Exam #2

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serious6
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105494
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Exam #2
Updated:
2011-10-03 13:00:18
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Calcium Channel Blockers Renin Angiotensin Aldosterone System
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Pharm Prototype Drugs
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  1. What are the therapeutic and pharmacologic classifications of Nifedipine (Adalat, Procardia XL)?
    • Therapeutic: Antihypertensive
    • Pharmacologic: Calcium Channel blocker, dihydropyidine type
  2. What are the therapeutic effects and uses of Nifedipine (Adalat, Procardia XL)?
    • HTN, chronic stable or variant angina, reflex tachycardia (when used concurrently with a beta-adrenergic blocker)
    • off label: hypertensive emergencies, persistent hiccups, or premature labor contractions, prevent migraines
  3. What is the mechanism of action for Nifedipine (Adalat, Procardia)?
    selectively blocking calcium channels in vascular smooth muscle, including those in the coronary arteries, causing a decrease in the amount of intracellular calcium available for muscle contraction
  4. What are the pharmacokinetics for Nifedipine (Adalat, Procardia XL)?
    • Route(s): PO
    • Absorption: Well absorbed (90%)
    • Distribution: Widely distributed; secreted in breast milk, 92-98% bound to plasma protein
    • Primary Metabolism: hepatic; extensive first-pass metabolism
    • Primary excretion: renal (80%) with small amounts in the feces (15%)
  5. What are the adverse effects of Nifedipine (Adalat, Procardia XL)?
    hypotension, dizziness, headache, flushing , peripheral edema, hepotoxicity, MI, CHF, confusion
  6. What are the contraindications/precautions for Nifedipine (Adalat, Procardia XL)?
    hypersensitivity to nifedipine or other dihydropyridines, bradycardia, CHF, acute MI, cardiogenic shock, preexisting hypotension, pulmonary edema, hepatic impairment, older adults
  7. What are the drug interactions for Nifedipine (Adalat, Procardia XL)?
    • interact with drugs that induce or inhibit CYP3A4, antihypertensive (additive), beta-adrenergic blocker, digoxin, alcohol
    • Herbal/Food: Grapefruit juice, Melatonin, St. John's wort
  8. What is the pregnancy category for Nifedipine (Adalat, Procardia XL)?
    Category C
  9. What is the treatment of overdose for Nifedipine (Adalat, Procardia XL)?
    • rapid-acting vasopressors such as dopamine or dobutamine
    • calcium infusions may also be indicated
  10. What are the nursing responsibilities for Nifedipine (Adalat, Procardia XL)?
    • obtain VS
    • Inform the prescriber if the pt has preexisting CVD
    • monitor BP
    • monitor blood glucose in diabetics
    • for chronic HTN, use only the sustained release form swallowed whole with a glass of water
    • Discontinue CCBs gradually
    • Report gingival hyperplasia
  11. What are the patient and family education for Nifedipine (Adalat, Procardia XL)?
    • Monitor BP regularly
    • Immediately report palpitations, weight gain, swelling of ankles and feet, or rashes
    • Do not abruptly stop taking this drug
    • take a missed dose as soon as remembered
    • refrain from ingesting grapefruit or grapefruit juice
    • inspect gums daily for changes such as bleeding or enlargement
    • Discontinue smoking
    • Do not drink alcohol
    • Do not breast feed
  12. What are the therapeutic and pharmacologic classifications of Verapamil (Calan, Isoptin)?
    • Therapeutic: antihypertensive, antianginal, antidysrythmic
    • Pharmacological: calcium channel blocker; phenyalkylamine type
  13. What are the therapeutic effects and uses for Verapamil (Calan, Isoptin)?
    class IV antidysrhythmic, vasodilation of the arterioles, which lower BP and reduces cardiac workload, dilates the coronary arteries to treat angina
  14. What is the mechanism of action for Verapamil (Calan, Isoptin)?
    inhibiting the flow of calcium ions into both cardiac muscle cells and vascular smooth muscle cells
  15. What are the Pharmacokinetics of Verapamil (Calan, Isoptin)?
    • Route(s): PO, IV
    • Absorption: Well absorbed
    • Distribution: Widely distributed; crosses the placenta; secreted in breast milk
    • Primary Metabolism: Hepatic; extensive first-pass metabolism
    • Primary Excretion: Renal (70%) with small amounts in feces (16%)
  16. What is the mechanism of action for Lisinopril (Prinivil, Zertril)?
    • binds to and inhibits the action of ACE, this preventing the conversion of angiotensin I to angiotensin II.
    • the decrease in serum angiotensin II reduces aldosterone secretion, which results in less sodium and water retention
  17. What are the Pharmacokinetics of Lisinopril (Prinivil, Zestril)?
    • Route(s): PO
    • Absorption: 25-30% absorbed from the GI tract
    • Distribution: small amount crosses the BBB; crosses the placenta; limited amounts secreted in breast milk; not bound to plasma protein
    • Metabolism: Not metabolized
    • Excretion: Renal
  18. What are the adverse effects of Lisinopril (Prinivil, Zestril)?
    • cough, headache, dizziness, orthostatic hypotension,rash, hyperkalemia
    • serious: gioedema, agranulcytosis, hepatotoxicity
  19. What are the contraindications/precations for Lisinopril (Prinivil, Zestril)?
    hyperkalemia, hx of angioedema, pregnancy, serious renal impairment
  20. What are the drug interactions for Lisinopril (Prinivil, Zestril)?
    • Indomethacin and other NSAIDS, diuretics and other antihypertensives such as ACE inhibitors, potassium
    • Herbal/Food: Hawthron
  21. What is the pregnancy category for Lisinopril (Prinivil, Zestril)?
    Categories C (first trimester) and D (second and third trimester)
  22. What is the treatment of overdose of Lisinopril (Prinivil, Zertril)?
    • treated with normal saline or a vasopressor
    • may also be removed by hemodialysis
  23. What are the nursing responsibilities for Lisinopril (Prinivil, Zestril)?
    • Obtain a complete HH
    • Notify prescriber if the pt has kidney disease, liver disease, CHF, or connective tissue disease such as lupus, scleroderma, or rheumatoid arthritis
    • Monitor BP
    • Keep the pt supine
    • evaluate antihypertensive effects
    • Discontinue drug if there is any evidence of angioedema
    • Monitor serum Na and K
    • Monitor pts with renal impairments
    • Monitor kidney functions
    • Monitor lithium levels
  24. What is the patient and family education for Lisinopril (Prinivil, Zestril)?
    • Monitor BP regularly
    • Immediately report any swelling of the face, mouth, hands, or feet; hoarseness; sudden trouble breathing; or any sign of infection
    • Proper diet, including Na and K restrictions
    • Report vomiting, diarrhea, or heavy sweating
    • take missed dose as soon as remembered
    • do not drive
    • make position changes slowly
    • drink as least 6-8 glasses of water per day
    • do not drink alcohol
    • avoid OTC NSAIDs
    • keep scheduled appts
    • immediately inform provider of pregnancy
    • do not breast feed
  25. What are the therapeutic and pharmacologic classifications of Losartan (Cozaar)?
    • Therapeutic: Antihypertensive
    • Pharmacologic: Antgiotensin II receptor blocker
  26. What are the therapeutic effects of Losartan (Cozaar)?
    HTN, CVA prophylaxis in pts with left ventricular hypertrophy, prevention of diabetic nephropathy
  27. What is the mechanism of action for Losartan (Cozaar)?
    • selectively blocs antgiotensin AT1 receptors, resulting in a decline in BP
    • the blockade of antgiotensin II receptors prevents cardiac remodeling and deterioration of renal function in patients with diabetes
  28. What are the Pharmacokinetics of Losartan (Cozaar)?
    • Route(s): PO
    • Absorption: Well absorbed from the GI tract
    • Distribution: Does not appear to cross the BBB or the placenta, or to be secreted in breast milk; approx 99% bound to protein
    • Metabolism: Hepatic; extensive first-pass metabolism; converted to active metabolite
    • Excretion: 35% renal, 60% in feces
  29. What are the adverse effects to Losartan (Cozaar)?
    • headache, dizziness, nasal congestion, fatigue, insomnia
    • serious: angioedema, acute renal failure
  30. What are the Contraindications/Precautions of Losartan (Cozaar)?
    prior hypersensitivity to the drug, pregnancy, lactation, serious renal or hepatic impairment, hx of angioedema, hypovolemia
  31. What are the drug interactions of Losartan (Cozaar)?
    • ACE inhibitors, Indomethacin and other NSAIDS, potassium supplements, diuretics and other antihypertensives, lithium
    • Herbal/Food: Hawthorn
  32. What is the pregnancy category for Losartan (Cozaar)?
    Categories C (first trimester) and D (second and third trimester)
  33. What is the treatment of overdose for Losartan (Cozaar)?
    • treated with infusion of normal saline or vasopressor
    • The drug is not removed by hemodialysis
  34. What are the nursing responsibilities for Losartan (Cozaar)?
    • Obtain complete HH
    • If evident, any volume depletion should be corrected
    • notify prescriber if pt has serious renal or hepatic impairment, hx of angioedema, of hypovolemia
    • monitor BP
    • Evaluate the antihypertensive effect
    • monitor labs
  35. What is the patient and family education for Losartan (Cozaar)?
    • Monitor BP regularly
    • Avoid OTC meds for colds, sinus or fever, asthma, or appetit control
    • proper diet
    • report symptoms of hypotension such as dizziness or fainting
    • do not drive
    • report vomiting, diarrhea, or heavy sweating
    • keep regular scheduled appts
    • avoid alcohol
    • avoid heavy exercise
    • immediately report S&S of angioedema
    • immediately report pregnancy
    • do not breast feed

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