Pharmacology Drug Safety Quiz

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Questions and Answers

What is a potential side effect of the drug mentioned?

Improved gastric health

Enhanced muscle energy

Skin patches (correct)

Increased heart rate

In which patient demographic should this drug not be used?

Patients with kidney issues

Patients with myocardial infarction (correct)

Patients with high blood pressure

Patients over the age of 70

Which of the following symptoms might indicate toxicity from the drug?

Increased appetite

Normal pulse

Bradycardia (correct)

Rapid weight gain

What effect can the drug cause within minutes of administration?

Skin irritation Signup and view all the answers

What is the rationale for avoiding this drug in certain patients?

It can cause gastric upset Signup and view all the answers

What role does the sympathetic nervous system play in blood flow regulation?

It can worsen blood flow due to stress. Signup and view all the answers

What condition could potentially lead to decreased coronary artery blood supply?

Coronary artery spasm Signup and view all the answers

What might cause an increase in myocardial oxygen consumption?

Emotional stress Signup and view all the answers

How can certain medications impact coronary artery function?

They can induce tolerance in blood vessels. Signup and view all the answers

What is a significant factor that can diminish blood supply during stress?

Stimulation of the sympathetic nervous system Signup and view all the answers

Which of the following describes a potential effect of insufficient blood supply to the heart?

Increased risk of angina Signup and view all the answers

What physiological change can occur as a result of sympathetic activation?

Increased heart rate Signup and view all the answers

What can exacerbate conditions leading to coronary artery issues?

Smoking and high-stress levels Signup and view all the answers

What is the primary role of action potentials in neuron signaling?

To propagate electrical signals along neurons Signup and view all the answers

Which ion is primarily responsible for the depolarization phase of an action potential?

Sodium ion (Na⁺) Signup and view all the answers

What characterizes a non-selective receptor?

It can bind to multiple types of ions or molecules. Signup and view all the answers

How does bronchospasm affect the respiratory system?

Causes the airways to become narrowed Signup and view all the answers

What is the consequence of ventricular tachycardia?

Increased heart rate with reduced efficiency Signup and view all the answers

In the context of cardiac function, what is 'resting potential'?

The electrical charge difference across the cell membrane at rest Signup and view all the answers

What does the term 'action potential' specifically refer to?

A rapid change in electrical potential across a membrane Signup and view all the answers

Which condition is often associated with dysregulation of impulse conduction?

Myocardial infarction Signup and view all the answers

What is the primary concern associated with limited coronary artery blood supply?

Worsening of ischemic conditions Signup and view all the answers

Which factor is most likely to worsen coronary artery conditions?

Stress and spasm Signup and view all the answers

What is a potential consequence of venous blood supply being limited during ischemic conditions?

Worsening of ischemic symptoms Signup and view all the answers

In the context of coronary artery health, what does spasm refer to?

Temporary tightening of artery walls Signup and view all the answers

How might age influence drug storage and administration in coronary artery disease treatment?

Elderly patients require lower doses Signup and view all the answers

What might be a common non-pharmacological approach to manage coronary artery conditions?

Participation in stress management therapies Signup and view all the answers

What role does skin irritation play in the context of drug patches for coronary artery disease treatment?

Signals potential allergic reaction Signup and view all the answers

What is a significant risk associated with coronary artery spasm?

It can lead to sudden cardiac events Signup and view all the answers

Study Notes

References

Karch, A. M. (2020): Focus on nursing pharmacology, 8th Edition, Lippincott Williams & Wilkins, ISBN: 978-1-9751-0096-4, Chapter 44: 2294-2352

Drugs Acting on Cardiovascular System

Antiarrhythmic Agents

The Conducting System of the Heart

SA node
AV node
Bundle of His
Right bundle branch
Left bundle branch
Purkinje fibers

Five Phases of the Action Potential of the Cardiac Muscle Cell

Phase 0: Occurs when the cell reaches a point of stimulation
Phase 1: Short period during which sodium ion concentration equalizes inside and outside of the cell
Phase 2: (Plateau Stage): Occurs as the cell membrane becomes less permeable to sodium, calcium slowly enters the cell and potassium begins to leave the cell
Phase 3: Repolarization
Phase 4: The cell comes to rest; the sodium-potassium pump returns the membrane to its resting membrane potential.

Causes of Cardiac Arrhythmias

Electrolyte disturbances that alter the action potential
Structural damage
Pathway changes
Acidosis of waste products
Drugs that alter action potential or cardiac conduction

Types of Cardiac Arrhythmias

Tachycardia (faster heart rate)
Bradycardia (slower heart rate)
Premature atrial contractions (PACS)
Premature ventricular contractions (PVCs)
Atrial flutter
Atrial fibrillation or (ventricular fibrillation)
Heart Blocks
Bundle branch blocks

Classifications of Antiarrhythmics

Class I: Block sodium channels in the cell membrane during an action potential
Class II: Block beta-receptors, causing a depression of phase 4 of the action potential
Class III: Block potassium channels, prolonging phase 3 of the action potential
Class IV: Block calcium channels in the cell membrane

Use of Antiarrhythmic Across the Lifespan

Children: Minimized use, careful monitoring for adverse effects, and calculated dosing based on weight and age.
Adults: Monitor total drug regimen, frequent monitoring, and medical follow-up.
Older adults: Start with lower doses, monitor closely, and adjust based on response.

Prototype Class I Antiarrhythmic - Lidocaine

Indications: Management of acute ventricular arrhythmias, typically during cardiac surgery or acute myocardial infarction (MI)
Route: IV administration
Actions: Decreases depolarization, resulting in fewer impulses. Increases ventricular fibrillation threshold
Adverse effects: Dizziness, light-headedness, fatigue, arrhythmias, cardiac arrest, and nausea
Usual indications: Treatment of life-threatening ventricular arrhythmias, also used during acute myocardial infarction (MI) and cardiac surgery.

Class II Antiarrhythmic - Propranolol

Indications: Treats cardiac arrhythmias (particularly supraventricular tachycardias)
Route: Oral or IV
Actions: Blocks beta-receptors, decreasing heart rate, and cardiac excitability
Adverse effects: Bradycardia, heart failure, cardiac arrhythmias, heart blocks, cerebrovascular accident
T1/2: 3 to 6 hours

Class III Antiarrhythmic- Amiodarone

Indications: Life-threatening ventricular arrhythmias
Route: Oral or IV
Actions: Primarily prolongs action potential
Adverse effects: Malaise, fatigue, dizziness, heart failure, cardiac arrhythmias, cardiac arrest

Class IV Antiarrhythmic - Diltiazem

Indications: Paroxysmal supraventricular tachycardia (SVT) in Adults
Route: Oral or IV
Actions: Blocks movement of calcium ions, slows automaticity and conduction through AV node
Adverse effects: Dizziness, light-headedness, headache, asthenia, peripheral edema, bradycardia

Other Drugs Used to Treat Arrhythmias

Adenosine (Adenocard): Used to convert supraventricular tachycardia to sinus rhythm
Digoxin: Slows calcium from leaving cell, prolonging action potential
Dronedarone (Multaq): Reduces risk of hospitalization in patients with persistent atrial fibrillation (AF).

Nursing Considerations for Antiarrhythmic Therapy

Assess patient history and physical exam (allergies, kidney/liver function, hypotension, shock, electrolyte imbalances.)
Pregnancy and lactation status
Baseline ECG, and appropriate lab values

Coronary Artery Disease (CAD)

Definition: narrowing of the heart arteries.
Symptoms: Stable angina, unstable angina, myocardial infarction.

Types of Angina

Stable Angina: Partial blockage with typical chest pain relieved with rest or medication
Unstable Angina: Increasing chest pain not relieved by rest or medication.
Prinzmetal’s Angina: Related to coronary spasm

Actions of Antianginal Drugs

Improved blood delivery to heart muscle
Increased oxygen delivery
Decreasing the heart's workload
Decreasing oxygen demand

Factors Affecting Myocardial Oxygen Demand

Myocardial oxygen consumption, heart rate,
Blood volume (preload), blood pressure (afterload)
Left ventricular muscle size, muscle contractility

Use of Antianginal Agents across the Lifespan

Consideration of age-related physiological changes to adjust drug dosages.
Monitoring patients for adverse reactions

Question 1

Swallowing the sublingual tablet is incorrect. The tablet needs to be placed under the tongue.

Question 4

Bronchospasm is a known side effect of the class II antiarrhythmics

Question 3

Increasing absorption is the primary reason why nitroglycerin is given sublingually; it's intended to avoid first-pass metabolism by the liver.

Question 2

Pounding headaches can result from vasodilation of cerebral vessels caused by nitrates' effects

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Test your knowledge on the side effects and safety considerations of a specific drug. This quiz covers important information regarding patient demographics, potential toxicity symptoms, and immediate effects after administration. Perfect for those studying pharmacology or healthcare.