contractility of heart (positive inotrope); inhibits Na+K+ATPase, the enzyme responsible for pumping sodium (Na+) ions out of the myocardial cell in exchange for potassium (K+) ions. As sodium accumulates, calcium are released from their storage areas in the cell. The release of calcium produces a more forceful contraction of the heart fibers; Increases CO >> increases urine production >> decreases BV, relieves distressing; suppresses sinoatrial node (decreases HR)

Question 59

digoxin administered alerts

Answer 59

take apical pulse for 1 full minute, note rhythm and quality. If HR less than parameter set by HC provider (usually less than 60bpm) then withhold the dose and notify the provider; check serum digoxin levels before administering (narrow therapeutic range); use cautiously in elderly and pediatric patients due to renal and hepatic immaturity or decreased function

Question 60

digoxin adverse effects

Answer 60

concurrent use of digoxin and diuretics can lead to hypokalemia, leading to dysrhythmias; periodic check of drug levels required.

Question 61

digoxin contraindications

Answer 61

do NOT give to those with AV block or ventricular arrhythmias unrelated to HF as digoxin can worsen conditions

Question 62

digoxin Drug-Drug interactions

Answer 62

concurrent use with ACE I can cause hyperkalemia and reduce therapeutic action of digoxin

Question 63

digoxin antidote

Answer 63

digibind

Question 64

milrinone therapeutic class

Answer 64

drug for acute HF

Question 65

milrinone pharmacologic class

Answer 65

phosphodiesterase (PDE) inhibitor

Question 66

milrinone actions/uses

Answer 66

blocks enzyme phosphodiesterase in cardiac and smooth muscle, increases force of cardiac contraction and increases CO, very short half-life; heart increases calcium availability to heart muscle >> increases contraction; vessels — PDE inhibition prevents cGMP metabolism in the smooth musculature causing vasodilation

Question 67

milrinone adverse effects

Answer 67

ventricular dysrhythmia — which occurs in every 1 in 10 patients — need continuous ECG monitoring during infusion to prevent hypotension. Correct hypokalemia as it can risk of dysrhythmia! Can cause headache, nausea and vomiting (usually related to vasodilation)