PHARMACOLOGY HESI REVIEW 1
Cardiac Drugs/Diuretics
Digoxin –
o Positive inotrope (increases force of contraction);
o Negative chronotrope (decreases heart rate).
How do you assess for this? (Always take AP for a full minute!)
Client with long hx of daily digoxin and furosemide (Lasix) use;
o Creates a high risk for dig toxicity
(Lasix can cause hypokalemia, which can lead to dig toxicity)
Digoxin toxicity – know normal digoxin level (0.5 – 2 ng/mL);
o Serum potassium (K+) level (3.5 to 5.0 mEq/L);
Low potassium or magnesium levels may
o risk for digoxin toxicity;
S/S of dig toxicity include:
o anorexia
o bradycardia
o headache,
o dizziness
o confusion
o nausea
o visual disturbances (blurred vision, yellow vision, and/or halo
vision);
Hold digoxin if AP less than 60.
Labetalol (beta blocker) for HTN and Severe HTN emergencies: blocks alpha and
beta receptors
o Notify prescriber for low pulse rate and do not give med;
o SE is weight gain (fluid retention) – pulmonary assessment (which is…
pulm edema crackles).
o Remember monitoring weight is one of the best indicators of fluid gain or
loss
o 1 kg (2.2 lb) = 1,000 mL fluid gain or loss in 24 hrs.
Nitroglycerin transdermal patch Tx chest pain (angina) –
o Remove at night to allow 8 hours without patch (can produce tolerance in
24 hours);
o May use SL nitro when wearing patch if patient having chest pain
Summer 2016 Page 1
, Why wear gloves when applying nitroglycerin paste or patch?
(Severe vasodilation, ↓BP, intense HA [may give acetaminophen for
HA])
Angina – for chest pain
o If Vital Sign OK, leave nitro patch on and administer PRN Sublingual nitro
Pt. in CCU/ICU on nitro drip;
o Becomes hypotensive, decrease rate of nitro drip
Calcium channel blockers – dipine (like amlopidine) verapamil (Calan) and
diltiazem (Cardizem).
o – dipine affect vessels only (vasodilation).
SE: dizziness, facial flushing, hypotension, edema.
o Verapamil (Calan) and diltiazem (Cardizem) also affect heart.
o Monitor BP, HR (↓).
Constipation & HTNis SE. Avoid grapefruit juice.
Aliskiren (Tekturna) – (direct renin inhibitor for HTN);
o Teach don’t take if pregnant (stop drug if become pregnant);
o don’t take with high fat meal.
o May increase K+, so don’t take with other drugs that ↑ K+.
Furosemide (Lasix) – loop diuretic; rapid acting;
o Used for rapid diuresis in emergencies (pulmonary edema);
May produce hypokalemia (assess for muscle cramps, muscle
weakness). Hypotension, F/E abnormalities, dehydration.
o SE: dizziness, HA, tinnitus, N/V/D, ↓ K+, hyperglycemia,
ototoxicity with aminoglycosides (-mycin drugs).
May need potassium supplement.
o Foods containing potassium: dried fruits, fish, leafy veggies, squash,
beans, meats, nuts, bananas, potatoes, dairy products.
IV potassium (KCl) – assess overall condition of the veins. Use large vein, like
antecubital (AC) vein when administering potassium.
o Venous access is important because IV potassium can irritate the vein.
o Have patient notify nurse immediately if burning at site. IV K+
extravasation can cause necrosis of tissues.
o Calculate and set the rate as ordered, know anticipated duration of
therapy, know restrictions imposed by patient’s history.
Summer 2016 Page 2
, Don’t give IV push; infuse at a rate no greater than 20
mEq/hr;
Concentration no greater than 40 mEq/L.
Always use infusion pump.
Assess IV site every hour.
Antihypertensives and low potassium (K+); hypokalemia.
o Antihypertensive effects are more pronounced in the elderly.
Osmitrol (Mannitol) – osmotic diuretic;
o Effectiveness determined by ↓ ICP.
o NOT used for peripheral edema;
o Used to treat pt. with closed head injury; effective response is
decreased ICP
Spironolactone (Aldactone), amiloride (Midamor); triamterene (Dyrenium) –
potassium-sparing diuretic (can cause ↑K+).
o Blocks receptors for aldosterone.
o Inhibits sodium and water reabsorption.
Take in a.m. (diuretics in the morning if possible);
Avoid salt substitutes, ACE inhibitors, ARBs.
Often taken with other (thiazide) diuretics to treat edema,
hypertension, and heart failure.
Can be taken with other meds that lower K+.
Lab value for atorvastatin (Lipitor) –
o HDL & LDL and total cholesterol
Other statin drugs include rosuvastatin (Crestor), fluvastatin,
lovastatin, simvastatin, pravastatin.
LFTs routinely and CK for any c/o of muscle pain. How do you
evaluate effectiveness? May be seen in 2 weeks LDL decreases
Adrenergics/SNS Drugs & Adrenergic Blockers
Remember: alpha 1 stimulation – vasoconstriction;
o beta 1 (one heart) HR,CO
and contractility renin
production so BP
o beta 2 (two lungs) Bronchodilation, relaxation, BS
glycogenolysis Tremors,
vasodilation(dilation)
Mydriatics –
o Produce dilation of pupils for eye exams and ocular surgery
Tamsulosin (Flomax) –
Summer 2016 Page 3
Cardiac Drugs/Diuretics
Digoxin –
o Positive inotrope (increases force of contraction);
o Negative chronotrope (decreases heart rate).
How do you assess for this? (Always take AP for a full minute!)
Client with long hx of daily digoxin and furosemide (Lasix) use;
o Creates a high risk for dig toxicity
(Lasix can cause hypokalemia, which can lead to dig toxicity)
Digoxin toxicity – know normal digoxin level (0.5 – 2 ng/mL);
o Serum potassium (K+) level (3.5 to 5.0 mEq/L);
Low potassium or magnesium levels may
o risk for digoxin toxicity;
S/S of dig toxicity include:
o anorexia
o bradycardia
o headache,
o dizziness
o confusion
o nausea
o visual disturbances (blurred vision, yellow vision, and/or halo
vision);
Hold digoxin if AP less than 60.
Labetalol (beta blocker) for HTN and Severe HTN emergencies: blocks alpha and
beta receptors
o Notify prescriber for low pulse rate and do not give med;
o SE is weight gain (fluid retention) – pulmonary assessment (which is…
pulm edema crackles).
o Remember monitoring weight is one of the best indicators of fluid gain or
loss
o 1 kg (2.2 lb) = 1,000 mL fluid gain or loss in 24 hrs.
Nitroglycerin transdermal patch Tx chest pain (angina) –
o Remove at night to allow 8 hours without patch (can produce tolerance in
24 hours);
o May use SL nitro when wearing patch if patient having chest pain
Summer 2016 Page 1
, Why wear gloves when applying nitroglycerin paste or patch?
(Severe vasodilation, ↓BP, intense HA [may give acetaminophen for
HA])
Angina – for chest pain
o If Vital Sign OK, leave nitro patch on and administer PRN Sublingual nitro
Pt. in CCU/ICU on nitro drip;
o Becomes hypotensive, decrease rate of nitro drip
Calcium channel blockers – dipine (like amlopidine) verapamil (Calan) and
diltiazem (Cardizem).
o – dipine affect vessels only (vasodilation).
SE: dizziness, facial flushing, hypotension, edema.
o Verapamil (Calan) and diltiazem (Cardizem) also affect heart.
o Monitor BP, HR (↓).
Constipation & HTNis SE. Avoid grapefruit juice.
Aliskiren (Tekturna) – (direct renin inhibitor for HTN);
o Teach don’t take if pregnant (stop drug if become pregnant);
o don’t take with high fat meal.
o May increase K+, so don’t take with other drugs that ↑ K+.
Furosemide (Lasix) – loop diuretic; rapid acting;
o Used for rapid diuresis in emergencies (pulmonary edema);
May produce hypokalemia (assess for muscle cramps, muscle
weakness). Hypotension, F/E abnormalities, dehydration.
o SE: dizziness, HA, tinnitus, N/V/D, ↓ K+, hyperglycemia,
ototoxicity with aminoglycosides (-mycin drugs).
May need potassium supplement.
o Foods containing potassium: dried fruits, fish, leafy veggies, squash,
beans, meats, nuts, bananas, potatoes, dairy products.
IV potassium (KCl) – assess overall condition of the veins. Use large vein, like
antecubital (AC) vein when administering potassium.
o Venous access is important because IV potassium can irritate the vein.
o Have patient notify nurse immediately if burning at site. IV K+
extravasation can cause necrosis of tissues.
o Calculate and set the rate as ordered, know anticipated duration of
therapy, know restrictions imposed by patient’s history.
Summer 2016 Page 2
, Don’t give IV push; infuse at a rate no greater than 20
mEq/hr;
Concentration no greater than 40 mEq/L.
Always use infusion pump.
Assess IV site every hour.
Antihypertensives and low potassium (K+); hypokalemia.
o Antihypertensive effects are more pronounced in the elderly.
Osmitrol (Mannitol) – osmotic diuretic;
o Effectiveness determined by ↓ ICP.
o NOT used for peripheral edema;
o Used to treat pt. with closed head injury; effective response is
decreased ICP
Spironolactone (Aldactone), amiloride (Midamor); triamterene (Dyrenium) –
potassium-sparing diuretic (can cause ↑K+).
o Blocks receptors for aldosterone.
o Inhibits sodium and water reabsorption.
Take in a.m. (diuretics in the morning if possible);
Avoid salt substitutes, ACE inhibitors, ARBs.
Often taken with other (thiazide) diuretics to treat edema,
hypertension, and heart failure.
Can be taken with other meds that lower K+.
Lab value for atorvastatin (Lipitor) –
o HDL & LDL and total cholesterol
Other statin drugs include rosuvastatin (Crestor), fluvastatin,
lovastatin, simvastatin, pravastatin.
LFTs routinely and CK for any c/o of muscle pain. How do you
evaluate effectiveness? May be seen in 2 weeks LDL decreases
Adrenergics/SNS Drugs & Adrenergic Blockers
Remember: alpha 1 stimulation – vasoconstriction;
o beta 1 (one heart) HR,CO
and contractility renin
production so BP
o beta 2 (two lungs) Bronchodilation, relaxation, BS
glycogenolysis Tremors,
vasodilation(dilation)
Mydriatics –
o Produce dilation of pupils for eye exams and ocular surgery
Tamsulosin (Flomax) –
Summer 2016 Page 3
