Pharmacology: Losartan Overview

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Questions and Answers

What should be avoided to minimize risk after administering Heparin?

Injecting into the muscle (correct)

Using a larger needle gauge

Administering the drug in smaller doses

Massaging the injection site (correct)

Which statement regarding Lovenox administration is correct?

It can be injected into any part of the arm.

Air bubbles should be expelled prior to injection.

It should be administered in the abdominal wall. (correct)

The injection site can be massaged after administration.

How often can Direct Oral Anticoagulants be administered?

Every other day

Once daily or twice daily (correct)

Once a week

Thrice daily

What should patients report to their physician while taking anticoagulants?

Unusual bleeding or bruising Signup and view all the answers

Which combination of substances should be avoided to reduce bleeding risk?

Garlic and ginkgo Signup and view all the answers

Which medication class is specifically indicated for the treatment of heart failure?

Beta blockers Signup and view all the answers

What is a serious adverse reaction associated with beta blockers?

Bronchospasm Signup and view all the answers

Which of the following is a common reaction to alpha adrenergic agents?

Orthostatic hypotension Signup and view all the answers

In patients with diabetes, which initial therapy options can be considered?

Angiotensin receptor blockers and thiazide diuretics Signup and view all the answers

What advice should be given to patients regarding their antihypertensive medications?

Increased fluid intake should be encouraged. Signup and view all the answers

Which condition has thiazide diuretics indicated for recurrent stroke prevention?

High cardiovascular disease risk Signup and view all the answers

Which of the following should nurses monitor when initiating treatment with beta blockers?

Blood pressure and heart rate Signup and view all the answers

Which drug class is indicated for both hypertension and post myocardial infarction?

Beta blockers Signup and view all the answers

What is a serious adverse reaction associated with the use of coronary vasodilators?

Thrombocytopenia Signup and view all the answers

Which condition is NOT an indication for the use of nitroglycerin?

Hypotension Signup and view all the answers

What precaution should be taken when administering nitroglycerin intravenously?

Use a glass bottle and special tubing Signup and view all the answers

When administering a transdermal nitroglycerin patch, which instruction is correct?

Rotate application sites Signup and view all the answers

How should sublingual nitroglycerin tablets be utilized during an anginal attack?

Take up to 3 tablets at 5-minute intervals Signup and view all the answers

Which interaction poses a contraindication when using nitrates?

Concurrent use with Viagra Signup and view all the answers

What is a common reaction experienced by patients taking nitrates?

Migraine headache Signup and view all the answers

Which of these medications is classified as a calcium channel blocker used for angina?

Amlodipine Signup and view all the answers

What is an important consideration for patients taking anticoagulants like Heparin?

Monitor for signs of thrombocytopenia. Signup and view all the answers

Which of the following is a serious reaction associated with Amiodarone?

Ventricular arrhythmia Signup and view all the answers

What should be closely monitored in diabetic patients when taking certain medications?

Serum glucose levels Signup and view all the answers

What is a common side effect of Lidocaine?

Bradycardia Signup and view all the answers

What instruction is critical for patients potentially taking medications that may cause dizziness?

Consult a physician before taking over-the-counter medicines. Signup and view all the answers

What effect does Losartan primarily block in the body?

Vasoconstrictor and aldosterone-secreting effects of angiotensin II Signup and view all the answers

Which of the following are serious adverse reactions associated with Digoxin?

AV block Signup and view all the answers

What is an important nursing consideration when administering Digoxin?

Take apical pulse before administering and hold for certain rates Signup and view all the answers

What should a patient be advised about taking Losartan?

Consult a physician before using NSAIDs Signup and view all the answers

Which non-cardiac sign could indicate digoxin toxicity?

Vision changes such as yellow halos Signup and view all the answers

How should a patient take their first dose of Losartan?

At bedtime to minimize side effects Signup and view all the answers

Patients on Digoxin should maintain adequate dietary intake of which nutrient?

Potassium Signup and view all the answers

What should a patient do if they experience palpitations while taking Digoxin?

Notify the physician immediately Signup and view all the answers

Study Notes

Losartan - Angiotensin II Receptor Blocker

Losartan blocks the effects of Angiotensin II which causes vasoconstriction and release of aldosterone.
Serious Adverse Reactions: Angioedema, Severe Hypotension, Hepatotoxicity, Leukopenia, Neutropenia, Hyperkalemia.
Nursing Considerations:
- Monitor for hypotension and tachycardia, especially in patients with CHF.
- Assess for hyponatremia and volume depletion.
- Assess for orthostatic hypotension (dizziness when moving from lying or sitting to standing).
- Monitor creatinine and BUN levels.
Patient Education:
- Take as directed, do not discontinue without consulting the physician.
- Take the first dose at bedtime.
- Consult physician before using NSAIDs.
- May cause dizziness, fainting, lightheadedness.
- Report chest pain or palpitations, unrelenting headache, swelling of extremities, face or tongue, difficulty breathing, or unusual cough.

Digoxin - Cardiac Glycosides

Used to treat CHF and slow the ventricular rate for tachyarrhythmias.
Serious Adverse Reactions: AV block, Bradycardia, Ventricular Arrhythmia, Thrombocytopenia (rare), Delirium, Hallucinations.
Nursing Considerations:
- Monitor for non-cardiac signs of toxicity (anorexia, vision changes, confusion, depression, fatigue).
- Monitor changes in pulse rate, rhythm, or BP (take apical pulse before administering, withhold dose and notify physician if pulse is less than 60 or greater than 120).
- Narrow therapeutic index, monitor levels accordingly.
- Monitor potassium levels (hypokalemia increases toxicity risk).
- Digibind is the antidote for digoxin toxicity.
- Elderly patients are at greater risk of digoxin toxicity.
Patient Education:
- Take as directed, do not discontinue without consulting the physician.
- Maintain adequate potassium intake to reduce toxicity risk.
- Take pulse at the same time daily and follow physician's instructions for reporting concerns.
- Report loss of appetite, nausea & vomiting, persistent diarrhea, swelling of extremities, palpitations, yellowing or blurred vision, mental confusion, depression, or fatigue to physician.

Nitroglycerin (NTG) - Coronary Vasodilators

Used to treat angina pectoris, CHF, pulmonary hypertension, and hypertensive emergencies.
Serious Adverse Reactions: Thrombocytopenia, Orthostatic Hypotension
Common Reactions: Hypotension, Migraine headache.
Nursing Considerations:
- IV form must be prepared in glass bottles and special IV tubing may be needed due to drug absorption by plastic.
- Transdermal patch labeled in mg/hour.
- Patches may be ordered to be removed at night to allow for a nitrate-free period.
- Do not crush sublingual drug product.
- Infusions should be administered via IV pump and titrated as ordered.
- Isorbide mononitrate is a sustained-release nitrate.
- Viagra and other vasodilators used to treat ED potentiate the hypotensive effects of nitrates; concurrent use is contraindicated.
- Beta and calcium channel blockers, antihypertensives, and antidepressants may enhance hypotensive effects.
Patient Education:
- Sublingual NTG:
  - Carry bottle with you. Keep in original dark glass bottle and replace 6 months after opening.
  - Place 1 tablet under tongue at first sign of anginal attack.
  - Sit or lie down for 10-15 minutes after taking to decrease side effects.
  - Take additional SL tablets (up to 3) at 5-minute intervals if pain is not relieved (if pain still present after 15 minutes, call 911).
  - Use caution in elderly patients (risk of hypotension).
- Do not chew or swallow sublingual tablets.
- Do not chew extended-release capsules.
- Nitro spray is sprayed directly on mucous membranes, do not inhale.
- Transdermal patches are placed on hair-free areas of skin, rotate sites.
- May cause dizziness, use caution when changing position.

Calcium Channel Blockers

Diltiazem (Cardizem), Amlopidine (Norvasc), Nifedipine (Procardia), Verapamil (Calan, Calan SR, Isoptin)
Used for treatment of angina, hypertension, and pulmonary hypertension.
Serious Adverse Reactions: Bradycardia/AV block, Arrhythmias, Hypotension, Syncope, CHF.
Compelling Indications for Individual Drug Classes:
- Heart failure: Thiazide diuretic, Beta blocker, ACE inhibitor, Angiotensin Receptor Blocker, Aldosterone antagonist
- Post Myocardial Infarction: Beta blocker, ACE inhibitor, Aldosterone antagonist
- High CVD risk: Thiazide diuretic, Beta blocker, ACE inhibitor, Calcium Channel Blocker
- Diabetes: Thiazide diuretic, Beta blocker, ACE inhibitor, Angiotensin Receptor Blocker, Calcium Channel Blocker
- Chronic kidney disease: ACE Inhibitor, Angiotensin Receptor Blocker
- Recurrent stroke prevention: Thiazide diuretic, ACE Inhibitor

Beta Blockers and Alpha Adrenergic Agents

Beta Blockers:
- Indications: Treatment of hypertension, post myocardial infarction, improving cardiovascular outcomes in patients undergoing noncardiac surgery, treatment of atrial fibrillation, unstable angina, and heart failure (cardiac selective).
- Serious Reactions: Bronchospasm, Severe Hypotension, Cardiac failure.
- Common Reactions: Hypotension, Dizziness, Nausea, Somnolence, Confusion.
Alpha Adrenergic Agents:
- Indications: Treatment of hypertension.
- Serious Reactions: Arrhythmia
- Common Reactions: Dizziness, Headache, Orthostatic hypotension, Fatigue.
Nursing Considerations:
- Minimize risk of bradycardia by starting with low dose and titrating upwards slowly.
- Administer medication with food.
- Monitor blood pressure and heart rate.
- Response rates in elderly patients are significantly lower (20-50%).
- Beta-blockers may mask symptoms of hypoglycemia.
Patient Education:
- Report lightheadedness/dizziness.
- Do not stop medication abruptly.
- Increase fluid intake (and dietary bulk to prevent constipation, a common side effect).
- Do not take with antacids and avoid over-the-counter medications and alcohol without consulting physician.
- Monitor serum glucose closely if diabetic.
- May cause fatigue, dizziness, or postural hypotension, use caution when changing positions.
- May cause alteration in sexual performance.
- Report unresolved swelling of extremities, difficulty breathing, or new cough.

Antiarrhythmics

Amiodarone, Procainamide (Pronestyl)
Lidocaine hydrochloride (Xylocaine) - IV only
Lidocaine IV is used for acute treatment of ventricular arrhythmias due to myocardial infarction, cardiac manipulation and digitalis intoxication.
Amiodarone and Procainamide are used for the treatment of both atrial and ventricular arrhythmias.
Amiodarone:
- Serious Reactions: Ventricular arrhythmia, Prolonged QT, Severe Bradycardia, Severe Hypotension, CHF.
- Common Reactions: Photosensitivity (may result in bluish coloring of the skin), Fatigue.
Procainamide:
- Serious Reactions: Ventricular fibrillation, Asystole, Seizures, Thrombocytopenia.
- Common Reactions: Hypotension, Bradycardia.
Lidocaine:
- Serious Reactions: Seizures, Respiratory arrest, Worsened arrhythmia, Status asthmaticus, Heart block, Bradycardia, Coma.
- Common Reactions: Tremor, Confusion, Hypotension, Blurred Vision.

Anticoagulants

Heparin:
- Antagonist is protamine sulfate. Report heparin overdose immediately. Drug withdrawal may be sufficient to manage overdose. If not, protamine sulfate should be administered by a physician.
- Never administered IM due to pain, irritation and hematoma formation.
- Do not massage the site after injection.
Lovenox:
- Administer by deep subcutaneous injection to the left or right anterolateral and left or right posterolateral abdominal wall.
- Do not expel air bubble from the syringe prior to injection.
- Do not massage the injection site.
Direct Oral Anticoagulants (DOACs):
- Do not require routine laboratory level monitoring.
- Dosing may be once daily or twice daily.
- Avoid in liver or renal dysfunction.
- Reversal process is dependent on the agent used:
  - Idarucizumab (Praxbind) reverses Dabigatron.
  - Andexanet alfa (Andexxa®) reverses Rivaroxaban and Apixaban.
- Henry Ford Health has a Tier 1 anticoagulation reversal guideline in place.
Patient Education:
- Do not take any medication without physician's knowledge and follow diet and activity recommendations.
- You may tend to bleed easily while taking this drug.
- Brush teeth with soft brush, floss with waxed floss, use electric razor, and avoid scissors or sharp knives and potentially harmful activities.
- Report chest pain, persistent constipation, unusual bleeding or bruising, pain in joints or back, or numbness/tingling/swelling/pain at injection site.
- Increased risk of bleeding if combined with chamomile, garlic, ginger, ginkgo, or ginseng therapy.

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Description

This quiz covers essential information about Losartan, an Angiotensin II receptor blocker. It highlights its mechanism of action, serious adverse reactions, nursing considerations, and key patient education points. Test your knowledge and understanding of this important medication used in managing cardiovascular conditions.