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level: Level 1

Questions and Answers List

level questions: Level 1

QuestionAnswer
HMG CoA reductase inhibitor; HyperlipidemiaAtorvastatin: Class and Indication
Inhibits HMG CoA reductase, causing decreased production of cholesterolAtorvastatin: Mechanism of Action
Myopathy - myalgia, rhabdomyolysis; ocular and liver toxicity, headacheAtorvastatin: Side Effects
Pregnancy, liver problemsAtorvastatin: C/C
Take with evening meal (enzymes more active at night); may not see improvement for 6-12 monthsAtorvastatin: Nursing Implications
Thiazide diuretic; Hypertension and edema in HFHydrochlorothiazide: Class and Indication
Block Na+ reabsorption, accelerating urine formation and removal of Na+ and H2OHydrochlorothiazide: Mechanism of Action
Dehydration, electrolyte imbalancesHydrochlorothiazide: Side Effects
Should not be used if creatinine clearance is lowHydrochlorothiazide: C/C
Monitor electrolytes, fluidsHydrochlorothiazide: Nursing Implications
Non-selective beta-1 adrenergic antagonist; HypertensionPropranolol: Class and Indication
Reduce HR; Reduce PVR; Reduce secretion of reninPropranolol: Mechanism of Action
Bradycardia, hypotension, rebound hypertension, bronchospasm, bronchoconstriction, depression, impotencePropranolol: Side Effects
COPD/asthma, diabetes, reduced renal output, SABA/LABA, abrupt withdrawal not advisedPropranolol and Metoprolol: C/C
Monitor pulse rates; warn patient to not change position abruptly; warn to not abruptly stop medicationPropranolol and Metoprolol: Nursing Implications
Selective beta-1 adrenergic antagonist; HypertensionMetoprolol: Class and Indication
Competes with endogenous catecholamines at adrenergic cardiac receptors; High doses may affect beta-2 receptorsMetoprolol: Mechanism of Action
Bradycardia, hypotension, rebound hypertension, depression, impotenceMetoprolol: Side Effects
Angiotensin Converting Enzyme (ACE) inhibitor; HypertensionLisinopril: Class and Indication
Blocks conversion of angiotensin I to angiotensin II; Blocks breakdown of bradykinin; Increases prostaglandin productionLisinopril: Mechanism of Action
Non-productive cough, angioedema, hypotension, hyperkalemia, renal failureLisinopril: Side Effects
Renal disease, pregnancyLisinopril: C/C
Monitor BP and labs carefully; Take 1 hour before meals; Take 2 hours apart from antacidsLisinopril: Nursing Implications
Angiotensin II Receptor Blocker (ARB); HypertensionLosartan: Class and Indication
Blocks angiotensin II from binding on receptors in blood vessels and renal cortexLosartan: Mechanism of Action
Headache, dizziness, weakness, syncopeLosartan: Side Effects
Renal disease, pregnancy, use cautiously if patients experienced angioedema using ACE inhibitorsLosartan: C/C
Monitor BP and labsLosartan: Nursing Implications
Calcium channel blockers; HypertensionVerapamil, Nifedipine, Diltiazem: Class and Indication
Bind to different subunits of L-type calcium channels; bind to open-type calcium channels; prevent movement of calcium into cardiac and smooth muscle cellsVerapamil and Diltiazem: Mechanism of Action
Orthostatic hypotension, peripheral edema, bradycardia, reflex tachycardia, constipation, cardiac suppressionVerapamil, Nifedipine, Diltiazem: Side Effects
Heart block or sick sinus syndrome; beta blockers; cautiously in older adults; caution with kidney and liver disorders and heart failureVerapamil, Nifedipine, Diltiazem: C/C
Monitor heart rate, EKG, BP, edema, and weight; don't eat grapefruitVerapamil, Nifedipine, Diltiazem: Nursing Implications
Bind reversibly to closed-type calcium channels; prevent movement of calcium into cardiac and smooth muscle cellsNifedipine: Mechanism of Action
Direct vasodilator; severe hypertensionHydralazine: Class and Indication
Causes peripheral vasodilation in arterioles; Increases heart rate and cardiac outputHydralazine: Mechanism of Action
Headache, reflex tachycardia, edema and flushing, N/V/ diarrheaHydralazine and Sodium Nitroprusside: Side Effects
Any condition where drop in BP would be harmful. Caution in older adults; caution in liver and kidney patients; fluid and electrolyte imbalancesHydralazine: C/C
Monitor BP and serum electrolytesHydralazine: Nursing Implications
Direct vasodilator; Hypertensive emergencySodium nitroprusside: Class and Indication
Direct relaxation of arteries and veinsSodium nitroprusside: Mechanism of Action
Requires dilution; can cause irreversible ischemic injury and death; risk of cyanide accumulationSodium nitroprusside: C/C
Monitor BP and serum electrolytes, should not be given with another medicationSodium nitroprusside: Nursing Implications
Cardiac glycoside; Heart failureDigoxin: Class and Indication
Increase contractile force of myocardium, decrease HR by inhibiting Na/K pump; Increased ICF Na causes exchange for CaDigoxin: Mechanism of Action
Headache, dizziness, nausea, vomiting, bradycarda, arrhythmiasDigoxin: Side Effects
Visual disturbances, cardiac disturbancesDigoxin: Toxicity
Ventricular dysrhythmia; heart block or sick sinus syndrome; aortic stenosis; acute MI; electrolyte imbalance; renal failureDigoxin: C/C
Check pulse before administering; Same time daily; Monitor drug and K+ levelsDigoxin: Nursing Implications
Antidote for Digoxin; Digoxin toxicityDigibind: Class and Indication
Antidysrhythmic; Narrow QRS tachycardiaAdenosine: Class and Indication
Slows conduction through AV nodeAdenosine: Mechanism of Action
Sinus arrest, flushing, sinus bradycardia, hypotension, dyspnea, dysrhythmiasAdenosine: Side Effects
Atrial fibrillation, atrial flutter, heart blockAdenosine: C/C
Flush IV port immediately after bolusAdenosine: Nursing Implications
Potassium channel blocker; Pulseless ventricle fibrillation, ventricle tachycardia, atrial fibrillationAmiodarone: Class and Indication
Blocks K+ channels decreasing heart rate, contractility, and conductionAmiodarone: Mechanism of Action
Pulmonary toxicity, new arrhythmiaAmiodarone: Side Effects
Interacts with grapefruit, cardiac drugsAmiodarone: C/C
Half life is 25-110 days - toxicity can occur even after discontinuing; Emergency use primarily, but also in atrial fibrillation patients long-termAmiodarone: Nursing Implications
COX inhibitor; AnginaAspirin: Class and Indication
Slows platelet aggregation by blocking thromboxane, reducing risk of further occlusionAspirin: Mechanism of Action
GI side effects, tinnitus, hearing loss, bleeding riskAspirin: Side Effects
Anticholinergic; Bradycardia (1st line)Atropine: Class and Indication
Blocks parasympathetic activation by acetylcholine; causes fight-or-flight symptomsAtropine: Mechanism of Action
Drying of mucosa; constipation; urinary retention; ventricular fibrillationAtropine: Side Effects
COPD/asthma, cardiovascular diseaseAtropine: C/C
Catecholamine; Bradycardia (2nd line), hypotensive shock, heart failureDopamine: Class and Indication
Low dose - activates receptors in kidneys producing renal artery dilation; Moderate dose - activates beta-1 receptors increasing heart rate and contractility; High dose - activates alpha receptors producing vasoconstrictionDopamine: Mechanism of Action
Changes in blood pressure, dysrhythmias and palpitations, angina, tissue necrosisDopamine: Side Effects
Tachydysrhythmias, ventricular fibrillationDopamine: C/C
Monitor IV site for extravasation, own IV line requiredDopamine: Nursing Implications
Catecholamine; Cardiac arrest, bradycardiaEpinephrine: Class and Indication
Adrenergic agonistEpinephrine: Mechanism of Action
TachycardiaEpinephrine: Side Effects
Tachydysrhythmias, beta blockersEpinephrine: C/C
Class 1b Na+ channel blocker, local anesthetic; ventricular arrhythmiasLidocaine: Class and Indication
Blocks Na+ channels of heart's conduction system, slowing conductionLidocaine: Mechanism of Action
Many, new arrhythmiasLidocaine: Side Effects
IV drip must be started soon after bolus or serum level will drop below therapeutic rangeLidocaine: Nursing Implications
Opioid; AnginaMorphine: Class and Indication
Reduces some sympathetic response, venodilatorMorphine: Mechanism of Action
Respiratory depressionMorphine: Side Effects
Nitrate; AnginaNitroglycerin: Class and Indication
Relaxes smooth muscles in vascular systemNitroglycerin: Mechanism of Action
Headache is most common; hypotension; facial flushing; tachycardiaNitroglycerin: Side Effects
Do not take with Viagra or other PDE5 inhibitors - may cause life threatening hypotension; AlcoholNitroglycerin: C/C
Monitor vitals; Advise patient to remain supine or seated when taking medication; Emphasize changing position slowly; Offer sips of water before giving sublinguallyNitroglycerin: Nursing Implications
Atorvastatin: Class and IndicationHMG CoA reductase inhibitor; Hyperlipidemia
Atorvastatin: Mechanism of ActionInhibits HMG CoA reductase, causing decreased production of cholesterol
Atorvastatin: Side EffectsMyopathy - myalgia, rhabdomyolysis; ocular and liver toxicity, headache
Atorvastatin: C/CPregnancy, liver problems
Atorvastatin: Nursing ImplicationsTake with evening meal (enzymes more active at night); may not see improvement for 6-12 months
Hydrochlorothiazide: Class and IndicationThiazide diuretic; Hypertension and edema in HF
Hydrochlorothiazide: Mechanism of ActionBlock Na+ reabsorption, accelerating urine formation and removal of Na+ and H2O
Hydrochlorothiazide: Side EffectsDehydration, electrolyte imbalances
Hydrochlorothiazide: C/CShould not be used if creatinine clearance is low
Hydrochlorothiazide: Nursing ImplicationsMonitor electrolytes, fluids
Propranolol: Class and IndicationNon-selective beta-1 adrenergic antagonist; Hypertension
Propranolol: Mechanism of ActionReduce HR; Reduce PVR; Reduce secretion of renin
Propranolol: Side EffectsBradycardia, hypotension, rebound hypertension, bronchospasm, bronchoconstriction, depression, impotence
Propranolol and Metoprolol: C/CCOPD/asthma, diabetes, reduced renal output, SABA/LABA, abrupt withdrawal not advised
Propranolol and Metoprolol: Nursing ImplicationsMonitor pulse rates; warn patient to not change position abruptly; warn to not abruptly stop medication
Metoprolol: Class and IndicationSelective beta-1 adrenergic antagonist; Hypertension
Metoprolol: Mechanism of ActionCompetes with endogenous catecholamines at adrenergic cardiac receptors; High doses may affect beta-2 receptors
Metoprolol: Side EffectsBradycardia, hypotension, rebound hypertension, depression, impotence
Lisinopril: Class and IndicationAngiotensin Converting Enzyme (ACE) inhibitor; Hypertension
Lisinopril: Mechanism of ActionBlocks conversion of angiotensin I to angiotensin II; Blocks breakdown of bradykinin; Increases prostaglandin production
Lisinopril: Side EffectsNon-productive cough, angioedema, hypotension, hyperkalemia, renal failure
Lisinopril: C/CRenal disease, pregnancy
Lisinopril: Nursing ImplicationsMonitor BP and labs carefully; Take 1 hour before meals; Take 2 hours apart from antacids
Losartan: Class and IndicationAngiotensin II Receptor Blocker (ARB); Hypertension
Losartan: Mechanism of ActionBlocks angiotensin II from binding on receptors in blood vessels and renal cortex
Losartan: Side EffectsHeadache, dizziness, weakness, syncope
Losartan: C/CRenal disease, pregnancy, use cautiously if patients experienced angioedema using ACE inhibitors
Losartan: Nursing ImplicationsMonitor BP and labs
Verapamil, Nifedipine, Diltiazem: Class and IndicationCalcium channel blockers; Hypertension
Verapamil and Diltiazem: Mechanism of ActionBind to different subunits of L-type calcium channels; bind to open-type calcium channels; prevent movement of calcium into cardiac and smooth muscle cells
Verapamil, Nifedipine, Diltiazem: Side EffectsOrthostatic hypertension, peripheral edema, bradycardia, reflex tachycardia, constipation, cardiac suppression
Verapamil, Nifedipine, Diltiazem: C/CHeart block or sick sinus syndrome; beta blockers; cautiously in older adults; caution with kidney and liver disorders and heart failure
Verapamil, Nifedipine, Diltiazem: Nursing ImplicationsMonitor heart rate, EKG, BP, edema, and weight; don't eat grapefruit
Nifedipine: Mechanism of ActionBind reversibly to closed-type calcium channels; prevent movement of calcium into cardiac and smooth muscle cells
Hydralazine: Class and IndicationDirect vasodilator; severe hypertension
Hydralazine: Mechanism of ActionCauses peripheral vasodilation in arterioles; Increases heart rate and cardiac output
Hydralazine and Sodium Nitroprusside: Side EffectsHeadache, reflex tachycardia, edema and flushing, N/V/ diarrhea
Hydralazine: C/CAny condition where drop in BP would be harmful. Caution in older adults; caution in liver and kidney patients; fluid and electrolyte imbalances
Hydralazine: Nursing ImplicationsMonitor BP and serum electrolytes
Sodium nitroprusside: Class and IndicationDirect vasodilator; Hypertensive emergency
Sodium nitroprusside: Mechanism of ActionDirect relaxation of arteries and veins
Sodium nitroprusside: C/CRequires dilution; can cause irreversible ischemic injury and death; risk of cyanide accumulation
Sodium nitroprusside: Nursing ImplicationsMonitor BP and serum electrolytes, should not be given with another medication
Digoxin: Class and IndicationCardiac glycoside; Heart failure
Digoxin: Mechanism of ActionIncrease contractile force of myocardium, decrease HR by inhibiting Na/K pump; Increased ICF Na causes exchange for Ca
Digoxin: Side EffectsHeadache, dizziness, nausea, vomiting, bradycarda, arrhythmias
Digoxin: ToxicityVisual disturbances, cardiac disturbances
Digoxin: C/CVentricular dysrhythmia; heart block or sick sinus syndrome; aortic stenosis; acute MI; electrolyte imbalance; renal failure
Digoxin: Nursing ImplicationsCheck pulse before administering; Same time daily; Monitor drug and K+ levels
Digibind: Class and IndicationAntidote for Digoxin; Digoxin toxicity
Adenosine: Class and IndicationAntidysrhythmic; Narrow QRS tachycardia
Adenosine: Mechanism of ActionSlows conduction through AV node
Adenosine: Side EffectsSinus arrest, flushing, sinus bradycardia, hypotension, dyspnea, dysrhythmias
Adenosine: C/CAtrial fibrillation, atrial flutter, heart block
Adenosine: Nursing ImplicationsFlush IV port immediately after bolus
Amiodarone: Class and IndicationPotassium channel blocker; Pulseless ventricle fibrillation, ventricle tachycardia, atrial fibrillation
Amiodarone: Mechanism of ActionBlocks K+ channels decreasing heart rate, contractility, and conduction
Amiodarone: Side EffectsPulmonary toxicity, new arrhythmia
Amiodarone: C/CInteracts with grapefruit, cardiac drugs
Amiodarone: Nursing ImplicationsHalf life is 25-110 days - toxicity can occur even after discontinuing; Emergency use primarily, but also in atrial fibrillation patients long-term
Aspirin: Class and IndicationCOX inhibitor; Angina
Aspirin: Mechanism of ActionSlows platelet aggregation by blocking thromboxane, reducing risk of further occlusion
Aspirin: Side EffectsGI side effects, tinnitus, hearing loss, bleeding risk
Atropine: Class and IndicationAnticholinergic; Bradycardia (1st line)
Atropine: Mechanism of ActionBlocks parasympathetic activation by acetylcholine; causes fight-or-flight symptoms
Atropine: Side EffectsDrying of mucosa; constipation; urinary retention; ventricular fibrillation
Atropine: C/CCOPD/asthma, cardiovascular disease
Dopamine: Class and IndicationCatecholamine; Bradycardia (2nd line), hypotensive shock, heart failure
Dopamine: Mechanism of ActionLow dose - activates receptors in kidneys producing renal artery dilation; Moderate dose - activates beta-1 receptors increasing heart rate and contractility; High dose - activates alpha receptors producing vasoconstriction
Dopamine: Side EffectsChanges in blood pressure, dysrhythmias and palpitations, angina, tissue necrosis
Dopamine: C/CTachydysrhythmias, ventricular fibrillation
Dopamine: Nursing ImplicationsMonitor IV site for extravasation, own IV line required
Epinephrine: Class and IndicationCatecholamine; Cardiac arrest, bradycardia
Epinephrine: Mechanism of ActionAdrenergic agonist
Epinephrine: Side EffectsTachycardia
Epinephrine: C/CTachydysrhythmias, beta blockers
Lidocaine: Class and IndicationClass 1b Na+ channel blocker, local anesthetic; ventricular arrhythmias
Lidocaine: Mechanism of ActionBlocks Na+ channels of heart's conduction system, slowing conduction
Lidocaine: Side EffectsMany, new arrhythmias
Lidocaine: Nursing ImplicationsIV drip must be started soon after bolus or serum level will drop below therapeutic range
Morphine: Class and IndicationOpioid; Angina
Morphine: Mechanism of ActionReduces some sympathetic response, venodilator
Morphine: Side EffectsRespiratory depression
Nitroglycerin: Class and IndicationNitrate; Angina
Nitroglycerin: Mechanism of ActionRelaxes smooth muscles in vascular system
Nitroglycerin: Side EffectsHeadache is most common; hypotension; facial flushing; tachycardia
Nitroglycerin: C/CDo not take with Viagra or other PDE5 inhibitors - may cause life threatening hypotension; Alcohol
Nitroglycerin: Nursing ImplicationsMonitor vitals; Advise patient to remain supine or seated when taking medication; Emphasize changing position slowly; Offer sips of water before giving sublingually