Pharmacology Exam 2 (Cardiac)
What kind of drug is spironolactone (Aldactone)?
potassium sparing diuretic
Why is it VERY important to push loop diuretics slowly?
rapid IV push can cause hearing loss and deafness
T/F The risk of coronary heart disease in patients with cholesterol of 300mg/dl is 3-4x greater than that in patients with levels less than 200mg/dl
true
T/F We should instruct patients taking nitrates to NEVER chew or swallow the sublingual forms
true
T/F We would give fibric acid derivatives specifically in patients with very high amounts of triglycerides
true
T/F When taking with NSAIDs, garlic can enhance bleeding
true
T/F dizziness or lightheadedness can occur when patients are taking sustained-release oral nitroglycerin capsules
true
What is the action of loop diuretics?
inhibit electrolyte reabsorption in the Loop of Henle
T/F It is important to educate patients taking statins to note any muscle pain or changes in urine color
true
T/F Nitrates have a high first pass effect which is why they are given in different routes (sublingual, translingual, transdermal patches)
true
T/F Osmotic diuretics can crystallize out of solution at low temperatures and must be warmed for dissolution of crystals
true
T/F Osmotic diuretics cross the BBB
true
T/F Patients taking statins should stay away from other anticoagulants (like warfarin)
true
T/F The IV form of nitroglycerin is commonly given for HTN
true
A patient with angina pectoris is prescribed sublingual nitroglycerin. Which statement made by the patient indicates understanding of the medication teaching?
"I may experience a headache as a side effect"
The nurse teaches a patient diagnosed with chronic stable angina about the mechanism of action of nitroglycerin. The nurse should include which instruction?
"Nitroglycerin dilates veins, which decreases the amount of oxygen needed by the heart"
What blood pressure characterizes a hypertensive emergency?
180/120
How is tolerance prevented in patients taking nitrates?
by allowing a regular nitrate-free period to allow enzyme pathways to replenish
What drug class blocks the conversion of angiotensin I to angiotensin II?
ACE inhibitors
catopril (Capoten), enalapril (Vasotec), and lisinopril (Prinivil) are all what class of drug?
ACE inhibitors
What class of drug does losartan (Cozaar) belong to?
ARBs
What class of drugs block the action of angiotensin II?
ARBs
What is the most common loop diuretic?
Furosemide (Lasix)
What is considered "good cholesterol" ?
HDL (high density lipoprotein)
What is the most common thiazide diuretic?
Hydrochlorothiazide (HCTZ)
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. What form of nitroglycerin is most appropriate?
IV infusion
What is considered "bad cholesterol"?
LDL (low density lipoprotein)
What is the most common osmotic diuretic?
Mannitol (Osmitrol)
What kind of drugs are alirocumab (Praluent) and evolocumab (Repatha)?
PCSK-9 inhibitors
What is the mechanism of action of HMG-CoA Reductase Inhibitors?
inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol
What is the mechanism of action of Niacin (Nicotinic Acid) Vitamin B3?
activates lipase (enzyme that breaks down lipids)
Nitrates or nitrates are most commonly used for what?
angina pectoris
A patient is taking lisinopril and comes into the ER complaining of swelling of the tongue, lips, and neck leading the nurse to believe they are having what adverse reaction?
angioedema
When should patients take as-needed nitrates?
at the first hint of anginal pain
What drug lowers total and LDL cholesterol levels as well as triglyceride levels and raises "good" cholesterol (HDL)?
atorvastatin (Lipitor)
When is typically the best time to give/take statins?
bedtime
What class is considered the second line choice after statins?
bile acid sequestrants
What is the mechanism of action of bile acid sequestrants?
binds intestinal bile acids, which blocks bile acid and reduces absorption of cholesterol in the intestines
How does spironolactone work?
blocks aldosterone and indirectly affects the sodium uptake and potassium secretion
What is the mechanism of action of nitrates?
cause vasodilation because of relaxation of smooth muscles
What bile acid sequestrant is available in powder form?
cholesyramine (Questran)
____________ is an adverse effect of bile acid sequestrants because they block the intestines
constipation
high doses of bile acid sequestrants ____________ the absorption of fat-soluble vitamins (A, D, E, and K)
decrease
We want to make sure to monitor patients on statins for what?
elevations in liver enzymes or liver disease
____________ (Inspra) is an aldosterone antagonist that selectively blocks aldosterone receptors in the kidney and results in excretion of sodium and water and retention of potassium
eplerenone
What drug is a cholesterol absorption inhibitor and inhibits the absorption of cholesterol and related sterols from the small intestine?
ezetimibe (Zetia)
What class of drugs activates lipase and suppress the release of free fatty acid from adipose tissues, inhibit synthesis of triglycerides in the liver, and increase excretion of cholesterol in the bile
fabric acid derivatives
T/F It is okay to administer lasix for patients with a potassium level of 3.4
false
T/F Nitrates are meant to be exposed to light places
false
T/F Patients diet does not matter when they are taking antilipemic drugs
false
T/F Patients taking statins can drink as much grapefruit juice as they want
false
T/F Patients with Gout are okay to take Niacin
false
T/F bile acid sequestrants cannot be used with statins
false
What herbal product can we give to help patients pass stool when constipated?
flax
___________ is an adverse effect of Niacin when given in high amounts, caused by histamine release
flushing
What herbal supplement is contraindicated in patients with bowel obstruction?
garlic
herbal product used as an antispasmodic, antihypertensive, antiplatelet, and lipid reducer
garlic
What should we be monitoring in patients taking fibric acid derivatives?
hemoglobin, hematocrit, and WBC
What are the common side effects of diuretics that we should monitor for as nurses?
hypovolemia, acid-base disturbances, and electrolyte imbalances
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?
if one sublingual tablet does not relieve the pain after 5 minutes
What is the action of thiazide diuretics?
increase excretion of sodium chloride, water and potassium
What do we want to educate patients taking bile acid sequestrants to do?
increase fiber intake and fluid intake
What does PCSK9 do?
increases production of LDL cholesterol
fibric acid derivatives are contraindicated in patients with...
liver disease, kidney disease, or gallbladder disease
What are the three types of diuretics?
loop diuretics, thiazide diuretics, and osmotic diuretics
What kind of diet should be encourage in a patient taking thiazide diuretics?
low sodium, high potassium
Osmotic Diuretics move water from areas of ______ concentration to areas of ______ concentration
low; high
What diuretic would be given to a patient with increased intracranial pressure (ICP)?
mannitol
What is a common adverse effect of statins that can lead to the serious condition of rhabdomyolysis?
myopathy
_________ and __________ are calcium channel blockers that act ONLY on the vascular smooth muscle
nifedipine; amlodipine
What is the prototypical nitrate?
nitroglycerin
What do we want to make sure to do as a nurse for ALL patients taking ANY lipid lowering drugs?
obtain baseline liver function studies
Herbal fish oil product used to reduce cholesterol
omega-3 fatty acids
What would we use lovastatin, pravastatin, atorvastatin, and fluvastatin for?
patients with high cholesterol
What drug class is important to inform the provider a patient is taking before beginning prescribed nitroglycerin?
phosphodiesterase inhibitors (erectile dysfunction medication)
What types of angina do nitrates treat?
stable, unstable, and vasospastic angina
What is the best way to avoid problems with flushing or pruritus when patients are taking niacin?
start with a low initial dose and then increase it gradually
Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors are also known as...
statins
What is the first line drug therapy for patients with hypercholesterolemia (high cholesterol)?
statins
What is the most common route that nitroglycerin is given to patients with angina for rapid acting effects?
sublingually
A patient is mowing lawn on a hot Saturday afternoon. He begins to notice chest pain. What should his first action be?
take his nitroglycerin tablet
The nurse will teach a patient who is prescribed niacin (Niacor) to prevent flushing of the face by doing what?
taking 325mg of aspirin 30 minutes before each dose
Why must statins be taken at bedtime?
the timeframe correlates better with the natural diurnal rhythm of cholesterol production
Why wouldn't we give bile acid sequestrants to pregnant moms?
they decrease absorption of fat-soluble vitamins
Why would it be important for a nurse to make sure a commode is available for older, unsteady patients taking loop diuretics?
they have to pee often and getting up increases their risk for falls
Why wouldn't we give thiazide diuretics to a patient in a hypertensive emergency?
they take one month to see the full effect
What is the preferred initial drug therapy for primary hypertension per JNC 8 guidelines?
thiazide diuretics
How should a patient apply transdermal nitroglycerin?
to hairless areas of the body
Why do we use antilipemic drugs?
to lover cholesterol levels
What is an adverse effect that happens when patients are taking nitrates around the clock or with long-acting forms?
tolerance
_____________ are a type of fat in the blood that the body uses for energy
triglycerides
T/F Bile acid sequestrants should be administered 1 hour before or 4-6 hours after any other oral medications
true
T/F Diuretics are given to patients that have excess amounts of fluid to cause diuresis
true
T/F It is VERY important to dose appropriately when giving statins with fibric acid derivatives because when given together there is an increased risk of myositis, myalgias, and rhabdomyolysis
true
ARBs block ___________ and block ___________— which is why they work similar to diuretics
vasoconstriction; aldosterone
__________ and _________ are calcium channel blockers that act on the heart and vascular smooth muscle (arteries, arterioles)
verapamil; diltiazem
loop diuretics are potassium __________
wasting
when do loop diuretics work best?
when patients have a urine output of less than 30ml/hr
When do thiazide diuretics work best?
when the patient has a urine output over 30
A patient is prescribed lovastatin (Mevacor). The nurse will teach the patient to take the medication at which time?
with the evening meal