HOSA Pharmacology (NEW 2026/ 2027 Update) | Questions & Answers | Grade A| 100% Correct (Verified Answers).

…..DLDD HOSA Pharmacology (NEW 2026/ 2027 Update) | Questions & Answers | Grade A| 100% Correct (Verified Answers). Q. A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which method of medication administration provides the client with the greatest first-pass effect? A) Oral. B) Sublingual. C) Intravenous. D) Subcutaneous ANSWERS A) Oral Q. An older client with a decreased percentage of lean body mass is likely to receive a prescription that is adjusted based on which pharmacokinetic process? A) Absorption B) Metabolism C) Elimination D) Distribution ANSWERS D) Distribution Q. Which of the following is a parenteral method of administering a drug? A) Topical B) Oral C) Sublingual D) Rectal ANSWERS A) Topical Q. Which of the following is an enteral method of administering drugs? A. Rectal B. Intranasal C. Topical D. Tracheal ANSWERS A. Rectal Q. How are the solid forms of drugs most frequently administered? A. Parenteral B. Intravenous C. Enteral D. Inhalation ANSWERS C. Enteral Q. Which of the following methods of medication administration is described as readily available, painless, and noninvasive but has limited value in an emergent situation because of slow or erratic absorption? A. Sublingual B. Oral C. Topical D. Rectal ANSWERS B. Oral Q. What method of medication administration is best described as painless and has a rapid onset of action but requires a responsive, cooperative patient with an intact gag reflex? A. Topical B. Oral C. IV D. Buccal ANSWERS D. Buccal Q. Which of the following methods of medication administration is easily accessible during an active seizure if an IV is unobtainable? A. IO B. SL C. Rectal D. Tracheal ANSWERS C. Rectal Q. Which of the following medication administration methods has an immediate onset and is easily accessible, but is painful and time-consuming and has a significant potential for causing adverse reactions? A. IM B. SL C. Rectal D. IV ANSWERS D. IV Q. Valium is an example of which type of drug name? A. Generic name B. Chemical name C. Official name D. Trade name ANSWERS D. Trade name Q. Which of the following best describes the absorption of topical nitroglycerin in a patient with poor peripheral circulation? A. Absorption is enhanced, and the results may be stronger than expected. B. Absorption decreases, and the results may be stronger than expected. C. Absorption is unchanged, and the results can be typical. D. Absorption decreases, and the results may be less than desired. ANSWERS D. Absorption decreases, and the results may be less than desired. Q. Which of the following terms is best defined as the passive transport of solutes? A. Absorption B. Diffusion C. Osmosis D. Concentration ANSWERS B. Diffusion Q. The method of administration of a drug will have the greatest impact on which of the following actions? A. Absorption B. Excretion C. Metabolism D. Elimination ANSWERS A. Absorption Q. Which of the following terms is used to describe a drug that produces a physiologic response when bonded with a receptor? A. Affinity B. Partial agonist C. Antagonist D. Agonist ANSWERS D. Agonist Q. Which of the following terms describes the amount of a drug that is required to provide a beneficial effect in 50% of the drug-tested population? A. Therapeutic dose B. Plasma-level profile C. Therapy state D. Lethal dose ANSWERS A. Therapeutic dose Q. Which of the following routes of administration provides the fastest rate of absorption? A. IM B. PO C. IV D. Sub-Q ANSWERS C. IV Q. Which of the following actions is most likely to occur when a patient with chronic renal failure receives a medication? A. Liver failure along with renal failure B. Impaired ability to eliminate the drug C. Kidney stones from an excess of drug in the system D. A need for a diuretic to help eliminate the drug ANSWERS B. Impaired ability to eliminate the drug Which of the following drug classifications is an example of a drug's mechanism of action? A. Chemical classification B. Cardiac therapy C. Therapeutic classification D. Physiologic classification C. Therapeutic classification Which of the following drug classifications would best describe the bronchodilation effects of Brethine? A. Class of agent B. Mechanism of action C. Body system D. Physiologic classification B. Mechanism of action Once a drug has been developed, what is the next step the pharmaceutical company must take to gain FDA approval? A. Put the drug into the U.S. Pharmacopoia before allowing any sales. B. Secure a patent on the medication, and then sell it to various pharmacies. C. List the medication on the stock market to recoup development costs. D. Test the drug's effectiveness as an investigational drug. D. Test the drug's effectiveness as an investigational drug. Which of the following best describes why standardization of drugs is necessary? A. Drugs are produced by the same company under different names. B. Drugs have different doses depending on whether they are brand-name or generic drugs. C. Drugs do not vary by dose and length of action based on where the drug is made. D. Drugs may vary by strength and activity among drug manufacturers. D. Drugs may vary by strength and activity among drug manufacturers. Why is it important to know and understand the medications a patient is taking? A. For testing purposes B. For safe medication administration C. For documentation purposes D. For billing purposes B. For safe medication administration With ________ classifications, drugs are organized on the basis of their usefulness in treating a particular disorder. A. therapeutic B. pharmacologic c. chemical A. therapeutic Drugs organized by ______ classifications are categorized based on how they produce their effects in the body. A. therapeutic B. pharmacologic c. chemical B. pharmacologic A ________ drug is the original, well-understood drug model from which other drugs in a particular class have been deployed. Prototype The description given to a drug by the International Union of Pure and Applied Chemistry (IUPAC) is its __________ name. Chemical The three types of drug names are: chemical, generic, and trade names One of the main arguments against substituting generic drugs for brand name drugs is differences in: Bioavailability Drugs with more than one active ingredient are called: Combination drugs The process of drug movement to achieve drug action Pharmacokinetics What is the key to the therapeutic classification of a drug? Link the disorder to the drug's clinical usefulness A drug's trade name is assigned by whom? developing pharmaceutical company Why is a drug scheduled drug? the drug can cause dependency What is an example of a commonly scheduled drug? Morphine In the United States, what law or agency restricts the use of controlled substances? Controlled Substances Act If for a particular drug there are no controlled studies in women or if studies in women and animals are not available to establish risk in pregnancy, the FDA classification is: Category C The _______ route means the nurse will administer the drug to the patient by mounts, under the tongue, or into the rectum. Enteral The traditional ___________ of drug administration form the operational basis for the safe delivery of medication. 10 rights __________ and _________ are examples of rectal administration methods Suppositories; enemas The most common method of drug delivery is the: Intramuscular route Drugs are injected directly into the muscle in the: Transdermal route One popular method for delivering drugs across the skin at a slow steady rate is the: Transdermal patch _________, _________, and _______ type drug delivery methods are useful in treating respiratory and reproductive ailments. Inhalation's; intimations; irrigations Implants are generally administered by which drug administration method? Subcutaneous The study of the science of how various drug forms influence the pharmacokinetics and pharmacodynamic activity. A. Pharmacokinetics B. Pharmacodynamic C. Pharmaceutics D. Pharmacognosy E. Pharmacotherapeutics C. Pharmaceutics What the body does with the drug; Absorption-Distribution-Metabolism-Excretion? A. Pharmaceutics B. Pharmacokinetics C. Pharmacodynamics D. Pharmacotherapeutics E. Pharmacognosy A. Pharmaceutics The biochemical and physiological effect of the drug on the body tissue and microorganisms in or on the body. A. Pharmaceutics B. Pharmacotherapeutics C. Pharmacokinetics D. Pharmacodynamics E. Pharmacognosy D. Pharmacodynamics The use of drugs and the clinical indications for drugs to prevent and treat diseases. A. Pharmaceutics B. Pharmacognosy C. Pharmacodynamics D. Pharmacokinetics E. Pharmacotherapeutics E. Pharmacotherapeutics The study of natural (plant and animal) drug sources, commonly known as herbals. A. Pharmacognosy B. Pharmaceutics C. Pharmacodynamics D. Pharmacotherapeutics E. Pharmacokinetics A. Pharmacognosy Movement of a drug from its site of administration into systemic circulation (blood) A. Absorption B. Administration C. Metabolism D. Distribution E. None of the above A. Absorption Dosage form, route of administration, bioavailability of the drug, and status of patient's circulation are all factors affecting. A. Distribution B. Absorption C. Metabolism D. Excretion E. All of the above B. Absorption Liquids, elixers and syrups have the fastest absorption rates, rivaled only by enteric coated tablets. A. True B. False B. False Process by which drug becomes available to the body fluids and body tissues A. Absorption B. Excretion C. Distribution D. Metabolism E. None of the above C. Distribution Drug moves from the blood into: A. Tissues B. Organs C. Body fluids D. All the above D. All the above Areas of more rapid distribution will result in higher drug concentrations. A. True B. False A. True Drug characteristics, tissue properties, blood flow, protein binding properties, water-soluble/fat-soluble and blood-brain barrier are factors affecting. A. Metabolism B. Distribution C. Absorption D. All the above E. None of the above B. Distribution Which is not a drug distribution pattern? A. Drug stays within vascular system B. Drug distributes throughout body water C. Drug concentrates in specific tissues D. Drug distributes throughout body and tissue E. None of the above E. None of the above A drug with a large molecular weight that tightly binds to plasma proteins would most likely follow what pattern of distribution. A. Drug distributes throughout body water B. Drug concentrates in specific tissues C. Drug distributes throughout body and tissue D. Drug stays in vascular system E. None of the above D. Drug stays in vascular system A drug of low molecular weight would most likely follow what distribution pattern. A. Drug distributes throughout body water B. Drug concentrates in specific tissues C. Drug distributes throughout body and tissue D. Drug stays in vascular system E. None of the above A. Drug distributes throughout body water Chloroquine in the liver, tetracycline in bone and teeth, iodine in thyroid glands describes which distribution pattern. A. Drug distributes throughout body water B. Drug concentrates in specific tissues C. Drug distributes throughout body and tissue D. Drug stays in vascular system E. None of the above B. Drug concentrates in specific tissues Most common distribution pattern, determined by the drug's ability to cross the cell membrane, with highest concentrations in organs of elimination (kidneys, liver, intestine) A. Drug distributes throughout body water B. Drug concentrates in specific tissues C. Drug distributes throughout body fluids and tissue D. Drug stays in vascular system E. None of the above C. Drug distributes throughout body fluids and tissue Which is not an area of rapid distribution? A. Heart B. Liver C. Kidneys D. Brain E. Muscle E. Muscle Which is not an area of slow distribution? A. Muscle B. Fat C. Skin D. Heart E. None of the above D. Heart Drug Any chemical that affects the processes of a living organism pharmacology the study of drugs and their interactions with living organisms and human beings prescription drugs those drugs that are not safe to use except under professional medical supervision over-the-counter drugs one that can be purchased without a prescription and is generally considered safe for consumers to use if the label's directions are followed carefully and all warnings are heeded FACTORS AFFECTING DISTRIBUTION Blood flow Drug affinity Protein-binding effect Malnutrition Aging Abscess/Exudates Body glands Tumors Drug Enforcement Administration regulates the manufacturing and dispensing of controlled substances FACTORS AFFECTING DYNAMIC EQUILIBRIUM Absorption from the site of entry Distribution to the active site Biotransformation (metabolism) in the liver Excretion from the body Orphan Drug Act of 1983 purpose was to facilitate the development of new drugs to treat rare diseases pharmacodynamics the mechanism of action by which drugs produce their effects based on time and dose half-life the time required for drug levels in the serum to decrease from 100 percent to 50 percent placebo a drug form that exerts no pharmacologic effect, no therapeutic effect, and has no side effects when administered Rights of Medication Administration Right Drug Right Patient Right Dose Right Route Right Time and Frequency Right Documentation Right History and Assessment Drug approach and Right to Refuse Right Drug-Drug Interaction and Evaluation Right Education and Information During medication administration how can the nurse properly confirm he or she has the right patient?* A. Ask the patient to state their last name and compared this to the patient's ID arm band. B. Ask the patient to state their full name and compare this information to the medication administration record and the patient's ID arm band. C. Ask the patient to state their full name along with their date of birth and compare this information to the medication administration record and the patient's ID arm band. C. Ask the patient to state their full name along with their date of birth and compare this information to the medication administration record and the patient's ID arm band. The doctor writes an order for a medication. The nurse notes the order says to administer 12.5 mg PO. Pharmacy dispenses the nurse with 6.25 mg tablets. How many tablets will the nurse administer and what medication administration right is the nurse assessing?* A. 2 tablets, right evaluation B. 2.5 tablets, right calculation C. 2 tablet, right dosage D. 2.5 tablets, right time C. 2 tablet, right dosage The doctor ordered a patient who is post-op from surgery to receive 2 mg of IV Morphine. The patient can have the pain medication every 4 hours PRN for a breakthrough pain rating of 5 or greater on 1-10 scale. The patient's current pain rating is a 6 on 1-10 scale. The patient's last dose was at 0400 and it is now 1000. You administer the medication as ordered. What information will you include in your documentation? Select all that applies:* A. Pain Rating B. Route C. Location of the Pain D. Dosage E. Medication Name F. Current Vital Signs G. Follow-up Pain Rating H. Time I. All of the above I. All of the above You received a new medication order on a patient for the treatment of glaucoma. The patient has no other health history and is allergic to Penicillin. The order says to administer Timolol 0.25% 1 gtt twice a day. Your NEXT action is to:* A. Administer the medication as ordered. B. Confirm you have been dispensed with the right medication before administering the medication and then administer the medication. C. Hold the order until you can obtain an order clarification from the prescribing physician. D. Educate the patient on how to perform punctual occlusion before administering the medication. C. Hold the order until you can obtain an order clarification from the prescribing physician. A patient is admitted with right-sided heart failure. The patient is prescribed Lisinopril, Metoprolol, and Furosemide. You prepare the medications as ordered using the medication administration rights to ensure patient safety. When assessing the "Right Reason" for Furosemide you determine?* A. This medication is a loop diuretic that will help increase urination and remove extra fluid from the blood. B. This medication is a nitrate that will help dilate the coronary arteries and increase oxygen delivery to the myocardium. C. This medication is a HMG-CoA reductase inhibitor and will help decrease lipid levels in the blood. D. This medication is an ACE inhibitor and will help decrease cardiac output. A. This medication is a loop diuretic that will help increase urination and remove extra fluid from the blood A patient is scheduled to take three medications at 1000. The nurse confirms the following about each medication: right medication, right dose, right time, and right route. When thinking of the first 8 Rights of Medication Administration what "right" is the nurse missing?* A. Right Site B. Right Assessment C. Right Documentation D. Right Patient D. Right Patient True or False: The purpose of the medication administration rights is to help prevent medication errors.* A. True B. False A. True Pharmacotherapeutics the desired therapeutic effect of the drug; the reason for prescribing the drug Response curve the relationship between the dose of a drug administered and the response it produces Steady state the balance of drug being administered and amount being eliminated Intrinsic activity drug's ability to stimulate its receptor Loading dose large dose. when a pt needs an immediate and full drug effect Adverse effect an undesirable effect other than the intended therapeutic effect Side effect any effect that is caused by a drug and that is different from the drug's intended effect. Normal, however undesirable Toxic effect specific groups of symptoms related to drug therapy that carry risk for permanent damage or death Pharmacogenomics The study of genetic variations that cause differences in drug response among individuals or populations. Pharmacogenetics The study of genetic causes of INDIVIDUAL variations in drug response Genotype - The genetic constitution of an individual person- The set of genes in our DNA Phenotype The observable characteristics or physical manifestations of a person's genotype After how many doses of a medication is the therapeutic effect concentration commonly reached? 5 doses What happens to a drugs half life when you add more doses before the drug has fully been removed from the body The concentration in the body increases, bringing the concentration closer to the level needed to reach the "therapeutic effect" of the drug. Sources of drugs natural and synthetic Natural source Drugs made from plants, animals and organic compounds Synthetic sources drugs made from laboratories; genetically modified 3 Principle of Pharmacology 1.Pharmacokinetics 2.Pharmacodynamics 3.Pharmacotherapeutics Liberation first step in the process by which medication enters the body and liberates the active ingredient that has been administered 3 Phases of Liberation Disintegration Disaggregation Dissolution Disintegration - breakdown of drugs into smaller particles. - Happens in the mouth Disaggregation Separate from one component to another. Dissolution disintegrate particles dissolves into liquid form Absorption movement of drug particles form GI tract to the body fluid Absorption Process passive diffusion, active transport, filtration Onset of drug action how long it takes to observe the beginning of the therapeutic effect Duration of drug effect how long the patient will experience the drug effect. Passive occurs mostly by diffusion (movement from higher to lower concentration). Active it requires carrier such as enzymes or protein to move against concentration gradient Pinocytosis cell carry the drug by engulfing & carrying across the membrane Hepatic first pass (half-life or t ½) time it takes for half of the drug to be eliminated Peak effect - Highest plasma concentration- how long it will take to see the maximum effect of the drug. Critical Concentration amount of a drug that is needed to cause a therapeutic effect Dynamic Equilibrium actual concentration that a drug reaches into the body Metabolism process by which the drug is breakdown or synthesized by the liver into inactive form Receptor sites located in the cell membranes and usually it is affected by the various chemicals that can either stimulate, breakdown or block, or compete. receptor site activities Agonist - stimulates Antagonist — block Competitive Antagonist DRUG EVALUATION After a chemical that might have therapeutic value is identified, it must undergo a series of scientific tests to evaluate its actual therapeutic and toxic effects. Approved drug a medicine that has been proven safe and effective to relieve or remedy a medical condition; Is given a brand name (trade name) by the pharmaceutical company that developed it. Generic name the original designation that a drug is given when the drug company that developed it applies for the approval process Chemical names Describes the drug's chemical composition and molecular structure Orphan drugs drugs that have been discovered but that are not financially viable because they have a limited market or a narrow margin of safety Pure Food and Drug Act (1906) Prevented the marketing of adulterated drug; required labelling to eliminate false or misleading claims. Federal Food, Drug and Cosmetic Act (1938) Mandated tests for drug toxicity and means for recall of drugs; established procedures for introducing new drugs; gave FDA the power of enforcement. Durham -Humphrey Amendment Durham-Humphrey Amendment (1952) Tightened control of certain drugs; specified drugs to be labelled "may not be distributed without prescription Harrison Narcotic Law (1914) regulated habit-forming narcotics. importation, manufacture, sale, use. Kefauver-Harris Act (1962) Tightened control over the quality of drugs; gave FDA regulatory power over the procedure of drug investigations; stated that efficacy as well safety of drugs had to be established Controlled Substance (1970) Define drug abuse and classified drugs as to their potential for abuse; provided strict controls over the distributions, storage, and use of these drugs Orphan Drug Act (1983) Provided incentives for the development of orphan drugs for treatment of rare disease. Pregnancy Category Established drug categories to indicate the potential for systemically absorbed drug to cause birth defects. Pregnancy Category A: no demonstrated risk to the fetus during the 1st and last trimester of pregnancy. Pregnancy Category B: Animal studies have not demonstrated a risk to the fetus, but there are no adequate studies in pregnant women Pregnancy Category C: Animal studies have shown an adverse effect on fetus but there are no adequate studies in human Pregnancy Category D: there is evidence of human fetal risk; but the potential benefits from the use of the drug in pregnant women may be acceptable despite potential risk Pregnancy Category X: A risk to human fetus has been proved. Risk Outweighs the benefit and drug should be avoided during pregnancy Controlled Substances Act of 1970 Act that control the distribution, storage and use of potentially addictive drugs. Controlled Substances drug or other substance that is tightly controlled by the government because it may be abused or cause addiction Schedule I (C-I): High abuse potential and no accepted medical use (heroin, marijuana, LSD) Schedule II (C-II): High abuse potential with severe dependence liability narcotics, amphetamines, and barbiturates) Schedule III (C-III): Less abuse potential than schedule II drugs and moderate dependence liability (non-barbiturates sedative, non-amphetamine, limited amount of some narcotics) Schedule IV (C-IV): Less abuse potential than schedule III and limited dependence liability (some sedatives, antianxiety, non- narcotic analgesic) Schedule V (C-V): Limited abuse potential; can be purchased in limited quantities without prescription. But purchasers must be 18 years old and must provide identification Drug administration an important component of providing comprehensive nursing care that incorporates all aspects of the nursing process. Standing order may or may not have termination date. p.n.r. order (as per needed) permits the nurse to give a medication when in his/her judgment the patient requires it Buccal a medication (e.g., a tablet) is held in the mouth against the mucous membranes of the cheek until the drug dissolves. Sublingual -a drug is placed under the tongue, where it dissolves. -In a relatively short time, the drug is largely absorbed into the blood vessels on the underside of the tongue. Intradermal The drug is injected into the layers of the skin raising a bleb, e.g. BCG vaccine, tests for allergy or by multiple punctures of the epidermis through a drop of the drug, e.g. smallpox vaccine. Ophthalmic Nasal -is used for both local and systemic drugadministration. Intravenous -the drug is injected into one of the superficial veins so that it directly reaches the circulation and is immediately available for action. Oral - the most common, least expensive, and most convenient route for most clients. - the drug is swallowed. Because the skin is not broken as it is for an injection, oral administration is also a safe method when is it acceptable for the nurse to take a verbal order from the prescriber before giving a drug to a patient? a. during the night shift when the prescriber is not at the hospital b. in an emergency situation such as a cardiac arrest c. when a patient is experiencing severe pain d. at any time it is necessary b. in an emergency situation such as a cardiac arrest The prescriber orders atenolol (Tenormin) 25 mg to be given orally once a day to control a patients high blood pressure. The nurse takes the patient's vital signs and finds that the blood pressure is 128/80 and the heart rate is 60 b/m. What does the nurse do first before giving this drug? a. check the order for prescriber limitations on when the drug should be given b. notify the prescriber and ask if the drug should be given c. reassess the blood pressure and heart rate in 30 minutes d. give the drug exactly as prescribed. a. check the order for prescriber limitations on when the drug should be given If Phenergan is available in 100 mg/2 mL ampules, which of the following represents the amount is needed in mL to give a dose of 12.5 mg IM? a. 0.20 b. 0.25 c. 0.50 d. 0.75 b. 0.25 The order reads: Lanoxin 0.125 mg PO now. The medication is available in 0.25 mg tablets. Which of the following represent the number of tablets the nurse will give. a. 2 tab b. 1/2 tab c. 1 1/2 tab d. 1/4 tab b. 1/2 tab FACTORS AFFECTING BLOOD PRESSURE: Contraction of the left ventricle Systemic vascular Resistance Elasticity of arterial wall Cardiac Output Volume of blood pump per minute Stroke Volume the volume of blood pumped out by a ventricle with each heartbeat Vascular resistance friction between blood and vessel walls Which of the following drugs is NOT considered anAngiotension Receptor Blocker (ARBs) medication used in hypertension? A. Losartan B. Catapres C. Valsartan D. Benicar B. Catapres A 65-year-old male patient is prescribed an ACE inhibitor for the treatment of hypertension. Which medication below is an ACE inhibitor? A. Metoprolol B. Benazepril C. Losartan D. Amlodipine B. Benazepril Which statements below CORRECTLY describe how ACE Inhibitors work? Select all that apply: A. This group of medications inhibits the renin-angiotensin-aldosterone system (RAAS). B. ACE Inhibitors prevent the conversion of Angiotensin I to Angiotensin II. C. ACE Inhibitors prevent Angiotensinogen from converting to Angiotensin I. D. ACE Inhibitors have a positive chronotropic and negative inotropic effect on the heart. A and B Angiotensin-converting enzyme (ACE) performs what roles in the body? Select all that apply: A. Inactivates bradykinin by breaking it down B. Dilates vessels C. Causes the kidneys to keep sodium and water D. Converts Angiotensin I to Angiotensin II A and D Fill in the blanks: Angiotensin II causes ___________ of the vessels and triggers the release of ____________. A. vasodilation; anti-diuretic hormone (ADH) B. vasodilation; aldosterone C. vasoconstriction; aldosterone D. vasoconstriction; anti-diuretic hormone (ADH) C. vasoconstriction; aldosterone Which patient below would MOST benefit from an ACE Inhibitor? A. A 50-year-old female with systolic dysfunction heart failure. B. A 48-year-old male with severe renal failure. C. A 35-year-old female with chronic hepatitis. D. A 54-year-old male with hypovolemic shock A. A 50-year-old female with systolic dysfunction heart failure. A physician writes a new medication order for a patient who has cardiovascular disease. The medication is an angiotensin II receptor blocker (ARB). What new medication on the patient's scheduled medication list is an ARB? A. Metoprolol B. Losartan C. Lisinopril D. Nicardipine B. Losartan A patient in the clinic reports difficulty tolerating the current ACE inhibitor medication, and questions if another medication could be used. The nurse correctly suspects the prescriber will choose which medication, which affects the renin-angiotensin-aldosterone system? A. atenolol B. losartan C. spironolactone D. adenosine C. spironolactone A patient has an order for metoprolol. Prior to medication administration, what does the nurse need to assess? A. Respirations B. Temperature C. Heart rate D. Oxygen saturation B. Temperature The three primary elements that determine the pressure in the cardiovascular system are heart rate, stroke volume, and: A. Baroreceptors B. Peripheral resistance C. Renin-Angiotensin-Aldosterone System (RAAS) D. All of the above B. Peripheral resistance Untreated hypertension can result to which of the following: A. Stroke B. Renal failure C. Loss of vision D. All of the above D. All of the above Contraction of the left ventricle shortening of the muscle the ventricle which pushes the oxygenated blood to the aorta and to the systemic circulation Systemic vascular Resistance resistance of the arterial wall to the blood flow created by systemic circulation. Elasticity of arterial wall resiliency of the arterial wall (contraction and relaxation) BLOOD PRESSURE (BP) Cardiac Output (CO) x Systemic Vascular Resistance (SVR) Primary /Idiopathic/ Essential HPN type of hypotension 90% of all cases with unidentifiable cause. Secondary HPN type of hypotension cause by other diseases (Cushing's syndrome, hyperthyroidism, Chronic renal disease, DM) ALPHA 1 BLOCKER blocks the action of alpha 1 receptor thus smooth muscle constriction and blood vessel constriction will not occu SELECTIVE BETA BLOCKERS blocks BETA 1 receptor which causes decrease heart rate CENTRALLY ACTING ADRENERGIC DRUGS it blocks the sympathetic activity of the central nervous system thus no Beta 1 and Alpha 1 receptor activation that will leads to smooth muscle constriction DIHYDROPYRIDINES Selectively inhibit L type of calcium in vascular smooth muscle resulting to deconstriction of smooth muscle NON DIHYDROPYRIDINES Not only capable of blocking the CA in smooth muscle but also in the cardiac cell such as; SA and AV nodes NURSING CARE/CONSIDERATION 1. Obtain baseline data`, hemodynamic status (HR,BP, SV, CO, TPR) , cardiac function. 2. Assess cardiovascular and pulmonary status by PE 3. Administer drug according to the prescribes doses 4. Monitor effect on BP, HR, and check for evidence of chest pain and hypotension 5. Drug should not discontinue rapidly due to the risk of angina/severe hypotension 6. Monitor for signs of excessive vasodilation that might lead to hypotension (tachycardia, dizziness, headache, diaphoresis, cold clammy skin, paleness, ↓BP) 7. Teach the client on how to recognize signs and symptom of side effects. 8. Instruct the client when to seek help. RENIN ANGIOTENSIN-ALDOSTERONE-SYSTEM DRUGS RENIN is release by the kidney in response to drop in blood pressure - renin will stimulate the release of ANGIOTENSIN I (liver) - precursor in conversion of ANGIOTENSIN II (lungs) -which is the target of RENIN INHIBITOR. ANGIOTENSIN CONVERTING ENZYME INHIBITOR (ACE) blocks the release of AT1 thus preventing AT2 Angiotensin II (AT2) Receptor Blockers AT2 increases heart rate and CO thus increasing BP. SIDE EFFECT of ARBs: · Hyperkalemia due to Aldosterone inhibition release resulting to excessive production of aldosterone.o Manifestation of hyperkalemia: nausea and vomiting, diarrhea, palpitation or dysrhythmia, numbness or weakness of limb, chest pain.· Dry cough - due to accumulation of bradykinin which cause inflammation in the lungs.· Angioedema - swelling of deeper layer of skin due to accumulation of fluids. Adrenergic Agonist (Sympathomimetics agents) drug that mimics/ stimulate the function of sympathetic nervous system that increases HR, blood pressure, breathing, pupillary response. EPINEPHRINE Natural catecholamine with beta 1 and alpha 1 agonists effect· contractility, conduction, bronchodilation, gluconeogenesis Note: this drug cannot be use if the cause of hypotension and bradycardia is cause by hypovolemia NOREPINEPHRINE - potent catecholamine and alpha 1 agonist· Potent vasoconstrictor· Increases myocardial contractility· Increased vascular resistance INDICATION:· Hypotension resulting to shock cause by septic or neurogenic shock. ISOPROTERENOL (Isuprel) a beta-1 and beta-2 adrenergic receptor agonist resulting in the following: Increased heart rate. Increased heart contractility. Relaxation of bronchial, gastrointestinal, and uterine smooth muscle. DOPAMINE: (Inoptrin) Naturally occurring catecholamine ACTION:· Activate dopaminergic receptor in major organs and periphery· Increase force of cardiac contractility, Vasoconstriction INDICATION· ↑ renal perfusion· Treatment of hypotension· Use after resuscitation to increase cerebral perfusion· Treatment of pulmonary congestion, with low CO, hypotension with left ventricular dysfunction. · Septic shock to improve left ventricular function NOTE: Monitor the site because dopamine can cause tissue necrosis extravasation. Never use peripheral access, always ensure central vein access. (internal jugular, subclavian, femoral) DOBUTAMINE (Dobutrex) ACTION:· directly stimulates beta-1 receptors of the heart to increase myocardial contractility and stroke volume, resulting in increased cardiac output· ionotropic effect increases contractility, leading to decreased end-systolic volume and, therefore, increased stroke volume· improves cardiac output, decreases pulmonary wedge pressure, and decreases total systemic vascular resistance with little effect on heart rate or systemic arterial pressure.· This is only given IV and IOINDICATION:· Depressed contractility due to surgery/organic heart disease = hypotension· Heart failure· Correction of hemodynamic imbalances ( Shock =decreased BP· Trauma = decreased BP Dosage: Infusion solution, in D5W 80 mg/100mL1 60 mg/100mL 320 mg/100mL Injectable solution 40 mg/100mL 80 mg/100mL 160 mg/100mL ANTIARRHYTHMIC AGENTS are used to treat arrhythmias (disturbances in the normal heart rhythm). Class I antiarrhythmics the largest group of antiarrhythmic drugs, consist of sodium channel blockers. This Affect the conduction activity of AV node, Purkinjie fiber and Bundle of His. Class IA antiarrhythmics are used to treat a wide variety of atrial and ventricular de:• disopyramide phosphate• procainamide hydrochloride• quinidine (sulfate, gluconate). control arrhythmias by altering the myocardial cell membrane and interfering with autonomic nervous system control of pacemaker cells. combined with other antiarrhythmics, such as beta adrenergic blockers, increase the risk of arrhythmias `FOUR CLASSES OF ANTIARYTHMIC AGENTS:(Class I, II, III, & IV) Drugs that affect myocardial conduction (Class I, II, III, & IV)· The etiology and type of arrythmia will dictate the choice of drug.· Mechanisms of action of antiarrhythmic drugs vary widely, and a few drugs exhibit properties common to more than one class Class I antiarrhythmics sodium channel blockers suppress or correct dysrhythmias by interfering fast depolarization. (movement of Na+ inside the cell making the outside muscle and nerve of the heart less charge All class I suppress arrhythmias by blocking the sodium channels in the cell membrane during an action potential, thereby interfering with the conduction of impulses along adjacent cardiac cells and producing a more membrane-stabilizing effect Class IB antiarrhythmics drugs work by blocking the rapid influx of sodium ions during the depolarization- (phase of the heart's depolarization-repolarization cycle. This results in a decreased refractory period, which reduces the risk of arrhythmias).· affect the Purkinje fibers (fibers in the conduction system of the heart) and myocardial cells in the ventricles, they're only used to treat ventricular arrhythmias used to treat ventricular ectopic beats, ventricular tachycardia, and ventricular fibrillation. may exhibit additive or antagonistic effects when administered with other antiarrhythmics, such as phenytoin, propranolol, procainamide, and quinidine. Adverse reactions to class IB antiarrhythmics include: • drowsiness • light-headedness • paresthesia • sensory disturbances • hypotension • bradycardia Class IC antiarrhythmics antiarrhythmics are used to treat certain severe, refractory (resistant) ventricular arrhythmias. Class IC antiarrhythmics include: • flecainide acetate • moricizine (a class I antiarrhythmic drug that shares class IA, IB, and IC properties) • propafenone hydrochloride. Class II antiarrhythmics beta blockers composed of beta-adrenergic antagonists, which are also known as beta-adrenergic blockers or beta blockers; block beta-adrenergic receptor sites in the conduction system of the heart. As a result, the ability of the SA node to fire spontaneously (automaticity) is slowed. The ability of the AV node and other cells to receive and conduct an electrical impulse to nearby cells (conductivity) is also reduced; also reduce the strength of the heart's contractions. When the heart beats less forcefully, it doesn't require as much oxygen to do its work. Beta-adrenergic blockers used as antiarrhythmics include: • acebutolol (not commonly used) • esmolol • propranolol Class III antiarrhythmics Potassium channel blockers Class III antiarrhythmics are used to treat ventricular arrhythmias.· amiodarone· dofetilide, ibutilide· sotalol are thought to suppress arrhythmias by converting a unidirectional block to a bidirectional block. They have little or no effect on depolarization. These drugs delay repolarization and lengthen the refractory period and duration of the action potential. Class IV antiarrhythmics Calcium channel blockers used to treat arrhythmias include verapamil and diltiazem. inhibit calcium ion influx across cardiac and smooth-muscle cells, thus decreasing myocardial contractility and oxygen demand. They also dilate coronary arteries and arterioles used to relieve angina, lower blood pressure, and restore normal sinus rhythm SA node, AV node, bundle of his, purkinje fibers electrical signal through heart route arrhythimia electrical signal through heart that doesn't follow normal route