NUR 2407 / NUR2407 Pharmacology Questions and Answers Latest 2023/2024

How do calcium channel blockers work in the heart, the rest of the body? (CCB) calcium channels are found in myocardium and vascular smooth muscle cells -Free calcium ^^ muscle contractility -Peripheral resistance -Blood pressure ~CCB block calcium channel in vascular smooth muscle , which promotes VASODILATION **HIGHLY PROTEIN BOUND** (ex. Phenytoin, warfarin) Long half life Work better in African American DO NOT TAKE WITH GRAPEFRUIT JUICE VERAPAMIL Treat: supraventricular tachydysrhythmias prevent PSVT, angina, and hypertension Contraindicated : cardiogenic shock, 2nd and 3rd degree AV block, severe hypotension, heart failure DILTIAZEM Treat: PVST, afib, atrial flutter Contraindicated: 2nd and 3rd degree AV block, hypotension When to hold beta blockers-what do they impact? HR, BP “OLOL” drugs *reduce cardiac output, decrease HR and force* -with continued use vascular resistance is diminished and BP is reduced CHECK: HR and BP before administration HOLD IF apical pulse 60bpm, SBP90 -reduce heart rate, contractility, and renin release ** African American ** so not respond well to beta blockers alone to control HTN should be on combo diuretic and beta blocker NON-SELECTIVE BETA BLOCKERS: propanolol, carvidilol, inhibit beta 1 [heart] and beta 2 [lungs] BP decreases secondary to heart rate decrease BRONCHOCONSTRICTION Contraindicated: ASTHMA SELECTIVE BETA BLOCKERS: atenolol, metoprolol Acts on beta 1 [heart] Adverse effects: bradycardia, hypotension, hypoglycemia, thrombocytopenia, complete heart block, bronchospasm (CAUTION ASTHMA), agranulocytosis Minipress teaching “Praxosin” * Alpha Adrenergic Blockers* When taken with nitroglycerin can cause hypotension resulting in syncope -educate patient to change positions slowly When should we tell clients to take diuretics? Morning, afternoon, bedtime? Take in the AM! Use of potassium as a supplement, when to give, when to hold For a patient taking potassium wasting diuretics such as HCTZ and LASIX and taking potassium supplement, what would you do if the serum potassium level came back 5.0?- HOLD notify MD If patient on potassium wasting diuretic and serum potassium comes back 2.8 what would you do?- call MD. hold lasix, give potassium supplement Antidote for heparin (protamine sulfate) and Coumadin (vit K) Importance of daily weights in monitoring heart failure Why do patients taking diuretics need to report a weight gain of 2lbs in 24 hours? could be onset of worsening heart failure or pulmonary edema Interactions of Coumadin and antibiotics, what happens to INR levels and what may we need to do? Alterations in INR Increase risk of bleeding Give VITAMIN K Side effects of ACE inhibitors **cough** **cough** Cough When to hold digoxin, what are the side effects of digoxin, client complaints/symptoms the 3 effects on heart muscle: 1. positive inotropic= ^ myocardial contraction 2. negative chronotropic = decrease heart rate (allow for fill time