Nurs 306 Exam 2 [Cardiovascular Drugs]

Front 1

At what stage of hypertension is medication prescribed?

Back 1

Hypertension, Stage 1

Front 2

Identify the 3 types of diuretics.

Back 2

K+ Sparing
Thiazides
Loop Diuretics

Front 3

Identify the 2 K+ sparing diuretics discussed in lecture.

Back 3

Spironolactone (Aldactone)
Triamteren (Dyrenium)

Front 4

If K+ levels are high for your patient, will you hold or give the K+ sparing drug?

Back 4

You will hold the K+ sparing drug and inform the doctor.

Front 5

Do patients on K+ sparing diuretics need a potassium chloride supplement?

Back 5

No.

This is considered an interaction.

Front 6

Identify the 2 thiazide diuretics discussed in lecture.

Back 6

Chlorothiazide (Diuril)
Hydrochlorothiazide (Microzide)

Front 7

It is most important to monitor _______ levels for a pt on a thiazide diuretic because ______.

Back 7

electrolyte levels (and potassium levels)

because pts on thiazides are urinating a lot, and are at risk for dehydration

Front 8

Thiazides tend to _______ potassium, although not as much as other K+ diuretics.

Back 8

retain

Front 9

What med always needs to be ordered in conjunction with loop diuretics?

Back 9

Loop diuretics excrete potassium, so potassium chloride needs to be ordered in conjunction.

Front 10

_____ diuretics are the most potent when it comes to producing diuresis.

Back 10

Loop diuretics

Front 11

Thiazides tend to give a pt elevated blood glucose levels, so what are nursing responsibilities for a pt with diabetes?

Back 11

Monitor blood glucose levels

Front 12

Identify the 2 common routes for furosemide (Lasix).

Back 12

PO
IV

Front 13

Identify the 4 therapeutic uses for diuretics.

Back 13

HTN
CHF
Edema (systemic or abdominal)
Ascites from liver cirrhosis

Front 14

Why are loop diuretics given in the morning?

Back 14

So the pt will not pee at night and increase their risk for fall

Front 15

If you give furosemide (Lasix) IV push, it must be pushed over ____ minutes. If you don't do this, what could happen?

Back 15

IV push over 2 minutes, slow

Ototoxicity (deafness, ear damage, tinnitus)

Front 16

Identify the mechanism of action for the following drug class: K+ sparing diuretics.

Back 16

blocks aldosterone action in the kidney

Front 17

Identify the mechanism of action for the following drug class: thiazides.

Back 17

block Na re-absorption in distal convoluted tubule

Tip: T for thiazides and T for tubule

Front 18

Identify the mechanism of action for the following drug class: loop diuretics.

Back 18

blocks Na re-absorption in the the ascending loop of Henle

Front 19

Identify the 3 loop diuretics discussed in lecture.

Back 19

furosemide (Lasix)
bumetanide (Bumex)
torsemide (Demadex)

Front 20

Identify the drug class associated with the following suffix: -ide.

Back 20

Loop diuretics

Front 21

Identify the drug class associated with the following suffix: -thiazide.

Back 21

Thiazides

Note: Some end in -one and -mide.

Front 22

Why are individuals on diuretics at risk for dizziness?

Back 22

Fluid leaves body, BP goes down, thus individual is dizzy

Front 23

Which diuretic would cause hyperglycemia?

Back 23

Thiazides

Front 24

Hyperkalemia is seen most in patients taking ______.

Back 24

K+ sparing diuretic

Front 25

Identify the mechanism of action(s) for the following drug class: calcium channel blockers (CCBs).

Back 25

– Vasodilation (decrease BP)
– Decrease HR
– Decrease force of contraction

Front 26

Identify the 4 therapeutic uses for CCBs.

Back 26

– Hypertension *
– Angina pectoris related to coronary spasm
– CHF *
– Cardiac dysrythmias

Front 27

Identify the drug class associated with the following suffix: -dipine.

Back 27

CCBs

Front 28

Identify the 2 CCBs discussed in lecture.

Back 28

nifedipine (Adalat, Procardia)
amlodipine (Norvasc)

Front 29

Identify the normal action of calcium within the heart.

Identify the normal action of calcium in the peripheral arterioles.

Back 29

Heart - Calcium goes to heart and causes contraction, which raises HR

Peripheral arterioles - Calcium causes contraction, which raises BP

Front 30

Identify the 2 CCBs discussed in lecture that DO NOT end in -dipine.

Back 30

verapamil (Calan, Verelan, Isoptin)
diltiazem (Cardizem, Tiamate, Tiazac)

Front 31

Identify the common adverse effects of CCBs. (2)

Back 31

- Constipation
- Edema (non-pitting) of ankles and feet

Note: Intervention for edema is to raise feet

Front 32

Identify the 4 drug interaction(s) for CCBs.

Back 32

- Digoxin (increased Dig level)
- Alcohol
- Watch for other HTN meds.
- Beta blockers (increased risk for CHF)

Front 33

Identify the drug class associated with the following suffix: -pril.

Back 33

ACE inhibitors

Front 34

Identify the 3 mechanism of action(s) for the following drug class: ACE inhibitors.

Back 34

Block conversion of Angiotensin I to
Angiotensin II, in the RAAS, thus blocking the increase of BP

Decrease aldosterone levels

Inhibition of kinase II (aka ACE) increases levels of bradykinin (vasodilator)

Front 35

Identify the 4 ACE inhibitors discussed in lecture.

Back 35

benazepril (Lotensin)
enalapril (Vasotec)
ramipril (Altace)
lisinopril (Prinivil, Zetril)

Tip: BERL

Front 36

Identify the main therapeutic use for ACE inhibitors.

Back 36

HTN

Front 37

Identify the 4 other therapeutic use(s) for ACE inhibitors.

Back 37

– Heart failure
– Myocardial Infarction
– Diabetic and Nondiabetic Nephropathy
– Prevention of MI, Stroke, and death in patients at high cardiovascular risk

Front 38

ACE inhibitors tend to increase ______.

Back 38

potassium

Front 39

What is 1st dose hypotension?

Back 39

Hypotension with 1st dose, so remember to monitor BP levels

Front 40

Identify the adverse effect that causes most patients to stop taking ACE inhibitors.

Back 40

Non-productive cough

Front 41

Identify 7 adverse effects of ACE inhibitors.

Back 41

1st dose hypotension
Cough (non productive)
Hyperkalemia
Renal failure (renal stenosis)
Angioedema,
Neutropenia
Loss of taste

Front 42

neutropenia

Back 42

leukopenia in which the decrease is primarily in number of neutrophils (the chief phagocytic leukocyte).

Front 43

angioedema

Back 43

swelling of deep dermis, subcutaneous, or submucosal tissue due to vascular leakage; part of anaphylaxis

Front 44

Identify the mechanism of action(s) for the following drug class: angiotensin II receptor blockers (ARBs).

Back 44

Directly blocks actions of Angiotensin II receptors on blood vessels, in heart, & adrenal glands

Causes:
Blood vessel dilation
Prevent pathologic changes in heart
Decrease release of aldosterone

Front 45

Identify 3 therapeutic uses for ARBs.

Back 45

Therapeutic Uses – Hypertension

Other Therapeutic Uses of ARBs
– Diovan for CHF
– Avapro & Cozaar for Diabetic Nephropathy

Front 46

Identify the 4 ARBs discussed in lecture.

Back 46

Irbestartan (Avapro)
Valsartan (Diovan)
Losartan (Cozaar)
Olmesartan (Benicar)

Tip: LOVI

Front 47

Identify the drug class associated with the following suffix: -sartan.

Back 47

angiotensin II receptor blockers (ARBs)

Front 48

Why does dizziness and syncope occur with ARBs?

Back 48

1st dose hypotension, a significant decrease in BP, thus decrease of blood going to brain.

Front 49

orthostatic hypotension

Back 49

low blood pressure occurring in some people when they stand up

Note: To measure, you measure when sitting vs. standing, difference is 20+ mmHg or more

Front 50

Identify the drug class associated with the following suffix: -lol.

Back 50

beta blockers (BBs)

Front 51

Identify where the following beta receptors are commonly found.

Beta 1 -

Beta 2 -

Back 51

Beta 1 - heart

Beta 2 - lungs

Tip: 1 heart for Beta 1, 2 lungs for Beta 2

Front 52

Identify the normal physiology of beta 1 receptors.

Back 52

Increase heart rate, increase contraction of heart

Front 53

Identify the normal physiology of beta 2 receptors.

Back 53

Bronchodilation, causes airway to open so person breathes better

Front 54

Identify the 2 types of beta blockers.

Back 54

Non-selective - Affects beta 1 receptors and beta 2 receptors

Cardioselective - Only works on beta 1 receptors

Front 55

If a patient has asthma, which type of beta blocker should you give them?

Back 55

Cardioselective, because it will work only on the heart.

Note: DO NOT GIVE NONSELECTIVE B/C IT BLOCKS BETA 2 IN THE LUNGS!

Front 56

Identify the 5 therapeutic uses for beta blockers.

Back 56

– Angina Pectoris
– Cardiac Dysrhythmias
– MI
– CHF
– Migraine

Front 57

Identify the 5 adverse effects for BBs.

Back 57

Bradycardia
Impotence
Heart block (AV block)
Dizziness
Hypotension

Front 58

Identify the 2 direct acting vasodilators for HTN discussed in class.

Back 58

hydralazine (Apresoline)
nitroprusside (Nipride)

Front 59

Identify the mechanism of action(s) for the following drug class: direct acting vasodilators.

Back 59

Direct vasodilation of arterial smooth muscle causing decrease in blood pressure

Front 60

Identify 3 therapeutic uses for direct acting vasodilators.

Back 60

– HTN
– heart failure
– hypertensive crisis (IV)

Front 61

Identify the main adverse effect of direct acting vasodilators.

Back 61

reflex tachycardia - heart rate bounces back up

Front 62

What is the purpose of giving drugs to patients with angina/MI?

Back 62

Drugs are given to increase oxygen to heart by decreasing the heart's demand on the heart.

Increase oxygenation, not to relieve pain.

Front 63

Identify the 3 routes of nitroglycerin.

Back 63

Topical
IV
Sublingual

Front 64

Why does nitroglycerin never have the first pass effect?

Back 64

It is never given PO.

Front 65

Identify the mechanism of action(s) for nitroglycerin.

Back 65

Vasodilation of veins & vascular smooth muscle

Front 66

Identify the adverse effect(s) of nitroglycerin. (3)

Back 66

Headache (common), orthostatic
hypotension, tachycardia

Note: If pt experiences headache, put patch on thigh.
Tip: HOT

Front 67

Identify the interaction(s) for nitroglycerin. (2)

Back 67

BP meds
Viagra (the blood that the heart needs goes to their genitals, thus causing MI)

Front 68

Identify the 4 drug classes for heart failure.

Back 68

ACE inhibitors
Beta blockers
Diuretics
Direct vasodilators

Front 69

Identify the main cardiac glycoside mentioned in lecture.

Back 69

Digoxin

Front 70

Why is monitoring digoxin levels important?

Back 70

Check plasma levels (digoxin level) because it could be toxic

Front 71

Identify 2 therapeutic uses for digoxin.

Back 71

CHF
Dysrhythmias

Front 72

Identify the mechanism(s) of action for digoxin. (2)

Back 72

– Increase force of contraction (Inotropic) --> increase CO
– Affects electrical activity of heart

Note: Digoxin makes contraction more efficient, thus decreasing HR.

Front 73

Why is important to check potassium levels before giving digoxin?

Back 73

Increased digoxin levels when a pt has hypokalemia

Note: If a pt is on digoxin, there might be increased digoxin levels, so check K+ before giving next dose b/c digoxin levels might be too high.

Front 74

Identify the side fx/adverse rxns for digoxin. (4)

Back 74

Visual disturbances, dysrythmias, N/V, fatigue

Front 75

Why is treating lipid disorders important in relation to cardiovascular drugs?

Back 75

Because high lipid values may cause atherosclerosis

Front 76

Why are HMG-CoA reductase inhibitors ("statins") given at night?

Back 76

Given at night b/c liver produces cholesterol at night

Front 77

Identify the mechanism of action(s) for the following drug class: HMG-CoA reducatase inhibitors (statins).

Back 77

Decrease serum cholesterol and LDL levels

Front 78

Identify the main side effect of HMG-CoA reducatase inhibitors (statins).

Back 78

Myopathy (muscle pain)

Front 79

Identify therapeutic uses for HMG-CoA reducatase inhibitors (statins). (4)

Back 79

Hyperlipidemia
hypercholesterolemia
CAD
MI

Front 80

Which is the good cholesterol and which is the bad?

LDL, HDL

Back 80

LDL = bad

HDL = good

Tip: L for lousy, H for happy

Front 81

Is it a good idea to give patients on hypertensive medications statins?

Back 81

Yes.

Front 82

Identify the drug class associated with the following suffix: -statin.

Back 82

HMG-CoA reducatase inhibitors (statins)

Front 83

Identify the mechanism of action(s) for the following drug class: bile acid sequestrant.

Back 83

bind with bile acids => excretion in feces

Note: Cholesterol excreted in feces

Front 84

Identify therapeutic use(s) for the following drug class: bile acid sequestrants. (2)

Back 84

– also used as an adjunct to diet and
exercise
– Hypercholesterolemia

Front 85

Why are bile acid sequestrants NOT popular?

Back 85

They produce a lot of gas in the small intestine and cause bloating.

Front 86

Cholestyramine (Questran) is a _______.

Back 86

bile-acid sequestrant

Front 87

Identify the 2 fibric acid agents discussed in lecture.

Back 87

gemfibrozil (Lopid)
fenofibrate (Tricor)

Front 88

Identify the mechanism of action(s) for the following drug class: fibric acid agents.

Back 88

stimulates breakdown of lipoproteins from tissues and their removal from the plasma

Front 89

Identify 1 therapeutic use(s) for fibric acid agents.

Back 89

Hyperlipidemia

Front 90

rhabdomyolysis
(rab-do-mi-OL-ih-sis)

Back 90

life-threatening muscle damage; caused by myoglobin being released (due to muscle breakdown), thus causing harm to kidneys

Front 91

Why is myopathy a concern for patients on statins?

Back 91

It is a concern because muscle breakdown causes myoglobin to be released, which is detrimental to the kidneys.

See: rhabdomyolysis

Tip: Double check this.

Front 92

TRUE/FALSE

Nicotinic acid, which is Niacin (Niaspan) is a prescription drug.

Back 92

False

This is vitamin B3, so it can be found OTC.

Front 93

Identify the 3 common adverse effects of nicotinic acid [Niacin (Niaspan)].

Back 93

Intense Flushing
Abdominal discomfort
Nausea

Front 94

What is given to patients who experience flushing while on nicotinic acid [Niacin (Niaspan)]?

Back 94

Aspirin

Front 95

Identify 1 therapeutic use(s) for nicotinic acid [Niacin (Niaspan)].

Back 95

hypercholesterolemia

Front 96

Identify the mechanism of action(s) for the following drug: nicotinic acid [Niacin (Niaspan)].

Back 96

inhibit lipoprotein synthesis, thus decreasing LDL and triglyceride levels

Front 97

Cardiac glycosides produce a positive ________ action, which increases the force of myocardial contractions.

Back 97

inotropic

Front 98

Cardiac glycosides produce a negative _______ action, which slows the heart rate.

Back 98

chronotropic

Front 99

Identify all 4 CCBs discussed in class.

Back 99

verapamil (Calan, Verelan, Isoptin)
amlodipine (Norvasc)
nifedipine (Adalat, Procardia)
diltiazem (Cardizem, Tiamate, Tiazac)

Tip: VAND

Front 100

Which is more potent and causes rapid diuresis: thiazides or loop diuretics?

Back 100

Loop diuretics

Front 101

Identify the effects of loop diuretics on the body. (3)

Back 101

Decreased vascular fluid volume
Decreased cardiac output
Decreased BP

Front 102

What type of patients are more sensitive to digoxin sensitivity?

Back 102

Older patients

Front 103

neutropenia

Back 103

an abnormally low count of neutrophils, white blood cells that help your immune system fight off infections

Front 104

Identify 6 foods high in potassium.

Back 104

Avocados
Dried fruits (raisins)
Pistachios
Beans
Fish
Oranges

Front 105

Loop diuretics have (a) ______ effect on blood glucose level.

little/large

Back 105

little

Front 106

Identify the 4 drug classes/drugs of lipid drugs discussed in lecture.

Back 106

HMG-CoA reducatase inhibotrs ('statins')

Bile Acid Sequestrants

Fibric Acid Agents

Nicotinic Acid (vitamin B3)

Front 107

For ascites due to liver cirrhossis, which diuretic is usually prescribed?

Back 107

Spironolactone

Front 108

For edema, which diuretic is usually prescribed?

Back 108

Loop diuretic, e.g. furosemide (Laxis)

Front 109

For CHF, which diuretic is usually prescribed?

Back 109

furosemide or spironolactone

Front 110

Which drug class has interaction with digoxin, causing an increased digoxin level?

Back 110

CCBs

Front 111

Which drug has the adverse side effect of reflex tachycardia?

Back 111

Direct acting vasodilators

Front 112

_________ digoxin level in the presence of hypokalemia.

Back 112

Increased

Front 113

Describe the instructions you would give to a client taking nitroglycerin via sublingual route..

Back 113

Instruct the client to take one tablet for pain and repeat every 5 minutes, for a total of three doses.

Front 114

Direct-acting vasodilators promote an
increase in blood flow to the _______ and _______.

Back 114

brain and kidney

Front 115

Gemfibrozil should not be taken with
_______ because ________.

Back 115

anticoagulants, because they compete for protein sites

Front 116

Do not administer gemfibrozil with _______ because it increases the risk
for myositis, myalgias, and rhabdomyolysis.

Back 116

HMG-CoA reductase inhibitors

Front 117

The client is taking
cholestyramine (Questran). Which of the following statements, if made
by the client, indicates the need for further education?

1. “Constipation and bloating might be a problem.”
2. “I'll continue to watch my diet and reduce my fats.”
3. “Walking a mile each day will help the whole process.”
4. “I'll continue my nicotinic acid from the health food store.”

Back 117

4. “I'll continue my nicotinic acid from the health food store.”

Front 118

A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse
provides instructions to the client about the medication. Which statement by the client would indicate an understanding of the
instructions?

1. “It is not necessary to avoid the use of alcohol.”
2. “The medication should be taken with meals to decrease flushing.”
3. “Clay-colored stools are a common side effect and should not be of concern.”
4. “Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing.”

Back 118

4. “Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing.”


Rationale: Ibuprofen is an NSAID and will help with flushing. Taking with meals doesn't reduce flushing, it reduces GI upset.

Front 119

Identify early signs of digoxin toxicity. (3)

Back 119

Double vision
Loss of appetite
Nausea

Front 120

A client is being treated for acute congestive heart failure with
intravenously administered bumetanide (Bumex). The vital signs are as
follows: blood pressure, 100/60 mm Hg; pulse, 96 beats/min; and
respirations, 24 breaths/min. After the initial dose, which of the
following is the priority assessment?
1. Monitoring weight loss
2. Monitoring urine output
3. Monitoring blood pressure
4. Monitoring potassium level

Back 120

3. Monitoring blood pressure

Rationale: Hypotension is a common side effect. Others are important also, but not priority.