Nursing > Study Guide > Study Guide for NR 293 Exam 3
Alpha 2 -adrenergic receptor stimulators (agonists)/clonidine o Stimulate alpha2-adrenergic receptors in the brain o Decrease sympathetic outflow from the CNS, decrease norepinephrine production o Stimulates alpha2-adrenergi receptors, thus reducing renin o Examples: Clonidine (Catapres), M ... ethyldopa (aldomet): used for pregnant women w/htn Alpha 1 -blockers/”azosin,” o Block alpha 1 -adrenergic receptors o Management of severe heart failure (HF) when used with cardiac glycosides and diuretics o Some used to relieve symptoms of BPH- increase urinary flow rate o Example: “ Azosin” (doxazosin (Cardura) o Adverse Effects: Serious: hypotension (first dose) syncope Common: dizziness o Nursing implications: instruct pt. to lie down after taking first dose because they may become dizzy Beta-blockers “olol”: First-line treatment for heart failure & HTN o Reduce BP by reducing heart rate through beta 1 blockade (block receptors for norepinhrine) o Cause reduced secretion of renin o Long-term use causes reduced peripheral vascular resistance o Adverse Effects: orthostatic hypotension, bradycardia w/ reflex tachycardia, sexual dysfunction in men, possible hypoglycemia or hyperglycemia Angiotensin-converting enzyme inhibitor, “pril” Captopril o Mechanism of Action: Inhibit angiotensin-converting enzyme, which is responsible for converting angiotensin I (through the action of renin) to angiotensin II Angiotensin II is a potent vasoconstrictor and causes aldosterone secretion from the adrenal glands Result in decreased systemic vascular resistance (afterload), vasodilation, and therefore decreased blood pressure o Indications: First-line treatment for heart failure & HTN HF (either alone or in combination with diuretics or other drugs) 1Slow progression of left ventricular hypertrophy after MI (cardio protective) Renal protective effects in patients with diabetes Captopril and lisinopril can be used if a patient has liver dysfunction, unlike other ACE inhibitors that are pro-drugs *Pro-drugs are inactive in their administered form and must be metabolized in the liver to an active form so as to be effective o Adverse Effects: hyperkalemia & dry, nonproductive cough o Serious drug interaction: NSAIDs Angiotensin II receptor blocker “sartan” losartan (Dovan) o Mechanism of Action: Allow angiotensin I to be converted to angiotensin II, but block the receptors that receive angiotensin II Block vasoconstriction and release of aldosterone Well tolerated, do not cause a dry cough Indications: first-line treatment for heart failure & HTN o Adverse Effects: URI, headache May cause occasional dizziness, inability to sleep, diarrhea Calcium channel blockers: Amlodipine “dipine” verapamil (calan), diltiazem (cardizem) o Mechanism of Action: cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction o Adverse effect: constipation High-fiber diet with plenty of fluids will help prevent constipation o Indications: hypertension Angina- ch. 23 Ischemia: o Ischemic heart disease: Poor blood supply to the heart muscle (Atherosclerosis, Coronary artery disease) o Myocardial infarction (MI): Necrosis, or death, of cardiac tissue, disabling or fatal Therapeutic Objectives o Minimize the frequency of attacks and decrease the duration and intensity of anginal pain o Improve the patient’s functional capacity o Prevent or delay the worst possible outcome: MI Cardiac glycosides: Digoxin o Therapeutic level: between 0.5-2ng/mL o Digoxin doses are held and the prescriber notified if the apical pulse is 60 beats/minute o Negative chronotropic effect decreases HR 2o Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose Required use of digitab when potassium level is above 5 mEq/L, severe sinus bradycardia that does not respond to cardiac pacing, or an overdose of more than 10 mg of digoxin. o Avoid bran muffins when taking digoxin o Hypokalemia increases the chance of digitalis toxicity Class III drugs: Amiodarone (ch. 25) o Mechanism of action: prolonging action potential duration o Indications: ventricular dysrhythmias o Contraindication: hypersensitivity and bradycardia or AV block Adverse effects: FDA black box warning: pulmonary toxicity, hepatotoxicity arrhythmia worsening-sinus bradycardia, constipation, QT prolongation, hypotension, blue-gray coloring of the skin [Show More]
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Study Guide
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Nursing
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