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99 Cards in this Set
- Front
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3 physiologic effects of Alpha 1 |
Bladder neck contraction (urinary retention) Eyes (pupil dilation) mydriasis Vasoconstriction (skin and mucous membranes and visceral) |
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Physiologic effects of Alpha 2 |
Inhibits NE release causing a drop of blood pressure |
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Physiologic effects of Beta 1 |
Heart stimulation (HR, AV velocity and contraction) Kidneys (RAAS activation causing an elevation of blood pressure) |
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Physiologic effects of Beta 2 |
Arteriolar vasodilation (heart, lung and skeletal muscle) Bronchodilation (asthma) Uterine relaxation (preterm labor) Liver glycogenolysis (elevation blood sugar) |
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5 clinical consequences of Alpha 1 |
Stops bleeding (hemostasis/vasoconstriction) Elevation of BP (VC) Anesthesia (local) longer effects/VC Mydriasis Alpha 1 Nasal decongestion (VC less edema) |
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3 adverse effects of Alpha 1 |
Hypertension (VC) Necrosis (VC - less blood flow) Bradycardia (baroreceptor reflex) |
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2 clinical consequences of Alpha 2 |
Blood pressure (reduced) Pain (reduced) |
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1 adverse effect of Alpha 2 |
Hypotension (monitor BP - HOLD <90/60) |
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4 clinical consequences of Beta 1 |
Cardiac arrest Atrioventricular block Shock Heart failure |
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2 adverse effects of Beta 1 |
Chest pain (inc demand) Cardiac dysrhythmias (inc AV velocity) |
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2 clinical consequences of Beta 2 |
Bronchodilation (asthma) Uterine relaxation (delay preterm labor) |
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2 adverse effects of Beta 2 |
Hyperglycemia Tremor (enhanced skeletal muscle contraction) |
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3 clinical consequences of dopamine activation |
Dilation of renal blood vessels Improve renal perfusion Dose dependent drug |
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5 therapeutic applications of Alpha blockade |
Raynaud's disease Essential hypertension Pheochromocytoma Prostate gland enlargement Reversal toxicity from Alpha 1 agonists |
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3 adverse effects of Alpha blockade |
Reflex tachycardia Orthostatic hypotension Nasal congestion |
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6 therapeutic applications of Beta blockade |
Cardiac dysrhythmias Hypertension Hyperthyroidism Angina pectoris Reduction of stage fright Myocardial infarction |
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3 adverse effects of Beta 1 |
Bradycardia Heart block Heart failure (decreased contraction) |
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2 adverse effects of Beta 2 |
Bronchoconstriction Hypoglycemia |
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2 centrally acting Alpha 2 agonist drugs |
Clonidine Methyldopa |
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Intermittent vasospasm |
Raynaud's disease |
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Tumor in adrenal glands |
Pheochromocytoma |
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Protein released by liver |
Angiotensinogen |
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3 types of hypertension |
1. Primary hypertension (hereditary) 2. Secondary hypertension (kidney failure) 3. Gestational hypertension (PIH) |
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Example of ACE inhibitor drug |
captopril enalapril lisinopril ramipril |
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MOA of ACE inhibitors |
Blocks the conversion of angiotensin I to angiotensin II |
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3 effects of ACE I |
1. Vasodilation 2. Excretion of Na and H2O 3. Prevents release of aldosterone |
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4 therapeutic effects of ACE I |
Hypertension Heart failure Myocardial infarction Diabetic nephropathy |
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5 adverse effects of ACE I |
1. Orthostatic hypotension (first dose) 2. Angioedema (tongue and pharynx) 3. Neutropenia (rare but serious) 4. Cough 5. Hyperkalemia |
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What is increased in ACE I if taken? |
Lithium level |
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3 nursing considerations for ACE I |
1. Monitor BP 2. With or without food 3. Notify if A/E is very prominent |
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Side effect of ARB |
Hyperkalemia |
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Example of ARB |
losartan valsartan irbesartan candesartan |
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MOA of ARB |
Blocks the action of angiotensin II |
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2 effects of ARB |
1. Vasodilation 2. Excretion of Na and H2O |
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4 therapeutic effects of ARB |
1. Hypertension 2. Heart failure 3. Stroke prevention 4. Delay progession of diabetic nephropathy |
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Interaction of ARB |
Additive effect on antihypertensive medications |
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Example of aldosterone antagonists |
spinorolactone eplerenone |
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MOA of aldosterone antagonists |
Reduces blood volume by blocking aldosterone receptors on the kidneys |
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2 therapeutic effects of aldosterone antagonists |
Hypertension Heart failure |
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Effect of aldosterone antagonists |
Promotes excretion of Na and H2O |
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What to avoid while taking aldosterone antagonists |
Potassium supplements Salt substitutes |
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Example of direct renin inhibitors |
aliskiren (Tekturna) |
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MOA of direct renin inhibitors |
Inhibits cleavage angiotensinogen to prevent production of Alpha 1 thus both production of Alpha 2 and aldosterone are inhibited |
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3 adverse effects of direct renin inhibitors |
Diarrhea Allergic reaction Hyperkalemia |
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Calcium channel blocker examples |
nifedipine (Adalat) amlodipine (Norvasc) felodipine (Plendil) nicardipine (Cardene) verapamil (Calan) diltiazem (Cardizem) |
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MOA of nifedipine |
Blocks calcium channels in the blood vessels |
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MOA of verapamil/diltiazem |
Blocks calcium channel blockers in the blood vessels and in the myocardium |
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3 adverse effects of nifedipine |
Reflex tachycardia Peripheral edema Acute toxicity |
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5 adverse effects of verapamil/diltiazem |
Orthostatic hypotension Constipation Suppression of cardiac function Bradycardia AV block |
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Example of cardiac glycoside |
digoxin (Lanoxin) |
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3 T/E of digoxin |
Heart failure Dysrhythmias Atrial fibrilation |
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MOA of cardiac glycoside |
(+) inotropic (inc force of myocardial contraction) (-) chronotropic (dec firing of SA node/heart rate) |
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6 considerations for cardiac glycoside |
60bpm (adult) 70bpm (children) 90bpm (infant) Monitor for hypokalemia Bradycardia Teach high potassium foods |
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Sublingual NTG |
isosorbide dinitrate (Isordil) |
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Oral NTG |
isosorbide mononitrate |
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Drugs used to treat angina |
Nitroglycerins |
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2 T/E of NTG |
Acute angina attack Prophylaxis of stable angina/variant angina |
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MOA of NTG |
Dilates veins and decreases venous return (preload) Reduces coronary artery spasm increasing O2 supply |
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4 A/E of NTG |
Headache Orthostatic hypotension Reflex tachycardia Tolerance |
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1 Contraindications/precautions of NTG |
Traumatic brain injury |
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Nx cons. in SL NTG |
Stored in dark, tight original bottles |
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3 Nx cons. in transdermal NTG |
1. Place in hairless area 2. Rotates site to prevent skin irritation 3. Patch free (10 and 12 hrs/day) |
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What is PDE 5? |
Phosphodiesterase 5 |
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Nx cons. in IV NTG |
Glass IV bottle |
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Antidysrhythmic medications class I MOA |
Sodium channel blockers stabilize cardiac membranes |
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Antidysrhythmic medications class II MOA |
Beta-adrenergic blockers prevent SNS stimulation of the heart |
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Antidysrhythmic medications class III MOA |
Potassium channel blockers prolong the action potential and refractory period of the cardiac cycle |
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Antidysrhythmic medications class IV MOA |
Calcium channel blockers depress depolarization and decrease oxygen demand of the heart |
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Example of Class I prototype medication |
procainamide quinidine lidocaine tocainide propafenone flecainaide |
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Example of Class III prototype medication |
amiodarone (Cordarone) sotalol (Betapace) |
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Blood in cough |
Hemoptysis |
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Blood in vomit |
Hematemesis |
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Blood in skin or like bruises |
Hematoma/Petichiae |
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What is FOBT? |
Fecal Occult Blood Testing |
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Blood in feces |
Hematochezia |
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4 antilipemic agents |
1. HMG COA reductase inhibitors 2. Bile-acid sequestrants 3. Nicotinic acid/Niacin 4. Fibrates |
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Example of HMG COA reductase inhibitors |
atorvastatin simvastatin rosuvastatin |
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Action of HMG COA reductase inhibitors |
Decreases manufacture of LDL, VLDL and increase manufacture of HDL |
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4 T/E of HMG COA reductase inhibitors |
Coronary events MI Stroke Pimary hypercholesterolemia |
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3 A/E HMG COA reductase inhibitors |
1. Hepatotoxic 2. Myopathy 3. Rhabdomyolysis |
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Interactions of HMG COA reductase inhibitors |
Grapefruit juice suppresses CYP3A4 (inc level of drug) |
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Nx cons in HMG COA reductase inhibitors |
Baseline cholesterol, HDL, LDL and TG |
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Example of bile-acid sequestrants |
colesevelam (Welchol) - for constipation |
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Example of fibrate |
fenofibrate |
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Used for intrinsic and extrinsic clotting factors |
Anti-coagulants |
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Example of anti-coagulant |
heparin (LMWH) enoxaparin (Lovenox) fondaparinux (Arixtra) |
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Action of anti-coagulant |
Prevent clotting by activating anti-thrombin, thus indirectly inactivating both thrombin and factor Xa (inhibits fibrin formation) |
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4 T/E of anticoagulant |
Evolving stroke Pulmonary embolism Massive DVT Postop venous thrombosis |
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3 A/E of anticoagulant |
Hemorrhage Hypersensitivity Heparin-induced thrombocytopenia |
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5 nx contraindications in anticoagulant |
1. Pt with low platelet count 2. Pt with uncontrollable bleeding 3. Pt undergoing surgery 4. Used cautiously (dissecting aneurysm, PUD, threatened abortion) 5. Pt taking NSAIDs |
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2 nx administration for anticoagulants |
1. Obtain baseline VS 2. Labs: CBC, PC, HCT, APTT |
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Inflammation of the airways (hyper-responsiveness) |
Asthma |
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6 bronchodilators for asthma |
1. Beta 2 adrenergic agonists 2. Methylxanthines 3. Anticholinergics 4. Anti-inflammatory agents 5. Mast cell stabilizers 6. Leukotriene modifiers |
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Examples of Beta 2 adrenergic agonists |
albuterol formoterol salmeterol terbutaline |
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MOA of Beta 2 adrenergic agonists |
Selectively activating Beta 2 in the bronchial smooth muscle |
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3 A/E of Beta 2 adrenergic agonists |
Tachycardia Angina Tremors |
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What negates effects of bronchodilators? |
Beta blockers |
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It increase the risk of tachycardia and angina for bronchodilators |
MAOIs and TCA |
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3 examples of MAOI |
tranycypromine (Parnate) isocarboxazid (Marplan) phenelzine (Nardil) |
