PHARM WEEK 3 CARDIOVASCULAR AGENTS PART 1A Flashcards
(249 cards)
1
Q
any damage to the ____, _____, and _____ of the heart will affect the heart’s function.
A
myocardium, pericardium and endocardium
2
Q
The heart will get damaged if not enough ___ is delivered.
A
O2
3
Q
ekg can detect ___ if symptoms are absent.
A
MI
4
Q
Vasospasm can limit blood flow to the heart and thus…
A
decreasing O2 and the heart will get hurt :(
5
Q
Nitrates is an old or new drug.
A
old!
6
Q
Name 3 facts about sublingual drugs.
A
- fast acting because there are a lot of blood vessels under the tongue
- effects last only 10 minutes
- sublingual meds are kept in brown containers because heat and light can decompose the meds.
7
Q
Nitroglycerin patch and ointment must be removed after ___ hours
A
12
8
Q
2nd block means
A
increased PR interval, increased time in communication between SA node and AV node
9
Q
3rd block means
A
no communication between SA node and the ventricles. This is considered an emergency because the beatings are individualized, no communication between the cells.
10
Q
Selective Beta 1 blockers affect only the
A
Heart rate
11
Q
Nonselective Beta 1 blockers affect…
A
both the bronchospasm and heart rate so need to be careful when using this for pts with COPD.
12
Q
If not enough O2 is delivered to the peripheral vessels, what will happen?
A
intermittent claudication (pain) in legs
13
Q
____ makes angiotensinogen… goes to the lungs to convert ______ to ________. In the lungs, ACE converts _____ to _______. All acts on adrenal cortex to release aldosterone.
A
Liver, angiotensinogen, angiotensin I, angiotensin I, angiotensin II.
14
Q
aldosterone increases reabsorption of ___ and ___.
A
sodium and h2o
15
Q
aldosterone increases ___ ____
A
potassium excretion.
16
Q
aldosterone increases ___ ____ and also ___
A
blood volume, bp
17
Q
if aldosterone is not working, what should the nurse do?
A
give pt fluid or vasoconstriction.
18
Q
what can cause vasoconstriction?
A
norepinephrine
19
Q
what are some risk factors for htn (4)?
A
african american race, mexican american race and low social-economical income, increase stress
20
Q
smoking can vasoconstrict via?
A
smoking can increase norepinephrine so it can vasoconstrict.
21
Q
Secondary htn is caused by:
A
htn due to other disorders (neural, kidney…)
22
Q
htn pts usually eat diet low in ___ so there is an increase in ___ retention.
A
potassium, sodium
23
Q
good sources of K+:
A
potatoes, dried molasses, figs
24
Q
In medical settings, there is a disparity for African Americans and Mexican Americans compared to other races. Please explain.
A
African Americans and Mexican Americans are usually not prescribed htn meds even tho they have htn, so lower outcomes of htn control in these people.
25
htn education should start when?
as early as adolescent years.
26
Daily K+ needed?
4,700 mg
27
dehydration can cause:
metabolic alkalosis
28
selective and nonselective beta blockers should not be given to ____. Why (2)?
Pts with diabetes, because (1) the meds can lower blood sugar and (2) meds will mask the symptoms of hypoglycemia
29
metoprolol can decrease what?
libido, impotence...
30
selective beta blockers are selective only until ____. Over that dose, it will...
a certain dose.
| It will affect both Beta 1 and Beta 2 (nonselective)
31
centrally acting Alpha 2 agonists are used to
used to lower bp for people with alcohol and drug withdrawal. It is a symptomatic management, won't help with the actual addiction. Therefore this med is mostly prescribed in detox centers.
32
Only ____ meds affect ___ ____, not ___ meds
Beta, glucose metabolism, alpha
33
meds end in -ril or -pril
ACE inhibitors
34
meds end in -lol
beta blockers
35
Pts using ACE inhibitors should be watched out for?
hyperkalemia
36
meds end in -tan
ARB; angiotensin receptor blockers
37
Ca channel blockers block ___ into cells so it can ____ the arterial muscles.
Ca, relaxes
38
meds end in -pine
Ca channel blockers
39
Direct- Acting arteriolar vasodilators are used in ___ ____. Why?
severe htn, because they are fast acting.
40
What is one side effect of Direct- Acting arteriolar vasodilators?
hair growth
41
What is one example of Direct- Acting arteriolar vasodilators?
Rogane(spelling?)
42
Interventions for Direct- Acting arteriolar vasodilators?
if pill med, recheck bp after an hour of taking the med
| if IV med, recheck bp after 5 to 10 minutes
43
what is appropriate exercise routine?
exercise 5 out of 7 days per week, for at least 30 minutes
44
what is normal blood sugar level?
70 to 100
45
What is the most commonly prescribed meds of all?
antilipidemics Medications.
46
what is the action of Zetia?
it inhibits cholesterol absorption in the lower intestines
| ** Fatty stool = diarrhea
47
Nursing interventions for pts taking Atorvastatin (3)
check liver function, pregnancy, and if pt drinks
48
LFT stands for
liver function test
49
Some heart diseases are not related to high ____
cholesterol.
50
The reason for MI is
inflammation
51
Inflammation is due to what?
stress
52
when you are inflamed, your blood becomes ____
hypercoagulatable.
53
what are the three types of cardiovascular agents?
1. Antianginals
2. Antihypertensives
3. Antilipidemics & peripheral vasodilators
54
What is the myocardium?
it's the heart muscle,
| surrounding the ventricles and atria. Ventricles have thick walls and atria have thin walls
55
What is the pericardium?
It's the fibrous covering the heart, to protects the heart from injury
56
What is the endocardium?
It's the inner lining of the heart chambers. It is a three-layered membrane
57
Coronary arteries are separated into what 2 structures?
Right and Left coronary arteries
58
Describe Right coronary artery
Divides into branches that supply blood to the right atrium and both ventricles of the heart
59
describe Left coronary artery (3)
1. Divides near its origin
2. Forms the left circumflex artery and anterior descending artery
3. Supplies blood to the left atrium and both ventricles of the heart
60
Blockage of the heart will lead to what?
myocardial infarction (MI)
61
what are the five structures in the heart conduction system?
1. SA node
2. AV node
3. Ventricles
4. Sympathetic NS
5. Parasympathetic NS
62
SA node is how many beats per min?
60-80
63
AV node is how many beats per min?
40-60
64
Ventricles are how many beats per min?
30-40
65
what will the sympathetic NS do for the heart conduction system?
increase heart rate through epic and norepi
66
what will the parasympathetic NS do for the heart conduction system?
decreases heart rate through acetylcholine
67
describe the anatomy of the Cardiac Conduction System: Sinus Node.
The normal cardiac impulse originates in the sinus node
68
where is the Sinus node?
a structure located in the long, superior portion of the right atrium at its juncture with the superior vena cava.
69
conduction from the sinus node is thought to occur over what pathways?
internodal pathways
70
what are the three internal pathways?
1. the anterior internodal pathway
2. the middle internodal pathway
3 the posterior internodal pathway
71
describe the anterior internodal pathway.
It arises at the cranial end of the sinus node. It divides into branches, one to the left atrium (Bachmann’s bundle) and the other along the right side of the interatrial septum to the AV node.
72
describe the middle internodal pathway.
It arises along the endocardial surface of the sinus node and descends through the interatrial septum to the AV node.
73
describe the posterior internodal pathway
It arises from the caudal end of the sinus node and approaches the AV node at its posterior aspect.
74
What is the speed of conduction through the atria via the internodal pathways?
approximately 1000 mm/s.
75
where is the AV node?
The AV node is located inferiorly in the right atrium, anterior to the ostium of the coronary sinus and above the tricuspid valve
76
what is the speed of conduction through the AV node?
about 200 mm/s
77
Tell me 3 things about the AV node.
1. It is anatomically a complicated network of fibers. These fibers converge at its lower margin to form a discrete bundle of fibers, the bundle of His (or AV bundle).
2. This structure penetrates the annulus fibrosis and arrives at the upper margin of the muscular intraventricular septum.
3. There the bundle of His gives origin to the bundle branches.
78
where are the bundle branches?
The left bundle branch arises as a series of radiations, or fascicles, at right angles to the bundle of His.
79
What do the bundle branches break up into?
Purkinje network
80
What is the first section of the ventricle to begin depolarization?
the midportion of the interventricular septum from the left side, giving rise to the normal Q wave on the 12-lead ECG
81
Are the walls of the left and right ventricles depolarized simultaneously?
Yes
82
what is the speed of conduction through the ventricular Purkinje network?
about 4000 mm/s
83
what is the speed of conduction through the ventricular muscle?
about 400 mm/s
84
CO =
HR x Stroke volume
85
Stroke volume is determined by?
Preload, contractility and afterload
86
What is preload
the blood flow force that stretches the ventricle
87
what is contractility
the force of ventricular contraction
88
what is afterload
the systemic vascular resistance
89
Pulmonary artery does what?
sends deoxygenated blood to the lungs
90
what does the pulmonary vein do?
sends oxygenated blood to left atrium
91
for the systemic circulation, left ventricle does what?
send oxygenated blood into the aorta
92
general circulation pathway...
arteries to arterioles to capillary beds (exchange) to venules to veins and back to the right ventricle with deoxygenated blood
93
what drug is used to treat angina pectoris?
antianginal drugs
94
what is angina pectoris?
Acute cardiac pain caused by inadequate myocardial blood flow.
95
what can lead to inadequate myocardial blood flow (2)?
1. Plaque or blood clot occlusions
| 2. Coronary artery spasms
96
what can cause anginal pain?
decrease in myocardial O2 supply
97
what are some symptoms of angina?
1. Chest tightness or pressure with pain radiating down left arm
2. Referred jaw or neck pain
3. May have SOB, diaphoresis, pallor, clammy skin, GI symptoms
4. Usually lasts a few minutes; may lead to MI
98
Is it possible for patients to have no symptoms of MI?
Yes, silent MIs.
99
what are 3 types of angina pectoris?
Classic (stable), Unstable (pre-infarction) and variant (Prinzmetal, vasopastic)
100
what is one thing about the classic angina pectoris?
Occurs with stress or emotion due to coronary artery narrowing or partial occlusion
101
what is one thing about unstable (pre-infarction) angina pectoris?
Occurs frequently over course of a day with ↑ severity due to coronary artery narrowing or partial occlusion
102
what is one thing about variant (prinzmetal, vasospastic) angina pectoris?
Occurs with rest, caused by vasospasm (caused by atherosclerotic plaques, or drugs that induced vasospasm)
103
angina drug therapy is to ___ the O2 supply and demand
balance
104
what are the 3 types of antianginal drugs?
nitrates, beta-blockers and calcium channel blockers
105
what is the actions of antianginal drugs?
Increase myocardial blood flow by increasing O2 supply or decreasing O2 demand
106
what are 2 facts about nitrates?
1. developed in 1840s.
| 2. first agents used to relieve angina
107
what do nitrates affect?
venous blood vessels and coronary arteries
108
what is the action of nitrates?
cause generalized vascular and coronary vasodilation to increase blood flow through coronary arteries to myocardial cells, and decrease myocardial ischemia but causes decrease bp
109
increase blood flow to the coronary arteries and decrease the amount of blood that is returned to the heart will do what?
decreased preload and decrease peripheral vascular resistance.
110
what are the effects of nitrates on variant (vasospastic) angina?
relaxes coronary arteries by decreasing vasospasm and increase O2 supply
111
what are the effects of nitrates on classic (stable) angina?
dilates veins by decreasing preload and O2 demand
112
Name one prototype drug of nitrates.
nitroglycerin.
113
what are the 4 pharmacodynamics of nitroglycerin?
1. Reduces myocardial oxygen demand
2.Increases cyclic guanosine monophosphate
(Smooth muscle relaxation and vasodilation)
3. Decreases preload
(Amount of blood in RV at end of diastole)
4.Decreases afterload
(Peripheral vascular resistance)
114
what is the nitroglycerin dosage for an adult?
- adult is PO or SL at various dosages.
| - SL is most commonly used because it is readily absorbed
115
What is the onset and effects of nitroglycerin?
-onset is 1 to 3 min, effects last 10 mins.
116
where should nitroglycerin be kept?
SL tabs decompose when exposed to heat or light so must be kept in original container.
117
Other routes of nitroglycerin? other than SL.
IV, Topical and PO
118
What is dosage of IV nitroglycerin?
dose is usually titrated to relieve angina or manage acute CHF exacerbation
119
What are 3 things about the topical nitroglycerin?
1. Ointment 2%: Apply ½ to two inches chest or thigh
2. Ointment or patch should be removed after 12 hrs to avoid tolerance (8-12hr nitrate free interval)
3. Transdermal patch: pre-measured dose to chest or thigh
120
What is one thing about PO nitroglycerin?
oral extended release capsule or tablet.
121
Ointment nitroglycerin is used when?
in emergency cases, and transdermal patch is the norm (more regulated)
122
What are 4 special nursing considerations for IV Nitroglycerin?
1. dilute in D5W
2. use glass infusion bottles and non-polyvinyl tubing
3. do not use plastic IV bags or tubing
4. Plastic absorbs nitroglycerin
123
What are the most common side effects of nitroglycerin?
headache (most common)
decrease bp, dizziness, lightheadedness, Rebound effect of myocardial ischemia if NTG ointment or transdermal patch not tapered over several weeks, reflex tachycardia if NTG given too rapidly
Life threatening: Circulatory collapse
124
Nitroglycerin will have enhanced hypotensive effect if given with what 4 meds/chemical?
1. beta blockers
2. ca channel blockers
3. antihypertensives
4. alcohol
125
IV nitroglycerin may decrease effects of what med?
heparin
126
nitroglycerin is contraindicated with what 3 meds?
1. sildenafil (viagra)
2. tadalafil (Cialis)
3. Vardenafil (levitra)
* * these are 2nd to potential for risk of sever hypotension or CV collapse.
127
What does beta blocker do?
block the beta 1 and beta 2 receptor sites
128
what are the effects of beta blockers (2)?
1. ↓ effects of sympathetic nervous system by blocking action of catecholamines
Epinephrine & norepinephrine
2. ↓ HR & BP
129
what are the uses of beta blockers?
Antianginal
Antidysrhythmic
Antihypertensive
130
what are 2 examples of beta blockers?
Atenolol (Tenormin)
| Propranolol (Inderal)
131
Beta blockers are effective ___? How?
antianginals, by decreasing HR, myocardial contractility, O2 consumption, and thus anginal pain
132
What is one thing to be careful when using beta blockers?
should not discontinue abruptly. taper over specified number of days to avoid reflex tachycardia and recurrent angina.
133
beta blockers are usually not given if...
decreased HR and BP, so check specific parameters
134
beta blockers are effective for?
classic angina pectoris
135
what are the contraindications for beta blockers?
2nd or 3rd degree AV block (severe conduction disturbances and possible death)
136
what is one nonselective (B1 and B2) prototype of beta blockers?
propranolol (inderal)
137
what does propranolol do?
decrease HR and BP
138
what are two adverse reactions for propranolol?
bronchoconstriction and impotence
139
what should the nurse monitor for the pt taking propranolol?
monitor VS closely in early treatment, and assess lungs since it can cause bronchospasm.
140
What are two selective (mostly B1) prototypes of beta blockers?
metoprolol (lopressor) and atenolol (tenormin)
141
what are the effects of metoprolol and atenolol?
decrease HR and BP
142
What should the nurse monitor for a pt on metoprolol or atenolol?
monitor VS closely in early treatment.
143
When was Ca channel blockers introduced?
1982
144
what is the action of Ca channel blockers?
Inhibits calcium ion from entering calcium ion channels into vascular smooth muscle and myocardium
145
how does a Ca channel blockers work?
Causes relaxation of smooth muscle and coronary vasodilation by ↓ workload & O2 demand and by ↓ afterload, ↓ peripheral vascular resistance
146
what are Ca channel blockers effective for (2)?
1. Classic (stable) angina
by ↓ O2 demand by relaxing peripheral arterioles
2. Variant (vasospastic) angina
by relaxes coronary arteries
147
what are the other uses of Ca channel blockers?
some dysrhythmias and htn.
148
By relaxing smooth muscle, what is accomplished?
increase delivery of oxygenated blood to the heart.
149
What are 4 long term treatment of angina?
1. Verapamil (Calan)
2. Nifedipine (Procardia)
3. Diltiazem (Cardizem)
4. Amlodipine (Norvasc) **NEWER
150
what should pt on verapamil be cautioned of?
bradycardia is a common problem.
151
what should pt on Nifedipine be cautioned of?
hypotension can occur, can be profound
152
what is the most potent long term treatment of angina?
Nifedipine (Procardia)
153
What do the 4 long term treatment of angina have in common?
highly protein bound.
154
what are the side effects of Ca channel blockers?
headache, hypotension (> with nifedipine;
155
Why did some pts not want to take Ca Channel blockers?
the med can cause peripheral edema, ankle is swollen.
156
What should the nurse assess for, for a pt who is on Ca channel blockers?
bp, pulse, ekg periodically (med can prolong PR interval), I & O, daily weight, signs of CHF (peripheral edema, crackles, dyspnea, weight gain, JVD).
If pt is also on digoxin, monitor serum digoxin level for toxicity.
157
What are the 5 nursing pearls of wisdom for antianginals?
1. NTG SL if angina
| 2. Monitor VS, look for hypotension (withhold drug if systolic BP
158
client teaching for nitroglycerin:
take one NTG, call 911 if unrelieved or worsen. Do not discontinue drugs without notifying HCP
159
client teaching for Beta blockers and Ca channel blockers
teach pt how to take own pulse, and don't discontinue without provider approval.
160
what are some nursing interventions for pt with chest pain in the ER
history and physical exam, monitor VS, start O2, pain meds (morphin IV, nitro), 12-lead EKG, cardiac biomarkers (troponin, CK MB)
161
what is an appropriate goal for a pt with chest pain in the ER
goal is client will be pain free.
162
What med is for peripheral arterial (vascular) disease (PAD, PVD), arteriosclerosis, hyperlipidemia?
peripheral vasodilators.
163
what is the goal of peripheral vasodilators?
to improve blood flow.
164
What are the 5 classifications of peripheral vasodilators?
1. Alpha-adrenergic antagonists
2. Direct-acting peripheral vasodilators
3. hemorrheologic
4. antiplatelets
5. selected antihypertensives.
165
what are 2 drugs that promote vasodilation (peripheral vasodilators)?
1. Prazosin (Minipress): Alpha 1 blocker
| 2. Nifedipine (Procardia): Calcium channel blocker
166
what are some side effects of peripheral vasodilators?
Lightheadedness, dizziness, orthostatic hypotension, tachycardia, palpitation, flush, and GI distress
167
what is the most often experienced symptom in patients with PAD?
intermittent claudication that goes away at rest.
168
what are some further complications of PAD?
lower O2 levels in lower extremities leading to ischemia leading to necrosis and leading to possible amputation
169
what is an example of anti platelet drug?
cilostazol (Pletal)
170
what is the action of cilostazol (pletal)
direct-acting vasodilator, it inhibits platelet aggregation.
171
what can cilostazol (pletal) treat?
intermittent claudication
172
what are some side effects of cilostazol (pletal)?
Nausea, vomiting, dizziness, syncope, blood in eye, headache, abdominal pain, abnormal stools, peripheral edema
173
what is an example of hemorrheologic agent?
Pentoxifylline (Trental)
174
what are the 5 actions of Pentoxifylline (Trental)?
1. Improves microcirculation and tissue perfusion
2. Decreases blood viscosity
3. Improves flexibility of erythrocytes
4. Inhibits aggregation of platelets and red blood cells
5. Decreases blood viscosity
175
nursing diagnoses for vasodilators (2)
impaired tissue integrity, acute pain
176
assessments for vasodilators
check baseline vs, assess signs and symptoms of inadequate blood flow to extremities
177
interventions for vasodilators
monitor vs, esp BP and HR
178
evaluation (goal) for vasodilators
pt's blood flow to extremity will improve and pain will be controlled.
179
what 4 cardiac factors influence bp?
1. heart rate
2. inotropic state
3. neural- nerves innervates the blood vessels
4. humoral
180
what 3 renal fluid volume control factors influence bp?
1. Renin-angiotensin
2. aldosterone
3. atrial natriuretic factor
181
the factors that influence bp also has an influence on what?
CO
182
what are the 2 types of htn?
essential and secondary
183
what is the most common of the 2 types of htn?
essential, 90% people affected
184
what is the etiology of essential htn?
unknown
185
what are the contributing factors of essential htn?
- Family hx, hyperlipidemia
- African-American background, Mexican Americans
- Diabetes, obesity
- Aging, stress, excessive smoking & alcohol
186
Secondary htn is associated with what (2)?
1. 10% cases related to renal & endocrine disorders
| 2. sleep apnea -> associated with high blood pressure and hemorrhagic stroke -> CO2 retention -> atherosclerosis
187
how is glucocorticoids related to htn?
Glucocorticoids – release stress hormones – produce epinephrine and norepinephrine – blood sugar goes up -> hyperglycemia -> produced atherosclerosis -> diabetes -> increases atherosclerosis -> hypertension
188
how is one's diet physiological risk factors for htn?
diet high in fat and carbs. carbs can affect sympathetic NS.
| alcohol, renin secretion leads to increase angiotensin II
189
how is one's obesity physiological risk factors for htn?
obesity causes increased CO, SV, and left ventricular filling. 2/3 of hypertensives are obese.
190
what can decreased htn?
normal weight loss and mild to moderate sodium restriction.
191
what is normal htn?
systolic
192
what is pre-htn?
systolic : 120-139, diastolic: 80-89
193
what is stage 1 htn?
systolic 140 - 159 and diastolic 90-99
194
what is stage 2 htn?
systolic >160 and diastolic >100
195
what are the african americans cultural variations on antihypertensives?
1. african american get htn at earlier age and have higher mortality than whites.
2. beta blockers and ACE inhibitors is less effective
3. alpha 1 blockers and Ca channel blockers are more effective
4. African americans respond to diuretics as initial mono therapy.
196
what are the asian americans cultural variations on antihypertensives?
asians are twice as sensitive to beta-blockers and other antihypertensives than white, so they usually need lower dosage.
197
what are the white americans cultural variations on antihypertensives?
whites respond well to all antihypertensive agents.
198
by age 65, the stats for htn in older adults are
26% males, 30% females
199
htn in older adults...
both sys and dis htn associated with increased CV mortality and morbidity
200
the side effects of antihypertensives for htn in older adults
orthostatic hypotension and may need to decrease dose and use another drug.
201
what are some instructions nurses can give to older adults with htn on modifying lifestyle?
2Gm Na+ diet, avoid tobacco, lose weight if overweight/obese
202
in order to have healthier older adults, we should...
concentrate on adolescent's health now.
203
what are the benefits of lowering bp?
reduction in average percentage of stroke incidence, myocardial infarction and heart failure (as high as 50%).
204
what are the 8 types of antihypertensive drugs?
1. Diuretics
2. Beta-blockers
3. Alpha2 agonists
4. Alpha adrenergic blockers
5. ACE inhibitors
6. Angiotensin II receptor antagonists (blockers)
7. Direct renin inhibitor
8. Calcium channel blockers
205
what is the action of diuretics?
Promote Na+ and water depletion
| ↓ extracellular fluid volume
206
Diuretics is effective as
first line treatment for mild htn
207
what is an example of loop diuretics?
Furosemide
208
what are the side effects of Furosemide?
nausea, diarrhea, electrolyte imbalances (hypokalemia)
209
what is an example of thiazides (diuretics)?
hydrochlorothiaziede
210
what are the side effects of hydrochlorothiazide?
hypokalemia, dehydration
211
where do the loop diuretics work on?
they work in the loop of henle, water and sodium get excreted here.
212
where do the thiazides work on?
Thiazides work in the distal convoluted tubule, so it inhibits Na reabsorption. It can also lose some of the electrolytes like K – some pts may develop hypokalemia – tend to develop metabolic alkalosis
213
one of the causes of alkalosis is?
dehydration
214
One treatment of heart failure is using
diuretics
215
what are diuretics?
Diuretics are drugs which eliminate Na and water by acting directly on the kidney
216
what are the two types of beta-adrenergic blockers?
beta 1 (selective) beta 2 (non-selective)
217
what are the actions of beta-adrenergic blockers?
decrease CO, decrease systemic vascular resistance, decrease HR, contractility and renin release and lowers bp
218
what is one prototype drug of beta-adrenergic blockers?
metoprolol (Lopressor)
219
ideally, try one med at a time, if it doesn't work...
add an additional drug
220
selective beta blockers work on ?
beta 1 receptors only
221
non-selective beta blockers work on?
beta 2 and beta 1 receptors.
222
what is sympatholytics?
sympathetic depressants
223
what are 2 examples of Nonselective beta blockers?
propranolol (Inderal) and carvedilol (Coreg)
224
what is a contraindication for beta - adrenergic blockers?
chronic obstructive pulmonary disease (COPD) because the meds blocks beta 2 effects of bronchodilation -> so it bronchoconstricts -> may experience SOB
225
What are 5 examples of Selective beta blockers?
```
acebutolol (Sectral)
atenolol (Tenormin)
betaxolol (Kerlone)
bisoprolol (Zebeta)
metoprolol (Lopressor)
```
226
what are some contraindications for selective beta blockers?
patients with diabetes mellitus when taking beta blockers bc Beta blockers can cause decreased release of glucagon -> will cause hypoglycemia
227
What are the side effects of metoprolol (Lopressor)?
```
Dizziness
Fatigue, weakness
N/V, diarrhea
Nasal stuffiness
Impotence
Decreased libido
Depression
Mental changes
Bradycardia/heart block
Thrombocytopenia
Agranulocytosis
```
228
What are some contraindications for beta-blockers?
- Second or third degree AV block
- Sinus bradycardia
- Heart failure (but may be prescribed for early use in chronic HF)
- Non-cardioselective beta-blockers, e.g., Inderal
229
Beta-blockers should be avoid giving to pts with (4) conditions:
Asthma
COPD
CHF
DM
230
The stimulation of alpha 1 adrenoceptors will result in:
vasoconstriction, increase peripheral resistance, increase bp, mydriasis(dilation of pupils) , and increased closure of internal sphincter of the bladder
231
The stimulation of alpha 2 adrenoceptors will result in:
inhibition of norepinephrine release, inhibitions acetylcholine release and inhibitions insulin release
232
The stimulation of beta 1 adrenoceptors will result in:
tachycardia, increased lipolysis, increased myocardial contractility, and increased release of renin
233
The stimulation of beta 2 adrenoceptors will result in:
vasodilation of skeletal muscles, slightly decreased peripheral resistance, bronchodilation, increased muscle and liver glycogenolysis, increase release of glucagon, and relaxed uterine smooth muscle.
234
what are the actions of Centrally Acting Alpha2 Agonists?
↓ sympathetic activity (brainstem)
↑ Vagus activity
↓ CO, serum epinephrine,
lowers bp
norepinephrine, & renin release
Reduced peripheral vascular resistance and increased vasodilation
Minimal effect on cardiac output & renal blood flow
235
Centrally Acting Alpha2 Agonists are not given with?
beta-blockers
236
what is an example of Centrally Acting Alpha2 Agonists?
Clonidine (Catapres)
237
Centrally Acting Alpha2 Agonists is a drug of choice for?
drug abuse/benzodiazepine withdrawal, etoh withdrawal, cocaine/heroin withdrawal
238
What are the side effects and adverse reactions of Centrally Acting Alpha2 Agonists?
Drowsiness
Dry mouth
Dizziness
Bradycardia
Rebound hypertensive crisis if D/C abruptly
If need to stop immediately, prescribe another antihypertensive
Peripheral edema due to Na+ & H2O retention
Methyldopa (treat HTN) shouldn’t be used if impaired liver function
Monitor serum liver enzymes
239
What are the actions of Alpha-Adrenergic Blockers?
- Blocks alpha 1 or alpha 2 receptors
- Vasodilation & lowers blood pressure
- Maintain renal blood flow
- Useful in treating hypertension if lipid abnormalities – can lower LDL
- Do not affect glucose metabolism or respiratory function
- Selective alpha1 adrenergic blockers used to ↓ BP & for BPH (benign prostate hypertropy)
240
what is an example drug for Alpha-Adrenergic Blockers?
Prazosin HCl (Minipress)- sometimes prescribed for BPH (benign prostate hypertrophy)
241
Pt with benign prostate hypertrophy -> if you block alpha 1, you will be able to...
open up internal sphincter of the bladder
242
When taking Alpha-Adrenergic Blockers...
Less of orthostatic hypotension if taken at night
243
The antihypertensive drugs that are effective for African-Americans are...
alpha1 blockers and calcium channel blockers.
244
What are the contraindications for Alpha-Adrenergic Blockers?
renal failure due to sodium and water retention
245
What is Orthostatic hypotension?
Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing compared with blood pressure from the sitting or supine position.
246
What are the side effects and adverse reactions for Alpha-Adrenergic Blockers?
```
ORTHOSTATIC HYPOTENSION
Nausea
Drowsiness
Edema
Weight gain
Impotence
```
247
What is the drug interactions for Alpha-Adrenergic Blockers?
Nitrates: decrease bp
248
What are the first 2 of 5 nursing pearls of wisdom for antianginals?
1. NTG SL if angina
| 2. Monitor VS, look for hypotension (withhold drug if systolic BP
249
What are the last 3 nursing pearls of wisdom for antianginals
3. Have client sit or lie down when taking nitrate 1st time & always with SL NTG
Follow special procedures for prescribed route
4. Do not touch topical NTG with your fingers
5. Do not place topical nitrate in area of cardioverter-defibrillator paddle placement
