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Test 5 Blueprint…

Pharmacology

+Why take andrenergic blockers?

Part of the andrenergic antagonist class that assists in lowering cardiac output and/or peripheral resistance.

Sympathetic nervous system relies on 2 andrenergic neurohormones or neurotransmitters, epinephrine and norepinephrine.

Andrenergic inhibitors (blockers) occupy the adrenergic receptors to prevent stimulation

Lowers blood pressure by stopping epi/norepi which relaxes the walls of the blood vessels and lets the heart pump more slowly and easily

Used in the treatment of HTN

+Beta Blocker Teaching

+Andrenergic blockers other uses

Can be used to treat benign prostatic hyperplasia

+Medications used for BPH

+Atropine Side Effects

+Andrenergic blocker side effects

+What is stepped care?

Stepped care is a medication management plan starting with the least invasive drugs and progressing as needed to more invasive drugs.

+What is the drug of choice for hypertension?

Diuretics are the drug of choice for hypertension Work quite well Are safe Are well tolerated Not expensive

+Why is hypokalemia common with diuretics and which diuretics? Hypokalemia is common with diuretics because:

Diuretics induce urinary loss Patients may not ingest enough potassium in the diet to

combat what is lost during the urinary loss

Thiazide and loop diuretics are the ones known to cause hypokalemia

+ACE inhibitors and diabeticsCatopril, vasotec

+Cardizem teaching/Diltiazem Take drug with or without meals

Avoid large amounts of grapefruit juice

Teach patient to monitor pulse

Instruct patient to maintain good dental hygiene and regular dental check ups

Swallow Extended Release capsule whole…don’t crush or break

If you can’t swallow whole, carefully open it, sprinkle contents onto cool applesauce, and immediately swallow contents with full glass of water without chewing

Notify prescriber if chest pain worsens or you get a rash

Avoid driving until you know how the drug will affect you

Move slowly when sitting up or standing to avoid dizziness

Tell prescriber if you’re pg or bf’ing

Protect against photosensitivity

+How do rennin-angiotensin blockers work?

They promote a decrease in the work of the heart (vascular afterload and preload) through vasodilation (vascular opening) when angiotensin II is inhibited.

They block the vasoconstrictive and alsdosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to angiotensin receptors in many tissues.

+What medications are ACE inhibitors:

+Patient teaching for beta andrenergic blockers…

Same as slide 3

+What do cardiac glycosides do?Drugs used to increase the efficiency and improve the contraction of the heart muscle; used to tread HF and atrial fibrillation

+What are digoxin levels?

Therapeutic levels are 0.5 to 2 ng/mL (nanograms per milliliter)

Toxic levels 2.5 ng/mL or more

Used as a cardiotonic (makes heart beat stronger and slower similar to cardiac glycosides)

Take apical pulse for 1 minute if it is below 60, don’t administer and notify physician

+What drugs are used to decrease fluid overload?

Diuretics

+What are signs of digoxin toxicity?

One of the earliest symptoms is often extreme fatigue!

Atropine counteracts digoxin toxicity!

+What are sodium channel blockers and how do they work?

+What is supraventricular dysrhythmia?

SVT

Any tachycardic rhythm originating above the ventricular tissue

Can come on suddenly and go away without treatment

Caused for a reason other than stress, exercise or emotion

From a few minutes to a few days

Pounding heart, shortness of breath, chest pain, rapid breathing, dizziness, loss of consciousness, & numbness of various body parts

Probably in a drug card as a medication side effect

+Myocardial Infarctions are usually fatal…T or F…

False

+Vital signs needed with nitro

Blood pressure and pulse before administration

+Side effects of nitrates

+Why take statins in the evening and how do they work?

Statins are often given with dinner to obtain the maximum beneficial effects, since the highest rate of cholesterol production happens between midnight and 5 am

+Side effects of cholesterol meds…

+Side effects of niacinNiacin is one of the most effective antihyperlipidemics at lowering triglyceride levels and increasing HDL levels.

+ACE cough

Frequent, dry, hacking, non-productive cough associates with the use of ACE inhibitors

+H2 blockers

Used for the treatment of GERD

+How diuretics cause a decrease in blood pressure

Indirectly reduce blood pressure by producing sodium and water loss and lowering the tone or rigidity of the arteries

Cause the kidneys to excrete sodium and water into the urine resulting in less fluid in the blood causing a reduction in blood pressure

+Why increased cholesterol leads to heart disease…

+Chronic renal failure means a decrease in medications

Decrease in medications that are able to be absorbed into your system

Decrease in the effectiveness of the medications

Cannot use medications that act on the kidneys

+What are common medications for angina?

+Foods that help with potassium

+What is digitalizing?

There are 2 different kinds of dosages for patients taking digoxin…

The initial digitalizing dose is the loading dose The maintenance dose is the regular daily dose

+What is long-acting nitrate for?

Long acting nitrates and topical, transdermal, transmucosal, and oral sustained-release nitroglycerin products are used: to prevent or treat anginal attacks WHEN they are likely to

occur Like during exercise

To reduce the severity and frequency of anginal attacts To reduce the work in the heart in cases of MI & chronic

heart failure For relief of gallbladder GI, urethral, and bronchial smooth

muscle pain

+What is special about aldactone/spironolactone?

Potassium sparing diuretic

Induces water and sodium loss but spares potassium

Do not take this with an ACE inhibitor because it can cause severe hyperkalemia

Used in elderly pts. With poor kidney function

CHF, nephrotic syndrome, kidney disease

Antagonizes aldosterone at the late distal tubule & late cortical collecting tubule

+What are the different types of diuretics?

+How do vasodilator medications work?

Relax the smooth muscles in the arterioles and lowers PVR

Used in the treatment of HTN

Drugs that help expand or open up the arteries by relaxing the smooth muscles of peripheral arterial blood vessels and help lead to better circulation to the arms and legs

+What are some geriatric considerations when taking antihypertensives?

+What electrolyte needs to be replaced when on diuretics?

potassium

+What is the difference between thiazide and loop diuretics?

+How to decrease nitroglycerin?

+How do you take other medications with antihyperlipdemics?

+What is important about the storage of nitroglycerin?

+Nitroglycerin instructions…

•Take on an empty stomach, no alcoholic beverages, & minimize foods/drinks w/ caffeine•Pt. can develop a tolerance•In hospital blood pressure should be taken before dosing and between doses•Pt. should keep a record of all anginal attacks•Pt. should use nitro when an attack is expected•Meds are only part of the therapy…weight loss, avoiding triggers, and exercise are important•Keep out of reach of children

+Lidocaine can be given IV to treat dysrhythmias…

True?

Lidocaine acts as an antidysrhythmic by raising the ventricular myocardium threshold

+Signs of digoxin toxicity in males…caused by digoxin’s estrogen like effects