Advanced Pharm for Nursing Practice 2
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| Beta-blockers generic names often end in? | beta-blockers end in -OLOL
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| 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
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| What’s the prototype for non-selective beta-blocker? | propranolol*
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| What’s the prototype for cardioselective beta-blocker? | metoprolol* (Lopressor) for HTN or angina; atenolol (Toprol) for HTN, angina, or heart failure
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| What’s the prototype for alpha-beta blockers? | Labetolol and carvedilol
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| 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.
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| How long will it take before seeing a max effect of beta-blockers? | 1 week
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| 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
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| 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.
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| 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
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| 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
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| What are SE/ADR of beta-blockers? | if you decr cardiac output & O2 to muscles, they’ll get tired; insomnia & vivid dreams; bradycardia
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| 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
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| 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
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| 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.
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| 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
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| Generic selective alpha1-blockers end in what? | selective alpha1-blockers end in –ZOSIN
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| What are the selective alpha1-blocker prototypes? | Prasozin (Minipress), Terazosin (Hytrin), & Doxazosin (Cardura)
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| 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.
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| What’s the action of alpha1-blockers? | the dilation of the small bld vessels assists in the decr of bld pressure
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| What’s the indication for selective alpha1-blockers? | for tx of BPH and in reduction of HBP
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| What are SE/ADR of selective alpha1-bockers? | Na+ and H2O retention; Headache & dizziness; palpitations
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| 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
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| What medication is used for BPH for men w/o HTN? | Tamsulosin* (Flomax); it’s an specific prostatic alpha1a-antagonist
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| What are common SE of Tamsulosin* (Flomax)? | Headache, dizziness, ortho hypotension, rhinitis, & abnormal ejaculation
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| 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)
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| What is the prototype for non-selective alpha-blockers? | phentolamine
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| 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)
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| What’s a consideration w/ administering phentolamine? | be sure to give on pump very slowly
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| 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)
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| 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
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| What’s the SE/ADR of non-selective alpha-blockers like phentolomine? | non-selective alpha-blocker SE/ADRs are angina, reflex tachycardia, hypotension
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| What step are vasodilators for HTN? | vasodilators are 3rd or 4th step drugs for HTN
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| What are the prototypes for vasodilators? | hydralazine* (Apresoline) and Minoxidil (Loniten), and nitroprusside* sodium (Nipride)
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| How do vasodilators work? | vasodilators act directly on bld vessels to cause dilation of vascular smooth muscle; this lowers bld pressure
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| What are SE/ADRs of vasodilators? | reflex tachycardia; Na+ & H2O retention; palpitations, tachycardia, and edema; Minoxidil causes hypertrichosis (XS growth of fine body hairs)
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| 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
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| 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
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| 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
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| 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
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| 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)
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| 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
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| What are prototypes for pulmonary HTN drugs? | epoprotenol sodium (IV), trepostinil (IV or sub-q), iloprost (inhalation 6-9x/day)
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| What are the MOAs for pulmonary HTN drugs? | systemic vasodilation (they hv direct action on pulmonary artery beds
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| SE of pulmonary HTN drugs? | flushing, HA, nausea, and anxiety
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| 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
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| 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
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| What’s the warning with endothelin-1A antagonists? | Liver Damage
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