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Questions and Answers
The physician has ordered doxazosin mesylate (Cardura®) for a female patient. What important information should the nurse give this patient?
The physician has ordered doxazosin mesylate (Cardura®) for a female patient. What important information should the nurse give this patient?
- She must increase her potassium intake by eating more bananas and apricots.
- The impaired taste associated with the medication usually goes away in 2 to 3 weeks.
- She should take her first dose while lying down, because prazosin has a first-dose effect. (correct)
- She should weigh herself daily and report any weight loss to the physician.
Which is the best angiotensin-converting enzyme (ACE) inhibitor for a patient who has liver dysfunction in addition to an acute myocardial infarction?
Which is the best angiotensin-converting enzyme (ACE) inhibitor for a patient who has liver dysfunction in addition to an acute myocardial infarction?
- lisinopril (Prinivil®) because it can be dosed only once a day
- enalapril (Vasotec®) because it is also available in a parenteral form
- quinapril (Accupril®) because it is a prodrug
- captopril (Capoten®) because it is not a prodrug (correct)
Why does a physician examine the fundus of a patient's eyes during antihypertensive therapy?
Why does a physician examine the fundus of a patient's eyes during antihypertensive therapy?
- To evaluate the long-term effectiveness of the treatment (correct)
- To monitor for drug toxicity
- To assess for increased intraocular pressure
- To assess for visual changes that may occur with drug therapy
Which parameters determine the regulation of arterial blood pressure?
Which parameters determine the regulation of arterial blood pressure?
Which adverse effect commonly occurs in male patients who are taking antihypertensive medications?
Which adverse effect commonly occurs in male patients who are taking antihypertensive medications?
Antihypertensive drug therapy has been prescribed for a Black male patient newly diagnosed with stage 1 hypertension. What is most likely included in his medication therapy?
Antihypertensive drug therapy has been prescribed for a Black male patient newly diagnosed with stage 1 hypertension. What is most likely included in his medication therapy?
A patient is taking antihypertensive drugs and complains of having a dry cough, what kind of drugs is she taking?
A patient is taking antihypertensive drugs and complains of having a dry cough, what kind of drugs is she taking?
A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. What is the best answer to the patient's question?
A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. What is the best answer to the patient's question?
A persistent cough is an adverse effect of which class of antihypertensive drugs?
A persistent cough is an adverse effect of which class of antihypertensive drugs?
A patient diagnosed with prehypertension has which blood pressure reading?
A patient diagnosed with prehypertension has which blood pressure reading?
A patient has hypertension, together with type I diabetes mellitus and proteinuria. Which drug is considered to have renal-protective effects for these medical diagnoses?
A patient has hypertension, together with type I diabetes mellitus and proteinuria. Which drug is considered to have renal-protective effects for these medical diagnoses?
Why do patients on a-adrenergic agonists require close assessment of pulse, blood pressure, and weight?
Why do patients on a-adrenergic agonists require close assessment of pulse, blood pressure, and weight?
A patient who has diabetes has been started on antihypertensive drug therapy. The health care provider considers this treatment effective if the blood pressure is lower than _____ mm Hg.
A patient who has diabetes has been started on antihypertensive drug therapy. The health care provider considers this treatment effective if the blood pressure is lower than _____ mm Hg.
Which is a true statement concerning the administration of topical nitroglycerin ointment?
Which is a true statement concerning the administration of topical nitroglycerin ointment?
The nurse is administering intravenous nitroglycerin to a patient who has just been admitted for an acute myocardial infarction. Which statement is true in regard to the administration of this medication?
The nurse is administering intravenous nitroglycerin to a patient who has just been admitted for an acute myocardial infarction. Which statement is true in regard to the administration of this medication?
A 53-year-old male patient has been admitted for evaluation of chest pain. He has been diagnosed with angina and prescribed sublingual nitroglycerin tablets. What important instructions for using this medication should the nurse give the patient?
A 53-year-old male patient has been admitted for evaluation of chest pain. He has been diagnosed with angina and prescribed sublingual nitroglycerin tablets. What important instructions for using this medication should the nurse give the patient?
A 74-year-old professional golfer has chest pain that occurs toward the end of his golf games. He says the pain usually goes away after he takes one or two sublingual nitroglycerin tablets and rests. What type of angina does he have?
A 74-year-old professional golfer has chest pain that occurs toward the end of his golf games. He says the pain usually goes away after he takes one or two sublingual nitroglycerin tablets and rests. What type of angina does he have?
A female patient arrives in the emergency department with severe chest pain. She has had pain off and on for a week. Which assessment finding indicates a need for cautious use of nitrates and nitrites?
A female patient arrives in the emergency department with severe chest pain. She has had pain off and on for a week. Which assessment finding indicates a need for cautious use of nitrates and nitrites?
Which instructions should the nurse give the patient about this medication?
Which instructions should the nurse give the patient about this medication?
A patient has been prescribed transdermal nitroglycerin patches. What important instructions for applying these patches should the nurse give the patient?
A patient has been prescribed transdermal nitroglycerin patches. What important instructions for applying these patches should the nurse give the patient?
A patient has developed tolerance to transdermal nitroglycerin therapy. Which instruction is the best one for the nurse to give the patient?
A patient has developed tolerance to transdermal nitroglycerin therapy. Which instruction is the best one for the nurse to give the patient?
A person who is experiencing chest pain while playing tennis has brought along a bottle of sublingual nitroglycerin. In this situation, which action is appropriate for this person to take? (Select all that apply.)
A person who is experiencing chest pain while playing tennis has brought along a bottle of sublingual nitroglycerin. In this situation, which action is appropriate for this person to take? (Select all that apply.)
Unstable angina is the most dangerous type of angina.
Unstable angina is the most dangerous type of angina.
Contraindications include known drug allergy, acute MI, second- or third-degree AV block (unless the patient has a pacemaker), and hypotension.
Contraindications include known drug allergy, acute MI, second- or third-degree AV block (unless the patient has a pacemaker), and hypotension.
The onset of action of oral metoprolol is 1 hour.
The onset of action of oral metoprolol is 1 hour.
Most available -blockers demonstrate antianginal efficacy.
Most available -blockers demonstrate antianginal efficacy.
Amlodipine (Norvasc®) can be used to treat both angina and hypertension.
Amlodipine (Norvasc®) can be used to treat both angina and hypertension.
A patient about to receive his morning dose of digoxin (Lanoxin®) has an apical pulse of 70 beats per minute. What should the nurse do?
A patient about to receive his morning dose of digoxin (Lanoxin®) has an apical pulse of 70 beats per minute. What should the nurse do?
The nurse is assessing the patient before administration of a cardiac glycoside. Which condition can predispose a patient to digitalis toxicity?
The nurse is assessing the patient before administration of a cardiac glycoside. Which condition can predispose a patient to digitalis toxicity?
The nurse who is assessing a patient who is receiving intravenous (IV) digitalis recognizes that the drug has a negative chronotropic effect. How is a negative chronotropic effect evident in a patient?
The nurse who is assessing a patient who is receiving intravenous (IV) digitalis recognizes that the drug has a negative chronotropic effect. How is a negative chronotropic effect evident in a patient?
A patient has been taking digoxin (Lanoxin) at home but has developed toxicity. The physician has ordered digoxin immune Fab. The patient asks the nurse why the medication has been changed. Which is the nurse's best response?
A patient has been taking digoxin (Lanoxin) at home but has developed toxicity. The physician has ordered digoxin immune Fab. The patient asks the nurse why the medication has been changed. Which is the nurse's best response?
A patient has been placed on a milrinone infusion as part of the therapy for end-stage heart failure. What risk should the nurse keep in mind while assessing this patient during the infusion?
A patient has been placed on a milrinone infusion as part of the therapy for end-stage heart failure. What risk should the nurse keep in mind while assessing this patient during the infusion?
A patient with atrial fibrillation has been started on digoxin (Lanoxin), and 1 week later a digoxin level is drawn. Which result is within the normal therapeutic levels for digoxin?
A patient with atrial fibrillation has been started on digoxin (Lanoxin), and 1 week later a digoxin level is drawn. Which result is within the normal therapeutic levels for digoxin?
A patient has been started on digoxin. The nurse is aware that which laboratory result, if noted in the patient's chart, may increase the possibility of digoxin toxicity?
A patient has been started on digoxin. The nurse is aware that which laboratory result, if noted in the patient's chart, may increase the possibility of digoxin toxicity?
A patient is beginning digoxin (Lanoxin) therapy. Which food should the nurse tell this patient to avoid when taking the digoxin dose?
A patient is beginning digoxin (Lanoxin) therapy. Which food should the nurse tell this patient to avoid when taking the digoxin dose?
The nurse is assessing a patient before administration of a cardiac glycoside. Which laboratory result can increase the toxicity of the drug?
The nurse is assessing a patient before administration of a cardiac glycoside. Which laboratory result can increase the toxicity of the drug?
The nurse is administering the phosphodiesterase inhibitor milrinone. What is the drug's positive inotropic effect?
The nurse is administering the phosphodiesterase inhibitor milrinone. What is the drug's positive inotropic effect?
Which condition predisposes a patient to digitalis toxicity?
Which condition predisposes a patient to digitalis toxicity?
Which assessment result is the most important indicator of an exacerbation of heart failure?
Which assessment result is the most important indicator of an exacerbation of heart failure?
When a patient is experiencing digoxin toxicity, which clinical situations necessitate the use of digoxin immune Fab? (Select all that apply.)
When a patient is experiencing digoxin toxicity, which clinical situations necessitate the use of digoxin immune Fab? (Select all that apply.)
Flashcards
Doxazosin (Cardura) Instructions
Doxazosin (Cardura) Instructions
Take the first dose lying down due to the first-dose effect.
Best ACE inhibitor with liver dysfunction?
Best ACE inhibitor with liver dysfunction?
Is not a prodrug, so it doesn't rely on liver function to convert to its active form.
Why examine the fundus?
Why examine the fundus?
To evaluate the long-term effectiveness of treatment.
Regulation of arterial blood pressure parameters
Regulation of arterial blood pressure parameters
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Common adverse effect in men on antihypertensives?
Common adverse effect in men on antihypertensives?
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Best initial antihypertensive for Black patients?
Best initial antihypertensive for Black patients?
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How long will drug therapy for hypertension be needed?
How long will drug therapy for hypertension be needed?
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Blood pressure range in prehypertension
Blood pressure range in prehypertension
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Drug with renal-protective effects for diabetics?
Drug with renal-protective effects for diabetics?
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Why assess pulse, BP, and weight on alpha-adrenergic agonists?
Why assess pulse, BP, and weight on alpha-adrenergic agonists?
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Study Notes
- The following are study notes on pharmacology for Canadian health care practice
Doxazosin Mesylate (Cardura)
- When starting doxazosin mesylate, the first dose should be taken lying down due to the first-dose effect.
Angiotensin-Converting Enzyme (ACE) Inhibitors
- Captopril is the best ACE inhibitor for patients with liver dysfunction and acute myocardial infarction because it is not a prodrug.
- Prodrugs rely on a functioning liver to be converted to their active form.
Antihypertensive Therapy
- A physician examines the fundus of a patient's eyes during antihypertensive therapy to evaluate the long-term effectiveness of the treatment.
Regulation of Arterial Blood Pressure
- Arterial blood pressure is determined by cardiac output and systemic vascular resistance.
Adverse Effects of Antihypertensive Medications
- Erectile dysfunction is a common adverse effect of antihypertensive medications in male patients.
Antihypertensive Drug Therapy and Black Patients
- Calcium channel blockers and thiazide diuretics are more effective in older adults and Black patients with stage 1 hypertension. Thiazide diuretics are recommended for newly diagnosed stage 1 hypertension.
Adverse Effects of Antihypertensive Drug Therapy
- Sexual dysfunction is a possible adverse effect of antihypertensive drug therapy.
Duration of Antihypertensive Drug Therapy
- Hypertension treatment is typically lifelong because there is no cure.
Persistent Cough
- A persistent cough can be an adverse effect of ACE inhibitors and reverses when therapy is stopped
Prehypertension
- Prehypertension is defined as a systolic blood pressure between 120 and 139 mm Hg and a diastolic blood pressure between 80 and 89 mm Hg.
Renal-Protective Effects
- ACE inhibitors have a protective effect on the kidneys by reducing glomerular filtration pressure, making them suitable for diabetic patients.
Alpha-Adrenergic Agonists
- Patients on alpha-adrenergic agonists require close assessment of pulse, blood pressure, and weight due to their strong vasodilating properties and hypotensive adverse effects.
Antihypertensive Drug Therapy
- Effective blood pressure is lower than 130/80 mm Hg for patients with diabetes on antihypertensive drug therapy.
Topical Nitroglycerin Ointment
- The old ointment should be removed before applying a new dose, avoiding massage or spreading on the skin, and it is not indicated for acute angina.
Intravenous Nitroglycerin
- IV nitroglycerin must be contained in specifically designed non-PVC plastic IV bags. It is stable for 96 hours after preparation, cannot be given with other drugs, and IV filters will absorb the drug.
Sublingual Nitroglycerin
- Sublingual nitroglycerin may cause hypotension; patients should sit or lie down, move slowly.
- One tablet should be taken every 5 minutes, up to 3 tablets in 15 minutes; never chew.
- If chest pain persists after the first tablet and within 5 minutes, call 911.
Angina Types
- A 74-year-old golfer with chest pain towards the end of games has classic angina.
- Classic angina, also called chronic stable angina, is triggered by exertion or stress and subsides within 15 minutes with rest or drug therapy.
Contraindications for Nitrates and Nitrites
- Anemia is a contraindication to the use of nitrates and nitrites.
Calcium Channel Blockers
- Extended-release tablets should never be chewed or crushed.
- High-fiber diet with plenty of fluids will help to prevent the constipation that may occur.
- May cause hypotension; should never be discontinued abruptly due to risks of rebound hypertension and worsening of tissue ischemia.
Transdermal Nitroglycerin Patches
- Apply to any nonhairy area; remove the old patch first.
- Patches can be worn while swimming, but replace if it comes off after cleansing the old site.
- Rotate application sites.
Tolerance to Transdermal Nitroglycerin
- Remove the transdermal patch at night for eight hours and apply a new one in the morning to prevent tolerance.
Chest Pain Relief Actions
- The appropriate actions for a person with chest pain while playing tennis who has sublingual nitroglycerin are:
- Stop the activity and lie down or sit down.
- Place a tablet under the tongue.
- Take another sublingual tablet if chest pain is not relieved after 5 minutes.
- Call 911 if the pain is not relieved within 5 minutes after taking one sublingual tablet.
Unstable Angina
- Unstable angina is the clinical presentation of acute coronary syndrome with cardiac ischemia without persistent ST-segment elevation
Digoxin (Lanoxin)
- Administer digoxin if the apical pulse is 70 beats per minute.
- The dose should be held and the physician notified if the apical pulse is 60 beats per minute or less or higher than 120 beats per minute.
Digitalis Toxicity
- Hypokalemia can predispose a patient to digitalis toxicity.
Negative Chronotropic Effect
- A negative chronotropic effect results in a reduced heart rate
Digoxin Immune Fab
- Digoxin immune Fab, available as an IV dose only, is the antidote for a severe digoxin overdose.
Milrinone
- Milrinone may cause significant hypotension.
Digoxin Therapeutic Levels
- The digoxin therapeutic window is between 0.8 and 2 ng/mL.
Drug Interactions
- Common drug-drug interactions with digoxin are with amiodarone hydrochloride, quinidine sulphate, and verapamil hydrochloride.
- These drugs can increase digoxin levels by 50%.
Digoxin and Food
- Bran, in large amounts, may decrease the absorption of oral digitalis drugs.
Laboratory Result
- Hypokalemia increases the chance of digitalis toxicity.
Positive Inotropic Effect
- Positive inotropic drugs increase myocardial contractility.
Conditions Predisposing Digitalis Toxicity
- Advanced age, atrioventricular block, dysrhythmias, hypercalcemia, hypokalemia, hypothyroid, respiratory or kidney disease, liver dysfunction, use of a pacemaker, and ventricular fibrillation are conditions that predispose a patient to digitalis toxicity.
Heart Failure
- An increased weight is an important indicator of fluid volume overload or the exacerbation of heart failure.
Digoxin Toxicity
Clinical situations include the use of digoxin immune Fab; serum potassium levels above 5 mmol/L.
- Long runs of ventricular tachycardia.
- Severe sinus bradycardia that is not responding to cardiac pacing.
- An overdose of greater than 10mg of digoxin.
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