Exam III Flashcards
(179 cards)
1
Q
What type of angina is caused by coronary spasm?
A
Variant
2
Q
What kind of angina does not respond to beta-blockers?
A
Variant
3
Q
Nitrates predominately vasodilate which vessels in low doses? Prevent spasm where?
A
Veins. Coronary arteries.
4
Q
Headaches due to nitrates can be expected to do what over time?
A
Diminish
5
Q
What adverse effect is triggered by baroreceptors in response to venous dilation?
A
Reflex tachycardia
6
Q
What drugs are contraindicated in men who are taking nitrates?
A
Phosphodiesterase type 5 inhibitors
7
Q
Which nitrate formulation is recommended for intermittent angina treatment at home?
A
SL nitroglycerin
8
Q
How are SL nitroglycerin tablets taken?
A
1 Tablet (0.3-0.6 mg) every 5 minutes x 3, Emergency department if angina persists 5 min
9
Q
What must the nurse check before administering nitroglycerin?
A
Blood pressure and pulse
10
Q
Why should nitroglycerin paste be removed at night?
A
Prevent tachyphylaxis (tolerance)
11
Q
How would a dry mouth affect the absorption of nitroglycerin?
A
Slows absorption
12
Q
Nitrates in low doses decrease afterload or preload? Arterioles or veins?
A
Preload. Veins.
13
Q
Selective beta-blockers block which receptors at low doses?
A
Beta-1
14
Q
Beta-blockers decrease three parameters. What are they?
A
Heart rate, blood pressure, contractility
15
Q
What may beta-blockers mask in diabetes and during allergy shots?
A
Signs of hypoglycemia and allergic reactions.
16
Q
Which drug given for allergic reactions may be inhibited by beta-blockers?
A
Epinephrine
17
Q
In asthmatics, beta-blockers may cause what symptom? Block what receptor?
A
Bronchoconstriction. Beta-2.
18
Q
Beta-blockers with verapamil or diltiazem can severely decrease which vital sign parameter?
A
Heart rate
19
Q
Abrupt cessation of beta-blockers can lead to excitation or depression of the beta-adrenergic receptors?
A
Excitation
20
Q
Do not give beta-blockers if the pulse is below ____ or the systolic BP is below____.
A
Pulse 50, SBP 90
21
Q
What is the family of calcium-channel blockers which does not include verapamil or diltiazem?
A
Dihydropyridines
22
Q
Calcium-channel blockers vasodilate which blood vessels?
A
Arterioles
23
Q
Calcium-channel blockers decrease afterload or preload?
A
Afterload
24
Q
Dihydropyridines may cause what side effect which can be treated with beta-blockers?
A
Reflex tachycardia
25
Swelling of extremities may be caused by what 2 classes of antihypertensive agents?
Nitrates & calcium-channel blockers
26
Calcium-channel blockers are used for what kinds of angina?
Stable and variant
27
Vasodilation of arteries reduces afterload or preload?
Afterload
28
How does ranolazine (Ranexa) work?
The drug decreases sodium and calcium in the myocardial cells, which allows the cells to use energy more efficiently.
29
How does ranolazine (Ranexa) cause torsades de pointes?
The drug prolongs the QT interval.
30
Digoxin (Lanoxin) is used in heart failure primarily for what effect?
Positive inotropic effect
31
What should the nurse do before giving digoxin?
Take the apical pulse for 1 minute.
32
What electrolyte competes with digoxin for the receptor?
Potassium
33
What are some signs of digitalis toxicity?
Anorexia, nausea, vomiting, arrhythmias, weakness, yellow vision, halos around lights, blurred vision
34
What is the antidote for digoxin toxicity?
Digibind
35
What common drug classes can precipitate digoxin toxicity?
Loop and thiazide diuretics
36
What are the effects of alpha-1 activation by catecholamines?
Vasoconstriction of arterioles in skin, viscera, & mucous membranes and in veins.
37
What are the effects of beta-1 activation by catecholamines?
Increased heart rate, contractility, and conduction rate. Renin release.
38
What are the effects of beta-2 activation in the lungs and liver?
Bronchodilation & glycogenolysis.
39
What are the renal effects of dopamine activation?
Renal blood vessel dilation.
40
Which IV continuous drug is used to increase contractility without causing vasoconstriction?
Dobutamine (Dobutrex).
41
Common drug ending -olol
Beta-adrenergic blocker (ex: Metoprolol)
42
Common drug ending -dipine
Calcium channel blocker (ex: Amlodipine)
43
Common drug ending -zosin
Alpha-adrenergic blocker (ex: Prazosin)
44
Common drug ending -pril
Angiotensin-converting enzyme (ACE) inhibitor (ex: Lisinopril)
45
Common drug ending -sartan
Angiotensin-receptor blocker (ex: Losartan, Candesartan)
46
Common drug ending -statin
HMG-CoA reductase inhibitor (ex: Atorvastatin)
47
Common drug ending -ase, -plase
Thrombolytic (ex: Alteplase)
48
Common drug ending -parin
Anticoagulant (ex: Enoxaparin)
49
Common drug ending -xaban
Direct Factor Xa Inhibitor (ex: Rivaroxaban)
50
What should the nurse check before administering antihypertensives?
Blood pressure and pulse
51
Antihypertensive agents should be given for what period of time?
Lifelong
52
What is the systolic blood pressure range for prehypertension?
120-139
53
What side effect may occur with the coadministration of an antihypertensive drug with another antihypertensive drug or diuretic?
Hypotension
54
Which drug classification is the first-line therapy for hypertension?
Thiazides.
55
How do thiazide diuretics affect blood vessels?
Arteriole dilation.
56
What are three effects of beta-blockers on the heart?
Decreased heart rate, AV block, decreased contractility
57
Name two ways beta-blockers affect diabetic patients.
Block glycogenolysis. Mask symptoms of hypoglycemia.
58
What hormone do beta1-blockers block?
Renin
59
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.
60
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.
61
Which alpha2-agonist is commonly-used for hypertension that starts during pregnancy?
Methyldopa (Aldomet).
62
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.
63
Which calcium channel blockers should not be given with beta-blockers? Why?
Diltiazem and verapamil. Suppresses heart function in persons with heart disease.
64
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.
65
Direct renin inhibitors prevent what? Why is it used?
Renin from binding with the receptor. Hypertension.
66
What is a common electrolyte disturbance caused by ACEIs?
Hyperkalemia
67
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.
68
ACEIs cause vasodilation of which blood vessels? Which vasodilates the most?
Arterioles and veins. Arterioles.
69
RAAS drugs are the only hypertensive drugs contraindicated for what?
Pregnancy
70
Why would a patient be encouraged to lie down prior to the first dose of an ACEI?
First dose hypotension
71
What category of diuretics should a person on ACEIs avoid?
Potassium-sparing diuretics
72
What side effect of ACE inhibitors commonly leads to the discontinuation of these drugs?
Persistent, nonproductive cough
73
How do ARBs work?
Block angiotensin II receptors.
74
What are the adverse effects of angiotensin II receptor blockers (ARBs)?
Hypotension, fatigue, headache, dizziness, diarrhea, rare angioedema.
75
How does spironolactone (Aldactone) work?
Blocks aldosterone receptors
76
Spironolactone (Aldactone) may cause gynecomastia by interfering with what?
Steroid hormones like progesterone, androgens, corticosteroids
77
Spironolactone (Aldactone) may cause what electrolyte disturbance?
Hyperkalemia
78
How does blocking aldosterone affect the sodium stores of the body? How might this influence lithium?
Promotes sodium loss which lowers body sodium stores. Prevents excretion of lithium.
79
Sodium nitroprusside (Nitropress) vasodilates which blood vessels?
Arterioles and veins
80
Why is nitroprusside (Nitropress) used?
Emergency treatment of severely elevated blood pressure
81
What blood levels are monitored with sodium nitroprusside (Nitropress) use?
Thiocyanate levels
82
When should diuretics be taken?
In the morning if daily, morning and 2 pm if bid
83
Where does the most reabsorption take place?
Proximal convoluted tubule
84
Where is 20% of the sodium reabsorbed?
Ascending loop of Henle
85
Which diuretics have the greatest potential for diuresis? Why?
Osmotic diuretics followed by loop diuretics.
| They block sodium reabsorption at sites where more sodium is normally reabsorbed.
86
Large dose of loop diuretics may adversely affect what organ?
Ear, ototoxicity
87
What permanent adverse effect may occur with ethacrynic acid (Edecrin)?
Ototoxicity
88
What change in calcium may occur with loop diuretics?
Hypocalcemia
89
What class of diuretics does not cause calcium loss?
Thiazides
90
What change in blood sugar may be seen with loop diuretics?
Hyperglycemia
91
Thiazide diuretics are contraindicated with an allergy to what?
Sulfonamides
92
When might thiazide diuretics be ineffective?
When the glomerular filtration rate (GFR) is below 15-20 mL/min
93
What are some signs of electrolyte imbalance?
Muscle weakness, twitching, nausea and vomiting, dysrhythmias, dry mouth and thirst, confusion, etc.
94
Loop diuretics decrease which electrolytes?
K+, Na+, Cl-, Ca2+, Mg2+
95
The coadministration of digoxin (Lanoxin) and diuretics may precipitate what condition?
Digoxin toxicity with dysrhythmias.
96
Potassium-sparing diuretics should not be used with which three antihypertensive drug categories that may raise potassium levels? Name two common potassium-sparing diuretics.
ACE inhibitors, Angiotensin II receptor blockers, direct renin inhibitors.
Spironolactone (Aldactone) and triamterene (Dyrenium)
97
Diuretics and antihypertensive drugs can cause what adverse effect?
Additive hypotension
98
Why are osmotic diuretics used in renal failure?
To maintain urine flow through the tubule.
99
Why are osmotic diuretics used for cerebral edema?
Used to reduce intracranial pressure
100
What is added to deter patients from taking diphenoxylate (Lomotil) for analgesic effects?
Atropine, causes dry mouth and tachycardia.
101
Name 2 contraindications for Diphenoxylate (Lomotil)?
Infectious diarrheas and pseudomembranous colitis.
102
What are the mechanisms of action for bulk-laxatives?
Form nondigestible gel that expands with bacterial action. The enlarged fecal size triggers peristalsis.
103
List contraindications for laxatives. Why?
Abdominal pain, nausea, cramps, appendicitis, bowel obstruction, diverticulitis, ulcerative colitis, enteritis.
Worry about bowel perforation.
104
Why must a bulk laxative be administered with a full glass of fluids?
To prevent bowel obstructions.
105
What are the mechanisms of action for surfactant laxatives?
Decrease surface tension allowing water to penetrate stool, inhibit fluid absorption in gut, and increase water and electrolyte secretion into gut.
106
What is the difference between Docusate sodium (Colace) and Peri-Colace?
Peri-Colace includes a stimulant laxative, sennosides.
107
What are the mechanisms of action for stimulant laxatives?
Increase peristalsis, inhibit fluid reabsorption in gut, and increase water and electrolyte secretion in gut.
108
What food substance and drug category may not be taken within 1 hour of bisacodyl (Dulcolax), a stimulant laxative? Why?
Milk and antacids. They dissolve the enteric coating meant to protect the stomach from the drug.
109
What harmless urinary side effect is caused by senna, a stimulant laxative?
Yellowish-brown or pinkish urine.
110
What are the mechanisms of action for saline laxatives?
Attracts water that stretches the gut and causes peristalsis.
111
What is a non-GI contraindication to magnesium hydroxide? Why?
Renal disease. Magnesium accumulates and causes CNC toxicity.
112
What are the mechanisms of action for lactulose?
The disaccharide is metabolized into acid by gut bacteria. The acids cause an osmotic action.
113
Name a non-GI use for lactulose?
High ammonium blood levels.
114
What are the mechanisms of action for glycerin suppositories? Where do they work?
Softens and lubricates stool. Stimulates rectal contraction. Rectum.
115
What is the most important indication of constipation?
Hard, pellet-like feces.
116
What is a possible effect of laxatives during pregnancy?
Initiation of labor.
117
Discuss the use of laxatives during lactation.
The drug may be found in breast milk.
118
What are the indications for lubiprostone?
Idiopathic constipation, irritable bowel syndrome in women older than 18, and opioid induced constipation
119
How often should adults be screened for high cholesterol?
Every 5 years
120
Cholesterol is mainly produced when?
At night
121
Which lipoproteins are the “bad” lipoproteins?
LDL
122
The triglycerides are carried by which lipoproteins?
VLDL
123
Carbohydrates should be restricted to 50-60% of the caloric intake because they can form what?
Triglycerides
124
Saturated fats should be what percent of the caloric intake?
< 7%
125
How do HMG-CoA Reductase Inhibitors work?
Reduce synthesis of cholesterol by inhibiting the enzyme. And increasing the number of LDL receptors in the liver.
126
When should statins be taken?
In the evening
127
What are two severe adverse effects of statins?
Hepatoxicity and myopathy
128
What are two contraindications for statins?
Liver disease and pregnancy
129
How do bile-acid sequestrants lower cholesterol?
They inhibit reabsorption of bile and cause the liver to use LDLs in the blood to make more bile. The liver increases the number of LDL receptors in the liver.
130
What deficiencies can be caused by bile-acid sequestrants?
Vitamin A, D, E, K
131
A patient must wait how long after the administration of a bile-acid sequestrant before taking another medication?
4 hours
132
Bile-acid sequestrants are taken to lower what?
LDL
133
Fibrates (or fibric acid derivatives) are the most effective drug for lowering what?
Triglycerides
134
Fibrates can cause what gastrointestinal dysfunction?
Gallstones, nausea, diarrhea, and abdominal pain
135
What major risk increases when fibrates are coadministered with statins?
Risk of myopathy. (Also liver injury and kidney disease)
136
Do fibrates increase or decrease the effect of warfarin?
Increase by displacing warfarin from the albumin.
137
How does ezetimibe (Zetia) work?
Blocks reabsorption of dietary and biliary cholesterol
138
What are the side effects of ezetimibe (Zetia)?
Myopathy, rhabdomyolysis, pancreatitis, hepatitis, thrombocytopenia.
139
Lovaza is used to decrease which lipid?
Triglycerides.
140
What are the two stages of hemostasis?
Formation of platelet plug, reinforcement of platelet plug with fibrin (coagulation).
141
How does heparin work as an anticoagulant?
Assists antithrombin in inactivating thrombin & factor Xa
142
How does warfarin work as an anticoagulant?
Decreases synthesis of clotting factors dependent on vitamin K
143
How do thrombolytic drugs work?
Promote conversion of plasminogen to plasmin
144
Arterial thrombi cause what kind of injury?
Local injury
145
Venous thrombi cause what type of injury
Distal injury
146
Name the three categories of drugs for thromboembolic disorders? Where in the vascular system do they work?
Anticoagulants - veins
Antiplatelet agents - arteries
Thrombolytics – veins or arteries
147
What factors does heparin deactivate? What does this prevent?
Assists antithrombin in deactivating thrombin & factor Xa to prevent more venous thrombi.
148
What factor do low molecular weight anticoagulants deactivate?
Factor Xa
149
Which anticoagulant can be given during pregnancy?
Heparin
150
What is the antidote for heparin?
Protamine sulfate
151
Which lab is used to monitor heparin? What is the recommended range?
aPTT 1.5-2X the control
152
What potentially-fatal disorder occurs with heparin?
Heparin induced thrombocytopenia (HIT)
153
List contraindications to heparin.
Thrombocytopenia; uncontrollable bleeding; surgery of eye, brain, or spinal cord; lumbar puncture or regional anesthesia
154
List signs and symptoms indicative of bleeding?
Decreased BP, increased HR, gum bleeding, bruises, petechiae, hematomas, red or black/tarry stools, discolored/cloudy urine, pelvic pain from ovaries, headache or faintness, lumbar pain from adrenal gland
155
Discuss the proper administration of heparin SubQ.
Lower abdomen, rotate sites; no rubbing; no aspiration; 2” from umbilicus; 25-26 gauges, 1/2 to 5/8 needle; gentle, firm pressure for 1-2 min after.
156
List drugs which may increase bleeding with heparin.
ASA, antiplatelet drugs, NSAIDS, glucocorticoids
157
What is the antidote for low molecular weight anticoagulants?
Protamine sulfate
158
How does warfarin work?
Interferes with synthesis of Vitamin K-dependent clotting factors
159
Where in the vascular system does warfarin work?
Veins
160
How is warfarin distributed? Can it enter the placenta or breast milk?
Highly-protein bound, crosses placenta and enters breast milk
161
What lab is used to monitor warfarin therapy? What is the suggested range?
PT & INR; INR 2-3 (3-4.5 if mechanical heart valve)
162
Which anticoagulant is Pregnancy Category X?
Warfarin (Coumadin)
163
What is the antidote for warfarin?
Vitamin K (phytonadione), fresh frozen plasma (FFP)
164
List contraindications to warfarin.
Active bleeding; severe thrombocytopenia; decreased synthesis of vitamin K (alcoholism, Vitamin K deficiency, liver disease); surgery of eye, brain, & spinal cord; lumbar puncture or regional anesthesia; pregnancy & lactation
165
What would you tell a patient on warfarin who wants to take Tylenol?
Need to monitor INR - 4 325 mg tablets a day for one week can increase risk of elevated INR by 10X (May need to lower warfarin dose)
166
What two drugs increase the synthesis of Vitamin K-dependent clotting factors?
Vitamin K, oral contraceptives
167
What foods are high in vitamin K?
Spinach, kale, lettuce, turnips, greens, cabbage, watercress, peas, asparagus, broccoli, oats, whole wheat, green tea, mayonnaise, canola oil, soybean oil.
168
How does dabigatran (Pradaxa) work?
Directly binds thrombin, which prevents fibrin formation and activation of factor VIII.
169
What are the advantages of dabigatran (Pradaxa) over warfarin? Disadvantages?
Less bleeding, faster onset, no blood work, fewer food interactions, fixed dosing, reversal agent Praxibind. GI distress, less experience, BID dosing, must give on time.
170
How does rivaroxaban (Xarelto) work?
Directly inhibits Factor Xa in clots and serum and inhibits prothrombinase, which prevents fibrin formation.
171
How does apixaban (Eliquis) work? What is the approved use?
Directly inhibits Factor Xa in clots and serum and inhibits prothrombinase, which prevents fibrin formation.
Prevention of stroke and systemic embolization in nonvalvular atrial fibrillation.
172
In what part of the vascular system do antiplatelet agents work?
Arteries
173
List three classes of antiplatelet agents.
ASA, P2Y12ADP receptor antagonists, glycoprotein IIb/IIIa receptor antagonists
174
How does aspirin work? How long are platelets affected? How many days before surgery should aspirin be stopped?
Inhibits COX-1, decreasing platelet aggregation, and inhibits COX-2, decreasing vasoconstriction. 7-10 days. 7 days.g
175
How do ADP receptor antagonists work? How long are platelets affected?
Block ADP receptors and prevents platelet aggregation (clopidogrel- Plavix). 7-10 days, take off 5days prior to surgery.
176
What is a significant adverse blood dyscrasia that may be caused by the ADP receptor antagonist, clopidogrel (Plavix)? What drugs may prevent its action?
Thrombotic thrombocytopenia purpura (TTP). Proton inhibitors may inhibit CYP2C19, which activates clopidogrel (Plavix).
177
How do GP IIb/IIIa receptor antagonists work? Size of effect?
Blocks GP IIb/IIIa receptors & prevents fibrinogen bridges. Large effect, because final step in platelet aggregation.
178
What is the major adverse effect of thrombolytic therapy?
Serious bleeding.
179
Which thrombolytic drug is administered as a single IV bolus?
Tenectaplase (TKNase)
