Pharmacology for Hypertension Management
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Questions and Answers

What is the primary mechanism of action of beta-blockers in the treatment of hypertension?

  • They increase heart rate and contractility.
  • They directly dilate blood vessels.
  • They promote the retention of sodium and water.
  • They block the release of stress hormones. (correct)

    • Which of the following is a common side effect associated with the use of diuretics for hypertension?

  • Weight gain
  • Hypotension
  • Hypokalemia (correct)
  • Increased heart rate

    • What is an important nursing consideration when administering anti-hypertensive medications?

  • Monitor blood pressure closely before and after administration. (correct)
  • Administer only at night to enhance effectiveness.
  • Provide a high-salt diet to enhance medication efficacy.
  • Encourage patients to stop medication if headaches occur.

    • Which class of drugs is primarily used to manage acute angina by increasing oxygen delivery to the heart?

    <p>Antianginal drugs</p> Signup and view all the answers

    Which of the following medications is classified as an Angiotensin II Receptor Blocker (ARB)?

    <p>Losartan</p> Signup and view all the answers

    What is the primary mechanism of action of centrally acting antihypertensive drugs like alpha2-adrenergic agonists?

    <p>Stimulation of alpha 2 adrenoceptors in the CNS</p> Signup and view all the answers

    Which medication is an example of a centrally acting antihypertensive drug?

    <p>Methyldopa</p> Signup and view all the answers

    What is a significant nursing alert for patients taking alpha2-adrenergic agonists?

    <p>Do not drive or operate heavy machinery</p> Signup and view all the answers

    Which of the following is a potential side effect of vasodilators?

    <p>Angina</p> Signup and view all the answers

    What role do lifestyle modifications play in managing hypertension with medication?

    <p>They enhance the effectiveness of medication</p> Signup and view all the answers

    For which condition is Methyldopa particularly noted for being safe to use?

    <p>Hypertension in pregnancy</p> Signup and view all the answers

    Which type of angina is characterized by predictable triggers and relief from rest or medication?

    <p>Stable angina</p> Signup and view all the answers

    Which of the following is a common side effect reported by patients taking vasodilators?

    <p>Flushing</p> Signup and view all the answers

    What is the primary mechanism of action of ACE inhibitors?

    <p>They block the action of angiotensin II.</p> Signup and view all the answers

    Which of the following ACE inhibitors should be taken before meals?

    <p>Captopril</p> Signup and view all the answers

    What is a common side effect of both ACE inhibitors and ARBs?

    <p>Headache</p> Signup and view all the answers

    Which of the following nursing considerations is essential for patients on ARBs?

    <p>Avoid potassium-containing supplements without consulting a doctor.</p> Signup and view all the answers

    Which of the following is NOT an example of an ARB?

    <p>Lisinopril</p> Signup and view all the answers

    What side effect is most commonly associated with ACE inhibitors?

    <p>Taste disturbance</p> Signup and view all the answers

    Why are ACE inhibitors contraindicated during pregnancy?

    <p>They can cause fetal abnormalities.</p> Signup and view all the answers

    Which statement is true regarding the side effects of ARBs compared to ACE inhibitors?

    <p>ARBs are less likely to produce side effects than ACE inhibitors.</p> Signup and view all the answers

    What is a significant side effect specifically associated with non-dihydropyridine calcium channel blockers?

    <p>Bradycardia</p> Signup and view all the answers

    Which nursing alert is important for patients taking diuretics?

    <p>Monitor for hypokalemia and hyponatremia</p> Signup and view all the answers

    What dietary advice should be provided to patients taking dihydropyridine calcium channel blockers?

    <p>Reduce grapefruit juice consumption</p> Signup and view all the answers

    Which type of ACE inhibitor is long-acting and requires administration only once a day?

    <p>Perindopril</p> Signup and view all the answers

    What is a potential side effect of both diuretics and calcium channel blockers?

    <p>Flushed face</p> Signup and view all the answers

    What is a typical side effect of alpha2-adrenergic agonists like Methyldopa?

    <p>Postural hypotension</p> Signup and view all the answers

    Which nursing alert is essential for a patient taking vasodilators?

    <p>Inform the doctor about joint pain</p> Signup and view all the answers

    Which lifestyle modification is emphasized for better management of hypertension?

    <p>Regular exercising</p> Signup and view all the answers

    For which condition is Methyldopa indicated as particularly safe?

    <p>Hypertension in pregnancy</p> Signup and view all the answers

    What should patients commonly avoid while taking alpha2-adrenergic agonists?

    <p>Driving or operating machinery</p> Signup and view all the answers

    Which is an example of a vasodilator used to treat high blood pressure?

    <p>Hydralazine</p> Signup and view all the answers

    What is a common symptom of angina that differentiates stable angina from unstable angina?

    <p>Predictable triggers</p> Signup and view all the answers

    What is an expected outcome from using vasodilators in managing hypertension and heart failure?

    <p>Relaxation of blood vessels</p> Signup and view all the answers

    What is the primary effect of dihydropyridines in the treatment of hypertension?

    <p>Promote vasodilation of blood vessels</p> Signup and view all the answers

    Which of the following is a non-dihydropyridine calcium channel blocker?

    <p>Verapamil</p> Signup and view all the answers

    How do non-dihydropyridine calcium channel blockers primarily affect heart function?

    <p>Slow down the heart rate</p> Signup and view all the answers

    What is a common suffix for dihydropyridine calcium channel blockers?

    <p>-pine</p> Signup and view all the answers

    Which of the following agents is primarily effective in controlling fast heart rhythms?

    <p>Diltiazem</p> Signup and view all the answers

    What is a significant effect of calcium channel blockers on blood vessels?

    <p>Relax and widen arteries</p> Signup and view all the answers

    Which of the following calcium channel blockers is specifically mentioned as effective against atrial fibrillation?

    <p>Verapamil</p> Signup and view all the answers

    Dihydropyridines predominantly affect which of the following systems?

    <p>Cardiovascular system</p> Signup and view all the answers

    What characterizes unstable angina?

    <p>It lasts longer than expected and has a change in patterns.</p> Signup and view all the answers

    Which statement describes the mechanism of action of nitrates?

    <p>They convert to nitric oxide and cause peripheral vasodilation.</p> Signup and view all the answers

    When taking TNG Sublingual tablets for angina, how long should a patient wait after the first dose before considering a second dose?

    <p>5 minutes</p> Signup and view all the answers

    Which condition is a contraindication for taking nitrates?

    <p>Hypotension</p> Signup and view all the answers

    What should patients do if chest pain persists after taking the third dose of TNG?

    <p>Contact emergency services for immediate help.</p> Signup and view all the answers

    What is the primary effect of nitrates on cardiac workload?

    <p>They reduce afterload and preload.</p> Signup and view all the answers

    Which route is NOT listed for TNG administration?

    <p>Oral capsule</p> Signup and view all the answers

    How do nitrates affect coronary vasodilation?

    <p>They enhance oxygen delivery to the heart muscle.</p> Signup and view all the answers

    What is a serious risk associated with taking Viagra (Sildenafil) with nitrates?

    <p>Severe hypotension</p> Signup and view all the answers

    What is the primary therapeutic effect of digoxin in heart failure treatment?

    <p>Increases myocardial contractility</p> Signup and view all the answers

    Which of the following conditions is NOT an indication for digoxin use?

    <p>Coronary artery disease</p> Signup and view all the answers

    Which instruction should NOT be followed when storing nitrates like glyceryl trinitrate?

    <p>Keep in the fridge</p> Signup and view all the answers

    What immediate action should be taken if chest pain persists after administering 3 doses of nitrates?

    <p>Seek medical attention immediately</p> Signup and view all the answers

    What is a key nursing alert to monitor when a patient is on digoxin?

    <p>Renal function and potassium levels</p> Signup and view all the answers

    What is the effect of digoxin on AV conduction?

    <p>Decreases conduction and prolongs the PR interval</p> Signup and view all the answers

    What should male patients be taught regarding erectile dysfunction drugs like Viagra?

    <p>They should avoid taking them within 24 hours of nitrate use</p> Signup and view all the answers

    Which of the following is a potential side effect of digoxin treatment?

    <p>Hallucinations</p> Signup and view all the answers

    Which of the following side effects is most commonly associated with the use of nitrates?

    <p>Severe hypotension</p> Signup and view all the answers

    What should be done prior to applying a transdermal patch of glyceryl trinitrate?

    <p>Clean and dry the skin area</p> Signup and view all the answers

    Which of the following activities should be avoided while taking nitrates?

    <p>Driving a car</p> Signup and view all the answers

    What is a contraindication for the use of nitrates?

    <p>Severe hepatic and renal impairment</p> Signup and view all the answers

    What is the primary mechanism of action of SNRIs?

    <p>Block the reuptake of serotonin and norepinephrine</p> Signup and view all the answers

    Which side effect is commonly associated with SNRIs?

    <p>Hyponatremia</p> Signup and view all the answers

    What potential risk is associated with the abrupt cessation of SNRIs?

    <p>Withdrawal symptoms</p> Signup and view all the answers

    Why should SNRIs be used cautiously in pregnant and lactating women?

    <p>They could adversely affect the fetus and baby</p> Signup and view all the answers

    Which nursing consideration is essential when prescribing SNRIs?

    <p>Monitor for serotonin syndrome and effects on mood</p> Signup and view all the answers

    What is the primary function of the autonomic nervous system (ANS)?

    <p>Involuntary control over smooth and cardiac muscles</p> Signup and view all the answers

    Which group of drugs is primarily used to manage depression and anxiety?

    <p>Selective serotonin reuptake inhibitors (SSRIs)</p> Signup and view all the answers

    What happens to neurotransmitters in the synaptic cleft during the action of inhibitors?

    <p>They remain available longer due to blockage</p> Signup and view all the answers

    Which receptors are activated by adrenergic drugs in the sympathetic nervous system?

    <p>Adrenergic receptors</p> Signup and view all the answers

    What is a common side effect of SSRIs?

    <p>Agitation or anxiety</p> Signup and view all the answers

    Under which condition is the parasympathetic nervous system activated?

    <p>During non-stressful conditions</p> Signup and view all the answers

    Which class of antidepressants primarily works by blocking the reuptake of serotonin?

    <p>Selective serotonin reuptake inhibitors (SSRIs)</p> Signup and view all the answers

    What is an important nursing consideration when administering SSRIs?

    <p>Monitor for serotonin syndrome</p> Signup and view all the answers

    Which pathway in the autonomic nervous system involves the release of both ACh and NE?

    <p>Sympathetic nervous system pathway</p> Signup and view all the answers

    What is a key mechanism of benzodiazepines in treating anxiety?

    <p>Enhancing the effects of GABA</p> Signup and view all the answers

    What is a common side effect of tricyclic antidepressants (TCAs)?

    <p>Hypertension</p> Signup and view all the answers

    Why should tricyclic antidepressants be used cautiously in pregnant women?

    <p>They pose potential adverse effects on the fetus.</p> Signup and view all the answers

    What should be monitored in a patient taking tricyclic antidepressants?

    <p>Vision</p> Signup and view all the answers

    Which condition is a contraindication for the use of tricyclic antidepressants?

    <p>Myocardial infarction</p> Signup and view all the answers

    What is the primary function of benzodiazepines?

    <p>To enhance the effect of GABA</p> Signup and view all the answers

    For what purpose are benzodiazepines commonly prescribed?

    <p>Short-term treatment of anxiety</p> Signup and view all the answers

    What effect can abrupt cessation of tricyclic antidepressants lead to?

    <p>Withdrawal symptoms</p> Signup and view all the answers

    What is one of the risks associated with the use of benzodiazepines?

    <p>Dependence and withdrawal</p> Signup and view all the answers

    What effect do benzodiazepines have on neuronal excitability?

    <p>They reduce neuronal excitability.</p> Signup and view all the answers

    Which neurotransmitter is primarily affected by benzodiazepines?

    <p>Gamma-aminobutyric acid (GABA)</p> Signup and view all the answers

    How do antiseizure drugs achieve suppression of abnormal neuronal firing?

    <p>They prevent sodium influx.</p> Signup and view all the answers

    What is a common side effect of benzodiazepines?

    <p>Drowsiness</p> Signup and view all the answers

    What results from the influx of chloride ions in neurons?

    <p>Hyperpolarization and reduced firing</p> Signup and view all the answers

    An imbalance in which two neurotransmitters contributes to Parkinson's disease?

    <p>Dopamine and acetylcholine</p> Signup and view all the answers

    Which of the following benzodiazepines is classified as an anxiolytic?

    <p>Alprazolam</p> Signup and view all the answers

    Which mechanism is associated with the action of GABA at its receptor?

    <p>Chloride selective channel opening</p> Signup and view all the answers

    What is the role of dopamine in the control of movements within the body?

    <p>Facilitates smooth, controlled movements</p> Signup and view all the answers

    What happens to acetylcholine levels when there is a drop in dopamine?

    <p>Acetylcholine compensates and becomes overly active</p> Signup and view all the answers

    Which drug is known to cross the blood-brain barrier and convert into dopamine?

    <p>Levodopa</p> Signup and view all the answers

    What is a primary goal of pharmacotherapy in the treatment of Parkinson's disease?

    <p>Restore the balance of dopamine and acetylcholine</p> Signup and view all the answers

    In pain management, how do opioids act on pre-synaptic afferent nerves?

    <p>Block Ca2+ channels to inhibit neurotransmitter release</p> Signup and view all the answers

    Which of the following is a potential adverse effect of opioid use?

    <p>Sedation</p> Signup and view all the answers

    What is the function of naloxone in an opioid overdose situation?

    <p>It reverses the effects of opioids</p> Signup and view all the answers

    Which of the following specifies the mechanism of action of opioids post-synaptically?

    <p>They open K+ channels to hyperpolarize cell membranes</p> Signup and view all the answers

    What role do nociceptors play in the sensation of pain?

    <p>They initiate the sensation of pain</p> Signup and view all the answers

    Study Notes

    NUR2047 Pharmacology - Cardiovascular and Hematopoietic System

    • This course covers medications for the cardiovascular and hematopoietic systems.

    Medications for Cardiovascular System

    • Anti-hypertension drugs: Include beta-blockers, calcium channel blockers, ACE inhibitors, ARB blockers, centrally acting antihypertensive drugs, and vasodilators.

    • Antianginal drugs: Include nitrates (short-acting and long-acting), beta-blockers, and calcium channel blockers.

    • Drugs for Cardiovascular Diseases: Cover antidysrhythmics and inotropes.

    • Lipid-lowering drugs: Cover statins, bile-sequestering drugs, fibrates, and nicotinic acid.

    • Anticoagulants: Include heparin (unfractionated and low molecular weight), vitamin K antagonists (e.g., warfarin), direct thrombin inhibitors (DTIs), and direct factor Xa inhibitors.

    • Antiplatelets: Include COX-1 inhibitors (e.g., aspirin), P2Y12 receptor antagonists (e.g., clopidogrel, prasugrel, ticagrelor), and phosphodiesterase inhibitors (e.g., dipyridamole).

    • Thrombolytics: Tissue plasminogen activator (tPA).

    Hypertension

    • Hypertension is the pressure exerted on blood vessels during heart contraction and relaxation, measured in mmHg.
    • Systolic blood pressure (SBP) is recorded during heart contraction and diastolic blood pressure (DBP) during relaxation.
    • Blood pressure categories include optimal, normal, high normal, and hypertension, with corresponding systolic and diastolic ranges.
    • There are various recommendations for rechecking blood pressure based on the readings.
    • Asymptomatic, mild headache can be a symptom of high blood pressure.
    • Dangerous high blood pressure (malignant hypertension) can lead to serious complications like stroke, myocardial infarction, and kidney damage.

    A1. Beta-blocker (Examples)

    • Selective beta-blockers (B1): Acebutolol, Atenolol, Bisoprolol, Metoprolol, Esmolol, Bisoprolol + hydrochlorothiazide, Labetalol.

    • Non-selective beta-blockers (B1, B2): Nadolol, Propranolol, Sotalol, Carvedilol.

    • Side effects: tiredness, cold hands and feet, slow heartbeat, diarrhea, nausea,sleep disturbances, nightmares and erectile dysfunction.

    • Special nursing alerts: can trigger asthma, mask hypoglycemia in diabetics, may worsen uncontrolled heart failure or hypotension, or certain rhythm problems.

    A2. Calcium Channel Blockers (Examples)

    • Dihydropyridines: Nifedipine, Amlodipine, Felodipine, Nimodipine, Lercanidipine, Lacidipine

    • Non-dihydropyridines: Verapamil, Diltiazem.

    • Side effects: flushed face, headaches, dizziness, swollen ankles, hypotension, reflex tachycardia, constipation, and bradycardia.

    • Special nursing alerts: Avoid large quantities of grapefruit juice, high-fiber diet, and plenty of fluids to reduce constipation.

    A3. Diuretics (Examples)

    • Indapamide, Furosemide (Lasix), Spironolactone (Aldactone)

    • Side effects: flushed face, headaches, swollen ankles, constipation, dizziness, tiredness.

    • Special nursing alerts: Take in the morning, monitor for hypokalemia, educate patients on preventing postural hypotension, and ensure accurate records of daily body weights.

    A4. ACE Inhibitors (Examples)

    • Captopril, Enalapril, Lisinopril, Perindopril, Ramipril.

    • Side effects: persistent dry cough (most common), dizziness, taste disturbance, and rashes.

    • Special nursing alerts: Not suitable during pregnancy, avoid salt substitutes or potassium supplements, and should typically be taken before meals (unless otherwise specified).

    A5. Angiotensin II Receptor Blockers (ARBs, Examples)

    • Candesartan, Irbesartan, Losartan, Telmisartan, Valsartan.

    • Side effects: Headache, dizziness.

    • Special nursing alerts: Not suitable during pregnancy, medications may raise potassium levels in the blood, and ARBs are less likely to have side effects than ACE inhibitors.

    A6. Centrally Acting Antihypertensive Drugs (Example)

    • Methyldopa (Aldomet)

    • Side effects: Headache, postural hypotension.

    • Special nursing alerts: Should not drive or operate machinery (due to dizziness), avoid alcohol, may rarely cause fatal liver disease or anemia, and may be used to manage hypertension in pregnancy.

    A7. Vasodilators (Example)

    • Hydralazine (Apresoline)

    • Side effects: angina, swelling in arms and legs, flushing, gastrointestinal disorders, headache, joint disorders, muscle pain, nasal congestion, and palpitations.

    • Special nursing alerts: Inform your doctor of any symptoms like arthritis, fever, or tiredness.

    Anti-hypertensive Drugs - General Advice

    • Combination with lifestyle modification (diet + exercise + quit smoking + less alcohol) is important for better and lifelong management.
    • Medications often start at low doses, and a second from a different class can be added if needed.
    • Proper education for patients is crucial, including taking drugs regularly, checking for drug compliance, not driving or operating machinery while on medication, and reporting pregnancy to the doctor.
    • Patients should track their blood pressure and discuss self-monitoring strategies with their doctor.

    B. Antianginal Drugs

    • Nitrates: short-acting and long-acting
    • Beta-blockers
    • Calcium channel blockers

    Angina

    • Stable angina: regular pattern, triggered by exertion, relieved by rest and medication
    • Unstable angina: unpredictable, frequent attacks, even at rest, could indicate a heart attack
    • Variant angina: occurs at rest, often requires medication intervention

    Drugs Management Plan (for Angina)

    • Initial treatment could be beta-blockers, calcium channel blockers or both. An additional, short-acting nitrate is often appropriate to relieve angina attacks.

    • Short-acting nitrates: for immediate relief. (Examples - nitrostat, Nitro-bid, Imdur.)

    • Long-acting nitrates: designed for long-term prevention of symptoms. (Examples - Isordil, Elantan.)

    • Alternative antianginal drugs are available if initial drugs are not tolerated.

    B1. Nitrates

    • Nitrates work by converting to nitric oxide, resulting in peripheral vasodilation, decreasing preload, afterload and workload. Coronary vasodilation increased blood supply to the myocardium.

    Routes for Nitroglycerin (NTG) Medications

    • Sublingual tablets
    • Sublingual spray
    • Transdermal patches
    • Slow IV infusion.

    Patient Instructions - What to Do When Feeling Angina

    • Assess for symptoms
    • Stop activity
    • Take medications as directed
    • Follow-up with medical professional if pain persists

    Nitrate Side Effects / Contraindications

    • Side effects: Hypotension (low blood pressure), throbbing headache, warmth/flushed face.
    • Contraindications: Avoid concomitant use with alcohol or medications for erectile dysfunction (may induce severe hypotension.)

    Nitrate More Special Nursing Alerts

    • Avoid machinery/high-alert tasks
    • Caution with severe hepatic or renal impairment
    • Drug interactions with other cardiovascular medications
    • proper storage and use time for medications

    How to Apply Glyceryl Trinitrate (NTG) - Transdermal Patch?

    • Clean the area with no hair, scars, cuts.
    • Follow application guidelines
    • Don't expose to direct heat
    • Avoid applying to the same location within 14 days.

    How to Use NTG Sublingual (SL) Spray?

    • Follow steps and guidelines
    • Hold the spray under the tongue, don't swallow/inhale
    • Store the medication at a suitable temperature.

    Antianginal Drug List

    • Provides a list of long-acting nitrates, beta-blockers, and calcium channel blockers

    C. Drugs for Cardiovascular Diseases

    • Anti-dysrhythmics: Digoxin, Amiodarone, Diltiazem
    • Inotropes: Dopamine

    C1. Anti-dysrhythmics - Digoxin

    • Side effects: Cardiac symptoms (bradycardia, heart block, palpitations), neurologic symptoms (headache, dizziness, confusion, hallucinations), GI symptoms (nausea, vomiting, diarrhea), visual disturbances (blurred or yellowish vision, seeing halos).
    • Special nursing alerts: Monitor for any slow heart rate, low blood pressure, blurred vision, and renal function tests (especially potassium). Report electrolyte deficits or low potassium levels.

    C1. Anti-dysrhythmics - Amiodarone

    • Side effects: Nausea, vomiting, taste disturbances, raised serum transaminases, jaundice, bradycardia, pulmonary toxicity, tremor, headache, sleep disorders, hypothyroidism, hyperthyroidism, and skin discoloration.
    • Special nursing alerts: Monitor thyroid, liver, and pulmonary function regularly. Correct electrolyte disorders before starting treatment. Chest x-ray is recommended..

    C1. Anti-dysrhythmics - Diltiazem

    • Side effects: Headache, fatigue, dysrhythmia, heart block (asystole), bradycardia, heart failure, nausea, vomiting, diarrhea, dizziness, flushing, light-headedness.
    • Special nursing alerts: Monitor BP, pulse, ECG (PR, QRS, QT intervals). Notify doctor if SBP < 90 mmHg or HR < 50 bpm. Swallow tablets whole; avoid grapefruit juice/avoid interference with other drugs or substances.

    C2. Intropin - Dopamine

    • Side effects: Nausea, vomiting, orthostatic hypotension, headache, dizziness, cardiac arrhythmia.
    • Indications: Cardiogenic and septic shock, hypotension.

    D. Lipid Lowering Drugs

    • Statins: (e.g., atorvastatin, fluvastatin, lovastatin, rosuvastatin, pravastatin, simvastatin)
    • Bile-sequestering drugs: (e.g., cholestyramine)
    • Fibrates: (e.g., bezafibrate, fenofibrate, gemfibrozil)
    • Nicotinic acid: (e.g., niacin)

    D1. Statins (Examples)

    • Side effects: Gastrointestinal discomfort, muscle pain, and abnormal liver function (abnormal liver function tests).
    • Special nursing alerts: Monitor for unexplained muscle pain, weakness or dark urine; yellowing of skin/eyes; severe gastrointestinal problems (appetite loss); Monitor liver function tests (LFTs); Avoid grapefruit juice; Not suitable for pregnancy.

    D2. Bile acid sequestering (BAS) Drugs

    • Side effects: Gastrointestinal discomfort, constipation, nausea, and may increase triglycerides.
    • Special nursing alerts: Do not take in dry powder form; should be mixed with liquid; High-fiber diet and plenty of fluids to reduce side effects; Other medications should be taken at least 1 hour before or 4-6 hours after; Alert for pregnancy.

    D3. Fibrates

    • Side effects: Gastrointestinal discomfort (nausea, anorexia), rash, vertigo, headache.
    • Special nursing alerts: May increase the effect of other blood thinners (like warfarin); May interact with some statins. Alert for patients with renal or thyroid disease.

    D4. Nicotinic Acid

    • Side effects: Warmth or redness in the face or neck, hyperglycemia, gout, hepatotoxicity, mild nausea, or vomiting, diarrhea.
    • Special nursing alerts: High doses may cause liver damage; Monitor LFTs; Avoid use during pregnancy or breastfeeding; Take with a low-fat meal, avoid alcohol, and spicy foods.

    E. Anticoagulants

    • Parenteral anticoagulants: Heparin (unfractionated and low-molecular-weight).
    • Oral anticoagulants: Vitamin K antagonists (e.g., warfarin), direct thrombin inhibitors (DTIs), and direct factor Xa inhibitors.

    E1. Heparins

    • Actions: Activates antithrombin III, which inhibits thrombin and factor Xa in the blood clotting cascade.
    • Indications: Treatment of acute and chronic coagulopathies, disseminated intravascular coagulation, blood transfusions, extracorporeal circulation, and dialysis procedures.
    • Special Nursing Alerts: Monitoring for potential side effects, especially bleeding, noting potential patient education on possible side effects
    • Low-molecular-weight heparins: generally require less frequent monitoring compared to unfractionated heparin.

    E2. Vitamin K Antagonists - Warfarin

    • Actions: Inhibits vitamin K, thus decreasing the production of clotting factors. (Factors II, VII, IX, and X.)
    • Special Nursing Alert: Important to monitor (International normalized ratio, INR), and not given during pregnancy; may interact with other medications; dietary changes must be considered to mitigate potential effects of the drug.
    • Dosage regimen: Varies based on patient's condition/response, but often administered on a scheduled basis.

    E3. Direct Thrombin Inhibitors (DTIs)

    • Actions: Directly inhibits thrombin.
    • Side effects: Bleeding
    • Special Nursing Alerts: Caution in elderly and patients with low body weight; caution with patients with bleeding disorders, thrombocytopenia; concomitant use of drugs.

    E4. Direct Factor Xa Inhibitors

    • Actions: Inhibits factor Xa.
    • Side effects: Bleeding
    • Special Nursing Alerts: Caution in patients at risk of bleeding; avoid concomitant use with drugs.

    F. Antiplatelets

    • COX-1 inhibitors (aspirin); P2Y12 receptor antagonists (clopidogrel, ticagrelor, prasugrel); Phosphodiesterase inhibitors (dipyridamole).

    F1. COX-1 inhibitor - Aspirin

    • Mechanism of action: Inhibits platelet cyclooxygenase (COX) which is critical for platelet activation and aggregation.
    • All registered antiplatelet drugs: are prescription-only, except aspirin.
    • Side Effects and Special Nursing Alerts: Monitor for gastrointestinal irritation, haemorrhage and increased risk of bleeding in renal impaired or patients with asthma and previous peptic ulceration. Avoid use in patients with increased risk of bleeding, or where it is contraindicated.

    F2. P2Y12 Receptor Antagonists

    • Mechanism of Action: Prevent blood aggregation by inhibiting ADP receptor.
    • Examples: ticlopidine, clopidogrel, prasugrel, and ticagrelor.
    • Side Effects and Nursing Alerts: Monitor for hemorrhages, gastrointestinal disturbances, rash, blood dyscrasia, and bleeding in patients with risk factors.

    F3. Phosphodiesterase Inhibitors

    • Mechanism of action: Inhibits adenosine uptake and cyclic GMP phosphodiesterase activity, which decreases platelet aggregability.
    • Examples: Dipyramidole
    • Side Effects and Special Nursing Alerts: Increased risk of blood bleeding, angina worsening, aortic stenosis, recent myocardial infarction, use with caution in pregnancy/lactation, impaired renal/liver function/bleeding disorders.

    G. Thrombolytics

    • Tissue plasminogen activator (tPA): Dissolves blood clots (thrombi) in blood vessels.

    G1. Tissue Plasminogen Activator (tPA)

    • Mechanism of Action: Activating plasminogen into plasmin, which then breaks down fibrin strands in blood clots.
    • Indications: Acute myocardial infarction, acute ischemic stroke, peripheral artery occlusion, and thrombi in arterial-venous cannulas.
    • Special Nursing Alerts : Ensure an adequate assessment and monitoring.

    H. Drugs for Hematopoietic Disorders

    • G1. Tranexamic Acid (Transamin): An antifibrinolytic agent that prevents the breakdown of blood clots.
    • G2. Iron/Drugs for Anemia: Iron salts, vitamin supplements (e.g. vitamin B9, B12, Folic acid) to treat anemia, where the body is deficient in iron or other nutrients.

    G2. Iron/ Drugs for Anemia

    • Special Nursing Alerts: Oral iron is taken best when on an empty stomach; avoid taking with substances that reduce absorption (tea/coffee, antacids, milk); monitor for any dark/colored stools; educate patients on side effects.

    General Advice/Additional Information

    • Other factors are important in managing cardiovascular and blood related diseases. This includes lifestyle changes (diet/exercise/weight management), monitoring/tracking of current conditions, and consulting with appropriate healthcare professionals (doctor/pharmacist.)

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    Description

    Test your knowledge on pharmacological treatments for hypertension, including mechanisms of action, common medications, and nursing considerations. This quiz covers various drug classes such as beta-blockers, diuretics, and ARBs. Assess your understanding of both medication effects and lifestyle modifications in managing high blood pressure.

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