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67 Cards in this Set

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What are side effects are important to watch with calcium channel blockers?
Hypotension, peripheral edema, flushing headache and GI upset.
What side effects are important to watch with beta-adrenergic blockers?
Bradycardia, Lethargy, GI disturbance, hypotension, CHF, bronchospasms, depression and impotence.
What is the action of ACE inhibitors?
Blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor. This block causes vasodilation and therefore decreases PVR, resulting in a decrease in sodium and water retention.
What is the action of Beta-adrenergic blockers?
Prevent sympathetic stimulation of the heart (blocks beta-receptors in the heart) which causes:

Decreased HR, Decreased Force of contraction and decreased rate of AV conduction.
What is the action of Calcium Channel Blockers?
Blocks calcium influx into the beta-receptors, decrease the force of the myocardial contraction, reduce the heart rate and decrease PVR>
What is the typical drug therapy plan for a patient beginning anti-hypertensive therapy.
The initial drug selection starts with a thiazide diuretic, typically followed by a beta-adrenergic blocker or an ACE inhibitor or CCB.
When using Beta-adrenergic blockers, ACE inhibitors or Calcium Channel Blockers what is one very important nursing teaching the refers to how they should be taken?
DO NOT stop taking medication abruptly.
What are important nursing actions to do prior to administering a Beta-blocker?
-Evaluate BP and pulse for significant changes.
-Hold is SBP is below 90 mmHg
What is important to know about diabetic patients taking beta-blockers?
Tachycardia (a symptom of hypoglycemia) is often masked as a result of beta1 blockade.
What hint can be used to identify beta-blockers?
They end in OLOL.

ex: Propranolol (Inderal), Atenolol (Tenormin)
What is the difference between a cardioselective beta blocker and a nonselective beta blocker? Give examples of each.
Propranolol has both beta1 and beta 2 receptor blockign actions and is considered nonselective.

-Metopropolol (lopressor) is cardioselective, meaning it only blocks beta1

-Atenolol (Tenorim) is considered a cardioselective beta1 blocker, but it blocks beta 2 at high doses.
What is the hint to identifying an ACE inhibitor? And give examples.
The name ends in PRIL.

Capotopril (Capoten), Enalapril (Vasotec) and Benazepril (Lotensin).
What is the action of ACE inhibitors?
Decreases perpipheral vascular resistance without increasing:

Cardiac output, cardia rate and cardiac contractility.
What are the important side effects of ACE inhibitors.
Dizziness, Orthostatic hypotension, GI distress, cough and headache.
What is important patient teaching with ACE-inhibitors?
-Rise slowly to reduce postural hypotensive effects.
-Teach client to notify health care provider if cough develops.
-Teach client to avoid potassium supplements or potassium containing salt substitutes.
What is important nursing implications when administering ACE inhibitors?
-Monitor blood pressure, especially for 2 hours after the first dose--severe first-dose hypotension often develops.
-Assess the client for history or presence of renal impairment
-Administer on a empty stomach for best absorption.
What is the action of calcium channel blockers?
Blocks calcium access to cells causing a decrease in contractility and a decrease in the conductivity of the heart.

-These decrease the demand for oxygen.
What are the side effects of Calcium channel blockers?
Hypotension, bradycardia, may precipitate AV block, headache, abdominal discomfort (constipation, nausea), Peripheral edema.
What is a way to remember some of the calcium channel blockers?
VERy, NIce, Drugs

Verapamil (Calan), Nifedipine (Procardia) and Diltaizem (Cardizem)

Other drugs include: Amlodipine (Norvasc)
What are important nursing considerations when administering Calcium Channel Blockers?
-Do not crush or allow client to chew sustained-release medication preparations
-Monitor vital signs and watch for low blood pressure
-Weight client; report any edema or weight gain
What are important patient teaching points for a person taking Calcium channel blockers?
-Postural hypotension education.
-Teach client to avoid GRAPEFRUIT
-Constipation can be minimized by increasing dietary fiber and fluid.
What are the uses of Beta-blocker?
Uncomplicated hypertension, dysrhythmias and angina.
What are the various uses for ACE inhibitors?
Hypertension and Heart Failure.
What are the various uses of Calcium Channel Blockers?
Angina, hypertension (nifedipine) and dysrhythmias (verapamil and dilitiazem)
What are the various uses of Nitroglycerin?
-Relief of Anginal pain
-In conjunction with beta blockers or calcium channel blockers to suppress tachycardia.
What are the side effects of Nitroglycerine?
Orthostatic hypotension, headaches, tachycardia, dry mouth and blurred vision.
What are the important patient teaching points for a patient on Nitroglycerine?
-Clients with angina pectoris should carry nitrates with them at all times
-teach client to call 911 if pain is not relieved within 5 minutes of taking. May take one table every five minutes for a total of three tables while waiting for emergency care.
What is the mechanism of action of sodium channel blockers when used as an antidysrhythmics.
Blocks sodium, slowing the impulse in the atria, ventricles, and nodal and Purkinje systems (Quinidine, Procainamide)
How do Beta-adrenergic blockers work when used as a antidysrhythmic?
Reduce calcium entry and automaticity in the sinoatrial (SA) node, slow conduction velocity in teh atrioventricular (AV) node, and reduce contractility in the atria and ventricles (Propranolol [Inderal])
How are potasssium channel blockers used as an antidysrhythmic?
Delays the repolarization of fast potentials, prolong action potential duration and effective refractory period (Amiodarone)
How are calcium channel blockers used as an antidysrhythmic?
Reduce the automaticity in the SA node, delay conduciton through the AV node, and delay reduction of myocardial contractility (Diltiazem).
What are the major side effects of antidysrhythmics?
Dizziness, bradycardia and pulmonary toxicity (with amiodarone)
What are the two most important nursing interventions when administering Digitalis [Digoxin]?
-Get baseline vital signs, including a full-minute apical pulse (at a minimum of 60 bpm),
-Check lab values for digitalis and potassium levels.
What side effects need to be monitored for with a patient on Digitalis [Digoxin]?
Watch for fatigue, dysrhythmias, visual distrubances, anorexia and hypokalemia.
What is the function and use of Digitalis [Digoxin]?
Has the power to control cardiac output and ventricular response in atrial fibrillation.
-Used in Heart failure (improves cardiac output), and Atrial fibrillation and flutter.
What are important client teaching topics for those taking Digitalis [Digoxin]?
-Teach clients to take their pulse
-Teach client to recognize early signs of hypokalemia (muscle weakness) and digitalis toxicity (nausea, vomiting, diarrhea, blurred or yellow visual distrubances), and to notify primary health care provider if they occur.
When giving Digitalis [Digoxin] to a pediatric patient, what is an important nursing action?
-Monitor pulse rate, if it is below 100 mmhg, hold the dose and notify the primary health care provider.
What are the s/s of lidocaine Toxicity?
SAMS

-Slurred or difficult speech (Paresthesias, numbness of lips/tongue)
-Altered central nervous system (Drowsiness, Dizziness, Dysrhythmias, Restlessness, Confusion)
-Muscle twitching (Tremors)
-Seizures (Convulsions, respiratory depression, respiratory and cardiac arrest).
When giving lidocaine IV, what actions does the nurse need to take in order to monitor for toxicity?
-Assess LOC and orientation
-Protect for possible seizure activity
-Check VS frequently
-Monitor ECD and report unusual activity
-Assess respiratory system, bentilation, and gas exchange (oxygen saturation).
What is the effects of lidocaine on the heart and ECG?
-Blocks sodium channels and slows conduction
-REduces automaticity in ventricles and HIS-Purkinje system
-Accelerates repolarization.
What drugs are used for Bradycardia and decreased BP?
bright IDEA:

-Isoproterenol [Isuprel]
-Dopamine
-Epinephrine [Adrenalin]
-Atropine
What type of drug is Isoproterenol and what is its mechanism of action?
-Sympathomimetic, catecholamine
Action: Increases heart rate and cardiac output, and cuases bronchodilation.
What are the adverse effects of Isoproterenol [Isuprel]?
Tachycardia and angina

-May cause hypergycemia in diabetics.
What type of drug is Dopamine and what is its MOA?
-Sympathomimetic, catecholamine

At low doses, causes renal vasodilaiton. Moderate doses increase cardiac contractility, stroke volume and cardiac output. Higher doses increase peripheral resistance, blood pressure and renal vasoconstriction.
What are the adverse effects of Dopamine?
Tachycardia, dysrhythmias, vasoconstriction leading to tissue necrosis with extravasion (serious/life threatening).
What type of drug is Epinerphrine [Adrenalin] and what is its MOA?
-Adrenergic agonist, catecholamine

Causes vasoconstriction and increases heart rate, bronchodilator and is the treatment of choice for anaphylactic reactions.
What type of drug is Atropine and what is its MOA?
-Anticholinergic, antidysrhytmic

Acts on smooth muscle of the heart and increases cardiac rate.
What is the adverse effects of epinephrine [adrenalin]?
Hypertension, dysrhythmias, anginal pain, restlessness.
What are the adverse effects of Atropine?
Tachycardia, dry mouth, drowsiness, urinary hesitancy.
What are the major side effects of Adrenergic Antagonists? (Alpha-blockers)
Orthostatic hypotension, Tachycardia, Vertigo, Sexual dysfunction.
What are examples of Adrenergic Antagonists?
Doxazosin (Cardura)
Prazosin (Minipress)
What is the MOA of Alpha Adrenergic Antagonists (Alpha Blockers)?
Stimulate central alpha receptors, which decreases sympathetic outflow from the central nervous system, causing a decrease in peripheral vascular resistance and a slight decrease in cardiac output.
What are the uses of Alpha-Adrenergic Antagonists (Alpha-Blockers)?
Mild to moderate hypertension.
What are important nursing implications for Alpha-Adrenergic antagonists?
-Watch for orthostatic hypotention, which is intensified with prolonged standing, hot baths or showers, hot weather, alcohol use and strenuous exercise.
-Discontinue slowly to avoid rebound hypertension
What are important teaching points for a patient taking Alpha-adrenergic antagonists (Alpha-blockers)?
-Client should take at bedtime to avoid drowsiness during the day.
-Teach client about the first dose effect of severe orthostatic hypotension and to avoid hazardous activities and driving for 12 to 24 hours after the initial dose. To decrease risk instruct client to take the first does at bedtime.
What is the difference between the action of cardioselective and nonselective beta blockers?
-Beta1 blockers (cardioselective) have a predominant effect on the heart by decreasing rate and contractility and decreasing velocity of impulse conduction at the atrioventricular (AV) node.
-Beta2 blockers (nonselective) have the same actions as beta1 blockers, however, they also affect the lungs, causing bronchoconstriction, and they block blood vessel receptors, causing vasoconstriction.
Give examples of beta1 blockers.
Metoprolol (Lopressor, Troprol XL) used for angina and hypertension.
Give examples of nonselective beta blockers.
Propranolol (Inderal) used for angina, hypertension and dysrhythmias.
What are the contraindications of nonselective beta blockers?
Bradycardia or cardiac block, hypotension.
What is the contraindications of beta2 blockers?
Chronic obstructive pulmonary problems.
What are the side effects of beta2 blockers?
Bronchospasm, bradycardia.
What are the side effects of adrenergic antagonists (beta-blockers)?
Hypotension, bradycardia (AV block), symptoms of heart failure, drowsiness and depression.
What is the mechanism of action of antihyperlipidemics (Statins)?
HMG-CoA reductase is an enzyme made in our livers, which helps the liver produce cholesterol, Statins lowers cholesterol levels by inhibiting the formation of HMG-CoA reductase.
What are the uses of HMG-CoA Reductase Inhibitors (Statins)?
Hypercholesterolemia, Primary and secondary prevention of cardiovascular events and Clients with type II diabetes and coronary heart disease.
What are the side effects of HMG-CoA Reductase Inhibitors (Statins)
Myopathy--Rhabdomyolysis (severe form)

Hepatoxicity--liver injury with increases in serum transaminases.
What are important patient teaching for HMG-CoA Reductase Inhibitors (Statins)?
-Instruct client to report unexplained muscle pain or tenderness
-Inform women of childbearing age about the potential for fetal harm should they become pregnant.
-Instruct client about dietary changes to reduce weight and cholesterol.
What are important nursing implications for HMG-CoA Reductase Inhibitors (Statins)?
-Monitor liver function studies
-Administer medications in the evening without regard to meals.