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Cardio Drugs 2

Advanced Pharm for Nursing Practice 2

QuestionAnswer
Beta-blockers generic names often end in? beta-blockers end in -OLOL
How do beta-blockers work on the heart? slow the hrt rate & decrease contractility by binding to &blocking the beta-adrenergic receptors in the heart; this ultimately decr work load of heart
What’s the prototype for non-selective beta-blocker? propranolol*
What’s the prototype for cardioselective beta-blocker? metoprolol* (Lopressor) for HTN or angina; atenolol (Toprol) for HTN, angina, or heart failure
What’s the prototype for alpha-beta blockers? Labetolol and carvedilol
When using a beta-blocker, what’s the benefit of slowing the heart rate? if t/ heart is beating too fast, not enough time in diastole when it can fill /c O2 & nutrient-rich blood. As hrt beats faster, the insufficient O2 causes ischemia & pain. Beta-blockers slow t/ heart down, heart gets time to fill /c O2.
How long will it take before seeing a max effect of beta-blockers? 1 week
How do beta-blockers affect renin? beta-blockers inhibit renin (part of renin-aldosterone-angiotensin sys). Renin is a potent vasoconstrictor t/ kidneys release when they sense poor bld perfusion. Renin block allows bld vessels to/from kidneys to dilate--> decr bld pressure
Why should beta-blockers be given to post MI pts? beta-blockers block the release of catecholamines (Norepi and Epi) from the now damaged heart. This is a good thing bc the catecholamines would attempt to incr heart rate.
What are the contraindications for beta-blockers? 1st degree heart block; sinus bradycardia (bc the heart’s already too slow & don’t want to slow it down more); bronchoconstrictive diseases
What are warnings about beta-blockers? may cause/mask hypoglycemia, esp in diabetics bc decr breakdown of glycogen to glucose (t/ normal S/S of palpitations & tachycardia are also masked by beta-blockers; DON’T STOP ABRUPTLY, esp those w/ angina; alpha/beta-blockers cause ortho hypotension
What are SE/ADR of beta-blockers? if you decr cardiac output & O2 to muscles, they’ll get tired; insomnia & vivid dreams; bradycardia
What are possible interactions with beta-blockers? biggest concern is additive effect; ex: digoxin and Beta-blockers slow the heart; verapamil (CCBs) and beta-blockers slow the heart; cimetidine incr beta-blocker bld level; rifampin (enzyme inducer) decr effectiveness of beta-blockers
How does atenolol (Tenormin) work in the body? atenolol is a cardioselective beta1-blocker and is indicated for prophylactic tx of angina pectoris; its use /p MI has been hown to lead to decr in mortality
How does metoprolol (Lopressor) work in the body? metoprolol is a cardioselective beta1-blocker used for prophylactic tx of angina; it decr mortality in MI pts and helps treat angina.
How does propranolol (Inderal) work in the body? propranolol is a nonselective beta-blocker; it’s the most lipophilic beta-blocker and can penetrate into many organs, including the brain
Generic selective alpha1-blockers end in what? selective alpha1-blockers end in –ZOSIN
What are the selective alpha1-blocker prototypes? Prasozin (Minipress), Terazosin (Hytrin), & Doxazosin (Cardura)
How do selective alpha1-blockers work? they selectively block t/ post synaptic alpha1-receptors; there are receptors in the eye bld vessels and various other places in body; selective alpha1-blockers affect mostly bld vessels of skin and splanchnic area.
What’s the action of alpha1-blockers? the dilation of the small bld vessels assists in the decr of bld pressure
What’s the indication for selective alpha1-blockers? for tx of BPH and in reduction of HBP
What are SE/ADR of selective alpha1-bockers? Na+ and H2O retention; Headache & dizziness; palpitations
What is a warning for pts regarding selective alpha1-blockers? 1ST DOSE EFEFCT-profound hypotension, important to start with smallest dose @ bedtime and titrate up
What medication is used for BPH for men w/o HTN? Tamsulosin* (Flomax); it’s an specific prostatic alpha1a-antagonist
What are common SE of Tamsulosin* (Flomax)? Headache, dizziness, ortho hypotension, rhinitis, & abnormal ejaculation
How do alpha1-blockers work in BPH? Terazosin (Hytrin) blocks alpha1a (blood vessels) and alpha1b (prostate gland receptors) & relax smooth muscles; 5-alpha reductase inhibits DHT formation & finasteride (Proscar) inhibits its action (thereby stopping prostate tissue growth over time)
What is the prototype for non-selective alpha-blockers? phentolamine
How do non-selective alpha-blockers work? non-selective alpha-blockers block both alpha1-receptor in bld vessels (--> vasodilation and decr BP) AND blocks alpha2-receptor on post-ganglionic neuron (where neg feedback occurs)
What’s a consideration w/ administering phentolamine? be sure to give on pump very slowly
What’s the indication for phentolomine? phentolomine is often used when Levophed & Dopamine (both vasoconstrictors) IVs infiltrate into tissues; main use: pheochromocytoma (that’s what causes the hypertensive crisis)
What’s a serious effect of phentolomine administration? phentolamine administration is likely to cause XS Norepi release which will stimulate the heart and cause reflex tachycardia which will then transition to hypotension; be sure to give drug very slowly on IV pump bc it acts fast
What’s the SE/ADR of non-selective alpha-blockers like phentolomine? non-selective alpha-blocker SE/ADRs are angina, reflex tachycardia, hypotension
What step are vasodilators for HTN? vasodilators are 3rd or 4th step drugs for HTN
What are the prototypes for vasodilators? hydralazine* (Apresoline) and Minoxidil (Loniten), and nitroprusside* sodium (Nipride)
How do vasodilators work? vasodilators act directly on bld vessels to cause dilation of vascular smooth muscle; this lowers bld pressure
What are SE/ADRs of vasodilators? reflex tachycardia; Na+ & H2O retention; palpitations, tachycardia, and edema; Minoxidil causes hypertrichosis (XS growth of fine body hairs)
Explain why you must give a beta-blocker before giving a vasodilator? prob is when you lower bld pressure, you stimulate the carotid and aortic sinuses to cause reflex tachycardia (bc brain thinks BP is too low); for this reason, give BETA-BLOCKER /a giving vasodilator to prevent t/ tachycardia
Explain why you must give a diuretic while using a vasodilator? when vasodilation is started, it sets of renin-angiotensin-aldosterone sys, causing Na+ & H2O retention, so give diuretic
When is Minoxidil indicated as vasodilator? What’s the warning? Minoxidil is ONLY indicated for tx of pts /c poor renal function. Must take Lasix for diuretic bc minoxidil causes extreme Na+ retention; BLACK BOX WARNING /c Minoxidil: pericardial effusion progressing to tamponade, can worsen angina pectoris
What’s the indication for nitroprusside* (Nipride)? nitroprusside is used for hypertensive crisis; very fast acting; ACTS IN 2 MINS, & only lasts a few min /p infusion
What’s the warning with nitroprusside* (Nipride)? maintaining low BP requires continuous IV infusion of nitroprusside; but nitroprusside metabolizes to Cyanide (therefore, there’s a set dose you can only give for certain amt of time, & MUST MONITOR FOR CYANIDE TOXICITY)
What are considerations with nitroprusside* (Nipride)? Protect bottle from light (it turns brown upon exposure) KEEP IN BROWN WRAPPER OR TINFOIL; must use IV pump
What are prototypes for pulmonary HTN drugs? epoprotenol sodium (IV), trepostinil (IV or sub-q), iloprost (inhalation 6-9x/day)
What are the MOAs for pulmonary HTN drugs? systemic vasodilation (they hv direct action on pulmonary artery beds
SE of pulmonary HTN drugs? flushing, HA, nausea, and anxiety
What are the 2 endothelin-1A antagonist prototypes? How do they work? ambristentan (Letairis) & bosetan (Tracleer) are oral drugs; these drugs block the endothelin-1A receptors in the pulmonary sys and reduce the pulm HTN
What is endothelin-1A? endothelin -1A is a neurohormone that binds to receptors & causes vasoconstriction; pts /c pulm HTN have XS level of endothelin -1A
What’s the warning with endothelin-1A antagonists? Liver Damage
Created by: Fukanwa