Cardiovascular Drugs

Anoxia

total lack of oxygen

Digoxin has been in use since the ______. 1400s 1500s 1600s 1700s

1700s

Hyperlipemia

Excess fat can deposited on or in the walls of the blood vessels

ACE inhibitors

"PRIL" Captopril, Enalapril, Afosiopril Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss. Check BP before giving (hypotension) *Orthostatic Hypotension

Pulmonary circulation

- rhythmic pumping of the heart - sends the blood out to the lungs via the pulmonary artery to obtain oxygen - oxygen-rich blood is then returned to the heart via the pulmonary veins

Angiotensin receptor blockers (ARBs)

-sartan 2nd choice of BP reducing medication Think "relax man" - Losartan Spare potassium (avoid potassium rich foods) Risk of hyperkalemia

List 5 Sources of Shock

1. Cardiogenic origin (heart stops pumping) 2. Hypovolemic origin (loss of blood volume) 3. Neurogenic origin (central nervous system fails leading to vasodilation) 4. Septic origin (invasion of a microorganism) 5. Anaphylactic (allergen)

Richard has just been hospitalized for a pulmonary embolism. He wants to know why he has to wear such tight stockings and also take medications. What would you tell him about his antiembolic stockings and medication therapy?

Anti embolic stockings can help reduce potential for developing a DVT, as well as help prevent edema

Which keeps platelets from aggregating and forming clots? Anticoagulants Antiplatelets Antifibrinolytics Thrombolytics

Antiplatelets

Which are used to treat hypertension? Anticoagulants Diuretics Anti-infectives Thrombolytics

Diuretics

T/F Antianginals destroy clots.

False

T/F Anticoagulants increase clot formation.

False

A nurse is caring for a client who has a new prescription for aliskiren to treat hypertension. The nurse should monitor the client for which of the following findings as an adverse effect of the drug? (select all that apply) Hyperkalemia Throat swelling Constipation Cough Joint pain

Hyperkalemia Throat swelling Cough aliskiren - a direct renin inhibitor can cause elevated potassium levels (especially when taken in combination with an ACE inhibitor, potassium supplements, or potassium-sparring diuretic),. can cause angioedema and coughing

Ischemia

Lack or reduction of oxygen prevents the tissues of the heart from receiving enough nourishment - lead to tissue injury

A nurse is caring for a client who has a new prescription for dobutamine. The nurse should clarify the prescription with the provider if the client is receiving which of the following types of drugs? (Select all that apply). ACE inhibitor MAOI General anesthetic Tricyclic antidepressant Beta blocker

MAOI (cause tachydysrhythmias) General anesthetic (cause dysrhythmias) Tricyclic antidepressant (cause tachydysrhythmias) Beta blocker (like propranolol, can decrease effects)

Shock

collapse of the cardiovascular system

A nurse is teaching a client who has a new prescription for quinidine. Which of the following statements should the nurse include? Monitor your pulse rate and report changes. Remain upright for 30 minutes after taking this medication. This medication can decrease digoxin levels. This medication can cause urinary incontinence.

Monitor your pulse rate and report changes. Sodium channel blockers, like quinidine, can worsen dysrhythmias, or cause new ones. The nurse should teach the client to monitor their pulse rate and report changes from prescribed parameters. It can be helpful to instruct the client to keep a written record of their pulse rate for the provider.

A nurse is providing teaching to a client who is taking simvastatin. The nurse should instruct the client to report which of the following manifestations as an indication of a serious adverse reaction that could require discontinuing drug therapy? Bronchoconstriction Muscle pain Lip numbness Somnolence

Muscle pain simvastatin - a HMG-CoA-reductase inhibitor (statin), can cause myopathy or pain in muscles and joints that can progress to rhabdomyolysis. Rare, but serious adverse effect, muscle protein breaks down and is excreted, resulting in kidney damage.

A nurse is caring for a client who is taking atorvastatin and has a new prescription for gemfibrozil. The new combination places the client at an increased risk for which of the following adverse effects? Myopathy Hypoglycemia Irregular pulse Kidney failure

Myopathy When taking a statin, it is important to know that concurrent use of fabric acid derivatives, such as gemfibrozil, or other drugs to lower cholesterol increase the risk for myopathy.

A nurse is caring for a client who is taking spironolactone to treat hypertension. The nurse should recognize that which of the following client laboratory values requires immediate intervention? Sodium 140 mEq/L Potassium 5.2 mEq/L Chloride 100 mEq/L Magnesium 1.9 mEq/l

Potassium 5.2 mEq/L spironolactone is a diuretic and an aldosterone antagonist that can cause hyperkalemia and places the client at risk for cardiac dysrhythmias. This potassium level is outside the expected reference range of 3.5 - 5.0 mQz/L and requires immediate intervention.

A nurse is caring for a client who is taking a diuretic. The nurse should instruct the client to include which of the following foods in their diet to increase potassium intake? Raisins Cabbage Cheese Eggs

Raisins Diuretics can deplete the body of potassium, so the nurse should instruct the client to include potassium-rich foods in their diet, such as raisins and other dried fruits.

A nurse is caring for a client who has a new prescription for verapamil. The nurse should clarify the prescription with the provider if the client has a history of which of the following condition? Migraine headaches Pancreatitis Second-degree AV block Angina pectoris

Second-degree AV block Verapamil, a calcium channel blocker, can affect AV conduction and is contraindicated for clients who have sick sinus syndrome or second- or third-degree AV block. Verapamil is indicated for hypertension, angina pectoris, and the management of atrial flutter and fibrillation. It is also prescribed for the management of migraine headaches.

A nurse is caring for a client who has a glomerular filtration rate of 10 mL/min and reduced urine output. The nurse should clarify a prescription for hydrochlorothiazide for this client because of which of the following characteristics of the drug? The drug can cause hypoglycemia in clients who have low urine output. The drug does not reduce blood pressure for clients who have a low muring output The drug can increase the risk of pulmonary edema for clients who have renal insufficiency The drug does not promote diuresis for clients who have renal insufficiency.

The drug does not promote diuresis for clients who have renal insufficiency. Adequate kidney function is essential for clients who take hydrochlorothiazide, a thiazide diuretic promote urine production and effective excretion.

T/F Diet can decrease blood lipid levels.

True

Low-density lipoprotein (LDL)

bad cholesterol deposit fat in the blood vessels

A nurse should recognize that milrinone is contraindicated for a client who has which of the following conditions? Acute myocardial infarction Perihpheral vascular disease Ulcerative colitis Ventricular tachycardia

milrinone Milrinone, a phosphodiesterase inhibitor, is contraindicated for clients who have had an allergic reaction to phosphodiesterase inhibitors and for clients who have an acute myocardial infarction and aortic or pulmonary valve disorders.

Antiplatelet medications

prevent platelets from clumping together to form clots

Hypoxia

significantly reduced oxygen

Hemostasis

to stop or control bleeding

The LPN is reviewing patient medications and lab values. Which of the following patients is most likely to be taking potassium gluconate? a. A patient with heart failure taking bumetanide (Bumex) b. A patient with hypertension taking trandolapril (Mavik) c. A patient with surpraventricular tachycardia taking propafenone (Rythmol) d. A patient with heart failure taking valsartan (Diovan)

A - Bumetanide is a loop diuretic, which is associated with potassium loss. This patient should be taking potassium supplements.

A new LPN is assisting in the admission of a patient in a rehab facility who is being transferred from the hospital after a left hip replacement. The nurse would expect the patient to be taking which of the following medications? a. Enoxaparin (Lovenox) b. Tenecteplase (TNKase) c. Aminocaproic acid (Amicar) d. Ferrous sulfate (Feosol)

A - Enoxaparin (Lovenox) is an anticoagulant given to patients at risk for developing blood clots. This patient is at risk due to the surgery to replace the hip.

The LPN is providing medications to a patient recently diagnosed with atrial fibrillation who has been prescribed quinidine (Cardioquin) 300 mg every 6 hours. Which of the following statements would the nurse include in the patient teaching? a. "This medication alters sodium exchange in the heart muscle to block irregular rhythms." b. "This medication will help slow the heart rate by interfering with calcium ion exchange." c. "You may notice a slight tingling under your tongue when you take this medication." d. "You will need to wear a heart monitor when you go home, to watch for side effects."

A - Quinidine is a sodium channel blocker that alters the sodium exchange to block irregular rhythms.

A nurse working in the emergency department is assisting in the care of a patient who came in with symptoms of a cerebral vascular accident (CVA). As the team considers the use of tissue plasminogen activator (tPA), the nurse recognizes the most important assessment would be: a. When the symptoms of stroke began b. If the patient has a history of hypertension c. When the patient last ate or drank anything d. If the patient has an allergy to aspirin

A - Tissue plasminogen activator can only be administered if the symptoms started less than 60 minutes prior to treatment.

Cyanosis

A bluish discoloration of the skin and mucous membranes.

Embolus

A clot that breaks lose and travels through the bloodstream.

Aspirin is an_______ Antipyretic Anticoagulant Analgesic All of the above

All the above

A nurse is caring for a client who is taking digoxin and develops changes on their ECG tracing and other manifestations that indicate the client has severe digoxin toxicity. Which of the following drugs should the nurse expect to administer to treat this complication? Acetylcysteine Flumazenil Antigen-binding fragments Deferoxamine

Antigen-binding fragments Antigen-binding fragments, also called digoxin immune Fab, binds to digoxin and blocks its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity.

A nurse is caring for a client who will begin using transdermal nitroglycerin to treat angina pectoris. When speaking to the client about the drug, which of the following instructions should the nurse include? (select all that apply) Apply a new patch at the onset of anginas pain Apply the patch to dry skin and cover the area with plastic wrap Apply the patch to a hairless area and rotate sites Apply a new patch when you start your day Remove patches for 10 -12 hours each day

Apply the patch to a hairless area and rotate sites Apply a new patch when you start your day Remove patches for 10 -12 hours each day

A patient newly prescribed hydrochlorothiazide (Esidrix) daily should be instructed to take this medication at what time? a. In the evening with dinner b. In the morning with or without food c. At bedtime d. At lunchtime

B - Hydrocholorthiazide should be taken in the morning due to the increased urination it causes. It can be taken with or without food.

While assisting in the care of a patient with pernicious anemia, the LPN would anticipate which of the following medications? a. Ascorbic acid (vitamin C) orally twice daily b. Cyanocobalamin (vitamin B12) injection monthly c. Ferrous sulfate (Fer-in-Sol) by mouth daily d. Warfarin (Coumadin) by mouth every evening

B - Vitamin B12 injections are used to manage pernicious anemia in patients who cannot effectively absorb vitamin B12 through the GI tract.

An LPN working in a gynecologist's office is discussing medication use with a patient who takes ferrous sulfate (Feosol). The nurse would assess for which of the following side effects? a. Urinary retention b. Blurry vision c. Gastric irritation d. Insomnia

C - Gastric irritation is a common side effect of ferrous sulfate therapy. It can be reduced by taking it with food.

All of the following are types of lipids EXCEPT ______. HDL CDL LDL VLDL

CDL

Anthony has congestive heart failure. He has been prescribed Digoxin. What are some of the symptoms to watch for closely as an indication of toxicity?

Confusion. Irregular pulse. Loss of appetite. Nausea, vomiting, diarrhea. Fast heartbeat. Vision changes (unusual), including blind spots, blurred vision, changes in how colors look (green glow), or seeing spots.

The LPN is assisting in the care of a patient newly prescribed captopril (Capoten). The nurse would instruct the patient to take which of the following precautions? a. Avoid foods that are high in potassium b. Limit visitors and avoid crowds c. Increase the amount of fiber in the diet d. Avoid changing positions rapidly

D - Captopril is an ACE inhibitor, which will decrease blood pressure and increase the risk for falls related to orthostatic hypotension. A safety precaution is to have the patient avoid rapid changes in position.

A nurse is providing teaching to a client who has a new prescription for losartan to treat hypertension. The nurse should instruct the client that which of the following findings could indicate an adverse reaction to the drug and needs to be reported? Facial edema Sleepiness Peripheral edema Constipation

Facial edema losartan (ACE Inhibitor) can cause angioedema

A nurse is caring for a client who is taking amiodarone to treat atrial fibrillation. Which of the following should the nurse instruct the client to avoid while taking this drug? Grapefruit juice Milk Foods high in vitamin K NSAIDS

Grapefruit juice amiodarone - Class III Potassium Channel Blocker Grapefruit juice can cause toxicity of potassium channel blockers, like amiodarone

A nurse is teaching a client who has a new prescription for nitroglycerin. The nurse should instruct the client that which of the manifestations is a potential adverse effect of this drug? Headache Constipation Hypertension Hyperglycemia

Headache Adverse effects of nitrates, such as nitroglycerin, include headaches, which can be severe at the beginning of pirate therapy but decrease with continued exposure to nitrates.

Dysrhythmias can be caused by all of the following EXCEPT ______. Hypertension Cardiac Disease Potassium level alterations Hernia

Hernia

A nurse is caring for a client who is taking carvedilol and has a prescription for an oral antidiabetic drug to manage their new diagnosis of type 2 dates. By taking both drugs concurrently, the nurse should identify that the client is at an increased risk for which of the following conditions? Hyperglycemia Bradycardia Hypotension Hypoglycemia

Hypoglycemia There are two factors that increase the client's risk for hypoglycemia. Alpha/beta blockers, such as carvedilol, potentiate the hypoglycemic effects of insulin and oral hypoglycemic drugs. Also, carvedilol can mask tachycardia in clients who have hypoglycemia. Carvedilol should be used with caution by clients who have diabetes mellitus.

A nurse is assessing a client who is taking a loop diuretic and is experiencing a thready, irregular pulse, orthostatic hypotension, and confusion. The nurse should identify that these manifestations indicate which of the following adverse effects? Hypokalemia Hypoglycemia Hypouricemia Hyponatremia

Hypokalemia Manifestations of hypokalemia include a thready, irregular pulse, orthostatic hypotension, anxiety, confusion, skeletal muscle weakness, hypoactive bowel sounds, polyuria, nausea, and vomiting.

A nurse is reviewing a new prescription with a client who has heart disease. The nurse should instruct the client that which of the following drugs is prescribed to treat hypercholesterolemia? Simvastatin Furosemide Losartan Nitroglycerin

Simvastatin Simvastatin is an HMG-CoA reductase inhibitor. It blocks synthesis of cholesterol by the body to help lower cholesterol levels.

Cerebrovascular accident (CVA)

Stroke - brain is deprived of oxygen and blood flow for several minutes causing brain damage

Which of the following does not affect blood pressure? Heart rate Stroke volume Peripheral resistance Temperature

Temperature

Barbara has been prescribed a diuretic and is now having heart arrhythmias. She asks why this is happening and what she can do to prevent this. What would you tell her?

Thiazide diuretics can cause potassium wasting. The loss of potassium is called hypokalemia. Signs and symptoms are fatigue, muscle cramps, and abnormal heart rhythms. Eating a diet RICH in potassium can help offset these symptoms Bananas Raisins Oranges and orange juice Tomatoes, tomato sauce, and tomato juice Leafy green vegetables, such as spinach, kale, salad greens, collards, and chard Melons (all kinds) Potatoes/Sweet potatoes Peas Beans Nuts

Vitamin K

a vitamin necessary for coagulation

Thrombolytics

dissolve clots that have already formed

A nurse is teaching a client who has a new prescription for gemfibrozil. Which of the following instructions should the nurse include? (select all that apply). Take the drug with food Report any new intolerance to fried foods Report muscle tenderness Expect periodic liver function testing Take the drug once each day

gemfibrozil - fibrate (for high cholesterol) report any new intolerance to fried foods report muscle tenderness expect periodic liver function testing

Myocardial infarction (MI)

heart attack

Dysrhythmias

heart rhythm irregularities

Hypertension (HTN)

high blood pressure

Anticoagulants

interrupt the clotting process and ensure that blood flows smoothly through the vessels

A nurse should identify that which of the following drugs is used only for the short-term treatment of cardiac dysrhythmia because of the serious adverse effects associated with long-term use? quinidine procainamide nitrogylcerin verapamil

procainamide - sodium channel blocker and broad-spectrum antidysrhythmic DO NOT USE LONG-TERM risk of serious adverse effects including cardio toxicity and arterial embolism

A nurse is caring for a client who has a depressive disorder and requires a prescription drug to treat hypertension. The nurse should recognize that which of the following antihypertensive drugs is contraindicated for this client? Reserpine Captopril Hydralazine Eplernone

reserpine (not a first line drug of choice due to adverse effects) severe depression and an increased risk of suicide are adverse effects of adrenergic neuron blockers like reserpine. These effects can linger after discontinuation, and develop because of the depletion of serotonin and norepinephrine.

Atherosclerosis

fatty plaques in the arteries

Deep vein thrombosis (DVT)

formation of a clot in a deep vein of the body, occurring most often in the femoral and iliac veins

Which drug is indicated within 60 minutes of the onset of stroke symptoms? Digoxin Lasix tPA Cozaar

tPA

Nicotine has what effect on blood pressure? Decreases Increases Has no effect Stabilizes

Increases

Infarction

Tissue death of the heart due to sustained lack of oxygen and nourishment

Contractility

ability of the heart to contract

Very low-density lipoprotein (VLDL)

the worst fats they are so small, wedge themselves inside the blood vessel walls and are difficult to clear.

While grocery shopping, the nurse notes that a middle-aged woman in the aisle stops frequently and rubs her left arm and shoulder. As the nurse gets closer, he notes the woman is pale and appears slightly short of breath. The nurse's additional assessment will be based on which of the following? a. Awareness that symptoms of a myocardial infarction in woman are atypical in nature. b. Knowledge that chronic respiratory disease is common among smokers. c. Comprehension that early action in the presence of stroke symptoms saves lives. d. Understanding that polypharmacy is a growing problem among middle-aged individuals.

A - The woman is demonstrating symptoms more commonly associated with an MI in women. Women often present with symptoms that are different than those seen in men.

Antihypertensives include which of the following? ACE inhibitors Calcium channel blockers Beta-blockers A and B

A and B

The LPN is assisting in the care of a patient who is recovering from a myocardial infarction and was newly started on clopidogrel (Plavix). The nurse would include which of the following statements in the patient teaching? a. "You will need to have weekly blood tests done to follow your clotting and bleeding times." b. "This medication helps prevent platelets from sticking together and forming clots." c. "You should avoid taking any over-the-counter medications with acetaminophen (Tylenol)." d. "Clopidogrel prevents clotting by interfering with the factors involved in the bleeding cascade."

B - The clopidogrel acts to decrease blood clotting by decreasing the ability of platelets to stick together.

The LPN is assisting in the care of a patient newly prescribed warfarin (Coumadin). The nurse recognizes that teaching is effective if the patient chooses which of the following meals? a. Grilled chicken with rice pilaf, garden salad, bok choy, and ice cream b. Spinach lasagna, broccoli, fruit cocktail, bread, and a glass of wine c. Pork chop, baked potato with butter, cooked carrots, and a sliced apple d. Chef salad, chips with hummus, minestrone soup, and a cup of green tea

C - This meal does not contain foods with high levels of vitamin K and can be consumed when taking warfarin.

The LPN caring for a patient with heart failure is preparing to provide multiple medications. Which of the following medications will impact the heart contractility? a. Pravastatin (Pravachol) b. Trandolapril (Mavik) c. Venlafaxine (Effexor) d. Digoxin (Cardoxin)

D - Digoxin is a glycoside that improves cardiac contractility.

In talking to a neighbor who is undergoing chemotherapy for breast cancer, the nurse learns the woman's most recent chemotherapy treatment was not given because her white blood cell count was too low. The nurse would expect the woman to also be receiving which of the following medications? a. Digoxin (Cardoxin) b. Ferrous sulfate (Ferra-TD) c. Disopyramide (Norpace) d. Filgrastim (Neupogen)

D - Filgrastim is used to promote the production of WBCs and often used to assist in managing low WBCs in patients undergoing chemotherapy.

A nurse is caring for a client who has a new prescription for propranolol to treat a tachydysrhythmia. The nurse should instruct the client to avoid taking which of the following types of OTC drugs while taking propranolol? Antihistamines Potassium supplements NSAIDs Vitamin C

NSAIDS NSAIDs can interact with propranolol and decrease the anti-hypertensive action because vasoconstriction can occur in some COX-2 inhibitors. The nurse should instruct the client to avoid taking NSAIDs and propranolol at the same time.

T/F HDLs are the best kind of lipids.

True

T/F Infarction is tissue death.

True

Sherrie has just had a stroke. Although she agrees to take the medications the physician prescribes, she asks you what behaviors she could adopt to reduce the risk for another stroke. What would you teach her?

Wear anti embolic stockings if prescribed Decrease dietary fats Increase fiber, fruit Monitor of hypertension Exercise regularly Maintain a healthy weight Limit alcohol

Henry has just been given a prescription for Lipitor. Does he need to make lifestyle changes?

Yes Monitor BMI Reduce fat intake (saturated & trans fats) Watch for signs of myopathy Exercise regularly Stop smoking

Thrombus

blood clot in a vessel

High-density lipoprotein (HDL)

good cholesterol act as street sweepers and clean out blood vessels

Congestive heart failure (CHF)

failure of the heart to pump efficiently, leading to excessive blood or fluids in the lungs, the body, or both

An LPN is visiting a friend in the hospital who was recently diagnosed with a right-sided thrombotic stroke. The individual says, "I don't understand why they want to give me blood thinners if I had bleeding in my brain." Which of the following responses by the nurse is best? a. "Blood thinners are used to help the heart not have to work so hard to pump blood around." b. "The blood-brain barrier protects your brain from the medications they give you." c. "Are you sure they're giving you blood thinners? What medication have they prescribed?" d. "Your stroke was due to a clot blocking the blood flow within your brain, not bleeding."

D - A thrombotic stroke is a stroke caused by a blood clot blocking blood flow through the brain tissue. It is important that the patient understands the actual cause of the stroke.

The LPN is called into the room of a patient with known cardiac disease at 7:30 a.m. The patient reports heavy pressure and chest pain. Which action by the nurse is best? a. Provide the patient with the atenolol (Tenormin) scheduled for 9 a.m. b. Provide the patient nitroglycerin sublingual scheduled prn. c. Determine the patient's level of consciousness. d. Assess the patient's respiratory rate and effort.

D - Nitroglycerin is indicated for acute symptoms of an MI. It works by dilating cardiac blood vessels, allowing for improved oxygenation to the myocardium in an effort to decrease the symptoms of chest pain reported.

A nurse is administering hydrochlorothiazide to a client who has gouty arthritis. The nurse should monitor the client for which of the following findings that indicates an adverse effect of this drug? Hyperuricemia Hypernatremia Hyperkalemia Hypoglycemia

Hyperuricemia Hyperuricemia, or increased uric acid levels, along with gouty arthritis can occur in clients who have a history of these conditions and are taking hydrochlorothiazide.

A nurse is caring for a client who has a new prescription for verapamil to treat atrial fibrillation. The nurse should instruct the client to avoid drinking grapefruit juice while taking verapamil because it can cause the client to experience which of the following conditions? Tachycardia Dehydration Diarrhea Hypotension

Hypotension Large amounts of grapefruit juice can increase blood levels of verapamil by inhibiting its metabolism. An excess amount of the drug in the body can intensify otherwise therapeutic effects like hypotension, causing serious risk for syncope and dizziness.

A nurse is caring for a client about to begin captopril therapy. Which of the following adverse effects should the nurse instruct the client to report because it can indicate a need to discontinue drug therapy? (select all that apply) Rash Distorted taste Swelling of the tongue Photosensitivity Dry cough

captopril - ACE inhibitor Rash Distorted taste Swelling of the tongue Dry cough

Angina pectoris

chest pain caused by a lack of oxygen and nutrients in the heart tissue