Pharm week 2 extra learning
EXTRA LEARNING
1) The nurse checks which items prior to administering
hydrochlorothiazide? A hyperkalemia, hypoglycemia, penicillin
allergy
B hypokalemia, hyperglycemia, sulfa allergy
C increased risk of osteoporosis
D hypomagnesemia, hypouricemia
2) A 66 year old client complaining of not feeling well is seen in a clinic. The client is taking several
medications for heart disease and hypertension. They include atenolol, digoxin, and
hydrochlorothiazide. A tentative diagnosis of digoxin toxicity is made. Which of the following
assessment data would support this diagnosis?
A dyspnea, edema, and palpitations
B chest pain, hypotension, and paresthesias
C visual disturbances, bradycardia, and nausea
D constipation, dry mouth, and sleep disorder
3) When monitoring a patient for hypokalemia related to diuretic use, the nurse looks for which
possible symptoms?
A nausea, vomiting, and anorexia
B diarrhea and abdominal pain
C orthostatic hypotension
D muscle cramps and lethargy
4) A 60-year-old patient with diabetes has a blood pressure reading of 150/96 mmHg. After three
months of increased exercise and decreased calories, the patient has lost 10 lb (4.54 kg). The
patient's follow-up blood pressure is 142/94 mmHg. Which medication does the family nurse
practitioner prescribe?
A enalapril (Vasotec)
B furosemide (Lasix)
, C amlodipine (Norvasc)
D propranolol (Inderal)
E metoprolol and hydrochlorothiazide (Lopressor HCT)
Summary of antihypertensive medications
Diuretics can decrease blood pressure by promoting the excretion of sodium and water in the urine.
When the total blood volume decreases, so does blood pressure.
On the surface of the cell membranes of the myocardial cells in the heart and the smooth muscle in the
blood vessels and bronchi are beta-receptors. All of the beta-receptors respond to epinephrine in
reaction to stress or danger (aka the “fight or flight” response). When beta1 receptors are stimulated in
the heart, the heart beats faster. When beta2 receptors are stimulated on the smooth muscles of the
blood vessels, epinephrine causes them to constrict, raising blood pressure. However the opposite is
true for the lungs, epinephrine causes the bronchi to dilate making it easier for air to pass through the
lungs and it is easier to breathe. Beta-antagonist medications block the ability of epinephrine to
stimulate the beta-receptor, slowing the heart rate and lowering blood pressure. Cardioselective beta-
blockers are designed to block only the beta1 receptors on the heart and the beta2 receptors on the
blood vessels. Examples include: atenolol (Tenormin), metoprolol (Lopressor), bisoprolol (Zebeta),
and nebivolol (Bystolic).
Another receptor on the peripheral blood vessels is the alpha1 receptor. Blocking these receptors
causes arteries and veins to dilate and lower blood pressure. Examples of alpha
antagonists are doxazosin (Cardura), prazosin (Minipress), and terazosin (Hytrin). There are also drugs that
are considered alpha and beta-blockers. These medications block both kinds of receptors in the
smooth muscles of the vessels to lower blood pressure. Carvedilol (Coreg) and labetalol (Normodyne)
are examples of this category.
Calcium is necessary for the heart muscle and blood vessel cells to contract. Calcium channel blockers
work by preventing calcium ions from entering the cell, therefore making muscle contraction harder
to achieve. Calcium channel blockers such
as amlodipine (Norvasc), diltiazem (Cardizem), verapamil (Calan), and nifedipine (Procardia) can slow
the heart rate, dilate the arteries, and lower blood pressure.
The kidneys also play a vital role in regulating blood pressure with the renin angiotensin system. In this
system, angiotensin II is a potent vasoconstrictor. The enzyme responsible for converting angiotensin I
to angiotensin II is appropriately called ACE or angiotensin converting enzyme. Hence the importance
of the classes of medications called the ACE inhibitors (ACEIs) and the angiotensin receptor blockers
(ARBs). When ACE is blocked, angiotensin II is not produced, blood vessels relax and blood pressure
goes down. Some examples
of ACEIs include: benazepril (Lotensin), enalapril (Capoten), lisinopril (Zestril),
and ramipril (Altace). The angiotensin receptor blockers like, losartan (Cozaar), valsartan (Diovan) and
olmesartan (Benicar), prevent the action of angiotensin II, in turn lowering the blood
EXTRA LEARNING
1) The nurse checks which items prior to administering
hydrochlorothiazide? A hyperkalemia, hypoglycemia, penicillin
allergy
B hypokalemia, hyperglycemia, sulfa allergy
C increased risk of osteoporosis
D hypomagnesemia, hypouricemia
2) A 66 year old client complaining of not feeling well is seen in a clinic. The client is taking several
medications for heart disease and hypertension. They include atenolol, digoxin, and
hydrochlorothiazide. A tentative diagnosis of digoxin toxicity is made. Which of the following
assessment data would support this diagnosis?
A dyspnea, edema, and palpitations
B chest pain, hypotension, and paresthesias
C visual disturbances, bradycardia, and nausea
D constipation, dry mouth, and sleep disorder
3) When monitoring a patient for hypokalemia related to diuretic use, the nurse looks for which
possible symptoms?
A nausea, vomiting, and anorexia
B diarrhea and abdominal pain
C orthostatic hypotension
D muscle cramps and lethargy
4) A 60-year-old patient with diabetes has a blood pressure reading of 150/96 mmHg. After three
months of increased exercise and decreased calories, the patient has lost 10 lb (4.54 kg). The
patient's follow-up blood pressure is 142/94 mmHg. Which medication does the family nurse
practitioner prescribe?
A enalapril (Vasotec)
B furosemide (Lasix)
, C amlodipine (Norvasc)
D propranolol (Inderal)
E metoprolol and hydrochlorothiazide (Lopressor HCT)
Summary of antihypertensive medications
Diuretics can decrease blood pressure by promoting the excretion of sodium and water in the urine.
When the total blood volume decreases, so does blood pressure.
On the surface of the cell membranes of the myocardial cells in the heart and the smooth muscle in the
blood vessels and bronchi are beta-receptors. All of the beta-receptors respond to epinephrine in
reaction to stress or danger (aka the “fight or flight” response). When beta1 receptors are stimulated in
the heart, the heart beats faster. When beta2 receptors are stimulated on the smooth muscles of the
blood vessels, epinephrine causes them to constrict, raising blood pressure. However the opposite is
true for the lungs, epinephrine causes the bronchi to dilate making it easier for air to pass through the
lungs and it is easier to breathe. Beta-antagonist medications block the ability of epinephrine to
stimulate the beta-receptor, slowing the heart rate and lowering blood pressure. Cardioselective beta-
blockers are designed to block only the beta1 receptors on the heart and the beta2 receptors on the
blood vessels. Examples include: atenolol (Tenormin), metoprolol (Lopressor), bisoprolol (Zebeta),
and nebivolol (Bystolic).
Another receptor on the peripheral blood vessels is the alpha1 receptor. Blocking these receptors
causes arteries and veins to dilate and lower blood pressure. Examples of alpha
antagonists are doxazosin (Cardura), prazosin (Minipress), and terazosin (Hytrin). There are also drugs that
are considered alpha and beta-blockers. These medications block both kinds of receptors in the
smooth muscles of the vessels to lower blood pressure. Carvedilol (Coreg) and labetalol (Normodyne)
are examples of this category.
Calcium is necessary for the heart muscle and blood vessel cells to contract. Calcium channel blockers
work by preventing calcium ions from entering the cell, therefore making muscle contraction harder
to achieve. Calcium channel blockers such
as amlodipine (Norvasc), diltiazem (Cardizem), verapamil (Calan), and nifedipine (Procardia) can slow
the heart rate, dilate the arteries, and lower blood pressure.
The kidneys also play a vital role in regulating blood pressure with the renin angiotensin system. In this
system, angiotensin II is a potent vasoconstrictor. The enzyme responsible for converting angiotensin I
to angiotensin II is appropriately called ACE or angiotensin converting enzyme. Hence the importance
of the classes of medications called the ACE inhibitors (ACEIs) and the angiotensin receptor blockers
(ARBs). When ACE is blocked, angiotensin II is not produced, blood vessels relax and blood pressure
goes down. Some examples
of ACEIs include: benazepril (Lotensin), enalapril (Capoten), lisinopril (Zestril),
and ramipril (Altace). The angiotensin receptor blockers like, losartan (Cozaar), valsartan (Diovan) and
olmesartan (Benicar), prevent the action of angiotensin II, in turn lowering the blood
