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NURS 617 Exam 1
a condition in which a person believes that a drug is needed in order to feel good or to function
normally - ANS-Psychological dependence
A drug-induced, secondary effect of a drug that produces a change in a patients condition that is
noxious, harmful or unpleasant, which requires treatment or reduction or discontinuation of the
drug and which usually occurs at therapeutic doses. - ANS-Adverse Effect
a nearly unavoidable secondary effect of a drug produced at therapeutic doses which is
generally predictable and with an intensity that is dose-dependent - ANS-Medication side effect
ACE inhibitors are contraindicated in what patients? - ANS-- Those with bilateral renal stenosis
- Those with history of angioedema
- Pregnant patients
act in the distal tubule to block the reabsorption of the filtered load of NaCl from the nephron
back to the blood. They have a natriuretic effect and promote renal excretion of sodium and
water. The amount of water in the blood is then decreased which decreases stroke volume and
cardiac output therefore decreasing blood pressure. - ANS-Thiazide Diuretics
Acts directly on vascular smooth muscle. Increases the release of nitric oxide in smooth muscle
cells of arterioles and veins. In doing so, they cause the activation of a smooth muscle relaxing
factor which produces vasodilation in veins primarily and also in arteries. This results in an
increase in capacitance of the venous system, decrease in venous return to the heart, and a
marked decrease in left ventricular preload. Decrease in both preload and afterload will result in
a significant reduction in myocardial oxygen consumption by decreasing left ventricular filling
pressure, left ventricular wall pressure, and myocardial contractility. - ANS-Nitroglycerin
(Nitrostat)
Administering loperamide and Milk of Magnesia together will cancel each others actions
producing no benefit for the patient either way. What type of drug interaction is this? -
ANS-Harmful inhibitory drug interaction
Advantages of Nitroglycerin in treatment of heart failure - ANS-- Can be given IV for acute or
critically ill
- Rapid onset of action, immediate when given IV
- Short duration of action which results in rapid recovery from adverse effects
- Easy conversion to other nitrates, if necessary for long term nitrate therapy
- Very useful in those with acute CHF in association with ischemic heart disease or MI
Alternate uses for non-selective beta blockers - ANS-Angina
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Arrhythmia therapy
Migraines
Hyperthyroidism
Anxiety
Alternative uses for Calcium channel blockers - ANS-Angina, Arrhythmias, Migraine prophylaxis,
and M.I.
An immunologic hypersensitivity reaction resulting from the unusual sensitivity of a patient to a
particular medication; a type of adverse drug event. - ANS-Allergic reaction
antagonists to the adrenergic neurotransmitters on both Beta 1 and Beta 2 adrenergic
receptors. Blockade of the Beta 1 receptors in the heart slows heart rate and myocardial
contractility deceases. Blockade of the Beta 2 receptors in the lungs and peripheral muscular
arteries is not a therapeutic action of theses drugs but is responsible for many adverse effects. -
ANS-Non selective Beta Blockers
Antihypertensive effects of beta blockers are blunted by concurrent administration of what drug
class? - ANS-NSAIDS
Antihypertensive medication class that is glucose neutral, lipid neutral and has minimal adverse
effects - ANS-ARBs (sartans)
Antihypertensive medication that can treat both HTN and BPH? - ANS-Alpha 1 blockers
(-zosins)
Antiplatelets are useful in what type of Angina - ANS-Unstable
Aspirin and Codeine are both analgesic drugs and when administered concurrently the combo
provides better pain relief than either one alone. What type of drug interaction is this? -
ANS-Beneficial potentiative drug-drug interaction
Bind to various sites on the calcium transport channels inhibiting the entry of calcium ions into
muscle cells therefore decreasing the force of contraction of these muscle cells. This leads to
decrease in myocardial contraction, a decrease in cardiac output, a decrease in peripheral
vascular tone and peripheral resistance, and decrease in BP. - ANS-Calcium Channel Blockers
Binds to and blocks the enzyme Na-K ATPase which is the activator of the Na-K pump in
excitable cells. By blocking this enzyme it is prevented from activating the pump that keeps
sodium ions outside of the cells. As sodium ions accumulate inside the cells, they in turn, trigger
the accumulation of calcium ions in the cells. It is this increase of calcium that is responsible for
increased force of contraction of myocardial cells and the increase in stroke volume, cardiac
output, renal perfusion, and decrease in left ventricular filling pressure and preload.
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The combo of increased cardiac output and lowered heart reat allows enhanced cardiac
pumping performance without corresponding increase in myocardial oxygen consumption. -
ANS-Cardiac Glycosides (Digoxin)
Binds to and blocks the synthesis of the COX 1 and COX 2 enzymes which prevents the
formation of the prostaglandin thromboxane A2 which promotes the agglutination of platelets.
Blood clotting is then slowed and the tendency for a patient to form a thrombus is prevented. -
ANS-Aspirin
block only beta 1 receptors when administered at normal doses. - ANS-Selective Beta 1
Blockers
block the action of aldosterone (sodium and water retention), which results in potassium
retention and the secretion of sodium and water - ANS-Potassium sparing diuretics
blocks angiotensin converting enzyme which converts the inactive protein, angiotensin 1 into the
very active protein, angiotensin 2. In this way, the normal actions of angiotensin 2 are blocked
(peripheral arterial vasoconstriction and stimulation of aldosterone secretion by adrenal gland)
therefore lowering blood pressure. - ANS-ACE inhibitors
Blood pressure goal for hypertensive patients aged 18-59, those with diabetes, or patients with
chronic kidney disease - ANS-<140/90
Blood pressure goal in hypertensive patients 60+ years old with no diabetes of chronic kidney
disease - ANS-<150/90
BP medication that commonly causes hypokalemia, hyponatremia, and hypochoremia -
ANS-Thiazide Diuretics
BP medication that reduces the tendency for reflex tachycardia that is caused by other anti
hypertensive medication - ANS-Clonidine (alpha 2 agonist)
calcium channel blockers can be used as mono-therapy in which patients ? - ANS-Older adults
and AA because HTN in these groups is not related to increase in Renin levels
Concurrent use of aspirin with Coumadin will significantly increase each others inhibitory effects
on blood coagulation, resulting in an increase risk for bleeding. What type of drug interaction is
this? - ANS-Harmful potentiative Drug-Drug interaction
Concurrent use of calcium channel blockers and ?? may increase free drug levels of CCBs -
ANS-Drugs that inhibit CYP-450 system including grapefruit juice
condition where a person's body becomes unable to function normally without a particular drug -
ANS-Physical drug dependence
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Direct antagonists on alpha 1 receptors located on the smooth muscle cells making up the walls
of the peripheral arterioles and peripheral veins. This blocks the normal vasoconstrictive effects
of the sympathetic nervous system causing veins to become more dilated. This results in
decreased peripheral resistance and decreased venous return therefore lowering blood
pressure. - ANS-Alpha 1 blockers
Disadvantages of ACE inhibitors (-pril) - ANS--May lower BP too much especially when being
used with diuretics
-May produce severe hyperkalemia especially in those with renal insufficiency
-Angioedema
-May cause an increase in renal insufficiency
-Persistent nocturnal cough
-Teratogenic in pregnancy
Disadvantages of adrenergic neuron blockers - ANS-Slow onset of action- takes 1-2 weeks for
peak effect
Dizziness, sedation
Fatigue and Lethargy
Depression and suicide
Bradycardia and CHF
Nasal stuffiness
Some cholinergic effects
Disadvantages of ARBs (sartans) - ANS-- Hypotension
- Contraindicated in pregnancy
- Very expensive
- May cause some skeletal muscle cramping
- Some references report a persistent nocturnal cough in some patients though the mechanism
is unclear .
- headache and diarrhea are occasionally reported.
Disadvantages of Calcium Channel Blockers - ANS-- Possible bradycardia and CHF
- Orthostatic hypotension
- Can cause a variety of arrhythmias (especially likely with verapamil and nifedipine)
- Constipation
- May worsen GERD symptoms
- More expensive
- Other than some limited studies with nifedipine, these are generally not safe in pregnancy
Disadvantages of Digoxin - ANS-- Highly toxic drug with very low therapeutic index
- GI adverse effects including anorexia, nausea and vomiting
- Bradycardia and arrhythmias are common
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NURS 617 Exam 1
a condition in which a person believes that a drug is needed in order to feel good or to function
normally - ANS-Psychological dependence
A drug-induced, secondary effect of a drug that produces a change in a patients condition that is
noxious, harmful or unpleasant, which requires treatment or reduction or discontinuation of the
drug and which usually occurs at therapeutic doses. - ANS-Adverse Effect
a nearly unavoidable secondary effect of a drug produced at therapeutic doses which is
generally predictable and with an intensity that is dose-dependent - ANS-Medication side effect
ACE inhibitors are contraindicated in what patients? - ANS-- Those with bilateral renal stenosis
- Those with history of angioedema
- Pregnant patients
act in the distal tubule to block the reabsorption of the filtered load of NaCl from the nephron
back to the blood. They have a natriuretic effect and promote renal excretion of sodium and
water. The amount of water in the blood is then decreased which decreases stroke volume and
cardiac output therefore decreasing blood pressure. - ANS-Thiazide Diuretics
Acts directly on vascular smooth muscle. Increases the release of nitric oxide in smooth muscle
cells of arterioles and veins. In doing so, they cause the activation of a smooth muscle relaxing
factor which produces vasodilation in veins primarily and also in arteries. This results in an
increase in capacitance of the venous system, decrease in venous return to the heart, and a
marked decrease in left ventricular preload. Decrease in both preload and afterload will result in
a significant reduction in myocardial oxygen consumption by decreasing left ventricular filling
pressure, left ventricular wall pressure, and myocardial contractility. - ANS-Nitroglycerin
(Nitrostat)
Administering loperamide and Milk of Magnesia together will cancel each others actions
producing no benefit for the patient either way. What type of drug interaction is this? -
ANS-Harmful inhibitory drug interaction
Advantages of Nitroglycerin in treatment of heart failure - ANS-- Can be given IV for acute or
critically ill
- Rapid onset of action, immediate when given IV
- Short duration of action which results in rapid recovery from adverse effects
- Easy conversion to other nitrates, if necessary for long term nitrate therapy
- Very useful in those with acute CHF in association with ischemic heart disease or MI
Alternate uses for non-selective beta blockers - ANS-Angina
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Arrhythmia therapy
Migraines
Hyperthyroidism
Anxiety
Alternative uses for Calcium channel blockers - ANS-Angina, Arrhythmias, Migraine prophylaxis,
and M.I.
An immunologic hypersensitivity reaction resulting from the unusual sensitivity of a patient to a
particular medication; a type of adverse drug event. - ANS-Allergic reaction
antagonists to the adrenergic neurotransmitters on both Beta 1 and Beta 2 adrenergic
receptors. Blockade of the Beta 1 receptors in the heart slows heart rate and myocardial
contractility deceases. Blockade of the Beta 2 receptors in the lungs and peripheral muscular
arteries is not a therapeutic action of theses drugs but is responsible for many adverse effects. -
ANS-Non selective Beta Blockers
Antihypertensive effects of beta blockers are blunted by concurrent administration of what drug
class? - ANS-NSAIDS
Antihypertensive medication class that is glucose neutral, lipid neutral and has minimal adverse
effects - ANS-ARBs (sartans)
Antihypertensive medication that can treat both HTN and BPH? - ANS-Alpha 1 blockers
(-zosins)
Antiplatelets are useful in what type of Angina - ANS-Unstable
Aspirin and Codeine are both analgesic drugs and when administered concurrently the combo
provides better pain relief than either one alone. What type of drug interaction is this? -
ANS-Beneficial potentiative drug-drug interaction
Bind to various sites on the calcium transport channels inhibiting the entry of calcium ions into
muscle cells therefore decreasing the force of contraction of these muscle cells. This leads to
decrease in myocardial contraction, a decrease in cardiac output, a decrease in peripheral
vascular tone and peripheral resistance, and decrease in BP. - ANS-Calcium Channel Blockers
Binds to and blocks the enzyme Na-K ATPase which is the activator of the Na-K pump in
excitable cells. By blocking this enzyme it is prevented from activating the pump that keeps
sodium ions outside of the cells. As sodium ions accumulate inside the cells, they in turn, trigger
the accumulation of calcium ions in the cells. It is this increase of calcium that is responsible for
increased force of contraction of myocardial cells and the increase in stroke volume, cardiac
output, renal perfusion, and decrease in left ventricular filling pressure and preload.
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The combo of increased cardiac output and lowered heart reat allows enhanced cardiac
pumping performance without corresponding increase in myocardial oxygen consumption. -
ANS-Cardiac Glycosides (Digoxin)
Binds to and blocks the synthesis of the COX 1 and COX 2 enzymes which prevents the
formation of the prostaglandin thromboxane A2 which promotes the agglutination of platelets.
Blood clotting is then slowed and the tendency for a patient to form a thrombus is prevented. -
ANS-Aspirin
block only beta 1 receptors when administered at normal doses. - ANS-Selective Beta 1
Blockers
block the action of aldosterone (sodium and water retention), which results in potassium
retention and the secretion of sodium and water - ANS-Potassium sparing diuretics
blocks angiotensin converting enzyme which converts the inactive protein, angiotensin 1 into the
very active protein, angiotensin 2. In this way, the normal actions of angiotensin 2 are blocked
(peripheral arterial vasoconstriction and stimulation of aldosterone secretion by adrenal gland)
therefore lowering blood pressure. - ANS-ACE inhibitors
Blood pressure goal for hypertensive patients aged 18-59, those with diabetes, or patients with
chronic kidney disease - ANS-<140/90
Blood pressure goal in hypertensive patients 60+ years old with no diabetes of chronic kidney
disease - ANS-<150/90
BP medication that commonly causes hypokalemia, hyponatremia, and hypochoremia -
ANS-Thiazide Diuretics
BP medication that reduces the tendency for reflex tachycardia that is caused by other anti
hypertensive medication - ANS-Clonidine (alpha 2 agonist)
calcium channel blockers can be used as mono-therapy in which patients ? - ANS-Older adults
and AA because HTN in these groups is not related to increase in Renin levels
Concurrent use of aspirin with Coumadin will significantly increase each others inhibitory effects
on blood coagulation, resulting in an increase risk for bleeding. What type of drug interaction is
this? - ANS-Harmful potentiative Drug-Drug interaction
Concurrent use of calcium channel blockers and ?? may increase free drug levels of CCBs -
ANS-Drugs that inhibit CYP-450 system including grapefruit juice
condition where a person's body becomes unable to function normally without a particular drug -
ANS-Physical drug dependence
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Direct antagonists on alpha 1 receptors located on the smooth muscle cells making up the walls
of the peripheral arterioles and peripheral veins. This blocks the normal vasoconstrictive effects
of the sympathetic nervous system causing veins to become more dilated. This results in
decreased peripheral resistance and decreased venous return therefore lowering blood
pressure. - ANS-Alpha 1 blockers
Disadvantages of ACE inhibitors (-pril) - ANS--May lower BP too much especially when being
used with diuretics
-May produce severe hyperkalemia especially in those with renal insufficiency
-Angioedema
-May cause an increase in renal insufficiency
-Persistent nocturnal cough
-Teratogenic in pregnancy
Disadvantages of adrenergic neuron blockers - ANS-Slow onset of action- takes 1-2 weeks for
peak effect
Dizziness, sedation
Fatigue and Lethargy
Depression and suicide
Bradycardia and CHF
Nasal stuffiness
Some cholinergic effects
Disadvantages of ARBs (sartans) - ANS-- Hypotension
- Contraindicated in pregnancy
- Very expensive
- May cause some skeletal muscle cramping
- Some references report a persistent nocturnal cough in some patients though the mechanism
is unclear .
- headache and diarrhea are occasionally reported.
Disadvantages of Calcium Channel Blockers - ANS-- Possible bradycardia and CHF
- Orthostatic hypotension
- Can cause a variety of arrhythmias (especially likely with verapamil and nifedipine)
- Constipation
- May worsen GERD symptoms
- More expensive
- Other than some limited studies with nifedipine, these are generally not safe in pregnancy
Disadvantages of Digoxin - ANS-- Highly toxic drug with very low therapeutic index
- GI adverse effects including anorexia, nausea and vomiting
- Bradycardia and arrhythmias are common
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