UNIVERSITY OF CINCINNATI-NURS 8024 TEST 2 STUDY GUIDE | QUESTIONS
AND ANSWERS | 2026 UPDATE | 100% CORRECT.
Know the mechanisms of action, pharmacodynamics, adverse effects, warnings, monitoring, of each of the
following drug classes
e Beta blockers
o Most effective in decreasing blood pressure!! — but not first line for HTN
= BI: heart kidney
= B2 lunis‘ arteriolar smooth muscle, liver, iancreas
o
= Improved morbidity, reduced hospitalizations/mortality
o MOA:
= Negative chronotropic and inotropic effects
= Inhibit renin release (can mitigate reflex tachycardia caused by vasodilators)
o Indications
= HTN, CHF, post-myocardial infarction, angina
= Hyperthyroidism, glaucoma, migraine h/a
= Afib and Aflutter — decrease HR
= Perioperative HIN
= Bradycardia, AV conduction abnormalities (2°¢ and 3¢ degree heart block), acute HF
= Bronchospasm — in COPD/asthma pts
= Blunts s/s hypoglycemia — be careful in diabetic pts
= Don’t stop abruptly!!!
« Inheart disease: unstable angina, ML, rebound HTN
+ w/o heart disease: tachycardia, malaise, inc. BP
= worsens intermittent claudication or rainaud’s ihenomenon
o Propranolol - first B blocker shown to be effective in HTN and ischemic heart disease!! —
nonselective
= Highly lipophilic = crosses BBB easy * causes CNS effects (dizzy, drowsy)
= Can be better for non-cardiac issues = migraines, essential tremor, thyrotoxicosis
o Cardio-selective: metoprolol and atenolol
= Better for comorbids DM, asthma, COPD
= Cardio-selective, but at higher doses it is less selective!!
= Metoprolol succinate — sustained release
« Shown efficacy in post MI and dec. mortality from HF
« Atenolol less effecting in preventing complications r/t HTN
= Other drugs: nadolol, betaxolol, bisoprolol
o Combined alpha/beta blocking agents: _
= Labetalol
« used IV in hypertensive crisis!!
« Canbe used in pregnancy
= Carvedilol (Coreg)
+ Decreased mortality in HF
ACEI (the “pril” drugs)
Lisinopril, Captopril**, Enalapril, benzapril, ramipril, quinapril
Can be used 1*' line for HTN — especially in T1DM w/ proteinuria or renal insufficiency
MOA: inhibits the conversion of angiotensinl to angiotensin2
Indications
, = Diabetic nephropathy and nondiabetic kidney disease
= HF w/ systolic dysfunction
= PostMI
= Cough**, hypotension, hyperkalemia, angioedema!, AKI, rash
o Contraindications!
= Pregnancy!!
= Renal artery stenosis
= Hx of angioedema
= Caution w/ renal dysfunction
o Monitor
= Renal function/electrolyte labs!
= Hyperkalemia — careful w/ potassium-sparing diuretics (may need loop diuretic if
prescribed also)
Angiotension receptor blockers — ARBs
o Losartan, valsartan, candesartan, irbesartan, olmesartan
o MOA: directly blocks angiotensinl receptor that mediates effects of angiotensin2!
= Similar to ACEL but different mechanisms
DO NOT GIVE WITH ACEI!
= ARBs do not breakdown bradykinin = no ACE cough!
= Renal insufficiency w/ AKI
= Hyperkalemia
= Angioedema and cough (but less than ACEI)
o Contraindications
= Pregnancy!
= Renal artery stenosis
= Caution w/ renal dysfunction
Calcium channel blockers- CCB
o Can be 1 line agent and effective monotherapy!
= Used in raynaud’s syndrome and certain arrhythmias!
o MOA:
= Inhibit Ca influx across membrane into arterial smooth muscle cells
w/ less reflex tachycardia, fluid retention than other vasodilators
o Cautionw/
= beta blockers = increased risk of heart block!!
= Ischemia= worsens ischemia 1/t depletion of energy stores r/t increased calcium
influx due to ischemia
o Two subclasses!!
= Nondihydropyridines: verapamil, diltiazem
MOA: decrease HR (slows AV conduction) and decreased cardiac
contractility and O2 demand
o Verapamil more potent/effective!!!
o Diltiazem used for coronary artery spasm (vasospastic angina)
ADE:
o Peripheral edema, hypotension, bradycardia, constipation
= Verapamil: HF
= Dihydropyridines: nifedipine, amlodipine
arterial vasodilator, minimal effects on conduction or HR
Indications
o HTN and chronic angina
, ADE
o Peripheral edema, gingival hyperplasia, flushing, h/a, hypotension,
mood change, constipation, reflex tachy w/marked peripheral
vasodilation
o Do not use short-acting nifedipine = too much BP variation
Selective Alpha 1 blocker's (-osin, -zosin)
o Tamsulosin (Flomax), doxazosin (Cardura), prazosin (minipress), terazosin (Hytin)
o Typically used in combination with other drugs — i
o MOA: reduce vascular resistance/venous return
= Inhibit catecholamine uptake in smooth muscle cells in peripheral vasculature
o ADE
Dizzy, palpitations, possible syncope
Occurs within several hours of dose — first dose or with increased dose!
o Education
= Minimize orthostasis — caution w/ position change, rising, standing
Centrally acting alpha agonists
o Clonidine: resistant hypertension — needs to be used with 2 other meds!!
o Methyldopa: can be used for pregnancy HTN — not effective though
o MOA:
= Stimulates a2-adrenergic receptors in brain * reduces sympathetic outflow from
= Na and water retention! (Use with diuretic!)
= DO NOT ABRUPTLY STOP!! Leads to severe rebound hypertension can cause
stroke, MI, aneurysm
Tapered gradually to d/c
Vasodilators: Hydralazine, Minoxidil
o MOA: relaxes smooth muscle - dilates arterioles (not veins)
= Decrease BP - activation of baroreceptors * compensatory increase in sympathetic
outflow + increase in HR, CO and renin release
Can be counteracted with concurrent use of beta blockers!!!
= Tachyphylaxis to antihypertensive effects develops rapidly
give more doses = less effective!
o Indications
= Severe hypertension
= Hypertensive crisis in pregnant women
= African-American patients = good with nitrates in HF and HIN
= h/a, nausea, flushing, hypotension, palpitations, tachy, dizzy, angina
= myocardial ischemia r/t increased O2 demand
= drug-induced lupus syndrome
o Minoxidil: dilation of arterioles — specifically renal artery
= Should be given w/ diuretic and beta blocker
= Effective in most severe/drug-resistant forms of HTN
= ADE:
+ Significant Na/Water retention * edema, CHF exac.
o May need large dose of loop diuretic
Hypertrichosis — abnormal hair growth
Increase HR, contractility, and myocardial O2 consumption
Stevens-Johnson syndrome (rare)
AND ANSWERS | 2026 UPDATE | 100% CORRECT.
Know the mechanisms of action, pharmacodynamics, adverse effects, warnings, monitoring, of each of the
following drug classes
e Beta blockers
o Most effective in decreasing blood pressure!! — but not first line for HTN
= BI: heart kidney
= B2 lunis‘ arteriolar smooth muscle, liver, iancreas
o
= Improved morbidity, reduced hospitalizations/mortality
o MOA:
= Negative chronotropic and inotropic effects
= Inhibit renin release (can mitigate reflex tachycardia caused by vasodilators)
o Indications
= HTN, CHF, post-myocardial infarction, angina
= Hyperthyroidism, glaucoma, migraine h/a
= Afib and Aflutter — decrease HR
= Perioperative HIN
= Bradycardia, AV conduction abnormalities (2°¢ and 3¢ degree heart block), acute HF
= Bronchospasm — in COPD/asthma pts
= Blunts s/s hypoglycemia — be careful in diabetic pts
= Don’t stop abruptly!!!
« Inheart disease: unstable angina, ML, rebound HTN
+ w/o heart disease: tachycardia, malaise, inc. BP
= worsens intermittent claudication or rainaud’s ihenomenon
o Propranolol - first B blocker shown to be effective in HTN and ischemic heart disease!! —
nonselective
= Highly lipophilic = crosses BBB easy * causes CNS effects (dizzy, drowsy)
= Can be better for non-cardiac issues = migraines, essential tremor, thyrotoxicosis
o Cardio-selective: metoprolol and atenolol
= Better for comorbids DM, asthma, COPD
= Cardio-selective, but at higher doses it is less selective!!
= Metoprolol succinate — sustained release
« Shown efficacy in post MI and dec. mortality from HF
« Atenolol less effecting in preventing complications r/t HTN
= Other drugs: nadolol, betaxolol, bisoprolol
o Combined alpha/beta blocking agents: _
= Labetalol
« used IV in hypertensive crisis!!
« Canbe used in pregnancy
= Carvedilol (Coreg)
+ Decreased mortality in HF
ACEI (the “pril” drugs)
Lisinopril, Captopril**, Enalapril, benzapril, ramipril, quinapril
Can be used 1*' line for HTN — especially in T1DM w/ proteinuria or renal insufficiency
MOA: inhibits the conversion of angiotensinl to angiotensin2
Indications
, = Diabetic nephropathy and nondiabetic kidney disease
= HF w/ systolic dysfunction
= PostMI
= Cough**, hypotension, hyperkalemia, angioedema!, AKI, rash
o Contraindications!
= Pregnancy!!
= Renal artery stenosis
= Hx of angioedema
= Caution w/ renal dysfunction
o Monitor
= Renal function/electrolyte labs!
= Hyperkalemia — careful w/ potassium-sparing diuretics (may need loop diuretic if
prescribed also)
Angiotension receptor blockers — ARBs
o Losartan, valsartan, candesartan, irbesartan, olmesartan
o MOA: directly blocks angiotensinl receptor that mediates effects of angiotensin2!
= Similar to ACEL but different mechanisms
DO NOT GIVE WITH ACEI!
= ARBs do not breakdown bradykinin = no ACE cough!
= Renal insufficiency w/ AKI
= Hyperkalemia
= Angioedema and cough (but less than ACEI)
o Contraindications
= Pregnancy!
= Renal artery stenosis
= Caution w/ renal dysfunction
Calcium channel blockers- CCB
o Can be 1 line agent and effective monotherapy!
= Used in raynaud’s syndrome and certain arrhythmias!
o MOA:
= Inhibit Ca influx across membrane into arterial smooth muscle cells
w/ less reflex tachycardia, fluid retention than other vasodilators
o Cautionw/
= beta blockers = increased risk of heart block!!
= Ischemia= worsens ischemia 1/t depletion of energy stores r/t increased calcium
influx due to ischemia
o Two subclasses!!
= Nondihydropyridines: verapamil, diltiazem
MOA: decrease HR (slows AV conduction) and decreased cardiac
contractility and O2 demand
o Verapamil more potent/effective!!!
o Diltiazem used for coronary artery spasm (vasospastic angina)
ADE:
o Peripheral edema, hypotension, bradycardia, constipation
= Verapamil: HF
= Dihydropyridines: nifedipine, amlodipine
arterial vasodilator, minimal effects on conduction or HR
Indications
o HTN and chronic angina
, ADE
o Peripheral edema, gingival hyperplasia, flushing, h/a, hypotension,
mood change, constipation, reflex tachy w/marked peripheral
vasodilation
o Do not use short-acting nifedipine = too much BP variation
Selective Alpha 1 blocker's (-osin, -zosin)
o Tamsulosin (Flomax), doxazosin (Cardura), prazosin (minipress), terazosin (Hytin)
o Typically used in combination with other drugs — i
o MOA: reduce vascular resistance/venous return
= Inhibit catecholamine uptake in smooth muscle cells in peripheral vasculature
o ADE
Dizzy, palpitations, possible syncope
Occurs within several hours of dose — first dose or with increased dose!
o Education
= Minimize orthostasis — caution w/ position change, rising, standing
Centrally acting alpha agonists
o Clonidine: resistant hypertension — needs to be used with 2 other meds!!
o Methyldopa: can be used for pregnancy HTN — not effective though
o MOA:
= Stimulates a2-adrenergic receptors in brain * reduces sympathetic outflow from
= Na and water retention! (Use with diuretic!)
= DO NOT ABRUPTLY STOP!! Leads to severe rebound hypertension can cause
stroke, MI, aneurysm
Tapered gradually to d/c
Vasodilators: Hydralazine, Minoxidil
o MOA: relaxes smooth muscle - dilates arterioles (not veins)
= Decrease BP - activation of baroreceptors * compensatory increase in sympathetic
outflow + increase in HR, CO and renin release
Can be counteracted with concurrent use of beta blockers!!!
= Tachyphylaxis to antihypertensive effects develops rapidly
give more doses = less effective!
o Indications
= Severe hypertension
= Hypertensive crisis in pregnant women
= African-American patients = good with nitrates in HF and HIN
= h/a, nausea, flushing, hypotension, palpitations, tachy, dizzy, angina
= myocardial ischemia r/t increased O2 demand
= drug-induced lupus syndrome
o Minoxidil: dilation of arterioles — specifically renal artery
= Should be given w/ diuretic and beta blocker
= Effective in most severe/drug-resistant forms of HTN
= ADE:
+ Significant Na/Water retention * edema, CHF exac.
o May need large dose of loop diuretic
Hypertrichosis — abnormal hair growth
Increase HR, contractility, and myocardial O2 consumption
Stevens-Johnson syndrome (rare)
