Exam 3

Question 1

Quinidine & Procainamide

Answer 1

Class 1a sodium channel blockers

prolongs action potential, moderate strength, for both atrial and ventricular arrhythmias

Quarter Pounder

Question 2

Lidocaine

Answer 2

Class 1b sodium channel blocker

shortens action potential, weak, for ventricular arrhythmias and ischemic tissue

Lettuce

Question 3

Flecainide & Propafenone

Answer 3

Class 1c sodium channel blockers

minimal effect on action potential, strong, for SVT and refractory arrhythmias

Fries Please

Question 4

Class 2 Beta blockers

Answer 4

(the LOLs)

Action: block beta-adrenergic receptors, reducing HR, contractility and bp

Use: HTN, HF, arrhythmias, post MI, angina, migraines

Adverse Effects: bradycardia, fatigue, hypotension, bronchospasm (non-selective), depression

Contraindications: severe bradycardia, heart block, asthma (non-selective)

Interactions: Calcium channel blockers (bradycardia), insulin (masks hypoglycemia), NSAIDs

Question 5

Amiodarone & Dofetilide

Answer 5

Class 3 Potassium channel blockers

prolong the action potential duration and repolarization and increase the refractory period (preventing reentry of arrhythmia), useful for AFib and Ventricular arrhythmias

due to QT prolongation, risk of TORSADES DE POINTES (twisting QRS complex, rapid irregular heart rhythm, HR between 150-300, which can lead to VFib)

A Dog Plays Kickball

Question 6

Verapamil & Dilitazem

Answer 6

Class 4 Calcium channel blockers

used for rate control in AFib and SVTs

Slows AV node conduction

Very Delicate Heart rate control

Question 7

Adenosine

Answer 7

nucleoside

slows HR for SVT

A Dash of Speed (works fast, short duration)

Question 8

Digoxin

Answer 8

glycoside

treats HF and AFib, increases the force of heart contractions while slowing HR

D - do not admin if HR is less than 60
I - increases calcium
G - goes slow (slows HR)

digoxin toxicity symptoms: confusion, dysrhythmia, nausea, vision changes

Question 9

Coronary artery disease (CAD) disrupts the heart’s ability to

Answer 9

meet its oxygen demands by impairing blood flow through the coronary arteries

normally, the heart regulates oxygen supply by adjusting coronary artery dilation and constriction. CAD compromises the balance

Question 10

Isorbide dinitrate & Nitroglycerin

Answer 10

Nitrates

dilate veins more than arteries, reducing preload and afterload, and reducing cardiac oxygen demand, used for angina relief

Action: convert to nitric oxide, leading to vasodilation and reduced myocardial oxygen demand

Use: angina, HF

Adverse Effects: headache, hypotension, reflex tachycardia

Contraindications: hypotension, concurrent PDE-5 inhibitor

Interactions: PDE-5 inhibitor, beta blockers

ID - slower onset, longer duration
N - faster onset, shorter duration

I Need Oxygen!
I - Isorbide Dinitrate
N - Nitroglycerin
O - increases oxygen supply to the heart by vasodilation

Question 11

Amlodipine & Nifedipine

Answer 11

calcium channel blockers

The pines vasodilate and block calcium to relieve angina

Question 12

ACE Inhibitors reduce _______ and improve ________

Answer 12

reduce afterload and improve blood flow

Question 13

ACE inhibitors

Answer 13

The PRILS

Action: block the conversion of angiotensin I and II, leading to vasodilation and reduced bp

Use: treat HTN, post MI, and diabetic nephropathy

Adverse Effects: dry cough, hyperkalemia, hyptotension, andioedema, renal dysfunction

Contraindications: pregnancy, history of angioedema

Interactions: NSAIDs, potassium-sparing diuretics, lithium

Question 14

valsartan/sacubitril/(Entresto)

Answer 14

ARB
(the SARTANs)

Action: blocks angiotensin II receptors, inhibits neprilysin (increasing natriuretic peptides for vasodilation)

Use: HF with reduced ejection fraction

Adverse Effects: hypotension, hyperkalemia, dizziness, angioedema

Contraindications: pregnancy, history of angioedema, CONCURRENT ACE INHIBITOR USE

Interactions: NSAIDs, potassium-sparing diuretics, lithium

Question 15

Calcium channel blockers

Answer 15

Action: block cancium influx into cardiac and vascular smooth muscle, leading to vasodilation and reduced contractility

Use: HTN, angina, arrhythmia

Adverse Effects: peripheral edema, constipation, dizziness, hypotension

Contraindications: severe HF, hypotension

Interactions: beta blockers, grapefruit juice

Question 16

Digoxin

Answer 16

Action: inhibits sodium/potassium ATPase, increasing intracellular calcium for stronger cardiac contractions and slowing AV node conduction

Use: HF, AFib

Adverse Effects: nausea, vomiting, visual disturbances (halos), arrhythmias

Contraindications: VFib, hypokalemia

Interactions: diuretics, amiodarone, beta blockers

Question 17

Direct acting vasodilators

Answer 17

Action: relax vascular smooth muscle, leading to vasodilation and reduced bp

Use: hypertensive emergencies, HF

Adverse Effects: reflex tachycardia, hypotension, headache, edema

Contraindications: coronary artery disease, mitral valve disease

Interactions: beta blockers, diuretics

Question 18

Diuretics

Answer 18

Action: increase urine output by inhibiting sodium and water reabsorption in the kidneys

Use: HTN, HF, edema

Adverse Effects: electrolyte imbalances, dehydration, hypotension

Contraindications: severe renal dysfunction, dehydration

Interactions: NSAIDs, digoxin, lithium

Question 19

Dobutamine

Answer 19

Action: Beta-1 agonist that increases cardiac contractility and output

Use: acute HF, cardiogenic shock

Adverse Effects: tachycardia, arrhythmias, HTN

Contraindication: hypertrophic cardiomyopathy, sever hypotension

Interactions: beta blockers, MAO inhibitors

Question 20

the function of the thyroid gland

Answer 20

regulate metabolism

Question 21

levothyroxine/Synthiroid

Answer 21

Category: synthetic thyroid hormone (T4)

Indications: hypothyroidism

Contraindications: untreated hyperthyroidism, recent MI, uncorrected adrenal insufficiency

Adverse Effects: nervousness, tremors, tachycardia, palpitations, weight loss, insomnia, cardiac arrhythmias, angina, thyroid storm

Interactions: reduced absorption with calcium, iron and antacids, NSAIDs, increased effects with warfarin

Available Forms: tablet, IV

Nursing Considerations: admin in the morning on an empty stomach to enhance absorption, monitor TSH levels regularly, watch for signs of overdose (tachycardia, tremors, head tolerance), educate patients to avoid witching brands without consulting a provider

Question 22

iodine-131

Answer 22

Category: antithyroid: radioactive isotope used for thyroid ablation

Indications: hyperthyroidism (Graves disease), thyroid cancer (to destroy remaining thyroid tissue after surgery)

Contraindications: pregnancy and breastfeeding, sever ophthalmopathy, young children

Adverse Effects: hypothyroidism, radiation thyroiditis (temporary inflammation), sore throat/dry mouth

Interactions: avoid antithyroid drugs (before treatment, reduce iodine uptake)

Available forms: oral capsule or liquid

Nursing Consideration: educate patients on radiation precautions (avoid close contact with others for several days), monitor thyroid function post-treatment for hypothyroidism, encourage hydration to help eliminate excess radiation

Question 23

propylthiouracil (PTU)

Answer 23

Category: thiomide antithyroid agent
Indications: hyperthyroidism (Graves’ disease), thyroid storm, pre-surgical thyroid suppression

Contraindications: severe liver disease, pregnancy (2nd and 3rd trimester), bone marrow suppression

Adverse Effects: agranulocytosis, hepatoxicity (monitor liver enzymes), rash/nausea/dizziness
Interactions: increased risk of agranulocytosis with phenothiazines, additive effects with lithium and potassium iodide

Available forms: oral tablet

Nursing Considerations: monitor WBC count for agranulocytosis, assess liver function regularly, educate patient to report signs of infection (fever/sore throat), take with food to reduce GI upset

Question 24

Octreotide

Answer 24

Category: Pituitary / somatostatin analog

Indications: Acromegaly (reduces growth hormone levels), Carcinoid tumors (controls diarrhea and flushing), Esophageal varices bleeding (reduces portal hypertension)

Contraindications: hypersensitivity, gallbladder disease/gallstones, diabetes

Adverse Effects: GI disturbances (nausea, diarrhea, abdominal pain), Bradycardia/arrhythmias, Hyperglycemia or hypoglycemia
Interactions: may alter insulin and oral hypoglycemic drug effects, increased risk of bradycardia w/ beta blockers

Available Forms: SQ, IV

Nursing Considerations: monitor blood glucose, asses for gallbladder issues, monitor cardiac function (risk of bradycardia)

Question 25

Somatropin

Answer 25

Category: Pituitary / recombinant human growth hormone Indications: growth hormone deficiency, Turner syndrome, Prader-Willi syndrome, Muscle wasting in HIV/AIDS Contraindications: active malignancy (stimulates cell growth), severe obesity or respiratory impairment (risk of complications), closed epiphyses in children (no further growth possible) Adverse Effects: edema, joint pain, hyperglycemia (may induce insulin resistance), increased intracranial pressure (headache/vision changes) Interactions: glucocorticoids, insulin and oral hypoglycemics (may require dose adjustment) Available Form: SQ Nursing Considerations: monitor growth parameters in children, assess for signs of increased intracranial pressure, monitor blood glucose levels

Question 26

Vasopressin

Answer 26

Category: Pituitary / Antidiuretic hormone (ADH) analog Indications: Diabetes insipidus (reduces excessive urination), vasodilatory shock (increases bp), esophageal varices bleeding (reduces portal pressure) Contraindications: coronary artery disease (risk of ischemia), chronic kidney disease (fluid overload risk), HTN (vasoconstrictive effects) Adverse Effects: hyponatremia (water retention), HTN, arrhythmias, abdominal cramps, nausea Interactions: NSAIDs may enhance antidiuretic effects, diuretics may counteract effects Available Forms: IV, nasal spray Nursing Considerations: monitory electrolyte levels (risk of hyponatremia), assess bp and cardiac function, monitor urine output for effectiveness

Question 27

AndroGel (testosterone gel)

Answer 27

Action: Short-acting Androgen, provides topical testosterone replacement, increasing serum testosterone levels Use: treats hypogonadism in men with low testosterone Adverse Effects: skin irritations, acne, mood changes, increased RBC count, risk of secondary exposure to others Contraindications: prostate or breast cancer, pregnancy Interactions: warfarin, insulin

Question 28

Androderm (testosterone transdermal patch)

Answer 28

Action: Short-acting Androgen, provides continuous testosterone delivery via a transdermal patch Use: treats primary and hypogonadotropic hypogonadism Adverse Effects: skin irritation, fluid retention, mood swings, increased hematocrit Contraindications: prostate or breast cancer, pregnancy Interactions: corticosteroids (fluid retention risk), anticoagulants (increased bleeding risk)

Question 29

Testopel (testosterone pellets)

Answer 29

Action: Long-acting Androgen, subcutaneous testosterone pellets that provide long-term androgen replacement Use: Treats hypogonadism, delayed puberty, and testosterone deficiency Adverse Effects: injection site pain, mood changes, increased RBC count, acne Contraindications: prostate or breast cancer, severe liver disease Interactions: blood thinners, insulin

Question 30

Methyltestosterone

Answer 30

Action: oral androgen, synthetic androgen that mimics testosterone effects Use: treats hypogonadism, delayed puberty, and breast cancer in postmenopausal women Adverse Effects: liver toxicity, acne, mood changes, increased cholesterol, fluid retention Contraindications: prostate or breast cancer, sever liver disease, pregnancy Interactions: warfarin, diabetes medications

Question 31

alendronate, risedronate, zoledronic acid

Answer 31

Bisphosphonates (the DRONATEs) Action: inhibit osteoclast-mediate bone resorption, increasing bone Use: treat osteoporosis, Paget’s disease, and hypercalcemia of malignancy Adverse Effects: esophagitis, jaw osteonecrosis, atypical femur fractures, GI upset Contraindications: hypocalcemia, esophageal disorders, inability to remain upright after dosing Interactions: calcium, antacids, and iron supplements reduce absorption

Question 32

Tamsulosin

Answer 32

Alpha-1 Adrenergic Blocking Agent Action: selectively blocks alpha-1 receptors in the prostate and bladder neck, relaxing smooth muscle Use: treat benign prostatic hyperplasia (BPH) and improve urinary flow Adverse Effects: dizziness, orthostatic hypotension, retrograde ejaculation, nasal congestion Contraindications: sever hepatic impairment, hypersensitivity Interactions: increased hypotensive effects with antihypertensives, PDE-5 inhibitors

Question 33

Finasteride

Answer 33

Antiandrogen Agent Action: inhibits 5-alpha reductase, reducing dihydrotestosterone (DHT) levels Use: treat BPH and male pattern baldness Adverse Effects: sexual dysfunction, gynecomastia, depression Contraindications: pregnancy, liver disease Interactions: reduces effectiveness of testosterone replacement therapy

Question 34

avanafil, sildenafil, tadalafil, varenafil

Answer 34

Phosphodiesterase Inhibitors Action: inhibit PDE-5, increasing cGMP, leading to vasodilation and improved erectile function Use: treat erectile dysfunction (ED) and pulmonary HTN (sildenafil) Adverse Effects: headache, flushing, hypotension, priapism, visual disturbances Contraindications: concurrent nitrate therapy (risk of severe hypotension) Interactions: CYP3A4 inhibitors increase drug levels, nitrates cause life-threatening hypotension the PI Fils

Question 35

inotropic

Answer 35

contractility

Question 36

chronotropic

Answer 36

heart rate