ATI PN PHARMACOLOGY PROCTORED EXAM REVIEW – PRACTICAL NURSING PHARMACOLOGY NOTES
AND PRACTICE QUESTIONS – COMPREHENSIVE MEDICATION REVIEW GUIDE A+ ALREADY GRADED
1. Receptors: Norepinephrine-Adrenergic (adrenergic comes from the word adrenalin)
Alpha 1-all sympathetic target organs except the heart-constrict the blood vessels and dilation of pupils
Alpha 2-Presynaptic adrenergic nerve terminal-inhibits the release of norepinephrine
Beta 1-Heart and Kidneys (BETA 1-ONE HEART)-increased heart rate and force of contraction, release of renin
Beta 2-All sympathetic target organs-inhibits smooth muscle (BETA 2-TWO LUNGS)
2. Beta blockers/olol's: Beta-Adrenergic Blockers
Metoprolol/Lopressor ENDING OLOL
Beta Blockers are use with heart failure, hypertension, angina and with myocardial infarctions.
Action = Blocks Beta-Receptors in the heart causing...
Decreases = HR, force of contraction, Rate of atrioventricular (AV) conduction
SE = Bradycardia, lethargy, GI disturbance, congestive heart failure, decrease BP, depression
The beta blockers stop sympathetic nervous system stimulation of the heart. Does not allow the heart rate and blood
pressure to rise with stress thus lowering the oxygen demand of the heart. It is very heart protective!
Will slow the heart rate and lower the blood pressure
Can have beta 2 blockage with larger doses-will constrict the bronchioles-watch for clients with known COPD, Asthma
Nursing Interventions
Check pulse-needs to be 60 or above
Check blood pressure-if hypotensive do not give (Systolic below 100 is a good rule of thumb I go by)
Monitor for sexual dysfunction-impotence for men-a good reason for non-compliance
Drowsiness/Fatigue-operating heavy machinery, driving could put client at risk
Insomnia-
Contraindicated with Heart Blocks, Bradycardia, Worsening Heart Failure
Increases Hypoglycemic ettect of Insulin-monitor blood sugars and for hypoglycemia, may need to lower insulin
dosage
Beta Blockers have to be weaned slowly to prevent rebound hypertension and tachycardia-if a client wants to stop
his beta-blocker they need to contract their physician
3. CCB,/calcium channel blockers: Nifedipine/Adalat/Procardia/Norvasc-controls blood vessels
Diltiazem/Cardizem
Verapamil/Calan/Isoptin/Verelan-controls heart rate and blood vessels
, ATI PN PHARMACOLOGY PROCTORED EXAM REVIEW – PRACTICAL NURSING PHARMACOLOGY NOTES
AND PRACTICE QUESTIONS – COMPREHENSIVE MEDICATION REVIEW GUIDE A+ ALREADY GRADED
Angina/Raynaud's/Vasospastic Angina/Atrial Arrhythmia's
Blocks calcium channels in the myocardial and vascular smooth muscles, decreases the contraction of smooth
muscle-relaxes the arteries-vasodilation. Blocking of calcium channels in the SA and AV node-Slows conduction
through the SA and AV node. Decreases the force of contraction slows heart rate
Grapefruit juice may increase absorption of nifedipine
Side Ettects: Relaxes smooth muscle and cardiac muscle-
Headache
Dizziness-Take lying, sitting and standing B/P, educate client to sit and stand slowly
Peripheral edema-assess for edema, monitor for worsening (diuretic)
Flushing
Reflex tachycardia-monitor for elevated heart rate (may need a BB)
Constipation-increase fibers and fluids (if not restricted) stool softener
Fatigue-Due to low heart rate-monitor EKG, pulse rate and rhythm
Weakness-Monitor B/P and Heart Rate
Impotence and sexual dysfunction-Discuss possibility with client-have client to call and not just to stop medications
Hepatotoxicity-ALT, AST, ALK PHOS, Bilirubin
MI-Monitor for chest pain, dyspnea, increases fatigue, weakness
CHF-Monitor for chest pain, dyspnea, edema, increasing weight, decreasing output, increasing HR and B/P
Angioedema-edema in face, throat, trouble swallowing, trouble breathing, thickened tongue
Grapefruit juice may increase absorption of nifedipine
Acute Toxicity
With an overdose or overmedicated
Gastric lavage
Monitor EKG-bradycardia-widening QRS, hypotension
Norepinephrine to treat hypotension and decreased cardiac contractility
Atropine or Isoproterenol-Bradycardia and Cardiac Blocks
Verapamil (Calan, Covera, Isoptin Verelan)
, ATI PN PHARMACOLOGY PROCTORED EXAM REVIEW – PRACTICAL NURSING PHARMACOLOGY NOTES
AND PRACTICE QUESTIONS – COMPREHENSIVE MEDICATION REVIEW GUIDE A+ ALREADY GRADED
Class IV antidysrhythmic
Calcium channel blocker
Inhibits the flow of calcium ions both into the myocardia cells and the vascular smooth muscle, slow the conductions
velocity and stabilizes dysrhythmias. Lowers the blood pressure, reduces cardiac workload and lowers the blood
pressure. Dilates the coronary arteries-anti-anginal
Side Ettects: Headache, constipation, hypotension, edema, bradycardia
4. Pril/ace inhibitors: Enalapril/Vasotec
PRIL-is the ending for ace's
Reduces Angiotensin 2 and aldosterone levels
Prevents Angiotensin 1 from converting to Angiotensin 2 in the lungs-leaves the Angiotensin 1 hanging in the
lungs-creates irritation-cough
Vasodilation-mostly arteriole (decreases afterload)
Excretion of sodium and water-retention of K (decreases preload)
Treats hypertension and heart failure
Do not take 2nd and 3rd Trimester of pregnancy
SE = Angioedema-allergic reaction-swelling of tongue, throat-stop taking and notify md
Hyperkalemia-monitor for widening and slowing of pulse/qrs, weakness, fatigue, avoid high K foods, AVOID SALT
SUBSTITUTES-usually very high in K, avoid potassium sparing diuretics, sport drinks are high in K also
Orthostatic Hypotension-teach client to sit and stand slowly, enact fall precautions
Neutropenia/Agranulocytosis-monitor CBC-WBC count, reoccurring infections
Renal Insuflciency-Monitor weight, edema, I/O, BUN, Cr, and GFR
Hepatic Insuflciency-Monitor AST, ALT, ALK PHOS, Bilirubin
Cough-Cough lozenges, hard candy, increase fluid intake, sleep with HOB elevated, antihistamines
ACE Inhibitors
Discussed these medications with hypertension
Arb's-Angiotensin receptor blockers, sartan's
No Cough, same ettects and side ettects as Ace's-just not as potent
, ATI PN PHARMACOLOGY PROCTORED EXAM REVIEW – PRACTICAL NURSING PHARMACOLOGY NOTES
AND PRACTICE QUESTIONS – COMPREHENSIVE MEDICATION REVIEW GUIDE A+ ALREADY GRADED
5. Sartan's/angiotension blockers/arb's: ...
Arb's-Angiotensin receptor blockers, sartan's
No Cough, same ettects and side ettects as Ace's-just not as potent
6. Nitrates: Nitroglycerin/Nitrostat, Nitro-Bid, Nitro-Dur
Nitrates form nitric acid which is a relaxes smooth muscle and dilates venous and arterial blood vessels
Open veins-blood pools in the legs-not as much blood returning to the heart-reduces preload
Open arteries-heart does not have to work as hard to pump blood out of the heart-reduces afterload
Opens the coronary arteries and helps supply blood to the heart tissue
Can be given sublingually, orally, topically, IV, buccal
Can be for acute or long term use
Nitroglycerin dilates any artery and vein-including yours if you touch it while administering it-WEAR GLOVES
Nitroglycerin IV needs a glass bottle and covered from light-some hospitals still use special tubing (nitro is absorbed
in the tubing)
Short term-nitrostat-sublingually-1 tablet every 5 minutes x 3 for relief of chest pain-still having chest pain call
911/physician
Long-term nitro-dur will last for up to 14 hours in the body
Side Ettects:
Headache-dilates the cerebral arteries-do not give with head trauma or increased intracranial pressure
Hypotension and reflex tachycardia-do not give with hypotension, monitor blood pressure and HR when administer-
ing
Hypotension-correct hypervolemia prior to giving nitroglycerin
DO NOT GIVE WITH VIAGRA, LEVITRA, OR CIALIS (nitroglycerin and Viagra increase nitric acid and relaxation of the
smooth muscles-can kill a client with hypotension with a combination of these drugs)
7. Digoxin: Cardiac Glycoside
Digoxin/Digitek, Lanoxin, Lanoxicaps (Dig)
Increases the contractility of the heart muscle - Inotropic ettect-
Increases cardiac output
Also Suppresses the SA node and slows conduction through the AV node
Half-life is 3-4 days
Great Drug-real side ettects
AND PRACTICE QUESTIONS – COMPREHENSIVE MEDICATION REVIEW GUIDE A+ ALREADY GRADED
1. Receptors: Norepinephrine-Adrenergic (adrenergic comes from the word adrenalin)
Alpha 1-all sympathetic target organs except the heart-constrict the blood vessels and dilation of pupils
Alpha 2-Presynaptic adrenergic nerve terminal-inhibits the release of norepinephrine
Beta 1-Heart and Kidneys (BETA 1-ONE HEART)-increased heart rate and force of contraction, release of renin
Beta 2-All sympathetic target organs-inhibits smooth muscle (BETA 2-TWO LUNGS)
2. Beta blockers/olol's: Beta-Adrenergic Blockers
Metoprolol/Lopressor ENDING OLOL
Beta Blockers are use with heart failure, hypertension, angina and with myocardial infarctions.
Action = Blocks Beta-Receptors in the heart causing...
Decreases = HR, force of contraction, Rate of atrioventricular (AV) conduction
SE = Bradycardia, lethargy, GI disturbance, congestive heart failure, decrease BP, depression
The beta blockers stop sympathetic nervous system stimulation of the heart. Does not allow the heart rate and blood
pressure to rise with stress thus lowering the oxygen demand of the heart. It is very heart protective!
Will slow the heart rate and lower the blood pressure
Can have beta 2 blockage with larger doses-will constrict the bronchioles-watch for clients with known COPD, Asthma
Nursing Interventions
Check pulse-needs to be 60 or above
Check blood pressure-if hypotensive do not give (Systolic below 100 is a good rule of thumb I go by)
Monitor for sexual dysfunction-impotence for men-a good reason for non-compliance
Drowsiness/Fatigue-operating heavy machinery, driving could put client at risk
Insomnia-
Contraindicated with Heart Blocks, Bradycardia, Worsening Heart Failure
Increases Hypoglycemic ettect of Insulin-monitor blood sugars and for hypoglycemia, may need to lower insulin
dosage
Beta Blockers have to be weaned slowly to prevent rebound hypertension and tachycardia-if a client wants to stop
his beta-blocker they need to contract their physician
3. CCB,/calcium channel blockers: Nifedipine/Adalat/Procardia/Norvasc-controls blood vessels
Diltiazem/Cardizem
Verapamil/Calan/Isoptin/Verelan-controls heart rate and blood vessels
, ATI PN PHARMACOLOGY PROCTORED EXAM REVIEW – PRACTICAL NURSING PHARMACOLOGY NOTES
AND PRACTICE QUESTIONS – COMPREHENSIVE MEDICATION REVIEW GUIDE A+ ALREADY GRADED
Angina/Raynaud's/Vasospastic Angina/Atrial Arrhythmia's
Blocks calcium channels in the myocardial and vascular smooth muscles, decreases the contraction of smooth
muscle-relaxes the arteries-vasodilation. Blocking of calcium channels in the SA and AV node-Slows conduction
through the SA and AV node. Decreases the force of contraction slows heart rate
Grapefruit juice may increase absorption of nifedipine
Side Ettects: Relaxes smooth muscle and cardiac muscle-
Headache
Dizziness-Take lying, sitting and standing B/P, educate client to sit and stand slowly
Peripheral edema-assess for edema, monitor for worsening (diuretic)
Flushing
Reflex tachycardia-monitor for elevated heart rate (may need a BB)
Constipation-increase fibers and fluids (if not restricted) stool softener
Fatigue-Due to low heart rate-monitor EKG, pulse rate and rhythm
Weakness-Monitor B/P and Heart Rate
Impotence and sexual dysfunction-Discuss possibility with client-have client to call and not just to stop medications
Hepatotoxicity-ALT, AST, ALK PHOS, Bilirubin
MI-Monitor for chest pain, dyspnea, increases fatigue, weakness
CHF-Monitor for chest pain, dyspnea, edema, increasing weight, decreasing output, increasing HR and B/P
Angioedema-edema in face, throat, trouble swallowing, trouble breathing, thickened tongue
Grapefruit juice may increase absorption of nifedipine
Acute Toxicity
With an overdose or overmedicated
Gastric lavage
Monitor EKG-bradycardia-widening QRS, hypotension
Norepinephrine to treat hypotension and decreased cardiac contractility
Atropine or Isoproterenol-Bradycardia and Cardiac Blocks
Verapamil (Calan, Covera, Isoptin Verelan)
, ATI PN PHARMACOLOGY PROCTORED EXAM REVIEW – PRACTICAL NURSING PHARMACOLOGY NOTES
AND PRACTICE QUESTIONS – COMPREHENSIVE MEDICATION REVIEW GUIDE A+ ALREADY GRADED
Class IV antidysrhythmic
Calcium channel blocker
Inhibits the flow of calcium ions both into the myocardia cells and the vascular smooth muscle, slow the conductions
velocity and stabilizes dysrhythmias. Lowers the blood pressure, reduces cardiac workload and lowers the blood
pressure. Dilates the coronary arteries-anti-anginal
Side Ettects: Headache, constipation, hypotension, edema, bradycardia
4. Pril/ace inhibitors: Enalapril/Vasotec
PRIL-is the ending for ace's
Reduces Angiotensin 2 and aldosterone levels
Prevents Angiotensin 1 from converting to Angiotensin 2 in the lungs-leaves the Angiotensin 1 hanging in the
lungs-creates irritation-cough
Vasodilation-mostly arteriole (decreases afterload)
Excretion of sodium and water-retention of K (decreases preload)
Treats hypertension and heart failure
Do not take 2nd and 3rd Trimester of pregnancy
SE = Angioedema-allergic reaction-swelling of tongue, throat-stop taking and notify md
Hyperkalemia-monitor for widening and slowing of pulse/qrs, weakness, fatigue, avoid high K foods, AVOID SALT
SUBSTITUTES-usually very high in K, avoid potassium sparing diuretics, sport drinks are high in K also
Orthostatic Hypotension-teach client to sit and stand slowly, enact fall precautions
Neutropenia/Agranulocytosis-monitor CBC-WBC count, reoccurring infections
Renal Insuflciency-Monitor weight, edema, I/O, BUN, Cr, and GFR
Hepatic Insuflciency-Monitor AST, ALT, ALK PHOS, Bilirubin
Cough-Cough lozenges, hard candy, increase fluid intake, sleep with HOB elevated, antihistamines
ACE Inhibitors
Discussed these medications with hypertension
Arb's-Angiotensin receptor blockers, sartan's
No Cough, same ettects and side ettects as Ace's-just not as potent
, ATI PN PHARMACOLOGY PROCTORED EXAM REVIEW – PRACTICAL NURSING PHARMACOLOGY NOTES
AND PRACTICE QUESTIONS – COMPREHENSIVE MEDICATION REVIEW GUIDE A+ ALREADY GRADED
5. Sartan's/angiotension blockers/arb's: ...
Arb's-Angiotensin receptor blockers, sartan's
No Cough, same ettects and side ettects as Ace's-just not as potent
6. Nitrates: Nitroglycerin/Nitrostat, Nitro-Bid, Nitro-Dur
Nitrates form nitric acid which is a relaxes smooth muscle and dilates venous and arterial blood vessels
Open veins-blood pools in the legs-not as much blood returning to the heart-reduces preload
Open arteries-heart does not have to work as hard to pump blood out of the heart-reduces afterload
Opens the coronary arteries and helps supply blood to the heart tissue
Can be given sublingually, orally, topically, IV, buccal
Can be for acute or long term use
Nitroglycerin dilates any artery and vein-including yours if you touch it while administering it-WEAR GLOVES
Nitroglycerin IV needs a glass bottle and covered from light-some hospitals still use special tubing (nitro is absorbed
in the tubing)
Short term-nitrostat-sublingually-1 tablet every 5 minutes x 3 for relief of chest pain-still having chest pain call
911/physician
Long-term nitro-dur will last for up to 14 hours in the body
Side Ettects:
Headache-dilates the cerebral arteries-do not give with head trauma or increased intracranial pressure
Hypotension and reflex tachycardia-do not give with hypotension, monitor blood pressure and HR when administer-
ing
Hypotension-correct hypervolemia prior to giving nitroglycerin
DO NOT GIVE WITH VIAGRA, LEVITRA, OR CIALIS (nitroglycerin and Viagra increase nitric acid and relaxation of the
smooth muscles-can kill a client with hypotension with a combination of these drugs)
7. Digoxin: Cardiac Glycoside
Digoxin/Digitek, Lanoxin, Lanoxicaps (Dig)
Increases the contractility of the heart muscle - Inotropic ettect-
Increases cardiac output
Also Suppresses the SA node and slows conduction through the AV node
Half-life is 3-4 days
Great Drug-real side ettects
