NR 293 PHARMACOLOGY ROK EXAM

Review iof iKnowledge i(ROK): iPharmacology iNR293 Course NR293 iPharmacology: iANSWER iKEY Exam Exam i2: iWeek i5- iChapters i22, i23, i24, i25, i26, i27, i28, i54…and iconcepts ifrom ipreventing imed ierrors iand ipatient ieducation ifrom iclass idiscussion i& iclass iROK. Purpose: iThe iReview iof iKnowledge i(ROK) ifocuses ion icourse ioutcomes, iunit ioutcomes iand ikey iconcepts ito ienhance istudent isuccess ion iexams. iUse ithis idocument ias ia ifocused iguide ifor istudy iin iconjunction iwith iassigned ireadings, iPowerPoint ipresentations, iand iother icourse iresources. iSupplement ithis idocument iby ioutlining iyour iown inotes ifrom ithe itextbook ichapters iand iplace iyour iexpanded imore idetailed inotes iin ithe iStudent iNotes icolumn. iThis idocument ishould iNOT ibe iused ias ia isubstitute ifor icompleting ithe iassigned ireadings. Key iConcepts Chapters Student iNotes Antihypertensive iDrugs Chapter i22 **You ido inot ineed ito iwrite iout ieach idefinition. iMake isure iyou iunderstand ithese iwords ior iwrite ia ibrief idefinition iin iyour iown iwords. iChapter i22: Alpha1 iBlockers Centrally iacting iadrenergic Essential ihypertension Secondary ihypertension Orthostatic ihypotension Chapter i23: Angina ipectoris Reflex itachycardia Vasospastic iangina Chapter i24: Atrial iFibrillation Chronotropic idrugs Dromotopic iDrugs Inotropic idrugs Heart ifailure Chapter i25: Arrhythmia ivs. iDysrhythmia Action ipotential Depolarization Supraventricular iTachycardia Ventricular iTachycardia Torsades ide ipointes Antihypertensive iDrugs: i“Drug itherapy ifor ihypertension ineeds ito ibe iindividualized. iImportant iconsiderations iin iplanning idrug itherapy iare iwhether ithe ipatient ihas imultiple imedical iproblems iand iwhat iimpact idrug itherapy iwill ihave ion ithe ipatient's iquality iof ilife. iFor iexample, isexual idysfunction iin imales iis ia icommon iadverse ieffect iof imany iantihypertensive idrugs, ibut iespecially ibeta iblockers, iand iis ithe imost icommon ireason ifor inonadherence ito idrug itherapy. iDemographic ifactors, icultural iimplications, ithe iease iof imedication iadministration i(e.g., ia ionce-a-day idosing ischedule ior itransdermal iadministration), iand icost iare iother iimportant iconsiderations. iThere iare iessentially iseven imain icategories iof ipharmacologic idrugs iused ito itreat ihypertension: i1.) idiuretics, i2) iadrenergic idrugs, i3) ivasodilators, i4) iangiotensin iconverting ienzyme i(ACE) iinhibitors,5) iangiotensin ireceptor iblockers i(ARBs), i6) icalcium ichannel iblockers i(CCBs), iand i7) idirect irenin iinhibitors. iThere iare idrugs iin ithe ivasodilator icategory icalled i8) idirect ivasodilators. iDrugs iin iany iof ithese iclasses imay ibe iused ieither ialone ior iin icombination. iThe ivarious icategories iand isubcategories iof iantihypertensive idrugs iare ilisted iin iBox i22-1.” i(Lilley ip i349) 1. What ido iwe ineed ito iconsider iwhen itreating ia ipregnant ihypertensive iclient? iDrug itransfer ito ifetus ithrough iplacenta: iACE/ARBs iare iCategory iD iduring i2nd/3rd itrimester. iCommonly iuse imethyldopa i(Aldomet) ias ifirst ichoice, ibut iother iclasses imay ibe iused. 2. What imedication(s) iwould ibe iconsidered iappropriate? iMethyldopa icommonly ifirst iline iin ipregnancy ifor iHTN iWhat imedication(s) iwould ibe icontraindicated? iACE i& iARBS iare iCat iD iin i2nd/3rd itrimester 3. At ihow imany iweeks igestation iis ia ipregnant iclient iwith ihigh iblood ipressure iconsidered ito ihave iprimary ihypertension iversus ipreeclampsia? iif idiagnosed iless ithan i20 iweeks iof ipregnancy, iit iis iprimary ihypertension: i> i20 iweek, iit iis ian iOB iproblem, isuch ias ipreeclampsia i(to ibe ifurther ilearned iin iyour iOB irotation!!) 4. List inursing iconsiderations ifor ihypertension itreatment iin ithe ielderly. istart ilow; igo islow. iCheck ifor idrug iinteractions, idue ito ielderly itaking imore imedications. iThey imay inot itolerate idrugs ias iwell, igiven iage iand iunderlying imedical iconditions. iCounsel ion iincreased irisk ifor ipotential ifor iorthostatic ihypotension iand iincreased irisk ipossible ifalls: iFrequently imonitor ivital isigns, iespecially iblood ipressure iand ipulse irate, iwhen ithe ipatient iis itaking iany iof ithe iadrenergic idrugs ibecause iof itheir icardiovascular iand icerebrovascular ieffects Use iof iBeta-Adrenergic iAgonists iin iElderly i(Beta iBlockers)…IMPORTANT!!! ***Baroreceptors ido inot iwork ias ieffectively iin ithe ielderly ipatient. iReduced ibaroreceptor iactivity imay ilead ito iorthostatic ihypotension, iand iincrease irisk iof ifalls, iespecially iwhen iblood ipressure imedications iare itaken, iincluding iBeta iBlockers. iTeach iclient iabout ithese ipotential ieffects • Several iphysiologic ichanges ioccur iin ithe icardiovascular isystem iof ithe iolder iadult, iincluding ia idecline iin ithe iefficiency iand icontractile iability iof ithe iheart imuscle, idecrease iin icardiac ioutput, iand idiminished istroke ivolume. iStress, iheat, iand iuse iof ibeta- iadrenergic iagonists imay ilead ito isignificant iincreases iin iblood ipressure iand ipulse irate. • Advise ipatients ithat iany ioccurrence iof ichest ipain, ipalpitations, iheadache, ior iseizures imust ibe ireported iimmediately ito ithe iprescriber iand/or iemergency icare iaccessed. • Caution ipatients iabout ithe iuse iof iover-the-counter idrugs, iherbals, isupplements, iand iother imedications. iThis icaution iis idue ito ipossible idrug-drug iinteractions ias iwell ias ithe ielderly iperson's iincreased isensitivity ito imany idrugs iand iother ichemicals. i(Lilley i303) Briefly idescribe ihow ieach idrug iclass igenerally iworks: iThe isampling iof idrugs iwe iwill ibe ifocusing ion iare ilisted ibelow. Drug iclass Brief: iMechanism iof iAction Central iActing iAlpha2Adrenergic i(Clonidine i& iMethydopa) Per iyour itextbook: iEach idrug iclass ihas i“mechanism iof iaction i& idrug ieffects. iJust isummarize iin i1 ior i2 ior iyour iown isentences. Decrease iSNS ioutflow ifrom ithe ibrain: idecrease ithe iaction iof i“flight ior ifright” Alpha iblockers-peripheral iacting (Prazosin, iDoxasozin) Block ialpha ireceptors iin ithe iblood ivessels= ivasodilation: imore ichance ifor iorthostatic hypotension idue ito ithe ialpha iblockade. Beta iBlockers- i(cardioselective i& inoncardioselective) (Atenolol; iLabetolol; iMetoprolol) Block ibeta ireceptors iin ithe iheart- idecrease iheart irate iand icontractility; ialso, iblock irenin irelease i(a ivasoconstrictor) ifrom ithe ikidneys Dual-Action iAlpha1 i& iBeta ireceptor blocker i(carvedilol; ilabetolol) Blocks ibeta iand ialpha ireceptor i(as iabove): imore ichance ifor iorthostatic ihypotension idue ito the ialpha iblockade, iespecially iin ithe ielderly. Angiotensin-converting ienzyme iinhibitors i(ACE iinhibitors) i(Lisinopril) Inhibit ithe iangiotensin iconverting ienzyme, iso ithat iA1 idoesn’t iconvert ito iA2; iA2 iis ia ivasoconstrictor iand ialso istimulates irelease iof iAldosterone, iwhich icauses iNa+/H20 retention. iSO, iTHESE iACTIONS iARE iBLOCKED. Angiotensin iII i(A2)receptor iblockers i(ARBS) i(Losarten) These idrugs iblock iAngiotensin i2 ifrom iactivating icell ireceptor isites: iA2 iis ia ivasoconstrictor and ialso iactivates iAldosterone, iwhich icauses iNa+/H20 iretention i(overall ieffect iis isimilar ito iACE) Calcium ichannel iblockers i(Amlodipine, iDilitiazem, iProcardia) Block ithe iinflux iof icalcium ineeded ifor ismooth imuscle icontraction; ithus iyou iget ismooth muscle irelaxation i& idecrease iin iBP; ithey ialso iact ion ithe idepolarization ifor icardiac iconduction, iso ithey ihelp iwith iSVT/atrial idysrhythmias ilike iAtrial ifibrillation/A iflutter. Vasodilators Direct ivasodilate ithe iblood ivessels= idecreased iblood ipressure; imore irisk iof iorthostasis. Diuretics ( iReview iChapter i28) Nitropursside i(hypertensive icrisis) Used iin iICU Put ithe ifollowing idrug iclass iinto ithe iappropriate iindication: i(not ievery icolumn iwill ibe icompletely ifilled): iDiuretics Angiotensin iconverting ienzyme iinhibitors i(ACE iinhibitors) Alpha iBlocker Alpha1 i& iBeta ireceptor iblockers-Dual-Action i(ex. icarvedilol i& ilabetalol) Angiotensin iII ireceptor iblockers i(ARB’s) Calcium ichannel iblockers Vasodilators Beta iBlocker Nitrites