Cardiology: Beta Blockers and Calcium Channel Blockers

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Questions and Answers

What is a potential risk of using beta blockers concurrently with diuretics?

Enhanced hypotensive effects (correct)

Increased heart rate

Elevated blood pressure

Decreased cardiac output

Which of the following conditions is a contraindication for the use of beta blockers?

Angina

Tachycardia

Hypertension

Asthma (correct)

What is one of the primary actions of calcium channel blockers?

Stimulate the adrenal glands

Increase venous return

Decrease vascular resistance (correct)

Enhance contraction strength of the heart

Which of the following is a common indication for calcium channel blockers?

Chronic stable angina Signup and view all the answers

Which drug interaction is associated with calcium channel blockers?

Increased levels of digoxin Signup and view all the answers

What measurement should be monitored before administering beta blockers?

Pulse rate Signup and view all the answers

Which side effect is associated with beta blockers?

Bradycardia Signup and view all the answers

During which condition should calcium channel blockers be avoided?

Heart blocks Signup and view all the answers

What is one of the primary therapeutic actions of ACE inhibitors?

Blocks the conversion of angiotensin I to angiotensin II Signup and view all the answers

What monitoring should be done for patients taking beta blockers?

Assess blood pressure and heart rate regularly Signup and view all the answers

Which is a significant contraindication for using calcium channel blockers?

Heart failure with reduced ejection fraction Signup and view all the answers

What is an indication for the use of vasodilators in cardiovascular management?

Control of hypertension Signup and view all the answers

Which interaction should be considered when prescribing ACE inhibitors?

Hypotensive effects with NSAIDs or potassium-sparing diuretics Signup and view all the answers

Which of the following is an undesirable effect commonly associated with ACE inhibitors?

Hyperkalemia Signup and view all the answers

What caution should be taken when initiating ACE inhibitor therapy?

Avoid abrupt cessation of the medication Signup and view all the answers

What is an important nursing consideration when administering ACE inhibitors?

Monitor serum/urine protein and BUN levels Signup and view all the answers

What is the main action of phosphodiesterase inhibitors?

Block the enzyme phosphodiesterase, leading to increased cAMP Signup and view all the answers

Which of the following drugs should not be given with sildenafil when managing congestive heart failure?

Nitroglycerin Signup and view all the answers

What should be monitored regularly during therapy with phosphodiesterase inhibitors?

Platelet counts Signup and view all the answers

What is one of the primary indications for the use of antianginal agents?

Treatment of acute angina Signup and view all the answers

Why should topical forms of nitroglycerin be rotated frequently?

To minimize the risk of site breakdown and abrasions Signup and view all the answers

Which medication when administered with antianginal agents may lead to reduced therapeutic effects of heparin?

Ergot derivatives Signup and view all the answers

What is an important intervention when administering phosphodiesterase inhibitors?

Provide life support equipment on standby Signup and view all the answers

Which of the following therapies is contraindicated when using sildenafil for erectile dysfunction?

Organic nitrate therapy Signup and view all the answers

Study Notes

Beta Blockers

Increased risk of bradycardia when used with cardiac glycosides and calcium channel blockers.
Increased risk of hypotensive effects when used with diuretics.
Abrupt discontinuation may lead to refractory hypertension.
Avoid use in patients with COPD and asthma.
May cause bradycardia, lipidemia, libido issues, bronchospasm, CHF, conduction abnormalities, peripheral vascular constriction, exhaustion, emotional depression, and reduce recognition of hypoglycemia.

Beta Blockers: Interventions

Monitor blood sugar closely in diabetic patients.
Monitor triglyceride and cholesterol levels (LDL).
Monitor BP and pulse before administering the drug. Hold the medication if pulse is < 60 or SBP < 90 and notify the healthcare provider.
Monitor for any changes in cardiac rhythm or signs of CHF.
Report any dizziness.

Calcium Channel Blockers

Common drugs include: amplodipine, bepridil, diltiazem, felodipine, isradipine, nicardipine, nifedipine, nimodipine, nisoldipine, and verapamil.

Calcium Channel Blockers: Action

Block calcium access to cells, causing a decrease in contractility, arteriolar constriction, PVR, and BP.

Calcium Channel Blockers: Indications

Hypertension, vasospastic angina, classic chronic stable angina, atrial fibrillation or flutter, migraine headaches.
Nimodipine is selective for cerebral arteries.
Bepridil prevents coronary artery spasm, making it an agent for chronic stable angina.
Bepridil and Nimodipine are not indicated for hypertension.

Calcium Channel Blockers: Other Specific Information

Beta-adrenergic blockers may increase cardiac depression when given with calcium channel blockers.
Increased serum levels of digoxin, carbamazepine, and quinidine can result when given with calcium channel blockers, cimetidine, or ranitidine.
The antidote for CCB Toxicity is glucagon (hypoglycemia), and insulin (hyperglycemia).

Calcium Channel Blockers: Interventions

Monitor hepatic and renal function tests.
Monitor ECG and avoid giving when heart blocks are present.
During bepridil therapy, periodic K+ levels may be required.
Have emergency equipment available with IV administration.
Protect the drug from light and moisture.
Position the client to reduce peripheral edema.
Perform a carotid massage.

Phosphodiesterase Inhibitors

Common drugs include: inamrinone, milrinone, sildenafil, tadalafil, vardenafil.
May be contraindicated in some cases but are sometimes used to treat moderate CHF.
The primary indication is for erectile dysfunction.

Phosphodiesterase Inhibitors: Action

Block the enzyme phosphodiesterase, leading to an increase in myocardial cell cyclic adenosine monophosphate (cAMP), which increases calcium levels in the cell.

Phosphodiesterase Inhibitors: Indication

Short-term treatment of CHF that has not responded to digoxin or diuretics alone or that has had a poor response to digoxin, diuretics, and vasodilators.

Phosphodiesterase Inhibitors: Other Specific Information

Precipitates form when these drugs are given in solution with furosemide. Use alternate lines if both drugs are being given intravenously.
Viagra should not be given with CHF or in nitrate management.

Phosphodiesterase Inhibitors: Interventions

Monitor pulse and BP.
Monitor input/output and record daily weight.
Monitor platelet counts before and regularly during therapy.
Monitor injection sites and provide comfort measures.
Provide life support equipment on standby.

Antianginal Agents

Common drugs include: nitroglycerin, amyl nitrate, isosorbide dinitrate, isosorbide mononitrate.

Antianginal Agents: Action

Relaxes vascular smooth muscle, resulting in a decrease in venous return and arterial blood pressure, reducing left ventricular workload and decreasing myocardial oxygen consumption.

Antianginal Agents: Indications

Treatment of acute angina, prophylaxis of angina, intravenous treatment of angina unresponsive to beta blockers or organic nitrates, perioperative hypertension, CHF associated with acute MI, and to produce controlled hypotension during surgery.

Antianginal Agents: Other Specific Information

Increased risk of hypotension and decreased antianginal effects if given with ergot derivatives.
Decreased therapeutic effects of heparin if given together.

Antianginal Agents: Interventions

Administer sublingual under the tongue or buccal pouch, and encourage the patient not to swallow.
Administer sustained-release forms with water and caution the patient not to chew or crush the medication.
Rotate the sites of topical forms to reduce breakdown and abrasions.
Provide life support equipment on a standby basis for the patch: Apply to the left anterior chest wall for at least 16 hours on and 8 hours off. Area should be dry, clean and hairless.

ACE Inhibitor

Common Drugs include: benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril.

ACE Inhibitor: Action

Suppresses the renin-angiotensin-aldosterone system; blocks conversion of angiotensin I to angiotensin II (a potent vasoconstrictor).

ACE Inhibitor: Indications

Hypertension, adjunct therapy for CHF, reduces development of serve heart failure following MI in clients with impaired left ventricular function, prevents kidney failure in type II diabetes.

ACE Inhibitor: Undesirable Effects

Gastric irritation, headache, dizziness, tachycardia, angioedema, cough, maculopapular rash, pruritis, infection, hyperkalemia.

ACE Inhibitor: Other Specific Information

Probenecid can affect the elimination of ACE inhibitors.
NSAIDs may cause hypotensive effects with other antihypertensives as well as with potassium-sparing diuretics, potassium supplements, or potassium-containing salt substitutes.

ACE Inhibitor: Interventions

Obtain baseline and monitor serum/urine protein, BUN, creatinine, glucose, CBC with differential, potassium and sodium levels.
Advise rest as first-dose syncope may occur in those with CHF.
Provide mouth care; alteration in taste may occur.
Report any signs of infection, bruising or bleeding.

Cardiovascular Medications: Nursing Considerations

Monitor blood pressure.
Rise slowly to reduce orthostatic hypotension.
Consider dietary modifications.
Adhere to medication regimen.
Do not skip or stop medications.
Be aware of undesirable responses.
Encourage exercise and limit alcohol and caffeine consumption.
Eliminate smoking and provide patient education.

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Description

This quiz covers essential information regarding beta blockers and calcium channel blockers, focusing on their effects, risks, and clinical interventions. It addresses critical monitoring parameters for diabetic patients and potential side effects that healthcare providers need to consider. Test your knowledge on these vital cardiovascular medications.