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Study Guide for NR 293 Exam 3
• Alpha2-adrenergic receptor stimulators (agonists)/clonidine o Stimulate alpha2-adrenergic
receptors in the brain
o Decrease sympathetic outflow from the CNS, decrease norepinephrine production
o Stimulates alpha2-adrenergi receptors, thus reducing renin
o Examples: Clonidine (Catapres), Methyldopa (aldomet): used for pregnant women w/htn
• Alpha1-blockers/”azosin,” o Block alpha1-adrenergic receptors
o Management of severe heart failure (HF) when used with cardiac glycosides and diuretics
o Some used to relieve symptoms of BPH- increase urinary flow rate o Example: “ Azosin”
(doxazosin (Cardura) o Adverse Effects :
Serious: hypotension (first dose) syncope
Common: dizziness
o Nursing implications: instruct pt. to lie down after taking first dose because they may
become dizzy
• Beta-blockers “olol”: First-line treatment for heart failure & HTN o Reduce BP by reducing heart
rate through beta1 blockade (block receptors for norepinhrine)
o Cause reduced secretion of renin o Long-term use causes reduced peripheral vascular
resistance o Adverse Effects : orthostatic hypotension, bradycardia w/ reflex tachycardia,
sexual dysfunction in men, possible hypoglycemia or hyperglycemia
• Angiotensin-converting enzyme inhibitor, “pril” Captopril o Mechanism of Action :
Inhibit angiotensin-converting enzyme, which is responsible for converting
angiotensin I (through the action of renin) to angiotensin
II
Angiotensin II is a potent vasoconstrictor and causes aldosterone secretion from the
adrenal glands
Result in decreased systemic vascular resistance (afterload), vasodilation, and
therefore decreased blood pressure
o Indications :
First-line treatment for heart failure & HTN
HF (either alone or in combination with diuretics or other drugs)
Slow progression of left ventricular hypertrophy after MI (cardio protective)
Renal protective effects in patients with diabetes
Captopril and lisinopril can be used if a patient has liver dysfunction, unlike other ACE
inhibitors that are pro-drugs
• *Pro-drugs are inactive in their administered form and must be metabolized in the liver to an
active form so as to be effective
, lOMoARcPSD| 63525276
o Adverse Effects : hyperkalemia & dry, nonproductive cough o Serious drug interaction:
NSAIDs
• Angiotensin II receptor blocker “sartan” losartan (Dovan) o Mechanism of Action :
Allow angiotensin I to be converted to angiotensin II, but block the receptors that
receive angiotensin II
Block vasoconstriction and release of aldosterone
Well tolerated, do not cause a dry cough
Indications: first-line treatment for heart failure & HTN o Adverse Effects : URI,
headache
May cause occasional dizziness, inability to sleep, diarrhea
• Calcium channel blockers: Amlodipine “dipine” verapamil (calan), diltiazem (cardizem) o
Mechanism of Action : cause smooth muscle relaxation by blocking the binding of calcium to its
receptors, preventing muscle contraction
o Adverse effect : constipation
High-fiber diet with plenty of fluids will help prevent constipation o Indications :
hypertension
Angina- ch. 23
• Ischemia:
o Ischemic heart disease: Poor blood supply to the heart muscle
(Atherosclerosis, Coronary artery disease)
o Myocardial infarction (MI): Necrosis, or death, of cardiac tissue,
disabling or fatal
• Therapeutic Objectives o Minimize the frequency of attacks and decrease the duration and
intensity of anginal pain
o Improve the patient’s functional capacity o Prevent or
delay the worst possible outcome: MI
• Cardiac glycosides: Digoxin
o Therapeutic level: between 0.5-2ng/mL
o Digoxin doses are held and the prescriber notified if the apical pulse is 60 beats/minute o
Negative chronotropic effect decreases HR
o Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose
Required use of digitab when potassium level is above 5 mEq/L, severe sinus
bradycardia that does not respond to cardiac pacing, or an overdose of more than 10
mg of digoxin.
o Avoid bran muffins when taking digoxin o Hypokalemia increases the chance of digitalis
toxicity
2
, lOMoARcPSD| 63525276
• Class III drugs: Amiodarone (ch. 25) o Mechanism of action : prolonging
action potential duration o Indications : ventricular dysrhythmias o
Contraindication : hypersensitivity and bradycardia or AV block
Adverse effects: FDA black box warning: pulmonary toxicity, hepatotoxicity arrhythmia worsening-sinus
bradycardia, constipation, QT prolongation, hypotension, blue-gray coloring of the skin on the face, arms,
and neck
• Unclassified antidysrhythmics: Adenosine (Ch. 25)
Slows conduction through the AV node
Used to convert paroxysmal supraventricular tachycardia to sinus
rhythm
Very short half-life (less than 10 seconds)
• Flush with 20cc of normal saline
Only administered as fast IV push
May cause asystole for a few seconds
Adverse Effects
• ALL antidysrhythmics can cause dysrhythmias!
• Hypersensitivity reactions, nausea, vomiting, diarrhea, dizziness, blurred
vision, headache
Assessment
• Obtain a thorough drug and medical history
• Baseline BP, P, I&O, and cardiac rhythm
• Measure serum potassium levels before initiating therapy
• Conditions that may be contraindications for use of specific drugs
• Potential drug interactions During therapy,
• Monitor cardiac rhythm, heart rate, BP, general well-being, skin color,
temperature, heart and lung sounds
• Assess plasma drug levels as indicated
• Monitor for toxic effects
• Take medications as scheduled and not to skip doses or double up for missed
doses
• Contact their physician for instructions if a dose is missed
• Notify health care provider of any worsening of dysrhythmia or toxic effects
• Nitrates and nitrites: Nitroglycerin o Prototypical nitrate
o Large first-pass effect with oral forms o Used for symptomatic treatment of ischemic heart
conditions (angina) o IV form used for BP control in perioperative hypertension, treatment
of HF, ischemic pain,
pulmonary edema associated with acute MI, and hypertensive emergencies
o Adverse effects : headaches
Study Guide for NR 293 Exam 3
• Alpha2-adrenergic receptor stimulators (agonists)/clonidine o Stimulate alpha2-adrenergic
receptors in the brain
o Decrease sympathetic outflow from the CNS, decrease norepinephrine production
o Stimulates alpha2-adrenergi receptors, thus reducing renin
o Examples: Clonidine (Catapres), Methyldopa (aldomet): used for pregnant women w/htn
• Alpha1-blockers/”azosin,” o Block alpha1-adrenergic receptors
o Management of severe heart failure (HF) when used with cardiac glycosides and diuretics
o Some used to relieve symptoms of BPH- increase urinary flow rate o Example: “ Azosin”
(doxazosin (Cardura) o Adverse Effects :
Serious: hypotension (first dose) syncope
Common: dizziness
o Nursing implications: instruct pt. to lie down after taking first dose because they may
become dizzy
• Beta-blockers “olol”: First-line treatment for heart failure & HTN o Reduce BP by reducing heart
rate through beta1 blockade (block receptors for norepinhrine)
o Cause reduced secretion of renin o Long-term use causes reduced peripheral vascular
resistance o Adverse Effects : orthostatic hypotension, bradycardia w/ reflex tachycardia,
sexual dysfunction in men, possible hypoglycemia or hyperglycemia
• Angiotensin-converting enzyme inhibitor, “pril” Captopril o Mechanism of Action :
Inhibit angiotensin-converting enzyme, which is responsible for converting
angiotensin I (through the action of renin) to angiotensin
II
Angiotensin II is a potent vasoconstrictor and causes aldosterone secretion from the
adrenal glands
Result in decreased systemic vascular resistance (afterload), vasodilation, and
therefore decreased blood pressure
o Indications :
First-line treatment for heart failure & HTN
HF (either alone or in combination with diuretics or other drugs)
Slow progression of left ventricular hypertrophy after MI (cardio protective)
Renal protective effects in patients with diabetes
Captopril and lisinopril can be used if a patient has liver dysfunction, unlike other ACE
inhibitors that are pro-drugs
• *Pro-drugs are inactive in their administered form and must be metabolized in the liver to an
active form so as to be effective
, lOMoARcPSD| 63525276
o Adverse Effects : hyperkalemia & dry, nonproductive cough o Serious drug interaction:
NSAIDs
• Angiotensin II receptor blocker “sartan” losartan (Dovan) o Mechanism of Action :
Allow angiotensin I to be converted to angiotensin II, but block the receptors that
receive angiotensin II
Block vasoconstriction and release of aldosterone
Well tolerated, do not cause a dry cough
Indications: first-line treatment for heart failure & HTN o Adverse Effects : URI,
headache
May cause occasional dizziness, inability to sleep, diarrhea
• Calcium channel blockers: Amlodipine “dipine” verapamil (calan), diltiazem (cardizem) o
Mechanism of Action : cause smooth muscle relaxation by blocking the binding of calcium to its
receptors, preventing muscle contraction
o Adverse effect : constipation
High-fiber diet with plenty of fluids will help prevent constipation o Indications :
hypertension
Angina- ch. 23
• Ischemia:
o Ischemic heart disease: Poor blood supply to the heart muscle
(Atherosclerosis, Coronary artery disease)
o Myocardial infarction (MI): Necrosis, or death, of cardiac tissue,
disabling or fatal
• Therapeutic Objectives o Minimize the frequency of attacks and decrease the duration and
intensity of anginal pain
o Improve the patient’s functional capacity o Prevent or
delay the worst possible outcome: MI
• Cardiac glycosides: Digoxin
o Therapeutic level: between 0.5-2ng/mL
o Digoxin doses are held and the prescriber notified if the apical pulse is 60 beats/minute o
Negative chronotropic effect decreases HR
o Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose
Required use of digitab when potassium level is above 5 mEq/L, severe sinus
bradycardia that does not respond to cardiac pacing, or an overdose of more than 10
mg of digoxin.
o Avoid bran muffins when taking digoxin o Hypokalemia increases the chance of digitalis
toxicity
2
, lOMoARcPSD| 63525276
• Class III drugs: Amiodarone (ch. 25) o Mechanism of action : prolonging
action potential duration o Indications : ventricular dysrhythmias o
Contraindication : hypersensitivity and bradycardia or AV block
Adverse effects: FDA black box warning: pulmonary toxicity, hepatotoxicity arrhythmia worsening-sinus
bradycardia, constipation, QT prolongation, hypotension, blue-gray coloring of the skin on the face, arms,
and neck
• Unclassified antidysrhythmics: Adenosine (Ch. 25)
Slows conduction through the AV node
Used to convert paroxysmal supraventricular tachycardia to sinus
rhythm
Very short half-life (less than 10 seconds)
• Flush with 20cc of normal saline
Only administered as fast IV push
May cause asystole for a few seconds
Adverse Effects
• ALL antidysrhythmics can cause dysrhythmias!
• Hypersensitivity reactions, nausea, vomiting, diarrhea, dizziness, blurred
vision, headache
Assessment
• Obtain a thorough drug and medical history
• Baseline BP, P, I&O, and cardiac rhythm
• Measure serum potassium levels before initiating therapy
• Conditions that may be contraindications for use of specific drugs
• Potential drug interactions During therapy,
• Monitor cardiac rhythm, heart rate, BP, general well-being, skin color,
temperature, heart and lung sounds
• Assess plasma drug levels as indicated
• Monitor for toxic effects
• Take medications as scheduled and not to skip doses or double up for missed
doses
• Contact their physician for instructions if a dose is missed
• Notify health care provider of any worsening of dysrhythmia or toxic effects
• Nitrates and nitrites: Nitroglycerin o Prototypical nitrate
o Large first-pass effect with oral forms o Used for symptomatic treatment of ischemic heart
conditions (angina) o IV form used for BP control in perioperative hypertension, treatment
of HF, ischemic pain,
pulmonary edema associated with acute MI, and hypertensive emergencies
o Adverse effects : headaches
