lOMoAR cPSD| 47061011
Study Guide for NR 293 Exam 3 Questions and Answers
100% Verified UPDATED!!!
• 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)
1
, lOMoAR cPSD| 47061011
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)
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
2
, lOMoAR cPSD| 47061011
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
• 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
3
Study Guide for NR 293 Exam 3 Questions and Answers
100% Verified UPDATED!!!
• 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)
1
, lOMoAR cPSD| 47061011
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)
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
2
, lOMoAR cPSD| 47061011
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
• 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
3
