NURS 8024 Test 2 Study Guide 2026/2027 | University of Cincinnati | Cardiovascular
& Respiratory Pharmacology Exam with Complete Solution
Pharmacology for APNs- Cardiovascular Study Guide
Know the mechanisms of action, pharmacodynamics, adverse effects, warnings, monitoring, of each of the
following drug classes
• Beta blockers
o Most effective in decreasing blood pressure!! – but not first line for HTN
▪ B1: heart kidney
▪ B2: lungs, arteriolar smooth muscle, liver, pancreas
o Should always be used in pts w/ stable HF and decreased LVEF!!
▪ 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 HTN
o ADE
▪ Bradycardia, AV conduction abnormalities (2nd and 3rd degree heart block), acute HF
▪ Bronchospasm – in COPD/asthma pts
▪ Blunts s/s hypoglycemia – be careful in diabetic pts
▪ Don’t stop abruptly!!!
• In heart disease: unstable angina, MI, rebound HTN
• w/o heart disease: tachycardia, malaise, inc. BP
▪ worsens intermittent claudication or raynaud’s phenomenon
▪ all can cause hypotension, bradycardia, impaired exercise tolerance, fatigue, and
erectile dysfunction!
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: both start low dose and titrate up!!
▪ Labetalol
• used IV in hypertensive crisis!!
• Can be used in pregnancy
▪ Carvedilol (Coreg)
• Decreased mortality in HF
• ACEI (the “pril” drugs)
o Lisinopril, Captopril**, Enalapril, benzapril, ramipril, quinapril
o Can be used 1st line for HTN – especially in T1DM w/ proteinuria or renal insufficiency
o MOA: inhibits the conversion of angiotensin1 to angiotensin2
o Indications
, ▪ Diabetic nephropathy and nondiabetic kidney disease
▪ HF w/ systolic dysfunction
▪ Post MI
o ADE:
▪ 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 angiotensin1 receptor that mediates effects of angiotensin2!
▪ Similar to ACEI, but different mechanisms
• DO NOT GIVE WITH ACEI!
▪ ARBs do not breakdown bradykinin = no ACE cough!
o ADE
▪ 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 1st line agent and effective monotherapy!
▪ Used in raynaud’s syndrome and certain arrhythmias!
o MOA:
▪ Peripheral vasodilation!!
▪ Inhibit Ca influx across membrane into arterial smooth muscle cells
• w/ less reflex tachycardia, fluid retention than other vasodilators
o Caution w/
▪ beta blockers = increased risk of heart block!!
▪ Ischemia = worsens ischemia r/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 blockers (-osin, -zosin)
o Tamsulosin (Flomax), doxazosin (Cardura), prazosin (minipress), terazosin (Hytin)
o Typically used in combination with other drugs – good for tx of BPH!
o MOA: reduce vascular resistance/venous return
▪ Inhibit catecholamine uptake in smooth muscle cells in peripheral vasculature
o ADE
▪ First dose phenomenon – orthostatic hypotension
• Dizzy, palpitations, possible syncope
• Occurs within several hours of dose – first dose or with increased dose!
▪ Na/water retention = good to give w/ diuretic!!
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
vasomotor center = central acting!!!!!
o ADE:
▪ 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 HTN
o ADE
▪ 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)
& Respiratory Pharmacology Exam with Complete Solution
Pharmacology for APNs- Cardiovascular Study Guide
Know the mechanisms of action, pharmacodynamics, adverse effects, warnings, monitoring, of each of the
following drug classes
• Beta blockers
o Most effective in decreasing blood pressure!! – but not first line for HTN
▪ B1: heart kidney
▪ B2: lungs, arteriolar smooth muscle, liver, pancreas
o Should always be used in pts w/ stable HF and decreased LVEF!!
▪ 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 HTN
o ADE
▪ Bradycardia, AV conduction abnormalities (2nd and 3rd degree heart block), acute HF
▪ Bronchospasm – in COPD/asthma pts
▪ Blunts s/s hypoglycemia – be careful in diabetic pts
▪ Don’t stop abruptly!!!
• In heart disease: unstable angina, MI, rebound HTN
• w/o heart disease: tachycardia, malaise, inc. BP
▪ worsens intermittent claudication or raynaud’s phenomenon
▪ all can cause hypotension, bradycardia, impaired exercise tolerance, fatigue, and
erectile dysfunction!
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: both start low dose and titrate up!!
▪ Labetalol
• used IV in hypertensive crisis!!
• Can be used in pregnancy
▪ Carvedilol (Coreg)
• Decreased mortality in HF
• ACEI (the “pril” drugs)
o Lisinopril, Captopril**, Enalapril, benzapril, ramipril, quinapril
o Can be used 1st line for HTN – especially in T1DM w/ proteinuria or renal insufficiency
o MOA: inhibits the conversion of angiotensin1 to angiotensin2
o Indications
, ▪ Diabetic nephropathy and nondiabetic kidney disease
▪ HF w/ systolic dysfunction
▪ Post MI
o ADE:
▪ 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 angiotensin1 receptor that mediates effects of angiotensin2!
▪ Similar to ACEI, but different mechanisms
• DO NOT GIVE WITH ACEI!
▪ ARBs do not breakdown bradykinin = no ACE cough!
o ADE
▪ 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 1st line agent and effective monotherapy!
▪ Used in raynaud’s syndrome and certain arrhythmias!
o MOA:
▪ Peripheral vasodilation!!
▪ Inhibit Ca influx across membrane into arterial smooth muscle cells
• w/ less reflex tachycardia, fluid retention than other vasodilators
o Caution w/
▪ beta blockers = increased risk of heart block!!
▪ Ischemia = worsens ischemia r/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 blockers (-osin, -zosin)
o Tamsulosin (Flomax), doxazosin (Cardura), prazosin (minipress), terazosin (Hytin)
o Typically used in combination with other drugs – good for tx of BPH!
o MOA: reduce vascular resistance/venous return
▪ Inhibit catecholamine uptake in smooth muscle cells in peripheral vasculature
o ADE
▪ First dose phenomenon – orthostatic hypotension
• Dizzy, palpitations, possible syncope
• Occurs within several hours of dose – first dose or with increased dose!
▪ Na/water retention = good to give w/ diuretic!!
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
vasomotor center = central acting!!!!!
o ADE:
▪ 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 HTN
o ADE
▪ 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)
