NURSING
Exam 2 pharm review
Know everything about these meds
I. Beta- Adrenergic Blockers (Atenolol) 553-555
MOA: is a cardio-selective beta-adrenergic blocker
USE: Angina, MI, CHF, HTN, dysrhythmia especially (STV & V-Tach)
ADE: heart failure & negative chronotropic (causing slowing of the heart rate)
Contraindications: second-or third-degree heart block, & cardiogenetic shock,
severe bradycardia, heart failure, or hypotension, & asthma
Drug administration: PO & IV, monitor VS before given
RN implication: monitor BP & HR prior of given & 2-4 hours after the first dose,
withhold atenolol & notify the prescriber for a resting HR of 60 beats/min & or
systolic BP less than 90 mm Hg. The use of betablocker in pts w/diabetes can mask
the early warning S/ of hypoglycemic
Pts teaching: do not take abruptly (may cause rebound tachycardia), & move
slowly from a standing to a sitting position, take at the same time each & avoid
drinking large amount of orange juice
Lab tests: check blood sugar level if diabetes
It is important to note that nonselective beta-adrenergic blockers should not be used
in pts w/ variant angina because they are ineffective & may increase the tendency to
induce coronary vasospasm.
Cardio selective beta blockers (MEBA)
Metoprolol
Esmol
Bisoprolol
Atenolol
II. Nursing implication for patient allergic to a certain drug?
Stop the drug and administer an epi-pen and check the severity of the allergy
Bile acid sequestrants Cholestyramine (Questran, prevalite) (Colesevelam, colestipol)
MOA: binds bile acid in the intestinal lumen, cause the bile acid to excrete in feces,
preventing recirculation in the liver.
(We store cholesterol in the liver, with this meds the cholesterol doesn’t get store in the
liver, so the liver produces more bile acid to decreases the cholesterol.)
USE: mainly reduces LDL level, only a minimal of HDL & no effect on TGs
ADE: GI: the biggest is constipation abdominal fullness, diarrhea, can also increase the
risk of hyperchloremic metabolic acidosis in pts/w renal impairment.
, Exam 2 pharm review
Contraindications: complete biliary obstruction, vitamin K, & coagulopathy (use with
caution)
Decreases absorption of other meds (digoxin, folic acid, thyroid hormone, thiazide
diuretics, tetracycline)
, specially the absorption of those fat-soluble vitamin
Drug administration: PO; to minimize altered absorption, people should take the other
drugs 1hr before or 4-6hrs after cholestyramine.
RN implication: assess for adequate level of fat-soluble vitamins because deficiency may
occur; supplements may be required
Pts teaching: good dental hygiene is important because holding the mixture in the mouth
can damage the teeth.
III. Hypertension: A blood pressure of 140/ 90 that doesn’t decrease after a period of
rest.
IV. Medications for hypertensive crisis. (med-surge book 897)
Hypertensive crisis may cause organ damage (Sodium nitroprusside (Nitropress))
Hypertensive urgency is an elevated blood pressure with no signs of organ
damage, Fast acting beta blockers are the drug of choice (labetalol)
V. Loop diuretics Furosemide (Lasix) pg 664-667 (fastest working diuretics)
MOA: inhibit sodium & chloride reabsorption in the ascending loop of Henle
(where na+ reabsorption occurs)
USE: HTN, edema due to heart failure, hepatic impairment, & renal disease.
ADE: hyponatremia, hypokalemia, FVD, & ototoxicity (blurred vision,
dizziness, headache, vertigo, hearing loss, tinnitus, hypotension) may increase
blood glucose
Contraindications: hypersensitivity, anuria, if allergic to sulfonamides &
thiazides.
Nursing implication assess for fluid status, monitor daily weight, I&O, lung
sounds, edema, skin turgor, dry mouth, hypotension, weakness, lethargic, BP,
risk for fall, allergic to sulfonamides,
Pts teaching: limit sodium intake, eat potassium-rich, low sodium diet,
change position slowly, use sunscreen & protective clothes, monitor blood
glucose levels for diabetic pts, strategies for fall preventions, (stress
reduction, exercise, weight loss, moderate alcohol, no smoking), monitor
potassium levels
Lab test: monitor electrolyte, renal & hepatic function, K+, serum glucose,
uric acid level. creatine & BUN
Ace inhibitors pg 505- 508 *****
Angiotensin-Converting enzyme (ACE) inhibitor Captopril (Capoten) ends in Pril
Exam 2 pharm review
Know everything about these meds
I. Beta- Adrenergic Blockers (Atenolol) 553-555
MOA: is a cardio-selective beta-adrenergic blocker
USE: Angina, MI, CHF, HTN, dysrhythmia especially (STV & V-Tach)
ADE: heart failure & negative chronotropic (causing slowing of the heart rate)
Contraindications: second-or third-degree heart block, & cardiogenetic shock,
severe bradycardia, heart failure, or hypotension, & asthma
Drug administration: PO & IV, monitor VS before given
RN implication: monitor BP & HR prior of given & 2-4 hours after the first dose,
withhold atenolol & notify the prescriber for a resting HR of 60 beats/min & or
systolic BP less than 90 mm Hg. The use of betablocker in pts w/diabetes can mask
the early warning S/ of hypoglycemic
Pts teaching: do not take abruptly (may cause rebound tachycardia), & move
slowly from a standing to a sitting position, take at the same time each & avoid
drinking large amount of orange juice
Lab tests: check blood sugar level if diabetes
It is important to note that nonselective beta-adrenergic blockers should not be used
in pts w/ variant angina because they are ineffective & may increase the tendency to
induce coronary vasospasm.
Cardio selective beta blockers (MEBA)
Metoprolol
Esmol
Bisoprolol
Atenolol
II. Nursing implication for patient allergic to a certain drug?
Stop the drug and administer an epi-pen and check the severity of the allergy
Bile acid sequestrants Cholestyramine (Questran, prevalite) (Colesevelam, colestipol)
MOA: binds bile acid in the intestinal lumen, cause the bile acid to excrete in feces,
preventing recirculation in the liver.
(We store cholesterol in the liver, with this meds the cholesterol doesn’t get store in the
liver, so the liver produces more bile acid to decreases the cholesterol.)
USE: mainly reduces LDL level, only a minimal of HDL & no effect on TGs
ADE: GI: the biggest is constipation abdominal fullness, diarrhea, can also increase the
risk of hyperchloremic metabolic acidosis in pts/w renal impairment.
, Exam 2 pharm review
Contraindications: complete biliary obstruction, vitamin K, & coagulopathy (use with
caution)
Decreases absorption of other meds (digoxin, folic acid, thyroid hormone, thiazide
diuretics, tetracycline)
, specially the absorption of those fat-soluble vitamin
Drug administration: PO; to minimize altered absorption, people should take the other
drugs 1hr before or 4-6hrs after cholestyramine.
RN implication: assess for adequate level of fat-soluble vitamins because deficiency may
occur; supplements may be required
Pts teaching: good dental hygiene is important because holding the mixture in the mouth
can damage the teeth.
III. Hypertension: A blood pressure of 140/ 90 that doesn’t decrease after a period of
rest.
IV. Medications for hypertensive crisis. (med-surge book 897)
Hypertensive crisis may cause organ damage (Sodium nitroprusside (Nitropress))
Hypertensive urgency is an elevated blood pressure with no signs of organ
damage, Fast acting beta blockers are the drug of choice (labetalol)
V. Loop diuretics Furosemide (Lasix) pg 664-667 (fastest working diuretics)
MOA: inhibit sodium & chloride reabsorption in the ascending loop of Henle
(where na+ reabsorption occurs)
USE: HTN, edema due to heart failure, hepatic impairment, & renal disease.
ADE: hyponatremia, hypokalemia, FVD, & ototoxicity (blurred vision,
dizziness, headache, vertigo, hearing loss, tinnitus, hypotension) may increase
blood glucose
Contraindications: hypersensitivity, anuria, if allergic to sulfonamides &
thiazides.
Nursing implication assess for fluid status, monitor daily weight, I&O, lung
sounds, edema, skin turgor, dry mouth, hypotension, weakness, lethargic, BP,
risk for fall, allergic to sulfonamides,
Pts teaching: limit sodium intake, eat potassium-rich, low sodium diet,
change position slowly, use sunscreen & protective clothes, monitor blood
glucose levels for diabetic pts, strategies for fall preventions, (stress
reduction, exercise, weight loss, moderate alcohol, no smoking), monitor
potassium levels
Lab test: monitor electrolyte, renal & hepatic function, K+, serum glucose,
uric acid level. creatine & BUN
Ace inhibitors pg 505- 508 *****
Angiotensin-Converting enzyme (ACE) inhibitor Captopril (Capoten) ends in Pril
