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
1
, 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
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)
2
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
1
, 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
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)
2
