PHARMACOLOGY AND THE NURSING PROCESS 10TH
EDITION BY LINDA LILLEY, SHELLY COLLINS, JULIE
SNYDER – EXAM QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALE | 2027 Q&A |
INSTANT DOWNLOAD PDF
ace inhibitor mechanism of action - Correct Answer The development of the ACE inhibitors was
spurred by the discovery of the venom of a South American viper, which was found to inhibit
kininase activity. Kininase is an enzyme that normally breaks down bradykinin, a potent
vasodilator in the human body.
As their name implies, these drugs inhibit angiotensin-converting enzyme, which is responsible
for converting Angiotensin I (AI) (formed through the action of renin) to angiotensin 2 (AII). AII
is a potent vasoconstrictor and induces aldosterone secretion by the adrenal glands. Aldosterone
stimulates sodium and water resorption, which can raise blood pressure. Together, these
processes are referred to as the renin-angiotensin-aldosterone system. By inhibiting this process,
blood pressure is lowered.
The primary effects of the ACE inhibitors are cardiovascular and renal. Their cardiovascular
effects are due to their ability to reduce blood pressure by decreasing systemic vascular
resistance (SVR). They do this by preventing the breakdown of the vasodilating substance
bradykinin and substance P (another potent vasodilator), and preventing the formation of AII.
These combined effects decrease afterload, or the resistance against which the left ventricle must
pump to eject its volume of blood during contraction. The ACE inhibitors are beneficial in the
treatment of heart failure because they prevent sodium and 349water resorption by inhibiting
aldosterone secretion. This causes diuresis, which decreases blood volume and return to the
heart. This in turn decreases preload, or the left ventricular end-diastolic volume, and the work
required of the heart.
ace inhibitors - Correct Answer are considered the drugs of choice for hypertensive patients with
heart failure
adverse effects of ace inhibitors - Correct Answer Major CNS effects of the ACE inhibitors
include fatigue, dizziness, mood changes, and headaches. A characteristic dry, nonproductive
cough may occur that is reversible with discontinuation of the therapy. A first-dose hypotensive
effect can cause a significant decline in blood pressure. Other adverse effects include loss of
taste, hyperkalemia, angioedema, and renal impairment. In patients with severe heart failure
whose renal function may depend on the activity of the renin-angiotensin-aldosterone system,
treatment with ACE inhibitors may cause acute renal failure. ACE inhibitors promote potassium
resorption in the kidney, although they promote sodium excretion due to their reduction of
aldosterone secretion.
For this reason, serum potassium levels must be monitored regularly. This is especially true
when there is concurrent therapy with potassium-sparing diuretics, although many patients
tolerate both types of drug therapy with no major problems. One rare, but potentially fatal,
,adverse effect is angioedema. Angioedema is a strong vascular reaction involving inflammation
of submucosal tissues, which can progress to anaphylaxis.
adverse effects of andregenics - Correct Answer bradycardia with reflex tachycardia, postural
and postexercise hypotension, dry mouth, drowsiness, dizziness, depression, 346edema,
constipation, and sexual dysfunction (e.g., impotence). Other effects include headache, sleep
disturbances, nausea, rash, and palpitations. There is a high incidence of orthostatic hypotension
(a sudden drop in blood pressure during changes in position) in patients taking alpha blockers,
first dose syncope
the abrupt discontinuation of the centrally acting alpha2 receptor agonists can result in rebound
hypertension, characterized by a sudden and very high elevation of blood pressure. This may also
be true for other antihypertensive drug classes, especially beta blockers. Nonselective blocking
drugs are also commonly associated with bronchoconstriction as well as metabolic inhibition of
glycogenolysis in the liver.
ion, the abrupt discontinuation of the centrally acting alpha2 receptor agonists can result in
rebound hypertension, characterized by a sudden and very high elevation of blood pressure. This
may also be true for other antihypertensive drug classes, especially beta blockers. Nonselective
blocking drugs are also commonly associated with bronchoconstriction as well as metabolic
inhibition of glycogenolysis in the liver.
Any change in the dosing regimen for cardiovascular medications should be undertaken
gradually and with appropriate patient monitoring and follow-up. Although the same is also true
for most other classes of medications, abrupt dosage changes of cardiovascular medications,
either up or down, can be especially hazardous for the patient. Some of these drugs can also
cause disruptions in blood count as well as in serum electrolyte levels and renal function.
Periodic monitoring of white blood cell count, serum potassium, sodium and creatinine levels is
necessary.
Inte
adverse effects of anticoagulants - Correct Answer bleeding is the main complication of
anticoagulation therapy, and the risk increases with increasing dosages. Bleeding may be
localized (e.g., hematoma at the site of injection) or systemic. It also depends on the nature of the
patient's underlying clinical disorder and is increased in patients taking high doses of aspirin or
other drugs that impair platelet function. One particularly notable adverse effect of heparin is
heparin-induced thrombocytopenia (HIT). There are two types of HIT. Type I is characterized by
a more gradual reduction in platelets. In this type, heparin therapy can generally be continued. In
contrast, in type II HIT there is an acute fall in the number of platelets (more than 50% reduction
from baseline). Heparin therapy must be discontinued in patients with type II HIT. The greatest
risk to the patient with HIT is the paradoxical occurrence of thrombosis, something that heparin
normally prevents or alleviates. Thrombosis that occurs in the presence of HIT can be fatal. The
incidence of this disorder ranges from 5% to 15%. The direct thrombin inhibitors lepirudin and
argatroban are both specifically indicated for treatment of HIT. Warfarin can cause skin necrosis
and "purple toes" syndrome. Other adverse effects are listed in Table 26-2.
,adverse effects of antifibrinolytics - Correct Answer occur uncommonly and are mild. However,
there have been rare reports of these drugs causing thrombotic events, such as acute
cerebrovascular thrombosis and acute MI. The common adverse effects of antifibrinolytics are
listed in Table 26-6.
adverse effects of antiplatelet drugs - Correct Answer can be serious, and they all pose a risk for
inducing a serious bleeding episode
adverse effects of beta andregenics - Correct Answer Mixed alpha/beta agonists produce the
most adverse effects because they are nonselective. These include insomnia, restlessness,
anorexia, cardiac stimulation, hyperglycemia, tremor, and vascular headache. The adverse effects
of the nonselective beta agonists are limited to beta-adrenergic effects, including cardiac
stimulation, tremor, anginal pain, and vascular headache. The beta2 drugs can cause both
hypertension and hypotension, vascular headaches, and tremor. Overdose management may
include careful administration of a beta blocker while the patient is under close observation due
to the risk for bronchospasm. Because the half-life of most adrenergic agonists is relatively short,
the patient may just be observed while the body eliminates the medication.
adverse effects of thrombolytic drugs - Correct Answer internal, intracranial, and superficial
bleeding. Other problems include hypersensitivity, anaphylactoid reactions, nausea, vomiting,
and hypotension. These drugs can also induce cardiac dysrhythmias.
adverse effects of vasodilators - Correct Answer Diazoxide has many undesirable adverse effects
and is rarely used in clinical practice. Adverse effects of hydralazine include dizziness, headache,
anxiety, tachycardia, edema, dyspnea, nausea, vomiting, diarrhea, hepatitis, systemic lupus
erythematosus (SLE), vitamin B6 deficiency, and rash. Minoxidil adverse effects include T-wave
electrocardiographic changes, pericardial effusion or tamponade, angina, breast tenderness, rash,
and thrombocytopenia. Adverse effects of sodium nitroprusside include bradycardia, decreased
platelet aggregation, rash, hypothyroidism, hypotension, methemoglobinemia, and, rarely,
cyanide toxicity. Cyanide ions are a by-product of nitroprusside metabolism. Cyanide and
thiocyanate toxicity are seen clinically when nitroprusside is used at high dosages for long
periods of time and/or in patients with renal insufficiency. When nitroprusside is combined with
sodium thiosulfate, the potential for cyanide toxicity is greatly reduced.
Adverse effects to anticholinergics - Correct Answer The most commonly reported adverse
effects of inhaled anticholinergics are related to their pharmacology and include dry mouth or
throat, nasal congestion, heart palpitations, gastrointestinal (GI) distress, urinary retention,
increased intraocular pressure, headache, coughing, and anxiety. Ipratropium is classified as a
pregnancy category B drug; all others in this class are pregnancy category C.
(Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
Albuterol - Correct Answer Class : beta 2 agonist (short acting)
, Indications and mechanisms of action: is a short-acting beta2-specific bronchodilating beta
agonist. Other similar drugs include bitolterol (Tornalate), levalbuterol (Xopenex), pirbuterol
(Maxair), and terbutaline (Brethine). Albuterol is the most commonly used drug in this class. If
albuterol is used too frequently, dose-related adverse effects may be seen, because albuterol loses
its beta2-specific actions, especially at larger dosages
Contraindications :. As a consequence, the beta1 receptors are stimulated, which causes nausea,
increased anxiety, palpitations, tremors, and an increased heart rate.
Route: po and inhalation
Other facts: levorotatory isomeric form of albuterol, levalbuterol, is sometimes prescribed as an
albuterol alternative for patients with certain risk factors (e.g., tachycardia, including tachycardia
associated with albuterol treatment). (Lilley 583)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
alpha1 blockers - Correct Answer are doxazosin (Cardura), prazosin (Minipress), tamsulosin
(Flomax), and terazosin (Hytrin). Their use is contraindicated in patients who have shown a
hypersensitivity to them. They are classified as pregnancy category C drugs. They are available
only as oral preparations. Tamsulosin is not used to control blood pressure but is indicated solely
for symptomatic control of benign prostatic hyperplasia (BPH).
alpha2 andrengenic agonist - Correct Answer clonidine and methyldopa—clonidine is the most
commonly used and is the 347prototypical drug for this class. Methyldopa is commonly used to
treat hypertension in pregnancy. However, these drugs are not typically prescribed as first-line
antihypertensive drugs, because their use is associated with a high incidence of unwanted
adverse effects such as orthostatic hypotension, fatigue, and dizziness. They may be used as
adjunct drugs in the treatment of hypertension after other drugs have failed or may be used in
conjunction with other antihypertensives such as diuretics.
Alteplase (Activase) - Correct Answer class: thrombolytic drug
Indications and mechanisms of action: . It is fibrin specific and therefore does not produce a
systemic lytic state. In addition, because it is present in the human body in a natural state, its
425administration for therapeutic use does not induce an antigen-antibody reaction. Therefore, it
can be re-administered immediately in the event of reinfarction. The drug t-PA has a very short
half-life of 5 minutes. It is believed to open the clogged artery rapidly, but its action is short-
lived. Therefore, it is given with heparin to prevent reocclusion of the affected blood vessel
Route : parenteral form. There is also a smaller dosage form known as Cathflo Activase that is
used to flush clogged IV or arterial lines. Tenecteplase (TNKase) is a newer form of alteplase
that is given by IV push after MI. Alteplase is also used for ischemic stroke.
Aminocaproic acid (Amicar) - Correct Answer class : antifibrinolytic (synthetic)
EDITION BY LINDA LILLEY, SHELLY COLLINS, JULIE
SNYDER – EXAM QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALE | 2027 Q&A |
INSTANT DOWNLOAD PDF
ace inhibitor mechanism of action - Correct Answer The development of the ACE inhibitors was
spurred by the discovery of the venom of a South American viper, which was found to inhibit
kininase activity. Kininase is an enzyme that normally breaks down bradykinin, a potent
vasodilator in the human body.
As their name implies, these drugs inhibit angiotensin-converting enzyme, which is responsible
for converting Angiotensin I (AI) (formed through the action of renin) to angiotensin 2 (AII). AII
is a potent vasoconstrictor and induces aldosterone secretion by the adrenal glands. Aldosterone
stimulates sodium and water resorption, which can raise blood pressure. Together, these
processes are referred to as the renin-angiotensin-aldosterone system. By inhibiting this process,
blood pressure is lowered.
The primary effects of the ACE inhibitors are cardiovascular and renal. Their cardiovascular
effects are due to their ability to reduce blood pressure by decreasing systemic vascular
resistance (SVR). They do this by preventing the breakdown of the vasodilating substance
bradykinin and substance P (another potent vasodilator), and preventing the formation of AII.
These combined effects decrease afterload, or the resistance against which the left ventricle must
pump to eject its volume of blood during contraction. The ACE inhibitors are beneficial in the
treatment of heart failure because they prevent sodium and 349water resorption by inhibiting
aldosterone secretion. This causes diuresis, which decreases blood volume and return to the
heart. This in turn decreases preload, or the left ventricular end-diastolic volume, and the work
required of the heart.
ace inhibitors - Correct Answer are considered the drugs of choice for hypertensive patients with
heart failure
adverse effects of ace inhibitors - Correct Answer Major CNS effects of the ACE inhibitors
include fatigue, dizziness, mood changes, and headaches. A characteristic dry, nonproductive
cough may occur that is reversible with discontinuation of the therapy. A first-dose hypotensive
effect can cause a significant decline in blood pressure. Other adverse effects include loss of
taste, hyperkalemia, angioedema, and renal impairment. In patients with severe heart failure
whose renal function may depend on the activity of the renin-angiotensin-aldosterone system,
treatment with ACE inhibitors may cause acute renal failure. ACE inhibitors promote potassium
resorption in the kidney, although they promote sodium excretion due to their reduction of
aldosterone secretion.
For this reason, serum potassium levels must be monitored regularly. This is especially true
when there is concurrent therapy with potassium-sparing diuretics, although many patients
tolerate both types of drug therapy with no major problems. One rare, but potentially fatal,
,adverse effect is angioedema. Angioedema is a strong vascular reaction involving inflammation
of submucosal tissues, which can progress to anaphylaxis.
adverse effects of andregenics - Correct Answer bradycardia with reflex tachycardia, postural
and postexercise hypotension, dry mouth, drowsiness, dizziness, depression, 346edema,
constipation, and sexual dysfunction (e.g., impotence). Other effects include headache, sleep
disturbances, nausea, rash, and palpitations. There is a high incidence of orthostatic hypotension
(a sudden drop in blood pressure during changes in position) in patients taking alpha blockers,
first dose syncope
the abrupt discontinuation of the centrally acting alpha2 receptor agonists can result in rebound
hypertension, characterized by a sudden and very high elevation of blood pressure. This may also
be true for other antihypertensive drug classes, especially beta blockers. Nonselective blocking
drugs are also commonly associated with bronchoconstriction as well as metabolic inhibition of
glycogenolysis in the liver.
ion, the abrupt discontinuation of the centrally acting alpha2 receptor agonists can result in
rebound hypertension, characterized by a sudden and very high elevation of blood pressure. This
may also be true for other antihypertensive drug classes, especially beta blockers. Nonselective
blocking drugs are also commonly associated with bronchoconstriction as well as metabolic
inhibition of glycogenolysis in the liver.
Any change in the dosing regimen for cardiovascular medications should be undertaken
gradually and with appropriate patient monitoring and follow-up. Although the same is also true
for most other classes of medications, abrupt dosage changes of cardiovascular medications,
either up or down, can be especially hazardous for the patient. Some of these drugs can also
cause disruptions in blood count as well as in serum electrolyte levels and renal function.
Periodic monitoring of white blood cell count, serum potassium, sodium and creatinine levels is
necessary.
Inte
adverse effects of anticoagulants - Correct Answer bleeding is the main complication of
anticoagulation therapy, and the risk increases with increasing dosages. Bleeding may be
localized (e.g., hematoma at the site of injection) or systemic. It also depends on the nature of the
patient's underlying clinical disorder and is increased in patients taking high doses of aspirin or
other drugs that impair platelet function. One particularly notable adverse effect of heparin is
heparin-induced thrombocytopenia (HIT). There are two types of HIT. Type I is characterized by
a more gradual reduction in platelets. In this type, heparin therapy can generally be continued. In
contrast, in type II HIT there is an acute fall in the number of platelets (more than 50% reduction
from baseline). Heparin therapy must be discontinued in patients with type II HIT. The greatest
risk to the patient with HIT is the paradoxical occurrence of thrombosis, something that heparin
normally prevents or alleviates. Thrombosis that occurs in the presence of HIT can be fatal. The
incidence of this disorder ranges from 5% to 15%. The direct thrombin inhibitors lepirudin and
argatroban are both specifically indicated for treatment of HIT. Warfarin can cause skin necrosis
and "purple toes" syndrome. Other adverse effects are listed in Table 26-2.
,adverse effects of antifibrinolytics - Correct Answer occur uncommonly and are mild. However,
there have been rare reports of these drugs causing thrombotic events, such as acute
cerebrovascular thrombosis and acute MI. The common adverse effects of antifibrinolytics are
listed in Table 26-6.
adverse effects of antiplatelet drugs - Correct Answer can be serious, and they all pose a risk for
inducing a serious bleeding episode
adverse effects of beta andregenics - Correct Answer Mixed alpha/beta agonists produce the
most adverse effects because they are nonselective. These include insomnia, restlessness,
anorexia, cardiac stimulation, hyperglycemia, tremor, and vascular headache. The adverse effects
of the nonselective beta agonists are limited to beta-adrenergic effects, including cardiac
stimulation, tremor, anginal pain, and vascular headache. The beta2 drugs can cause both
hypertension and hypotension, vascular headaches, and tremor. Overdose management may
include careful administration of a beta blocker while the patient is under close observation due
to the risk for bronchospasm. Because the half-life of most adrenergic agonists is relatively short,
the patient may just be observed while the body eliminates the medication.
adverse effects of thrombolytic drugs - Correct Answer internal, intracranial, and superficial
bleeding. Other problems include hypersensitivity, anaphylactoid reactions, nausea, vomiting,
and hypotension. These drugs can also induce cardiac dysrhythmias.
adverse effects of vasodilators - Correct Answer Diazoxide has many undesirable adverse effects
and is rarely used in clinical practice. Adverse effects of hydralazine include dizziness, headache,
anxiety, tachycardia, edema, dyspnea, nausea, vomiting, diarrhea, hepatitis, systemic lupus
erythematosus (SLE), vitamin B6 deficiency, and rash. Minoxidil adverse effects include T-wave
electrocardiographic changes, pericardial effusion or tamponade, angina, breast tenderness, rash,
and thrombocytopenia. Adverse effects of sodium nitroprusside include bradycardia, decreased
platelet aggregation, rash, hypothyroidism, hypotension, methemoglobinemia, and, rarely,
cyanide toxicity. Cyanide ions are a by-product of nitroprusside metabolism. Cyanide and
thiocyanate toxicity are seen clinically when nitroprusside is used at high dosages for long
periods of time and/or in patients with renal insufficiency. When nitroprusside is combined with
sodium thiosulfate, the potential for cyanide toxicity is greatly reduced.
Adverse effects to anticholinergics - Correct Answer The most commonly reported adverse
effects of inhaled anticholinergics are related to their pharmacology and include dry mouth or
throat, nasal congestion, heart palpitations, gastrointestinal (GI) distress, urinary retention,
increased intraocular pressure, headache, coughing, and anxiety. Ipratropium is classified as a
pregnancy category B drug; all others in this class are pregnancy category C.
(Lilley 584)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
Albuterol - Correct Answer Class : beta 2 agonist (short acting)
, Indications and mechanisms of action: is a short-acting beta2-specific bronchodilating beta
agonist. Other similar drugs include bitolterol (Tornalate), levalbuterol (Xopenex), pirbuterol
(Maxair), and terbutaline (Brethine). Albuterol is the most commonly used drug in this class. If
albuterol is used too frequently, dose-related adverse effects may be seen, because albuterol loses
its beta2-specific actions, especially at larger dosages
Contraindications :. As a consequence, the beta1 receptors are stimulated, which causes nausea,
increased anxiety, palpitations, tremors, and an increased heart rate.
Route: po and inhalation
Other facts: levorotatory isomeric form of albuterol, levalbuterol, is sometimes prescribed as an
albuterol alternative for patients with certain risk factors (e.g., tachycardia, including tachycardia
associated with albuterol treatment). (Lilley 583)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition.
Mosby, 022016. VitalBook file.
alpha1 blockers - Correct Answer are doxazosin (Cardura), prazosin (Minipress), tamsulosin
(Flomax), and terazosin (Hytrin). Their use is contraindicated in patients who have shown a
hypersensitivity to them. They are classified as pregnancy category C drugs. They are available
only as oral preparations. Tamsulosin is not used to control blood pressure but is indicated solely
for symptomatic control of benign prostatic hyperplasia (BPH).
alpha2 andrengenic agonist - Correct Answer clonidine and methyldopa—clonidine is the most
commonly used and is the 347prototypical drug for this class. Methyldopa is commonly used to
treat hypertension in pregnancy. However, these drugs are not typically prescribed as first-line
antihypertensive drugs, because their use is associated with a high incidence of unwanted
adverse effects such as orthostatic hypotension, fatigue, and dizziness. They may be used as
adjunct drugs in the treatment of hypertension after other drugs have failed or may be used in
conjunction with other antihypertensives such as diuretics.
Alteplase (Activase) - Correct Answer class: thrombolytic drug
Indications and mechanisms of action: . It is fibrin specific and therefore does not produce a
systemic lytic state. In addition, because it is present in the human body in a natural state, its
425administration for therapeutic use does not induce an antigen-antibody reaction. Therefore, it
can be re-administered immediately in the event of reinfarction. The drug t-PA has a very short
half-life of 5 minutes. It is believed to open the clogged artery rapidly, but its action is short-
lived. Therefore, it is given with heparin to prevent reocclusion of the affected blood vessel
Route : parenteral form. There is also a smaller dosage form known as Cathflo Activase that is
used to flush clogged IV or arterial lines. Tenecteplase (TNKase) is a newer form of alteplase
that is given by IV push after MI. Alteplase is also used for ischemic stroke.
Aminocaproic acid (Amicar) - Correct Answer class : antifibrinolytic (synthetic)
