Exam III Flashcards
What type of angina is caused by coronary spasm?
Variant
What kind of angina does not respond to beta-blockers?
Variant
Nitrates predominately vasodilate which vessels in low doses? Prevent spasm where?
Veins. Coronary arteries.
Headaches due to nitrates can be expected to do what over time?
Diminish
What adverse effect is triggered by baroreceptors in response to venous dilation?
Reflex tachycardia
What drugs are contraindicated in men who are taking nitrates?
Phosphodiesterase type 5 inhibitors
Which nitrate formulation is recommended for intermittent angina treatment at home?
SL nitroglycerin
How are SL nitroglycerin tablets taken?
1 Tablet (0.3-0.6 mg) every 5 minutes x 3, Emergency department if angina persists 5 min
What must the nurse check before administering nitroglycerin?
Blood pressure and pulse
Why should nitroglycerin paste be removed at night?
Prevent tachyphylaxis (tolerance)
How would a dry mouth affect the absorption of nitroglycerin?
Slows absorption
Nitrates in low doses decrease afterload or preload? Arterioles or veins?
Preload. Veins.
Selective beta-blockers block which receptors at low doses?
Beta-1
Beta-blockers decrease three parameters. What are they?
Heart rate, blood pressure, contractility
What may beta-blockers mask in diabetes and during allergy shots?
Signs of hypoglycemia and allergic reactions.
Which drug given for allergic reactions may be inhibited by beta-blockers?
Epinephrine
In asthmatics, beta-blockers may cause what symptom? Block what receptor?
Bronchoconstriction. Beta-2.
Beta-blockers with verapamil or diltiazem can severely decrease which vital sign parameter?
Heart rate
Abrupt cessation of beta-blockers can lead to excitation or depression of the beta-adrenergic receptors?
Excitation
Do not give beta-blockers if the pulse is below ____ or the systolic BP is below____.
Pulse 50, SBP 90
What is the family of calcium-channel blockers which does not include verapamil or diltiazem?
Dihydropyridines
Calcium-channel blockers vasodilate which blood vessels?
Arterioles
Calcium-channel blockers decrease afterload or preload?
Afterload
Dihydropyridines may cause what side effect which can be treated with beta-blockers?
Reflex tachycardia
Swelling of extremities may be caused by what 2 classes of antihypertensive agents?
Nitrates & calcium-channel blockers
Calcium-channel blockers are used for what kinds of angina?
Stable and variant
Vasodilation of arteries reduces afterload or preload?
Afterload
How does ranolazine (Ranexa) work?
The drug decreases sodium and calcium in the myocardial cells, which allows the cells to use energy more efficiently.
How does ranolazine (Ranexa) cause torsades de pointes?
The drug prolongs the QT interval.
Digoxin (Lanoxin) is used in heart failure primarily for what effect?
Positive inotropic effect
What should the nurse do before giving digoxin?
Take the apical pulse for 1 minute.
What electrolyte competes with digoxin for the receptor?
Potassium
What are some signs of digitalis toxicity?
Anorexia, nausea, vomiting, arrhythmias, weakness, yellow vision, halos around lights, blurred vision
What is the antidote for digoxin toxicity?
Digibind
What common drug classes can precipitate digoxin toxicity?
Loop and thiazide diuretics
What are the effects of alpha-1 activation by catecholamines?
Vasoconstriction of arterioles in skin, viscera, & mucous membranes and in veins.
What are the effects of beta-1 activation by catecholamines?
Increased heart rate, contractility, and conduction rate. Renin release.
What are the effects of beta-2 activation in the lungs and liver?
Bronchodilation & glycogenolysis.
What are the renal effects of dopamine activation?
Renal blood vessel dilation.
Which IV continuous drug is used to increase contractility without causing vasoconstriction?
Dobutamine (Dobutrex).
Common drug ending -olol
Beta-adrenergic blocker (ex: Metoprolol)
Common drug ending -dipine
Calcium channel blocker (ex: Amlodipine)
Common drug ending -zosin
Alpha-adrenergic blocker (ex: Prazosin)
Common drug ending -pril
Angiotensin-converting enzyme (ACE) inhibitor (ex: Lisinopril)
Common drug ending -sartan
Angiotensin-receptor blocker (ex: Losartan, Candesartan)
Common drug ending -statin
HMG-CoA reductase inhibitor (ex: Atorvastatin)
Common drug ending -ase, -plase
Thrombolytic (ex: Alteplase)
Common drug ending -parin
Anticoagulant (ex: Enoxaparin)
Common drug ending -xaban
Direct Factor Xa Inhibitor (ex: Rivaroxaban)
What should the nurse check before administering antihypertensives?
Blood pressure and pulse
Antihypertensive agents should be given for what period of time?
Lifelong
What is the systolic blood pressure range for prehypertension?
120-139
What side effect may occur with the coadministration of an antihypertensive drug with another antihypertensive drug or diuretic?
Hypotension
Which drug classification is the first-line therapy for hypertension?
Thiazides.
How do thiazide diuretics affect blood vessels?
Arteriole dilation.
What are three effects of beta-blockers on the heart?
Decreased heart rate, AV block, decreased contractility
Name two ways beta-blockers affect diabetic patients.
Block glycogenolysis. Mask symptoms of hypoglycemia.
What hormone do beta1-blockers block?
Renin
Alpha1-blockers cause what? What disease may they be used for and why? Why are they seldom used?
Vasodilation of arterioles and veins. Benign prostatic hypertrophy, because it relaxes the smooth muscle of the prostatic capsule and bladder neck. Increased number of CV events.
By what mechanism do alpha2-agonists decrease blood pressure? What side effects disappear over time?
Decrease sympathetic outflow from brainstem and decrease norepinephrine release. Dry mouth and sedation.
Which alpha2-agonist is commonly-used for hypertension that starts during pregnancy?
Methyldopa (Aldomet).
Direct-acting vasodilators may cause what two important adverse effects? What drug category is used to prevent this?
Reflex tachycardia and renin release. Treat with beta-blockers.
Which calcium channel blockers should not be given with beta-blockers? Why?
Diltiazem and verapamil. Suppresses heart function in persons with heart disease.
How does grapefruit juice affect calcium channel blocker serum levels? What are the effects?
Raise calcium channel blocker serum levels. Raise heart rates in dihydropyridines and decrease heart rates with verapamil or diltiazem.
Direct renin inhibitors prevent what? Why is it used?
Renin from binding with the receptor. Hypertension.
What is a common electrolyte disturbance caused by ACEIs?
Hyperkalemia
The patient on an ACEI asks you whether he should use salt or salt substitute. What do you say?
Check to make sure that the salt substitute does not have potassium, which may increase potassium levels to an unsafe level.
ACEIs cause vasodilation of which blood vessels? Which vasodilates the most?
Arterioles and veins. Arterioles.
RAAS drugs are the only hypertensive drugs contraindicated for what?
Pregnancy
Why would a patient be encouraged to lie down prior to the first dose of an ACEI?
First dose hypotension
What category of diuretics should a person on ACEIs avoid?
Potassium-sparing diuretics