Pharmacology - Cardiac

Elevated Blood Pressure

120-129/<80 mmHg

Preload

Amount of blood prior to the heart contracting

Hydochlorothiazide (HCTZ)

Often times seen with another med

Renin

Produced by kidney Changes based on location and squeeze blood vessel

A client is about to start taking aliskiren to treat hypertension. Which of the following should you tell the client to avoid to ensure optimal absorption of the food? A. Soy sauce B. Green, leafy vegetables C. Fatty foods D. Foods high in carbohydrates

C. Fatty foods

Stage 1 hypertension

130-139/80-89 mmHg

Stage 2 hypertension

140/90 mmHg

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

A. "Monitor your pulse rate and report changes."

A nurse should recognize that milrinone is contraindicated or a client who has which of the following conditions? A. Acute myocardial infection B. Peripheral vascular disease C. Ulcerative colitis D. Ventricular tachycardia

A. Acute myocardial infection

You are caring for a client who is taking oral amiodaron to treat atrial fibrillation. Recognizing the adverse effects of amiodarone, you advise the client to watch for and report which of the following? (select all that apply) A. Cough B. Blurred vision C. Dizziness D. Sore thoart E. Fever

A. Cough B. Blurred vision C. Dizziness E. Fever

Digoxin is effective in treating heart failure due to which pharmacological actions? (Select all that apply) A. Exerts positive inotropic action B. Decreases cardiac output C. Decreases Sympathetic tone D. Increase Vascular Constriction E. Increases myocardial contractility

A. Exerts positive inotropic action C. Decreases symmpathetic tone E. Increases Myocardial contractility

A nurse is providing teaching to a client who has a new prescription for losaratan 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? A. Facial edema B. Sleepiness C. Peripheral edema D. Constipation

A. Facial edema

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

A. Grapefruit juice

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

A. Headache

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) A. Hyperkalemia B. Throat swelling C. Constipation D. Cough E. Joint pain

A. Hyperkalemia B. Throat swelling D. Cough

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 on this drug? A. Hyperuricemia B. Hypernatremia C. Hyperkalemia D. Hypoglycemia

A. Hyperuricemia

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? A. Hyperkalemia B. Hypoglycemia C. Hypouricemia D. Hyponatremia

A. Hypokalemia

A client is taking bumetanide and spironolactone. You explain to the client that using these drugs together may reduce the risk of which adverse effects? A. Hypokalemia B. Hyponatremia C. Hyperglycemia D. Hypochloremia

A. Hyprokalemia

A primary care provider prescribes captopril to treat the client's hypertension and also help alleviate his heart failure. It is essential for a health care provider to make sure a client understands that he should not take which over the counter drugs while taking captropril? A. Ibuprofen (Advil, Motrin) B. Acetaminophen (Tylenol) C. Calcium carbonate (Tums) D. Diphenhydramine (Bendadryl)

A. Ibuprofen (Advil, Motrin)

A nurse is caring for a client who is taking atorvastatin and has a new prescription for gemfibrozil. The nurse should recognize that this drug combination place the client at an increased risk for which of the following adverse effects? A. Myopathy B. Hypoglycemia C. Irregular pulse D. Kidney failure

A. Myopathy

Nitroglycerin sublingual is prescribed for anginal pain. When teaching how to use nitroglycerin, the nurse tells the client to place 1 tablet under the tongue when pain occurs and to repeat the dose in 5 minutes if the pain persists. The nurse should also the client to: A. Place 1 tablet under the tongue 3 minutes before activity and repeat the dose in 5 minutes if pain occurs B. Place 2 tablets under the tongue when intense pain occurs C. Place 1 tablet under the tongue when pain occurs and use an additional tablet after the attack to prevent recurrance D. Swallow 1 tablet and place 1 tablet under the tongue when pain is intense

A. Place 1 tablet under the tongue 3 minutes before activity and repeat the dose in 5 minutes if pain occurs

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? A. Raisins B. Cabbage C. Cheese D. Eggs

A. Raisins

A nurse is caring for a client who is 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) A. Rash B. Distorted taste C. Swelling of the tongue D. Photosensitivity E. Dry cough

A. Rash B. Distorted taste C. Swelling of the tongue E. Dry cough

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

A. Reserpine

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

A. Simvastatin

You are talking with a client who is taking losartan for hypertension. She ask you about stopping contraception and starting a family. You inform the client that losaratan is unsafe to take during pregnancy due to which risk? A. Macrosomia B. Fetal Injury C. Gestational diabetes D. Thromboembolic disease

B. Fetal Injury

A client taking medication for treatment of essential hypertension has a serum potassium level of 3.2 mEq/L. A nurse is reviewing the list of medications being taken by the client. Which medication on the list should the nurse conclude to be the causative factor for this serum potassium level? A. Potassium chloride (K-dur) B. Hydrochlorothiazide (HydroDiuril) C. Spironolactone (Aldactone) D. Enalapril (Vasotec)

B. Hydrochlorothiazide (HydroDiuril)

A client to start taking hydrochlorothiazide for hypertension. To assess for adverse effects of this drug, you monitor for which during drug therapy? (select all that apply) A. Ototoxicity B. Hyponatremia C. Hyprkalemia D. Dehydration E. Hypoglycemia

B. Hyponatremia C. Hyperkalemia D. Dehyrdation

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) A. ACE inhibitor B. MAOI C. General anesthetic D. Tricyclic antidepressant E. Beta Blocker

B. MAOI C. General anesthetic D. Tricyclic antidepressant E. Beta Blocker

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? A. Bronchooconstiction B. Muscle pain C. Lip numbness D. Somnolence

B. Muscle pain

A primary care provider prescribes lisinopril (Zestril, Prinvil) to treat a client with hypertension. The client returns to the clinic for a follow-up appointment. A nurse should evaluate the client for adverse effects by asking the client if he or she is experiencing: A. Petechiae B. Persistent cough C. Bleeding gums D. Muscle weakness

B. Persistent cough

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

B. Potassium 5.2 mEq/L

A nurse should identify that which of the following drugs is used only for the short-term treatment of a cardiac dysrhythmia because of the serious adverse effects associated with long term use? A. Quinidine B. Procainamide C. Nitroglycerin D. Verapamil

B. Procainamide

The nurse administers a medication, that is a digitalis derivative. Which nursing assessment is essential before administering this medication? A. Blood pressure B. Pulse rate C. Level of consciousness D. Respiratory rate

B. Pulse Rate

Loop Diuretics

Furosemide (Lasix) Torsemide (Demadex) Work directly on loop of henle Intended purpose is to lower blood pressure Push slowly 10-20 mg/min Check pt to be on potassium supplement

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

B. Report any new intolerance to fried foods C. Report muscle tenderness D. Expect periodic liver function testing

Propranolol (Inderal)

Beta adrenergic blocker that controls atrial and ventricular tachycardia

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) A. "Apply a new patch at the onset of anginal pain" B. "Apply the patch to dry skin and cover the area with plastic wrap." C. "Apply the patch to a hairless area and rotate sites." D. "Apply a new patch when you start your day." E. "Remove patches for 10 to 12 hours each day."

C. "Apply the patch to a hairless area and rotate sites." D. "Apply a new patch when you start your day." E. "Remove patches for 10 to 12 hours each day."

While instructing a client about using isosorbide to treat angina, you advise the client to avoid which of the following? A. Milk B. Caffeine C. Alcohol D. Grapefruit

C. Alcohol

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 serve digoxin toxicity. Which of the following drugs should the nurse expect to administer to treat her complications? A. Acetylcysteine B. Flumazenil C. Antigen-binding fragments D. Deferoxamine

C. Antigen-binding fragments

A patient is on hydrochlorothiazide once a day. Which fruit should the nurse encourage the patient to eat? A. Plum B. Orange C. Banana D. Tangerine

C. Banana

The nurse is administering an antihypertensive medication to a patient. Which patient adaptation should the nurse identify as an excessive response to the antihypertensive? A. Oral temperature of 98 degrees F B. Heart rate of 60 bpm C. Blood pressure of 80/60 mm Hg D. Respirations of 24 per minute

C. Blood Pressure of 80/60 mmHg

Recognizing the potential for a drug interaction between the diuretic, furosemide, and the cardiac glycoside, digoxin, the primary care provider plans to moniotr this client for which adverse effect? A. Hyperkalemia B. Ototoxicity C. Digoxin toxicity D. Hypoglycemia

C. Digoxin Toxicity

A primary care provider then prescribes quinidine gluconate as an oral antidysrhythmic agent. A health care professional should question the use of quinidine for a client taking digoxin, due to a possible drug interaction that can result in which adverse effect? A. Liver toxicity B. Quinidine toxicity C. Digoxin toxicity D. Cardiotoxicity

C. Digoxin toxicity

While talking with a client who is taking captopril to treat hypertension, which instructions do you include to help her manage the drug's adverse effects? A. Check your heart rate prior to taking the drug B. Wear sunscreen and protective clothing while outdoors C. Do not use salt substitutes to season your food D. Take the drug with a meal

C. Do not use salt substitutes to season your food

You are caring for a client whose artial dysrhytmia fails to respond to other antidysrhytmia therapies. You anticipate that the primary care provider might try which drugs whose off-label use includes refractory atrial dysrhythmias? A. Propranolol (inderal) B. Lidocaine (xylocaine) C. Flecainide (tambocor) D. Amiodarone (cordarone)

C. Flecainide (tambocor)

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

C. NSAIDs

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 the following conditions? A. Migraine headaches B. Pancreatitis C. Second-degree AV block D. Angina Pectoris

C. Second-degree AV block

Verapamil (Calan)

Calcium Channel blocker that treats supraventricular tachycaardia and atrial fibrillation or flutter

BP formula

Cardiac Output x Peripheral Resistance

Stroke Volume

Changed by changes in preload

The nurse is preparing to administer an injection of heparin. What is the preferred site for this injection? A. Arm B. Leg C. Buttock D. Abdomen

D. Abdomen

A patient asks the nurse why the physician ordered a lipid-lowering drug. When considering a response, the nurse understands that physicians generally order hyperlipidemia drug therapy: A. After 2 consecutive months of elevated serum lipid levels B.For patients over 60 years of age C.For those who are unable to exercise D. After failure of diet therapy

D. After failure of diet

A health care provider adds a second medication for blood pressure control for a client whose blood pressure has not been well-controlled with one antihypertensive medication. If the HCP orders the following medication combinations which combination should the nurse question? A. Captopril (Capoten) and furosemide (Lasix) B. Bumetanide (Bumex) and diltiazem (Cardizem) C. Metolazone (Zaroxolyn) and valsartan (Diovan) D. Atenalol (Tenormin) and metoprolol (Lopressor)

D. Atenalol (Tenormin) and metoprolol (Lopressor)

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

D. Hypoglycemia

A nurse is caring for a client who has a new prescription or 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? A. Tachycardia B. Dehydration C. Diarrhea D. Hypotension

D. Hypotension

A nurse is assessing a client who is taking atorvastatin (Lipitor). For which manifestation should the nurse specifically assess? A. Constipation and hemorrhoids B. Flushing and postural hypotension C. Fatigue and dysrhythmias D. Muscle pain and weakness

D. Muscle pain and weakness

A client starts drug therapy, but the following day he reports that he is having palpitations. His ECG at the emergency department indicates frequent premature ventricular contractions. So the primary care provider prescribes a stat dose of lidocaine, 50 mg via IV bolus. A health care professional who administers the drug monitors the client for which adverse reactions to lidocaine? A. Meatbolic alikalosis B. Hypertension C. Tachycardia D. Paresthesias

D. Paresthesias

You are administering lidocaine, 50 mg via IV bolus, to a client with a ventricular dysrhythmia. You monitor the client for which adverse reactions to lidocaine? A. Metabolic alkalosis B. Hypertension C. Tachycardia D. Paresthesias

D. Paresthesias

Vitamin K is essential for normal blood clotting because it promotes: A. Platelet aggregation B. Ionization of blood calcium C. Fibrinogen formation by the liver D. Prothrombin formation by the liver

D. Prothrombin formation by the liver

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

D. The drug does not promote diuresis for clients who have renal insufficiency

Angiotensive Converting Enzyme Inhibitor (ACE-I)

Enalapril (Vastec) Lisinopril (Zestril, Prinivil) Captopril (Capoten) Ramipril (Altace) Side effect: increase in BUN and CR, cough, angioedema/laryngeal, edema, Low blood pressure, dizziness, neutropenia

Heart's reaction to low Blood Pressure

Heart Rate increases

Cardiac Output

Heart Rate x Stroke Volume

Thiazides diuretics

Hyrdodiuril (Hydochlorothiazide (HCTZ)) Metolazone (Zaroxolyn) Potential to worsen gout

Norepheine

Lifesaving drugs Squeezing affect on blood pressure

Nonpharmacologic methods to control hypertension

Limit alcohol usage restrict sodium consumption reduce saturated fat and cholesterol (increase fresh fruit and vegetable intake) increase aerobic physical activity reduce stress maintain optimum weight

Angiotension Receptor Blockers (ARB)

Losartan (Cozaar) Irbesartan (avapro) Valsartan (Diovan) Telmisartan (Micardis)

Losaratan Potassium (Cozaar)

MOA: to block angiotensin receptors in arterial smooth muscle and adrenal glands Primary use: Hypertension Adverse effect: Hypotension Side effects: Increase in BUN and CR, Angioedema/laryngeal, edema, dizziness (early warning) Hold back NSAIDs Avoid this use with pregnant women

Mannitol

MOA: to quickly reduce plasma volume Primary use: reduce intracranial pressure due to cerebral edema Also used to maintain urine flow in prolonged surgery, acute renal failure, or severe renal hypoperfusion Monitor respiration and watch for dyspnea Adverse effects: HA, dizziness, tremors, dry mouth, fluid and electrolyte imbalances, thrombolphlebitis

Amiodarone (Cordarone)

Potassium channel blocker that treats ventricular fibrillation and ventricular tachycardia

Quinidine

Sodium channel blocker that treats supraventricular and venricular dysrhythrmias

Aldosterone Blockers

Spironolcatone (aldactone) Eplerenone (Inspra) Could be at risk for hyperkalemia (especially if with ACE inhibitor) Can see diaherria and rash Side effects: increase in BUN and CR, low blood pressure, dizziness, hyperkalemia, dysrythmias due to hyperkalemia, gynecomastia in males

Facts on hypertension medications

They are life long drugs If stopped suddenly can cause rebound hypertension A lot of hypertension medications can be used for other cardiac issues They are individualized to patient risk factors, medical conditions, degree of blood pressure elevation.

Blood viscosity

Thickness of blood

How many times should blood pressure be checked to determine high blood pressure?

Two times on Two different occasions

Cardiac Output

Volume of Blood in 1 min

Diuretic

Water Pill Don't take before bed Can let go of more potassium then normal Watch potassium levels with thiazide or loop diuretics

afterload

amount of pressure the heart exerts to move blood during contraction

Target organs affected by untreated hypertenstion

heart brain kidneys retina

what is the expected effect of dopamine?

increased myocardial contraction

Normal Blood Pressure

less than 120/80

Vasodilators treat hypertension by the way of which of the following mechanisms of action

reducing peripheral resistance, increasing contractility of the heart, dilating the arterioles

A nurse is caring for an older adult who has a new prescription for digoxin and takes multiple other medications. The nurse should recognize that concurrent use of which of the following medications places the client at risk for digoxin toxicity

veramapil