Perfusion

Question 1

Diuretics for hypertension

Answer 1

Thiazides
1st line therapy
Decrease blood volume = excretion of water
Watch out for dehydration (elderly), hypotension, and electrolyte loss

Question 2

CCBs for hypertension

Answer 2

Amlodipine

• Stops Ca+ from entering cell > limits muscular contraction > decreases workload on heart > decreases oxygen demand
• low doses > smooth muscle arterioles relax > decrease peripheral resistance > decrease BP

Side effects: dizziness, reflex tachycardia

Question 3

ACEIs for hypertension

Answer 3

Lisinopril
Benefits HF and diabetes (decrease renal damage)
Contraindicated in 2nd and 3rd trimester
SE: 1st dose hypotension, persistent cough, angioedema

Question 4

ARBs for hypertension

Answer 4

Losartan
Dilates arterioles and veins
Blocks angiotensin 2 after formation
Give ARBs if ACEIs produce a cough
Less likely to cause hyperkalemia (renal insufficient patients)
Angioedema

Question 5

Adrenergic agents for hypertension

Answer 5

Suppress SNS on heart, blood vessels, etc.
A1 blockers - terazosin: orthostatic hypotension, increase HR w 1st dose
Beta Blockers - metoprolol: mask hypoglycemic symptoms, decrease libido, bronchospasm
Nonselective beta blockers: slow HR, bronchoconstricton, check pulse

Question 6

General teaching for hypertension therapy

Answer 6

Thiazides are 1st line therapy
Drug selection based on comorbidities (race and ethnicity)
African Americans: BB and ACEIs less effective, salt sensitivity = diet & lifestyle changes,
Children/adolescents: treat underlying cause first, dont give ACEIs or ARBs to sexually active girls
Elderly: thiazides and CCBs, elderly women at higher risk
Self-monitoring!!!
Follow up on missed appointments
Simplify the regimen

Question 7

Drugs for heart failure

Answer 7

Cardiac glycosides
ACEIs
Vasodilator
Diuretics
Beta blockers

Question 8

Cardiac glycosides (HF)

Answer 8

Digoxin
\+ inotrope
Decrease heart rate
Narrow therapeutic effect = low: no therapy, high: toxic
Increased CO
Used for A-Fib
AE: dysrhythmias, yellow green halo
Digibind = antidote
Heart rate has to be 60+ and no sudden changes
Monitor K+ levels

Question 9

ACEIs for HF

Answer 9

Lisinopril (also used for hypertension
Decrease release of aldosterone
Decrease pre and after load = decrease workload on heart (different from hypertension bc it lowers BP)
May take 2-3 weeks to work

Question 10

Vasodilator for HF

Answer 10

Give instead of ACEIs if not working

Question 11

Diuretics for HF

Answer 11

Decrease blood volume, edema, pulmonary congestion
Monitor K+ levels if also on digoxin
Better breathing
Starts working right away
Furosemide prescribed commonly
Thiazides for long term

Question 12

BB for HF

Answer 12

Metoprolol & Carvedilol
- inotrope
Decrease BP & HR = decrease workload

Question 13

CAD

Answer 13

Coronary artery disease
Builds up over time = fatty diet, smoking, genetics, lifestyle
Narrowing or occlusion

Question 14

Angina

Answer 14

Acute chest pain
Comes and goes with activity
Insufficient O2

Question 15

MI

Answer 15

Clot, plaque, scar tissue
Acute obstruction
Muscle death

Question 16

Drugs for angina Nitrates

Answer 16

Nitroglycerin
Relaxes venous muscles
Decrease preload, afterload, work load, O2 demand, and pain

Question 17

Nitroglycerin

Answer 17

Effective, fast acting, inexpensive
Stable angina: opens the veins and decreases preload
Variant angina: relaxes and prevents spasms
AC: vasodilation
Effects increase with hypotension drugs
BB affect nitrates
Viagra increases vasodilation
8 hours “patch free” = avoid tolerance
Sublingual tabs: 3 tabs in 15 mins = call 911 if pain not relieved
Transdermal: avoid tolerance
Topical ointment: wear gloves = side effects will affect nurse
IV: use correct tubing
Don’t stop nitroglycerin suddenly = rebound effect

Question 18

Drugs for angina = BB

Answer 18

Change positions slowly
Masks hypoglycemia
Use for stable angina
Cause rebound if stopped 
Don’t give if hr is <60

Question 19

CCBs for angina

Answer 19

Nifedipine
Use for vasospastic angina
Avoid grapefruit juice

Question 20

Antidysrhytmic drugs

Answer 20

Adenosine = fast IV push, saline bolus immediately
Digoxin = A-Fib
Prodysrhythmic
Worsen existing condition
Make new ones
Nonpharm: pace maker, cardio version (synchronized defibrillation), ablation ( zaps dysrhythmia)

Question 21

Drugs for shock

Answer 21

Colloids = proteins, increase oncotic pressure, use blood products
Crystalloids = resemble plasma (normal saline)
Monitor for volume overload

Question 22

Drugs for shock + hypotensive states

Answer 22

Vasopressors
Must have adequate volume before administration
\+ inotrope 
IV only
Irritating to IV site
Ongoing assessment

Question 23

Lipid control drugs

Answer 23

Atorvastatin & simvastatin 
Stops cholesterol synthesis and LDL receptors
Rhabdomyolysis = muscle pain (report)
Category X
Avoid grapefruit juice
Liver dysfunction

Question 24

Other lipid control drugs

Answer 24

Ezetimibe and fibrates (avoid with anticoagulants)