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What are the 10 classifications used to treat HTN?
- 1. Diuretics
- 2. Beta blockers
- 3. Alpha 1 blockers
- 4. Alpha/beta blockers
- 5. Centrally acting Alpha 2 agonists
- 6. Adrenergic neuron blockers (not often)
- 7. Calcium Channel Blockers (CCBs)
- 8. Angiotensin converting enzyme inhibitors (ACE inhibitors)
- 9. Angiotension II receptor blockers (ARBs)
- 10. Alodsterone antagonists
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What happen when you stimulate alpha 1?
Mydriasis, arterioles constriction, ejaculation, prostate contraction, bladder contraction
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What are the action sites of alpha 1 receptor?
- 1. Eyes
- 2. Arterioles
- 3. Male sex organs
- 4. Prostate capsule
- 5. Bladder
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What is the action sites of alpha 2 receptor? What happen when you stimulate alpha 2?
Action site: presynaptic nerve terminals
Stimulation: Inhibition of transmitter release
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What is the action sites of beta 1 & what happen when you stimulate it?
- Action sites for beta 1 are heart & kidneys
- Stimulation: incr HR, force of contraction, AV conduction velocity, renin release
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What is beta 2's action sites & what happen when you stimulate it?
- Action sites: arterioles, bronchi, uterus, liver, skeletal muscle
- Stimulation: arterioles dilation, bronchi dilations, glycogenolysis, incr contraction & glycogenolysis
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Would you give a renal pt. potassium sparing meds? Why?
No. Because potassium sparing meds retain potassium. Renal Pt. is usually hyperkalemic since they cannot get rid of K+. Giving potassium sparing will exacerbate the condition & can lead to arrhythmias!
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What does aldosterone do?
Drug that blocks aldosterone does what to the body?
Increase reabsorption of sodium & water & promote secretion of potassium. That'll increase blood volume & BP.
Antihypertensive drug
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Pt. found a whole pill in their stool & thought that the med didn't get absorbed. You found Covera-HS (verapamil, a CCB) listed in her meds list. She took this at bedtime yesterday night.What explaination will you provide about the whole pill in the stool?
Covera HS is structurally engineered so that capsule has little permeable holes for medinces to come out. It passes the GI tract INTACT.
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What is the mech of action for CCB?
STOP contractile process
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Dihydropyridines or Nimotop?
1. For HTN
2. For cerebral vessels
3. For angina
4. For management of intracranial hemorrhage to prevent vasospasm
- 1. Dihyropyridines
- 2. Nimotop
- 3. Dihydropyridines
- 4. Nimotop
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Your patient is an 80 y.o female. She's taking Verapamil (a CCB) for her HTN. What do you need to teach her? What are some nursing interventions?
Major prob of FECAL IMPACTION!
N.I: increase fluid, fiber & exercise
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Your pt. is taking verapamil & diltiazem. You know that they're CCBs drugs and can decrease contractile of the heart. What cardiac side effects should you be lookin out for?
AV block, decrease contractility, reflex tachycardia (w/ diltiazem
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1. Your pt. is taking ACE inhibitors & the Dr. mindlessly prescribe diuretics to the pt.
What do you expect is going to happen to the patient and what are you going to do?
2. He then mindlessly prescribe potassium sparing to this pt. What are you going to tell him?
- 1. Diuretics will increase that 1st dose hypotension (the AE of ACE inhibitors)
- MAKE SURE pt. changes position SLOWLY!!!
2. "You should be fired. ACE inh. causes K retention. Now you're going to increase hyperkalemia by giving K-sparing. Did you get your license from the cereal box?"
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What should you be careful about when giving Digoxin to the elders?
They can get extremely toxic on this med extremely fast. So give in low doses
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1. You are encouraging your 80 y.o pt. to eat a high fiber meal to prevent constipation. However the dr. prescribed her digoxins later that day. What do you need to consider?
2. You're giving IV digoxin & you're going way too fast (2 minutes)... and now the pt.'s experiencing toxicity. What is the antidote for this situation?
- 1. Don't take it w/ meal. High fiber meal decreases dig level.
- 2. Fab (Digibind) antidote.
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Your pt. is developing dysrhythmia. What do you expect the Dr. is possibly going to prescribe to your pt. (list 5 drug classifications)
- 1. Class I: Sodium channel blockers
- 2. Class II: Beta blockers
- 3. Class II: Potassium channel blockers
- 4. Class IV: Calcium channel blockers
- 5. Class V: Digoxins
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Your 80 y.o pt. has dysrhythmia, thyroid prob & some type of liver damage dz. The Dr. mindless once again prescribed her amioderone, a class III antidysrhythmia drug (Potassium channel blockers). What are you concerned about? What tests would you suggest to get done?
This drug will put her at increased risk of liver damage (inflammation even) & thyroid dysfunction.
You need to check liver function test & do thyroid function test periodically
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Your pt. is prescribed w/ amioderone & when you walk in to check on her, she's taking grape fruit juice w her med.
What should you do???
Stop her!!! Grape fruit juice is going to increase toxicity. The drug will stay in there longer (it already has a half life of 25-110 days!)
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Your pt. is experiencing facial flushing d/t having to take high dose of Niacin. What can she do to reduce the flushing effect?
Take aspirin 325 mg 30 min prior to niacin
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What is atropine sulfate?
It is anticholinergic drug. Blocks the parasympathetic system, allows sympathetic effects
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What is a drug that only blocks beta 1 receptors (heart & kidney)?
metoprolol (Lopressor or Toprol): dereases HR, force of contraction. Used as an antihypertensive agent to lower the BP & PULSE
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What is a drug that only STIMULATES BETA 2 RECEPTORS.
This is called a receptor subtype. What is a receptor subtype?
Terbutaline: causes bronchial dilation & uterine relaxations
Receptor subtype is a partial response. It's an epinephrine but only partially.
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What 2 chemicals mediate the SNS
Epinephrine & norepinephrine
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What chemical mediates the parasympathetic nervous system?
acetylcholine
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Which branch of the autonomic nervous system would each drug mimic?
(Write sympathetic or parasympathetic after each word).
1. cholingergic
2. anticholingeric
3. sympathomimetic
4. sympatholytic
5. parasympathomimetic
6. parasympatholytic
7. adrenergic
8. catecholamine
- 1. parasympathetic
- 2. sympathetic
- 3. sympathetic
- 4. parasympathetic
- 5. parasympathetic
- 6. sympathetic
- 7. sympathetic
- 8. sympathetic
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Name 2 reasons atropine sulfate (anticholinergic) is used as a preop med
Increases HR (by inhibits vagal stimulation of the heart) & decreases salivary secretions that might cause aspiration
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"Leave them dead with Levophed".
Why?
- B/c it's the last-ditch drug. Used when everything else failed to get BP up.
- May cause digital necrosis d/t peripheral constriction
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What is pilocarpine used for? What class of drug is it?
Pilocarpine is used for glaucoma, induction of miosis to counteract sympathomimetics in surgery or opthalamic procedures; xerostomia (dry mouth)
It is a cholinergic agonists
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What are the common uses of drugs that stimulate/mimic the parasympathetic nervous system?
Decrease body's esults from sympathetic stimulation
i.e: beta blocker decreases HTN & HR
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Why must sympathomimeitc drugs such as dopamine or norpeinephrine be given via a CVL?
Because they are very dose specific & need to be highly controlled
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Bumex & Demadex are what kind of diuretics?
loop diuretics. Similar to Lasix
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Which diuretic is the first drug of choice in HTN?
& where on the loop of Henley does it work at?
thiazide diuretic
Works at end of loop of Henley, before distal
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Can thiazide be used w/ renal insufficiency pts?
No
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Which diuretic elevates plasma levels of uric acid & glucose?
So what do you need to watch for?
Thiazide
Need to watch for blood glucose & gout (uric acid)
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Do NSAIDs & loop or thiazide play well together??
Why or why not?
No. NSAIDs will counteract
NSAIDS cause reabsorption of water & Na. Loop or thiazide want to prevent that from happening
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Why should we be cautious when giving ACE inhibitor & aldactone together?
ACE inhibitor increases potassium level. Together they will increase risk of hyperkalemia
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Which diuretic is used to reduce ICP & IOP (glaucoma)? & prophylaxis of renal failure
Mannitol
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Which diuretic has a/e of edema & transient volume expansion?
Mannitol
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Which diuretic must we use a filter needle or inline filter for administration? (hint: this drug is given IV only)
If the bottle is crystallized, should we throw it away?
Mannitol (think sugar, huge molecule, need to filter out)
No, just warm it up to proper temperature.
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Potassium Chloride: How should you give this parentally?
What if the pt. complains of burning?
Dilute it in at least 100mL. Can be given as boluses
If pt. complains of burning, slow it down
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Where does sodium polysterene sulfonate work?
What routes can you give it?
In the gut.
Oral or as enema
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1. Besides EKG, I&O, dehydration, & K level, what else should you watch for in a pt. receiving sodium polysterene sulfonate? (what are the adverse effects)?m(hint: this drug works in the gut)
2. What are the contraindications for this drug?
1. diarrhea, nausea & vomitting, GI pain
2. If pt. has rectal bleeding or probs & you need to give it via enema route
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What is verapamil used for?
Mostly ventricular arrhythmic probs, angina, & HTN
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Which beta blocker is used solely as antiarrhythmic drug, and HTN as an adjunct?
(hint: it's an a nonselective beta blocker)
Sotalol
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What do you teach a pt. that's taking Catapres about stopping the drug?
Can Catapres be used singly?
DO NOT STOP ABRUPTLY! rebound htn might occur.
No. Usually as an adjunct or PRN
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Which anticoagulant is an antagonist of vitamin K?
warfarin (Coumadin)
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What is the antidote for heparin?
Protamine sulfate
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Which anticoagulant must u check ur INR regularly to regulate that medication?
Coumadin
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What is Coumadin used for?
Mitral valve replacement. H/o of DVT, PE, A-fib
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Your pt. is taking Coumadin regularly. But she needs to go to surgery. What would you expect your Dr. will order to replace her Coumadin?
Put her on heparin. Then 1 hr before, put her off heparin.
After surgery, put her on heparin, then on Coumadin
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Which antihypertensive classification of drug has lupus as an adverse effect?
vasodilators: hydralazine
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Pt. is having an unstable angina. Before administrating nitroglycerin, what drug must we check before giving it to the pt. NTG? This drug is contraindicated w/ NTG!
Viagra!
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Is it OK to give a pregnant woman ACE inhibitors?
NO! AE is fetal injury
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Which ARBs are approved for post MI & post HF?
Valsartans
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Pt. is on amioderone (to treat arrhythmic) & the dr. prescribed him w/ warfarin (Coumadin) b/c he had a h/o of DVT.
What are the drug interactions of these 2?
Amioderone will cause increase level of warfarin
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What is adenosine used for ?
convert SVT to normal sinus rhythm
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What are the MOA of HMG-CoA reductase inhibitor?
o 1. Lowers LDL
o 2. Increases HDL & LDL receptors
o 3. Lowers production of apolipoprotein
o 4. Promotes plague stability (MI prevention)
o 5. Decreases inflammation at plaque site
- 6. Decreases CAD
- progression/calcification
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Where do "statins" work at?
They work in the liver.
Remember they increase LDL receptors
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What are the adverse effects of "statins"?
- 1. Myopathy: Muscle pain.
- 2. Rhabdomyolysis: Destruction of enough muscle cells & release of CK that they get toxic. ARM & THIGH ACHE, MUSCLE WEAKNESS
- 3. Hepatotixicity
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B/c you have to take high dose of niacin for it work, what adverse effects are you expecting?
- Facial flushing
- Itching
- Hepatotoxicity
- GI upset
- Cause increased homocysteine (just give folate)
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Niacin might cause increased homocysteine, which will increase risk of CVD. How do you treat this adverse effect?
Give them folate
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When do you see bile-acid sequestrants (cholestyramine, colestipol)prescribed?
As an adjunct to statins. Or when they can't take statins
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Which drug, if you push too fast, will cause transient ototoxicity?
hint: you have to push it at 20mg/min
Lasix
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What do Gemfibrozil (Lopid) & Fenofibrate (Tricor) do?
Lowers TRIGLYCERIDES. Diabetics have excessive TRIGLYCERIDES
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What are the AE's of fibrates/fibric acid derivatives?
Rashes, GI, risk of GB stones, myopathy, liver injury
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Which cholesterol drug displaces warfarin from albumin & causes more active warfarin out there in the blood stream?
Fibrates/fibric acid derivatives
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What are the MOA of bile-acid sequestrants?
hint: it passes through the intestines unchanged
Reduces LDL by preventing reabsorption of bile acids & increasing excretion.
1) BINDS chol & prevents it from being reabsorped
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What is the reversal agent for streptokinase OD?
Aminocaproic acid (Amicar)
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What is so different about Dobutamine (cousin of dopamine)?
dobutamine has more beta 1 receptor & no alpha effect (so less tachycardic effects)
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What is a condition that is contraindicated if a pt. is taking dobutamine?
IHSS
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