Ch 22-29
What are the SUBCATEGORIES of Angiotensin-Converting Enzyme Inhibitors, Angiotensin II Receptor Blockers & Calcium Channel Blockers?
• Benzothiazepines • Dihydropyridines • Phenylalkylamines
Action potential duration
The interval beginning with the baseline (resting) membrane potential, followed by depolarization, and ending with repolarization to the baseline membrane potential.
Osmotic pressure
The pressure produced by a solution necessary to prevent the osmotic passage of solvent into it when the solution and solvent are separated by a semipermeable membrane.
Drug that Interacts with ARBs
NSAIDs lithium rifampin
Cholesterol
A fat-soluble steroid found in animal fats, oils, and egg yolk that is widely distributed in the body, especially in the bile, blood, brain tissue, liver, kidneys, adrenal glands, and myelin sheaths of nerve fibers.
Cardiac Arrhythmia Suppression Trial (CAST)
A major research study conducted to investigate the possibility of eliminating sudden cardiac death in patients with asymptomatic ectopy after a myocardial infarction (MI).
A pediatric patient weighing 66 lb is prescribed digoxin 12 mcg/kg in 3 evenly divided doses a day. How much will the nurse administer per dose?
120 mcg/kg To identify the dosage: 66 lb divided by 2.2 = 30 kg × 12 mcg/kg = 360 mcg/3 doses = 120 mcg/dose.
Adrenergic Drugs: Interactions
Can cause additive CNS depression with alcohol, benzodiazepines, opioids Always check for specific drug interactions
Coagulation System
"Cascade" Each activated factor serves as a catalyst that amplifies the next reaction Result is fibrin, a clot-forming substance Intrinsic pathway and extrinsic pathway
Assessment: Before any antihypertensive drug is given to a patient, what labs should you draw?
(1) serum sodium, potassium, chloride, magnesium, and calcium levels; (2) CBC and platelet count; (3) renal function studies, including BUN, serum, and urinary creatinine levels; (4) C-reactive protein to measure systemic inflammation; (5) cholesterol/lipid profiles; and (6) hepatic function studies, including serum levels of ALT and AST. Other cardiac-specific laboratory studies may be ordered for baseline comparative levels. These studies may include platelet function tests and cholesterol/lipid profiles.
Cardiac Glycosides:Adverse Effects
*Digoxin (Lanoxin) -very narrow therapeutic range and low TI -drug levels must be monitored --0.5 to 2 mg/ml *Hypokalemia increases its toxicity *Electrolyte levels must be monitored Digoxin (Lanoxin) Cardiovascular: dysrhythmias, including bradycardia or tachycardia ØCentral nervous system: headaches, fatigue, malaise, confusion, convulsions ØEyes: colored vision (seeing green, yellow, purple), halo vision, flickering lights ØGastrointestinal: anorexia, nausea, vomiting, diarrhea
Cardiac cell
*Inside the resting cardiac cell there exists a net negative charge relative to the outside of the cell *This difference in the electronegative charge results from an uneven distribution of ions (sodium, potassium, calcium) across the cell membrane -resting membrane potential (RMP)
Thiazide and Thiazide-Like Diuretics
*thiazide diuretics* -hydrochlorothiazide (Esidrix, HydroDIURIL) -chlorothiazide (Diuril) *Thiazide- like diuretics* -metolazone (Mykrox, Zaroxolyn) -Chlorthalidone (Hydone, Thalitone) -Indapamide (Lozol)
Adrenergic Drugs: Indications/Contraindications
- All used to treat hypertension - Glaucoma - BPH: doxazosin, prazosin, and terazosin - Management of severe heart failure (HF) when used with cardiac glycosides and diuretics Contraindications: - Acute HF - MOAIs - Peptic ulcers - Severe liver/kidney disease - Asthma (with beta blockers)
Adrenergic Drugs: Adverse Effects
- High incidence of orthostatic hypotension - MOST COMMON: bradycardia with reflex tachycardia, dry mouth, drowsiness, sedation, depression, constipation, edema, sexual dysfunction - Other: headaches, sleep disturbances, nausea, rash, cardiac disturbances (palpitations)
Aspects of Action Potential
- SA node, AV node, and His-Purkinje cells all possess the property of automaticity. - SA node is the natural pacemaker of the heart. - SA node has an intrinsic rate of 60 to 100 bpm. - AV node has an intrinsic rate of 40 to 60 bpm. - Ventricular Purkinje fibers have an intrinsic rate of 40 or fewer beats per minute.
Excessive potassium loss (other than diet) can be due to...
- diarrhea, vomiting, NG - diuretics, Mg depletion - diaphoresis - dialysis - increased insulin - alkalosis - starvation
Potassium-Sparing Diuretics: Indications
--*spironolactone and triamterene* -Hyperaldosteronism -Hypertension -Reversing potassium loss caused by potassium-losing drugs -Certain cases of HF --*amiloride* -Treatment of HF •Similar as spironolactone and triamterene, but amiloride is less effective in the long term
Thiazide and Thiazide-Like Diuretics: Indications
--Hypertension (one of the most prescribed group of drugs for this) --Edematous states --Idiopathic hypercalciuria --Diabetes insipidus --Heart failure due to diastolic dysfunction --Adjunct drugs in treatment of edema related to HF, hepatic cirrhosis, or corticosteroid or estrogen therapy
Loop Diuretics Drug Effects
--Potent diuresis and subsequent loss of fluid --Decreased fluid volume causes a reduction in: -Blood pressure -Pulmonary vascular resistance -Systemic vascular resistance -Central venous pressure -Left ventricular end-diastolic pressure --Potassium and sodium depletion
Coagulation Modifier Drugs
-Anticoagulants Inhibit the action or formation of clotting factors -Prevent clot formation Antiplatelet drugs -Inhibit platelet aggregation -Prevent platelet plugs -Hemorheologic drugs -Alter platelet function without preventing the platelets from working -Thrombolytic drugs -Lyse (break down) existing clots -Antifibrinolytic or hemostatic Promote blood coagulation
Primary Effects of the ACE Inhibitors
-Cardiovascular and renal -reduce BP by decreasing SVR -HF -Prevent sodium and water resorption by inhibiting aldosterone secretion -*Diuresis: decreases blood volume and return to the heart -Decreases preload, or the left ventricular end-diastolic volume -Decreases work required of the heart
Treatment:Toxic Effects of Warfarin
-Discontinue the warfarin. -May take 36 to 42 hours before the liver can resynthesize enough clotting factors to reverse the warfarin effects -Vitamin K1 (phytonadione) can hasten the return to normal coagulation. -High doses of vitamin K (10 mg) given IV will reverse the anticoagulation within 6 hours. -Caution: when vitamin K is given, warfarin resistance will occur for up to 7 days. -Severe bleeding: transfusions of human plasma or clotting factor concentrates. -Life-threatening bleeding from warfarin: Kcentra and Profiline -IV vitamin K: risk of anaphylaxis. Risk is diminished by diluting it and giving it over 30 minutes.
Loop Diuretics Indications
-Edema associated with HF or hepatic or renal disease -To control hypertension -To increase renal excretion of calcium in patients with hypercalcemia -In cases of HF resulting from diastolic dysfunction
Niacin: Indications
-Effective in lowering triglyceride, total serum cholesterol, and LDL levels -Increases HDL levels -Effective in the treatment of types IIa, IIb, III, IV, and V hyperlipidemias
Loop Diuretics Mechanism of Action
-Possess renal, cardiovascular, and metabolic effects -Act directly on the ascending limb of the loop of Henle to inhibit chloride and sodium resorption -Increase renal prostaglandins, resulting in the dilation of blood vessels and reduced peripheral vascular resistance -Useful in treatment of edema
Potassium-Sparing Diuretics: Drug Effects
-Prevent potassium from being pumped into the tubule, thus preventing its secretion -Competitively block aldosterone receptors and inhibit their action -Promote the excretion of sodium and water
Triglycerides and Cholesterol
-Two primary forms of lipids in the blood -Water-insoluble fats that must be bound to apolipoproteins, specialized lipid-carrying proteins -Lipoprotein is the combination of triglyceride or cholesterol with apolipoprotein
Niacin (Nicotinic Acid)
-Vitamin B3 -Lipid-lowering properties require much higher doses than when used as a vitamin -Effective, inexpensive, often used in combination with other lipid-lowering drugs
The order reads: Give hydralazine (Apresoline) 0.75 mg/kg/ day. The child weighs 16 pounds. How much hydralazine will be given? (Record your answer using two decimal places.)
16 ÷ 2.2 = 7.27 7.27 x 0.75 mg/kg/day = 5.45 mg/kg/day
The medication order for a patient who receives nutrition via a feeding tube reads: "Give digoxin 0.125 mg per feeding tube once every morning." The medication is available in a liquid form 50 mcg/mL. How many milliliters will the nurse give for each dose?
2.5 mL
A patient is in the emergency department with new-onset rapid-rate atrial fibrillation. The nurse is about to add a continuous infusion of diltiazem (Cardizem) at 5 mg/hr but must first give a bolus of 0.25 mg/kg over 2 minutes. The patient weighs 220 pounds. The medication comes in a vial of 25 mg/5 mL. How many milligrams will the patient receive for the bolus dose and how many milliliters will the nurse draw up for this dose?
25 mg, 5 mL
The order reads, "Give metoprolol (Lopressor) 300 mg/day PO in 2 divided doses." The tablets are available in 50-mg strength. How many tablets will the patient receive per dose?
3 tablets per dose (150 mg per dose);
Alpha1 Blockers
Doxazosin (Cardura) Prazosin (Minipress) Tamsulosin (Flomax)* Terazosin (Hytrin) *Tamsulosin is not used to control BP but is indicated solely for symptomatic control of BPH.
Most commonly used alpha1 blocker
Doxazosin (Cardura, Cardura XL)
Which statement by the patient demonstrates a need for further education regarding nitroglycerin sublingual tablets? A - "I can take up to four tablets at 5-minute intervals for chest pain." B - "If I get a headache, I should keep taking my nitroglycerin and use Tylenol to relieve my headache." C - "I should change positions slowly to avoid getting dizzy from the drug's effect on my blood pressure." D - "I should keep my nitroglycerin in a cool, dry place."
A - "I can take up to four tablets at 5-minute intervals for chest pain." Patients are taught to take up to three sublingual tablets 5 minutes apart. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after one dose, the patient (or family member) must call 911 immediately. The patient can take one more tablet while awaiting emergency care and a third tablet 5 minutes later, but no more than three tablets total. Patients should always sit or lie down before taking this medication.
The nurse is giving discharge instructions to a patient prescribed warfarin for atrial fibrillation. Which statement by the patient indicates a need for further instruction from the nurse? A - "I will increase the dark green leafy vegetables in my diet." B - "I will avoid activities that have a risk for injury such as contact sports." C - "I will contact my health care provider if I develop excessive bruising." D - "I will take my medication in the early evening each day."
A - "I will increase the dark green leafy vegetables in my diet." Dark green leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Therefore, it is important to maintain a consistent daily intake of vitamin K and avoid eating large amounts of these foods.
The patient states to the nurse, "My friend said nitroglycerin relieves angina pain by reducing preload. What is preload?" Which statement by the nurse explains preload to this patient? A - "It is the blood return to the heart." B - "It is dilation of arteries and veins throughout the body." C - "It is the oxygen demand of the heart." D - "It is the pressure against which the heart must pump."
A - "It is the blood return to the heart." Preload is determined by the amount of blood in the ventricle just before contraction.
Potassium-sparing diuretics may cause which common adverse reactions? (Select all that apply.) A - Headache B - Muscle weakness C - Dizziness D - Hyperkalemia E - Mental confusion
A - Headache C - Dizziness D - Hyperkalemia Hyperkalemia, dizziness, and headache are common adverse effects associated with potassium-sparing diuretics.
The patient asks the nurse, "What is the best way to store sublingual nitroglycerin when I travel?" What is the appropriate response by the nurse? A - "It's best to keep it in its original container away from heat and light." B - "You can protect it from heat by placing the bottle in an ice chest." C - "Keep it in the glove compartment of your car to prevent exposure to heat." D - "You can put a few tablets in a resealable bag and carry it in your pocket."
A - "It's best to keep it in its original container away from heat and light." Although sublingual nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest, where it could freeze. It should not be kept in the glove compartment of a car and needs to be kept away from heat, not in a clear plastic bag.
During discharge teaching, which statement by the nurse would be most appropriate for a patient prescribed a transdermal clonidine? A - "The patch should be applied to a non-hairy site, and you should not suddenly stop using this drug." B - "Occasional drooling is a common adverse effect of this medication." C - "Your blood pressure should be checked by your health care provider two to three times a week." D - "Prolonged sitting or standing does not cause hypotension symptoms."
A - "The patch should be applied to a non-hairy site, and you should not suddenly stop using this drug." (Transdermal clonidine patches should be applied to nonhairy areas of the skin, and application sites should be rotated. When the patch dosage form is used, it is important to remove the old patch before applying a new one. It must not be discontinued abruptly because it will lead to severe rebound hypertension (sudden high elevation of blood pressure). Prolonged standing can cause venous pooling and hypotension. Dry mouth, not drooling, is a common adverse effect of clonidine.)
The nurse would question the use of milrinone in a patient with which condition? A - Aortic regurgitation B - Systolic heart failure C - Acute renal failure D - Mitral valve prolapse
A - Aortic regurgitation Milrinone, a PDI, is contraindicated in severe aortic or pulmonary valvular disease and in diastolic heart failure.
To prevent the development of tolerance to nitroglycerin transdermal patch, the nurse instructs the patient to perform which action? A - Apply the nitroglycerin patch in the morning and remove it at night for 8 hours. B - Use the nitroglycerin patch for acute episodes of angina only. C - Apply a new nitroglycerin patch every other day. D - Switch to sublingual nitroglycerin when the systolic blood pressure is greater than 140 mm Hg.
A - Apply the nitroglycerin patch in the morning and remove it at night for 8 hours. To avoid development of tolerance to transdermal nitroglycerin patches, maintain an 8-hour nitrate-free period each day. A common regimen with transdermal patches is to remove them at night for 8 hours and apply a new patch in the morning.
A patient prescribed digoxin 0.25 mg and furosemide 40 mg for the treatment of systolic heart failure states, "I am starting to see yellow halos around lights." What is the appropriate nursing intervention? A - Assess for other symptoms of digoxin toxicity. B - Document the finding and reassess in 1 hour. C - Perform a visual acuity test on each eye. D - Prepare to administer digoxin immune fab.
A - Assess for other symptoms of digoxin toxicity. Yellow-green halos around objects are a symptom of digoxin toxicity. Other signs and symptoms of digoxin toxicity include headache, dizziness, confusion, nausea, and blurred vision. Electrocardiogram findings show heart block, atrial tachycardia with block, or ventricular dysrhythmias.
When caring for a patient with angina pectoris, the nurse would question a prescription for a noncardioselective beta blocker in a patient with which pre-existing condition? A - Bronchial asthma B - Atrial fibrillation C - Myocardial infarction D - Hypertension
A - Bronchial asthma Non-cardioselective beta blockers should be used with caution in patients with bronchial asthma, because any level of blockade of beta2 receptors can promote bronchoconstriction.
Sodium channel blockers are considered which class of antidysrhythmic drugs? A - Class I B - Class III C - Class IV D - Class II
A - Class I The Vaughan Williams classification is the most commonly used system to classify antidysrhythmic drugs. There are four major classes of antidysrhythmic drugs: I, II, III, and IV. Sodium channel blockers are classified as class I drugs.
The nurse recognizes that the patient understands the teaching about warfarin when the patient verbalizes an increased risk of bleeding with concurrent use of which herbal product/products? (Select all that apply.) A - Dong quai B - Glucosamine C - Ginkgo D - Garlic E - St. John's wort
A - Dong quai C - Ginkgo D - Garlic E - St. John's wort Garlic, ginkgo, dong quai, and St. John's wort alter blood coagulation and may increase the risk of bleeding when given concurrently with oral anticoagulants. Glucosamine does not affect coagulation.
What is the classification of carvedilol? A - Dual-action alpha1 and beta receptor blocker B - ACE inhibitor C - Beta blocker D - Alpha2 blocker
A - Dual-action alpha1 and beta receptor blocker (Carvedilol blocks both the alpha1 and beta receptors of the adrenergic nervous system.)
Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are generally administered at which time of day? A - Evening B - 12:00 noon C - Morning D - Afternoon
A - Evening The liver produces the majority of cholesterol during the night. Thus, statin drugs, which decrease the cholesterol synthesis, are generally administered in the evening or bedtime so that the peak drug levels coincide with cholesterol production.
Why does the health care provider prescribe furosemide 40 mg twice a day by mouth for a patient with a history of renal insufficiency? A - Furosemide is effective in treating patients with impaired kidney function. B - Furosemide helps the kidney with reabsorption of sodium and water. C - Furosemide has an antagonist effect to prevent respiratory alkalosis. D - Furosemide is effective in treating patients with hypoaldosteronism.
A - Furosemide is effective in treating patients with impaired kidney function. Furosemide effectiveness continues in impaired renal function. When creatinine clearance decreases below 25 L/min (normal is 125 L/min), the loop diuretics can still work.
For a patient prescribed hydrochlorothiazide, the nurse should closely monitor which laboratory test value? A - Glucose B - Calcium C - Chloride D - Sodium
A - Glucose Thiazide and thiazide-like diuretics are associated with adverse metabolic effects of hyperglycemia; therefore, close monitoring of blood glucose levels are needed. Other metabolic disturbances include hyperlipidemia and hyperuricemia.
The nurse would question a prescription for simvastatin in a patient with which condition? A - Hepatic disease B - Diabetes C - Heart failure D - Leukemia
A - Hepatic disease Simvastatin can cause an increase in liver enzymes and thus should not be used in patients with pre-existing liver disease.
Acetazolamide is used to treat which conditions? (Select all that apply.) A - High-altitude sickness B - Dry eye syndrome C - Edema associated with heart failure D - Cardiac dysrhythmias E - Open-angle glaucoma
A - High-altitude sickness C - Edema associated with heart failure E - Open-angle glaucoma Acetazolamide causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat high-altitude sickness, edema secondary to heart failure, open-angle glaucoma, and rarely as an antiepileptic drug. It is not used for treatment of dry eye syndrome or cardiac dysrhythmias.
A patient is taking spironolactone (aldactone) which of the following is a contraindication? A - Hyperkalemia. B - hypokalemia. C - hyponatremia. D - hypernatremia.
A - Hyperkalemia.
For patients prescribed amiodarone, the nurse should monitor for which potential adverse effects of this drug? (Select all that apply.) A - Hypothyroidism B - Diarrhea C - Visual halos D - Photosensitivity E - Blue gray skin discoloration F - Overgrowth of gum tissue
A - Hypothyroidism C - Visual halos D - Photosensitivity E - Blue gray skin discoloration Potential adverse effects from amiodarone include visual halos, photosensitivity, photophobia, dry eyes, bluish skin discoloration, hyperthyroidism, hypothyroidism, constipation, and decreased libido.
When caring for a patient with a serum potassium of 2.8 mEq/L, what is the appropriate nursing intervention when giving IV replacement therapy? A - Maintain infusion rate at no greater than 20 mEq/hr. B - Administer potassium as a bolus over 10 minutes. C - Apply ice packs to site of IV administration. D - Teach the patient signs and symptoms of hypokalemia.
A - Maintain infusion rate at no greater than 20 mEq/hr. Too rapid an infusion of potassium may cause cardiac arrest. Therefore, IV potassium infusion rates should not exceed 20 mEq/hr.
For a patient receiving IV nitroglycerin, what are the priority nursing interventions? (Select all that apply.) A - Monitor blood pressure. B - Assess for worsening chest pain. C - Measure intake and output. D - Auscultate lung sounds. E - Check the heart rate.
A - Monitor blood pressure. B - Assess for worsening chest pain. E - Check the heart rate. IV nitroglycerin can cause sudden and severe hypotension, worsening of chest pain, and significant changes in heart rate (100 beats/min).
For a patient receiving a positive inotropic drug, which nursing assessments should be performed? (Select all that apply.) A - Monitor serum electrolytes. B - Obtain daily weights. C - Auscultate lung sounds. D - Review red blood cell count. E - Check apical pulse.
A - Monitor serum electrolytes. B - Obtain daily weights. C - Auscultate lung sounds. E - Check apical pulse. Lung sounds and daily weights are appropriate assessments related to the treatment of heart failure with inotropic drugs. The apical pulse and serum electrolytes are important assessments related to potential adverse reactions (bradycardia, toxicity with hypokalemia).Bottom of Form
When teaching a patient about symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which symptom occurs? A - Muscle weakness B - Blurred vision C - Constipation D - Diaphoresis
A - Muscle weakness Muscle weakness is a common symptom of hypokalemia. The other answers are incorrect.
Before administering isosorbide mononitrate sustained-release tablet to a patient, what is the priority nursing intervention? A - Obtain a blood pressure reading. B - Advise the patient that Tylenol is used to treat headache. C - Emphasize that the patient should swallow the tablet whole. D - Remind the patient to take the tablet before meals.
A - Obtain a blood pressure reading. Mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.
Lab work needs to be drawn on the client who is on warfarin The nurse should expect that the health care provider will order which lab test: A - PT/INR B - CBC C - PTT D - aPTR
A - PT/INR
The nurse understands adenosine is used to treat which condition? A - Paroxysmal supraventricular tachycardia (PSVT) B - Atrial flutter C - Second-degree atrioventricular block D - Atrial fibrillation
A - Paroxysmal supraventricular tachycardia (PSVT) The only therapeutic indication of use for adenosine is the treatment of PSVT.
Which medication would the nurse question if prescribed together with ACE inhibitors? A - Potassium chloride B - Morphine C - Furosemide D - Docusate sodium
A - Potassium chloride (ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion; thus, a decrease in aldosterone production can result in an increase in serum potassium.)
ACE inhibitors and ARBs both work to decrease blood pressure by which action? A - Prevent aldosterone secretion B - Prevent the formation of angiotensin II C - Enhance sodium and water resorption D - Increase the breakdown of bradykinin
A - Prevent aldosterone secretion (Whereas ACE inhibitors block the formation of angiotensin II, ARBs allow the formation of angiotensin II but block its effect at the receptors. Without the receptors stimulated (because of either drug), aldosterone secretion is inhibited, preventing the reabsorption of sodium and water.)
The nurse is teaching a classical anti anginal drugs to a group of patients who have experienced myocardial infarction (MI). the nurse determines that learning has occurred when a patient makes which statement? A - These medications decrease how much oxygen my heart needs. B - These medications thin my blood so my heart receives more oxygen. C - These medications increase the amount of oxygen my heart receives. D - These medications increase oxygen to my heart by increasing nitric oxide production.
A - These medications decrease how much oxygen my heart needs.
Two main reasons for the use of diuretics are to: A - decrease blood pressure and decrease fluid. B - Increased blood pressure and decrease edema. C - Increase blood pressure and increase the heart rate. D - decrease blood pressure and increase pulse rate.
A - decrease blood pressure and decrease fluid.
Prior to administering a calcium channel blocker (Diltiazem), which of the following would the nurse assess? A - ensure blood pressure has been taken. B - patient is not an African American. C - ensure potassium level is between 3.5 and 5.0 D - Ensure oxygen saturation has been measured.
A - ensure blood pressure has been taken.
the client's serum cholesterol is elevated. Atorvastatin (Lipitor) is prescribed. The action of Atorvastatin (Lipitor) is to: A - inhibit synthesis of cholesterol. B - stimulate hepatic synthesis of cholesterol. C - Increase renal excretion of cholesterol. D - increase fecal excretion of cholesterol.
A - inhibit synthesis of cholesterol.
loop diuretics act on the: A - loop of Henle. B - distal tubules. C - collecting tubules. D - bladder.
A - loop of Henle.
Cardiac glycosides, such as dioxin (lanoxin), are effective in treating congestive heart failure (CHF) because they are: A - positive inotropics B - negative dromotropics C - positive chronotropics D - positive somatotropics
A - positive inotropics
Embolus
A blood clot (thrombus) that has been dislodged from the wall of a blood vessel and is traveling throughout the bloodstream. Emboli that lodge in critical blood vessels can result in ischemic injury to a vital organ (e.g., heart, lung, brain) and lead to disability or death.
Statins
A class of cholesterol-lowering drugs that are more formally known as HMG-CoA reductase inhibitors.
Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors
A class of cholesterol-lowering drugs that work by inhibiting the rate-limiting step in cholesterol synthesis; also commonly referred to as statins.
Orthostatic hypotension
A common adverse effect of adrenergic-blocking drugs involving a sudden drop in blood pressure when a person changes position, especially when rising from a seated or horizontal position.
Atrial fibrillation
A common cardiac dysrhythmia with atrial contractions that are so rapid they prevent full repolarization of myocardial fibers between heartbeats.
Atherosclerosis
A common form of arteriosclerosis involving deposits of fatty, cholesterol-containing material (plaques) within arterial walls.
Hypertension
A common, often asymptomatic disorder in which systolic blood pressure persistently exceeds 150 mm Hg and/or diastolic pressure exceeds 90 mm Hg in patients over 60 years of age and 140/90 for patients younger than 60 and those who have chronic kidney disease or diabetes.
Hypercholesterolemia
A condition in which higher than normal amounts of cholesterol are present in the blood. High levels of cholesterol and other lipids may lead to the development of atherosclerosis and serious illnesses such as coronary heart disease.
Open-angle glaucoma
A condition in which pressure is elevated in the eye because of obstruction of the outflow of aqueous humor.
Hypokalemia
A condition in which there is an inadequate amount of potassium in the bloodstream; possible causes include diarrhea, diuretic use, and others.
Hyponatremia
A condition in which there is an inadequate amount of sodium in the bloodstream, caused by inadequate excretion of water or by excessive water intake.
Lipoprotein
A conjugated protein, synthesized in the liver, that contains varying amounts of triglycerides, cholesterol, phospholipids, and protein; it is classified according to its composition and density.
Gradient
A difference in the concentration of a substance on two sides of a permeable barrier.
Prodrug
A drug that is inactive in its given form and must be metabolized to its active form in the body, generally by the liver, to be effective.
Aldosterone
A mineralocorticoid steroid hormone produced by the adrenal cortex that regulates sodium and water balance.
Tissue plasminogen activator
A naturally occurring plasminogen activator secreted by vascular endothelial cells in the walls of blood vessels. Thrombolytic drugs are based on this blood component.
Angiotensin II
A peptide hormone that stimulates constriction of precapillary arterioles and increases reabsorption of NaCl and water by the proximal tubules of the kidney, increasing blood pressure and volume.
Fibrinogen
A plasma protein that is converted into fibrin by thrombin in the presence of calcium ions.
Plasminogen
A plasma protein that is converted to plasmin.
Automaticity
A property of specialized excitable tissue in the heart that allows self-activation through the spontaneous development of an action potential, such as in the pacemaker cells of the heart.
Enzyme
A protein molecule that catalyzes chemical reactions of other substances without being altered or destroyed in the process.
Reflex tachycardia
A rapid heartbeat caused by a variety of autonomic nervous system effects, such as blood pressure changes, fever, or emotional stress.
Torsades de pointes
A rare ventricular arrhythmia that is associated with a long QT interval and, without medical intervention, can degenerate into ventricular fibrillation and sudden death; often simply referred to as torsades.
Hemophilia
A rare, inherited blood disorder in which the blood does not clot normally.
Fibrin
A stringy, insoluble protein produced by the action of thrombin on fibrinogen during the clotting process; a major component of blood clots or thrombi (see thrombus).
Antithrombin III
A substance that inactivates ("turns off") three major activating factors of the clotting cascade: activated factor II (thrombin), activated factor X, and activated factor IX.
Solute A substance that is dissolved in another substance.
A substance that is dissolved in another substance.
A patient is in the emergency department with an unspecified supraventricular dysrhythmia. The physician orders a dose of diltiazem (Cardizem) IV push. While the nurse administers the medication through the IV lock, the patient says she feels something wet spilling on her arm. Her heart rate was unchanged. What will the nurse do next? A.Assess the patient for diaphoresis. B.Check the IV lock to see if it is functioning properly. C.Repeat the dose of diltiazem (Cardizem). D.Restart the IV in another location.
ANS: B Because the heart rate was unchanged and the patient felt fluid on her arm, the IV lock is probably not working properly. Before anything else is done, the IV lock should be checked for proper functioning. Another dose would be wasted if the IV lock is not working.
Antihypertensive drugs
Medications used to treat hypertension.
Comparison of ACE Inhibitors and Angiotensin II Receptor Blockers
ACE inhibitors and ARBs appear to be equally effective for the treatment of hypertension. Both are well tolerated. ARBs do not cause cough. Evidence that ARBs are better tolerated and are associated with lower mortality after MI than ACE inhibitors Not yet clear whether ARBs are as effective as ACE inhibitors in treating HF (cardioprotective effects) or in protecting the kidneys, as in diabetes
ACE Inhibitors and Laboratory Values
ACE inhibitors can cause renal impairment, which can be identified with serum creatinine. ACE inhibitors can also cause hyperkalemia, so potassium levels need to be monitored.
Cardioprotective Effects of the ACE Inhibitors
ACE inhibitors decrease SVR (a measure of afterload) and preload. Used to prevent complications after MI Ventricular remodeling: left ventricular hypertrophy, which is sometimes seen after MI ACE inhibitors have been shown to decrease morbidity and mortality in patients with HF. Drugs of choice for hypertensive patients with HF
Renal Protective Effects of the ACE Inhibitors
ACE inhibitors: reduce glomerular filtration pressure Cardiovascular drugs of choice for patients with diabetes ACE inhibitors reduce proteinuria. Standard therapy for diabetic patients to prevent the progression of diabetic nephropathy
While preparing an infusion of mannitol (Osmitrol), the nurse notices small crystals in the IV tubing. What is the most appropriate action by the nurse? A.Administer the infusion slowly. B.Discard the solution and obtain another bag of medication. C.Obtain a filter and then infuse the solution. D.Return the fluid to the IV bag to dissolve the crystals.
ANS: B Even though a filter should always be used with this medication infusion, a solution with crystals present in the bag or tubing should never be infused. The nurse should first discard the solution and then restart the infusion with a new bag, ensuring that there is a filter on the IV line.
A patient is receiving oral quinidine. Which assessment finding is of most concern? A.Nausea B.Prolonged QT interval C.Diarrhea D.Occasional palpitations
ANS: B Patients taking quinidine need to be monitored for prolonged QRS and QT intervals, which may be a precursor to more serious dysrhythmia problems
3. Which of the following should the nurse include when providing dietary teaching for the patient receiving warfarin (Coumadin) therapy? A.Avoid drinking large amounts of green tea. B.Cranberry juice will provide you with needed nutrients while taking Coumadin. C.You must never eat spinach. D.You can only eat lettuce once a month.
ANS: A For patients taking warfarin therapy, it is recommended to avoid eating or drinking large amounts of kale, spinach, Brussels sprouts, collard or mustard greens, lettuce, chard, and green tea. Beverages that may increase the effect of warfarin and to be avoided include cranberry juice and alcohol.
The patient is being discharged home with furosemide (Lasix). 4. When providing discharge teaching, which instruction will the nurse include? A.Avoid prolonged exposure to the sun. B.Avoid foods high in potassium content. C.Stop taking the medication if you feel dizzy. D.Weigh yourself once a week and report a gain or loss of more than 1 lb.
ANS: A Patients taking furosemide (Lasix) should avoid prolonged exposure to the sun because the drug can cause photosensitivity. Although orthostatic hypotension is a possible adverse effect of the medication, patients should not stop taking the medication without consultation with their health care provider. Patients should weigh themselves once a day and report a weight gain or loss of approximately 3 lb. Patients taking furosemide (Lasix) should be encouraged to eat foods rich in potassium.
A patient asks the nurse to tell her more about a new drug the patient has been prescribed called ranolazine (Ranexa). 2. Which response by the nurse is accurate? A."We do not know how Ranexa works." B."This drug is the first medication your health care provider will use to treat your angina." C."This drug must be given intravenously." D."Ranexa is safe to use in patients with liver failure."
ANS: A The mechanism of action of Ranexa is not known. Ranexa is used only after treatment with other antianginals have not been effective. Ranexa is administered by mouth and is contraindicated for use in patients with liver failure.
When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of what response? A.Hypotension B.Hyperkalemia C.Oliguria D.Respiratory distress
ANS: A These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy.
When administering a loop diuretic to a patient, it is most important for the nurse to determine if the patient is also taking which drug? A.Lithium (Eskalith) B.Acetaminophen (Tylenol) C.Penicillin D.Theophylline
ANS: A Use of loop diuretics with lithium can increase the risk of lithium toxicity. Drug interactions with loop diuretic therapy can occur with concurrent use of nonsteroidal antiinflammatory drugs (NSAIDs), and vancomycin can cause increased neuro- and ototoxicity when used with loop diuretics. There is no associated risk of drug interaction when taking acetaminophen, penicillin, or theophylline with loop diuretics.
A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. What is the nurses' best response? A."The medication is better absorbed at this time." B."This timeframe correlates better with the natural diurnal rhythm of cholesterol production." C."There will be fewer adverse effects if taken at night instead of with the morning meal." D."This timing reduces the incidence of myopathy."
ANS: B All statins are generally dosed once daily, usually with the evening meal or at bedtime to best coincide with the body's natural diurnal rhythm of cholesterol production.
A patient is mowing his lawn on a hot Saturday afternoon. He begins to notice chest pain. What should his first action be? A.Take his nitroglycerin tablet. B.Stop mowing and sit or lie down. C.Go inside the house to cool off and get a drink of water. D.Call 911.
ANS: B At the first sign of chest pain, the person should stop all activity and sit or lie down before taking the nitroglycerin tablet.
A patient with extremely high blood pressure (BP) is in the emergency department. The physician will order therapy with nitroglycerin to manage the patient's BP. Which form of nitroglycerin is most appropriate? A.Sublingual spray B.Transdermal patch C.Oral capsule D.IV infusion
ANS: D The IV infusion of nitroglycerin will have the fastest effect, and the dose will be titrated to the patient's response.
The nurse is obtaining a medication history on a patient presenting with chest pain. What drug classification would necessitate the nurse informing the provider before beginning the prescribed nitroglycerin? A.Proton pump inhibitor B.Phosphodiesterase inhibitors (Erectile Dysfunction medications) C.Inhaled beta blocker D.Acetylsalicylic acid (aspirin)
ANS: B Phosphodiesterase inhibitors (erectile dysfunction medications) are potent vasodilators and therefore nitrates are contraindicated when the patient is taking this classification of medications. All other medication classifications can safely be used with nitrates.
A patient is receiving an IV infusion of a thrombolytic drug during treatment for an acute MI. The nurse notices that there is a slight amount of bleeding from the antecubital area where venous lab work was drawn. What will the nurse do first? A.Monitor the site for further bleeding. B.Apply pressure to the site with a gauze pad. C.Slow the rate of infusion of the thrombolytic drug. D.Stop the infusion of the thrombolytic drug.
ANS: B The most common undesirable effect of thrombolytic therapy is internal, intracranial, and superficial bleeding. If invasive procedures must be performed or injections given, appropriate pressure should be applied to bleeding sites, and all areas of venous or arterial catheter insertion should be closely watched for bleeding. This type of superficial bleeding is to be expected and does not warrant cessation of the thrombolytic therapy.
2. Before administering furosemide, it is most important for the nurse to assess the patient for allergies to which drug class? A.Aminoglycosides B.Sulfonamides C.Macrolides D.Penicillins
ANS: B The nurse should assess patients receiving furosemide (Lasix) for cross-sensitivity to sulfonamides. Although allergy to sulfonamide antibiotics is listed as a contraindication, analysis of the literature indicates that cross-reaction with the loop diuretics is unlikely to occur. Loop diuretics are commonly given to such patients in clinical practice. The nurse should closely monitor these patients.
Which location is the area where the highest percentage of sodium and water are resorbed back into the bloodstream? A. Glomerulus B. Proximal tubule C. Ascending loop of Henle D. Distal tubule
ANS: B The proximal convoluted (twisted) tubule or, more simply, proximal tubule, anatomically follows the glomerulus and returns 60% to 70% of the sodium and water from the filtered fluid back into the bloodstream. Another 20% to 25% of sodium is resorbed into the bloodstream in the ascending loop of Henle. The remaining 5% to 10% of sodium resorption takes place in the distal convoluted tubule, often called simply the distal tubule, which anatomically follows the ascending loop of Henle. The glomerulus does not resorb sodium or water but instead is the point of initial filtration of the blood.
The nurse is caring for a patient receiving IV heparin therapy for treatment of a pulmonary embolus. The patient is being converted to warfarin (Coumadin) therapy. The following questions relate nursing considerations when caring for this patient. 1. Nursing considerations for conversion of IV heparin to oral warfarin (Coumadin) therapy will include A.immediate discontinuation of IV heparin and administration of oral warfarin (Coumadin) therapy only. B.overlapping therapy of IV heparin and warfarin are for at least 5 days. C.monitoring the INR and stopping the IV heparin when the INR is 1.0.
ANS: B When the oral anticoagulant warfarin is prescribed, therapy is often initiated while the patient is still receiving heparin. This overlapping is done purposefully to allow time for the blood levels of warfarin to rise so that when the heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations for overlapping therapy of heparin and warfarin are for at least 5 days; the heparin is stopped after 5 days when the INR is above 2.
What patient history would the nurse recognize as a contraindication for beginning Niacin therapy? A.Allergy to erythromycin B.Gout C.Coronary artery disease D.Hypothyroidism
ANS: B With niacin, patient assessment includes noting contraindications such as liver disease, peptic ulcer disease, gout, hypertension, and any active bleeding. Although a thorough assessment of all patient conditions is helpful, the other conditions do not preclude use of niacin.
adenosine (Adenocard) to a patient who is experiencing an acute episode of paroxysmal supraventricular tachycardia. When giving this medication, which is important to remember? a. The onset of action occurs in 5 minutes. b. The medication must be given as a slow intravenous (IV) push. c. Asystole may occur for a few seconds after administration. d. The medication has a long half-life, and therefore duration of action is very long.
ANS: C Adenosine has an extremely short half-life of less than 10 seconds; its onset occurs within 1 minute; and it must be given as a fast IV push injection. In addition, a very brief episode of asystole may occur after administration.DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 405TOP: NURSING PROCESS: Implementation
A 75-year-old man fell at home and hit his head against a table. His wife reports to their daughter that he does not have cuts or scratches, but there is a small lump on his upper scalp. She does not see any blood. He is taking warfarin and an antidysrhythmic as part of his treatment for chronic atrial fibrillation. What is the main concern at this time? A.Pressure should be applied to the lump for 3 to 5 minutes. B.He will need to take two doses of warfarin tonight to prevent blood clotting. C.He needs to be examined for possible internal bleeding from the fall. D.As long as there is no bleeding, there is no concern.
ANS: C Careful examination will be needed to ensure that there is no hematoma or other internal bleeding as a result of the fall even if superficial bleeding is not noted.
A 72-year-old woman is taking an over-the-counter multivitamin that contains ginkgo. Her physician has recommended that she start taking low-dose aspirin therapy as part of her treatment for transient ischemic attacks. What is the concern with taking these two drugs together? A.Increased risk of gastric ulcer B.Decreased action of the aspirin because of the interaction with the ginkgo C.Increased risk of bleeding because of the ginkgo D.Antagonism of the action of the aspirin because of the multivitamins
ANS: C Ginkgo may cause some increased bleeding times, so taking aspirin with ginkgo may put the patient at a higher risk for bleeding episodes.
A patient is receiving an IV infusion of heparin and was started on warfarin therapy the night before. Which statement is most correct? A.The patient is receiving a double dose of anticoagulants. B.The heparin therapy was ineffective, so the warfarin was started. C.The heparin provides anticoagulation until therapeutic levels of warfarin are reached. D.The heparin and warfarin work together synergistically to provide anticoagulation.
ANS: C Heparin has a faster onset and therefore is used to provide anticoagulation until therapeutic levels of warfarin are reached.
A patient has been ordered the powdered form of the bile acid sequestrant colestipol. Which of the following does the nurse identify as true? A.The nurse should have the patient swallow the dose of the colestipol powder one teaspoonful at a time. B.The powder should be dissolved and immediately administered. C.The colestipol should be administered 1 hour before or 4 to 6 hours after any other oral medication. D.The colestipol should be administered with meals.
ANS: C It is important that colestipol and any bile acid sequestrant be taken 1 hour before or 4 to 6 hours after any other oral medication or meals because of the high risk for drug-drug and drug-food interactions. The powder should be dissolved for 1 full minute before administration and should not be taken in dry form.
Two days after admission, the nurse is reviewing laboratory results of the patient. 3. Which is the most common electrolyte finding resulting from the administration of furosemide (Lasix)? A.Hypocalcemia B.Hypophosphatemia C.Hypokalemia D.Hypomagnesemia
ANS: C Of all of the adverse effects of furosemide (Lasix) administration, hypokalemia is of serious clinical importance. To prevent hypokalemia, patients often receive potassium supplements along with furosemide. The other electrolyte disturbances listed do not occur as a result of furosemide (Lasix) therapy.
Which condition does the nurse identify as a late manifestation of hypokalemia? A.Muscle weakness B.Hypotension C.Palpitations D.Lethargy
ANS: C Palpitations are a late manifestation of hypokalemia. Early manifestations of hypokalemia include muscle weakness, lethargy, and hypotension.
A patient with a history of HF presents to the emergency department with difficulty breathing, cough, and edema of the lower extremities. 1. The nurse anticipates administration of which type of medication? ● A.Positive chronotrope B.Negative chronotrope C.Positive inotrope D.Negative inotrope
ANS: C Positive inotropes are used to increase the force of myocardial contraction in the treatment of patients with HF. Negative inotropes would cause the heart to have a decreased force of myocardial contraction and would not be effective. Positive chronotropes increase the rate at which the heartbeats, and negative chronotropes decrease the rate at which the heartbeats.
A patient who has had an MI is taking a beta blocker. What is the main benefit of beta blocker therapy for this patient? A.Vasodilation of the coronary arteries B.Increased force of cardiac contraction C.Slowing of the heart rate D.Maintaining adequate BP
ANS: C Slowing the heart rate in patients with ischemic heart disease reduces myocardial oxygen demand and allows the coronary arteries time to fill with oxygen- and nutrient-rich blood. Beta blockers also block the irritating effects of circulating catecholamines on the heart.
The patient is prescribed an ACE inhibitor. 2. What primary mechanism of ACE inhibitors will the nurse understand as the therapeutic action? A.To inhibit catecholamine release B.To inhibit acetylcholine release C.To inhibit aldosterone secretion D.To prevent vagal stimulation
ANS: C The ACE inhibitors are beneficial in the treatment of HF because they prevent sodium and water resorption by inhibiting aldosterone secretion. This causes diuresis, which decreases blood volume and blood return to the heart. This in turn decreases preload, or the left ventricular end-diastolic volume, and the work required of the heart.
A patient is receiving digoxin 0.25 mg/day as part of treatment for HF. The nurse assesses the patient before medication administration. Which assessment finding would be of most concern? A. Apical heart rate of 58 beats/min B. Ankle edema +1 bilaterally C. Serum potassium level of 2.9 mEq/L D. Serum digoxin level of 0.8 ng/mL
ANS: C The hypokalemia may precipitate digoxin toxicity; therefore, it is the biggest concern. The apical pulse is slightly under 60 beats/min, but bradycardia may occur with digoxin therapy, and the heart rate should be monitored. The ankle edema may be a manifestation of his HF and not a new concern. The digoxin level is within the normal range.
Which statement about ARBs does the nurse identify as being true? A.Hyperkalemia is more likely to occur than when using ACE inhibitors. B.Cough is more likely to occur than when using ACE inhibitors. C.Chest pain is a common adverse effect. D.Overdose is usually manifested by hypertension and bradycardia.
ANS: C The most common adverse effects of ARBs are chest pain, fatigue, hypoglycemia, diarrhea, urinary tract infection, anemia, and weakness. Hyperkalemia and cough are less likely to occur than with the ACE inhibitors. Overdose may manifest as hypotension and tachycardia; bradycardia occurs less often. Treatment is symptomatic and supportive and includes the administration of IV fluids to expand the blood volume.
A patient asks how to apply transdermal nitroglycerin. 4. What is the nurse's best response? A."Always apply the transdermal patch over the area of your chest where your heart is." B."Keep the previous patch on for 1 full day so you always have two patches on at a time." C."Apply the patch to hairless areas of the body." D."First apply Vaseline to your body; then apply the transdermal patch."
ANS: C The transdermal patch should be applied to a hairless, residual-free area of the body with the sites being rotated each time. The old transdermal patch should be completely removed and a new one applied.
3. What information will the nurse include when teaching the patients about taking beta2-blocking drugs for the treatment of angina? A."Call your health care provider if you heart rate is 64 beats/min." B."These drugs are safe to use in patients who have asthma." C."Call your health care provider if you experience a weight gain of 2 lb or more in 24 hours or 5 lb or more in 1 week." D."Avoid taking these medications with grapefruit juice."
ANS: C Weight gain can indicate serious adverse effects of beta2-blocking drugs, so the health care provider should be called. A pulse of 64 beats/min is acceptable; these drugs should be avoided in patients with asthma, and there is no interaction with grapefruit juice. CCBs should not be administered with grapefruit juice.
The patient is discharged home and returns to the emergency department 4 days later. The patient is admitted to the ICU with acute decompensated HF with dyspnea at rest. 3. The nurse anticipates administration of which medication? A.Atropine B.Carvedilol (Coreg) C.Lisinopril (Prinivil) D.Nesiritide (Natrecor)
ANS: D Nesiritide is used in the ICU setting as a final effort to treat severe, life-threatening HF, often in combination with several other cardiostimulatory medications. Lisinopril (Prinivil) is an ACE inhibitor that is used in the management of HF. Carvedilol (Coreg) has been shown to slow the progression of HF and to decrease the frequency of hospitalization in patients with mild to moderate (class II or III) HF. Atropine is used to increase heart rate.
Commonly used Colloids
Albumin (5% or 25%), dextran, hetastarch
A patient with a known history of angina was walking his dog and developed chest pain. The patient immediately stops walking and sits down. He continues to experience chest pain when sitting down. When should he call 911? A.Immediately B.If the pain becomes more severe C.If one sublingual tablet does not relieve the pain after 5 minutes D.If the pain is not relieved after three sublingual tablets, taken 5 minutes apart
ANS: C With sublingual nitroglycerin, the medication should be taken at the first sign of chest pain and not be delayed until the pain is severe. The patient should sit or lie down and take one sublingual tablet. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes after one dose, the patient (or family member) should call 911 immediately. The patient can take one more tablet while awaiting emergency care and a third tablet 5 minutes later but no more than three tablets in total. These guidelines reflect the fact that angina pain that does not respond to nitroglycerin may indicate an MI.
A patient is in the emergency department with new-onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect? A.Digoxin 0.25 mg PO daily B.Digoxin 1 mg PO now; then 0.25 mg PO daily C.Digoxin 0.5 mg IV push daily D.Digoxin 1 mg IV push now; then 0.25 mg IV daily
ANS: D A digitalizing dose is often used to quickly bring serum levels of the drug up to a therapeutic level. IV doses would accomplish this more quickly.
A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her physician has never told her that she has hypertension. What is the best explanation for this order? A.The doctor knows best. B.The patient is confused. C.This medication has cardioprotective properties. D.This medication has a protective effect on the kidneys for patients with diabetes.
ANS: D ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for patients with diabetes.
Which patient is the best candidate to receive nesiritide therapy? A.A patient with atrial fibrillation who has not responded to other drugs B.A patient needing initial treatment for HF C.A patient with reduced cardiac output D.A patient with acutely decompensated HF who has dyspnea at rest
ANS: D At this time, nesiritide is generally used in the intensive care setting as a final effort to treat severe, life-threatening HF, often in combination with several other cardiostimulatory medications. The manufacturer recommends that nesiritide not be used as a first-line drug for this purpose. In 2005, an expert panel reviewed nesiritide at the request of the US Food and Drug Administration in response to reports of worsened renal function and mortality. The expert panel stated that the use of nesiritide should be strictly limited to treatment of patients with acutely decompensated HF who have dyspnea at rest. It should not be used to replace diuretics and should not be used repetitively or to improve renal function.
A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? A.Clonidine B.Prazosin C.Diltiazem D.Captopril
ANS: D Captopril is not a prodrug; therefore, it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease.
A patient will be taking niacin as part of antilipemic therapy. What is the best way to avoid problems with flushing or pruritus? A.Take the medication at bedtime. B.Take the medication with a small dose of a steroid. C.Take the medication with a full glass of water on an empty stomach. D.Start with a low initial dose and then increase it gradually.
ANS: D Cutaneous flushing may be minimized if the niacin is started at a smaller dose and gradually increased. Premedication with a small dose of aspirin or a nonsteroidal antiinflammatory drug 30 minutes before taking the niacin, as well as taking the niacin with meals, may help to minimize these undesirable effects.
2. When converting from IV heparin to oral warfarin (Coumadin) therapy, the prescriber monitors which of the following to determine the next appropriate dose of warfarin? A.Platelet levels B.aPTT C.Red blood cell count D.PT/INR
ANS: D For conversion from heparin to an oral anticoagulant such as warfarin, the dose of the oral drug is the usual initial dosage amount, with the prescriber using the PT/INR levels to determine the next appropriate dosage of warfarin. When there is continuous therapeutic anticoagulation coverage and warfarin has reached therapeutic levels, the heparin or LMWH may be discontinued without tapering.
A patient wants to take garlic tablets to improve his cholesterol levels. Which condition would be a contraindication? A.Hypertension B.Bowel obstruction C.Sinus infection D.Scheduled surgery
ANS: D Garlic has antiplatelet activity and is contraindicated in patients who will undergo surgery within 2 weeks and in patients with human immunodeficiency virus infection or diabetes
4. The patient accidentally takes too much of the prescribed warfarin (Coumadin) and is readmitted to the hospital with bleeding. Which drug can the nurse anticipates administrating? A.Protamine sulfate B.Alteplase (Activase, Cathflo Activase) C.Reteplase (Retavase) D.Vitamin K
ANS: D High doses of vitamin K (10 mg) given IV will reverse the anticoagulation of warfarin within 6 hours. Protamine sulfate is used to reverse heparin. Alteplase and reteplase are thrombolytics.
The number of people with hypertension in the United States is estimated to be ● A.10 million. B.25 million. C.50 million. D.70 million.
ANS: D Hypertension affects approximately 70 million people in the United States and approximately 1 billion people worldwide, designating it as the most common disease state.
Which patient would benefit from administration of simvastatin (Zocor) 80 mg? A.A patient newly diagnosed with hyperlipidemia B.A patient with muscle aches who was taking another antilipidemic drug C.A patient who is taking verapamil D.A patient who has already been taking simvastatin (Zocor) for 12 months with no evidence of myopathy
ANS: D In 2011, the Food and Drug Administration imposed new prescribing restrictions on simvastatin, stating: "Physicians should limit using the 80-mg dose unless the patient has already been taking the drug for 12 months and there is no evidence of myopathy. Simvastatin 80 mg should not be started in new patients, including patients already taking lower doses of the drug." In patients taking verapamil, the dose of simvastatin is not to exceed 10 mg.
A patient has received an IV dose of adenosine, and almost immediately the heart monitor shows asystole. What should the nurse do next? A.Check the patient's pulse. B.Prepare to administer cardiopulmonary resuscitation. C.Set up for defibrillation. D.Continue to monitor the patient.
ANS: D The half-life of adenosine is very fast—only 10 seconds—and the asystole only lasts for a few seconds. The nurse should continue to monitor the patient for therapeutic and adverse effects of the medication.
patient with a creatinine clearance of 20 mL/min is admitted to the medical-surgical unit. The patient is in need of rapid diuresis. 1. Which class of diuretic does the nurse anticipate administering? A.Potassium sparing B.Thiazide C.Osmotic D.Loop
ANS: D The loop diuretics provide rapid diuresis because of their rapid onset of action. Loop diuretics are effective for patients with reduced kidney function (creatinine clearance below 25 mL/min).
Angiotensin II Receptor Blockers: Mechanism of Action
ARBs affect primarily vascular smooth muscle and the adrenal gland. Selectively block the binding of AII to the type 1 AII receptors in these tissues ARBs block vasoconstriction and the secretion of aldosterone.
Dysrhythmia
Abnormal heart rhythm
Vasodialators
Act directly on arteriolar and/or venous smooth muscles to cause relaxation.
What are the actions of Vasodilators?
Act directly on vascular smooth muscle cells, not through alpha or beta receptors
Anticoagulant: Heparin
Action: inhibit clotting factors IIa (thrombin) and Xa Unfractionated heparin: "heparin" Low-molecular-weight heparins (LMWHs) Enoxaparin (Lovenox) Dalteparin (Fragmin) Unfractionated heparin (heparin) Relatively large molecule that is derived from animal sources Frequent laboratory monitoring for bleeding times such as aPTT Heparin for catheter flush (10 to 100 units/mL): no monitoring is needed LMWHs Enoxaparin (Lovenox) and dalteparin (Fragmin) Synthetic smaller molecular structure More predictable anticoagulant response Frequent laboratory monitoring of bleeding times using tests such as aPTT not needed
Anticoagulant: Direct thrombin inhibitors
Action: inhibit thrombin (factor IIa) Human antithrombin III (Thrombate) Lepirudin (Refludan) Argatroban (Argatroban) Bivalirudin (Angiomax) Dabigatran (Pradaxa)
Anticoagulant: Coumarins
Action: inhibit vitamin K-dependent clotting factors II, VII, IX, and X Warfarin (Coumadin)
Adrenergic Drugs: Five Subcategories
Adrenergic neuron blockers (central and peripheral) Alpha2 receptor agonists (central) Alpha1 receptor blockers (peripheral) Beta receptor blockers (peripheral) Combination alpha1 and beta receptor blockers (peripheral)
Angiotensin II Receptor Blockers
Also referred to as angiotensin II blockers Well tolerated Do not cause a dry cough that is common with ACE inhibitors Losartan (Cozaar) Eprosartan (Teveten) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Telmisartan (Micardis) Azilsartan (Edarbi)
Calcium Channel Blockers for Chronic Stable Angina
Amlodipine Diltiazem Nicardipine Nifedipine Verapamil
Losartan (Cozaar)
An Angiotensin II Receptor Blocker Beneficial in patients with hypertension and HF Used with caution in patients with renal or hepatic dysfunction and in patients with renal artery stenosis Not safe for breastfeeding women and should not be used in pregnancy
Heart failure
An abnormal condition in which the heart cannot pump enough blood to keep up with the body's demand. It is often the result of myocardial infarction, ischemic heart disease, or cardiomyopathy.
Hyperkalemia
An abnormally high potassium concentration in the blood, most often due to defective renal excretion but also caused by excessive dietary potassium or certain drugs, such as potassium-sparing diuretics or angiotensin-converting enzyme (ACE) inhibitors and other causes such as acidosis.
Hypernatremia
An abnormally high sodium concentration in the blood; may be due to defective renal excretion but is more commonly caused by excessive dietary sodium or replacement therapy or due to loss of water.
Fibrinolytic system
An area of the circulatory system undergoing fibrinolysis
Glomerular filtration rate (GFR)
An estimate of the volume of blood that passes through the glomeruli of the kidney per minute.
Ascites
An intraperitoneal accumulation of fluid (defined as a volume of 500 mL or more) containing large amounts of protein and electrolytes.
Beta Blockers: Indications
Angina Antihypertensive Cardiac dysrhythmias Cardioprotective effects, especially after MI Some used for migraine headaches, essential tremors, and stage fright
Calcium Channel Blockers:Indications
Angina Hypertension Supraventricular tachycardia Coronary artery spasms (Prinzmetal angina) Short-term management of atrial fibrillation and flutter Migraine headaches Raynaud's disease Nimodipine: cerebral artery spasms associated with aneurysm rupture
Calcium Channel Blockers:Indications
Angina Hypertension: amlodipine (Norvasc) Dysrhythmias Migraine headaches Raynaud's disease Prevent the cerebral artery spasms after subarachnoid hemorrhage: nimodipine
ACE
Angiotensin-converting enzyme or ACE, is a central component of the renin-angiotensin system (RAS), which controls blood pressure by regulating the volume of fluids in the body. It converts the hormone angiotensin I to the active vasoconstrictor angiotensin II. Therefore, ACE indirectly increases blood pressure by causing blood vessels to constrict. **Can be found either attached to the membrane of cells in the intestines, kidney, testis, gallbladder, and heart)
Colloid oncotic pressure
Another name for oncotic pressure. It is a form of osmotic pressure exerted by protein in blood plasma that tends to pull water into the circulatory system.
Dysrhythmia
Any disturbance or abnormality in heart rhythm.
Coronary artery disease (CAD)
Any one of the abnormal conditions that can affect the arteries of the heart and produce various pathologic effects, especially a reduced supply of oxygen and nutrients to the myocardium.
Coronary arteries
Arteries that deliver oxygen to the heart muscle.
Nitrates and Nitrites
Available forms ØSublingual* ØChewable tablets ØOral capsules/tablets ØIntravenous (IV) solutions* ØTransdermal patches* ØOintments ØTranslingual sprays* Nitroglycerin (both rapid and long acting) Isosorbide dinitrate (both rapid and long acting) Isosorbide mononitrate (primarily long acting)
Which instruction would be included in the discharge teaching for a patient with a transdermal nitroglycerin patch? A - "Make sure to rub a lotion or cream on the skin before putting on a new patch." B - "Apply the patch to a hairless, non-irritated area of the chest, upper arm, back or shoulder." C - "If you get chest pain, apply a second patch next to the first patch." D - "If you get a headache, remove the patch for 4 hours and then reapply."
B - "Apply the patch to a hairless, non-irritated area of the chest, upper arm, back or shoulder." A nitroglycerin patch should be applied to a clean, residue-free, hairless, nonirritated area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and if headache occurs, the patient should not change the patch removal schedule to avoid these headaches. Sublingual nitroglycerin should be used to treat chest pain.
A patient is prescribed oral anticoagulant therapy while still receiving IV heparin infusion. The patient is concerned about risk for bleeding. What is the nurse's best response? A - "Because of your mechanical valve replacement, it is especially important for you to be fully anticoagulated, and the heparin and warfarin together are more effective than one alone." B - "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect." C - "Because you are now getting out of bed and walking around, you have a higher risk of blood clot formation and therefore need to be on both medications." D - "Bleeding is a common adverse effect of taking warfarin. If bleeding occurs, your health care provider will prescribe an injection of medication to stop the bleeding."
B - "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect." Warfarin works by decreasing the production of clotting factors. However, it takes 4 to 5 days for the body to use up present clotting factors and thus achieve a full therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved.
A patient asks the nurse about using potassium supplements while taking spironolactone. What is the nurse's best response? A - "I would recommend that you take two multivitamins every day." B - "This diuretic is potassium sparing, so there is no need for extra potassium." C - "You will need to take potassium supplements for the medication to be effective." D - "I will call your health care provider and discuss your concern."
B - "This diuretic is potassium sparing, so there is no need for extra potassium." Spironolactone is a potassium-sparing diuretic, and thus the patient does not need potassium supplementation. Intake of excess potassium may lead to hyperkalemia.
The nurse is reviewing the protocol for administration of IV adenosine. What is the most important nursing intervention to remember when giving this medication? A - Flush the IV catheter with normal saline. B - Administer it as a fast IV push. C - Monitor the infusion site for hematoma. D - Assess for burning sensation at the IV site.
B - Administer it as a fast IV push. Adenosine must be given as rapidly as possible because it has an extremely short half-life of less than 10 seconds. For this reason, it is administered only IV and only as a fast IV push.
The patient's serum digoxin level is 0.4 ng/mL. How does the nurse interpret this laboratory value result for digoxin? A - Normal therapeutic level B - Below the therapeutic level C - Above the therapeutic level D - A toxic serum blood level
B - Below the therapeutic level Therapeutic serum digoxin levels are 0.5 to 2 ng/mL.
Which statement by the nurse explains to the patient the action of cholestyramine to decrease blood lipid levels? A - Inhibits absorption of dietary cholesterol in the small and large intestine. B - Binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces. C - Inhibits lipolysis in adipose tissue and decreases the hepatic synthesis of triglycerides in the liver. D - Stimulates the biliary system to increase excretion of dietary cholesterol.
B - Binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces. Cholestyramine is an anion exchange resin that binds to bile acids in the small intestine to form an insoluble complex that is excreted in the feces. The liver must then use cholesterol to synthesize more bile.
The nurse will assess a patient receiving gemfibrozil and warfarin for the increased risk of which adverse effect? A - Deep vein thrombosis B - Bleeding C - Clotting D - Vitamin K toxicity
B - Bleeding Gemfibrozil can bind with vitamin K in the intestinal tract, reducing vitamin K absorption. Because vitamin K is the antidote for warfarin, a lack of vitamin K increases the anticoagulant effect of warfarin and thus the risk of bleeding.
Metoprolol (Lopressor) is a nonselective adrenergic blocker, and is contraindicated for a client with asthma because it may cause: A - rebound tachycardia. B - Bronchial construction. C - Bronchial dilation. D - Bronchial hypertension.
B - Bronchial construction.
Which drug class is used to treat both hypertension and dysrhythmias? A - Alpha-adrenergic-blocking B - Calcium channel blockers C - Direct-acting vasodilators D - Sodium channel blockers
B - Calcium channel blockers Calcium channel blockers are effective in treating both hypertension and dysrhythmias secondary to their negative inotropic and chronotropic effects.
Blood Pressure
Blood pressure (BP) = CO × SVR ØCO = cardiac output ØSVR = systemic vascular resistance Hypertension = high BP Hypertension is currently one of the most common disease states. Hypertension is major risk factor for coronary artery disease (CAD), cardiovascular disease (CVD).
Before administering eplerenone to a patient, what is the priority nursing action? A - Auscultate heart sounds. B - Check serum electrolytes. C - Obtain serum thiocyanate level. D - Assess level of consciousness.
B - Check serum electrolytes (Eplerenone is contraindicated in patients with an elevated serum potassium level (>5.5 mEq/L) or severe renal impairment. Therefore, it is imperative that the nurse assesses the patient's most recent serum electrolytes before administering this medication.)
Which medication is an antiplatelet drug? A - Enoxaparin B - Clopidogrel C - Alteplase D - Heparin
B - Clopidogrel Clopidogrel is an antiplatelet drug. Enoxaparin and heparin are anticoagulants. Alteplase is a thrombolytic drug.
Calcium channel blockers have which pharmacodynamic effect? A - Shortened refractory period B - Coronary vasodilation C - Positive inotropic D - Positive chronotropic
B - Coronary vasodilation Calcium channel blockers cause coronary vasodilation, a negative inotropic effect, a negative chronotropic effect, and a negative dromotropic effect.
Diltiazem, a calcium channel blocker, promotes vasodilation of the coronary vessels. when monitoring for the effects of this drug, the nurse should assess for: A - elevated blood pressure. B - Decreased blood pressure. C - pulse rate below 70 BPM. D - pulse rate greater than 80 BPM.
B - Decreased blood pressure.
The nurse understands a patient who is treated for hypertension may be switched to an angiotensin receptor blocker (ARB) because of which angiotensin-converting enzyme (ACE) inhibitor adverse effect? A - Fatigue B - Dry, nonproductive cough C - Hypokalemia D - Orthostatic hypotension
B - Dry, nonproductive cough (ACE inhibitors block the breakdown of bradykinins and may cause a dry, nonproductive cough. ARBs do not block this breakdown, thus minimizing this adverse effect. ACE inhibitors and ARBs are equally effective for the treatment of hypertension, but ARBs do not cause cough.)
The nurse understands that a patient receiving nitroglycerin would be monitored for which common adverse effects associated with this medication? (Select all that apply.) A - Blurred vision B - Flushing C - Dizziness D - Headache E - Hypotension
B - Flushing C - Dizziness D - Headache E - Hypotension The common adverse effects of nitroglycerin include flushing of the face, dizziness, fainting, headache, and hypotension.
The nurse is caring for a patient with renal insufficiency and thrombocytopenia. Along with platelet transfusions, the nurse would expect to administer which blood product to increase deficient clotting factors in this patient? A - Whole blood B - Fresh-frozen plasma C - Plasma protein factors D - Albumin
B - Fresh-frozen plasma Fresh-frozen plasma is indicated to increase clotting factors in patients with a known deficiency. Albumin and plasma protein factors do not contain clotting factors. Although whole blood does contain the same ingredients as fresh-frozen plasma, the amount of volume that must be administered to give the patient the necessary clotting factors may be contraindicated in a patient with renal insufficiency.
The nurse is caring for a patient who has peripheral edema and is hypotensive after receiving 5000 mL of normal saline intravenous (IV). The nurse anticipates administering which IV solution to correct the fluid imbalance? A - 3% saline solution B - Hetastarch C - Lactated Ringer's solution D - D5W
B - Hetastarch The patient needs to increase intravascular fluid volume. Hetastarch will enable this because it is a colloid that will increase osmotic pull from the extravascular spaces to the intravascular space. A 3% saline solution is also hypertonic, but its use is not preferred secondary to risk of hypernatremia.
Which laboratory test result is a common adverse effect of furosemide? A - Hypernatremia B - Hypokalemia C - Hypophosphatemia D - Hyperchloremia
B - Hypokalemia Furosemide is a potent loop diuretic, and the most common adverse effect of loop diuretics is electrolyte imbalances. This results in major electrolyte losses of potassium and sodium and, to a lesser extent, calcium.
What is the mechanism of action of ezetimibe? A - Decreases the adhesion of cholesterol in the arteries. B - Inhibits absorption of dietary and biliary cholesterol in the small intestine. C - Binds to bile acids in the intestine, inhibiting its reabsorption into the blood. D - Inhibits the biosynthesis of cholesterol in the liver.
B - Inhibits absorption of dietary and biliary cholesterol in the small intestine Ezetimibe selectively inhibits absorption of cholesterol in the small intestine.
A patient prescribed spironolactone asks the nurse to assist with food choices that are low in potassium. The nurse would recommend which food choices? (Select all that apply.) A - Winter squash B - Lean meat C - Bananas D - Apples E - Pineapple
B - Lean meat D - Apples E - Pineapple Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Bananas and winter (not summer) squash are high in potassium and should be avoided in patients taking spironolactone.
Enoxaparin sodium is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This medication is in which drug class? A - Thrombolytic drug B - Low-molecular-weight heparin C - Oral anticoagulant D - Glycoprotein IIb/IIIa inhibitor
B - Low-molecular-weight heparin Enoxaparin sodium is a low-molecular-weight heparin
The Community Health nurse visits a patient who has been prescribed after Atorvastatin (Lipitor). Which of the following statements, if made by the patient, indicates the further teaching is necessary concern in this drug therapy? A - I should try to maintain my body weight at an optimal level. B - Most patients with lipid disorders have chest pain or shortness of breath. C - statins can reduce LDL cholesterol levels by 20 to 40%. D - I would avoid beverages that contain grapefruit juice.
B - Most patients with lipid disorders have chest pain or shortness of breath.
To prevent cerebral artery spasms after a subarachnoid hemorrhage, the nurse anticipates administering which calcium channel blocker? A - Amlodipine B - Nimodipine C - Diltiazem D - Verapamil
B - Nimodipine (Nimodipine crosses the blood-brain barrier and has a greater effect on the cerebral arteries than on other arteries in the body; thus, it is indicated for the treatment of cerebral artery spasm after subarachnoid hemorrhage.)
For a patient receiving an IV infusion of alteplase which nursing actions should be taken? (Select all that apply.) A - Monitor for an increase in liver enzymes. B - Record vital signs and report changes. C - Administer injections intramuscularly. D - Assess for cardiac dysrhythmias. E - Observe for signs and symptoms of bleeding.
B - Record vital signs and report changes. D - Assess for cardiac dysrhythmias. E - Observe for signs and symptoms of bleeding. Alteplase can cause bleeding as well as cardiac dysrhythmias. Vital sign changes can alert the nurse to these complications. Alteplase does not directly affect liver enzymes. Injections should not be administered intramuscularly because of the increased risk of bleeding.
the client is to take Atorvastatin (Lipitor) to lower a high serum cholesterol level. what would the nurse include in the teaching for this drug? A - Watch for increased hair growth. B - Report muscle pain, tenderness or weakness right away. C - This drug is safe to take while pregnant. D - This drug has been used now since other medications were not effective.
B - Report muscle pain, tenderness or weakness right away.
what is a priority nurse and intervention for a patient who has just begun anti-hypertensive treatment with captopril? A - Monitor the patient for headaches. B - Take the patient's blood pressure. C - Order a sodium restricted diet for the patient. D - Review the patient's lab results for hypokalemia.
B - Take the patient's blood pressure.
The nurse is providing care to a patient who has experienced several episodes of angina. What is the primary outcome for this patient? A - The patient will experience relief of chest pain with anticoagulant therapy. B - The patient will experience relief of chest pain with nitroglycerin nitrate therapy. C - The patient will experience relief of chest pain with aspirin therapy. D - The patient will experience relief of chest pain with therapeutic lifestyle changes.
B - The patient will experience relief of chest pain with nitroglycerin nitrate therapy.
what is the main function of a diuretic? Increase blood pressure. A - decrease urine flow. B - change the volume or the composition of body fluids. C - stop urine flow. D - Increase blood pressure.
B - change the volume or the composition of body fluids.
when assessing a client on metoprolol (Lopressor) the nurse should expect to find: A - increased pulse. B - decreased pulse rate. C - increased temperature. D - increased blood pressure.
B - decreased pulse rate.
Which of the following drugs may be given to reduce the effects of sodium retention? A - Digitalis B - diuretics C - steroid D - narcotic
B - diuretics
The patients receives hydrochlorothiazide (HydroDIURIL). He tells the nurse he is urinating a lot and questions how this drug affects his blood pressure. what is the best response by the nurse? A - hydrochlorothiazide (HydroDIURIL) Enhances kidney function causing you to urinate more and that decreases your blood pressure. B - hydrochlorothiazide (HydroDIURIL) Decreases the fluid in your bloodstream and this lowers your blood pressure. C - hydrochlorothiazide (HydroDIURIL) Dilates your blood vessels so you urinate more and your blood pressure decreases. D - hydrochlorothiazide (HydroDIURIL) Increases your heart rate; this pumps blood faster to your kidneys so you urinate more and your blood pressure decreases.
B - hydrochlorothiazide (HydroDIURIL) Decreases the fluid in your bloodstream and this lowers your blood pressure.
Loop Diuretics Adverse Effects
Body System : Adverse Effects --Central nervous system (CNS): Dizziness, headache, tinnitus, blurred vision --Gastrointestinal (GI): Nausea, vomiting, diarrhea --Integumentary: Stevens-Johnson syndrome (torsemide) Hematologic - Agranulocytosis, neutropenia, thrombocytopenia Metabolic - Hypokalemia, hyperglycemia, hyperuricemia
Types of Diuretic Drugs
Carbonic anhydrase inhibitors (CAIs) Loop diuretics Osmotic diuretics Potassium-sparing diuretics Thiazide and thiazide-like diuretics
Thiazide and Thiazide-Like Diuretics: Adverse Effects
Body system CNS - Dizziness, headache, blurred vision GI - Anorexia, nausea, vomiting, diarrhea Genitourinary - Impotence Hematologic - Jaundice, leukopenia Integumentary - Dizziness, headache, blurred vision Metabolic - Hypokalemia, hyperglycemia, hyperuricemia, hypochloremic alkalosis
Treatment of PulmonaryHypertension
Bosentan (Tracleer) ØSpecifically indicated only for the treatment of pulmonary artery hypertension in patients with moderate to severe HF ØAction: blocks receptors of the hormone endothelin Other drugs used to treat pulmonary hypertension ØEpoprostenol ØTreprostinil ØIloprost ØAmbrisentan ØMacitentan ØSelexipag
Anticoagulants: Adverse Effects
Bleeding -Risk increases with increased dosages -May be localized or systemic May also cause: -Heparin-induced thrombocytopenia -Nausea, vomiting, abdominal cramps, thrombocytopenia, others
What drug is used to treat hypertension in pregnancy?
Methyldopa (Which is an alpha2 Receptor Agonists)
The patient asks the nurse, "What is the difference between dalteparin and heparin?" What is the nurse's best response? A - "There is really no difference, but dalteparin is preferred because it is less expensive." B - "The only difference is that the heparin dosage calculation is based on the patient's weight." C - "Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect." D - "I'm not really sure why some health care providers choose dalteparin and some heparin."
C - "Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect." A low-molecular-weight heparin is more predictable in its effect than regular heparin. Dalteparin is more expensive than heparin and is dosed based on the patient's weight.
The nurse determines the patient has a good understanding of the discharge instructions regarding warfarin with which patient statement? A - "I should keep taking ibuprofen for my arthritis." B - "I should decrease the dose if I start bruising easily." C - "I should use a soft toothbrush for dental hygiene." D - "I will double my dose if I forget to take it the day before."
C - "I should use a soft toothbrush for dental hygiene." The patient should reduce the risk of bleeding, such as using a soft toothbrush. The other choices are inaccurate.
The nurse provides discharge instructions to a patient prescribed cholestyramine. Which statement by the patient indicates teaching was effective for this drug? A - "I will take Questran 1 hour before my other medications." B - "This drug can cause flushing, itching and gastrointestinal upset." C - "I will increase fiber in my diet and drink more fluids." D - "I will notify my health care provider if I have muscle pain."
C - "I will increase fiber in my diet and drink more fluids." Cholestyramine can cause constipation; thus increasing dietary fiber and fluid intake is appropriate. All other drugs should be taken 1 hour before or 4 hours after cholestyramine to facilitate proper absorption.
The nurse is assessing the patient's knowledge regarding drug therapy prescribed for the treatment of hypertension. Which statement by the patient indicates the need for further teaching by the nurse? A - "I will move slowly from a sitting to standing position." B - "I will wear a medical alert bracelet." C - "When my blood pressure is over 140/90, I will take my medication." D - "Blood pressure drugs can cause changes in sexual functioning."
C - "When my blood pressure is over 140/90, I will take my medication." (Patients must adhere to prescribed antihypertensive regimen to prevent end-organ damage. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, but the medication may produce unwanted adverse effects. Patient teaching is essential.)
A patient weighing 44 lb is prescribed a digoxin loading dose of 0.03 mg/kg to be administered in three divided doses. How much will the nurse administer in each dose? A - 0.4 mg B - 0.6 mg C - 0.2 mg D - 0.3 mg
C - 0.2 mg 44 lb is converted to kilograms by dividing 44 by 2.2 kg = 20 kg. 0.03 mg/kg × 20 kg = 0.6 mg. 0.6 mg ÷ 3 doses = 0.2 mg/dose.
When preparing to administer intravenous furosemide to a patient with renal dysfunction, the nurse will administer the medication no faster than which rate? A - 6 mg/min B - 2 mg/min C - 4 mg/min D - 8 mg/min
C - 4 mg/min Furosemide controlled infusion rate should not exceed at a rate of 4 mg/min in patients with renal failure.
While assessing the patient, the nurse notes edema of the hands and feet at +3 from third spacing. The patient is having signs and symptoms of intravascular dehydration, and the total protein laboratory result is 4.6 g/dL. The nurse anticipates the health care provider will prescribe which IV solution for this patient? A - Whole blood B - Lactated Ringer's solution C - 5% albumin D - Normal saline
C - 5% albumin If the total protein level falls below 5.3 g/dL, fluid shifts out of blood vessels into the tissues. When this happens, colloid replacement therapy is required to reverse this process by increasing the colloid oncotic pressure. The three most commonly used are 5% albumin, dextran 40, and hetastarch. They all have a very rapid onset of action as well as a long duration of action.
The nurse would question the use of mannitol for which patient condition? A - Cerebral edema from head trauma B - Increased intraocular pressure C - Anuria related to end-stage kidney disease D - Oliguria from acute renal failure
C - Anuria related to end-stage kidney disease Mannitol does not influence urine production; it only increases existing urine output. It is not metabolized but excreted unchanged in the urine by the kidneys. Thus, if no urine is produced (anuria), mannitol is not excreted, which increases blood volume. Excess blood volume may cause the undesirable adverse effect of pulmonary edema.
The patient is prescribed ibutilide, a class III antiarrhythmic drug. The nurse understands this drug has been prescribed for which reason? A - Conversion of life-threatening ventricular dysrhythmias B - Treatment of PSVT C - Conversion of recent-onset atrial fibrillation and flutter D - Treatment of dysrhythmias in patients with acute renal failure
C - Conversion of recent-onset atrial fibrillation and flutter Ibutilide is specifically indicated only for treatment of recent-onset atrial fibrillation and flutter.
To evaluate the therapeutic effects of mannitol, the nurse should monitor the patient for which clinical finding? A - Increase in urine osmolality B - Decrease in serum osmolality C - Decrease in intracranial pressure D - Increase in cerebral blood volume
C - Decrease in intracranial pressure Mannitol is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This decreases intracranial pressure and cerebral blood volume, increases excretion of medications, decreases urine osmolality, and increases serum osmolality.
A patient receiving IV nitroglycerin at 20 mcg/min and now complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the priority nursing action? A - Notify the health care provider. B - Assess the patient's lung sounds. C - Decrease the IV nitroglycerin by 10 mcg/min. D - Recheck the patient's vital signs in 1 hour.
C - Decrease the IV nitroglycerin by 10 mcg/min. Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 minutes while changing the rate of the IV nitroglycerin infusion. Before notifying a provider, follow standing orders or protocol.
During the IV administration of a hypertonic saline solution to treat a patient with severe hyponatremia, the nurse monitors for which signs and symptoms of hypernatremia? A - Mental confusion and seizures B - Vomiting and diarrhea C - Flushed skin and increased thirst D - Lethargy and hypotension
C - Flushed skin and increased thirst Hypertonic saline solutions administered to raise sodium levels may cause hypernatremia. Thus, very close monitoring for signs and symptoms of hypernatremia is needed. Flushed skin and increased thirst are signs and symptoms of hypernatremia. The other choices are signs and symptoms of hyponatremia.
When assessing a patient taking triamterene, the nurse would monitor for which possible adverse effect? A - Hypokalemia B - Hypoglycemia C - Hyperkalemia D - Hypernatremia
C - Hyperkalemia Triamterene is a potassium-sparing diuretic, and therefore hyperkalemia is a possible adverse effect.
The nurse would question a prescription for a calcium channel blocker in a patient with which condition? A - Angina pectoris B - Increased intracranial pressure C - Hypotension D - Dysrhythmia
C - Hypotension (Calcium channel blockers cause smooth muscle vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.)
When administering nitroprusside by continuous intravenous infusion, the nurse monitors for which symptom of drug toxicity? A - Hyperglycemia B - Fever C - Hypotension D - Wheezing
C - Hypotension (The main symptom of sodium nitroprusside overdose or toxicity is excessive hypotension.)
The nurse is teaching the patient about lifestyle modifications to help manage the patient's hypertension. the nurse determines that teaching has been effective when the patient makes which statement? A - I need to get started on my medications right away. B - my father had hypertension, did nothing, and left to be 90 years old. C - I know I need to give up my cigarettes and alcohol. D - I won't be able to run in the marathon race anymore.
C - I know I need to give up my cigarettes and alcohol.
By which action does atorvastatin decrease lipid levels? A - Binding to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces B - Decreasing the amount of triglycerides produced by the liver and increasing the removal of triglycerides by the liver C - Inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liver D - Stimulating the gallbladder and biliary system to increase excretion of dietary cholesterol
C - Inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liver Atorvastatin is an HMG-CoA reductase inhibitor that inhibits HMG-CoA reductase, the enzyme needed to make cholesterol in the liver.
Calcium channel blockers reduce myocardial oxygen demand by decreasing afterload. How would the nurse explain afterload to the patient? A - It is the total volume of blood in the heart. B - It is the contractility of the heart muscle. C - It is the force against which the heart must pump. D - It is the pressure within the four chambers of the heart.
C - It is the force against which the heart must pump. Afterload is the force (systemic vascular resistance) against which the heart must exert itself when delivering blood to the body.
Which are therapeutic effects of digoxin? A - Positive inotropic, negative chronotropic, and negative dromotropic B - Positive inotropic, negative chronotropic, and positive dromotropic C - Negative inotropic, negative chronotropic, and negative dromotropic D - Positive inotropic, positive chronotropic, and negative dromotropic
C - Negative inotropic, negative chronotropic, and negative dromotropic Digoxin increases cardiac contractility (positive inotropic effect), decreases heart rate (negative chronotropic effect), and decreases conductivity (negative dromotropic effect).
When teaching a patient about a new prescription for carvedilol the nurse explains that this medication reduces blood pressure by which action? (Select all that apply.) A - Promotes excretion of sodium B - Relaxes muscle tone C - Peripheral vasodilation D - Decreases heart rate E - Increases urine output
C - Peripheral vasodilation AND D - Decreases heart rate (Carvedilol has the dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade).)
The nurse is caring for a patient prescribed amiodarone. The nurse knows the MOST serious adverse effect of this medication can occur in which body system? A - Gastrointestinal B - Immune C - Respiratory D - Nervous
C - Respiratory Pulmonary toxicity is the most serious potential adverse effect of amiodarone.
The nurse is teaching treatment of acute chest pain for a patient prescribed nitroglycerin sublingual tablets. Which instructions would the nurse include? A - Chew or swallow the tablet for the quickest effect. B - Keep the tablets locked in a safe place until you need them. C - Sit or lie down before taking medication. D - Take five tablets every 3 minutes for chest pain.
C - Sit or lie down before taking medication. Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. It should be kept in a readily accessible location for immediate use should chest pain occur. Three tablets may be taken 5 minutes apart. It should be placed under the tongue and allowed to dissolve.
The nurse notes a patient's international normalized ratio (INR) value of 2.5. What is the meaning of this reported value? A - The patient needs the subcutaneous heparin dose increased. B - The patient is not receiving enough warfarin for a therapeutic effect. C - The patient's warfarin dose is within the therapeutic range. D - The patient is receiving too much heparin and is at risk for bleeding.
C - The patient's warfarin dose is within the therapeutic range. INR determination is a routine test to evaluate coagulation while patients are taking warfarin, not heparin. A therapeutic INR is 2 to 3.
The nurse is preparing a patient with acute chest pain for an emergency angioplasty. The nurse would anticipate administering which medication to prevent platelet aggregation? A - Aminocaproic acid B - Warfarin C - Tirofiban D - Protamine
C - Tirofiban Tirofiban is a glycoprotein IIb/IIIa inhibitor that blocks the enzyme essential for platelet aggregation. This is given to prevent the formation of further clots and is faster acting than warfarin. Protamine sulfate is the antagonist for heparin, not an anticoagulant. Aminocaproic acid is an antifibrinolytic, the opposite of what is needed in this situation.
When teaching a patient regarding the administration of digoxin, the nurse instructs the patient not to take this medication with which food? A - French toast B - Scrambled eggs C - Wheat bran D - Bananas
C - Wheat bran Encourage patients to avoid using antacids or eating ice cream, milk products, yogurt, cheese (dairy products), or bran for 2 hours before or 2 hours after taking medication to avoid interference with the drugs absorption.
Before administering digoxin (Lanoxin), what must the nurse assess? A - urinary output. B - peripheral edema. C - apical pulse rate. D - blood pressure.
C - apical pulse rate.
a potassium sparing diuretic is? A - lasik (Furosemide) B- lisinopril C - spironolactone (aldactone) D - digoxin
C - spironolactone (aldactone)
Beta Blockers
Cardioprotective quality of beta blockers: prevent catecholamine-mediated actions on the heart by reducing or blocking sympathetic nervous system stimulation to the heart and the heart's conduction system Intended effects: reduced heart rate, delayed AV node conduction, reduced myocardial contractility, decreased myocardial automaticity Metoprolol Carvedilol (Coreg)
Potassium-Sparing Diuretics: Adverse Effects
CNS: dizziness, headache GI: cramps, nausea, vomiting, diarrhea Other: urinary frequency, weakness, hyperkalemia
Metoprolol (Lopressor, Toprol-XL)
Cardioselective beta1-adrenergic receptor blocker Indication: prophylactic treatment of angina Many of the same characteristics as atenolol Reduces mortality rate in patients after MI and in treating angina Forms: oral (immediate release and long acting) and parenteral (injectable) forms IV metoprolol is commonly administered to hospitalized patients after an MI and is used for treatment of hypertension in patients unable to take oral medicine.
Atenolol (Tenormin)
Cardioselective beta1-adrenergic receptor blocker Indication: prophylactic treatment of angina pectoris Use of atenolol after MI has been shown to decrease mortality.
Beta Blockers: Adverse Effects
Cardiovascular: - Bradycardia, hypotension, atrioventricular block Metabolic: - Hyperglycemia and/or hypoglycemia, hyperlipidemia CNS: - Dizziness, fatigue, depression, lethargy Other: - Impotence, wheezing, dyspnea
Drug that is a Dual-Action Alpha1 and Beta Receptor Blockers and is a widely used and well tolerated by most patients?
Carvedilol (Coreg) {Contraindications include known drug allergy, cardiogenic shock, severe bradycardia or decompensated heart failure, bronchospastic conditions, such as asthma, and various cardiac problems involving the conduction system.}
Calcium Channel Blockers:Mechanism of Action
Cause coronary artery vasodilation Cause peripheral arterial vasodilation, thus decreasing systemic vascular resistance Reduce the workload of the heart Result: decreased myocardial oxygen demand Dysrhythmias: depression of the automaticity of and conduction through the sinoatrial and AV nodes
Nitrates and Nitrites:Mechanism of Action and Drug Effects
Cause vasodilation because of relaxation of smooth muscles Potent dilating effect on coronary arteries Result: oxygen to ischemic myocardial tissue Used for prevention and treatment of angina
Chronic stable angina
Chest pain that is primarily caused by atherosclerosis, which results in a long-term but relatively stable level of obstruction in one or more coronary arteries.
Angina pectoris
Chest pain that occurs when the heart's supply of blood carrying oxygen is insufficient to meet the demands of the heart.
Types of Angina
Chronic stable angina (also called classic or effort angina) Unstable angina (also called preinfarction or crescendo angina) Vasospastic angina (also called Prinzmetal or variant angina)
Triglycerides
Compounds that consist of fatty acids and a type of alcohol known as glycerol. Triglycerides make up most animal and vegetable fats and are the principal lipids in the blood, where they circulate bound to a protein, forming high-density and low-density lipoproteins (HDLs and LDLs).
Alpha2-Adrenergic Receptor Stimulators (Agonists)
Clonidine and methyldopa Not typically prescribed as first-line antihypertensive drugs High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness Adjunct drugs to treat hypertension after other drugs have failed. Used in conjunction with other antihypertensives such as diuretics
Centrally Acting Adrenergic Drugs
Clonidine and methyldopa ØStimulate alpha2-adrenergic receptors in the brain ØDecrease sympathetic outflow from the central nervous system ØDecrease norepinephrine production ØStimulate alpha2-adrenergic receptors, thus reducing renin activity in the kidneys ØResult in decreased BP
Doxazosin (Cardura)
Commonly used alpha1 blocker Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels
Sildenafil and Tadalafil
Commonly used for erectile dysfunction Also used for pulmonary hypertension but with different trade names ØSildenafil: Revatio ØTadalafil: Adcirca
Warfarin (Coumadin)
Coumadin Most commonly prescribed oral anticoagulant Careful monitoring of the prothrombin time/international normalized ratio (PT/INR) A normal INR (without warfarin) is 1.0, but a therapeutic INR (with warfarin) ranges from 2 to 3.5, depending on the indication for use of the drug (e.g., atrial fibrillation, thromboprevention, prosthetic heart valve). Variations in certain genes, CYP2CP and VKORC1 Many drug interactions Dietary considerations
Antidysrhythmics: Drug Interactions
Coumadin: monitor international normalized ratio Grapefruit juice: amiodarone, disopyramide, and quinidine
Blood Products Indications
Cryoprecipitate and plasma protein factors -Management of acute bleeding (greater than 50% slow blood loss or 20% acutely) Fresh-frozen plasma (FFP) -Increase clotting factor levels in patients with demonstrated deficiency Packed red blood cells (PRBCs) -To increase oxygen-carrying capacity in patients with anemia, in patients with substantial hemoglobin deficits, and in patients who have lost up to 25% of their total blood volume Whole blood -Same as for PRBCs except that whole blood is more beneficial in cases of extreme (greater than 25%) loss of blood volume because whole blood also contains plasma -Contains plasma proteins, which help draw fluid back into blood vessels from surrounding tissues
Which discharge instruction should the nurse include for a patient prescribed an antilipemic medication? A - "Lifestyle changes are no longer necessary when taking this medication." B - "It is important to take a double dose to make up for a missed dose." C - "Stop taking the medication if it causes nausea and vomiting." D - "Continue your exercise program and maintain a low-fat diet."
D - "Continue your exercise program and maintain a low-fat diet." Antilipemic medications are in addition to, not a replacement of, therapeutic lifestyle changes used to decrease serum cholesterol. Maintain a low-fat, low-cholesterol diet is an integrated part of a change in lifestyle.
Which statement by the patient indicates a need for further instruction about colestipol from the nurse? A - "I might need to take fat-soluble vitamins to supplement my diet." B - "I should take this medication 1 hour after or 4 hours before my other medications." C - "The potential adverse effects of this drug are rash and itching." D - "I will mix and stir the powder thoroughly with at least 1 to 2 oz of fluid."
D - "I will mix and stir the powder thoroughly with at least 1 to 2 oz of fluid." Colestipol is available in powder form that must be mixed thoroughly with food or fluids (at least 4 to 6 oz of fluid) before administration to avoid esophageal irritation or obstruction and intestinal obstruction.
A patient who is taking nitroglycerin sublingual tablets is complaining of flushing and headaches. What is the nurse's best response? A - "Stop taking the nitroglycerin because you are experiencing an allergic reaction to the medication." B - "Put a cold wet washcloth or use an icepack on your forehead and lie down in a quiet place." C - "Immediately notify your health care provider because these symptoms are not related to the sublingual nitroglycerin." D - "These are the most common adverse effects of nitroglycerin. They should subside with continued use of nitroglycerin."
D - "These are the most common adverse effects of nitroglycerin. They should subside with continued use of nitroglycerin." Headache, flushing of the face, dizziness, and fainting are the most common adverse effects of nitroglycerin and the headache generally subsides after the start of therapy.
The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin? A - Complete blood count B - Prothrombin time (PT) C - Blood urea nitrogen D - Activated partial thromboplastin time (aPTT)
D - Activated partial thromboplastin time (aPTT) Heparin dosing is based on aPTT results. The PT is reflective of warfarin's anticoagulant effect.
To decrease the skin flushing adverse effect reaction of niacin (nicotinic acid), which action should the nurse take? A - Administer niacin with a liquid antacid. B - Give niacin with all other morning medications. C - Apply cold compresses to the head and neck. D - Administer aspirin 30 minutes before each dose.
D - Administer aspirin 30 minutes before each dose. To help minimize the adverse effect flushing of the skin, the patient should take a small dose of aspirin or nonsteroidal antiinflammatory drugs 30 minutes before taking niacin, but only as prescribed or recommended by the health care provider.
When applying nitroglycerin ointment, the nurse would perform which action? A - Use the fingers to spread the ointment evenly over a 3-inch area. B - Massage and then gently rub the ointment into the skin. C - Apply a thick layer of ointment on the nitroglycerin paper. D - Apply the ointment to a nonhairy part of the upper torso.
D - Apply the ointment to a nonhairy part of the upper torso. Use the proper dosing paper supplied by the drug company to apply a thin layer of ointment on clean, dry, hairless skin of the upper arms or body. Avoid areas below the knees and elbows. Wear gloves to avoid contact with the skin and subsequent absorption. Do not rub the ointment into the skin; cover the area with an occlusive dressing if not provided (e.g., plastic wrap).
To prevent the occurrence of cinchonism in a patient prescribed quinidine, which instruction is most important for the nurse to provide for this patient? A - Increase dietary intake of potassium. B - Remind the patient to change positions slowly. C - Advise the patient to wear sunscreen every day. D - Avoid drinking grapefruit juice.
D - Avoid drinking grapefruit juice. Grapefruit juice can inhibit the metabolism of quinidine, which increases the risk of cinchonism.
A patient who is prescribed tamsulosin does not have a history of hypertension. The nurse knows this medication is also used for what condition? A - Pulmonary emboli B - Migraine headache C - Subarachnoid hemorrhage D - Benign prostatic hyperplasia (BPH)
D - Benign prostatic hyperplasia (BPH) (Alpha1 blockers have beneficial in the treatment of BPH. The blocking of alpha1-adrenergic receptors decreases the urine outflow obstruction related to BPH by preventing smooth muscle contractions in the bladder neck and urethra.)
One of the beta-adrenergic blockers (beta blockers) was metoprolol. This drug blocks: A - A1 receptors only. B - beta one receptors, only. C - Better two receptors, only. D - Beta one and beta two receptors.
D - Beta one and beta two receptors.
The nurse would question a prescription for colesevelam in a patient with which condition? A - Glaucoma B - Renal disease C - Hepatic disease D - Bowel obstruction
D - Bowel obstruction Colesevelam is contraindicated in patients with a history of bowel obstruction.
Before administering a dose of an antidysrhythmic drug to a patient, what nursing assessment must be completed? A - Obtain temperature and pulse oximetry on room air. B - Evaluate peripheral pulses and level of consciousness. C - Measure urine output and specific gravity. D - Check apical pulse and blood pressure.
D - Check apical pulse and blood pressure. Antidysrhythmic drugs can cause both hypotension and bradycardia; therefore, it is important to assess blood pressure and apical pulse before administration.
The nurse is preparing to administer digoxin 0.25 mg intravenous push to a patient. Which is an expected patient outcome related to the administration of digoxin? A - Reduction in urine output B - Increase in blood pressure C - Low serum potassium D - Decrease in the heart rate
D - Decrease in the heart rate Digoxin has a negative chronotropic effect (decreased heart rate).
The nurse reviews an adult patient's laboratory values and notes a digoxin level of 11 ng/mL and a serum potassium level of 6.2 mEq/L. The nurse would notify the health care provider and anticipate which medication will be prescribed to administer? A - Atropine B - Epinephrine C - Sodium polystyrene sulfonate D - Digoxin immune Fab
D - Digoxin immune Fab Digoxin immune Fab is indicated for severe digoxin toxicity in patients with the following clinical findings: hyperkalemia (serum potassium level higher than 5 mEq/L) with digoxin toxicity; life-threatening digoxin overdose (more than 10 mg digoxin in adults; more than 4 mg digoxin in children); and life-threatening cardiac dysrhythmias, sustained ventricular tachycardia or fibrillation, and severe sinus bradycardia or heart block unresponsive to atropine treatment or cardiac pacing.
The nurse is conducting a community education program. When explaining different medication regimens to treat hypertension, it would be accurate to state that African Americans often respond better to which combination of medications? A - ACE inhibitors and diuretics B - ACE inhibitors and beta blockers C - Diuretics and beta blockers D - Diuretics and calcium channel blockers
D - Diuretics and calcium channel blockers (Research has demonstrated that African Americans do not typically respond therapeutically to beta blockers or ACE inhibitors. They respond better to diuretics and calcium channel blockers.)
It is most important for the nurse to instruct a patient prescribed nitroglycerin to avoid which substance? A - Grapefruit juice B - Antacids C - Potassium-sparing diuretics D - Erectile dysfunction drugs
D - Erectile dysfunction drugs Concurrent administration of nitrate drugs and erectile dysfunction drugs such as sildenafil citrate, tadalafil, and vardenafil can cause an additive hypotensive effect.
To treat a patient with pulmonary edema, the nurse prepares to administer which diuretic to this patient? A - Amiloride B - Spironolactone C - Triamterene D - Furosemide
D - Furosemide Furosemide is a potent, rapid-acting diuretic that would be the drug of choice to treat pulmonary edema. The other medications are not potent enough to cause the diuresis necessary to treat this condition
A patient with elevated triglyceride levels unresponsive to HMG-CoA reductase inhibitors will most likely be prescribed which drug? A - Cholestyramine B - Colestipol C - Simvastatin D - Gemfibrozil
D - Gemfibrozil Gemfibrozil, a fibric acid derivative, promotes catabolism of triglyceride-rich lipoproteins.
While the nurse is providing care to a patient, the health care provider prescribes an IV potassium chloride infusion. For which condition would this prescription be given? A - Multiple sclerosis B - Cirrhosis of the liver C - Hypertension D - Hypochloremia
D - Hypochloremia Potassium replacement therapy is indicated in the treatment or prevention of potassium depletion. The chloride is used to correct the hypochloremia (low chloride levels) in the blood that commonly accompanies potassium deficiency.
A patient who is prescribed an anticoagulant requests an aspirin (acetylsalicylic acid) for headache relief. What is the nurse's best action? A - Explain that acetylsalicylic acid is contraindicated and administer ibuprofen. B - Explain that a common initial adverse effect is a headache for this drug. C - Administer 650 mg of acetylsalicylic acid and reassess pain in 30 minutes. D - Inform the patient of potential drug interactions with anticoagulants.
D - Inform the patient of potential drug interactions with anticoagulants. Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding.
To assess for a potentially serious adverse effect to HMG-CoA reductase inhibitors, the nurse should monitor which laboratory results? A - Urine specific gravity B - Serum electrolytes C - Complete blood count D - Liver function studies
D - Liver function studies HMG-CoA reductase inhibitors can cause hepatic toxicity; thus, liver function studies are often measured every 6 to 8 weeks for the first 6 months of statin therapy and then every 3 to 6 months, depending on the prescriber and the patient situation.
While observing a patient self-administer enoxaparin, the nurse identifies the need for further teaching when the patient performs which self-injection action? A - Administers the medication into subcutaneous (fatty) tissue B - Does not aspirate before injecting the medication C - Injects the medication greater than 2 inches away from the umbilicus D - Massages the site after administration of the medication
D - Massages the site after administration of the medication It is not recommended to massage the area of injection of anticoagulants because of the increased risk of hematoma formation.
The nurse is providing discharge teaching for a patient about potential serious adverse effects to simvastatin. Which symptom may indicate the patient is experiencing a serious adverse effect to this medication? A - Headache B - Itching C - Weight loss D - Muscle pain
D - Muscle pain Unexplained muscle pain and soreness are symptoms of a relatively uncommon but serious adverse effect of rhabdomyolysis associated with statin drugs and must be immediately reported to the health care provider.
Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin? A - Phenytoin B - Vitamin E C - Vitamin K D - Protamine
D - Protamine Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect.
Cardiac output
The amount of blood ejected from the left ventricle.
To treat a patient diagnosed with primary hyperaldosteronism, the nurse would expect to administer which diuretic? A - Hydrochlorothiazide B - Furosemide C - Acetazolamide D - Spironolactone
D - Spironolactone Spironolactone is the direct antagonist for aldosterone.
A patient receiving an IV infusion of one unit of packed red blood cells suddenly develops shortness of breath, chills, and is feeling hot. What is the nurse's priority action? A - Maintain a patent IV line with normal saline. B - Check the vital signs. C - Notify the health care provider. D - Stop the blood transfusion.
D - Stop the blood transfusion. These are symptoms of a blood transfusion reaction. Thus, the nurse's priority action is to immediately stop the blood transfusion.
The nurse is providing education to a patient prescribed spironolactone and furosemide. What information does the nurse explain to the patient regarding both medications together? A - This combination maintains water balance to protect against dehydration and electrolyte imbalance. B - Using two drugs increases blood osmolality and the glomerular filtration rate. C - The lowest dose of two different types of diuretics is more effective than a large dose of one type. D - This combination promotes diuresis but decreases the risk of low levels of potassium.
D - This combination promotes diuresis but decreases the risk of low levels of potassium. Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes potassium loss.
Which method of administration of nitroglycerin has the longest duration of action? A - Intravenous (IV) infusion B - Immediate-release tablet C - Sublingual tablet D - Transdermal patch
D - Transdermal patch The transdermal patch has an 8- to 12-hour duration of action compared with 3 minutes to 6 hours for the other methods of administration of nitroglycerin.
Phosphodiesterase inhibitors (PDIs) have an added advantage in treating heart failure. These drugs cause a positive inotropic effect and what other effect? A - Platelet inhibition B - Vasoconstriction C - Bronchodilation D - Vasodilation
D - Vasodilation PDIs are also called inodilators because they have both positive inotropic and vasodilatory effects.
A patient is receiving lidocaine by continuous intravenous (IV) infusion. The nurse understands this medication is prescribed for what condition? A - Sinus bradycardia B - Atrial fibrillation C - First-degree heart block D - Ventricular dysrhythmias
D - Ventricular dysrhythmias Lidocaine is a sodium channel blocker drug used specifically to treat ventricular dysrhythmias.
The nurse is caring for a patient admitted with gastrointestinal bleeding who is anticoagulated with warfarin. Which medication should the nurse anticipate administering? A - Protamine B - Vitamin E C - Calcium gluconate D - Vitamin K
D - Vitamin K Vitamin K is the antagonist for warfarin.
All of the following are lifestyle changes EXCEPT: A - exercise B - stop smoking C - maintain a healthy weight D - eat foods high in cholesterol and saturated fats
D - eat foods high in cholesterol and saturated fats
A common side effect with early use of Nitrogycerine (NTG) is: A - diarrhea B - hypertension C - Restlessness D - headache
D - headache
which of the following high blood tests does NOT indicate an increased risk of coronary artery disease? A - Very low density lipoprotein (VLDL) B - triglyceride level C - low density low density lipoprotein (LDL) D - high density lipoprotein (HDL)
D - high density lipoprotein (HDL)
The nurses administering hydrochlorothiazide (microzide), what lab value should the nurse monitor? A - white blood cell count. B - glucose. C - red blood cell count. D - potassium.
D - potassium.
Vasodilators
Diazoxide (Hyperstat) Hydralazine (Apresoline) Minoxidil (Rogaine) ØFor hair regrowth Nitroprusside (Nitropress)
Vasodilators:Mechanism of Action
Directly relax arteriolar and/or venous smooth muscle: or both. Results in: Decreased systemic vascular response Decreased afterload Peripheral vasodilation
Beta Blockers: Common Drug Interactions
Diuretics and antihypertensives Calcium channel blockers (diltiazem, verapamil) Insulin and oral antidiabetic drugs
Peripherally Acting Alpha1 Blockers
Doxazosin, prazosin, and terazosin ØBlock alpha1-adrenergic receptors ØWhen alpha1-adrenergic receptors are blocked, BP is decreased. ØDilate arteries and veins ØAlpha1 blockers also increase urinary flow rates and decrease outflow obstruction by preventing smooth muscle contractions in the bladder neck and urethra. ØUse: benign prostatic hyperplasia (BPH)
Anticoagulants: Contraindications
Drug allergy Any acute bleeding process or high risk for such an occurrence Warfarin is strongly contraindicated in pregnancy. Other anticoagulants are rated in lower pregnancy categories (B or C). LMWHs are contraindicated in patients with an indwelling epidural catheter risk of epidural hematoma.
Diuretics
Drugs or other substances that promote the formation and excretion of urine.
Hemorheologic drugs
Drugs that alter the function of platelets without compromising their blood-clotting properties.
Thrombolytic drugs
Drugs that dissolve thrombi by functioning similarly to tissue plasminogen activator.
Dromotropic drugs
Drugs that influence the conduction of electrical impulses within tissues.
Inotropic drugs
Drugs that influence the force of muscular contractions, particularly contraction of the heart muscle.
Chronotropic drugs
Drugs that influence the rate of the heartbeat.
Centrally acting adrenergic drugs
Drugs that modify the function of the sympathetic nervous system in the brain by stimulating alpha2 receptors. Alpha2 receptors are inhibitory in nature and thus have a reverse sympathetic effect and cause decreased blood pressure.
Antifibrinolytic drugs
Drugs that prevent the lysis of fibrin and in doing so promote clot formation.
Alpha1 blockers
Drugs that primarily cause arterial and venous dilation through their action on peripheral sympathetic neurons.
Antilipemic drugs
Drugs that reduce lipid levels.
ACE Inhibitors
Drugs that relax blood vessels and lower blood pressure by blocking an enzyme that produces a substance called angiotensin II. Angiotensin II narrows blood vessels and makes the heart work harder, increasing the risk of heart problems, kidney disease, and stroke.
Diuretic Drugs
Drugs that remove fluid from the body, elevating the rate of bodily urine excretion.
Unstable angina
Early stage of progressive CAD.
Action potential
Electrical activity consisting of a series of polarizations and depolarizations that travel across the cell membrane of a nerve fiber during transmission of a nerve impulse and across the cell membranes of a muscle cell during contraction.
Essential hypertension
Elevated systemic arterial pressure for which no cause can be found; also called primary or idiopathic hypertension.
Thromboembolic events
Events in which a blood vessel is blocked by an embolus carried in the bloodstream from the site of its formation. The tissue supplied by an obstructed artery may tingle and become cold, numb, cyanotic, and eventually necrotic (dead).
Dehydration
Excessive loss of water from the body tissues. It is accompanied by an imbalance in the concentrations of electrolytes, particularly sodium, potassium, and chloride.
Classification of Blood Pressure
Hypertension can also be defined by its cause. Unknown cause Ø Essential, idiopathic, or primary hypertension Ø 90% of cases Known cause Ø Secondary hypertension Ø 10% of cases
ACE Inhibitors: Adverse Effects
Fatigue Dizziness Headache Mood changes Impaired taste Possible hyperkalemia Dry, nonproductive cough, which reverses when therapy is stopped Angioedema: rare but potentially fatal
Diuretics
First-line antihypertensives in the JNC 8 guidelines for the treatment of hypertension Decrease plasma and extracellular fluid volumes Results ØDecreased preload ØDecreased CO ØDecreased total peripheral resistance Overall effect ØDecreased workload of the heart and decreased BP Thiazide diuretics are the most commonly used diuretics for hypertension.
Drugs of Choice for Early Treatment of Heart Failure
Focus on reducing effects of the renin-angiotensin-aldosterone system and the sympathetic nervous system ACE inhibitors (lisinopril, enalapril, captopril, and others) ARBs (valsartan, candesartan, losartan, and others) Certain beta blockers (metoprolol, a cardioselective beta blocker; carvedilol, a nonspecific beta blocker) Loop diuretics (furosemide) are used to reduce the symptoms of HF secondary to fluid overload. Aldosterone inhibitors (spironolactone, eplerenone) are added as the HF progresses. Only after these drugs are used is digoxin added.
Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8)*
Four stages based on BP measurements 1. Normal 2. Prehypertension 3. Stage 1 hypertension 4. Stage 2 hypertension According to the JNC 8, therapy should be started if BP is at or greater than150/90 for patients older than 60 years and 140/90 for patients younger than 60 and those who have chronic kidney disease or diabetes.
Isotonic
Having the same concentration of solutes as another solution and hence exerting the same osmotic pressure as that solution, such as an isotonic saline solution that contains an amount of salt equal to that found in the intracellular and extracellular fluid.
Nitrates: Adverse Effects
Headaches ØUsually diminish in intensity and frequency with continued use Reflex tachycardia Postural hypotension Skin irritation with topical application Tolerance may develop.
Secondary hypertension
High blood pressure caused by another disease such as renal, pulmonary, endocrine, or vascular disease.
Vasodilators: Adverse Effects
Hydralazine: dizziness, headache, anxiety, tachycardia, edema, dyspnea, nausea, vomiting, diarrhea, hepatitis, systemic lupus erythematosus, vitamin B6 deficiency, and rash Minoxidil: T-wave electrocardiographic changes, pericardial effusion or tamponade, angina, breast tenderness, rash, and thrombocytopenia Sodium nitroprusside: bradycardia, decreased platelet aggregation, rash, hypothyroidism, hypotension, methemoglobinemia, and (rarely) cyanide toxicity
Angiotensin II Receptor Blockers: Indications
Hypertension Adjunctive drugs for the treatment of HF May be used alone or with other drugs such as diuretics
ACE Inhibitors:Indications
Hypertension HF (either alone or in combination with diuretics or other drugs) Slow progression of left ventricular hypertrophy after myocardial infarction (MI) (cardioprotective) Renal protective effects in patients with diabetes
Fluid Balance: What is Total Body Water composed of?
INTRACELLULAR FLUID (ICF)• EXTRACELLULAR FLUID (ECF)• INTERSTITIAL FLUID (ISF)• INTRAVASCULAR FLUID (IVF) And 60% OF ADULT HUMAN BODY IS WATER
Cardiac Glycosides:Mechanism of Action
Increase myocardial contractility Change electrical conduction properties of the heart ØDecrease rate of electrical conduction ØProlong the refractory period •Area between sinoatrial (SA) node and atrioventricular (AV) node
ACE Inhibitors: Mechanism of Action
Inhibit ACE ACE: converts angiotensin I (AI) (formed through the action of renin) to angiotensin II (AII) AII: potent vasoconstrictors that induce aldosterone secretion by the adrenal glands Aldosterone: stimulates sodium and water resorption, which can raise BP Renin-angiotensin-aldosterone system ACE inhibitors thus lower BP.
Anticoagulant: Warfarin
Inhibits vitamin K synthesis by bacteria in the gastrointestinal tract Inhibits production of vitamin K-dependent clotting factors II, VII, IX, and X, which are normally synthesized in the liver Final effect prevention of clot formation
Fibrinolytic System
Initiates the breakdown of clots and serves to balance the clotting process. Fibrinolysis: mechanism by which formed thrombi are lysed to prevent excessive clot formation and blood vessel blockage. Fibrin in the clot binds to a circulating protein known as plasminogen. This binding converts plasminogen to plasmin. Plasmin is the enzymatic protein that eventually breaks down the fibrin thrombus into fibrin degradation products. This keeps the thrombus localized to prevent it from becoming an embolus.
Clot
Insoluble solid elements of blood (e.g., cells, fibrin threads) that have chemically separated from the liquid (plasma) component of the blood.
Calcium Channel Blockers: Common Drug Interactions
Interacting Drugs: Beta blockers, digoxin, amiodarone (Azole antifungals, clarithromycin, erythromycin, HIV drugs) Statins & cyclosporine
Vasospastic angina
Ischemia-induced myocardial chest pain caused by spasms of the coronary arteries; also referred to as Prinzmetal or variant angina.
Calcium Channel Blockers: Contraindications
Known drug allergy Acute MI Second- or third-degree AV block (unless the patient has a pacemaker) Hypotension
Nitrates: Contraindications
Known drug allergy Severe anemia Closed-angle glaucoma Hypotension Severe head injury Use of the erectile dysfunction drugs sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)
Angiotensin-Converting Enzyme (ACE) Inhibitors
Large group of safe and effective drugs ØCurrently are 10 ACE inhibitors Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic or CCB Captopril (Capoten) Benazepril (Lotensin) Enalapril (Vasotec) Fosinopril (Monopril) Lisinopril (Prinivil) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik)
Calcium Channel Blockers: Adverse Effects
Limited Primarily relate to overexpression of their therapeutic effects May cause hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea, other adverse effects
Exogenous lipids
Lipids originating outside of the body or an organ (e.g., dietary fats).
Angiotensin II Receptor Blockers (ARBs)
Lower blood pressure by blocking the angiotensin II enzyme to the type 1 A II receptors in the tissues of the vascular smooth muscle and adrenal glands from causing vasoconstriction & secretion of aldosterone.
Beta Blockers
Mainstay in the treatment of several cardiovascular diseases ØAngina ØMI ØHypertension ØDysrhythmias
Warfarin (Coumadin):Nursing Implications
Many herbal products have potential interactions; increased bleeding may occur: Capsicum pepper Garlic Ginger Ginkgo St. John's wort Feverfew
Chylomicrons
Microscopic droplets made up of fat and protein that are produced by cells in the small intestine and released into the bloodstream. Their main purpose is to carry fats to the tissues throughout the body, primarily the liver. Chylomicrons consist of about 90% triglycerides and small amounts of cholesterol, phospholipids, and proteins.
Angiotensin II Receptor Blockers: Adverse Effects
Most common adverse effects of ARBs ØChest pain ØFatigue ØHypoglycemia ØDiarrhea ØUrinary tract infection ØAnemia ØWeakness ØHyperkalemia and cough are less likely to occur than with the ACE inhibitors.
Loop Diuretics: Furosemide (Lasix)
Most commonly used loop diuretic Uses: pulmonary edema and the edema associated with HF, liver disease, nephrotic syndrome, ascites, hypertension
Heart Failure: Causes
Myocardial infarction (MI) Coronary artery disease Cardiomyopathy Valvular insufficiency Atrial fibrillation Infection Tamponade Ischemia Pulmonary hypertension Systemic hypertension Outflow obstruction Hypervolemia Congenital abnormalities Anemia Thyroid disease Infection Diabetes
Heparin
Natural anticoagulant obtained from the lungs or intestinal mucosa of pigs 10 to 40,000 units/mL DVT prophylaxis: 5000 units subcutaneously two or three times a day; does not need to be monitored when used for prophylaxis When heparin is used therapeutically (for treatment), continuous IV infusion. ØMeasurement of aPTT (usually every 6 hours until therapeutic effects are seen) is necessary.
Beta Receptor Blocker
Nebivolol (Bystolic) Uses: hypertension and HF Action: blocks beta1 receptors and produces vasodilatation, which results in a decrease in SVR Less sexual dysfunction Do not stop abruptly; must be tapered over 1 to 2 weeks
Myocardial infarction (MI)
Necrosis of the myocardium following interruption of blood supply; it is almost always caused by atherosclerosis of the coronary arteries and is commonly called a heart attack.
Kidney Main Structural Unit
Nephron
Loop Diuretics: Interactions
Neurotoxic Nephrotoxic Increase serum levels of uric acid, glucose, alanine aminotransferase, and aspartate aminotransferase. Thiazide (metolazone): sequential nephron blockade Nonsteroidal antiinflammatory drugs (NSAIDs)
Angiotensin Receptor-Neprilysin Inhibitors (ARNI)
Newer class of drugs Valsartan/sacubitril (Entresto) Blocks the degradation of vasoactive peptides by inhibiting the neprilysin enzyme Common adverse effects: hypotension, hyperkalemia, increased serum creatinine
What is the prototypical nitrate?
Nitroglycerin
Stroke
Occlusion of the blood vessels of the brain by an embolus, thrombus, or cerebrovascular hemorrhage, resulting in ischemia of the brain tissue.
Calcium Channel Blockers:Mechanism of Action
Primary use: HTN and angina Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction Results in: ØDecreased peripheral smooth muscle tone ØDecreased SVR ØDecreased BP
Cardiac Glycosides
One of the oldest groups of cardiac drugs No longer used as first-line treatment Not been shown to reduce mortality in HF patients Originally obtained from Digitalis plant, foxglove Digoxin is the prototype. Used in HF and to control ventricular response to atrial fibrillation
Enalapril (Vasotec)
Only ACE inhibitor available in both oral and parenteral preparations Enalapril intravenous (IV) does not require cardiac monitoring. Oral enalapril: prodrug Improves patient's chances of survival after an MI Reduces the incidence of HF
Potassium adverse effects
Oral preparations - Diarrhea, nausea, vomiting, GI bleeding, ulceration IV administration -Pain at injection site -Phlebitis Excessive administration - Hyperkalemia, toxic effects
Vasodilators: Hydralazine (Apresoline)
Orally: routine cases of essential hypertension Injectable: hypertensive emergencies BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients
Isosorbide dinitrate (Isordil)
Organic nitrate Available in rapid-acting sublingual tablets, immediate-release tablets, and long-acting oral dosage forms Produces more consistent, steady, therapeutic response
Ischemic heart disease
Poor blood supply to the heart via the coronary arteries.
Drug Therapy for Heart Failure
Positive inotropic drugs -Increase the force of myocardial contraction Positive chronotropic drugs -Increase heart rate Positive dromotropic drugs -Accelerate cardiac conduction
Cardiac Glycosides:Drug Effects
Positive inotropic effect ØIncreased force and velocity of myocardial contraction (without an increase in oxygen consumption) Negative chronotropic effect ØReduced heart rate Negative dromotropic effect ØDecreased automaticity at SA node, decreased AV nodal conduction, and other effects Increased stroke volume Reduction in heart size during diastole Decrease in venous BP and vein engorgement Increase in coronary circulation Decrease in exertional and paroxysmal nocturnal dyspnea, cough, and cyanosis Improved symptom control, quality of life, and exercise tolerance No apparent reduction in mortality
Angiotensin II Receptor Blockers (ARBs)
Potent vasodilators; decrease systemic vascular resistance (afterload) Used alone or in combination with other drugs such as diuretics in the treatment of hypertension or HF Examples: valsartan (Diovan), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis), olmesartan (Benicar), and losartan (Cozaar)
What is the Prototypical peripheral Alpha-1 Receptor Blocker?
Prazosin (Minipress)
Antiplatelet drugs
Prevent platelet adhesion: Aspirin Cilostazol (Pletal) Clopidogrel (Plavix) Prasugrel (Effient) Treprostinil (Remodulin) Abciximab (ReoPro) Eptifibatide (Integrilin) Tirofiban (Aggrastat) Anagrelide (Agrylin) Dipyridamole (Persantine)
Colloids
Protein substances that increase the colloid oncotic pressure.
Enoxaparin (Lovenox)
Prototypical LMWH Greater affinity for factor Xa than for factor Iia Higher degree of bioavailability and longer elimination half-life Lab monitoring is not necessary. Injectable form Used for prophylaxis and treatment Pre-filled syringes Do not expel air bubble
Nitroglycerin
Prototypical nitrate The most important drug used in the symptomatic treatment of ischemic heart conditions such as angina Routes—PO, SL, metered-dose aerosol that is sprayed under the tongue, IV, and topical ØLarge first-pass effect with oral forms ØUsed for symptomatic treatment of ischemic heart conditions (angina) ØIV form used for BP control in perioperative hypertension, treatment of heart failure (HF), ischemic pain, pulmonary edema associated with acute MI, and hypertensive emergencies
Hemostatic
Referring to any procedure, device, or substance that arrests the flow of blood.
Antifibrinolytic Drugs
Result in promoting clot formation Used for prevention and treatment of excessive bleeding resulting from hyperfibrinolysis or surgical complications Treatment of hemophilia or von Willebrand's disease Aminocaproic acid (Amicar) Tranexamic acid (Cyklokapron) Desmopressin
Angiotensin-Converting Enzyme Inhibitors: Chart
See Chart
Some Angiotensin-Converting Enzyme Inhibitors: Therapeutic Effects: Chart
See Chart
Fondaparinux (Arixtra)
Selective inhibitor of factor Xa Prophylaxis or treatment of DVT or PE Bleeding is most common and serious adverse reaction. Anemia, wound drainage, hematoma, confusion, UTI, hypotension, dizziness, hypokalemia Thrombocytopenia can occur Should not be given for at least 6 to 8 hours after surgery Use with caution with warfarin Subcutaneous injections
Internodal pathways (Bachmann bundle)
Special pathways in the atria that carry electrical impulses generated by the sinoatrial (SA) node. These impulses cause the heart to beat.
Extracellular fluid (ECF)
That portion of the body fluid comprising the interstitial fluid and intravascular fluid.
Edema
The abnormal accumulation of fluid in interstitial spaces.
Crystalloids
Substances in a solution that diffuse through a semipermeable membrane.
Anticoagulants
Substances that prevent or delay coagulation of the blood.
Antiplatelet drugs
Substances that prevent platelet plugs from forming.
Heart Failure Symptoms
Symptoms depend on the cardiac area affected ØCommon symptoms: dyspnea, fatigue, fluid retention and/or pulmonary edema Ø"Left-sided" heart failure (HF): pulmonary edema, coughing, shortness of breath, and dyspnea Ø"Right-sided" HF: systemic venous congestion, pedal edema, jugular venous distension, ascites, and hepatic congestion
Treatment: Toxic Effects of Heparin
Symptoms: hematuria, melena (blood in the stool), petechiae, ecchymoses, and gum or mucous membrane bleeding Stop drug immediately. Intravenous (IV) protamine sulfate: 1 mg of protamine can reverse the effects of 100 units of heparin.
Beta Blockers: Contraindications
Systolic HF Serious conduction disturbances Caution: bronchial asthma because any level of blockade of beta2 receptors can promote bronchoconstriction Diabetes mellitus: can mask hypoglycemia-induced tachycardia Peripheral vascular disease: may further compromise cerebral or peripheral blood flow
Arrhythmia
Technically, "no rhythm," meaning the absence of heart rhythm (i.e., no heartbeat at all). It is more commonly used in clinical practice to refer to any variation from the normal rhythm of the heart. A synonymous term is dysrhythmia, the primary term used in this textbook.
Hemostasis
The arrest of bleeding, either by the physiologic properties of vasoconstriction and coagulation or by mechanical, surgical, or pharmacologic means.
Pulmonary embolism
The blockage of a pulmonary artery by foreign matter such as fat, air, a tumor, or a thrombus (which usually arises from a peripheral vein).
Foam cells
The characteristic initial lesion of atherosclerosis, also known as a fatty streak.
Serum
The clear, cell-free portion of the blood from which fibrinogen has also been separated during the clotting process, as typically carried out with a laboratory sample.
Glomerulus
The cluster of kidney capillaries that marks the beginning of the nephron and is immediately proximal to the proximal convoluted tubule.
Fibrinolysis
The continual process of fibrin decomposition produced by the actions of the enzymatic protein fibrinolysin. It is the normal mechanism for removing small fibrin clots and is stimulated by anoxia, inflammatory reactions, and other kinds of stress.
Threshold potential
The critical state of electrical tension required for spontaneous depolarization of a cell membrane.
Plasmin
The enzymatic protein that breaks down fibrin into fibrin degradation products; it is derived from plasminogen.
Interstitial fluid (ISF)
The extracellular fluid that fills in the spaces between most of the cells of the body.
Intravascular fluid (IVF)
The fluid inside blood vessels.
Intracellular fluid (ICF)
The fluid located within cell membranes throughout most of the body. It contains dissolved solutes that are essential to maintaining electrolyte balance and healthy metabolism.
Blood
The fluid that circulates through the heart, arteries, capillaries, and veins, carrying nutriment and oxygen to the body cells. It consists of plasma, its liquid component, plus three major solid components: erythrocytes (red blood cells or RBCs), leukocytes (white blood cells or WBCs), and platelets.
Transcellular fluid
The fluid that is contained within specialized body compartments such as cerebrospinal, pleural, and synovial cavities.
Deep vein thrombosis (DVT)
The formation of a thrombus in one of the deep veins of the body. The deep veins most commonly affected are the iliac and femoral veins.
Nephron
The functional filtration unit of the kidney, consisting of (in anatomic order from proximal to distal) the glomerulus, proximal convoluted tubule, loop of Henle, distal convoluted tubule, and collecting duct, which empties urine into the ureters.
Filtrate
The material that passes through a filter. In the kidney, the filter is the glomerulus and the filtrate is the material extracted from the blood (normally liquid), which becomes urine.
Collecting duct
The most distal part of the nephron between the distal convoluted tubule and the ureters, which lead to the urinary bladder.
Depolarization
The movement of positive and negative ions on either side of a cell membrane across the membrane in a direction that brings the net charge to zero.
The nurse is preparing to educate a group of patients on the management of angina. Ø 1.Which drug groups are most often used to treat patients with angina?
The nitrates and nitrites, the beta blockers, and the CCBs are the drugs most often used to treat patients with angina pectoris.
Glomerular capsule
The open, rounded, and most proximal part of the proximal convoluted tubule that surrounds the glomerulus and receives the filtrate from the blood.
Loop of Henle
The part of the nephron between the proximal and distal convoluted tubules.
Distal convoluted tubule
The part of the nephron immediately distal to the ascending loop of Henle and proximal to the collecting duct.
Proximal convoluted (twisted) tubule
The part of the nephron that is immediately distal to the glomerulus and proximal to the loop of Henle.
The nurse is caring for a pediatric patient with a prescription for 0.2 mg/kg bolus of verapamil. What is the correct dose for a pediatric patient with a weight of 34 lb?
The pediatric patient's weight of 34 lb is converted to kilograms by dividing 34 by 2.2, which equals 15.45 kg. When 15.45 kg is multiplied by 0.2 mg/kg, the result is 3.09 mg, which rounds to 3.1 mg.
Effective refractory period
The period after the firing of an impulse during which a cell may respond to a stimulus but the response will not be passed along or continued as another impulse.
Refractory period
The period during which a pulse generator (e.g., the sinoatrial node of the heart) is unresponsive to an electrical input signal, and during which it is impossible for the myocardium to respond. This is the period during which the cardiac cell is readjusting its sodium and potassium levels and cannot be depolarized again.
Coagulation
The process of blood clotting. More specifically, the sequential process by which the multiple coagulation factors of the blood interact in the coagulation cascade, ultimately forming an insoluble fibrin clot.
Fibrin specificity
The property of some thrombolytic drugs of activating the conversion of plasminogen to plasmin only in the presence of established clots having fibrin threads rather than inducing systemic plasminogen activation throughout the body.
Ejection fraction
The proportion of blood that is ejected during each ventricular contraction compared with the total ventricular filling volume.
Apolipoproteins
The protein components of lipoproteins.
Coagulation cascade
The series of steps beginning with the intrinsic or extrinsic pathways of coagulation and proceeding through the formation of a fibrin clot.
Afferent arterioles
The small blood vessels approaching the glomerulus (proximal part of the nephron).
Efferent arterioles
The small blood vessels exiting the glomerulus. At this point blood has completed its filtration in the glomerulus.
The nurse is providing discharge teaching for a patient with a new prescription for nitroglycerin sublingual tablets. Which statement by the patient indicates an understanding of the nurse's discharge instructions about this medication? A - "I will need to refill my prescription when I feel burning under my tongue." B - "I will keep my nitroglycerin tablets in their original glass container." C - "My nitroglycerin tablets are not affected by cold or heat." D -"I can take some aspirin if I get a headache related to nitroglycerin."
The sublingual dosage form of nitroglycerin needs to be kept in its original amber-colored glass container with metal lid to avoid loss of potency from exposure to heat, light, moisture, and cotton filler. It should be replaced every 3 to 6 months in order to maintain potency. Potency of the sublingual nitroglycerin is noted if there is burning or stinging when the medication is placed under the tongue; if the medication does not burn, then the drug has lost its potency, and a new prescription must be obtained. Headaches associated with nitrates last approximately 20 minutes (with sublingual forms) and may be managed with acetaminophen.
Vaughan Williams classification
The system most commonly used to classify antidysrhythmic drugs
Thrombus
The technical term for a blood clot (plural: thrombi); an aggregation of platelets, fibrin, clotting factors, and the cellular elements of the blood that is attached to the interior wall of a vein or artery, sometimes occluding the vessel lumen.
Homeostasis
The tendency of a cell or organism to maintain equilibrium by regulating its internal environment and adjusting its physiologic processes.
Relative refractory period
The time after generation of an action potential during which a nerve fiber will show a (reduced) response only to a strong stimulus.
Left ventricular end-diastolic volume
The total amount of blood in the ventricle immediately before it contracts, or the preload.
Resting membrane potential (RMP)
The voltage that exists when the cell membranes of heart muscle (or other muscle or nerve cells) are at rest.
Plasma
The watery, straw-colored fluid component of lymph and blood in which the leukocytes, erythrocytes, and platelets are suspended.
How many and what are the main categories of pharmacologic drugs used to treat hypertension?
There are 7: ①Diuretics ②adrenergic drugs ③vasodilators ④angiotensin-converting enzyme (ACE) inhibitors ⑤angiotensin receptor blockers (ARBs) ⑥calcium channel blockers (CCBs) ⑦direct renin inhibitors.
Niacin: Mechanism of Action
Thought to increase activity of lipase, which breaks down lipids Reduces the metabolism or catabolism of cholesterol and triglycerides
Nitrates and Nitrites: Indications
Treat stable, unstable, and vasospastic angina Rapid-acting forms ØUsed to treat acute anginal attacks ØSublingual tablets; IV infusion Long-acting forms ØUsed to PREVENT anginal episodes
Vasodilators: Indications
Treatment of hypertension May be used in combination with other drugs Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies.
Heparin-Induced Thrombocytopenia
Type I Gradual reduction in platelets Heparin therapy can generally be continued. Type II Acute fall in the number of platelets (more than 50% reduction from baseline) Discontinue heparin. Clinical manifestations Thrombosis that can be fatal Treatment: thrombin inhibitors lepirudin and argatroban Use of warfarin: can cause skin necrosis and "purple toes" syndrome
Sudden cardiac death
Unexpected fatal cardiac arrest
Antidysrhythmics
Used for the treatment and prevention of disturbances in cardiac rhythm
Clonidine (Catapres)
Used primarily for its ability to decrease blood pressure Also used for management of opioid withdrawal Oral and topical patch Do not stop abruptly ØMay lead to rebound hypertension
Anticoagulants: Indications
Used to prevent clot formation in certain settings in which clot formation is likely -MI -Unstable angina -Atrial fibrillation -Indwelling devices, such as mechanical heart valves -Major orthopedic surgery
Aldosterone Antagonists
Useful in severe stages of HF Action: activation of the renin-angiotensin-aldosterone system causes increased levels of aldosterone, which causes retention of sodium and water, leading to edema that can worsen HF. Spironolactone (Aldactone): potassium-sparing diuretic and aldosterone antagonist shown to reduce the symptoms of HF Eplerenone (Inspra): selective aldosterone blocker, blocking aldosterone at its receptors in the kidney, heart, blood vessels, and brain
Lisinopril (Prinivil, Zestril)
Uses: hypertension, HF, and acute MI Hyperkalemia Common adverse effect: dry cough, hyperkalemia, decreased renal function
Captopril (Capoten)
Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI Shortest half-life Must be administered multiple times throughout the day
Valsartan (Diovan)
Valsartan shares many of the same adverse effects as lisinopril. ARBs are not as likely to cause the cough associated with the ACE inhibitors. ARBs are not as likely to cause hyperkalemia.
Diltiazem (Cardizem, Dilacor, Tiazac)
Very effective for the treatment of angina pectoris resulting from coronary insufficiency and hypertension Used in the treatment of atrial fibrillation and flutter along with paroxysmal supraventricular tachycardia
Potassium-Sparing Diuretics: Mechanism of Action
Work in collecting ducts and distal convoluted tubules Interfere with sodium-potassium exchange Competitively bind to aldosterone receptors Block resorption of sodium and water usually induced by aldosterone
Carbonic anhydrase inhibitors (CAIs) - Mechanism of Action
a type of diuretic that also can lower intraocular pressure by reducing production of aqueous humor by as much as 60% and •Inhibition of carbonic anhydrase reduces H+ ion concentration in renal tubules.
Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem (Cardizem)? a. "I can take this drug to stop an attack of angina." b. "I understand that food and antacids alter the absorption of this oral drug." c. "When the long-acting forms are taken, the drug cannot be crushed." d. "This drug may cause my blood pressure to drop, so I need to be careful when getting up."
a. "I can take this drug to stop an attack of angina."
An older adult patient has been discharged following treatment for heart failure, and he will be taking a loop diuretic. Which instruction(s) from the nurse are appropriate? (Select all that apply.) a. "Take the diuretic at the same time each morning." b. "Take the diuretic only if you notice swelling in your feet." c. "Be sure to stand up slowly because the medicine may make you feel dizzy if you stand up quickly." d. "Drink at least 8 glasses of water each day." e. "Here is a list of foods that are high in potassium; you need to avoid these." f. "Please call your doctor immediately if you notice muscle weakness or increased dizziness"
a. "Take the diuretic at the same time each morning." c. "Be sure to stand up slowly because the medicine may make you feel dizzy if you stand up quickly." f. "Please call your doctor immediately if you notice muscle weakness or increased dizziness"
The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbide dinitrate (Isordil) as treatment for angina symptoms. Which substances listed below could potentially result in a drug interaction? (Select all that apply.) a. A glass of wine b. Thyroid replacement hormone c. Tadalafil (Cialis), an erectile dysfunction drug d. Metformin (Glucophage), an antidiabetic drug e. Carvedilol (Coreg), a beta blocker
a. A glass of wine c. Tadalafil (Cialis), an erectile dysfunction drug e. Carvedilol (Coreg), a beta blocker
2. When giving antihypertensive drugs, the nurse will con-sider giving the first dose at bedtime for which class of drugs? a. Alpha blockers such as doxazosin (Cardura) b. Diuretics such as furosemide (Lasix) c. ACE inhibitors such as captopril (Capoten) d. Vasodilators such as hydralazine (Apresoline)
a. Alpha blockers such as doxazosin (Cardura)
In monitoring laboratory test results for patients receiving loop and thiazide diuretics, the nurse knows to look for which of these results? a. Decreased serum levels of potassium b. Increased serum levels of calcium c. Decreased serum levels of glucose d. Increased serum levels of sodium
a. Decreased serum levels of potassium
While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used? (Select all that apply.) a. Diabetes mellitus b. Essential tremors c. Exertional angina d. Asthma e. Hypertension
a. Diabetes mellitus d. Asthma
When teaching the patient about the signs and symptoms of cardiac glycoside toxicity, the nurse should alert the patient to watch for which of these? (Select all that apply.) a. Dizziness b. Visual changes such as halos around lights c. Headaches d. Increased urine output e. Dark stools
a. Dizziness b. Visual changes such as halos around lights c. Headaches
When monitoring a patient who is receiving an intravenous infusion of nesiritide (Natrecor), the nurse will look for which adverse effect? a. Dysrhythmia b. Proteinuria c. Hyperglycemia d. Hypertension
a. Dysrhythmia
When a patient is being taught about the potential adverse effects of an ACE inhibitor, which of these effects should the nurse mention as possibly occurring when this drug is taken to treat hypertension? (Select all that apply.) a. Fatigue b. Nausea c. Dry, nonproductive cough d. Diarrhea e. Dizziness
a. Fatigue c. Dry, nonproductive cough and e. Dizziness
Which action by the nurse is most appropriate for the patient receiving an infusion of packed red blood cells? a. Flush the IV line with normal saline (NS) before the blood is added to the infusion. b. Flush the IV line with dextrose before the blood is added to the infusion. c. Check the patient's vital signs after the infusion is completed. d. Anticipate that flushed skin and fever are expected reactions to a blood transfusion.
a. Flush the IV line with normal saline (NS) before the blood is added to the infusion.
In administering niacin, the nurse must monitor for which adverse effects? (Select all that apply.) a. Flushing of the skin b. Muscle pain c. Pruritus d. Headache e. Constipation f. GI upset
a. Flushing of the skin c. Pruritus f. GI upset
The nurse is assessing a patient who has a new prescription for vorapaxar (Zontivity). Which of these conditions are considered contraindications to the use of vorapaxar? (Select all that apply.) a. Impaired renal function b. Impaired liver function c. History of myocardial infarction d. Peripheral artery disease e. History of intracranial hemorrhage
a. Impaired renal function b. Impaired liver function e. History of intracranial hemorrhage
The nurse is administering an intravenous infusion of a phosphodiesterase inhibitor to a patient who has heart failure. The nurse will evaluate the patient for which therapeutic effects? (Select all that apply.) a. Positive inotropic effects b. Vasodilation c. Decreased heart rate d. Increased blood pressure e. Positive chronotropic effects
a. Positive inotropic effects b. Vasodilation e. Positive chronotropic effects
A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medication? Select all that apply. a. aspirin b. acetaminophen c. NSAIDs d. The herbal product gingko e. Caffeine
a. aspirin c. NSAIDs d. The herbal product gingko
Crystalloids
are fluids given by IV injection that supply water and sodium to maintain the osmotic gradient between the extravascular and intravascular compartments. Their plasma volume-expanding capacity is related to their sodium concentration.
Colloids
are substances that increase the colloid oncotic pressure and move fluid from the interstitial compartment to the plasma compartment by pulling the fluid into the blood vessels.
Antianginal Beta Blockers
atenolol metoprolol propranolol nadolol
Beta blockers approved as antianginal drugs are:
atenolol, metoprolol, nadolol, and propranolol.
Which statement must be included when the nurse provides education for a patient with heart failure who is taking daily doses of spironolactone (Aldactone)? a. "Be sure to eat foods that are high in potassium." b. "Avoid foods that are high in potassium." c. "Avoid grapefruit juice while taking this medication." d. "A low-fiber diet will help prevent adverse effects of this medication."
b. "Avoid foods that are high in potassium."
When the nurse is teaching a patient about taking an anti-dysrhythmic drug, which statements by the nurse are correct? (Select all that apply.) a. "Take the medication with an antacid if stomach upset occurs." b. "Do not chew sustained-release capsules." c. "If a weight gain of 5 pounds occurs within 1 week, notify your physician at the next office visit." d. "If you experience severe adverse effects, stop the drug and notify your physician." e. "If stomach upset occurs, you may take the medication with food."
b. "Do not chew sustained-release capsules."
A 46-year-old man started antihypertensive drug therapy 3 months earlier and is in the office for a follow-up visit. While the nurse is taking his blood pressure, he informs the nurse that he has had some problems with sexual intercourse. Which is the most appropriate response by the nurse? a. "Not to worry. Eventually, tolerance will develop." b. "The physician can work with you on changing the dose and/or drugs." c. "Sexual dysfunction happens with this therapy, & you will learn to accept it." d. "This is an unusual occurrence, but it is important to stay on your medications."
b. "The physician can work with you on changing the dose and/or drugs."
The nurse is teaching a patient about the self-administration of enoxaparin (Lovenox). Which statement will be included in this teaching session? a. "We will need to teach a family member how to give this drug in your arm." b. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel." c. "This drug needs to be taken at the same time every day with a full glass of water." d. "Be sure to massage the injection site thoroughly after administering the drug."
b. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel."
A patient with a rapid, irregular heart rhythm is being treated in the emergency department with adenosine. During administration of this drug, the nurse will be prepared to monitor the patient for which effect? a. Nausea and vomiting b. A brief period of systole c. Muscle tetany d. Hypertension
b. A brief period of systole
A patient is currently taking a statin. The nurse considers that the patient may have a higher risk for developing rhabdomyolysis when also taking which product? a. NSAIDs b. A fibric acid derivative c. Orange juice d. Fat-soluble vitamins
b. A fibric acid derivative
A patient has a new prescription for an ACE inhibitor. During a review of the patient's list of current medications, which would cause concern for a possible interaction with this new prescription? (Select all that apply.) a. A benzodiazepine taken as needed for allergies b. A potassium supplement taken daily c. An oral anticoagulant taken daily d. An opioid used for occasional severe pain e. An NSAID taken as needed for headaches
b. A potassium supplement taken daily and e. An NSAID taken as needed for headaches
A nurse administering niacin would implement which action to help to reduce adverse effects? a. Give the medication with grapefruit juice. b. Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose. c. Administer the medication on an empty stomach. d. Have the patient increase dietary fiber intake.
b. Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose.
A patient is starting warfarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (Select all that apply.) a. Teach proper subcutaneous administration. b. Administer the oral dose at the same time every day. c. Assess carefully for excessive bruising or unusual bleeding. d. Monitor laboratory results for a target INR of 2 to 3. e. Monitor laboratory results for a therapeutic aPTT value of 1.5 to 2.5 times the control value.
b. Administer the oral dose at the same time every day. c. Assess carefully for excessive bruising or unusual bleeding. d. Monitor laboratory results for a target INR of 2 to 3.
The nurse is administering an IV solution that contains potassium chloride to a patient in the critical care unit who has a severely decreased serum potassium level. Which action(s) by the nurse are appropriate? (Select all that apply.) a. Administer the potassium by slow IV bolus. b. Administer the potassium at a rate no faster than 20 mEq/hr. c. Monitor the patient's cardiac rhythm with a heart monitor. d. Use an infusion pump for the administration of IV potassium chloride. e. Administer the potassium via IV push.
b. Administer the potassium at a rate no faster than 20 mEq/hr. c. Monitor the patient's cardiac rhythm with a heart monitor. d. Use an infusion pump for the administration of IV potassium chloride.
The nurse is administering cholestyramine (Questran), a bile acid sequestrant. Which nursing intervention(s) is(are) appropriate? (Select all that apply.) a. Administering the drug on an empty stomach b. Administering the drug with meals c. Instructing the patient to follow a low-fiber diet while taking this drug d. Instructing the patient to take a fiber supplement while taking this drug e. Increasing fluid intake f. Not administering this drug at the same time as other drugs
b. Administering the drug with meals d. Instructing the patient to take a fiber supplement while taking this drug e. Increasing fluid intake f. Not administering this drug at the same time as other drugs
The nurse is reviewing the medications that have been ordered for a patient for whom a loop diuretic has just been prescribed. The loop diuretic may have a possible interaction with which of the following? (Select all that apply.) a. Vitamin D b. Antidiabetic drugs c. Penicillins d. NSAIDs e. Corticosteroids f. warfarin
b. Antidiabetic drugs . Corticosteroids f. warfarin
A patient received a double dose of heparin during surgery and is bleeding through the incision site. While the surgeons are working to stop the bleeding at the incision site, the nurse will prepare to take what action? a. Give IV vitamin K as an antidote. b. Give IV protamine sulfate as an antidote. c. Call the blood bank for an immediate platelet transfusion. d. Obtain an order for packed red blood cells.
b. Give IV protamine sulfate as an antidote.
When assessing a patient who is about to receive an albumin infusion, which of these conditions must a nurse recognize as a possible contraindication to albumin infusion? (Select all that apply.) a. Pancreatitis b. Heart failure c. Severe burns d. Renal insufficiency e. Fluid-volume deficit
b. Heart failure
The nurse is administering antihypertensive drugs to older adult patients. The nurse knows that which adverse effect is of most concern for these patients? a. Dry mouth b. Hypotension c. Restlessness d. Constipation
b. Hypotension
A patient is taking an aminoglycoside antibiotic for pneumonia and will also be taking the loop diuretic furosemide (Lasix) due to fluid overload. The nurse will monitor carefully for which potential effect from the interaction of these two drugs? a. Nephrotoxicity b. Ototoxicity c. Pulmonary fibrosis d. Hepatotoxicity
b. Ototoxicity
A patient is about to receive a dose of the nonprotein plasma expander, dextran. The nurse knows that this product is indicated for which type of blood loss? a. Slow loss of 20% or less b. Slow loss of 20% to 50% c. Slow loss of over 50% or acute loss of 20% d. Loss of 80% or more
b. Slow loss of 20% to 50%
The nurse is assessing a patient who has been taking quinidine who asks about adverse effects. Which of these are potential adverse effects of quinidine? Select all that apply. a. Muscle pain b. Tinnitus c. Dyspnea d. Diarrhea e. Anorexia
b. Tinnitus d. Diarrhea e. Anorexia
A patient has been taking simvastatin (Zocor) for 6 months. Today he received a call that he needs to come to the office for a "laboratory check." The nurse expects which laboratory studies to be ordered at this time? (Select all that apply.) a. PT/INR b. Total cholesterol c. Triglycerides d. Liver function studies e. Complete blood count f. HDL and LDL levels
b. Total cholesterol c. Triglycerides d. Liver function studies f. HDL and LDL levels
A patient is taking a beta blocker as part of the treatment plan for heart failure. The nurse knows that the purpose of the beta blocker for this patient is to a. increase urine output. b. prevent stimulation of the heart by catecholamines. c. increase the contractility of the heart muscle. d. cause peripheral vasodilation.
b. prevent stimulation of the heart by catecholamines.
A patient is being assessed before a newly ordered antilipemic medication is started. Which condition would be a potential contraindication? a. Diabetes insipidus b. Pulmonary fibrosis c. Liver cirrhosis d. Myocardial infarction
c. Liver cirrhosis
The only Drug in the Antihypertensive category Direct Renin Inhibitors
• Aliskiren
A patient is in the clinic for a follow-up visit. He has been taking amiodarone (Cordarone) for almost 1 year, and today he tells the nurse, "I am noticing some blue color around my face, neck, and upper arms. Is that normal?" Which is the nurse's correct response? a. "This is an expected side effect and should go away soon." b. "This is a harmless effect. As long as the medication is working, we'll just monitor your skin." c. "This can happen with amiodarone. I will let your doctor know about it right away." d. "How much sun exposure have you had recently?"
c. "This can happen with amiodarone. I will let your doctor know about it right away."
A patient calls the family practice office to report that he has seen his pills in his stools when he has a bowel movement. How will the nurse respond? a. "The pills are not being digested properly. You need to take them on an empty stomach." b. "The pills are not being digested properly. You need to take them with food." c. "What you are seeing is the wax matrix that contained the medication, but the drug has been absorbed." d. "This indicates that you are not tolerating this medication and will need to switch to a different form."
c. "What you are seeing is the wax matrix that contained the medication, but the drug has been absorbed."
A patient with heart failure will be starting the beta blocker metoprolol (Lopressor). The nurse will monitor for which expected cardiovascular effects? (Select all that apply.) a. Increased heart rate b. Increased myocardial contractility. c. Delayed AV node conduction d. Reduced heart rate e. Decreased myocardial automaticity.
c. Delayed AV node conduction d. Reduced heart rate e. Decreased myocardial automaticity.
A nurse with adequate knowledge about the administration of intravenous nitroglycerin will recognize that which statement is correct? a. The intravenous form is given by IV push injection. b. Because the intravenous forms are short-lived, the dosing must be every 2 hours. c. Intravenous nitroglycerin must be protected from exposure to light through use of special tubing. d. Intravenous nitroglycerin can be given via gravity drip infusions.
c. Intravenous nitroglycerin must be protected from exposure to light through use of special tubing.
Which point will the nurse emphasize to a patient who is taking an antilipemic medication in the statin class? a. The drug must be taken on an empty stomach before meals. b. A low-fat diet is not necessary while taking these medications. c. It is important to report muscle pain immediately. d. Improved cholesterol levels will be evident within 2 weeks.
c. It is important to report muscle pain immediately.
In assessing a patient who has been taking amiodarone for 6 months, the nurse monitors for which potential adverse effect? a. Hyperglycemia b. Dysphagia c. Photophobia d. Urticaria
c. Photophobia
A patient is receiving dabigatran (Pradaxa) 150 mg twice daily as part of treatment for atrial fibrillation. Which condition, if present, would be a concern if the patient were to receive this dose? a. Asthma b. Elevated liver enzymes c. Renal impairment d. History of myocardial infarction
c. Renal impairment
When preparing an IV solution that contains potassium, which of these conditions must a nurse recognize as a contraindication to the potassium infusion? a. Diarrhea b. Serum sodium level of 145 mEq/L c. Serum potassium level of 5.6 mEq/L d. Dehydration
c. Serum potassium level of 5.6 mEq/L
When the nurse is checking the laboratory data for a patient taking spironolactone (Aldactone), which result would be a potential concern? a. Serum sodium level of 140 mEq/L b. Serum calcium level of 10.2 mg/dL c. Serum potassium level of 5.8 mEq/L d. Serum magnesium level of 2.0 mg/dL
c. Serum potassium level of 5.8 mEq/L
A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason? a. To relieve exertional angina b. To prevent palpitations c. To prevent the occurrence of angina d. To stop an episode of angina
c. To prevent the occurrence of angina
During assessment of a patient who is receiving digoxin, the nurse monitors for findings that would indicate an increased possibility of toxicity, such as a. apical pulse rate of 62 beats/min. b. digoxin level of 1.5 ng/mL. c. serum potassium level of 2.0 mEq/L. d. serum calcium level of 9.9 mEq/L.
c. serum potassium level of 2.0 mEq/L.
Of the two alpha2 -Adrenergic Receptor Stimulators (Agonists) —clonidine and methyldopa— which is the most commonly used and is the prototypical drug for this class?
clonidine
A patient with diabetes has a new prescription for a thiazide diuretic. Which statement will the nurse include in teaching the patient about the thiazide drug? a. "There is nothing for you to be concerned about when you are taking the thiazide diuretic." b. "Be sure to avoid foods that are high in potassium." c. "You need to take the thiazide at night to avoid interactions with the diabetes medicine." d. "Monitor your blood glucose level closely because the thiazide diuretic may cause the levels to increase."
d. "Monitor your blood glucose level closely because the thiazide diuretic may cause the levels to increase."
A 68-year-old male patient has been taking the nitrate isosor-bide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from the prescriber? a. "He will have to be switched to isosorbide mononitrate if he wants to take sildenafil." b. "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists." c. "I'll write a prescription, but if he uses it, he needs to stop taking the isosorbide for one dose." d. "These drugs are compatible with each other, and so I'll write a prescription."
d. "These drugs are compatible with each other, and so I'll write a prescription."
While monitoring a patient who is receiving an infusion of a crystalloid solution, the nurse will monitor for which potential problem? a. Bradycardia b. Hypotension c. Decreased skin turgor d. Fluid overload
d. Fluid overload
The nurse is preparing an infusion for a patient who has a deficiency in clotting factors. Which type of infusion is most appropriate? a. Albumin 5% b. Packed RBCs c. Whole blood d. Fresh frozen plasma
d. Fresh frozen plasma
The nurse is monitoring a patient who is receiving antithrom-bolytic therapy in the emergency department because of a possible MI. Which adverse effect would be of the greatest concern at this time? a. Dizziness b. Blood pressure of 130/98 mm Hg c. Slight bloody oozing from the IV insertion site d. Irregular heart rhythm
d. Irregular heart rhythm
The nurse is administering lidocaine and considers which condition, if present in the patient, is a caution for the use of this drug? a. Tachycardia b. Hypertension c. Ventricular dysrhythmias d. Renal dysfunction
d. Renal dysfunction
The nurse is assessing a patient who will be starting antihy-pertensive therapy with an ACE inhibitor. Which condition, if present in the patient, would be a reason for cautious use? a. Asthma b. Rheumatoid arthritis c. Hyperthyroidism d. Renal insufficiency
d. Renal insufficiency
A patient with angina has been given a prescription for a calcium channel blocker. The nurse knows that this class of drugs is used to treat which type of angina? a. Effort b. Unstable c. Crescendo d. Vasospastic
d. Vasospastic
The nurse is assessing a patient who is receiving a milrinone infusion and checks the patient's cardiac rhythm on the heart monitor. What adverse cardiac effect is most likely to occur in a patient who is receiving intravenous milrinone? a. Tachycardia b. Bradycardia c. Atrial fibrillation d. Ventricular dysrhythmia
d. Ventricular dysrhythmia
Calcium Channel Blockers (CCBs)
decrease myocardial oxygen demand by inhibiting the flow of calcium to smooth muscle cells of the heart, which causes arterial relaxation & minimizes contraction.
Alpha 1-adrenergic blockers (antagonist) are
drugs that work by blocking the alpha 1-receptors of vascular smooth muscle (Ex: the skin, sphincters of the gastrointestinal system, kidney, and brain) thus, preventing the uptake of catecholamines by the smooth muscle cells. This causes vasodilation and allows blood to flow more easily.
Alpha-2 blockers (antagonist) are . Alpha-2 blockers increase noradrenaline release.
drugs that work by blocking the alpha 2-receptors in the brain and in the periphery which in turn increases the release of norepinephrine. This reduces the force of vasodilation.
blood products adverse effects
incompatibility with recipients immune system, crossmatch testing, transfusion reaction, anaphylaxis, transmission of pathogens to recipient (hepatitis, HIV)
Atenolol (Tenormin) & Metoprolol (Lopressor, Toprol-XL)
is a cardioselective beta 1 - adrenergic receptor blocker and is indicated for the prophylactic treatment of angina pectoris.
Ischemia
is damaged cells/tissue as the result of inadequate oxygen supply
Potassium-Sparing Diuretics: Interactions
lithium, ACE inhibitors, potassium supplements, NSAIDs
Drugs for Angina
nitrates, beta blockers, calcium channel blockers
The most commonly used crystalloid solutions are:
normal saline (0.9% NaCl) and lactated Ringers solution
The three chemical classes of CCBs:
phenylalkylamines, benzothiazepines, and dihydropyridines, commonly represented by verapamil, diltiazem, and amlodipine, respectively
Sodium-potassium adenosine triphosphatase (ATPase)
pump A mechanism for transporting sodium and potassium ions across the cell membrane against an opposing concentration gradient. Energy for this transport is obtained from the hydrolysis of adenosine triphosphate (ATP) by means of the enzyme ATPase.
Potassium-Sparing Diuretics
spironolactone (Aldactone), triamterene (Dyrenium), amiloride (Midamor)
What are the three main classes of drugs used to treat angina pectoris?
the nitrates and nitrites, the beta blockers, and the calcium channel blockers (CCBs).
control of electrolytes
the renin-angiotensin-aldosterone system, antidiuretic hormone system, and sympathetic nervous system
What is the goal of antianginal drug therapy?
to increase blood flow to the ischemic myocardium, decrease myocardial oxygen demand, or both.
What are the additive hypotensive effects of Nitrate antianginal drugs?
when taken in combination with alcohol, beta blockers, CCBs, phenothiazines, and erectile-dysfunction drugs such as sildenafil, tadalafil, and vardenafil.
Potassium-Sparing Diuretics: Adverse Effects of Spironolactone (Aldactone)
§Gynecomastia §Amenorrhea §Irregular menses §Postmenopausal bleeding
Beta Blockers: Mechanism of Action
ØBlock beta1 receptors on the heart ØDecrease heart rate, resulting in decreased myocardial oxygen demand and increased oxygen delivery to the heart ØDecrease myocardial contractility, helping to conserve energy or decrease demand ØAfter an MI, a high level of circulating catecholamines irritates the heart, causing an imbalance in supply and demand ratio and even leading to life-threatening dysrhythmias. ØBeta blockers block the harmful effects of catecholamines, thus improving survival after an MI.
What are the SUBCATEGORIES of Adrenergic Antihypertensive Drugs?
• Centrally and peripherally acting adrenergic neuron blockers • Centrally acting alpha2 receptor agonists • Peripherally acting alpha1 receptor blockers • Peripherally acting beta receptor blockers (beta blockers) • Cardioselective (beta1 receptor blockers • Nonselective (beta1 and beta2 receptor blockers) • Peripherally acting dual alpha1 and beta receptor blockers
What are the SUBCATEGORIES of Diuretics?
• Loop diuretics • Potassium-sparing diuretics • Thiazides and thiazide-like diuretics
Lidocaine (Xylocaine)
•Class Ib •Action: raises the ventricular fibrillation threshold •Significant adverse effects: twitching, convulsions, confusion, respiratory depression or arrest, hypotension, bradycardia, and dysrhythmias •Contraindications: hypersensitive, severe SA or atrioventricular (AV) intraventricular block, or Stokes-Adams or Wolff-Parkinson-White syndrome
Procainamide (Pronestyl)
•Class Ia •Uses: atrial and ventricular tachydysrhythmias •Significant adverse effects: include ventricular dysrhythmias, blood disorders, systemic lupus erythematosus (SLE)-like syndrome, nausea, vomiting, diarrhea, fever, leukopenia, maculopapular rash, flushing, and torsades de pointes resulting from prolongation of the QT interval •Contraindications: known hypersensitivity, heart block, and SLE
Name the rapid-and long-acting nitrates available for clinical use:
• nitroglycerin (both rapid and long acting) • isosorbide dinitrate (both rapid and long acting) • isosorbide mononitrate (primarily long acting)
action potential
•A change in the distribution of ions causes cardiac cells to become excited. •The movement of ions across the cardiac cell's membrane results in an electrical impulse spreading across the cardiac cells. •This electrical impulse leads to contraction of the myocardial muscle. •Five phases •Phase 0: upstroke •Resting cardiac cell membrane suddenly becomes highly permeable to sodium ions; movement through sodium channels •Depolarization •Phase 1 •Begins a rapid process of repolarization that continues through Phases 2 and 3 to Phase 4, which is the RMP
Antidysrhythmics: Adverse Effects
•ALL antidysrhythmics can cause dysrhythmias! •Hypersensitivity reactions •Nausea, vomiting, and diarrhea •Dizziness •Headache and blurred vision •Prolongation of the QT interval
resting membrane potential
•An energy-requiring pump is needed to maintain this uneven distribution of ions. •Sodium-potassium ATPase pump •The RMP results from an uneven distribution of ions across the cell membrane. •Polarization
Rhabdomyloysis
•Breakdown of muscle protein •Myoglobinuria: urinary elimination of the muscle protein myoglobin •Can lead to acute renal failure and even death •When recognized reasonably early, rhabdomyolysis is usually reversible with discontinuation of the statin drug. •Instruct patients to immediately report any signs of toxicity, including muscle soreness or changes in urine color.
The Loop Diuretics are
•Bumetanide (Bumex) •Ethacrynic acid (Edecrin) •Furosemide (Lasix) •Torsemide (Demadex)
Antidysrhythmic Drugs
•Categorized according to where and how they affect cardiac cells •Vaughan Williams classification •System commonly used to classify antidysrhythmic drugs •Based on the electrophysiologic effect of particular drugs on the action potential
Vaughan Williams Classification:Mechanism of Action and Indications
•Class I •Membrane-stabilizing drugs •Fast sodium channel blockers Divided into Ia, Ib, and Ic drugs, according to effects •Class Ia: procainamide, quinidine, and disopyramide •Block sodium (fast) channels •Delay repolarization •Increase APD Used for atrial fibrillation, premature atrial contractions, premature ventricular contractions, ventricular tachycardia, Wolff-Parkinson-White syndrome •Class Ib: phenytoin, lidocaine •Block sodium channels •Accelerate repolarization •Increase or decrease APD •Lidocaine is used for ventricular dysrhythmias only. •Phenytoin is used for atrial and ventricular tachydysrhythmias caused by digitalis toxicity or long QT syndrome. Class Ic: flecainide, propafenone •Block sodium channels (more pronounced effect) •Little effect on APD or repolarization •Used for severe ventricular dysrhythmias •May be used in atrial fibrillation or flutter, Wolff-Parkinson-White syndrome, supraventricular tachycardia dysrhythmias •Class II: beta blockers •Reduce or block sympathetic nervous system stimulation, thus reducing transmission of impulses in the heart's conduction system •Depress Phase 4 depolarization •General myocardial depressants for both supraventricular and ventricular dysrhythmias Also used as antianginal and antihypertensive drugs •Class III: amiodarone, dronedarone, dofetilide, sotalol, ibutilide •Increase APD •Prolong repolarization in Phase 3 •Used for dysrhythmias that are difficult to treat Life-threatening ventricular tachycardia or fibrillation, atrial fibrillation or flutter that is resistant to other drugs •Class IV: •Calcium channel blockers •Inhibit slow-channel (calcium-dependent) pathways •Depress Phase 4 depolarization •Reduce AV node conduction Used for paroxysmal supraventricular tachycardia (PSVT); rate control for atrial fibrillation and flutter
Metoprolol (Lopressor)
•Class II •Another cardioselective beta blocker commonly given after an MI to reduce risk of sudden cardiac death •Treatment of hypertension and angina
Atenolol (Tenormin)
•Class II •Cardioselective beta blocker; preferentially blocks the beta1-adrenergic receptors that are located primarily in the heart. •Noncardioselective beta blockers block not only the beta1-adrenergic receptors in the heart but also the beta2-adrenergic receptors in the lungs and therefore can exacerbate pre-existing asthma or chronic obstructive pulmonary disease. •Uses: antidysrhythmic, hypertension, and angina •Contraindications: severe bradycardia, second- or third-degree heart block, heart failure, cardiogenic shock, or a known hypersensitivity
Quinidine (Quinidex)
•Class Ia •Both direction action on the electrical activity of the heart and indirect (anticholinergic) effect •Significant adverse effects: cardiac asystole and ventricular ectopic beats •Others: cinchonism (tinnitus, loss of hearing, blurring vision, GI upset) •Black box warning: can cause torsades de pointes
Flecainide (Tambocor)
•Class Ic •First-line drug in the treatment of atrial fibrillation •Negative inotropic effect and depresses left ventricular function •Adverse effects: dizziness, visual disturbances, and dyspnea •Contraindications: hypersensitivity, cardiogenic shock, second- or third-degree AV block, and non-life-threatening dysrhythmias
Crystalloids Indications:
•Indications include: •Acute liver failure •Acute nephrosis •Adult respiratory distress syndrome •Burns •Cardiopulmonary bypass •Hypoproteinemia •Renal dialysis •Reduction of the risk for deep vein thrombosis •Shock
Thiazide and Thiazide-Like Diuretics: Mechanism of Action
•Inhibit tubular resorption of sodium, chloride, and potassium ions •Action primarily in the distal convoluted tubule •Result: water, sodium, and chloride are excreted •Potassium is also excreted to a lesser extent. •Dilate the arterioles by direct relaxation
Action Potential Duration
•Interval between Phase 0 and Phase 4 •Absolute or effective refractory period •Relative refractory period •Threshold potential •Automaticity or pacemaker activity
Sodium Polystyrene Sulfonate (Potassium Exchange Resin)
•Kayexalate •Cation exchange resin used to treat hyperkalemia •Oral, nasogastric tubal, or as enema •Works in intestine •Closely monitor electrolytes •Do not give to patient who do not have normal bowel function
Contraindications to the Use of Antidysrhythmic Drugs
•Known drug allergy •Second- or third-degree AV block, bundle branch block, cardiogenic shock, sick sinus syndrome, and any other ECG changes depending on the clinical judgment of a cardiologist. •Other antidysrhythmic drugs
Atherosclerotic Plaque Formation
•Lipids and lipoproteins form athrosclerotic plaque leading to development of CHD. •When serum cholesterol levels are elevated, circulating monocytes adhere to smooth endothelial surfaces of coronary vasculature. •Macrophage cells are formed and fill with fat. •Foam cells develop. •Precursor lesion of atherosclerosis
•Most potent LDL reducers
•Lovastatin (Mevacor) •Pravastatin (Pravachol) •Simvastatin (Zocor) •Atorvastatin (Lipitor) •Fluvastatin (Lescol) •Rosuvastatin (Crestor) •Pitavastatin (Livalo)
Thiazide and Thiazide-Like Diuretics: Drug Effects
•Lowered peripheral vascular resistance •Depletion of sodium and water (and potassium) •Thiazides should not be used if creatinine clearance is less than 30 to 50 mL/min (normal is 125 mL/min). •Metolazone remains effective to a creatinine clearance of 10 mL/min.
Crystalloids Adverse Effects
•May cause edema, especially peripheral or pulmonary •May dilute plasma proteins, reducing COP •Effects may be short-lived. •Prolonged infusions may worsen alkalosis or acidosis.
Potassium is
•Most abundant positively charged electrolyte inside cells •95% of body's potassium is intracellular. •Potassium content outside of cells ranges from 3.5 to 5 mEq/L. •Potassium levels are critical to normal body function.
Sodium is
•Most abundant positively charged electrolyte outside cells •Normal concentration outside cells is 135 to 145 mEq/L •Maintained through dietary intake of sodium chloride •Salt, fish, meats, foods flavored or preserved with salt It is Also.. •Sodium is responsible for: •Control of water distribution •Fluid and electrolyte balance •Osmotic pressure of body fluids •Participation in acid-base balance
Hyperlipidemias and Treatment Guidelines
•National Cholesterol Education Program Adult Treatment Panel III of the National Institutes of Health •Antilipemic drugs Drugs used to lower lipid levels Used as an adjunct to diet therapy •Drug choice based on the specific lipid profile of the patient (phenotyping) •All reasonable nondrug means of controlling blood cholesterol levels (e.g., diet, exercise) should be tried for at least 6 months and found to fail before drug therapy is considered.
Simvastatin (Zocor)
•One of the first statins to become generic and one of the most commonly used drugs in this class •Used to primarily lower total and LDL cholesterol levels as well as triglyceride levels •Can moderately raise levels of HDL •Many drug interactions which may require dosing adjustments
Atorvastatin (Lipitor)
•One of the most commonly used drugs in this class of cholesterol-lowering drugs •Lowers total and LDL cholesterol levels as well as triglyceride levels and raises "good" cholesterol, the HDL component •Dosed once daily, usually with the evening meal or at bedtime to correlate with diurnal rhythm
Blood Products as a fluid
•Only class of fluids that are able to carry oxygen •Increase tissue oxygenation •Increase PV •Most expensive and least available fluid because they require human donors
Principles of Electrolytes
•Principal ECF electrolytes •Sodium cations (Na+) •Chloride anions (Cl−) •Principal ICF electrolyte •Potassium (K+) •Others •Calcium, magnesium, phosphorus
Kidney Parts
•Proximal Convoluted Tubule •Returns 60% to 70% of sodium and water from the filtered fluid back to the bloodstream •Passive reabsorption of chloride and water •Loop of Henle (ascending) •20% to 25% of sodium is reabsorbed here through active chloride reabsorption. •Distal convoluted tubule (distal tubule) • Remaining 5% to 10% of sodium is reabsorbed here. • Regulated by aldosterone •Collecting duct • Final pathway
Dextran
•Solution of glucose •Actions similar to those of human albumin in that it expands the plasma volume by drawing fluid from the interstitial space to the intravascular space
Antilipemics: HMG-CoA Reductase Inhibitors (Statins)
•Statins •Patients with clinical atherosclerotic cardiovascular disease (CVD) •Patients with LDL cholesterol levels >190 mg/dL •Patients with diabetes age 40 to 75 years with LDL levels of 70 to 189 mg/dL and without evidence of CVD •Patients without evidence of CVD or diabetes but who have LDL levels between 70 and 189 mg/dL and a 10-year risk of CVD > 7.5%
Common Dysrhythmias
•Supraventricular dysrhythmias •Originate above the ventricles in SA or AV node or atrial myocardium •Ventricular dysrhythmias •Originate below the AV node in the His-Purkinje system or ventricular myocardium •Ectopic foci •Outside the conduction system •Conduction blocks •Dysrhythmias that involve the disruption of impulse conduction between the atria and ventricles •Atrial fibrillation •AV nodal reentrant tachycardia (AVNRT) •Paroxysmal supraventricular tachycardia (PSVT) •Varying degrees of AV block •Premature ventricular contractions (PVC) •Ventricular fibrillation •Ventricular tachycardia
Sodium indications
•Treatment or prevention of sodium depletion when dietary measures are inadequate •Mild •Treated with oral sodium chloride and/or fluid restriction •Severe •Treated with IV NS or lactated Ringer's solution
Colloids Indications
•Used to treat wide variety of conditions when patient requires plasma volume expansion •Shock •Burns
Colloids Adverse Effects
•Usually safe •May cause altered coagulation, resulting in bleeding •Have no clotting factors or oxygen-carrying capacity •Rarely, dextran therapy causes anaphylaxis or renal failure.
Lipoproteins
•Very-low-density lipoprotein (VLDL) •Produced by the liver •Transports endogenous lipids to the cells •Low-density lipoprotein (LDL) •High-density lipoprotein (HDL) •Responsible for "recycling" of cholesterol •Also known as "good cholesterol"
Alpha1 blockers who are also classified as pregnancy category C drugs, are:
•doxazosin (Cardura) •prazosin (Minipress) •tamsulosin (Flomax) •terazosin (Hytrin)
What are three classic types of chest pain, or angina pectoris?
①Chronic stable angina ②Unstable angina ③Vasospastic angina