Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Pharmacology
Exam 2
| Question | Answer |
|---|---|
| What are the two main purposes for diuretics? To lower what 2 things? | Treat hypertension and edema -Lowering BP and decreasing Preload (through diuresis) |
| How do diuretics have antihypertensive properties? | They work on the RAA System 1) there's Diuresis - increase urine and release sodium and water which decreases fluid volume which decreases BP |
| Which diuretics are prescribed to treat hypertension? | 1) Thiazides, loop diuretics, Potassium sparing diuretics |
| How do loop diuretics differ from thiazide diuretics? | Both you are losing potassium, sodium, water, magnesium, chloride retain: Glucose, uric acid Loops: Stronger, excrete calcium, more vasodilation (doesn't affect renal blood flow, does not activate the RAAS)watch BP Thiazides: mild, reabsorb calcium |
| What is the action of spironolactone? | It is a potassium- sparing diuretic ~will release water, sodium, chloride, magnesium but it will retain potassium |
| What is the classification of furosemide e? | Loop-diuretic: takes off fluid, decreases preload, and takes work off the heart |
| How is furosemide(Loop) administered? What are the Pt's symptoms if potassium is low? | -IV 4-5 mins: remember if it's too fast, it will lead to ototoxicity - orally -full pill: Give earlier in the day, if given w/ dig (HF) watch potassium - Low potassium is more prone to cause dig toxicity pt -muscle weakness, tiredness, sluggish |
| What lab values should be monitored for thiazides? | I & O, potassium levels, calcium levels, sodium levels, magnesium levels, chloride levels, serum lipids, uric acid, glucose levels |
| What electrolyte imbalance may occur with acetazolamide (Diamox) | It is a carbonic anhydrase inhibitor:Diuretic(shift in acid/base balance) -will lose sodium, water and BICARBONATE -metabolic acidosis -used to treat Glaucoma and motion sickness |
| Lisinopril | Antihypertensive: Ace inhibitors: Work in the RAAS: lowers BP - Vasodilate, and diurese (blocking of aldosterone) -lose sodium, water and retain potassium |
| Diltiazem | Antihypertensive: Calcium Channel blockers: Lower BP - Dilate arterials (VASODILATE) -keeps blood in the periphery and doesn't come back to the heart - Brings preload down |
| Prazosin | Alpha 1 adrenergic blocker: Lowers BP - Vasodilates (inhibits norepinephrine) |
| Atenolol | Selective Beta Blocker (B1- renin): Decrease BP - decrease Heart rate - No renin effect- protection against it |
| Clonidine | Centrally-acting Alpha 2 agonist: Lower BP -vasodilation -adjunct med |
| Hydralazine | Direct- acting Arteriolar Vasodilator: Lower BP - make large arteries bigger -not much resistance to flow |
| Valsartan | ARBS:RAAS: Lowering BP - vasodilates, diuresis |
| Propanolol | Nonselective Beta Blocker (B1 & B2) - will cause bronchoconstriction: (anyone with bronchoconstriction AVOID) - decrease of myocardial contraction |
| Reserpine: NOT ON STUDY GUIDE | Adrenergic Neuron Blocker |
| Labetolol: NOT ON STUDY GUIDE | Alpha 1 and Beta 1 Adrenergic Receptor Blockers |
| Aliskiren: NOT ON STUDY GUIDE | Direct Renin inhibitor |
| Where in the body do direct- acting vasodilators act to decrease blood pressure? | Large arteries |
| With the use of direct-acting vasodilators, sodium and water are retained, and peripheral edema occurs. Which category of drugs should be given to avoid fluid retention? | Diuretics |
| What are the actions of Angiotensin 2 receptor blockers (ARBS)? | RAAS- They will block angiotensin 2,- the meds will help relax veins and arteries, lowering BP + diuresis, Vasodilation (release sodium and water, hold onto potassium) |
| Why is a thiazide diuretic often combined with an ARB? | ARBs retain potassium and thiazides get rid of potassium so they help balance potassium levels plus double diuretic effect |
| What is the most limiting factor regarding the use of angiotensin converting enzyme inhibitors (ACE inhibitors)? | RAAS- They affect the lungs so they can cause an irritating-dry cough -if they can't tolerate change to ARB |
| Name three effects of digitalis? | 1) positive inotropic: Increases contractions helps w/ failing heart 2)negative chronotropic: Decrease HR, allows time for the heart to fill better, also helps w/ dysrhythmias 3)Negative dromotropic: slows conduction time of the heart |
| What can be treated with digitalis? | -Heart failure for pts who need a better cardiac output - atrial arrhythmias: AFIB and Atrial flutter (Slow down ventricular response so that the heart can fill better) |
| Which electrolyte imbalance increases the risk of Dig toxicity? | Low potassium levels |
| What is the therapeutic digitalis level? | 0.5-2 |
| What is the antidote for dig- toxicity? | Digoxin immune Fab |
| How do phosphodiesterase inhibitors work? | Antihypertensives Ex: Milrinone: short use: Acute setting Positive Inotropic: strength in myocardial contractility + Vasodilation - comes in handy because when the ventricle is squeezing and contracting harder, the workload can decrease when you have va |
| How can ACE inhibitors help patients with heart failure? Think of the problem of HF -Contraction is no good, afterload is high- they might have trouble pumping against resistance | RAAS -vasodilates improves renal blood flow - inhibits renin -decreases preload- diurese (loses sodium and water, increases potassium retention) -takes off a lot of workload off of the heart works in the lungs so assess for cough |
| What drugs can be used to treat heart failure? | 1) Diuretics: Thiazide, Loops, Potassium Sparing Diuretics 2) Phosphodiesterase inhibitors: milrinone 3) Antihypertensives: Vasodilators: Ace and ARBs 4)Beta blockers 5)Cardiac Glycosides |
| Nitroglycerin acts directly on the ________ causing, relaxation and dilation Problem: heart has work to do and there not enough oxygen present w/o perfusin you get cell death | blood vessels -veins better than arteries -you will have VENODILATION bigger vessels, blood stays in the peripheries, Not too much comes back to the heart, the heart does not have to work as hard -discrepancy between workload and oxygen isn't as bad |
| What is the most common side effect of nitroglycerine? | Headache, Hypotension, dizziness, weakness, and faintness |
| What are some nursing interventions related to the administration of nitroglycerin (NTG) IV: Very fast drug, as soon as you titrate you will see a BP change -below 90.. stop and give fluids | Orally: more absorption through skin - pt lie down when taking the meds due to venous dilation: -Wet dry mouth first -teach pt to call 911 if chest pain persists after taking first dose - take vacations from patches to not become intolerant to it |
| What three drug groups can be used to treat chest pain? Problem: Discrepancy b/w workload and oxygen | 1) nitrates:vasodilates, widen coronary arteries- more blood-more O2, decreases workload 2) beta blockers: decrease workload by decreasing HR and contraction 3)calcium channel blockers: decrease workload by vasodilation and increased HR, widen coronary |
| Warfarin | Oral Anticoagulant: - Prevents DVT -Labs to look for: PT INR -antidote: vitamin K |
| Aspirin | Antiplatelet: - Prevents arterial clots from getting bigger |
| Enoxaparin | Low Molecular weight heparin: anticoagulant -more stable, better response -won't bleed as much -Don't need to do aPTT monitoring -longer half life than Heparin -protamine sulfate antidote |
| Protamine sulfate | Anticoagulant antagonist (antidote) |
| Clopidogrel (plavix) | Antiplatelet:ADP Antagonist - inhibit platelet aggregation |
| Streptokinase | Thrombolytic: -dissolves clots -saves disability from evolving MI or stroke (will take blood clot and make it dissolve) risk: bleeding |
| alteplase (tPA) | Thrombolytic -dissolves clots -saves disability from evolving MI or stroke (will take blood clot and make it dissolve) risk: bleeding |
| Anticoagulants are used to inhibit ? | Thrombi |
| The most frequent use of heparin is to prevent ? | -DVT and Pulmonary embolism -Evolving MI: Don't want the blood clot to get bigger |
| What are advantages of the use of low-molecular-weight-heparin? | -more stable, better response -won't bleed as much -Don't need to do aPTT monitoring -longer half life -protamine sulfate antidote |
| INR is a lab test to monitor the therapeutic effect of? | Warfarin: 2-3 PT INR gets high: Bump up foods w/ lots of vitamin k, given orally or injection |
| What is the major complication with the use of thrombolytic drugs? | 1) Prolonged bleeding |
| What is the antidote for heparin | protamine sulfate |
| what is the antidote for warfarin | Vitamin K |
| How does aspirin suppress blood clotting? | - inhibiting aggregation of platelet |
| What is clopidogrel (plavix)? Why is it prescribed? | -Antiplatelet: ADP antagonist - prevents aggregation of platelets |
| What is the antidote for thrombolytic medication | Aminocaproic Acid |
| Diuretics: Breaking up the classes | |
| Thiazides | -Work in the DCT: mild response - Hydrochlorothiazide -metolazone -releases: sodium, potassium, chloride, magnesium, water, -reabsorbs: glucose, uric acid, serum lipids, calcium -Don't give with GFR < 30 - Contraindication: renal failure |
| Loop Diuretics | -ascending Loop of Henle: More potent response - Furosemide -bumetanide -hearing loss - ototoxicity -lead to thrombocytopenia & leukopenia - can use with low GFR |
| Osmotic | -Work on the proximal tubules: Good diuretic - Mannitol -prevents kidney failure, Decrease IOP, ICP -warm the vial - crystallization -Contraindications: Heart failure, renal failure |
| Carbonic Anhydrase Inhibitors | - Acetazolamide (Diamox) -Blocks anhydrase balancing hydrogen and Bicarb -releases: Sodium, water, potassium, Bicarbonate -can lead to metabolic acidosis -used to treat IOP- Chronic glaucoma |
| Potassium-Sparing Diuretics | -Work on the collecting ducts & LDT -spironolactone & triamterene - release: sodium, water -retains: potassium - Don't combine with ACE or ARBs |
| Antihypertensives breaking up the classes | |
| Diuretics: -loops -thiazides | - loops do not repress renal blood flow -thiazides increase effectiveness of other antihypertensives +potassium sparing diuretics or ace inhibitors |
| Sympatholytics: antihypertensives Breaking up the classes | |
| Beta Adrenergic blockers | - Nonselective (B1&B2): Propranolol & Carvedilol: Bronchoconstriction (Be careful w/ COPD) -Selective (B1): Atenolol & Metoprolol -Antihypertensive, Antianginal, Antidysrhythmic -Drop in CO & BP -inhibits glucose -masks tachycardia |
| Centrally Acting Alpha 2 Agonists | -Clonidine -Vasodilates - Must give w/ a diuretic due to sodium and water retention |
| Alpha-Adrenergic Blockers | - Doxazosin & Prazosin -Vasodilates -Give with a diuretic due to sodium and water retention -HTN & BPH |
| Adrenergic Neuron Blocker | -Reserpine - Vasodilates, drops PVR, CO, BP - Give with a diuretic due to sodium and water retention |
| Alpha 1 and Alpha 2 Adrenergic Blockers | -Labetolol - Drops HR and Contraction -large dose: airway resistance and AV heart block |
| Direct- Acting Arteriolar Vasodilators | - Hydralazine - Relaxes smooth muscle of blood vessels - vasodilates - drops BP and raises HR -Give w/ diuretic: Sodium and water retention -Give w/ Beta blockers: to decrease the reflex of tachycardia |
| Angiotensin- Converting Enzyme (ACE) Inhibitors | - RAAS -Enalapril, Lisinopril, ramipril - Treat HTN & Heart failure, lower PVR - Cough, hyperkalemia, angioedema -contraindications: potassium sparing diuretics: spirinolactone |
| Angiotensin 2 receptor blockers (ARBS) | -RAAS - Losartan & Valsartan - blocks effects of angiotensin 2 -give with a thiazide diuretic: balances potassium -Hyperkalemia monitor for dizziness |
| Direct Renin Inhibitors | -RAAS -Aliskiren - Binds with renin prevents activation of RAAS -Use with a thiazide or ARB - african Americans have low renin |
| Calcium Channel Blockers | - Verapamil, Diltiazem, amlodipine - promote vasodilation - works best in small vessels and arteries -edema, flushing,headache |
Created by:
paolatorres2533
Popular Nursing sets