Pharm test 4

Prototype ACE inhibitor


Protoype Beta blocker


Prototype of ARBs


Prototype ca channel blocker


prototype Alpha2 blocker


Prototype Alpha/Beta blocker


Prototype HMG-CoA Reductase Inhibitor



the pressure that the heart must work against to eject blood during vent. Contraction.
Proportional to the average arterial pressure
The force or load against which the heart has to contract to eject blood


The initial stretching of the cardiac myocytes prior to contraction
Ventricular filling

Bp Meds: What qualities/conditions would trigger increased monitoring by the nurse?

-Women wishing to become pregnant
-Decreased renal function

Beta Blockers: What conditions would require careful monitoring?

Heart failure,
sinus bradycardia, PVD, renal and liver disorders, myasthenia graves, diabetes, depression

Alpha/beta blocker: contraindication
Know which conditions and/or nursing assessments are contraindicated

Asthma, Unstable heart failure, heart block, bradycardia
Caution: diabetic and children

calcium channel blocker: adverse effects

Medication lowers BP & Hr so monitor before administering
-Dependent edema
Reflex tachycardia, orthostatic hypotension, peripheral edema, arrhythmias

ACE inhibitor indications

Heart failure (HF)
Diabetic nephropathy

Angiotensin receptor blocker: action

Blocks angiotensin II receptors
Doesn't allow vasoconstriction

atorvastatin: adverse effects

Myopathy- muscle pain, and breakdown (rhabdomyolysis)
Hepatic toxicity

atorvastatin: contraindications

-grapefruit juice

atorvastatin: education

-Report muscle plain and monitor ck levels (myopathy)
-Report s/s of hepatic toxicity- abdominal pain, fatigue, anorexia, jaundice, and loss of appetite.
-prevents the synthesis of cholesterol by the liver, occurs overnight (restorative phase) take medica

atorvastatin: interactions

-Grapefruit juice
-Concurrent use of a fibrate or other drug to lower cholesterol can increase risk for myopathy or liver toxicity

fibrates: interactions
Know medication interactions

-Statin antilipemics greatly increase risk for myopathy -Warfarin with fibrates increases risk for bleeding

nitrates: action

After absorption, nitrate turns to nitric oxide w/ help from sulfydryl
Dilation of vascular smooth muscle of primarily the coronary veins and arteries
At the same time, venous dilation of the veins that feed the heart

nitroglycerin: short acting administration

Spray, sublingual

nitroglycerin: topical administration

Hairless, clean skin. Site needs to be rotated. Cream is ordered by inches. Squeeze on paper to measure. Nitroglycerin holiday (12 on 12 off) to reduce incident of tolerance.

nitroglycerin: routes of administration

IV, oral, topical, sublingual, and spray.

nitroglycerin: education

Know the route
Take at the first instance of pain (call 911), wait 5 mins, take another. Wait 5 mins. Take third dose.
Hypotension, tachycardia, headaches.

antiarrhythmics: assessment

Monitor VS and ECG rhythm continuously

class III: action/prototype

Class III: Potassium Blockers (Amiodarone)
Block K channel and affect Na and Ca channel
Block beta adrenergic receptors
Slows down automaticity
Lowers contractility and dilates coronary and peripheral blood vessels
Widened QRS and PR and QT

class III: administration

Potassium blocker (Amiodarone)
Start in hospital for EKG monitoring until stable
Correct electrolyte imbalance beforeing initiation
If IV large bore line
Monitor EKG, HR, BP

class Ia: adverse effects

Sodium Channel Blockers (Quinidine/procainamide)
Emboli- Arterial embolism may be mobilized. Blood thinners indicated if treating A-fib. Increase levels of warfarin (increase risk of bleeding). Bleeding precautions, adjusted dose.

Class II: contraindications

Beta blockers (propranolol)
Bradycardia, heart block, pulmonary edema, cardiogenic shock
Caution: hyperthyriod, diabetes

diuretics: Which dietary education is important to include?

Potassium rich foods: beans, prunes, raisins, tomato, spinach, baked potato

thiazide: education

Monitor blood glucose levels, Be aware that this effect may occur; usually without symptoms
Monitor for gout symptoms, especially with previous history.
Eat potassium rich food

digoxin: risk factors
What electrolyte imbalance is important to monitor?

Potassium, calcium, magnesium

digoxin: contraindications

Uncontrolled Ventricular dysrhythmias
AV block or severe heart disease
Digoxin toxicity

milrinone: administration

Available for IV infusion only
Give a loading dose over 10 minutes and then administer a dose based on client's weight by continuous infusion
Some solution incompatibilities exist; use dedicated IV line if possible

digoxin: s/s toxicity

Vision changes: blurry, double, or yellow/green halos

digoxin: action

Inhibits sodium-potassium pump
Helps the heart pump more efficiently
Inhibits normal function of Na/K pump
Positive inotrope: harder contractility
Negative chronotropic: slower heart rate
Negative dromotropic: slower SA/VA node impulse
Squeeze more blood

Digoxin antidote


spironolactone: education

Hyperkalemia- palpitations, irregular heart rate. Monitor labs.
Avoid potassium supplements, salt substitutes, foods
Menstrual irregularities and other hormonal charges

furosemide: interventions
What are nursing considerations when monitoring labs for a patient on furosemide?

Check electrolytes before administer medication; chemistry pannels (potassium and sodium)
Glucose levels
Monitor uric acid levels

furosemide: adverse effects

Electrolyte imbalance
Increase uric acid levels

furosemide: indications
When would furosemide be favored over other diuretics?

Treats pulmonary edema in heart failure

thiazides: contraindications

Allergy to sulfa
Anuria- produce urine
End stage renal failure

etanercept: administration
Which assessments are important before starting etanercept?

Weekly SQ
TB test prior to medication- ensure negative test before medication. Check routinely through treatment

methotrexate: interactions

NSAIDS, sulfa, and warfarin increase bleeding

raloxifene: education

Adequate calcium intake, vitamin D, and weight-bearing exercise
Monitor for DVT symptoms
Ensure bone density scans regularly

raloxifene: adverse effects

Increase risk of DVTs

raloxifene: evaluating outcomes

Bone density scans/ prevention of bone loss

bisphosphates: education

Report changes in swallowing
Remain upright after taking
Wait 30 minute before dairy, calcium intake
Osteo-necrosis jaw pain/ muscle joint pain

bisphosphonates: administration
Know the timing, patient positioning, interactions with other meds/dietary intake

Wait 30 minute for dairy, calcium supplements
Remain upright 30 minutes
Give with full glass of water

bisphosphates: adverse effects

Erosive esophagitis

calcitonin: adverse effects

Hypocalcemia (s/s muscle spasms/tingling)

calcium carbonate: administration

Chew tablets, drink a full glass of water

finasteride: action

Inhibits 5-alpha reductase, which reduces testosterone and reverse prostatic overgrowth

finasteride: indications

Benign prostatic hypertrophy (males only)

finasteride: evaluating outcomes

Serum PSA level decrease

tamsulosin: indications

Benign prostatic hypertrophy

tamsulosin: education

Report unrelieved headaches due to hypotension
Therapy is life long
Expected adverse effects: retrograde ejaculation
Contraindicated with sildenafil

testosterone: contraindications

Prostate cancer
Prostatic hyperplasia, obstruction

bethanechol: contraindications

COPD, asthma
GI/GU obstruction

oxybutynin: contraindications

Angle glaucoma, GI/GU obstruction

Class 1A, 1B, 1C

Sodium channel blockers
Controls rhythm
1A- Quinidine, Procainamide
1B- Lidocaine
1C- Flecaininde

Class II

Beta-adrenergic blockers
Controls rate

Class III

Potassium channel blockers
Controls rate and rhythm

Class IV

calcium channel blockers
Controls rate