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Ble, cvs, & renal sy
Pharmacology
| Question | Answer |
|---|---|
| a pharmacological agent that increases the action of the heart. via positive chronotropic action (i.e. increased rate) or inotropic action (i.e. increased intrinsic contractility) are called | Cardiac stimulant |
| Examples of cardiac stimulant drugs are | Epinephrine norepinephrine dopamine dobutamine isoproterenol phenylephrine Ephedrine. |
| drugs that help to improve the blood circulation either through vasoconstriction of peripheral blood vessels increasing the peripheral resistance leading to increase heart beat, OR drugs that stimulate the heart directly to increase heart beat | Circulatory or cardiac stimulate drugs |
| What group of drugs epinephrine in | is a Vasoconstrictor, Bronchial dilator and a Sympathetio stimulant drug. |
| What is the generic name of epinephrine drug | |
| What is the trade name of epinephrine drug | (Adrenaline or Sus-Phrine) |
| Mode of action in f epinephrine drug | It increases calcium influx in cardiac cells and acts directly on β1-adrenergic receptors of the myocardium, cells of the pacemaker and conducting tissues to produce acceleration of the heart rate. |
| Indication or used of epinephrine drug | Cardiac arrest anaphylaxis complete heart block Bronchial Asthma, Shock, Urticaria, Haemorrhagic conditions (e.g.Epistaxis), Angioneurotic oedema. |
| Dosage of epinephrine drug | Dose 1 in 10000 (i.e. 100mcg/ml) i.v or 1mg (10ml), repeated at 3-minutes interval. |
| Route of administration of epinephrine drug | Intracardiac Subcutaneously Topically and Rectally |
| Side effect of epinephrine drugs | Hypertension Palpitation Tachycardia Arrhythmia Nausea and Vomiting. |
| Adverse side effect of epinephrine drug | tachycardia tremor anxiety headache sweating dizziness weakness hyperglycaemia pulmonary oedema, cerebral haemorrhage. |
| Contraindication of epinephrine drug | Hypertension Thyrotoxicosis Phaeochromocytoma. |
| Nursing responsibilities or role of a nurse in used of epinephrine drug | Ascertain if patient has any precautionary conditions including heart disease, hypertension, DM, arrhythmias, etc. Also observe patient closely to detect any side effects in order to intervene. |
| Which group of drug nonepinephrine in | is a Vasoconstrictor and a sympathetic stimulant. |
| What is the generic name of nonepinephrine drug | |
| What is the trade name of nonepinephrine drug | (Noradrenaline) |
| Mode of action of nonepinephrine drugs | It constricts the peripheral blood vessels, increasing the peripheral resistance, which invariably leads to increase in blood pressure. Indications:- Surgical shock or Shock conditions, Hypotension. |
| Indication or used of nonepinephrine drug | Surgical shock or Shock conditions Hypotension. |
| Dosgae of nonepinephrine | 4ml of 1:1000 solution being added to 1 litre of saline OR 5% dextrose solution and infused at the rate of 0.5 - 2ml per minute OR 28 micrograms per minute by intravenous infusion. |
| Side effect of nonepinephrine | Hypertension Palpitation Tachycardia. |
| Route of administration of nonepinephrine | Intravenously |
| Contraindication of used of nonepinephrine drug | Hypertension Thyrotoxicosis Phaeochromocytoma. |
| Which group of drug dopamine in | It is an Inotropic Sympathomimetic or Cardiac stimulant drug. |
| What is the generic name of dopamine drug | |
| What is the trade name of dopamine drug | |
| Mode of action of dopamine | It acts as the Beta, receptor in the cardiac muscle and thereby increasing the contractility (contraction) with little effect on the heart rate. |
| Indication or used of dopamine drug | Cardiogenic shock infarction Cardiac surgery |
| Dosage of dopamine | 2.5-10 micrograms per kg body weight per minute./ITAT2A |
| Route of administration of dopamine drug | Intravenous by infusions |
| Side effect of dopamine drug | Tarchycardia Hypotension Nausea Vomiting Peripheral vasoconstriction Hypertension |
| Contraindications of dopamine | Tachyarrhythmia Phaeochromocytoma. |
| Which class of drug dobutamine in | is an Inotropic Sympathomimetic or Cardiac stimulant drug. |
| What is the generic name of dobutamine drug | |
| What is the trade name of dobutamine drug | |
| Mode of action of dobutamine drug | It acts as the Beta, receptor in the cardiac muscle and thereby increasing the contractility (contraction) with little effect on the heart rate. |
| Indication or used of dobutamine drug | Inotropic support in infarction Cardiac surger Septic shock Cardiogenic shock and Cardiomyopathies (i.e. disorders of cardiac muscle). |
| Dosage of dobutamine drug | 2.5-10 micrograms per kg body weight per minute./ITAT2A |
| Route of administration of dobutamine drug | By Intravenous infusion. |
| Side effect of dobutamine drug | Tachycardia and marked increase in systolic blood pressure indicate over dosage. |
| Contraindication of dobutamine drug | Tachyarrhythmia, Phaeochromocytoma. |
| Nursing responsibilities in used of dobutamine drug | 1) Monitor the patient's vital signs especially pulse, Blood pressure to assess the cardiopulmonary functions. 2) Don' administer to g groups of einpatients mentioned above under Contraindications. |
| Which class of drug isoproterenol | It is a bronchodilator. |
| What is the generic name of isoproterenol Drug | |
| What is the trade name of isoproterenol drug | |
| Mode of action of isoproterenol drug | It dilates the bronchial trees by relaxing the smooth muscles of the bronchi and bronchioles and also has a pronounced stimulant cardiac effect. |
| Indication or used of isoproterenol drug | Bronchial Asthma Chronic Bronchitis. |
| Dosages of isoproterenol | 5 - 20mg. 5mg in 500ml of 5% Dextrose for intravenous infusion. OR Adults and children = 1 - 3 puffs repeated after 30 minutes if necessary. Maximum of 24 puffs in 24 hours. |
| Route of administration of isoproterenol drug | Sublingually inhalation intravenously. |
| Side effect of isoproterenol | Tachycardia Arrhythmias headache Tremor Dry mouth, palpitation, Anxiety. |
| Contraindication of isoproterenol | Hyperthyroidism Acute coronary disease Cardiac Asthma Chronic heart disease.me |
| Which group of drug ephedrine | It is a bronchial dilator. |
| What is the generic name of ephedrine drug | |
| What is the trade name of ephedrine drug | Vaponefrin |
| Mode of action of ephedrine drug | (1) It relaxes the bronchial smooth muscles in a more prolonged and slower manner thereby making the air-way more patent along the bronchial trees. (2) It also constricts the peripheral blood vessels thereby raising the blood pressure. |
| Indication or used of ephedrine drug | Bronchial Asthma chronic bronchitis associated with Asthma Bronchial spasm. |
| Dosage of ephedrine drug | 15 - 60mg or one tablet thrice daily. |
| Route of administration of ephedrine | Orally (e.g. sublingually) inhalation as Nasal drop intravenously and subcutaneously. |
| Side effect of ephedrine | Tachycardia Nausea headache Gastrointestinal distress Arrhythmias hypertension insomnia Palpitation. |
| Contraindication of ephedrine drugs | Hyperthyroidism hypertension coronary diseases: |
| What are cardiac depressant drug | agent that decreases heart rate and contractility. |
| Some Examples of cardiac depressant drugs are | procainamide quinidine |
| Other drugs that produce cardiac depressants as side effect are | chlorpromazine carbamazepine phenobarbitone in high doses. |
| Which group of drug quinidine in | It is a cardiac depressant or Anti-Arrhythmic drug. |
| What is the generic name that f quinidine drug | |
| What is the trade name of quinidine drug | Quinora |
| Mode of action of quinidine drug | It helps to prevent ectopic beats and paroxysmal tachycardia, by increasing the refractory period of the heart and decreasing the myocardial contractility. |
| Indication or used of quinidine drug. | Ventricular Arrhythmias Atrial Fibrillation Premature heart contraction Paroxysmal supraventricular tachycardia. |
| Dosage of quinidine drug | 60 - 300mg or 200mg 3 - 4 times daily. |
| Route of administration of quinidine drug | Orally Intravenously. |
| Side effect of quinidine drug | Nausea Vomiting Diarrhoea hypotensio , Tinnitus rarely hypersensitivity reaction and Thrombocytopenia. |
| Contraindication of quinidine drug | Known hypersensitivity person. |
| Nursing responsibilities in used of quinidine drug | (1) Nurse to avoid over dosage of this drug that could lead to blurring of vision, Dizziness, headache, heart block, premature beats, ventricular tachycardia and fibrillation. (2) The nurse should monitor the Radial and Apical pulse rates |
| rates and inform the Doctor incase of any major change before administering it again. 3. Other aspects of the vital signs must be closely monitored. (4) It is advisable to administer the tablet form with food to prevent or reduce gastrointestinal upsets. | |
| What class of drug Procainamide | antiarrhythmic |
| What is the trade name of procainamide | Procan |
| Mode of action of procainamide drug | produce a direct cardiac effect to prolong the refractory period of the heart & depress the conduction of the cardiac impulse. |
| Used of procainamide drug | - ventricular tachycardia. - Atrial fibrillation. - Digitalis intoxication. |
| Contraindication of procainamide drug | Hypersensitivity complete AV heart block |
| Side effect of procainamide drug | Hypotension abdominal pain bitter taste |
| What are antiarrhythmic drug | They are drugs that can modify impulse generation and conduction and result in regularity of the heartbeat. |
| Antiarrhythmic drugs are classified based on | 1. Class 1- action is Na+ channel blockade e.g. procainamide, quinidine, disopyramide lidocaine, etc. 2. Class 2- beta-adrenoceptor blockers (or Sympatholytic). E.g. propranolol, esinolol, acebutolol, atenol. 3. Class 3- prolong refractory period e.g |
| e.g. Amiodarone, Bretylium, Sotalol. 4. Class 4- Ca2+ channel blockers e.g. verapamil, diltiazem. | |
| Examples of Na+ channel blockade under class 1 are | procainamide quinidine disopyramide lidocaine etc. |
| What class of drug lidocaine in | antiarrhrythmic. |
| Which group of drug lidocaine in | it is a local anaesthetic and an anti arrhythmic drug. |
| What is the generic name of lidocaine drug | |
| What is the trade name of lidocaine drug | xylocaine – Esracain |
| Mode of action of lidocaine drug | Lidocaine blocks both open and inactivated cardiac Na+ channels. |
| Indication or used of lidocaine drug | ventricular arrhythmias arising from myocardial ischaemia secondary to MI. |
| Dosage of lidocaine drug | 3-4mg/kg over 20-30 minutes or 100mg followed by 50mg 8hourly x 3 doses. |
| Side effect of lidocaine drug | Hypotension, 'bradycardia, respiratory arrest, irritability, Agitation, seizures, Aspiration due to suppressions of gag breflex in fo oropharyngeal mucosa. |
| Contraindication of lidocaine drug | Local skin rash known hypersensitivity, |
| Adverse side effect of lidocaine drug | Seizures in large rapid doses drowsiness slurred speech paresthesia agitation confusion cardiac arrhythmias. |
| Route of administration of lidocaine drug | I.V |
| Examples of beta-adrenoceptor blockers (or Sympatholytic) under class 2 of classification of antiarrhythmic drugs are | propranolol esinolol acebutolol atenol. |
| ___ are drugs useful in treating tachyarrhythmias caused by high sympathetic activity | Class 2: beta-adrenoceptor blockers (or Sympatholytic) |
| What class of drugs Propranolol in | |
| Which group of drug Propranolol in | It is both an Antihypertensive and Antiarrhythmic drug or Be blocking agent. |
| What is the generic name of Propranolol | |
| What is the trade name of Propranolol | |
| Mode of action of Propranolol | I. In hypertensive patient, it helps to reduce the plasm Renin activity thereby reducing the force of myocardial contraction. |
| Indication or used of Propranolol drug | Cardiac arrhythmia |
| Dosage of Propranolol | 10-40mg 3-4 times/daily (adult). |
| Route of administration of Propranolol | |
| Side effect of Propranolol or adverse effect | Bradycardia HF hypotension conduction disorders peripheral vasoconstriction. |
| Contraindications of Propranolol | uncontrolled HF asthma sick sinus Syndrome. |
| Nursing considerations in used of propranolol drug | • Patient to take before meals. • Avoid abrupt withdrawal especially in Ischaemic heart disease, DM, partial hypertension, etc. |
| Drugs that Reduces the incidence of sudden arrhythmic death after MI. | Propranolol drug |
| Mode of action of propranolol drug | 2. & Beta-receptor blocking agent preventing the stimulation of Bet receptors by exercise, Adrenaline and Noradrenaline thereby reducing the cardiac output. 3. |
| In Angina Pectoris, it inhibits Sympathomime influences and consequently slows the heart, reduces its forced contraction and decreases its Oxygen consumption. | |
| Propranolol Adult dose of drug for hypertensive patient are | Dosage:-Adult dose for Hypertension=160-320mg daily. OR 20 - 1000m daily in 2 or 3 doses. |
| Dose of propranolol for angina pectoris | Angina Pectoris=120 - 240mg daily. |
| Dose of propranolol for anxiety migraine and essential tremor are | For Anxiety Migraine and Essential Tremor=80 - 160mg daily. |
| Which group of drug ACEBUTOLOL in | It is an Antihypertensive or Beta-adrenergic-receptor blocking® drug. |
| What is the generic name of ACEBUTOLOL | |
| Trade name of ACEBUTOLOL drug | Sectral |
| Mode of action of ACEBUTOLOL | 1. It acts by preventing excessive sympathetic V stimulation of the heart muscle, thereby reducing the rate and force of myocardial contraction through vasodilatation, as well as reducing the work and oxygen requirement of the heart. |
| 2. It It also helps to suppress the plasma Renin activity which would have led to hypertension due to the formation of Angiotensin I| (Vasoconstrictor) in Renin-Angiotensin-w Aldosterone System. | |
| Indication or used of ACEBUTOLOL | Anxiety Prophylaxis of Migraine Hypertension Angina a pectoris Arrhythmias, Supraventricular: | tachycardia, o Preoperative° preparation for Thyroidectomy."'1o1 |
| Dosage of ACEBUTOLOL drug for hypertension and angina pectoris patients | For Hypertension = Initially 400mg once daily or 200mg twicedaily, increased after 2weeks to 400mg twice daily if necessary; and -For Angina pectoris = Initially 400mg once daily or 200mg twice daily or H 300mg three times daily in severe Angina. |
| Dosage of acebutolol for arrhythmias patient. | For Arrhythmias = 0.4-1.2gm daily in 2-3 divided doses. |
| Route of administration ACEBUTOLOL | Orally in capsule or Tablet form. |
| Side effect of ACEBUTOLOL drug | Bradycardia, Hypotension Bronchospasm Dysonoea Headache -Fatigue, Insomnia, Nausea, Diarrhoea, Cold Extremities, / Paraesthesia, Dizziness, Vertigo, Purpura, Thrombocytopenia, I Visual m disturbance, Alopecia, Peripheral vasoconstriction |
| Contraindication of ACEBUTOLOL | Asthma,a Uncontrolled heart failure, no Marked b Bradycardia, Hypotension, Cardiogenic shock, Metabolic acidosis, ob Phaeochromocytoma, Bronchospasm, 2nd nor 3rd degree AV blockllot Frequent episode of Hypoglycaemia.or |
| Which group of drug Atenolol in | It is an Anti-hypertensive and Beta-blocker Agent, |
| What is the generic name of Atenolol | |
| What is the trade name of Atenolol | Tenormin |
| Mode of action of Atenolol drug | _As discussed before under Propranolol. |
| Indication of Atenolol | Hypertension Angina pectoris Arrhythmias Acute myocardiac infarction |
| Dosage of Atenolol drug | Atenolol dose PO 50-100mg dly |
| Route of administration of Atenolol | Orally Intravenously. |
| Side effect of Atenolol | Bradycardia Leg pains Cold Extremities. Tiredness, Light headedness Fatigue Lethargy drowsiness depression, Diarrhoea Nausea Bronchospasm Dry eyes skin rash. |
| Contraindication of Atenolol | Sinus Bradycardia Cardiogenic shock Overt cardiac failure Anuria and Hypersensitivity to Atenolol, lactating mothers. |
| Which group of drug Metoprolol In | It Is an Antihypertensive or Beta-adrenergic-receptor blocking Drug |
| What is the generic name of of Metoprolol | |
| What is the trade name of Metoprolol | |
| Mode of action of Metoprolol | As discussed above under Acebutololom |
| Indication or used of Metoprolol | Hypertension Angina pectoris Arrhythmias, Prevention of heart attacks Myocardial infarction Hyperthyroidism, Migraine prophylaxis. |
| Dosage of Metoprolol for hypertension and angina pectoris patient | Hypertension => 100-450MG IN DIVIDED DOSES P.O Angina => 50-400mg dly bd P.O |
| Dosage of metoprolol for heart failure and myocardial infarction patient | MI => 5mg IV every 2 minutes as tolerated x 3 doses (i.e. 15mg maximum). Then switch to 50mg 6 hourly x 48 hours orally. HF => 25mg 200mg once daily |
| Route of administration of Metoprolol | Orally in tablet form, Also intravenously. |
| Adverse side effect of Metoprolol | Bradycardia hypertension palpitations, etc. |
| Contraindication of Metoprolol drug | As mentioned above under Acebutolol. |
| Side effect of metoprolol | As listed above under Acebutolol. |
| drugs that useful in treating tachyarrhythmias caused by high sympathetic activity are called | Class 2: beta-adrenoceptor blockers (or Sympatholytic). |
| Examples of prolong refractory period under class 3 classifications of antiarrhythmia drug are | Amiodarone Bretylium Sotalol. |
| What class of drug Amiodarone | Antiarrhythmic |
| Which group of drug Amiodarone in | It is an Anti-Arrhythmic drug |
| What is the generic name of Amiodarone | |
| What is the trade name of Amiodarone | Procor |
| Mode of action of Amiodarone | It blocks myocardial K+ channels and slows down the conduction and refractoriness. |
| Indication or used of Amiodarone | Severe rhythm disorders e.g. tachyarrhythmias atrial flutter paroxysmal tachyarrhythmias. |
| Dosage of Amiodarone | P.O 200mg tds x 1/52.maintenance = 200mg dly I.V = 150mg bolus in 10 minutes followed by 1mg/min IV for 6 hours, then 0.5mg/min for 18 hrs. Not for child. |
| Route of administration of Amiodarone | Orally in tablet form. |
| Side effect of Amiodarone | - Bradycardia, CHF, Fatigue, tremors. - Visual disturbances, photophobia, dry eyes. - Hemolytic or aplastic anemia. - Hepatotoxicity. |
| Contraindication of Amiodarone | Sensitivity. - Sinus bradycardia - AV block - Thyroid dysfunction |
| Which group of drug SOTALOL HYDROCHLORIDE in | It is an Antihypertensive, or Beta-adrenergic-receptor blocking drug |
| What is the generic name of SOTALOL HYDROCHLORIDE | |
| What is the trade name of SOTALOL HYDROCHLORIDE | (Beta-cardone, Sotacor) |
| Mode of action of SOTALOL HYDROCHLORIDE | (1) It helps suppress ventricular. ectopic beats and non-sustained ventricular tachycardia. (2) As discussed above unders Acebutolol. |
| Indication or used of SOTALOL HYDROCHLORIDE | Ventricular Arrhythmias Prophylaxis of Supraventricular Arrhythmias.goinsribem. |
| Dosage of SOTALOL HYDROCHLORIDE | |
| Side effect of SOTALOL HYDROCHLORIDE | Listed above under acebutolol |
| Contraindication of SOTALOL HYDROCHLORIDE | Renal failure Congenital or Acquired long syndrome. Others are as listed above under Acebutolol,ebrisip |
| Route of administration of sofa lol hydrochloride | Orally by tablet and intravenous |
| Examples of Ca2+ channel blockers under class 4 classifications of antiarrhythmia drugs are | verapamil diltiazem. |
| What class of drug Verapamili in | calcium channel blocking agent (anti-angina, antihypertensive, antiarrhythmia) |
| Which group of Verapamil in | |
| What is the generic name of Verapamil | |
| What is the trade name of Verapamil | Ikacor |
| Mode of action of Verapamil | |
| Indication or used of Verapamilm | Supraventrivular arrhythmias - angina pectoris. - arrhythmia (atrial fibrillation, and flutter). -Essential hypertension |
| Dosage of Verapamil | P.O 40-120mg tds dly or Initial 80-120 mg tid then 240-480 mg /day. |
| Route of administration of Verapamil | |
| Side effect of Verapamil. | AV block bradycardia headache dizziness abdominal cramps, blurring of vision, and edema. . |
| Contraindications of Verapamil drug | hypotension cardiac shock and MI |
| Mechanism of action of Class 4- Ca2+ channel blockers | They drugs slow conduction in tissues that are dependent on Ca2+ currents, such as the AV node by blocking the channels. |
| What are vasodilators | They are agent that queen blood vessel |
| What are digoxin | They are drugs that slows down conduction in the AV node and increases its refractory period thereby reducing ventricular rate, they improves the pumping of the heart owing to improved filling. And also |
| They acts primarily by inhibition of sodium potassium adenosine triphosphate (Na+/K+ ATPase) in the myocardium. | |
| Indication of digoxins drugs are | Atrial fibrillation atrial flutter HF |
| Dose of digoxin drugs are | 0.75mg-1.5mg in the first 24hrs as rapid digitalization. |
| Maintenance dose of digoxin | 125-250mg/day. |
| What are Vasodilation | These are agents that widen blood vessels therefore cause a ↓ in vascular resistance and ↑ in blood flow. |
| Mechanism of action of vasodilation drugs | They act by activating the vasomotor centre in the brain to bring about relaxation of smooth muscle in the blood vessel wall or they can act locally on blood vessel smooth muscle cells. |
| Indication or used of vasodilators drug | Hypertension, angina pectoris CCF ( congestive heart failure ) |
| Arterial dilators are however not suitable for angina pectoris disease because | they produce reflex cardiac stimulation |
| Venous dilators are thus the ones used in treating ___ | Angina pectoris |
| Venous dilators are also sometimes used in ____but they are not suitable in______ treatment. | CCF( congestive cardiac failure ) , hypertension |
| vasodilators are therapeutically in 3 categories they are | 1. Arterial dilators e.g. Hydralazine 2. Venous dilators e.g. Nitroglycerine 3. Mixed or balanced dilators |
| What are arterial dilation | |
| Benefit of arterial dilation | Benefits patient with heart failure Angina pectoris patient also Prevent arterial vasospasm that precipitate angina attacks. |
| How did arterial dilation prevent heart failure | by reducing the after load on the L.V and enhances SV, CO and ↓ses ventricular preload and venous pressure. |
| How did arterial dilation used in treatment of angina pectoris patient | they reduce after load of the heart, decrease O2 demand of the heart, and improve O2 supply. |
| What is the meaning of venous dilation | |
| Benefit of Venous dilation | • they reduce Venous pressure and therefore cardiac preload • reduce CO • Arterial pressure • reduce Myocardial O2 demand • reduce Capillary fluid filtration and tissue oedema |
| What mixed dilation | |
| Benefits of mixed dilation | • Decrease systemic vascular resistance and arterial pressure without much effect on CO. |
| One of the side effect of vasodilation can lead to ___ | renal retention of Na+ and H2O |
| renal retention of Na+ and H2O As side effect of vasodilation can lead to ___ | increases blood volume and CO and thereby compensates for reduced systemic vascular resistance. |
| What is systematic vasodilation | This refer to the dilation or widening of blood vessels throughout the entire circulatory system |
| Systemic vasodilation and arterial pressure reduction can lead to As side effect of vasodilation | baro-receptor-mediated reflex stimulation of the heart (as tachycardia and inotropy-force) |
| Vasodilator can impair normal ____ vasoconstriction when a person stands up, which can lead to ____ and ___ upon standing. | baro-receptor-mediated reflex, orthostatic hypotension and syncope |
| Vasodilation are classed based on their primary mechanism of action They are | 1. Organic nitrates (or Nitrodialtors) 2. Ca2+ channel antagonists or blockers (CCBs) 3. Β-adrenergic (or adrenoceptor) antagonists 4. α-adrenoceptor antagonists (α-blockers) 5. angiotensin converting enzyme (ACE) inhibitors 6. Centrally |
| Mechanism of action of Organic nitrates (or Nitrodialtors) | 1. They help in direct relaxation of blood vessels and smooth muscles by widening the blood vessel ( vasodilation) they decreases O2 requirements 2. They help in Relaxation of smooth muscles of coronary arteries by doing so they ( coronary vasodilation) |
| Increase blood supply to the myocardial muscle 3. They also help in Relaxation of arteries and veins by decreasing blood pressure and reducing the workload of the heart | |
| Examples of Organic nitrates (or Nitrodialtors) are | nitrodilators- nitroglycerin, sodium nitroprusside. |
| Low concentrations of nitroglycerin preferentially dilate ___ more than ___ | Veins more than arteries |
| venodilation Decrease ___ | L and R ventricular chamber size and end-diastolic pressure but results in little change in systemic vascular resistance. |
| Higher doses of organic nitrates cause ___ | venous pooling and may decrease arteriolar resistance as well thereby reducing SBP and DBP and CO and causing pallor, weakness, dizziness and activation of compensatory sympathetic reflexes of tachycardia, peripheral vasoconstriction, producing cold |
| cold clammy skin, etc. | |
| Dose of nitroglycerin | 2.5mg-6.5mg every 6-8hrly sublingually |
| Indication of nitroglycerin | 1. Prophylaxis and treatment of acute angina pectoris. 2. Treatment of chronic angina pectoris. 3. Treatment of hypertension associated with MI or CHF. 4. Nitroglycerin ointment for treatment of Raynaud’s disease. |
| Contraindication of nitroglycerin | heart attack severe anaemia glaucoma erectile dysfunction low BP orthostatic hypotension, etc. |
| Side effect of nitroglycerin | Headache hypotension tachycardia dry mouth nervousness vomiting feeling of light headedness fainting. |
| What class of drug Isosorbide dinitrate in | Coronary vasodilation |
| Which group of drug Isosorbide dinitrate in | It is a Vasodilator, or Anti-Angina, or Antinypertensive drug. |
| What is the generic name of Isosorbide dinitrate | |
| What is the trade name of Isosorbide dinitrate | Isoral, Cordil, Isotard. |
| Mode of action Isosorbide dinitrate | 1. It helps to dilate the peripheral veins increasing the venous return as well as the arterioles reducing the blood pressure. |
| Indication or used of Isosorbide dinitrate | prophylaxis and treatment of angina. |
| Dosage of Isosorbide dinitrate | adult P.O 30-120mg dly in divided doses. |
| Route of administration of Isosorbide dinitrate | Sublingually Intravenously Topically. |
| Side effect of Isosorbide dinitrate | Headache, hypotension |
| Contraindications of Isosorbide dinitrate | Hypersensitivity to nitrate Hypotension Constrictive pericarditis Mitral stenosis Severe anaemia Aortic stenosis Cardiac tempo are Hypovolemia Shock Burns |
| 2. It dilates the arterioles. Thus reducing both the peripheral vascular resistance and the left ventricles contraction and consequently improving the cardiac output. | |
| 3. narrowed crorondayeral blood vessel to coronany lores as well as the narrowed coronary arteries ( not due to allerona, hereby increasing oxygen supply in the blood to the myocardium, and consequently reducing the angina pain. | |
| Which group of drug Hydralazine in. | it so Vasodilator and an Antihypertensive drug. |
| What is the generic name of Hydralazine | |
| What is the trade name of Hydralazine | (Apresoline) |
| Mode of action of Hydralazine | Causes direct relaxation of arteriolar smooth muscles |
| Indication or used of Hydralazine | Moderate to severe hypertension hypertensive crisis preeclampsia HF ( heart failure ) |
| Route of administration of HYDRALAZINE HYDROCHLORIDE | Intravenously Orally. |
| Side effect of HYDRALAZINE HYDROCHLORIDE | Hypotension, Haemolytic anaemia, Agranulocytosis, Fever, Nausea, Hepatitis, , Glomerulo-nephritis, Acute renal failure, arthralgia, Joint swelling, Headache, Palpitation, Nasal congestion |
| Contraindication of HYDRALAZINE HYDROCHLORIDE | Severe lachycardia Heart failure Aortic aneurysm. Before Third Trimester of pregnancy, Systemic Lupus erythematosus Mitral valve rheumatic heart disease, Hypersensitivity reaction, Corona artery disease, Myocardial insufficiency, Porphyria. |
| Dosage of HYDRALAZINE HYDROCHLORIDE | P O 2.5mg 3-4 times dly |
| Dosage of hydralazine hydrochloride drug for hypertension patients | For Moderate to Severe Hypertension = 25mg twice orally, daily increased to the usual maximum dose of 50mg twice daily orally. |
| Dosage of hydralazine for heart failure patients | -For Heart failure = 25mg 3-4times daily, increased every 2days |
| Examples of vasodilation drugs are | 1. Isosorbide dinitrate 2. Nitroglycerin 3. Hydralazine |
| What are vasoconstriction drugs | drugs cause contraction of muscle cells in the walls of the blood vessels, narrowing their lumen and raising BP. |
| Examples of vasoconstriction drugs are | epinephrine norepinephrine vasopressin phenylephrine pseudoephedrine. |
| Drugs that used to treat hypertension are called | Antihypertensives |
| The used of antihypertensive drugs used in treating hypertension in other to prevent | Heart attack Stroke Heart failure |
| The most widely used antihypertensives are | 1. Diuretics 2. Adrenergic blockers: β-blockers and α-blockers 3. ACE inhibitors 4. Angiotensin II receptor antagonists 5. Renin inhibitors 6. Ca2+ channel blockers 7. Other antihypertensives- vasodilators, antiarrhythmic agents, etc |
| Antihypertensive drugs are classified base on | site of action and/or mode of action, which either way produce the therapeutic effects of vasodilation and cardiac depression among others. |
| Mechanism of action Adrenergic blockers- β-blockers | They are drugs reduce BP primarily by decreasing CO either via decreases of sympathetic influences from the CNS, inhibiting formation of angiotensin II and secreting of aldosterone via inhibition of renin from the kidneys |
| Why are Adrenergic blockers- β-blockers are not recommended for the first line of hypertension | due to relative adverse risk of stroke and new-onset of type 2 DM when compared to other medications. |
| Generally, systematic reviews of chemical trials of β-blockers suggest that they increase the risk of ___ compared to other antihypertensive therapies. | Mortality |
| What types of Antihypertensive drug play an important role in prevention of heart attacks in people who have already had a heart attack. | Adrenergic blockers- β-blockers |
| Examples of β-blockers Are | Propranolol atenolol metoprolol timolol. |
| Mechanism of action of α-blockers | They are drugs that decrease peripheral vascular resistance and lower arterial blood pressure by causing relaxation of both arterial and venous smooth muscles |
| α-blockers have been adjudged to be of poorer benefit in HTN endpoints and are no longer first line drugs in HTN. But they are useful for some men with symptoms of ____ | Prostrate disease |
| Examples of α-blockers include | 1. doxazosin 2. prazosin 3. Indoramin 4. Terasosin |
| Which group of Doxazocin in | It is an Anti-hypertensive, Vasodilator, and an alpha-1 Antagonist. |
| Mode of action of Doxazocin | 1. It relaxes the muscles. around the bladder exit and the prostate gland, so that urine may be passed out more easily, and also helping to lower the blood pressure in patients with enlarged prostate gland. |
| What is the trade name of Doxazocin | |
| Mode of a ton of Doxazocin | 2. It dilates the blood vessels, thereby making it easier for the heart to pump blood around the body and consequently reducing the blood pressure. 3. helps to lower the blood Lipid (total cholesterol) level. |
| Indication or used of Doxazocin | Hypertension |
| Dosage of Doxazocin | 1-16mg) dly P.O initially 1mg once dly, increasing to 2mg once dly after 1-2/52 and then 4mg once dly. Maximum dose = 16mg dly. |
| Route of administration Doxazocin | Orally in a tablet form |
| Contraindication of Doxazocin | Hypersensitivity Under 12 years of age, pregnancy, lactation Disorders of liver heart, Kidney Hypotension Patients on Ibuprofen, Diclofenac and Ephedrine therapy, |
| Which group of drug Prazosin in | It is an Antihypertensive, or Vasodilator or Alpha-adrenoceptor blocking drug. |
| What is the generic name of Prazosin | |
| What is the trade name of Prazosin | Hypovase |
| Mode of action of Prazosin | (1) It has post-synaptic Alpha-blocking and Vasodilator properties, dilating the arterioles thereby reducing the peripheral resistance and lowering the blood pressure. |
| Indication or used of Prazosin drug | Hypertension |
| Dosage of of Prazosin for hypertension | P.O 500mcg-20mg dly in divided doses |
| Route of administration of Prazosin | Orally in tablet form |
| Side effect of Prazosin | Postural hypotension Drowsiness Dizziness weakness Headache Palpitation Urinary frequency Hypersensitivity reaction. |
| Contraindication of Prazosin | Congestive heart failure |
| Nursing considerations in used of both Prazosin and doxazocin | - Prevent orthostatic hypotension by administering drug at bed time - Instruct patient to sit or lie down in dizziness and change position slowly - Avoid machines - Check for oedema- legs and face - Weigh patient daily where necessary - Check i/o |
| drugs that inhibit the conversion of Angiotensin I to Angiotensin II (a Vasoconstrictor), thereby preventing increase peripheral resistance but a lowering of the blood pressure through the dilatation of the peripheral blood vessels. | Angiotensin-converting enzyme inhibitors (ACE-Inhibitor) |
| The ACE inhibitors also results in decreased secretion of ___ | aldosterone ( reduced Na+ and H2O retention) |
| Classical examples of ACE-inhibitors are | enalapril captopril lisinopril, |
| Notable side effects of ACE inhibitors are | dry cough hyperkalaemia fatigue headaches loss of taste dizziness and hypotension. |
| ACE-inhibitors are also more effective at slowing down the decline of ____ | kidney function |
| ACE-inhibitors should not be first line treatment for ___ | black hypertensives without CKDs. |
| thiazide-diuretics and Ca-channel blockers are more beneficial/effective as monotherapy in improving ___ | CVS outcome ( Cardiovascular diseases) |
| ACE-inhibitors were less potent in lowering BP and had a 51% higher risk of stroke in black hypertensives when used as initial therapy compared to Ca2-channel blockers. | |
| Function of angiotensin 11 | Angiotensin II increases arterial blood pressure by directly acting on the blood vessels and causing vasoconstriction. |
| What class of drug Captopril in | antihypertensive, inhibitor of angiotensin synthesis |
| Which group of drugs Captopril in | is an Anti-hypertensive and Vasodilator drug. |
| What is the generic name of captopril drug | |
| What is the trade name of Captopril | (Epsitron, Capoten) |
| Mode of action of Captopril drug | It an enzyme that is responsible for the conversion of angiotensin I to angiotensin II which decrease BP. - Reduce peripheral arterial resistance. - Decrease aldosterone secretion which works to increase level of serum potassium. |
| Indication or used of Captopril drug | Hypertension CHF ( congestive heart failure or congestive cardiac failure) Renal artery stenosis |
| Dosage of Captopril drug | 6.25-12.5mg 2-3 times dly. Increases gradually at minimum of two-week interval according to response to 75-150mg dly in divided doses. |
| Route of administration of Captopril drug | Orally |
| Side effect of captopril drug | Skin rash loss of taste neutropnea nausea vomiting, hypotension, proteinuria, renal failure and hyperkalemia. |
| Contraindication of captopril drug | Hypersensitivity renovascular disease and pregnancy. Lactation Aortic stenosis |
| Nursing responsibilities in used of captopril drug | (1) Since Potassium is not lost in urine during excretion of sodium and water when Captopril is used, care must be taken not to give the patient Potassium supplement so. as not to cause hyperkalaemia. |
| (2) Monitor white blood celi count to avert blood disordes (3) Observe onset of dry cough when taking Epsitron and act immediate (4) Other Nursing measures are as shown under BRINERDIN | |
| What class of drug Enalapril in | ACE-inhibitor |
| Which group of drug Enalapril In | It is an Anti-hypertensive drug. |
| What is the generic name of Enalapril drug | |
| What is the trade name of Enalapril | |
| Mode of action of Enalapril | Lotrial inhibits Angiotensin-converting enzyme which converts Angiotensin 1 to Angiotensin lI, leading to decrease plasma Angiotensin Il, and resulting into decreased Vasopressor activity and Aldosterone secretion. |
| Indication or used of Enalapril | Hypertension HF |
| Dosage of Enalapril | 5-40mg once daily |
| Route of administration of Enalapril | Orally |
| Side effect of Enalapril | CNS: headache, dizziness, fatigue, vertigo, syncope. CV: hypotension, chest pain, angina pectoris. GI: diarrhea, nausea, abdominal pain, vomiting. GU: decreased renal function (in patients with bilateral renal artery stenosis or heart failure). |
| Hematologic: bone marrow depression. Respiratory: dyspnea, dry, persistent, nonproductive cough. Skin: rash. Other: angioedema. | |
| Contraindication of enalapril drug | Contraindicated in patients hypersensitive to drug and in those with a history of angioedema related to previous treatment with an ACE inhibitor. |
| Enalapril should be used cautiously in patient with | renal impairment or those with aortic stenosis or hypertrophic cardiomyopathy |
| Indication or used of Lisinopril | Essential and renovascular hypertension Adjuvant in CHF MI renal problem in DM |
| Dose of Lisinopril | 2.5mg-20mg dly |
| Which group of drug Lisinopriln | It is an Anti-hypertensive drug. |
| What is the generic name of Lisinopril | |
| What is the trade name of Lisinopril | |
| Mode of action of Lisinopril | Action:-(1) It inhibits Angiotensin converting enzyme, thereby reducing the peripheral resistance, dilating the blood vessels and reducing the blood pressure. |
| (2) It inhibits Angiotensin converting enzyme (ACE), hothereby inhibiting the conversion of Angiotensin 1 to Angiotensin il. The decreased plasma levels of Angiotensin If leads to decreased oic Vasopressor activity and decreased Aldosterone secretion. | |
| Indication of Lisinopril | Essential and renovascular hypertension Adjuvant in CHF ( congestive heart failure) MI ( myocardial infarction) renal problem in DM |
| Dosage of Lisinopril | 2.5mg-20mg dly |
| Route of administration of Lisinopril | Orally |
| Side effect of Lisinopriln | Hypotension Skin rash Angioedema Cough Taste distur-bance Impaired renal function Hyperkalaemia |
| Contraindication of lisinopriln | Hypersensitivity reaction to Lisinopril History of angioedema related to previous treatment with Angiotensin Converting Enzyme, Aortic Stenosis. |
| Nursing responsibilities of lisinopriln | 1. Should not be given to patients with Aortic stenosis, Urinary tract obstruction, and impaired renal function. 2. Patients with existing renal disease, or taking high doses should be regularty monitored for proteinuria |
| 3. Since Hyperkalaemia is a side effect of Lisinopril, therefore potassium sparing diuretics, potassium supplements, I Potassium containing salt substitutes or other drug that can cause hyperkalaemia should be used with caution. | |
| What are Angiotensin II-Receptor blockers drugs | They are drugs that influences the renin-angiotensin system. They block activation of angiotensin II receptors, preventing angiotensin II from binding by doing that they causes vasodilation, reduces secretion of vasopressin, and reduces production of |
| of secretion of aldosterone among other actions | |
| Examples of ARBs( Angiotensin II-Receptor blockers (or Sartans) include- | valsartam olmesartan losartam etc. |
| Which group of drug Valsartan in | It is an Antihypertensive drug or an Angiotensin II receptor antagonist |
| What is the generic name of Valsartan drug | |
| What is the trade name of Valsartan | (Diovan) |
| Mode of action of Valsartan | (1) It helps to inhibit or antagonize the effect of the vascconstrictor called Angiotensin II at the Myo-neural junction within the arterioles, thereby preventing increase peripheral resistance and lowering of the BP, through the dilation of the perip BV |
| Indication or used of Valsartan | Hypertension Myocardial infarction with left ventricular failure. |
| Dosage of Valsartan | P.O 20mg bd titrated dose over weeks can be 160mg bd. General dose is 20-320mg. |
| Route of administration of Valsartan | Orally in capsule or Tablet form Intravenously. |
| Side effect of Valsartan | Hypotension Dizziness Renal dysfunction Dyspepsia Decrease heart beat Hyperkalaemia Angioedema Rarely anaemia Neutropenia. |
| Contraindication of valsartan drug | Cirrhosis Biliary obstruction Breast feeding and pregnancy. |
| Nursing responsibilities In used of valsartan | (1) It should be used with caution on patients with renal artery stenosis to prevent progressive renal failure, since Angiotensin 1l receptor antagonists (like Angiotensin converting enzyme inhibitors) reduce the glomerular filtration. |
| (2) Monitor renal function and electrolyte levels before and when on any Angiotensin II receptor antagonist to prevent renal failure. (3) Monitor the vital signs especially blood pressure and pulse to assess the cardio pulmonary functions. | |
| Dose of Olmesartan | 10-40mg |
| Which group of drugs Losartan In | It is a Non-peptide Angiotensin II receptor Antagonist and a Novel Antihypertensive drug. |
| What is the generic name of Losartan | |
| What is the trade name of Losartan | (Cozaar, Losatrust) |
| Mode of action of Losartan drug | (1) It blocks the vasoconstrictor (Angiotensin l) and Aldosterone-secreting effects of Angiotensin II, thereby preventing the retention or reabsorption of Sodium and water, which invariably leads to decrease cardiac output and lowering of the B.p |
| (2) The blocking of vasoconstrictor (Angiotensin (I) causes dilatation of peripheral blood vessels leading to decrease cardiac output and lowering of the 'blood pressure. | |
| Indication or used of Losartan | Hypertension Left ventricular hypertrophy Diabetic nephropathy in type 2 Diabetes mellitus |
| Dosage of Losartan | Losartan Dose: 50-100mg dly |
| Route of administration of Losartan | Orally in tablet form |
| Side defect of Losartan | Diarrhoea Taste disturbance cough Arthralgia, Myalgia Asthenia Fatigue Migraine Vertigo Urticaria Pruritus Rash Headache Dizziness Abdominal pain Hyperkalaemia. |
| Contraindication of Losartan | Breast feeding Cirrhosis Biliary obstruction and pregnancy Hypersensitivity to Losartan Potassium. |
| (1) Watch for any hypersensitivity reactions and quickly discontinue the administration of this drug. (2) Monitor the vital signs especially blcod pressure and pulse to assess the cardiopulmonary functions. | |
| (3) Monitor the Intake and Output chart, since changes in renal function have been reported in susceptible individuals treated with this drug based on the consequence of inhibiting action of Losartan on the Renin-Angiotensir-Aldosterone system. | |
| What are calcium channels blockers | They are drugs that prevent or reduce the opening of Ca2+ channels thereby producing different effects for hypertension, their effect relaxes vascular smooth muscles and cause vasodilation thereby lowering Bp. |
| Example of Approved Ca2+ channel blockers drugs for hypertension are | 1. Nifedipine verapamil 2. diltiazem 3. amlodipine 4. nicardipine, etc. |
| Ca2+ channel blockers Drugs are divided into 3 chemical classes they are | 1. diphenylalkylamines 2. Bezothiazepines and 3. dihydropyridines. |
| Adverse effect of Calcium Channel Blockers Drugs | Dizziness headache and a feeling of fatigue. |
| What class of drugs Nifedipine in | calcium channel blocking agent (anti-angina, antihypertensive). |
| Which group of drugs Nifedipine | It is a Vasodilator, Antihypertensive and Calcium ion antagonist. |
| What is the generic name of Nifedipine | |
| What is the trade name of Nifedipine | (Nifecard, Adalat Retard, Procardia) |
| Mode of action of Nifedipine | (1) It dilates the arteries causing a reduction in peripheral vascular resistance and therefore decreasing arterial blood pressure. |
| Indication or used of Nifedipine | Hypertension |
| Dosage of Nifedipine | 20-100mg dly in 1-2 divided doses |
| Route of administration of Nifedipine | Orally |
| Side effect of Nifedipine | pulmonary and peripheral edema MI hypotension dizziness light headedness palpitation headache muscle cramps. |
| Contraindication of Nifedipine | hypersensitivity lactation. Arterial hypotension Severe Aortic valve stenosis Obstructive Cardiomyopathy, Porphyria, Hypersensitivity reaction. |
| (1) should not be used in Cardiogenic shock, and Angina Pectoris at rest because it may precipitate myocardial infarction. (2) It should be used with caution in patients with Congestive Heart Failure, Liver insufficiency, and Diabetes. | |
| (3) Since patients who have severe obstructive Coronary disease may develop (though rarely increased frequency, severity and duration of Angina pectoris attack after | |
| Other mode of action of nifedipine drugs | 2. It dilates the main Coronary arteries and arterioles both in the normal and ischaemic myocardial regions, thereby inhibiting Coronary artery spasm. 3. It is a potent inhibitor of Coronary artery spasm. |
| 4. increases myocardial Oxygen delivery which accounts for its effectiveness in the treatment of Angina Pectoris. 5. It inhibits the transmembrane influx of extracellular calcium ions across the membranes of myocardial cells or vascular smooth muscles | |
| muscles without blood calcium concentration. | |
| What class of drugs Amlodipine | calcium channel blocking agent (anti-angina, antihypertensive). |
| Which group of Amlodipine | It is a Calcium-Channel blocker or Calcium-Antagonist or Anli |
| What is the trade name of Amlodipine | Amicore |
| Mode of action of Amlodipine. | 1. It dilates the collateral blood vessels to Coronary arteries as well as the narrowed Coronary arteries, thereby increasing the oxygen supply in the blood to the myocardium and consequently reducing the Angina pain. |
| Indication or used of Amlodipine drug | Angina and hypertension. Coronary thrombosis |
| Dosage of Amlodipine | Dose: 5-10mg daily |
| Route of administration of Amlodipine | Orally in a tablet form |
| Side effect of Amlodipine | Headache Fatigue Dizziness Nausea Ankle swelling, Flushing, Abdominal pain, Palpitation, Sleep disturbance. |
| Contraindication of Amlodipine | Cardiogenic shock Unstable Angina Significant n Aortic stenosis Breast-feeding and Hypersensitivity to Dihydropyridines. |
| Another mode of action of amlodipine drugs | 2. (2) It relaxes and dilates the Coronary and Systemic blood vessels, allowing blood to flow freely from the heart, reducing the peripheral resistance, and consequently reducing the blood pressure. |
| Nursing responsibilities in used of amlodipine drugs | 1. Precautions must be taken before giving it to pregnant and lactating mothers, and those with impaired hepatic function. 2. Monitor the Vital signs closely. Other Nursing measures are as shown under "BRINERDIN." |
| 3. Where a daily dose is missed, don't take a double dose the next day. Just take only the day's dose. But try not to miss a daily dose to obtain the maximum effect of Amlodipine. | |
| _____ agents are the substances which enhance the urine formation and output. | Diuretics |
| Diuretics can be used as first-line drug therapy for ___ unless there are compelling reasons to choose another agent. | Hypertension |
| Low-dose diuretic therapy is safe, cheap and effective in preventing ___ | Low-dose diuretic therapy is safe, cheap and effective in prevg stroke, MI and CHF |
| Types/Classes of diuretics are | 1. High ceiling/loop diuretics 2. Thiazide diuretics (low ceiling) 3. Carbonic anhydrase inhibitors - 4. Potassium-sparing diuretics 5. Calcium-sparing diuretics 6. Osmotic diuretics (E.g. Mannitol) - |
| A class of diuretics drugs that act at the ascending loop by inhibiting the body’s ability to reabsorb sodium, leading to excretion of H2O in the urine is called | High ceiling/loop diuretics |
| What are diuretics agent | substances increase the excretion of water, sodium and chloride through urine. |
| Loop diuretic also decrease ____and increase ____ | renal vascular resistance and increase renal blood flow |
| Examples of high ceiling/loop diuretics include- | furosemide ethacrynic acid and torasemide |
| Loop diuretics act promptly even in patients with ____ | Poor renal function |
| Mechanism of action of diuretic drugs | 1- Increasing the glomerular filtration rate . 2- Decreasing the rate at which sodium is reabsorbed from the glomerular filtrate by the renal tubules, therefore water is excreted along with sodium 3-Promoting the excretion of sodium & therefore |
| water by the kidney. | |
| General Used of diuretic drugs are | Congestive heart failure hypertension edema. |
| Which group of drugs Furosemide | It is a loop or potent Diuretic. |
| What class of drug name of Furosemide | Loop diuretic |
| What is the trade name of Furosemide | (Lasix) |
| Mode of action of Furosemide | It inhibits the reabsorption of sodium and chloride in the ascending loop of Henle resulting in the excretion of sodium, chloride & to a lesser degree potassium & bicarbonate ions. |
| Indication of Furosemide | Edema associated with: -Congestive heart failure -Liver cirrhosis. -Nephrotic syndrome. - Acute pulmonary edema. - Hypertension. resistant hypertension. |
| Dosage of Furosemide | 20-80mg P.O according to patient’s condition Child: 1-3mg/kg dly; max. 40mg I.V or I.M, 20-50mg (max. rate 4mg/min)- adult Child’s I.V, 0.5-1.5mg/kg dly; max. 20mg dly |
| Route of administration of Furosemide | Orally Intramuscularly Intravenously. |
| Side effect of Furosemide | - Dehydration, hypovlemia. - Hypokalemia ,hyperglycemia, Hyponatremia - Nausea, vomiting, diarrhea, anorexia. - Tinnitus, blurring of vision, headache, orthostatic hypotension, rashes & photosensitivity |
| Contraindication of Furosemiden | hepatic coma associated with electrolyte depletion. - Anuria - Sever renal diseases . - Hypersensitivity. |
| Oral furosemide produces diuresis within ___ minutes of administration, with maximum effect in ___ | 30-60 minutes of administration, with maximum effect in 1-2 hours. |
| The effect of Oral furosemide last for | 4-6 hours |
| How many minute does I.V furosemide produces diuresis with maximum effect of and diuresis complete | 5 minutes with maximum effect in 20-60 minutes and diuresis complete within 2 hours |
| loop diuretics may cause ____ and excessive use may cause ___ with risk of ___ | Hypovalaemia , dehydration , circulatory collapse |
| Furosemide may cause ____ and ____ | hyperuricaemia and precipitate attacks of gout. |
| Rapid high dose injection or infusion of furosemide drug may cause ____ and even ____ | tinnitus and even deafness. |
| A nurse should Administer furosemide drug in the morning and early noon to avoid ___ | Nocturia |
| A nurse role is to Give furosemide I.V slowly over how many seconds | 30-60 seconds |
| ___ route of therapy should only be used in kids if P.O is impossible in used of furosemide drug | Parental route |
| What signs of electrolyte imbalance the nurse should observed in used of furosemide drug | cramps muscle weakness |
| The nurse should advised patient to avoid factors that can cause hypotension in used of furosemide drug factors such as | strenuous exercise in hot sun, alcohol, etc. |
| The nurse should Educate patient to report furosemide toxicity characterized by | tinnitus severe abdominal pain sore throat and fever |
| A class diuretic drugs that lower blood pressure by increasing Na+ and H2O excretion. They do that by inhibiting their reabsorption at the beginning of the distal convoluted tubule, decreasing ECF, CO and renal blood flow | Thiazide diuretics (low ceiling) |
| How many hour will Thiazide diuretics (low ceiling) take to produce diuretic | 1-2 hour |
| post oral administration and action Thiazide diuretics (low ceiling) may last for how many hours | 12-24 hours |
| Thiazide diuretics (low ceiling) include | hydrochlorothiazide and bendrofluazide. |
| Indication of Thiazide diuretics (low ceiling) | Hypertension |
| Adverse effect of thiazide diuretic ( low ceiling ) | Hypertension, hypokalemia |
| Example of thiazide diuretics include | 1. hydrochlorothiazide and 2. bendrofluazide. 3. Chlorothiazide |
| What class of drug Hydrochlorothiazide | |
| Which class of drug Hydrochlorothiazide | It is a slow but long - acting Diuretic. |
| What is the generic name of Hydrochlorothiazide | |
| What is the trade name of Hydrochlorothiazide | (Hydro Diuril, Esidrex) |
| Mode of action of Hydrochlorothiazide | It prevents sodium, chloride and water reabsorption, thereby increasing the urinary output with more potassium loss. It potentiates action of other antihypertensive drugs. |
| Indication or used of Hydrochlorothiazide | Hypertension congestive cardiac failure, Nephrotic syndrome, liver cirrhosis. |
| Dosage of Hydrochlorothiazide | 12.5-100mg dly |
| Route of administration of Hydrochlorothiazide | Orally |
| Side effect of Hydrochlorothiazide | Hypokalaemia, - Hyponatraemia, is Hyperuricaemia, hyperglycaemia, worsens Diabetes and gout, hypotension, dizziness, headache, blood dyscrasias, Impotence, visual disturbances, skin rashes, photosensitization. |
| Contraindication of Hydrochlorothiazide | Anuria, severe i renal o and ir hepatic failure, hypersensitivity B. to Chlortalidone and sulphonamide derivatives, Hypokalaemia, Hyponatraemia, Hypercalcaemia, gout, uric acid calculi, hypertension during pregnancy. |
| Which group of drug Bendrofluazide. In | It is a slow but long-acting Diuretic. |
| What is the generic name of Bendrofluazide | |
| What is the trade name of Bendrofluaziden | Aprinox |
| Mode of action of Bendrofluazide | It increases the urinary output of sodium chloride and water with more potassium loss. |
| Indication or used of Bendrofluazide | C.C.F. Hypertension Ascites" due to liver cirrhosis Hypoalbuminaemia |
| Dosage of Bendrofluazide | 5-10mg depending on the case |
| Route of administration of Bendrofluazide | Orally |
| Side effect of Bendrofluazide | Rashes Thrombocytopenia a, Agranulocytosis, hypotension Hypokalaemia. |
| Contraindication of Bendrofluazide | Hepatic or Renal failure. |
| Drugs that act by inhibiting the enzyme carbonic anhydrase which is formed in the proximal convoluted tubule. The inhibition results in bicarbonate accumulation and decreased Na+ absorption leading to increased urine output | Carbonic anhydrase inhibitors |
| Examples of Carbonic anhydrase inhibitors are | 1. acetazolamide and 2. methazolamide |
| What class of drug Acetazolamide In | anticonvulsant, diuretic. |
| Which group of drug Acetazolamide in | It is a mild Diuretic and a carbonic Anhydrase inhibitor agent. |
| What is the generic name of Acetazolamide | |
| What is the trade name of Acetazolamide | Diamox |
| Mode of action of Acetazolamide. | 1. It blocks the action of a kidney enzyme called carbonic anhydrase which controls the excretion of bicarbonate resulting in excretion of increased amount of |
| 2. It also decreases intraocular pressure by reducing the formation of aqueous humour to half of is baseline measurement. | |
| Indication or used of acetazolamide drug | CHF oedema abnormal fluid retention Glaucoma |
| Dosage of acetazolamide drug | 250-375mg once dly in the morning |
| Route of administration of acetazolamide | Orally intravenously |
| Side effect of acetazolamide | flushing thirst headache drowsiness polyuria, Drowsiness Confusion Anorexia |
| Contraindication of acetazolamide drug | Hypersensitivity, Hypotension. Low serum level of sodium & potassium. - Renal & hepatic dysfunction. - Adrenal insufficiency . |
| Nursing responsibilities In used of acetazolamide drugs | (1) Watch for side effects. (2) Maintain intake and output chart strictly as well as the vital signs. (3) The intravenous infusion should run gradually at the prescribed rate to prevent circulatory |
| A class of diuretics drugs that do not accept potassium into the urine are called | Potassium-sparing diuretics |
| Potassium-sparing diuretics are divide into two sub-categories class they are | 1. Aldosterone antagonists: e.g. spironolactone 2. Epithelial sodium channel blockers e.g. amiloride and triamterene |
| A class of Potassium-sparing diuretics that prevents aldosterone from entering the principal cells of the collecting ducts and late distal tubule of the nephron as well as preventing Na+ reabsorption (Aldosterone normally adds Na+ channels in the prin cel | Spironolactone |
| What class of drug Spironolactone | Diuretic – potassium sparing. |
| What is the generic name of Spironolactone | |
| What is the trade name of Spironolactone | Aldactone. |
| Mode of action of Spironolactone | Is a mild diuretic that acts on the distal tubule to inhibit sodium exchange for potassium which results in increased secretion of sodium and water & conservation of potassium |
| Indication or used of Spironolactone | - Edema due to congestive heart failure - liver cirrhosis. - Nephrotic syndrome . - Essential hypertension. - Primary hyperaldosteronism. - Hypokalemia (as in CHF). |
| Dosage of Spironolactone | 100-400mg dly P.O- adult 1-3mg/kg sly in 1-2 divided doses in children. |
| Route of administration of Spironolactone | Orally |
| Side effect of Spironolactone | - Hyperkalemia, hyponatremia ( dry mouth , lethargy, thirst & easy fatigability). - Vomiting , diarrhea, cramps. - Menstrual irregularities, gynecomastia, hirsutism & deeping of voice , impotence. - Skis rashes & breast carcinoma . |
| Contraindication of spironolactone drug | - Acute renal insufficiency. - Progressive renal failure. - Patients receiving potassium supplement. - Hyperkalemia. |
| Adverse side effect of spironolactone | hyperkalaemia, hyponatraemia, dehydration, increase in BUN, diarrhea, gynaecomastia, irregular menses, impotence, hirsutism, hepatotoxicity, etc. |
| Nursing role in the used of spironolactone drug | educate patient to avoid motion-related activities (as harzards) until response is known and predictable. - Be mindful of contraindications and precautions to guard against them - Give with meals if nausea occurs but this |
| this may slightly reduce absorption - Administer in the morning - Avoid K-rich foods e.g. banana, oranges - Weigh patient daily - Monitor i/o closely throughout therapy - Check for electrolyte imbalances especially in the elderly e.g. confusion | |
| Which group of drug Amiloride | It is a potassium-sparing (or conserving) Diuretic. 156/7 |
| What is the generic name of Amiloride | |
| What is the trade name of Amiloride | (Midamor) |
| Mode of action of Amiloride | It inhibits the exchange of sodium ions for potassium ions in the Distal convoluted tubule of the kidney, thereby increasing the urinary output through excretion of sodium chloride and water in urine with very little loss of potassium. |
| Indication or used of Amiloride | oedema in HF or liver cirrhosis, usually with thiazide and loop diuretics Hypertension congestive heart failure Ascites in cirrhosis of the liver |
| Dosage of Amiloride | 5-20mg dly P.O |
| Route of administration of Amiloride | Orally |
| Side effect of Amiloride | Hyperkalaemia hypotension nausea weakness metabolic Acidosis Hyponatraemia. |
| Contraindication of Amiloride | Hyperkalaemia nepotassium sparing Diuretics, in progressive or severe renal failure, Pregnancy, lactation, shock, burns, er cholera, Gastroenteritis.nbix |
| Which group of drug Triamterene in | It is a potassium-conserving Diuretic. |
| What is the generic name of Triamterene | |
| What is the trade name of Triamterene | (Dytac) |
| Mode of action of Triamterene | It inhibits the exchange of sodium ions for potassium ions in the Distal convoluted tubule of the kidney, thereby increasing the urinary output through excretion of sodium chloride and water in the urine with very little loss of potassium. |
| Indication or used of Triamterene | Congestive heart failure pulmonary oedema, Ascites in liver To. cirrhosis, Nephrotic syndrome drug induced or pre-menstrual edema. |
| Dosage of Triamterene | 100-300mg dly in divided doses |
| Route of administration of Triamterene | Orally |
| Side effect of Triamterene | Elevated Uric acid level Metabolic acidosis nausea vomiting diarrhoea weakness headache Rash Dry mouth hypotension and rarely blood dyscrasias. |
| Contraindication of Triamterene | Hyperkalaemia progressive renal failure potassium supplement other potassium-conserving drugs. |
| (1) Maintain intake and output chart for the patient. (2) observe the vital signs. (3) Weigh the patient daily. (4) Do not give potassium supplement like slow-K to prevent hyperkalaemia in patient. | |
| 5. Should not be administered to patients with Acute and chronic renal failure in order not to aggravate the existing potassium retention (i.e. hyperkalaemia). | |
| agents that produce a relatively low rate of excretion of calcium are | Calcium-sparing diuretics |
| The reduced calcium in the urine can lead to an increased calcium level in ____ | Serum |
| Example of calcium-sparing diuretics are | calcium-sparing diuretics. |
| ___ are Are substances that raise the osmolarity of plasma and renal tubular fluid. | Osmotic diuretics |
| Mechanism of action of Osmotic diuretics | They work by by expanding ECF and plasma volume, therefore increasing blood flow to the kidney, particularly the peritubular capillaries. |
| Osmotic diuretics are used to reduce or prevent ___ | cerebral oedema reduce IOP ( Intraocular pressure ) or treat disequilibrium syndrome. |
| Osmotic diuretic reduce high __ and ___ in 15 minutes of start of infusion | iCP ( increased intracranial pressure), IOP |
| Diuresis occurs after ___ | 1-3 hours. |
| Examples of osmotic diuretic drugs are | i. Urea ii. Mannitol iii. Sucrose Iv. Glucose |
| What class of drugs Mannitol in | Osmotic diuretic |
| Which group of drugs Mannitol | It is an Osmotic Diuretics |
| Mode of action of Mannitol | Increase the osmolarity of the glomerular filtrate which decrease the reabsorption of water while increasing the excretion of sodium and chloride. |
| Indication or used of Mannitol drug | Acute rend failure - Cerebral edema - To decrease intracranial pressure - Glaucoma |
| Dosage o of Mannitol drug | as a 20% solution, 200mg/kg, infused over 3-5 minutes (as Test dose). If no adverse reactions, but xxx is less than 30-50ml/hour, repeat test dose is given. |
| Route of administration of Mannitol | Intravenously and slowly |
| Adverse effect of Mannitol | fluid and electrolyte imbalance, circulatory overload, acidosis, etc |
| Side effect of Mannitol drug | Hypernatremia , electrolyte imbalance, acidosis Dehydration, dry mouth , thirst, edema, hypotension & hypertension , blurring of vision , headache , dizziness. |
| Contraindication of mannitol drug | -Anemia - Dehydration - pulmonary edema “ Progressive heart failure or pulmonary congestion after mannitol therapy”. |
| ___ are drugs that improve haemostasis ( the stoppage of bleeding, heamorrhage or blood flow through a body part or blood vessel. ) by improving primary haemostasis stimulating fibrin formation, or inhibiting finbrinolysis. | Haemostatics or haemostatic agents/drugs |
| Example of Haemostatic drugs are | Aprotinin Aminocaproic acid and tranexamic acid Desmopressin protamine sulfate and vitamin K. |
| Mechanism of action of Aprotinin drugs | Stops bleeding by blocking plasmin and other enzymes like streptokinase that increase the risk of bleeding. |
| Indication of aprotinin drugs | Prophylaxis in patients for complex surgeries such as in heart or liver operations. |
| Dosage of aprotinin drugs | Test dose 10,000IU at least 10 minutes before loading dose Loading dose: 2 million KIV over 20-30 minutes |
| Advance effect of aprotinin drug | atrial fibrillation, fever, nauseas, hypotension, anaphylaxis (xxx) |
| Which group of drug Vitamin K (Phytomenadione) in | It is an Anti-haemorrhagic Vitamin or Coagulant drug. |
| Mode of action of Vitamin K (Phytomenadione) | It helps to activate an enzyrne necessary for the formation of blood clotting factors like Prothrombin in the liver. |
| Indication or used of Vitamin K (Phytomenadione) | Bleeding tendencies |
| Dosage of Vitamin K (Phytomenadione) | condition dependent: read up Generally 5-40mg/day P.O 5-10mg dly I.V |
| Route of administration of Vitamin K (Phytomenadione) | Intramuscularly Intravenously Orally. |
| Advance effect of Vitamin K (Phytomenadione) | anaphylaxis, dyspnea, pain, swelling, phlebitis at injury site, dizziness, diaphoresis, etc. |
| ___ are drugs that work to prevent blood coagulation or prolong the clotting time. | Anticoagulants |
| The biggest risk of anticoagulation drugs is that | increased bleeding especially in those who have had recent surgery and other ill-conditions. |
| The benefit of anticoagulant drugs is the | prevention of or reduction of progression of a disease. |
| Some indications for anticoagulant therapy are: | atrial fibrillation coronary artery disease deep vein thrombosis (DVT) ischaemic stroke MI pulmonary embolism. |
| Types of anticoagulants Drugs are | • Traditional anticoagulants • Novel oral anticoagulants (NOACs) or directly acting oral anticoagulant (DOACs) |
| Examples of Traditional anticoagulants are | warfarin heparin coumarins |
| Examples of Novel oral anticoagulants (NOACs) or directly acting oral anticoagulants (DOACs) | dabigatran rivaroxaban apixaban |
| Based on mechanism of action, the traditional anticoagulants can be classed as: | 1. Those inhibiting the action of clotting factors 2. Those interfering with synthesis of clotting factors |
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Faith111