ATI PN Pharmacology Proctored Exam
Review
Receptors - CORRECT ANSWERS Norepinephrine-Adrenergic (adrenergic comes
from the word adrenalin)
Alpha 1-all sympathetic target organs except the heart-constrict the blood vessels and
dilation of pupils
Alpha 2-Presynaptic adrenergic nerve terminal...
ATI PN Pharmacology Proctored Exam
Review
Receptors - CORRECT ANSWERS Norepinephrine-Adrenergic (adrenergic comes
from the word adrenalin)
Alpha 1-all sympathetic target organs except the heart-constrict the blood vessels and
dilation of pupils
Alpha 2-Presynaptic adrenergic nerve terminal-inhibits the release of norepinephrine
Beta 1-Heart and Kidneys (BETA 1-ONE HEART)-increased heart rate and force of
contraction, release of renin
Beta 2-All sympathetic target organs-inhibits smooth muscle (BETA 2-TWO LUNGS)
Beta blockers/olol's - CORRECT ANSWERS Beta-Adrenergic Blockers
Metoprolol/Lopressor ENDING OLOL
Beta Blockers are use with heart failure, hypertension, angina and with myocardial
infarctions.
Action = Blocks Beta-Receptors in the heart causing...
Decreases = HR, force of contraction, Rate of atrioventricular (AV) conduction
SE = Bradycardia, lethargy, GI disturbance, congestive heart failure, decrease BP,
depression
The beta blockers stop sympathetic nervous system stimulation of the heart. Does not
allow the heart rate and blood pressure to rise with stress thus lowering the oxygen
demand of the heart. It is very heart protective!
Will slow the heart rate and lower the blood pressure
Can have beta 2 blockage with larger doses-will constrict the bronchioles-watch for
clients with known COPD, Asthma
Nursing Interventions
Check pulse-needs to be 60 or above
Check blood pressure-if hypotensive do not give (Systolic below 100 is a good rule of
thumb I go by)
Monitor for sexual dysfunction-impotence for men-a good reason for non-compliance
Drowsiness/Fatigue-operating heavy machinery, driving could put client at risk
Insomnia-
Contraindicated with Heart Blocks, Bradycardia, Worsening Heart Failure
Increases Hypoglycemic effect of Insulin-monitor blood sugars and for hypoglycemia,
may need to lower insulin dosage
Beta Blockers have to be weaned slowly to prevent rebound hypertension and
tachycardia-if a client wants to stop his beta-blocker they need to contract their
physician
Blocks calcium channels in the myocardial and vascular smooth muscles, decreases
the contraction of smooth muscle-relaxes the arteries-vasodilation. Blocking of calcium
channels in the SA and AV node-Slows conduction through the SA and AV node.
Decreases the force of contraction slows heart rate
Grapefruit juice may increase absorption of nifedipine
Side Effects: Relaxes smooth muscle and cardiac muscle-
Headache
Dizziness-Take lying, sitting and standing B/P, educate client to sit and stand slowly
Peripheral edema-assess for edema, monitor for worsening (diuretic)
Flushing
Reflex tachycardia-monitor for elevated heart rate (may need a BB)
Constipation-increase fibers and fluids (if not restricted) stool softener
Fatigue-Due to low heart rate-monitor EKG, pulse rate and rhythm
Weakness-Monitor B/P and Heart Rate
Impotence and sexual dysfunction-Discuss possibility with client-have client to call and
not just to stop medications
Hepatotoxicity-ALT, AST, ALK PHOS, Bilirubin
MI-Monitor for chest pain, dyspnea, increases fatigue, weakness
CHF-Monitor for chest pain, dyspnea, edema, increasing weight, decreasing output,
increasing HR and B/P
Angioedema-edema in face, throat, trouble swallowing, trouble breathing, thickened
tongue
Grapefruit juice may increase absorption of nifedipine
Acute Toxicity
With an overdose or overmedicated
Gastric lavage
Monitor EKG-bradycardia-widening QRS, hypotension
Norepinephrine to treat hypotension and decreased cardiac contractility
Atropine or Isoproterenol-Bradycardia and Cardiac Blocks
Verapamil (Calan, Covera, Isoptin Verelan)
Class IV antidysrhythmic
Calcium channel blocker
Inhi
,Pril/ace inhibitors - CORRECT ANSWERS Enalapril/Vasotec
PRIL-is the ending for ace's
Reduces Angiotensin 2 and aldosterone levels
Prevents Angiotensin 1 from converting to Angiotensin 2 in the lungs-leaves the
Angiotensin 1 hanging in the lungs-creates irritation-cough
Vasodilation-mostly arteriole (decreases afterload)
Excretion of sodium and water-retention of K (decreases preload)
Treats hypertension and heart failure
Do not take 2nd and 3rd Trimester of pregnancy
SE = Angioedema-allergic reaction-swelling of tongue, throat-stop taking and notify md
Hyperkalemia-monitor for widening and slowing of pulse/qrs, weakness, fatigue, avoid
high K foods, AVOID SALT SUBSTITUTES-usually very high in K, avoid potassium
sparing diuretics, sport drinks are high in K also
Orthostatic Hypotension-teach client to sit and stand slowly, enact fall precautions
Neutropenia/Agranulocytosis-monitor CBC-WBC count, reoccurring infections
Renal Insufficiency-Monitor weight, edema, I/O, BUN, Cr, and GFR
Hepatic Insufficiency-Monitor AST, ALT, ALK PHOS, Bilirubin
Cough-Cough lozenges, hard candy, increase fluid intake, sleep with HOB elevated,
antihistamines
ACE Inhibitors
Discussed these medications with hypertension
Arb's-Angiotensin receptor blockers, sartan's
No Cough, same effects and side effects as Ace's-just not as potent
Sartan's/angiotension blockers/arb's - CORRECT ANSWERS ...
Arb's-Angiotensin receptor blockers, sartan's
No Cough, same effects and side effects as Ace's-just not as potent
Nitrates - CORRECT ANSWERS Nitroglycerin/Nitrostat, Nitro-Bid, Nitro-Dur
Nitrates form nitric acid which is a relaxes smooth muscle and dilates venous and
arterial blood vessels
Open veins-blood pools in the legs-not as much blood returning to the heart-reduces
preload
Open arteries-heart does not have to work as hard to pump blood out of the heart-
reduces afterload
Opens the coronary arteries and helps supply blood to the heart tissue
Can be given sublingually, orally, topically, IV, buccal
Can be for acute or long term use
Nitroglycerin dilates any artery and vein-including yours if you touch it while
administering it-WEAR GLOVES
, Nitroglycerin IV needs a glass bottle and covered from light-some hospitals still use
special tubing (nitro is absorbed in the tubing)
Short term-nitrostat-sublingually-1 tablet every 5 minutes x 3 for relief of chest pain-still
having chest pain call 911/physician
Long-term nitro-dur will last for up to 14 hours in the body
Side Effects:
Headache-dilates the cerebral arteries-do not give with head trauma or increased
intracranial pressure
Hypotension and reflex tachycardia-do not give with hypotension, monitor blood
pressure and HR when administering
Hypotension-correct hypervolemia prior to giving nitroglycerin
DO NOT GIVE WITH VIAGRA, LEVITRA, OR CIALIS (nitroglycerin and Viagra increase
nitric acid and relaxation of the smooth muscles-can kill a client with hypotension with a
combination of these drugs)
Digoxin - CORRECT ANSWERS Cardiac Glycoside
Digoxin/Digitek, Lanoxin, Lanoxicaps (Dig)
Increases the contractility of the heart muscle - Inotropic effect-
Increases cardiac output
Also Suppresses the SA node and slows conduction through the AV node
Half-life is 3-4 days
Great Drug-real side effects
Digoxin SE =
Dysrhythmias
Toxicity 0.5-1.8 normal level
Signs of toxicity-halos around objects, Nausea/Vomiting/Anorexia, blurred vision, fatigue
Bradycardia-must take an apical pulse for one full minute, must be 60 or above to give
digoxin
Give with caution with pediatric and geriatric patients due to inadequate renal or hepatic
metabolic enzymes
Hyperkalemia can reduce effects of digoxin
Digoxin and Beta Blockers can really lower the pulse
Give with caution with renal failure-digoxin excreted via the kidneys
DIGIBIND IS THE ANTIDOTE FOR DIGOXIN TOXICITY
Digoxin
Decreases automaticity of the SA nose and slows conduction through the AV node
Atrial dysrhythmias
All the side effects and warnings are still important
Heparin - CORRECT ANSWERS Naturally found in the liver and lining of blood vessels
Prolong coagulation time
IV immediate onset, Sub Q 1 hour
Destroyed by gastric enzymes
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