Pharm exam 2
adverse effects to vasodilators
postural hypotension, reflex tachycardia, expansion of blood volume
When to use Niacin
unable to tolerate statins use with resin or statin Most effective agent to increase HDL very cheap and over the counter
Causes of high cholesterol
-High levels of LDL and TG - can be from lifestyle and diet or genetic
statin ending
-Statin
ACE inhibitors benefits
-arterial dialation -venous dialation -suppression of aldosterone release
beta blocker adverse effects
-bradycardia -decreased AV conduction -asthmatic effects -depression -sexual dysfunction
Drugs for Heart Failure
-diuretics -RAAS inhibitory(ACE inhibitors, Angiotensin 2 receptor blockers, Aldosterone antagonists, renin inhibitors) -Beta blockers (decrease BP and HR to give heart a break) -digoxin(inotropic agent) -dopamine(inotropic agent)
vasodiation
-drugs that dilate arterioles can decrease cardiac after load -drugs that dilate veins reduce the force of blood returned to the heart- preload
chronic stable angina(exertion) causes
-emotional excitement -large meals -cold exposure -coronary artery disease
ACE inhibitors adverse effects
-first-dose hypotension -cough -hyperkalemia (rare) -renal failure (in patients with renal artery stenosis) -fetal injury -angioedema -hyperkalemia
Uses for statins
-hypercholesterolemia -primary and secondary prevention of CV events - post MI therapy
ACE inhibitors therapeutic uses
-hypertension -heart failure -myocardial infarction -diabetic nephropathy -prevention of MI, stroke, and death in persons with high cardiovascular risk.
What are drug interactions with statins?
-most other lipid-lowering drugs(except bile-acid sequestrants) -drugs that inhibit CYP3A4 -use in pregnancy
Drugs for anti ischemic therapy
-nitroglycerin -beta blocker -supplemental o2 -ACEi
beta blocker ending
-olol
Aldoctone antagonist ending
-one
ACEi ending
-pril
ARB ending
-sartan
Hydralazine (Apresoline)
-selective dilation of arterioles -postural hypotension minimal -used with essential hypertension, hypertensive crisis and heart failure adverse effects: reflect tachycardia, heartache, sissiness, weakness, fatigue
side effects of niacin
-skin flushing, itching, GI probs, hyperglycermia, gout
nitroglycerin uses and adverse effects
-stable and variant angine -vasodialator headache, orthostatic hypotension,reflec tachycardia works by decreasing cardiac oxygen demand
How do statins work?
1. HMG-CoA reductase inhibitor (in liver) 2. Mild decrease LDL and Trigs 3. Mild increase HDL
What is an elevated TG number
>150
A patient with angina pectoris is prescribed sublingual nitroglycerin. Which statement made by the patient indicates understanding of the medication teaching? a."I may experience a headache as a side effect." b."The chest pain should be relieved within 20 minutes." c."I should swallow the tablet and drink a glass of water." d."I should take this medication in the morning before breakfast."
A
A patient with stage 2 hypertension has been prescribed a thiazide diuretic and an angiotensin-converting enzyme inhibitor. It is most appropriate for the nurse to do what? a.Contact the healthcare provider. b.Administer both drugs to the patient. c.Administer the thiazide diuretic at bedtime. d.Hold the medications if the blood pressure is normal.
A
Cholestyramine has been prescribed for a patient. Which instruction should the nurse include in patient teaching? a.Cholestyramine can impair absorption of fat-soluble vitamins. b.Stop taking the drug if you develop constipation. c.Take cholestyramine with other drugs you are prescribed to enhance absorption. d.Do not take the medication if the formula is cloudy after mixing with water.
A
The nurse teaches a patient about benazepril [Lotensin]. Which statement by the patient requires an intervention by the nurse? a."I use NoSalt instead of salt to season foods." b."I eat sweet potatoes once or twice a week." c."I drink 4 ounces of prune juice each morning." d."I like asparagus because it's high in vitamin K."
A
What time of day should statins be given and why?
At bedtime so that they are working when your liver is making cholesterol
A patient diagnosed with ST-elevation myocardial infarction has been scheduled for an angioplasty. Which medication does the nurse anticipate administering before this procedure? a.Dobutamine [Dobutrex] b.Abciximab [ReoPro] c.Alteplase [Activase] d.Warfarin [Coumadin]
B
A patient diagnosed with heart failure has stage 1 hypertension. Which medication, if ordered by the healthcare provider, should the nurse question? a.Angiotensin-converting enzyme inhibitor b.Calcium channel blocker c.Thiazide diuretic d.Beta blocker
B
A patient is prescribed hydralazine. What is most important for the nurse to teach the patient? a.Precautions for postural hypotension b.Prevention of reflex tachycardia c.High initial dose for slow acetylators d.Recognition of hypertrichosis
B
A patient is prescribed lovastatin [Mevacor]. The nurse will teach the patient to take the medication at which time? a.With any meal b.With the evening meal c.1 hour before breakfast d.2 hours after a meal
B
A patient who is hospitalized for an infection takes eplerenone [Inspra] for heart failure. Which medication, if ordered by the physician, should the nurse question? a.Ciprofloxacin [Cipro] b.Itraconazole [Sporanox] c.Tetracycline [Sumycin] d.Ampicillin [Principen]
B
A patient with severe hypertension is prescribed minoxidil. Which medications will the nurse expect to be administered to reduce adverse responses to minoxidil? a.Adenosine [Adenocard] and ticlopidine [Ticlid] b.Furosemide [Lasix] and propranolol [Inderal] c.Digoxin [Lanoxin] and captopril [Capoten] d.Donepezil [Aricept] and clonidine [Catapres]
B
The nurse will teach a patient who is prescribed niacin [Niacor] to prevent flushing of the face by doing what? a.Drinking a full glass of water after taking the medication b.Taking 325 mg of aspirin 30 minutes before each dose c.Ingesting a meal before taking the medication d.Increasing dietary fiber before and after each dose
B
A patient has been diagnosed with a STEMI. Which medications does the nurse expect to be prescribed for this patient? a.Beta blocker, angiotensin II receptor blocker, and oxygen b.Aspirin, angiotensin-converting enzyme inhibitor, and diuretics c.Aspirin, beta blocker, oxygen, morphine, and nitroglycerin d.Heparin, nitroprusside, morphine, and calcium channel blocker
C
A patient is prescribed a nitroglycerin transdermal patch. The nurse should include which statement when teaching the patient how to use this medication? a."Apply the patch to the chest over the heart." b."Change the patch each week." c."Remove the patch at bedtime." d."Put on the patch before exercising."
C
A patient who is taking spironolactone [Aldactone] is prescribed losartan [Cozaar]. The nurse should take which action? a.Assess for symptoms of hyperkalemia. b.Observe for a hypertensive crisis. c.Administer the medications as scheduled. d.Evaluate for first-dose hypotension.
C
The nurse teaches a patient diagnosed with chronic stable angina about the mechanism of action of nitroglycerin. The nurse should include which instruction? a."Nitroglycerin reduces vasospasms of the heart's arteries, which improves blood supply." b."Nitroglycerin opens the arteries to allow more oxygen to be delivered to the heart muscle." c."Nitroglycerin dilates veins, which decreases the amount of oxygen needed by the heart." d."Nitroglycerin improves blood flow to the heart muscle by increasing blood pressure."
C
low-density lipoprotein (LDL)
delivers cholesterol to cells for membrane production BAD
very low density lipoproteins
Carry triglycerides to tissues
A female patient who is diabetic sustained an ST-elevation myocardial infarction (STEMI). The nurse provides discharge teaching. Which statement, made by the patient, indicates that further teaching is required? a."Medications are needed to prevent heart failure." b."I will take aspirin, atenolol, and captopril indefinitely." c."My blood pressure should be less than 130/80 mm Hg." d."Daily estrogen will prevent another heart attack."
D
A patient in the emergency department is diagnosed with ST-elevation myocardial infarction (STEMI). The patient has been prescribed 325 mg of aspirin. Which action by the nurse is appropriate? a.Administer the medication to the patient if a headache develops. b.Administer the medication with a full glass of water. c.Instruct the patient to let the tablet dissolve under the tongue. d.Tell the patient to chew the tablet thoroughly.
D
A patient is prescribed sustained-release oral nitroglycerin capsules for chronic stable angina. The nurse should include which instruction? a."Avoid exercising to help prevent chest pain." b."Place the capsule under the tongue if chest pain occurs." c."Take the capsule as needed before exercise or exertion." d."Sit or lie down if dizziness or lightheadedness occurs."
D
Which patient is the most appropriate candidate for both lifestyle changes and drug therapy with an antihypertensive medication? a. A 47-year-old patient with blood pressure of 110/78 mm Hg and with type 2 diabetes mellitus b. A 76-year-old patient with blood pressure of 128/88 mm Hg and a history of dyslipidemia c. A 52-year-old patient with blood pressure of 136/89 mm Hg who smokes 1 pack of cigarettes per day d. A 32-year-old patient with blood pressure of 142/94 mm Hg who is sedentary
D
Which patient would most likely be prescribed sodium nitroprusside [Nitropress]? a.A patient with a recent diagnosis of essential hypertension b.A patient with heart failure who receives weekly home visits c.A patient who is hypotensive after a myocardial infarction d.A patient with a hypertensive crisis in the intensive care unit
D
ACE inhibitor drug interactions
Diuretics-1st dose hypotension Antihypertensive agents Drugs that raise K levels Lithium-levels become toxic NSAIDs-may reduce effectiveness
therapeutic uses of vasodilators
Essential hypertension Hypertensive crisis Angina pectoris Heart failure Myocardial infarction Pheochromocytoma Peripheral vascular disease Pulmonary arterial hypertension Production of controlled hypotension during surgery
what drug is used for elevated TG
Gemfibrozol
What are the side effects of statins
Headache, rash, gi disturbances, myopathy(muscle break down), hepatotoxicity, new onset diabetes, cataracts
cardiac remodeling definiton and how to prevent this
Heart changing shape after a MI give beta blocker to help prevent this
ACE inhibitors adverse effects
Hypotension Hyperkalemia Intractable cough Angioedema Renal failure if patient has bilateral renal artery stenosis Can cause fetal injury
consequences of hypertension
Kidney disease MI heart failure angina stoke
Whats Mona B stand for
M- morphine O- oxygen N- nitroglycerin: iv if an iv is in or under tongue A- aspirin: 325 mg chewed B- beta blocker
what are drugs for angina
Organic nitrates(nitroglycerin) Beta blockers(metopropolol) Calcium channel blockers(verapamil)
Angiotensin 2 receptor blockers (ARBS)
Pretty much the same thing as an ACE inhibitor doesn't work quiet as good but you dont have the adverse affect of a cough
What are some lifestyle changes to lower cholesterol
Stop smoking, healthy diet, exercise
what are the two kinds of heart failure?
Systolic-when myocardium is too weak and cannot contract to push blood out of the heart Diastolic-if ventricles are too still so they cant relax enough to let blood in
Symptoms of heart attack in women
Unusual fatigue Sleep disturbance Shortness of breath Indigestion Anxiety back pain
Sodium Nitroprusside (Nitropress)
Very potent vasodilator *drug of choice for hypotensive emergencies adverse effects are excessive hypotension and cyanide poisoning
Inotropic
a med that increases the force of contraction of the heart
How are ACE inhibitors administered?
all orally (except enalaprit - IV)
preload
amount of blood coming back to heart
after load
amount of blood ejecting through heart to body
Ischemia
an inadequate blood supply to an organ or part of the body, especially the heart muscles.
what foods have cholesterols
anything with a liver
drug for anti platelet therapy
aspirin, clopidogrel(plavix), abciximab(Reopro),eptifibatide(integrillin), tirofiban(aggrastat)
what should your TG level be
between 75-150
High-density lipoprotein (HDL)
blood fat that helps transport cholesterol out of the arteries, thereby protecting against heart disease
A patient has hypertension, type 2 diabetes, and chronic kidney disease. Which blood pressure goal would be most beneficial for this patient? a. Blood pressure less than 140/90 mm Hg b. Diastolic blood pressure less than 100 mm Hg c. Blood pressure less than 130/80 mm Hg d. Systolic blood pressure less than 160 mm Hg
c
Angiotensin-converting enzyme (ACE) action
catalyses the conversion of angiotensin 1 to angiotensin 2. IN LUNGS
unstable angina cause and treatment
caused by CAD and vasospasm(MI) treat with MONAB
Three forms of angina
chronic stable angina- exertion angina variant angina- vasospastic unstable angina- heart attack
how does the RAAS system regulate BP
constricts blood vessels or it acts on kidneys to promote the retention of sodium and water and excretion of potassium
variant angina cause
coronary artery spasm
drug for anticoagulant therapy
heparin
secondary hypertension
high blood pressure caused by the effects of another disease
Primary(essential) hypertension
high blood pressure with no known cause
types of vasodilators
hydralazine(apresoline) sodium nitroprusside(nitropress)
Nitroglycerin drug interactions
hypotensive drugs, phosphodiesterase type 5 inhibitors(drugs to treat ED), beta blockers, verapamil, and diltiazem
chronic stable angina(exertion) treatment
increase cardiac oxygen supply decrease oxygen demand nitroglycerin beta blockers calcium channel blockers
Variant angina treatment
increasing cardiac oxygen supply calcium channel blocker nitroglycerin
Where is renin produced and what does it do?
kidney, and it catalyses the formation of angiotensin 1 from angiotensinogen
What should total cholesterol be?
less than 200
reperfussion therapy
opening a artery by a stent or fibronlytic therapy which dissolves a clot
Natriuretic peptides
secreted by atrial myocardium of the heart in response to high blood pressure(stress)
Drugs for high cholesterol
statins niacin fibrates gemfibrozil
Why are statins given after a MI
to stabilize plaque
isosorbide mononitrate/dinitrate
used for African Americans
what drug interactions does gemfibrozol have
warfarin
diagnosis of STEMi
when heart is being damaged it gives enzymes off that can be seen in blood(troponin I and troponin T and CL-MB)
