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Questions and Answers
What should be monitored when a patient is taking alpha-adrenergic blockers?
Which of the following medications is an alpha-adrenergic blocker?
What is a key precaution when administering angiotensin-converting enzyme (ACE) inhibitors?
How do alpha-/beta-blockers reduce blood pressure?
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What should be done if a patient's heart rate drops below 60 bpm when on alpha-adrenergic blockers?
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What potential issue should be monitored in patients with diabetes taking alpha-adrenergic blockers?
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What is a significant side effect associated with ACE inhibitors that requires monitoring?
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What is a common effect of adrenergic agonists such as clonidine?
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What is a primary function of fibric acid agents?
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What monitoring should be conducted for patients using nitrates?
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Which statement is true regarding SGLT2 inhibitors?
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What should patients on statins monitor for, concerning side effects?
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What is the action of phosphodiesterase-3 inhibitors like milrinone?
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What is a significant risk when using thrombolytics?
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What effect do vasodilators have on the cardiovascular system?
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Which of the following is important when administering sympathomimetics to older adults?
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What is the recommended action for patients experiencing chest pain when using nitrates?
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What monitoring is crucial during intravenous administration of milrinone?
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What is the primary action of Angiotensin II Receptor Blockers (ARBs)?
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Which side effect is NOT commonly associated with Angiotensin II Receptor Blockers?
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Which drug class is used to suppress platelet aggregation?
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Which of the following medications is contraindicated in pregnancy?
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What common side effect should be monitored for in patients taking beta-adrenergic blockers?
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What is a key action of Direct Thrombin Inhibitors?
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Which medication class directly interferes with the synthesis of vitamin K-dependent clotting factors?
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What should patients avoid while taking Calcium Channel Blockers?
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Which symptom is a sign of potential bleeding complications in patients taking anticoagulants?
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Which type of medication is likely to decrease the heart rate by blocking beta receptors?
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What is an essential precaution for patients taking digoxin?
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What common side effect is associated with bile acid sequestrants?
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What is a primary use of Thiazide Diuretics?
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What adverse effect should be monitored for patients taking Loop Diuretics?
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Study Notes
Alpha-Adrenergic Blockers
- Block alpha-adrenergic receptors in the heart and arterioles to decrease blood pressure
- Examples: doxazosin (Cardura), prazosin (Minipress), terazosin
- Monitor vital signs & hold medication if heart rate is less than 60 bpm or if BP is less than 90/60 mmHg
- Use caution when ambulating due to potential orthostatic hypotension
- Monitor diabetic patients for hypoglycemia
Adrenergic Agonists
- Stimulate receptors in the central nervous system to decrease heart rate, cardiac output, and blood pressure
- Examples: clonidine (Catapres, Duraclon), guanfacine (Tenex)
- Obtain baseline vital signs, complete blood count (CBC), Coombs test, and liver function studies
Alpha-/Beta- Blockers
- Block the action of norepinephrine at alpha receptors and epinephrine at beta receptors to decrease heart rate & cause vasodilation
- Examples: carvedilol (Coreg), labetalol
- Monitor vital signs and digoxin level when used concurrently (can increase digoxin level)
- Do not discontinue abruptly
- Use caution when ambulating due to potential orthostatic hypotension
- Monitor diabetic patients for hypoglycemia
Angiotensin-Converting Enzyme (ACE) Inhibitors
- Interfere with the enzyme that converts angiotensin I to angiotensin II, a potent natural vasoconstrictor
- This results in vasodilation, decreased blood pressure, reduced afterload & improved cardiac output
- Examples: benazepril (Lotensin), captopril, enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), moexipril, perindopril, quinapril (Accupril), ramipril (Altace), trandolapril
- Follow vital sign changes (first dose may cause severe hypotension)
- Administer first dose at bedtime
- Monitor BP carefully if given intravenously and with subsequent alteration in level of consciousness
- Teach the patient to report the development of a persistent dry cough
- Assess for angioedema, which can be life-threatening
- Monitor CBC for neutropenia or agranulocytosis
Angiotensin II Receptor Blockers (ARBs)
- Block the action of angiotensin II at receptors on the arteries
- Examples: azilsartan (Edarbi), losartan (Cozaar), olmesartan (Benicar), valsartan (Diovan)
- Monitor patient for headache, dizziness, orthostatic hypotension, rash, and diarrhea
- Contraindicated in pregnancy
Anticoagulants
- Inhibit thrombin and the conversion of fibrinogen to fibrin and formation of a blood clot
- Assess for history of unexplained or active bleeding and laboratory results for abnormal clotting profile or evidence of active bleeding
- Monitor for unusual or masked bleeding
- Promptly report any evidence of bleeding such as hematemesis, hematuria, bleeding gums, or unexplained abdominal or back pain
- Teach patient not to take aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or other over-the-counter drugs without healthcare professional approval
- Keep vitamin K available for patients taking warfarin to reverse effects in the event of excessive bleeding or hemorrhage
Oral Anticoagulants
- Examples: warfarin (Coumadin, Jantoven)
- Interfere with synthesis of vitamin K-dependent clotting factors
Direct Thrombin Inhibitors
- Examples: bivalirudin (Angiomax), dabigatran (Pradaxa), desirudin
- Inactivate thrombin and prevent formation of blood clots
Factor Xa Inhibitors
- Examples: apixaban (Eliquis), betrixaban (Bevyxxa), edoxaban (Savaysa), rivaroxaban (Xarelto)
- Inhibit factor Xa of the clotting cascade
Antidysrhythmic Drugs
- Used to treat cardiac dysrhythmias
- Examples: amiodarone (Nexterone, Pacerone), digoxin, diltiazem (Cardizem, Cartia), disopyramide (Norpace), propranolol (Inderal), verapamil (Calan, Verelan)
- Some inhibit sodium flow into the heart muscle cell, others inhibit the flow of sodium, calcium, and potassium, others block beta receptors in the heart
- This slows the rate of impulse conduction, decreases heart rate, and prolongs the refractory period
- Obtain baseline data, including vital signs, cardiac rhythm (including rate, PR and QT intervals, and QRS duration), and physical assessment (especially cardiac, neurologic, and respiratory status)
### Antiplatelet Drugs
- Suppress platelet aggregation and the formation of blood clots
- Examples: Oral: aspirin (Bayer, St.Joseph), clopidogrel (Plavix); Intravenous: abciximab (ReoPro), eptifibatide (Integrilin), tirofiban (Aggrastat)
- Report any signs of increased bruising, petechiae, or occult bleeding
- Do not administer concurrently with warfarin (Coumadin)
Beta-Adrenergic Blockers
- Inhibit beta-receptor stimulation in the heart, resulting in decreased heart rate and cardiac output
- Examples: atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal), timolol
- These drugs interfere with renin release by the kidneys, decreasing the effects of angiotensin and aldosterone to decrease blood pressure
- Monitor patient for bronchospasm, fatigue, sleep disturbances, nightmares, bradycardia, heart block, worsening HF, gastrointestinal (GI) disturbances, impotence, and increased triglyceride levels
- Contraindicated in asthma, chronic lung disease, bradycardia, or heart block
- Assess BP and apical pulse prior to administration
Bile Acid Sequestrants
- Examples: cholestyramine (Questran), colesevelam (Welchol), colestipol (Colestid)
- Decrease cholesterol production in the liver and bind with bile acids in the intestine to excrete cholesterol in the stool
- Lower low-density lipoprotein (LDL) levels and reduce serum cholesterol
- Side effects include bloating, constipation, and reduced absorption of vitamins and minerals
Calcium Channel Blockers (CCBs)
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Inhibit the flow of calcium ions across the cell membrane of blood vessel and heart tissues
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Less calcium allows arterial smooth muscle to relax and the arteries to dilate
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Examples: amlodipine (Norvasc), diltiazem (Cardizem), nifedipine (Procardia), verapamil (Calan SR, Verelan)
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Used to treat angina, dysrhythmias, and hypertension
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Teach the patient to maintain a daily BP log, comply with medication regimen, avoid grapefruit juice, and monitor for tachycardia and hypotension if administered intravenously
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Contraindicated in patients with third-degree block or sick sinus syndrome
Cardiac Glycoside
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Example: digoxin (Digitek, Lanoxin)
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Digoxin causes the heart to beat more forcefully and more slowly, improving cardiac output (positive inotropic effect)
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Assess apical pulse before administering
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Report signs of digitalis toxicity & monitor serum potassium
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Administer with caution to older adults and those after myocardial infarction or with incomplete heart block or renal insufficiency
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Follow serum drug levels to maintain therapeutic levels
Diuretics
- Inhibit the reabsorption of sodium and water from the nephron tubule & promote their excretion in the urine, lowering blood pressure and treating heart failure
- Examples: Loop: bumetanide (Bumex), furosemide (Lasix); Potassium-Sparing: spironolactone (Aldactone), triamterene (Dyrenium); Thiazide: chlorothiazide (Diuril), hydrochlorothiazide
- Monitor serum electrolyte levels, obtain patient weight daily, teach the patient the importance of compliance with the medication regimen, assess hydration status, and monitor breath sounds for fluid volume excess
Fibric Acid Agents
- Block synthesis of triglycerides in the liver to lower the serum triglyceride level
- Examples: fenofibric acid (Fibricor), gemfibrozil (Lopid)
- Up to 2 months of treatment may be needed to achieve a therapeutic effect
Nitrates
- Potent vasodilators that dilate both arterial and venous smooth muscle
- Arterial dilation improves blood flow to the heart muscle and venous dilation reduces cardiac preload to treat angina pectoris
- Examples : isosorbide dinitrate (Dilatrate, Isordil), nitroglycerin (Minitran, Nitro-Bid, Nitro-Dur, Nitrolingual, NitroMist, Nitrostat)
- Monitor BP frequently for hypotension
- Teach the patient how to take medication for chest pain, how often it may be repeated before calling 9-1-1, and to avoid alcohol consumption (can lead to severe hypotension and cardiovascular collapse)
Phosphodiesterase-3 Inhibitors
- Example: milrinone (Primacor)
- Milrinone blocks the enzyme phosphodiesterase in cardiac and smooth muscle, increasing the amount of calcium available for myocardial contraction, which results in positive inotropic actions and vasodilation
- Assess serum potassium levels and monitor for dysrhythmias
- Monitor for ventricular dysrhythmias during IV administration
SGLT2 Inhibitors
- Example: dapagliflozin (Farxiga)
- Dapagliflozin decreases absorption of sodium and water from the renal tubules, which decreases blood volume and the pressure against which the heart must pump
- Monitor blood pressure, pulse, and urinary output
- All SGLT2 inhibitors are used to treat diabetes mellitus, including dapagliflozin
Statins (HMG-CoA Reductase Inhibitors)
- Inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA), a reductase, which decreases cholesterol synthesis in the liver and lowers the level of cholesterol in the blood
- Examples: atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin, pravastatin (Pravachol), rosuvastatin (Crestor), simvastatin (Zocor)
- Assess triglyceride, total cholesterol, LDL, and HDL levels
- Avoid use in patients who are or may become pregnant or are nursing
- Monitor liver function tests & avoid use in patients with liver disease or heavy alcohol consumption
- Teach the patient to avoid alcohol and assess for muscle pain, tenderness, or weakness
Sympathomimetics
- Stimulate alpha- or beta-adrenergic receptors, mimicking the sympathetic nervous system
- Alpha receptor stimulation produces vasoconstriction and increases the blood pressure
- Beta receptor stimulation increases the rate and force of heart contractions
- Examples: dopamine, dobutamine, epinephrine (Adrenalin), isoproterenol (Isuprel), norepinephrine (Levophed), phenylephrine (Vazculep)
- Carefully monitor responses in older adults (may be especially sensitive to these drugs and require lower doses)
- Use the intravenous route only with continuous-infusion pumps
- Carefully adjust the dose to accommodate the patient's cardiovascular status
### Thrombolytics
- Dissolve blood clots that have caused a myocardial infarction, pulmonary embolism, or stroke to quickly restore circulation
- Examples: alteplase (Activase), reteplase (Retavase), tenecteplase (TNKase)
- Must be administered within 12 hours after symptom onset (best if given within 3 hours after ischemic stroke)
- Monitor carefully for bleeding
- Do not administer to patients who have recently (within the past 2 weeks) fallen, been involved in a motor-vehicle crash, or experienced any form of trauma
- Closely monitor cardiac rhythm because return of perfusion to the blocked vessel often results in reperfusion dysrhythmias
Vasodilators
- Relax the smooth muscle around blood vessels, cause vasodilation, and decrease the blood pressure
- Examples: hydralazine, minoxidil, nesiritide, nitroprusside (Nipride, Nitropress), sacubitril/valsartan (Entresto)
- May produce reflex tachycardia and angina in patients with coronary artery disease
- Monitor for sodium and water retention and administer IV nitroprusside cautiously for hypertensive emergency
- The drugs metabolize to cyanide, so careful monitoring is required
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Description
This quiz covers the mechanisms and clinical considerations for alpha-adrenergic blockers, adrenergic agonists, and alpha/beta blockers. Test your understanding of their effects on blood pressure and heart rate, as well as important monitoring parameters. Prepare to identify key examples and understand the implications for patient care.
