ATI COMPREHENSIVE EXIT EXAM 2
QUESTION AND ANSWER.
increased HR- can give beta blocker to fix, observe for swelling (can give diuretic), acute
toxicity- monitor VS, admin. norepi, calcium, isoproterenol, lidocaine, iv fluids, gastric lavarge-
slowling HR w/ beta blockers, no grapefruit juice
verapamil, diltiazem
OH and peripheral edema, constipation, cardiac suppression, dysrhtymias, acute toxicity ,
increase digoxin, don't use w/ beta blockers, avoid grapefruit juice
alpha adrenergic blockers: prazosin, doxazosin mesylate, terazosin: HTN, BPH
start with low dose, first dose given at night, change positions slowly, use carefully w/
antihypertensives. take med w/ food.
centrally acting alpha agonists: clonidine, guanfacine HCL, methyldopa: migraine, ADHD,
HTN, withdrawal, severe cancer pain
drowsiness, dry mouth, rebound hypertension so taper. don't use patch w/ scleroderma and lupus,
use cautiously w/ stroke, MI, DM, depression, renal failure. careful w/ prazosin and TCAs,
Beta Blockers:
metoprolol, atenolol, metoprolol succinate, esmolol, propranolol, nadolol, carvedilol, labetalol:
HTN, agnina, migraine, glaucoma
metoprolol and propranolol
bradycardia, cautiously in diabetes, decreased cardiac output- monitor and notify, AV clock-
baseline ECG, OH, rebound myocardium excitation: taper off meds: monitor clients taking beta
blocker concurrently
propranolol
avoid w/ asthma, diabetes- monitor blood glucose b/c it masks signs of hypoglycemia
hypertensive crisis: nitroprusside, nitroglycerin, nicardipine, clevidipine, enalaprilat, esmolol
HCl
excessive hypotension, cyanide poisoning- increased for liver issues, reduce by giving less than
5mcg/kg/min or thiosulfate, avoid prolonged use, protect from light, discard after 24 hr
cardiac glycosides: digoxin: treatment of heart failure and dysrhythmias
dysrhythmias, consume high K foods, .5-2 serum levels of digoxin, avoid use of quinidine,
verapamil, thiazide, ACE can increase digoxin levels, antacids decrease
adrenergic agonists:
,epinephrine, dopamine, dobutamine, isoproterenol, terbutaline
Epinephrine: alpha 1, beta 1 and 2
vacoconstrict, increase HR, heart contraction, rate of conduction, bronchodilation helps w/ slows
absorption of local anesthetics, manages superficial bleeding, decreased congestion of nasal
mucosa, increased BP, treatment of AV block and cardiac arrest, asthma
dopamine: shock and heart failure
low dose: renal blood dilation
moderate: beta 1: renal dilation, increase HR, myocardial contractility, increased rate of
conduction
high: all above and vasoconstriction
dobutamine: beta 1
increased HR, myocardial contraction, rate of conduction: used w/ heart failure
epinephrine complications:
hypertension, dysrhythmias,
dopamine adverse
dysrhythmias, necrosis
dobutamine adverse
increased HR
Interactions of adrenergic agonists
MAOIs with epi, TCAs with epi, general anesthetics w/ epi, alpha and beta adrengergic blockers
and diuretics block dopamine
organic nitrates: nitroglycerin, nitro-time (capsules), nitrostat (subling tablet), nitorlingual
(spray), nitro-bid (topical), nitro-dur (transderm), nitro-bid Iv, isosorbide dinitrate, isosorbide
mononitrate- treat angina
use aspirin or acetaminophen to relive pain, OH, reflex tachy, tolerance, can increase cranial
pressure, avoid alcohol, careful w/ beta blocker, calcium channel, diuretic, NO with viagra etc.
sublingual tablet and translingual spray
rapid onset, short duration
treat acute attack, and prophylaxis of acute
use at first sign, prior to activity known to cause pain, stored in cool, dark place
,sustained release
slow onset, long duration
long term prophylaxis against anginal attacks
swallow w/o crushing or chewing- empty stomach w/ water
transdermal
slow onset, long duration
long-term prophylaxis against attacks
patches shouldn't be cut, rotate, no hair, remove w/ soap and water, remove at night
topical ointment
slow onset, long duration
long term phrophylaxis
remove prior dose before applying new dose, clean hairless area, cover w/ saran, avoid touching
ointment,
IV
used for angina that doesn't respond to other meds, contorl BP or induce hypotension suring
surgery, heart failure from acute MI
use glass IV bottle, start slow and titrate up,
antianginal agent: ranolazine; lower cardiac O2 demand
monitor ECG for QT prolonging, elevated BP, avoid use grapefruit juice, HIV protease,
macrolide antibiotics, verapamil, quinidine, digoxin, simvastatin
Class 1A-- Procainamide, quinidine gluconate, quinidien sulfast, disopyramide
decrease electrical conduction, automaticity, repolarization rate: used w/ supraventricular
tachycardia, ventricular tachycardia, atrial flutter, atrial fibrilation:
Class 1B-- LIdocaine: mexiletine, tocainide
decrease electrical conduction, automaticity, repolarization rate: short term use only for
ventricular dysrhythmias
Class 1C: propafenone, flecainide
decrease electrical conduction, decrease excitability, increase rate or repolarlization: SVT
HMG COA Reductase inhibitors: the statins
, decrease LDL, increase HDL, hepatotoxic, myopathy, monitor CK, no grapefruit juice,
erythromycin, ketoconazole, ezetimibe, gemfibrozil, fenofibrate
cholesterol absorption inhibitor: ezetimibe- decreases LDL
hepatitis, myopathy, don't take w/ bile acid, , fibrates if taken w/ statin monitor for more liver
issues
bile-acid sequestrants: colesevelam HCL, colestipol- decrease LDL
increase fiber intake, oral fluids, take other meds 4hr before admin
Nicotinic acid, niacin: lower LDL, raise HDL
GI distress- take w/ food, facial flushing- take aspirin 30 minutes before each dose,
hyperglycemia, hepatotoxicity, hyperuricemia,
fibrates: gemfibrozil, fenofibrate: increase HDL
GI distress, gallstones, myopathy, heaptotoxicity, increases risk of bleeding w/ warfarin, use w/
statins increase myopathy
class II medications: propanolol hydrochloride, esmolol hydrochloride, acebutolol hydrochloride
decreases HR, slow rate of conduction, decrease atrial ectopic stimulation: used w/ Atrial
fibrillation, atrial flutter, paroxysmal SVT, hypertension, angina
class III meds: Amiodarone, Dofetilide, Ibutilide, Sotalol
Decrease rate of repolarization,
Decrease electrical conduction, Decrease contractility, Decrease automaticity: used w/
Conversion of atrial fibrillation -oral route, Recurrent ventricular fibrillation, Recurrent
ventricular tachycardia
class IV meds: verapamil, diltiazem
Decrease force of contraction, Decrease heart rate, Slow rate of conduction through the SA and
AV nodes: Atrial fibrillation and flutter, SVT, Hypertension, Angina pectoris
adenosine
Decrease electrical conduction through AV node used w/ Paroxysmal SVT,
Wolff-Parkinson-White syndrome
digoxin
Decrease electrical conduction through AV node, Increase myocardial contraction used w/ H,
atrial fibrillation and flutter, paroxysmal SVT
