✅EXAM 1 Flashcards

Question

CHC that reduces withdrawal bleeding

Answer 1

Withdrawal bleeding not necessary (not necessary) Extended cycle products: shortened period of inactive pills reduces number withdrawal bleeding days. Ex: loestrin 24, YAZ, Beyaz Continuous dosing products: 1. Seasonale (jolessa) 91 day regimen w/ 84 days active and 7 days inactive: withdrawal bleeding 4 time a years; some people prefer that & some doesnt. 2. Lybreel: 28 day cycle NO withdrawal bleeding

Answer 2

Patch worn on stomach, buttocks, outer arm or upper torso; ROTATE SITE to revert irritation, keep integrity of patch (don’t cut), and keep areas clean and dry. Worn for 3 weeks, 1 week allows for withdrawl bleeding; SIMILAR ADVANTAGES TO ORAL form. Disadvantages: skin irritation, mensstural cramps, Change in vision or inability to wear contact lens., not as effective in women over 198 pounds (women weigh over that, its going to change the ability to absorb efficiently. ), Increaased risk for VTE, do not use if women are over 35 and smoke will increase risk of VTE

Answer 3

Has COMBINE HORMONE Take. It out for a week for withdrawal. Still need to use back up contraception, its not that effective. 2 inch inwelling ring that contains estrogen/progesterone. -interred in the first 5 days of menstration into the middle or upper 3rd of vagina, indweling for 3 weeks, removed for 1 week for withdrawal bleeding. - 1st seven days after insertion you have to use back-up-method -if falls out, must be put in within 3hours .. if not, you must use back up method for 7 days. -has increased risk for VTE, vaginal irritation, discharge or infection. (Risk increases in pt smokes)

Answer 4

There are some women that cannot take estrogen because of increase blood clots or VTE. If someone already has a blood clot, not going to put them. On estrogen. Ex: pt with lupus cant go on estrogen. Women who cant take estrogen and can take progestin only pills: -history of VTE -Heart disease -breast feeding -smokers - over 35 -HTN - or this who experience HA, chloasma, lipid changes Side effects: -higher incidence or irregular bleeding -fatigue -decreased libido -depression/mood changes - weight gain Can be given orally, IM, SQ or implantable.

Answer 5

Micronor, Nor QD, Aygestin PLAN B

Answer 6

Ex: Depo-Provera -Prevents ovulation -Injected every 11-13 weeks -an ovulation and amenorrhea If pt late for injection: they need a pregnancy test before injection/13 weeks and 1 day must be ruled out for pregnancy. -risk of decreased bone density and should be stopped after 2years of continuous use MUST increase intake of Ca+ and vit D. (Estrogen holds on to calcium and prevents osteoporosis… the progestin counter interacts and should intake calcium and vitamin D)

Answer 7

Ex: Nexeplon similar to Implanon -inserted for up to 3 years Nexeplon contains barium (radioactive) can be seen on X-RAY, US, CT scan and MRI. -not used to be in women with BMI >30 -99.6% effective …because its implanted inside you!

Answer 8

Missed dose: -miss 1 tab, take as soon as you remember. -missed 2 tabs (yesterday and today), take 2 as soon as realize and 2 the next day; use back up for rest of cycle. -missed 3 tabs; forgets it.. just start a new pack Some drugs decrease effectiveness.. for example, Abx can counter interact with birth control pills; use back up contraception.

Answer 9

Used to prevent pregnancy after unprotected intercourse. SHOULD NOT be used as birth control. Used in 24hrs after unprotected sex 1. CHC in documented effected regimen (has to be prescribed) 2. Plan B (progestin only) 3. Inserting copper-releasing IUD Can be taken if condom breaks, diaphragm or cervical cap dislodged, dose of CHC missed, sexual assault. MUST not be taken if already pregnant, should be taken within 24hrs of unprotected sex

Answer 10

Directly inhibits osteoclastic bone reabsorption/ gives calcium back to the bone - its a treatment for osteoporosis Contraindications: - drug allergy or allergy to salmon. Adverse effects: - flushing of the face, N/D (nausea or diarrhea), and decreased appetite.

Answer 11

Acts similar to the parathyroid hormone. - treats osteoporosis by modifying body’s metabolism of calcium and phosphorus (review relationship btwn -horrors and calcium) - treats osteoporosis. Contraindications - drug allergy Adverse effects: Chest pain, dizziness, hypercalcemia, nausea, arthralgia (pain in joint)

Answer 12

This is VERY acidic. Commonly use to treat and prevent osteoporosis. Inhibits osteoclast-mediated bone reabsorption, which in turn indirectly enhance mineral bone density. Contraindications: Hypocalcemia, esophageal dysfunction (the med is acidic; can get stuck in esophagus and causes burns) pt has to sit up or stand for 30 mins after dosing Adverse effects: HA/GI upset/joint paint. Risk for esophageal burns, if lodged in esophagus, drink full glass of H2O,sit up for 30 mins after.

Answer 13

Ex: menostar Once a week patch used for prevention of post-menopausal osteoporosis. - low does estrogen - reserved for those who are unable to tolerate other therapies -women who still have their uterus intact, progestin recommended every 6-12 mos.

Answer 14

Stimulates estrogen receptors on bone and increases bone density. -prevents post menopausal osteoporosis Contraindications : Drug allergy, pregnant or may become pregnant. Thrombosis disorder Adverse effects: Hot flashes/leg cramps/thrombosis-embolism, leukopenia - decrease the chances of breast cancer

Answer 15

Pair of oval glands located in scrotal sac - produce male sex hormones

Answer 16

Channels to the testes - site of spermatogenesis

Answer 17

Primarily TESTOSTERONE (anabolic steroid) - controls the development and Maintance of male primary and secondary sex characteristics. - helps maintain muscle mass -are the hormones that give men their 'male' characteristics. Androgen deficiency means the body has lower levels of male sex hormones, particularly testosterone, than is needed for good health. are the hormones that give men their 'male' characteristics. Androgen deficiency means the body has lower levels of male sex hormones, particularly testosterone, than is needed for good health. are the hormones that give men their 'male' characteristics. Androgen deficiency means the body has lower levels of male sex hormones, particularly testosterone, than is needed for good health.

Answer 18

Is a type of androgen -produced from interstitial cells btwn the seminiferous tubules. Anabolic activity: involved in development of bone and muscle tissue, and inhibits protein catabolism or break down of protein. - increases RBCs… (erythropoietin effects) usually used for people who have low rbcs (not really used for this anymore; we have other medications) Indications: who takes them? Patients with…. - primary and secondary HYypogonadism ( if they dont have their testes, dont have the hormones to respond to/A failure of the gonads, testes in men and ovaries in women, to function properly. Production of a man's testosterone and a woman's estrogen are inhibited.) - treatment of oligospermia (they’re not producing sperm) -inoperable breast Ca in women (counter act tumor enhancing estrogen activity)

Answer 19

We can use synthetic testosterone to improve the way hormones work. If we combine esters with testosterones, leads to poor PO absorption - we use testosterone for decrease in libido and fatigue (ex: if males feels like they are losing muscle mass, and libido.. have to becareful with using this because it is not reccomended for those with normal levels of testosterones because it’ll increase the side effects.) Example medications: Testosterone propionate: an oily solution that last 2-3 days and it is administered every/q 2-4wks Methyltestosterone/fluoxymestrone: effective w/ oral admin, buccal tab or injectable.

Answer 20

Synthetic drugs that mimics the natural hormone -can be a huge risk of abuse and dependence (used with body builders or athletes… and not used in the US unless they have low levels) - possesses high anabolic activity (he anabolic state is one where the body builds and repairs muscle tissue as opposed to a catabolic state that involves the process of breaking down tissue to replenish depleted energy levels of the body.) - increases muscle mass VERY SIGNIFICANTLY Indications: used for patients who have anemia, hereditary angioedema (swelling of face, lips; it’s cmmon for those who have this hereditary trait, it just happens), metastatic breast Ca, wasting syndrome due to HIV Schedule III drug: needs to have a DEA # to keep track of it; can lead to psychological or physical dependence. Four products available in US: - anadrol-50 -oxandrin -winstrol -nandrolone

Answer 21

A TRANSDERMAL PATCH is used when hormonal replacement therapy is the indication/ do have low testosterone levels. There are two types: 1. Androderm patch: applied to skin (not scrotal) 2. Testoderm: always applied to scrotal skin ( think of “testo” for teste).. always rotate site Pt should wash their hands and cover treated area as transfer to others can occur e; especially Prego women and children. Contraindications: Pts with these conditions, cant take it: - severe renal cardiac or hepatic disease - male breast Ca - prostate Ca -allergy to drug -genital bleeding (because they may have cancer and we dont want to increase hormones) Do NOT allow children to exposed to it, can cause inappropriate enlargement of genitalia, premature development of pubic hair, advanced bone aging, increased libido , aggressive behavior. Nurse considerations: - baseline lab testing BUN/Cr, LFT(LIVER FUNCTION TEST), CE’s (cardiac enzymes), Lipids When giving testosterones, can increase their lipids and cholesterol, as well… have to be mind ful… can increase for heart attack and stroke. Watch for weight gain or electrolyte disturbances (biggest concerns are potassium and magnesium).

Answer 22

When the prostate gets bigger; doesn’t always mean its cancerous; - it starts to close off urinary tract; if urine doesnt go out, that means urinary retention, which leads to renal failure. -Androgens maintain secondary health characteristics, growth and Maintenance of the prostate , often leads to prostate enlargement (BPH) -Process begins at 30 yrs old Causes urinary outflow obstruction: -frequent urination -dribbling -nocturnal (utilizing bathroom at night)

Answer 23

BRAND NAME: proscar GENERIC NAME: fineesteride Mode of action: REDUCES prostate size by inhibiting the enzyme that converts testosterone to 5-alphadihydotesterone (DHT), and eases the passage of urine. / helps prostate shrink and open up urinary tract to help urination flow. Additional Effects: - may increase hair growth in men (sometimes you would see men take his for baldness and increase hair growth) - it’s TERATOGENIC in pregnant women and children Indications (therapeutic uses): - Androgenic alopecia in men - BPH shrinks prostate in 3-6 mos. Contraindicated: -hypersensitivity (if allergic to meds, shouldn’t take it) - pregnant women ( DO NOT HANDLE) category X

Answer 24

10 million men experience ED - 20% of men 65 or older experience it; usually starts in late 40s Treatment: Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis) -You may see women taking Slidenafil for pulmonary artery hypertension. - all erectile dysfunction drugs ends in “-afil”

Answer 25

Brand Name: Viagra Inhibits the enzyme phosphodiesterase, that causes the build up. Of guanosine monophosphate, which then causes the relaxation of smooth muscle in the penis and permits the penis to have an erection/ cause blood flow into the penis. - Viagra needs to be taken 1 hr before intercourse and needs sexual simulation to make the erection happen. Contraindicated: -People who are on Nitrates.(people put it underneath their tongue if they’re having chest pain) its the ONLY true contraindication to ED drugs. If they’re on the nitrates, they should nOT be getting ED medications. -can cause hypotensive effects because of vasodialation. Adverse effect - hypotension -dyspepsia (indigestion) -priapism (erection lasting than 4 hours.. this is a medicAl emergency, if they dont get help, this will lead to a necrotic penis and needs to be removed.) -visual loss

Answer 26

- Oxytocin (Pitocin) -Terbutaline - Magnesium Sulfate

Answer 27

BRAND NAME: Pitocin -used to induce labor (a week or so pass their due date, utilize pitocin to induce) - increases uterine contractility (we have to make sure cervix is dilated) Side effects: HTN, dysrhythmias, hypercontraction of uterus Adverse reaction: seizures, water intoxication

Answer 28

To STOP preterm labor; if its too soon to give birth, use terbutaline. / decreases. Uterine contractions to stop pre-term labor Side effects: tachycardia in mother and fetus

Answer 29

Can be used for pre-termlabor to decrease contractions -may be safer than terbutaline because increases blood flow to uterus, less tachycardia Can be used for pre-eclampsia (Htn, spilling protein into the urine ; A potentially dangerous pregnancy complication characterized by high blood pressure. Pre-eclampsia usually begins after 20 weeks of pregnancy in a woman whose blood pressure had been normal. It can lead to serious, even fatal, complications for both mother and baby.)

Answer 30

There are two: Sympathetic: fight or flight Parasympathetic: rest and digest.

Answer 31

The parasympathetic sytem utilizes ACETYLCHOLINE and it is the NEUROTRANSMITTER that helps activate the parasympathetic system. Within it, we have cholinergic receptors such as, NICOTINIC (which helps with the cells muscle effects )and MUSCARINIC RECEPTORS (which helps with. The smooth muscle and the HR as well).

Answer 32

Located in ganglia of both sympathetic and parsympathetic systems/ helps with the cells muscle effects/effects skeletal muscles/which helps with. The smooth muscle and the HR as well

Answer 33

Located in post-synaptic effector organs (smooth and cardiac muscles, glands) -stimulate smooth muscle and slow hR .

Answer 34

There are two types: -Direct acting -Indirect acting

Answer 35

Is working AT THE RECEPTOR SITE. It doesnt need any help/ stimulate post-synaptic nerve cell release of acetylcholine at the receptor site.

Answer 36

It NEEDS HELP …there’s either an enzyme that is going to help it… it. Needs something to release it; so the medication is not acting on the receptor by itself. / inhibits acetylcholinesterase, (which means inhibiting the break down of acetylcholine), thereby increasing the acetylcholine level, and allowing the parasympathetic system to work….basically inhibiting an enzyme so that the receptors can work

Answer 37

Acetylcholine is an organic chemical that functions in the brain and body of many types of animals as a neurotransmitter -In the somatic nervous system, acetylcholine is used at the neuromuscular junctions, triggering the firing of motor neurons and affecting voluntary movements. -It plays a role in arousal, memory, learning, and neuroplasticity. It also helps to engage sensory functions upon waking, helps people sustain focus, and acts as part of the brain's reward system. Acetylcholine helps maintain rapid eye movement (REM) sleep, the part of sleep during which people dream

Answer 38

Remember the cholinergic system is REST and DIGEST. (Think about parasympathetic sytem is activated) Gi and urinary: increase gastric secretions, motility, urinary frequency ( the meds can increase urinary retention, diarrhea ( can help with people with constipation) ect. ) Miosis: constriction of pupil, decrease intraocular pressure (this medication could be good for patients with glaucoma) Cardiovascular: decreased hr, vasodilation (with this med, can cause hypotension) Lungs: increased secretion and restriction (. Those with COPD and asthma, shouldn’t take these meds because it causes bronchoconstriction). Skeletal: increased contraction (nicotinic)

Answer 39

A cholinergic medication Is direct acting; works right on the receptors Treatment: - we can use it for patients that have post-operative and postpartum non-obstructive urinary retention (so if sone has urinary retention because of a large prostate, we cannot utilize the medication; because this medication will increase urinary frequency by increasing bladder contractions. If we increase contractions and something is blocking it, nothing will happen just cause pain) In order for it to work, bladder can contract but the sphincter needs to be relaxed, to promote urine to come out. - we can also use it for patients who have a neurological disorder for patients who cannot contract/ the meds help the bladder contract -prevent and treat adverse effects of other drugs (ex: bladder dysfunction associated with Tricyclic antidepressant (TCA)) Side effects: N/V/D, heart burn, abdominal cramping, SOB, salivation, sweating, frequent urination, blurred vision Adverse effect: Orthostatic hypotension, bradycardia, muscle weakness, heart block/cardiac arrest, acute asthma attacks Mode of action: stimulates cholinergic receptors, promotes, contraction of the bladder, increases GI secretions and peristalsis, pupillary constriction and bronchoconstriction. Route: po/injection (ONLY SQ), NO IV &IM Contraindications: -severe bradycardia -hypotension -peptic ulcer (remember HCl in stomach is acidic.. this med causes more secreations, not ideal for a person with stomach ulcers) -intestinal or urinary obstruction (bladder can contract, but if theres an obstruction, wont do anything) - active bronchial asthma -COPD -Parkinsonism (the meds already increases contraction; patients w/ Parkinsons already has jerky movements… not ideal for them to take )

Answer 40

We need to get them up and running/ early ambulating and increase fluid intake if not contraindicated. - monitor vital signs (hr, bp) -asses urine output (should be >1500ml) we want t make sure that they are URINATING. If not, they may have something else going on, like a urinary obstruction. -monitor for cholinergic crisis ….. ex: look for muscle weakness & increase salivation (someone can go into. Respiratory failure, because of their muscle weakness of the diaphragm and Aalso the secretions) -Atropine antidote -change position slowly -give 1 hr before or 2 hrs after meals, can give with food if stomach is upset. .. medicine works better on an empty stomach

Answer 41

A direct acting cholinergic. -its typically eye drops, it will constrict the pupils, which allows the canal of schlemm to open up and drain the aqueous humor; which decreases the (intraocular) pressure behind the eye. -drops are used for glaucoma, and promotes miosis in eye surgery - it is also in oral form for patients who have dry mouth.

Answer 42

Cholinesterase (an enzyme) breaks down acetylcholine - only a small amount is needed to breakdown a large amount of acetylcholine.

Answer 43

Use the inhibitors to inhibit the break down of acetylcholine/ Bind with cholinesterase and allowing the action of acetylcholine. -activates muscarinic and nicotinic receptors -smooth muscle stimulation (increased force of contracting; think about pts with urine retention, that take this medicine and to get frequent urination) -bradycardia, miosis, increased GImotility, bronchial constriction (think about the muscles in lungs increase), increased Micturition (urination)

Answer 44

just means we can use the medication to REVERSE it Indications: -produce pupillary constriction in glaucoma - increase muscle strength in patients with Myasthenia Gravis Ex: Prostigmin (short acting), mestinon (moderate acting) Side effects: bradycardia, asthma, peptic ulcers

Answer 45

Antidote for anticholinergic toxicity - Anticholinesterase (indirect-acting) This means it inhibits Cholinesterase and allows the increase of acytocoline Indications: myasthenia gravis, reversal of anticholinergic drug effects of TCA overdose. Contraindications: -dont give when they have a known allergy, if they have asthma, gangrene, prior sever cholinergic reactions, hypothyroidism, CAD, and mechanical obstruction of GI or GU tracts. Adverse effects: GI upset, excessive salivation Interactions: anticholinergics (counteracts effects) -route: iM or IV

Answer 46

AKA Anticholinergics, parasympatholytics, antimuscarnic drugs Are still working in the parasympathetic system, but it is blocking THE PARASYMPAATHETIC SYSTEM, So, this means the ocular pressure will increase (not great for patients with glacoma), hr increase, bp wil increase, secretion in lungs decrease, constriction of lungs decrease , decrease GI MOTILITY AND SECREATIONS (GOOD For patients with diahreah), Urinary retention. MOA: -Block the action of acetylcholine - blocks to parasympathetic nerves allowing sympathetic (adrenergic) system to dominate. Sites of action: Heart, repertory, GI, bladder, eyes, and gland. Cardio vascular: increase HR, dysrhythmias CNS: restless, irritability, disorientation, hallucinations, delirium Eye: dilates pupils,decreased visual accommodation, increased intraocular pressure GI: decreased salivation, gastric secreations, motility GU: urinary retention Glandular: sweating Respiratory: decreased bronchial secretions

Answer 47

An anticholinergics “Atropine is a bradycardia ends in ‘A’” Ex: use for a patient who is coding Indications: treatment for bradycardia (systematic Brady cardia… some athletes have a resting hr of 45, but that doesn’t mean they need to get atropine; Rember SYSTEMATIC BRADYCARDIA, like shortness of breath, dizziness ect. ), pre-op control of secretions (like undergoing surgery and want the secretions of the lungs to decrease), treatment of organophosphate poisoning (insecticides) Contraindicated: Closed angle glaucoma, adhesions btwn iris and lens (can change how the lens can move), certain types of asthma, severe hepatic and renal dysfunction, intestinal atony (means that they already have a slow GI), hiatal hernias, obstruction GI or GU conditions, severe ulcerative colitis, reflux esophagitis. (If a patient is coding, its an excepting… we’ll worry about that later… just give them the atropine) Route: PO/IV/ophthalmic forms - atropine is added to diphenoxylate to make Lomotil (used for patients that have diarrhea) Side effects: Dry mouth, nausea headache, constipation, dry skin, blurred vision, palpitations, urinary retention. Adverse effects: Tachycardia, hypotension (if we increase their hr too long.. the heart cant fill, and if the heart cant fill, there’s nothing to pump out and if there’s nothing pump out, the bp goes down) , V-fib, Stevens-Johnson syndrome, coma

Answer 48

Its an antispasmodic cholinergic blocker/ anticholeinergic medication We use it to treat ibs, colic and entercolitis in infants. (Why? It wil decreased GI secretions, contractions) Contraindicated: Known drug allergy to anticholinergics, angle closure glacoma, GI tract obstruction, myasthenia grains, paralytic ileus, GI atony . Toxic mega colon. Route: PO/IV

Answer 49

An anticholinergic Indications: We want to decreassse the rigid muscles and tremor in Parkinson’s disease./ used to decrease the rigidity, tremors of Parkinson, little effect on bradykinesia due to drug-induced Parkinsonism (phenothiazines)/ meaning if patient is already taking phenothiazines, cogentin will have little effect on pt.) Mode of action: Parasympatholytics, which is cogentin, inhibit release of acetylcholine./ it inhibits the acetylcholine that helps the less movements of Parkinson’s disease. Examples: arcane, cogentin, akineton, parisdol, norflex, occasionally Benadryl. Side effects: Dry mouth, dry secretions, urinary retention, constipation, blurred vision, hr increase. Restlessness, confusion Life threatening: paralytic ileus Contraindicated: glaucoma

Answer 50

An anticholinergic Indications: For pts with overactive bladder because of a neurologic disorder (DONT use this medication if pt has urine retention)/ overactive bladder, antispasmodic for neurogenic a/w (alive and well) spinal cord juries and spina bifida. Contraindicated: Drug allergy, GU/GI retention, uncontrolled angle closure glaucoma (because of increase ocular pressure) Route: PO/Transdermal patch bladder Nursing considerations of patch use: Remove previous dose, then apply to clean, dry, non-hairy skin, rotate sites (decreases skin irritation) Take 1 hour before meals or 2 hours after with fluids. It works better without meals.

Answer 51

An antcholinerigic Indications: a med for overactive bladder/ urinary frequency, urgency, urge incontinence caused by bladder over activity. (This med works on the bladder receptor; patients gets less dry mouth, because it works directly on the bladder.) -used more often than other similar drugs b/c has lower incidence of dry mouth as a result of its high specificity to the bladder as opposed to the salivary glands. Contraindicated: Angle closure glaucoma, urinary retention, decreased hepatic function. • If poor metabolizers (elderly) or taking other drugs metabolized by cytochrome P-450 3A4 (ketoconazole, erthrothromycin start with 1mg twice daily. (1/2 nml starting dose) …. P-450 is a pathway in the liver that it goes through and it may become. Toxic or it doesn’t work. Route: PO .. take w.o food Side effects: dry mouth, eyes and skin, HA, dizziness, vertigo, N/V/D/C abd pain, urinary retention Grapefruit juice may increase drug levels.

Answer 52

Scopolamine: - patch behind the ear, wrist bands -patched used for 3 days Other examples: -Dramamine (helps with nausea) -Antivert (vertigo) -Ginger, ginger gum -whenever you go on a trip, take meds before hand/days before trip.

Answer 53

- assess urine output (we want to make sure they dont have urinary retention) - check hx (check if they have glaucoma) - monitor vital signs ( the meds can cause hr and bp to go up… or get orthostatic hypotension) -check for dry mouth. - monitor bowel sounds

Answer 54

Adrenergic drugs activates the sympathetic system. Sympathomimetic: mimic the effects of the catecholamines (norepinephrine, epinephrine, and dopamine) - Flight or flight -heart rate will increase, dialated pupils, increased bp, CO increase, GI motility will decrease, urine decrease, and broncho tubes dilates (these drugs are good for patients with asthma and COPD ) -think about when you are running away from something

Answer 55

Beta Adrenergic: Beta 1 (Heart) Beta 2 (lungs, visceral organs) Alpha adrenergic: Alpha 1 (tissues, muscles, organs) Alpha 2

Answer 56

The HEART is primarily made up of Beta 1 … *remember it by: “you only have 1 heart.” -when Beta 1 is activated, increases HR, BP (indirectly increase it because if the hR goes up, the BP automatically goes up), and Cardiac output.

Answer 57

The LUNGS are primarily made up of Beta 2. *remember it by: “you have 2 lungs”. -if we activate Beta 2: bronchodialation (used in patients who have bronchospasm, asthma or COPD),

Answer 58

When it is activated, there is potent vasoconstriction Blood vessels are constricted, that creates increase in blood pressure.

Answer 59

When they are activated, we see in the kidneys, the gut, and coronary arteries, and cerebral arteries in the brain, all DIALATE. When dialte, it increases blood flow to the tissues and they work better. -in the peripheral blood vessels, it will constrict and increase BP./ When stimulated cause the vessels of renal, mesenteric, coronary and cerebral arteries to dialate. Thus, increasing blood flow to peripheral arteries/ theses tissues.

Answer 60

Are drugs that mimic the sympathetic system. They can either be indirect acting, direct acting or mixed-acting adrenergic Direct acting: work right on the receptor/binds directly to the receptor causing a response/ they need no help) Ex: epinephrine Indirect acting: either a catecholamine that helps them , a storage space or an enzyme that helps. / causes a release of catecholamine from the vesicle (storage site) in the nerve endings, then binds to receptors causing response (ex: amphetamine) Mixed-acting adrenergic: a lil bit of both / acts directly by binding directly to the receptor site and indirectly by stimulating the release of the euro transmitter from the vesicles. (Ex: ephedrine).

Answer 61

Location: within the blood vessels—Receptor: Alpha 1— Response: if we activate alpha 1 within the blood vessels, we get VASOCONSTRICTION; that means we get increased BP Location: within the blood vessels. LUNGS—Receptor: Beta 2– Response: vasodialation in the lungs; that means the blood flow to the. Lungs will increase Location: within the cardiac muscles—Receptor: Beta 1— Response: increased contractility which is known as a +inotrope (that means it will increase cardiac output) we use + inotrope for patients who have heart failure because we want to increase their CO to help blood flow to the tissues. Location: AV node — Receptor: Beta 1— Response: increase HR (+ chronotrop) “how i remember chronotrop is chronological order… increasing time or increasing HR”. Location: SA node —Receptor: Beta 1— Response: increased hR Location: Liver (endocrine)—Receptor: Alpha 1, Beta 2— Response: Glycogenolysis; break down of glycogen. It increase blood sugar level in the kidneys. Location: Kidney —-Receptor: Beta 1— Response: The beta 1 increases RENIN secretions, which increases BP. Location: GI Muscle — Receptor: Alpha 1 & Beta 1–Response: Decreased motility (relaxation of GI smooth muscle)/ decreased contraction Location: GU Bladder, Sphincter— Receptor: Alpha 1—Response: constriction/ thats why we dont urinate…constrict the sphincter Location: bronchial muscles—Receptor: Beta 2 — Response: dilation (relaxation of bronchial smooth muscles)/ open up the bronchial tubes. Good for COPD or asthmatic pts. Location: pupillary muscles of the iris — Receptor: Alpha 1– Response: dilation of the pupils (Mydriasis); an increase in ocular pressure **LOOK AT SLIDE 8 & 7**

Answer 62

When we are talking about adrenergic agents, we consider them vasoactive,a n they are typically CARDIO SELECTIVE. -we use them in pts who have are in shock, decompensated heart failure, heart failure or congestive heart failure, to increase cardiac output and increase blood pressure. -Sometimes we can use this for patients who have orthostatic hypotension, that is NOT related to dehydration. -theses are typically fast acting -have to becareful when we titrate them because small increments make VERY big effects. -main concern is tachycardia and dysrhythmias are going to be the side effect. Remember they are cardio selective, so they are going to activate that cardiovascular system. / -Primarily cardio selective effect - used to support failing heart or treat shock - treatment of orthostatic hypotension -fast acting -careful titration and monitoring of vital signs

Answer 63

Is a vasoactive Adrenergic/ Class: Beta 1 adrenergic Beta 1 means it will work primarily in the heart and we will see that the hr will increase and cardio output. -we use this to increase cardio output -ex: pts in heart failure or post heart surgery when the heart is not pumping effectively, we would put them on the dobutrex.. will increase perfusion to all the other tissues, including the kidneys (which will help the kidneys filter efficiently/or get all the fluid off if they are in heart failure). -* Manly used to improve CO -*our main concern we are going to worry about is tachycardia and dysrhythmias / Indications: cardiac decompensation MOA: increases cardiac output, increased contractibility (+ inotrope), increase stroke volume. Adverse Effects: H/A, restlessness, HTN,, tachycardia, palpation, dysrhythmias

Answer 64

It can increase CO, but that is not how we typically utilize it. **We utilize it for increasing BP (think of the “P” in dopa”) if pt have hypotension or going into shock/cardiac arrest. Or we can use it in low dose to help dilate blood vessels to the kidneys (and improve kidney function) , gut and brain. -low dose dopamine can be used for pts who have renal failure/ insufficiency - we should be worried about tachycardia, because it can activate the heart too much. -this is rapid infusion. -can cause significant infiltration and can cause damages too the blood vessels, which can also cause necrosis… we have to be careful with this. Phenotoamine can help with the necrosis. / Potent dopaminergic effects, beta-1, alpha-adrenergic receptor activity depending on the dose. -low does 2-4 mcg/kg dopaminergic activity: dilates blood vessels in kidneys, brain, heart, mesentery. Increase blow flow to all these areas —higher doses beta 1 activity increase intake cardiac contractility and output. Indications: shock, cardiopulmonary arrest Contraindicated: catecholamines secreting tumor of adrenal gland (pheochromocytoma) -IV infusion…. If extravasation.. phentolamine (alpha blocker)

Answer 65

Utilize for someone who is in shock, because it activates Alpha and Beta 1 &2 ( remember beta-1 increase in cardiac output and hr, and indirectly increase bp; we can use it in someone who has cardiac arrest) -it also activates beta 2 (it will bronchodilator; we use this for pts thats in anaphylactic shock…which means they would have decrease in bp and bronchoconstriction and swelling.. so the epinephrine will increase the bp and bronchodilate and decrease the swelling) ex: epi pens for someone in anaphylactic shock -dont give it PO because it inactivates in the GI tract. -think about when you are nervous, the epinephrine will cause this reaction: jittering, nervousness, …. - any meds that lower bp and hr… can counter interact / Acts directly on alpha and beta receptors of tissues innervated by the SNS, strengthens cardiac contraction, bronchodialtions, increased HR, CO Indications: anaphaylaxis, cardiogenic shock, severe hypotension, cardiac arrest Given SQ, IV, IM; inactivated in the GI tract Side effects: anorexia, N/V, nervousness, tremors, agitation, HA, weakness, pallor, sweating, dizziness Adverse Effects: palpitations, tachycardia, HTN, dyspnea, necrosis, gangrene if IV infiltration Life Threatening: V-fib pulmonary Edema Drug interactions: increased effect with TCA, MAOI, decreased effects with BB, Methyldopa, Digoxin may cause dysrhythmias.

Answer 66

Norepinephrine only activates alpha-1 and beta-1 Will activate the Alpha 1 (when we activate alpha 1 remember it causes vasoconstriction… increase bp and hr) -*it does NOT effect Beta 2 (so think about the the “NO” in norepinephrine.. NO Beta 2”… so who should not get norepinephrine? : pts who has anaphylactic because this med will not help it.. it will be pointless.. only epinephrine. / -direct stimulation of alpha-adrenergic receptors causing vasoconstriction, also direct stimulation of beta-1. NO BETA-2 indications: hypotensive states (shock, s/p OHS) -Continuous infusion

Answer 67

It is going to increase the bp; has alpha-1, which is going to vasoconstrict (increase bp) Used for pts with hypotension and Paroxysmal SVT (parao means it comes and goes… ) SVT = Superventricular tachycardia; the heart is at a regular rhythm you but its over 150 bpm. - it is also used as a topical ophthalmic treatment and a nasal decongestant ( constricts the blood vessels in the nose. If constricting the blood vessels in the nose, it is going to decrease the secretions.) “Think of ‘Neo” for nose” / Alpha- adrenergic receptor Indications: hypotension , Paroxysmal SVT - Also used as ophthalmic treatment, nasal decongestant

Answer 68

Is a beta-2 andrenergic agonist.. it will activate the sympathetic system. When beta 2 is activated, it will dialte the broncho tubes. Used for patients with asthma or COPD - Becareful pts with cardiac disease -* Albuterol is the ONLY rescue medication for COPD and asthma. / Therapeutic use: treat bronchospasm, asthma, bronchitis, and COPD MOA: stimulates beta2- adrenergic receptors in the lung which relaxes the bronchial smooth muscle resulting in bronchodilation - PO, INH (inhaler/ nebulizers) Contraindications: Cardiac dysrhythmias, coronary artery disease Caution: severe cardiac disease, HTN, hyperthyroidism, DM, renal dysfunction, elderly, pregnancy Side Effects: tremor, nervousness, dizziness, restlessness, sweating. Blurred vision, flushing, HA, hoarseness, insomnia Adverse reactions: palpitations, tachycardia, Htn, hallucinations, seizures, hyperglycemia Life threatening: cardiac dysrhythmias, Steven-Johnsons syndrome Drug interactions: increased effects with sympathomimetic, TCA, MAOI, decreased effect BB

Answer 69

Alpha 2 is a centrally acting medication that causes vasodialation. Once we activate Alpha 2, we are going to dialate the blood vessels and lower blood pressure -Used to treat HTN - whenever we are centrally acting, side effects are always going to be sedation, confusion, dizziness , because we are decreasing brain activities.

Answer 70

Centrally acting medication (Alpha 2) “press against cat..’catecholamine’ “ -utilize it for HTN / treat high blood bressure - can be used in pts with menopause who cant take estrogen, we use this to sedate, decrease anxiety, and insomnia./ causes somnolence

Answer 71

- used to treat HTN (typically used for RENAL pts)

Answer 72

Are located on the nerves, and have inhibitory effect on the sympathetic nervous system. - vasodilation (bp decrease)

Answer 73

Will block the sympathetic system. They would activate the parasympathetic. ) Eyes will constrict, ocular pressure will decrease (good for pts with glacoma), hr decrease, bp decrease, CO decrease, GI (nothing will happen Cardio and respiratory selective not going to really see S&S in GI & GU) -If we block Beta-1 what will happen?: cardiac output decreases, decrease hr, decrease bp -If we block beta-2: bronchoconstriction of the lungs (not good for asthma and COPD pts.)

Answer 74

Blocks Alpha-1 -so we are going to see a decrease in bp (vasodilations), pupillary constriction (used for pts with glaucoma, and also will see bladder and prostate smooth muscle tone reduction). / Interrupt the SNS at the Alpha-1 receptors -displace norepinephrine from receptor -vasodilation - reduced blood pressure -Miosis (pupillary pressure) -reduced smooth muscle tone (bladder and prostate)/ going to relax the bladder and the prostate, which will decrease the symptoms of BPH (begin prostatic hyperplasia); allows the urinary output tract to be open up and decrease in BPH symptoms. -notice the alpha blockers for both BPH and HTN end in “azosin” Ex: Doxazosin, prazosin, terazosin Indications: HTN, BPH, Raynaud’s Ending “-osin”, these are alpha blockers that are more used for BPH. EX: Tamulosin (Flomax), Alfuzosin (Uraoxatral) Again… These are alpha blockers “Osin” used for only BPH “AZOSIN” IS for HTN and BPH

Answer 75

Is an alpha blocker, but has a high infinity to the bladder and the prostate. So it does not work on the peripheral alpha/ doesnt cause vasodilation. **It ONLY works on the prostate, and the bladder (When you have a higher affinity for the tissue, you will have less effects in the other tissues.) / Indications: treatment of BPH (BPH symptoms includes frequent dribbling, nocturia, poor urine flow, urinary frequency) MOA: relaxes smooth muscle fibers within the bladder and prostate improving urinary flow Contraindications:drug allergy, concurrent use of ED drugs (ex: slidenafil) / have to becareful with erectile disjunction drugs (remember the ONLY absolute contraindications of ED drugs are nitrates) Adverse effects: H/A, abdominal ejaculation, rhinitis Drug interactions: alpha blockers, Ca+ blockers, ED drugs PO

Answer 76

There are different types of beta blockers: -Selective (Beta1) aka Cardio Selective - Non-selective (Beta-1 and Beta-2) -Alpha-Beta blockers

Answer 77

Selective (Beta-1) aka Cardio selective “cardiO ‘OlOl’” This means that they work primarily. On beta-1 MOA: the heart rate will decrease,vasodialation (decrease in BP), decrease in CO… but we are going to see LESS SIDE EFFECTS IN THE LUNGS because it is really focusing on Beta-1 Theses meds are better for people that have COPD and Asthma, cause we are not going to see that much side effects in the lungs Ex: Metorolol, Atenolol, Esmolol (She’s not going to ask us which beta blocker is selective or not selective, just recognize that the beta blocker ENDS IN “olol”)

Answer 78

Non-Selective (Beta-1 and Beta-2) They both block bOTH beta-1 and beta-2 -if they block beta 1: decrease bp, decrease hr, and cardiac output -if they block beta 2: bronchoconstriction (not preferred for asthmatic and COPD) Remember …The beta-1s are NOT used to treat asthma & COPD, they are better choices for someone that needs a beta blocker for someone who has asthma or COPD and it doesn’t effect the lungs as much. Ex:propanolol , nadolol

Answer 79

This mean that it will block Alpha-1 ..if we block alpha1, will cause vasodialation (decrease bp) Also gonna block Beta-1… if we block beta1, decreases bp, hr, and co We have TWO pathways that is decreasing bp (alpha and beta pathway) We can see a GREATER decrease in bp with Alpha-Beta blocker than with Beta-Blockers Ex: carvedilol,labetolol

Answer 80

—-> Alpha-Beta

Answer 81

We use BB because it can decrease hr (espiecially for someone who has dysrhythmias, tachycardia), use it to decrease contractility, decreased CO -we dont want to decrease CO in pts who are already decompensated (or having an exacerbation of heart failure) however, we do know even if the pt has heart failure that is not decompesntated, it can help pts with heart failure, because that decrease in cardiac output will actually decrease the cardiac oxygen demand and helps the heart work efficiently. Allows the heart to WORK better, without using more energy. Then it also decreases the release of renin, which decreases Angiotensin II, which in turn, causes VASODILATION (so we can use it HTN).

Answer 82

Purpose: - decrease heart rate (negative chronotrope) - decreased contractility (negative inotrope) decreased CO -Reduces release of renin which decreases Angiotensin II (VASODILATION) Indications: in general, BB is utilize in pts who an MI (it helps slow down the conduction, so it helps prevents dysrhythmias that sometimes occur after a heart attack), helps with angina (decreases the cardiac oxygen demand, so the heart doesnt need that much oxygen to work efficiently, so the BB will decrease the angina), we can use it to decrease cardiac dysrhythmias because it decreases the conduction (slows the hr down), use it for HTN, use it for heart failure (causes the heart to work efficiently, as long as they dont have a decompensated heart), we can use it for people that gets a lot of migraines Contraindications: known drug allergy, uncompensated HF, shock (they already have a low bp), heart block (when the conduction is already slow), bradycardia, pregnancy, severe pulmonary dx (can constrict beta-2 or bronchoconstriction in asthma and COPD.. better alternative would be a Beta-Selctive, so it wont effect them), Raynud’s Side effects: mild and transien, bradycardia, AV block (slows down heart conduction), hypotension, bronchoconstriction, mask symtoms of hypoglycemia (diabetics..you have to let them. Know that the usual symtoms with hypoglycemia which is jitteriness, tachycardia, sweaty, the BB will block that reaction), inhibits glycogennolysis (helps prevent the blood sugar release) -Acute withdrawal can occur.. we cant just take them off, unless they are in acute HF. If taking ooff right away, they can get HTN crisis, exacerbate angina, MI Interactions: -if we have two BB combine, it will have a significant drop in bp; have to be careful. / Additive effects of similar acting drugs -Bradycardia and hypotension… calcium channel blockers (ca+ blockers) can cause hypotension -Antacids may decrease absorption/ antacids lowers the acidity in the stomach, so it can interfere with the absorption .. the recceomendation is to separate the meds btwn 2hrs -Masks the effects of hypoglycemia

Answer 83

We should tell pts not to discontinue their meds abruptly. - Advise clients to avid sudden changes in postion to prevent orthostatic hypotension/ Dont get up too quick! - Take with food to increase absorption -Tell pts to monitor hear rate and blood pressure

Answer 84

Indicated for pts with BPH. Has a HIGH affinity for bladder and prostate… ONLY INDICATOR IS BPH Check for less frequency and more improvement for symptoms

Answer 85

See the effectiveness with the decrease of blood pressure.

Answer 86

Remember they are going to lower blood pressure MORE. Look for decrease in blood pressure.

Answer 87

Systolic BP >140 Diastolic BP >90 Need meds There are two types of hypertension: Essential HTN Secondary HTN

Answer 88

The most common type 90% with HTN are essential Risk factors: - Family HTN - Hyperlipidemia (theres a higher chance of plaque forming in arteries…. Makes lumen smaller, bp higher) - African-American - diabetes (higher blood viscosity smaller blood vessels) -obesity Aging - stress Excessive smoking and ETOH

Answer 89

10% of HTN are secondary It is related to renal disorders and Endocrine disorders / hormonal or kidney disorder…more often it is a kidney disorder.

Answer 90

Kidneys: control blood volume / fluid volume, RAAS (renin angiotensin-aldosterone system) Blood vessels (ex: it constricts when bp is low) Hormones

Answer 91

*Baroreceptors in the Aorta, Carotid Sinus, Vasomotor center in the Medulla *look at slide 5 for mor info* You’re gonna have too read slides … missing flash cards for HTN, ARBS ect. PowerPoint

Answer 92

Diet with excess fat and carbohydrates increase BP - alcohol increases Renin secretions causing production of angiotensin II increasing BP - obesity causes increase cardiac output, stroke volume and LV (left ventricle) filling / the heart has to work extra harder; being over worked

Answer 93

Develop HTN earlier than caucasians. Higher mortality rate than in Caucasians *low renin hypertension dont respond well to Beta-Blockers and ACE inhibitors

Answer 94

Higher response to Beta-blockers and other hypertensive ; Lower does is often needed

Answer 95

Resistance to beta blockers Need a higher dose

Answer 96

Typically SBP>140 needs meds >160 typically needs two meds

Answer 97

-Diuretic -Sympatholytic -Direct-acting arteriolar vasodilators - ACE inhibitors -ARBS -Calcium channel blocker

Answer 98

Help to improve BP by getting rid of Sodium and water… BP is going to be lower Effective 1st line treatment Hydrochlorothiazide is typically used or combined with another drug . Causes vessels to dilate. Typically use for MILD HTN with no other comorbidities. Avoid use in renal insufficiency Maybe used in combination with potassium sparing drugs to minimize K+ loss Because can lose potassium while on this drug.

Answer 99

Beta-Adrenergic blockers • Centrally acting alpha 2 agonists • Alpha-adrenergic blockers • Adrenergic neuron blockers • Alpha1-beta1 adrenergic blockers

Answer 100

Beta-blockers Can be used in combination with diuretics for BP control - used in HTN, anti-angina, MI , dysrhythmias - Decrease HR, BP, contractility -* in African-Americans for HTN not usually effective, combine with diuretic. -* cardioselective has less bronchoconstriction, however at higher dose, bronchoconstriction can occur -we are not using it on decompensated HF.

Answer 101

Antihypertensive; beta-1 blocker Pregnancy category: C (D in second and third trimester) *Remeber that the PO onset is gonna be longer than the IV onset The dosage of the IV is going to be the quarter of the dosage of the PO .. Rember the PO version you’re going to lose someon the liver and the gut. Ex: typical dose the PO is 25mg .. in IV version would be 5mg. Contraindications - second and third degree heart block -Cardiogenic shock - decompensated HF -bradycardia Interactions: Digoxin (bradycardia) Anti hypertensives and ETOH (hypotension) Lower the bp even more Caution Hepatic and renal faiulre Asthma Diabetes (Rember Betablockers masks the symptoms of hypoglycemia) Thyroid dysfunction PVD Side effects Fatigue (usually tell them to take them at night time to avoid this side effect), weakness, dizziness, N/V/D, mental changes, impotence, decreased libido (esPecially in males, ED), depression Adverse : Bradycardia, thrombocytopenia, complete heart block, bronchospasm, agranulocytosis. Nursing considerations: Obtain vital signs (BP ) prior to drug administration - check lab values prior to administration - taper down dose to avoid rebound effect. We dont want them to have rapid withdrawl Instruct pt to rise slowly; orthostatic hypotension Teach pt how to take BP an radial puls

Answer 102

Remember alpha 2 vasodialates blood vessels. Central acting causes sedation Decrease sympathetic activity by stimulating alpha2 receptors resulting in decreased vagus activity, decreassed cardiac output, decreased PVR and increased vasodilation. Typically beta blockers are not given in conjunction b/c increased bradycardia and rebound hypertension with disconsolation therapy.

Answer 103

Centrally acting alpha2 agonist Has high dose of sodium and water retention; its typically used in conjunction with diuretic - one of the 1st drugs used for hypertension - DONT use in pt with hepatic dysfunction, monitor LFTs - used to treat pregnancy induced HTN or chronic HTN

Answer 104

Centrally acting alpha 2 agonist Indications: HTN PO or transdermal patch Pregnancy C Side effects: DROWSINESS, dizziness, dry mouth

Answer 105

Blocks the alpha adrenergic receptors Causes vasodilation, decrease renal blow flow Decrease LDL and increase HDL Safe with pt with diabetes because they do not effect glucose metabolism.

Answer 106

Remeber ‘azosin’- treat BPH and HTN Drug class: antihypertensive, alpha adrenergic blocker Indications: HTN, refractory HF, BPH Very often with alpha adrenergic blockers, can have a major drop in their bp; rebound effect. Or rebound tachycardia. MOA: Dialtaion of peripheral vessels via blocking alpha adrenergic receptors PO Contraindicated: Renal disease Side effects: dizziness, drowsiness, H/A, N/V/D, impotence, vertigo, urinary frequency Adverse reactions: orthostatic hypotension, palpitations, tachycardia, pancreatitis Drug interactions: increase hypotensive effects with other anytihypertensives, nitrates, and ETOH Nursing considerations: Monitor vital signs Monitor creatine Desired effects may take 4 weeks Any sudden decrease in BP should be reported May cause sodium and water retention Change postion slowly … may cause orthostatic hypotension Importance may occur tell pt to report provider.(impotence is when males cant get an erection)

Answer 107

Break up the sympathetic system/ peripheral acting sympatholytics (Reserpine) Potent antihypertensive Block the release of norepinephrine so it decreases BP. Decrease in CO and peripheral vascular resitance ( Orthostatic hypotension main side effect, however vivid dreams, nightmares and suicidal ideation Can cause sodium and water retention, may be taken alone or with diuretics.

Answer 108

Hydralazine and minoxidil Potent vasodilator that causes relaxation of smooth muscles of the blood vessels - promotes blood flow to the BRAIN and KIDNEYS Peripheral edema often occurs May induce rebound tachycardia and beta blockers are typically concurrent treatment Side effects: tachycardia, palpitations, edema, nasal congestion, H/A

Answer 109

Inhibits the angiotensin converting enzyme which then inhibits angiotensin II (a potent vasoconstrictor) and block the release of aldosterone These work very very well to treat HTN. causes vasodilation with little effect on HR or Cardiac output ACE inhibitors is K+ sparing.. check potassium levels Examples : benaze pril(lotensin), captopril (Capoten), enalapril (vasotec), Fosinopril (monopril), ramipril (altace) Notice the “pril” ending Side effect: orthostatic hypo., cough, hyperkalemia, angioedema. Think of ‘prilACE”

Answer 110

Similar to ACE inhibitors preventing the release of aldosterone. They lock ANGIOTENSIN II at the AT1 receptors Causes vasodilation and decreased PVR Do not cause dry cough. DO NOT USE IN PREGANCY Examples: valsartan, irbesartan, candesartan, olmesartan, telmisartan “Sartan” endings Think of. ARB Sartan”

Answer 111

Class:An ARB , antihypertensive Remember, if someone who had a Heart attack or strok, they should be on an ARB or ACE inhibitor, it will decrease the morbidity and mortality if pt have HF should be on an ARB or ACE to decrease the morbidity and mortality. It can also delay the progression Of diabetic neuropathy./delay the process of kidney damage DONT USE IN. PREGANCY Watch out for creatine levels.. it can increase creatine levels.. which mans declining kidney function. Indication: hypertension, MI, and stroke prevention, HF, delay progression of diabetic nephronpathy. SE: dizziness, drowsiness, hyperkalemia Adverse reaction: orthostatic HTN, hypoglycemia Life threatening:renal dysfuction Drug interaction: Anti HTN, MAOI, ETOH may increase hypotensive effects, ACE inhibitors and ASA may increase Hyperkalemia and renal dysfunction, NSAID may increase renal dysfunction, may increase lithium toxicity.

Answer 112

All calcium channel blockers are good for angina Two groups of calcium blocker 1. Verapamil (Calan) Diltiazem (carizem) These medications lower HR and BP … they lower BOTH. Therapeutic use: angina, HTN, cardiac dysrhythmias S/E: bradycardia, dizziness, hypotension, constipation 2. Amlodiprine (Norvasc) Nifedipine (Pracardia) ONLY lowered BP. Doesn’t affect HR. Therapeutic uses: angina, Htn Side effects: dizziness, hypotension, ankle edema Nifedipine — reflex tachycardia

✅EXAM 1 Flashcards

(136 cards)