Study Guide for NR 293 Exam 3
Alpha2-adrenergic receptor stimulators (agonists)/clonidine
Stimulate alpha2-adrenergic receptors in the brain
Decrease sympathetic outflow from the CNS, decrease norepinephrine
production
Stimulates alpha2-adrenergi receptors, thus reducing renin
Examples: Clonidine (Catapres), Methyldopa (aldomet): used for pregnant
women w/htn
Alpha1-blockers/”azosin,”
Block alpha1-adrenergic receptors
Management of severe heart failure (HF) when used with cardiac
glycosides and diuretics
Some used to relieve symptoms of BPH- increase urinary flow rate
Example: ― Azosin‖ (doxazosin (Cardura)
Adverse Effects:
▪ Serious: hypotension (first dose) syncope
▪ Common: dizziness
Nursing implications: instruct pt. to lie down after taking first dose becausethey may
become dizzy
Beta-blockers “olol”: First-line treatment for heart failure & HTN
Reduce BP by reducing heart rate through beta1 blockade (block receptorsfor
norepinhrine)
Cause reduced secretion of renin
Long-term use causes reduced peripheral vascular resistance
Adverse Effects: orthostatic hypotension, bradycardia w/ reflex
tachycardia, sexual dysfunction in men, possible hypoglycemia or
hyperglycemia
Angiotensin-converting enzyme inhibitor, “pril” Captopril
Mechanism of Action:
▪ Inhibit angiotensin-converting enzyme, which is responsible for converting
angiotensin I (through the action of renin) to angiotensinII
▪ 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
Indications:
▪ First-line treatment for heart failure & HTN
▪ HF (either alone or in combination with diuretics or other drugs)
1
, ▪ 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
Adverse Effects: hyperkalemia & dry, nonproductive cough
Serious drug interaction: NSAIDs
Angiotensin II receptor blocker “sartan” losartan (Dovan)
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
Adverse Effects: URI, headache
▪ May cause occasional dizziness, inability to sleep, diarrhea
Calcium channel blockers: Amlodipine “dipine” verapamil (calan),
diltiazem (cardizem)
Mechanism of Action: cause smooth muscle relaxation by blocking thebinding
of calcium to its receptors, preventing muscle contraction
Adverse effect: constipation
▪ High-fiber diet with plenty of fluids will help prevent constipation
Indications: hypertension
▪ Angina- ch. 23
• Ischemia:
o Ischemic heart disease: Poor blood supply to the heartmuscle
(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
Therapeutic level: between 0.5-2ng/mL
Digoxin doses are held and the prescriber notified if the apical pulse is 60 beats/minute
Negative chronotropic effect decreases HR
2
, Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose
▪ 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.
Avoid bran muffins when taking digoxin
Hypokalemia increases the chance of digitalis toxicity
Class III drugs: Amiodarone (ch. 25)
Mechanism of action: prolonging action potential duration
Indications: ventricular dysrhythmias
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 sinusrhythm
▪ 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 specificdrugs
• 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 doubleup for
missed doses
3
Alpha2-adrenergic receptor stimulators (agonists)/clonidine
Stimulate alpha2-adrenergic receptors in the brain
Decrease sympathetic outflow from the CNS, decrease norepinephrine
production
Stimulates alpha2-adrenergi receptors, thus reducing renin
Examples: Clonidine (Catapres), Methyldopa (aldomet): used for pregnant
women w/htn
Alpha1-blockers/”azosin,”
Block alpha1-adrenergic receptors
Management of severe heart failure (HF) when used with cardiac
glycosides and diuretics
Some used to relieve symptoms of BPH- increase urinary flow rate
Example: ― Azosin‖ (doxazosin (Cardura)
Adverse Effects:
▪ Serious: hypotension (first dose) syncope
▪ Common: dizziness
Nursing implications: instruct pt. to lie down after taking first dose becausethey may
become dizzy
Beta-blockers “olol”: First-line treatment for heart failure & HTN
Reduce BP by reducing heart rate through beta1 blockade (block receptorsfor
norepinhrine)
Cause reduced secretion of renin
Long-term use causes reduced peripheral vascular resistance
Adverse Effects: orthostatic hypotension, bradycardia w/ reflex
tachycardia, sexual dysfunction in men, possible hypoglycemia or
hyperglycemia
Angiotensin-converting enzyme inhibitor, “pril” Captopril
Mechanism of Action:
▪ Inhibit angiotensin-converting enzyme, which is responsible for converting
angiotensin I (through the action of renin) to angiotensinII
▪ 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
Indications:
▪ First-line treatment for heart failure & HTN
▪ HF (either alone or in combination with diuretics or other drugs)
1
, ▪ 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
Adverse Effects: hyperkalemia & dry, nonproductive cough
Serious drug interaction: NSAIDs
Angiotensin II receptor blocker “sartan” losartan (Dovan)
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
Adverse Effects: URI, headache
▪ May cause occasional dizziness, inability to sleep, diarrhea
Calcium channel blockers: Amlodipine “dipine” verapamil (calan),
diltiazem (cardizem)
Mechanism of Action: cause smooth muscle relaxation by blocking thebinding
of calcium to its receptors, preventing muscle contraction
Adverse effect: constipation
▪ High-fiber diet with plenty of fluids will help prevent constipation
Indications: hypertension
▪ Angina- ch. 23
• Ischemia:
o Ischemic heart disease: Poor blood supply to the heartmuscle
(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
Therapeutic level: between 0.5-2ng/mL
Digoxin doses are held and the prescriber notified if the apical pulse is 60 beats/minute
Negative chronotropic effect decreases HR
2
, Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose
▪ 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.
Avoid bran muffins when taking digoxin
Hypokalemia increases the chance of digitalis toxicity
Class III drugs: Amiodarone (ch. 25)
Mechanism of action: prolonging action potential duration
Indications: ventricular dysrhythmias
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 sinusrhythm
▪ 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 specificdrugs
• 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 doubleup for
missed doses
3
