NR I293 IExam I3 IStudy IGuide
• Alpha2-adrenergic I receptor I stimulators I (agonists)/clonidine
o Stimulate I alpha2-adrenergic I receptors I in I the I brain
o Decrease I sympathetic I outflow I from I the I CNS, I decrease I norepinephrine
Iproduction
o Stimulates I alpha2-adrenergi I receptors, I thus I reducing I renin
o Examples: I Clonidine I (Catapres), I Methyldopa I (aldomet): I used I for I pregnantIwomen
Iw/htn
• Alpha1-blockers/”azosin,”
o Block I alpha1-adrenergic I receptors
o Management I of I severe I heart I failure I (HF) I when I used I with I cardiac
Iglycosides Iand Idiuretics
o Some Iused Ito Irelieve Isymptoms Iof IBPH- Iincrease Iurinary Iflow Irate
o Example: I “ I Azosin” I (doxazosin I (Cardura)
o Adverse I Effects:
▪ Serious: Ihypotension I(first Idose) Isyncope
▪ Common: Idizziness
o Nursing Iimplications: Iinstruct Ipt. Ito Ilie Idown Iafter Itaking Ifirst Idose IbecauseIthey Imay
Ibecome Idizzy
• Beta-blockers I“olol”: IFirst-line Itreatment Ifor Iheart Ifailure I& IHTN
o Reduce I BP I by I reducing I heart I rate I through I beta1 Iblockade I (block I receptorsIfor
Inorepinhrine)
o Cause Ireduced I secretion I of I renin
o Long-term Iuse Icauses Ireduced Iperipheral Ivascular Iresistance
o Adverse IEffects: Iorthostatic Ihypotension, Ibradycardia Iw/ Ireflex
Itachycardia, I sexual I dysfunction I in I men, I possible I hypoglycemia I or
Ihyperglycemia
• Angiotensin-converting Ienzyme Iinhibitor, I“pril” ICaptopril
o Mechanism I of I Action:
▪ Inhibit I angiotensin-converting Ienzyme, Iwhich Iis Iresponsible Ifor Iconverting
I angiotensin I I I (through I the I action I of I renin) I to I angiotensinIII
▪ Angiotensin I II I is I a I potent I vasoconstrictor I and I causes I aldosterone
Isecretion Ifrom Ithe Iadrenal Iglands
▪ Result I in I decreased I systemic I vascular I resistance I (afterload),
vasodilation, I and I therefore I decreased I blood I pressure
o Indications:
▪ First-line Itreatment Ifor Iheart Ifailure I& IHTN
▪ HF I(either Ialone Ior Iin Icombination Iwith Idiuretics Ior Iother Idrugs)
1
, ▪
Slow Iprogression Iof Ileft Iventricular Ihypertrophy Iafter IMI I(cardio
Iprotective)
▪ Renal Iprotective Ieffects Iin Ipatients Iwith Idiabetes
▪ Captopril Iand Ilisinopril Ican Ibe Iused Iif Ia Ipatient Ihas Iliver Idysfunction,Iunlike
Iother IACE Iinhibitors Ithat Iare Ipro-drugs
• *Pro-drugs I are I inactive I in I their I administered I form I and I must I be
Imetabolized Iin Ithe Iliver Ito Ian Iactive Iform Iso Ias Ito Ibe Ieffective
o Adverse I Effects: I hyperkalemia I & I dry, I nonproductive I cough
o Serious Idrug Iinteraction: INSAIDs
• Angiotensin III Ireceptor Iblocker I“sartan” Ilosartan I(Dovan)
o Mechanism I of I Action:
▪ Allow Iangiotensin II Ito Ibe Iconverted Ito Iangiotensin III, Ibut Iblock Ithe
Ireceptors Ithat Ireceive Iangiotensin III
▪ Block I vasoconstriction I and I release I of I aldosterone
▪ Well Itolerated, Ido Inot Icause Ia Idry Icough
▪ Indications: I first-line Itreatment Ifor Iheart Ifailure I& IHTN
o Adverse I Effects: I URI, I headache
▪ May Icause I occasional I dizziness, I inability I to I sleep, I diarrhea
• Calcium Ichannel Iblockers: I Amlodipine I“dipine” Iverapamil I(calan),
Idiltiazem I(cardizem)
o Mechanism I of I Action: I cause I smooth I muscle I relaxation I by I blocking I the
Ibinding Iof Icalcium Ito Iits Ireceptors, Ipreventing Imuscle Icontraction
o Adverse Ieffect: Iconstipation
▪ High-fiber Idiet Iwith Iplenty Iof Ifluids Iwill Ihelp Iprevent Iconstipation
o Indications: I hypertension
▪ Angina- Ich. I23
• Ischemia:
o Ischemic I heart I disease: IPoor I blood I supply I to I the I heart
Imuscle I (Atherosclerosis, I Coronary I artery I disease)
o Myocardial Iinfarction I(MI): INecrosis, Ior Ideath, Iof IcardiacItissue,
Idisabling Ior Ifatal
• Therapeutic IObjectives
o Minimize I the I frequency I of I attacks I and I decrease I the
Iduration Iand Iintensity Iof Ianginal Ipain
o Improve Ithe Ipatient’s Ifunctional Icapacity
o Prevent I or Idelay Ithe Iworst I possible I outcome: I MI
• Cardiac I glycosides: I Digoxin
o Therapeutic Ilevel: Ibetween I0.5-2ng/mL
o Digoxin Idoses Iare Iheld Iand Ithe Iprescriber Inotified Iif Ithe Iapical Ipulse Iis I60 Ibeats/minute
o Negative Ichronotropic Ieffect Idecreases IHR
2
, o Digoxin Iimmune IFab I(Digifab) Iis Ithe Iantidote Ifor Ia Isevere Idigoxin Ioverdose
▪ Required Iuse Iof Idigitab Iwhen Ipotassium Ilevel Iis Iabove I5 ImEq/L, Isevere Isinus
Ibradycardia Ithat Idoes Inot Irespond Ito Icardiac Ipacing, Ior Ian Ioverdose Iof Imore Ithan I10Img
Iof Idigoxin.
o Avoid Ibran Imuffins Iwhen Itaking Idigoxin
o Hypokalemia Iincreases Ithe Ichance Iof Idigitalis Itoxicity
• Class IIII Idrugs: IAmiodarone I(ch. I25)
o Mechanism Iof Iaction: Iprolonging Iaction Ipotential Iduration
o Indications: Iventricular Idysrhythmias
o Contraindication: Ihypersensitivity Iand Ibradycardia Ior IAV Iblock
Adverse Ieffects: IFDA Iblack Ibox Iwarning: Ipulmonary Itoxicity, Ihepatotoxicity Iarrhythmia Iworsening-sinus
Ibradycardia, Iconstipation, IQT Iprolongation, Ihypotension, Iblue-gray Icoloring Iof Ithe Iskin Ion Ithe Iface, Iarms,
Iand Ineck
• Unclassified Iantidysrhythmics: I Adenosine I(Ch. I25)
▪ Slows I conduction I through I the I AV I node
▪ Used I to I convert I paroxysmal I supraventricular I tachycardia I to I sinusIrhythm
▪ Very I short I half-life I (less Ithan I10 Iseconds)
• Flush Iwith I 20cc I of Inormal I saline
▪ Only Iadministered Ias Ifast IIV Ipush
▪ May Icause Iasystole Ifor Ia Ifew Iseconds
▪ Adverse I Effects
• ALL Iantidysrhythmics Ican Icause Idysrhythmias!
• Hypersensitivity I reactions, I nausea, I vomiting, I diarrhea,
Idizziness, Iblurred Ivision, Iheadache
▪ Assessment
• Obtain IaIthorough Idrug Iand Imedical Ihistory
• Baseline IBP, IP, II&O, Iand Icardiac Irhythm
• Measure I serum I potassium I levels I before I initiating I therapy
• Conditions I that Imay Ibe Icontraindications I for Iuse Iof IspecificIdrugs
• Potential Idrug Iinteractions
▪ During I therapy,
• Monitor Icardiac Irhythm, Iheart Irate, IBP, Igeneral Iwell-being,Iskin
Icolor, I temperature, Iheart Iand Ilung Isounds
• Assess Iplasma Idrug Ilevels Ias Iindicated
• Monitor Ifor Itoxic Ieffects
• Take I medications I as I scheduled I and I not I to I skip I doses I or I doubleIup Ifor
Imissed Idoses
3
• Alpha2-adrenergic I receptor I stimulators I (agonists)/clonidine
o Stimulate I alpha2-adrenergic I receptors I in I the I brain
o Decrease I sympathetic I outflow I from I the I CNS, I decrease I norepinephrine
Iproduction
o Stimulates I alpha2-adrenergi I receptors, I thus I reducing I renin
o Examples: I Clonidine I (Catapres), I Methyldopa I (aldomet): I used I for I pregnantIwomen
Iw/htn
• Alpha1-blockers/”azosin,”
o Block I alpha1-adrenergic I receptors
o Management I of I severe I heart I failure I (HF) I when I used I with I cardiac
Iglycosides Iand Idiuretics
o Some Iused Ito Irelieve Isymptoms Iof IBPH- Iincrease Iurinary Iflow Irate
o Example: I “ I Azosin” I (doxazosin I (Cardura)
o Adverse I Effects:
▪ Serious: Ihypotension I(first Idose) Isyncope
▪ Common: Idizziness
o Nursing Iimplications: Iinstruct Ipt. Ito Ilie Idown Iafter Itaking Ifirst Idose IbecauseIthey Imay
Ibecome Idizzy
• Beta-blockers I“olol”: IFirst-line Itreatment Ifor Iheart Ifailure I& IHTN
o Reduce I BP I by I reducing I heart I rate I through I beta1 Iblockade I (block I receptorsIfor
Inorepinhrine)
o Cause Ireduced I secretion I of I renin
o Long-term Iuse Icauses Ireduced Iperipheral Ivascular Iresistance
o Adverse IEffects: Iorthostatic Ihypotension, Ibradycardia Iw/ Ireflex
Itachycardia, I sexual I dysfunction I in I men, I possible I hypoglycemia I or
Ihyperglycemia
• Angiotensin-converting Ienzyme Iinhibitor, I“pril” ICaptopril
o Mechanism I of I Action:
▪ Inhibit I angiotensin-converting Ienzyme, Iwhich Iis Iresponsible Ifor Iconverting
I angiotensin I I I (through I the I action I of I renin) I to I angiotensinIII
▪ Angiotensin I II I is I a I potent I vasoconstrictor I and I causes I aldosterone
Isecretion Ifrom Ithe Iadrenal Iglands
▪ Result I in I decreased I systemic I vascular I resistance I (afterload),
vasodilation, I and I therefore I decreased I blood I pressure
o Indications:
▪ First-line Itreatment Ifor Iheart Ifailure I& IHTN
▪ HF I(either Ialone Ior Iin Icombination Iwith Idiuretics Ior Iother Idrugs)
1
, ▪
Slow Iprogression Iof Ileft Iventricular Ihypertrophy Iafter IMI I(cardio
Iprotective)
▪ Renal Iprotective Ieffects Iin Ipatients Iwith Idiabetes
▪ Captopril Iand Ilisinopril Ican Ibe Iused Iif Ia Ipatient Ihas Iliver Idysfunction,Iunlike
Iother IACE Iinhibitors Ithat Iare Ipro-drugs
• *Pro-drugs I are I inactive I in I their I administered I form I and I must I be
Imetabolized Iin Ithe Iliver Ito Ian Iactive Iform Iso Ias Ito Ibe Ieffective
o Adverse I Effects: I hyperkalemia I & I dry, I nonproductive I cough
o Serious Idrug Iinteraction: INSAIDs
• Angiotensin III Ireceptor Iblocker I“sartan” Ilosartan I(Dovan)
o Mechanism I of I Action:
▪ Allow Iangiotensin II Ito Ibe Iconverted Ito Iangiotensin III, Ibut Iblock Ithe
Ireceptors Ithat Ireceive Iangiotensin III
▪ Block I vasoconstriction I and I release I of I aldosterone
▪ Well Itolerated, Ido Inot Icause Ia Idry Icough
▪ Indications: I first-line Itreatment Ifor Iheart Ifailure I& IHTN
o Adverse I Effects: I URI, I headache
▪ May Icause I occasional I dizziness, I inability I to I sleep, I diarrhea
• Calcium Ichannel Iblockers: I Amlodipine I“dipine” Iverapamil I(calan),
Idiltiazem I(cardizem)
o Mechanism I of I Action: I cause I smooth I muscle I relaxation I by I blocking I the
Ibinding Iof Icalcium Ito Iits Ireceptors, Ipreventing Imuscle Icontraction
o Adverse Ieffect: Iconstipation
▪ High-fiber Idiet Iwith Iplenty Iof Ifluids Iwill Ihelp Iprevent Iconstipation
o Indications: I hypertension
▪ Angina- Ich. I23
• Ischemia:
o Ischemic I heart I disease: IPoor I blood I supply I to I the I heart
Imuscle I (Atherosclerosis, I Coronary I artery I disease)
o Myocardial Iinfarction I(MI): INecrosis, Ior Ideath, Iof IcardiacItissue,
Idisabling Ior Ifatal
• Therapeutic IObjectives
o Minimize I the I frequency I of I attacks I and I decrease I the
Iduration Iand Iintensity Iof Ianginal Ipain
o Improve Ithe Ipatient’s Ifunctional Icapacity
o Prevent I or Idelay Ithe Iworst I possible I outcome: I MI
• Cardiac I glycosides: I Digoxin
o Therapeutic Ilevel: Ibetween I0.5-2ng/mL
o Digoxin Idoses Iare Iheld Iand Ithe Iprescriber Inotified Iif Ithe Iapical Ipulse Iis I60 Ibeats/minute
o Negative Ichronotropic Ieffect Idecreases IHR
2
, o Digoxin Iimmune IFab I(Digifab) Iis Ithe Iantidote Ifor Ia Isevere Idigoxin Ioverdose
▪ Required Iuse Iof Idigitab Iwhen Ipotassium Ilevel Iis Iabove I5 ImEq/L, Isevere Isinus
Ibradycardia Ithat Idoes Inot Irespond Ito Icardiac Ipacing, Ior Ian Ioverdose Iof Imore Ithan I10Img
Iof Idigoxin.
o Avoid Ibran Imuffins Iwhen Itaking Idigoxin
o Hypokalemia Iincreases Ithe Ichance Iof Idigitalis Itoxicity
• Class IIII Idrugs: IAmiodarone I(ch. I25)
o Mechanism Iof Iaction: Iprolonging Iaction Ipotential Iduration
o Indications: Iventricular Idysrhythmias
o Contraindication: Ihypersensitivity Iand Ibradycardia Ior IAV Iblock
Adverse Ieffects: IFDA Iblack Ibox Iwarning: Ipulmonary Itoxicity, Ihepatotoxicity Iarrhythmia Iworsening-sinus
Ibradycardia, Iconstipation, IQT Iprolongation, Ihypotension, Iblue-gray Icoloring Iof Ithe Iskin Ion Ithe Iface, Iarms,
Iand Ineck
• Unclassified Iantidysrhythmics: I Adenosine I(Ch. I25)
▪ Slows I conduction I through I the I AV I node
▪ Used I to I convert I paroxysmal I supraventricular I tachycardia I to I sinusIrhythm
▪ Very I short I half-life I (less Ithan I10 Iseconds)
• Flush Iwith I 20cc I of Inormal I saline
▪ Only Iadministered Ias Ifast IIV Ipush
▪ May Icause Iasystole Ifor Ia Ifew Iseconds
▪ Adverse I Effects
• ALL Iantidysrhythmics Ican Icause Idysrhythmias!
• Hypersensitivity I reactions, I nausea, I vomiting, I diarrhea,
Idizziness, Iblurred Ivision, Iheadache
▪ Assessment
• Obtain IaIthorough Idrug Iand Imedical Ihistory
• Baseline IBP, IP, II&O, Iand Icardiac Irhythm
• Measure I serum I potassium I levels I before I initiating I therapy
• Conditions I that Imay Ibe Icontraindications I for Iuse Iof IspecificIdrugs
• Potential Idrug Iinteractions
▪ During I therapy,
• Monitor Icardiac Irhythm, Iheart Irate, IBP, Igeneral Iwell-being,Iskin
Icolor, I temperature, Iheart Iand Ilung Isounds
• Assess Iplasma Idrug Ilevels Ias Iindicated
• Monitor Ifor Itoxic Ieffects
• Take I medications I as I scheduled I and I not I to I skip I doses I or I doubleIup Ifor
Imissed Idoses
3
