ATI Pharmacology Made Easy – Cardio Module – ACE inhibitors

Treats hypertension, heart failure, diabetic nephropathy, and left ventricular dysfunction following MI
ACE inhibitors

Prototype ACE inhibitor
captopril

Common ending for ACE inhibitor names
-pril

Captopril, benazepril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril are what class of drug?
ACE inhibitors

What class of drug is first line of treatment for hypertension and heart failure?
ACE inhibitors

Which class of drug can be used to prevent left ventricular remodeling after an MI?
ACE inhibitor

What class of antihypertensive is best for diabetics because it reduces glomerular filtration pressure?
ACE inhibitor

ACE inhibitors are contraindicated during pregnancy and breast feeding because they are ___ to the fetus and neonate.
harmful

What class of drugs includes enalapril, fosinopril, and lisinopril?
ACE inhibitors

What is the mechanism of ACE inhibitors
blocks conversion of angiotensin I to angiotensin II

What are the effects of ACE inhibitors?
vasodilation, excretion of sodium and water, and urinary retention of potassium

What are the two water and sodium resorbing chemicals that do not get produced if angiotensin II is not produced?
aldosterone and ADH

Angiotensin II triggers production of important chemicals in the RAAS system, but it has it’s own action. What does it do?
vasoconstriction

ADH is a
vasoconstrictor

What does ADH do?
constricts blood vessels and causes water to be retained

Which type of antihypertensive is most likely to cause the first dose effect?
ACE inhibitors

What do ACE inhibitor do to K levels?
increase

Which class of antihypertensives causes a dry cough?
ACE inhibitors

Which classes of antihypertensives causes angioedema, with swelling of the mouth and throat?
ACE inhibitors, ARBs

Which class of antihypertensives can cause neutropenia?
ACE inhibitors

Which class of antihypertensives can cause a rash and a metallic taste in the mouth?
ACE inhibitors

Which class of antihypertensives causes an increase in bradykinin?
ACE inhibitors

How are ACE inhibitors dosed initially?
low with gradual increase

For which class of antihypertensives would a diuretic be temporarily stopped for the first dose?
ACE inhibitors

What would you monitor carefully after the first dose of ACE inhibitors?
blood pressure

With what would you treat angioedema caused by an ACE inhibitor, and what route would you use?
IV epinephrine

What lab values would you monitor with ACE inhibitor treatment?
potassium and WBCs

How many times a day should patient take ACE inhibitors?
2 or 3

Should captopril be given 1 hr before meals or 1 hr after to maximize absorption?
before

If severe angioedema results from ACE inhibitor, what should patient do?
call 911

Which flavoring agents and supplements must be avoided when taking ACE inhibitors?
salt substitutes and potassium supplements

Palpitations, muscle twitching, weakness, and paresthesias are signs of what complication of ACE inhibitor treatment?
hyperkalemia

What class of antihypertensive can cause sore throat and other signs of infection?
ACE inhibitor

Females who are ___ or ___ shouldn’t take ACE inhibitors.
pregnant, breast feeding

Patients with ____ shouldn’t be given ACE inhibitors.
hypotension

Precautions for which class of antihypertensives include:
-decreased renal function
-bone marrow depression
-immunosuppressing drugs
-autoimmune disorders
-cardiovascular disease
-cerebral vascular disease
-heart failure
-hyperkalemia and hyponatremia
-older adults
ACE inhibitors

Spirolactone shouldn’t be given which which class of antihypertensives?
ACE inhibitors

What happens when other antihypertensive drugs, diuretics, and nitrates are given with ACE inhibitors?
hypotension

What do NSAIDs do to effectiveness of ACE inhibitors?
decrease

What happens with lithium is taken with ACE inhibitor?
litium toxicity

Take beta adrenergic blockers at
same time every day

Take atenolol ____ ____ (relative to food)
before meals

Which beta adrenergic blockers can be given via IV for acute MI?
atenolol, metoprolol

When should patient measure heart rate when taking beta adrenergic blocker?
before dose

Four cardiovascular contraindications for beta adrenergic blockers
sinus bradycardia, heart block greater than 1st degree, moderate to severe heart failure, cariogenic shock

Vascular contraindication for beta adrenergic blockers
Raynaud’s disease

Drug that should be used with caution in:
-patients with asthma or COPD
-patients with heart failure controlled by digitalis and diuretics
-renal or liver disease
-myasthenia gravis
-hyperthyroidism
-DM
-major depression
-pheochromocytoma
beta adrenergic blockers

___ may decrease absorption of beta adrenergic blockers.
antacids

Cardiac effect of digoxin used with beta adrenergic blocker
bradycardia

Blood sugar effects of beta adrenergic blockers
hypoglycemia

Beta blockers ___ effect of muscle relaxers.
increase

Anticholinergic drugs ___ effect of beta blockers.
decrease

Adrenergic neuron blockers are not a first line medicine because they can cause severe
orthostatic hypotension

Prototype adrenergic neuron blocker
reserpine

Indication for adrenergic neuron blocker
hypertension

Adrenergic neuron blockers work by making ___ unavailable for use.
norepinephrine

Neurologic effects of adrenergic neuron blockers (2)
severe depression, suicide

Gastrointestinal side effects of adrenergic neuron blockers (2)
gastritis, diarrhea

Cardiovascular side effects of adrenergic neuron blockers
bradycardia, orthostatic hypotension

Relative to food, adrenergic neuron blockers should be taken
with food or milk

Indications for centrally acting alpha-2 agonists (5)
hypertension, migraine prophylaxis, substance withdrawal, PMS, ADHD

Prototype centrally acting alpha-2 agonist
clonidine

Methyldopa and clonidine are in the class
centrally acting alpha-2 agonists

Class of antihypertensive that acts by inhibiting innervation of sympathetic neurons in the CNS
centrally acting alpha-2 agonists

Vascular and cardio effects of centrally acting alpha-2 agonists
bradycardia, decreased cardiac output, peripheral vasodilation

Result of stopping clonidine abruptly
rebound hypertensive crisis

Neurologic side effects of centrally acting alpha-2 agonists (especially present at beginning) include ____, ____, and ___ ____.
drowsiness, dizziness, dry mouth

Patients taking ___ should not be given centrally acting alpha-2 agonists.
anticoagulants

Patients with ____ ___ or ____ should not be given transdermal centrally acting alpha-2 agonists.
polyarteritis nodosa, scleroderma

Centrally acting alpha-2 agonists ____ effect of CNS depressants and ___ effect of tricyclics.
increase, decrease

Cardiovascular benefits of alpha/beta blockers include control of ____, treatment of ____ ____when given with digoxin, and improved ____ ___ ___ with MI.
hypertension, heart failure, chance of survival

Prototype alpha/beta blocker
carvedilol

Carvedilol and labetalol are in which class of antihypertensives?
alpha/beta blockers

What are the three sites acted on by alpha/beta blockers?
heart, peripheral arterioles, kidneys

What is the vascular effect of alpha/beta blockers?
peripheral vasodilation

What are the 2 cardiac effects of alpha/beta blockers
decreased heart rate, decrease in contractility

What is urologic effect of alpha/beta blockers?
decrease in renin

What form(s) is/are carvedilol available?
oral

When, relative to food, should alpha/beta blockers be given?
with food

Carvedilol can cause ___ ___ when given with digoxin.
digoxin toxicity

Which class of antihypertensive has the following interactions:
-increase risk of hypoglycemia with insulin
-increase in digoxin toxicity
-bradycardia/hypotension with MAOI
-decrease in cimetidine levels
-hypotension with other antihypertensives
alpha/beta blockers

Direct acting vasodilators work on ___ arterioles.
peripheral

Which class of antihypertensives can be used in a hypertensive crisis?
direct acting vasodilators

What class of antihypertensive is hydrazine?
direct acting vasodilator

Prototype direct acting vasodilator
hydralazine

What class of antihypertensives includes:
-hydralazine
-diazoxide
-minoxidil
-nitroprusside
centrally acting vasodilator

Centrally acting vasodilators __ and __ are used for hypertensive emergencies
nitroprusside, diazoxide

Cardio therapeutic effects of direct acting vasodilators
increased heart rate, increased contractility

Which class of antihypertensives may cause a condition similar to systemic lupus erythematosus?
direct acting vasodilator

The 2 Cardio side effects of direct acting vasodilators include:
tachycardia, palpitations

A ____ ___ may be added to reduce the tachycardia caused by ___ __ __ but you have to monitor for hypotension.
beta blocker, direct acting vasodilator

If symptoms like lupus occur, the patient should gradually discontinue
hydralazine

Fluid imbalance caused by hydrazine (direct acting vasodilators)
edema, crackles

If giving direct acting vasodilators ,such as ___, via IV, do not dilute; do not add to any other solutions
hydralazine

Patients with rheumatic heart disease caused by mitral valve dysfunction should not take this class of antihypertensive.
direct acting vasodilators

Patients with lupus should use ___ ___ ___ only with caution and monitoring.
direct acting vasodilators

Four types of drugs used for heart failure include
diuretics, cardiac glycosides, sympathomimetics, phosphodiesterase inhibitors

Patients with heart failure eventually die from ___ ___ and ___ ___.
pulmonary edema, cardiogenic shock

Three types of diuretics:
thiazide, potassium sparing, loop

Which class of drug does JNC consider the first line of defense against hypertension?
diuretics

Primary effect of diuretics is decreasing __ and ___fluid volume.
extracellular, plasma

Thiazide diuretics used for (4)
heart failure, hypertension, liver failure, renal failure

Prototype thiazide diuretic
hydrochlorothiazide

Hydrochlorothiazide and chlorothiazide belong to the class of drugs called ___ ___.
thiazide diuretics

Thiazide diuretics act on ___ part of ___ ___ __.
proximal, distal convoluted tubule

Thiazide diuretics blocks ___ of ___ and ___.
resorption of sodium and chloride

Adequate kidney perfusion and glomerular filtration rate is needed for a ___ __ to work.
thiazide diuretic

Electrolyte imbalances that can occur with thiazide diuretics include
hyponatremia, hypochloremia, and hypokalemia

Change in blood sugar caused/exacerbated by thiazide diuretics
hyperglycemia

____ ___ can cause increased uric acid levels and gouty arthritis
thiazide diuretics

___ ___ can be given alone or with potassium-sparing diuretics, ACE inhibitors, ARBs, beta blockers, and other type of antihypertensives
thiazide diuretics

Thiazide diuretics should be given when, relative to food?
with food

3 foods high in potassium include:
citrus fruits, potatoes, bananas

Patients taking this kind of diuretic need to eat foods high in potassium
thiazide

Can have cross reaction in patients allergic to sulfonamides
thiazide diuretics

Patients with anuria can’t take this kind of diuretic
thiazide

This diuretic class may cause lithium or digoxin toxicity
thiazide

Cholestyramine and cholesterol can decrease absorption of
thiazide diuretics

These diuretics are the strongest
loop

Loop diuretics can be used to treat edema related to failure of
kidneys, liver, or heart

Prototype loop diuretic
furosemide

furosemide, ethacrynic acid, and bumetanide are of the class of drugs called
loop diuretics

Loop diuretics act on the___ __ __ ___ in the __ ___.
ascending loop of Henle, renal tubule

Loop diuretics cause increased excretion of (4)
water, sodium, chloride, and potassium

Ototoxicity can be caused by
loop diuretics

Furosemide blocks the release of
insulin

Loop diuretics can cause ___ arthritis
gouty

Potassium supplements or potassium sparing diuretic may be needed for patients taking
loop diuretics

Loop diuretic should be given when, relative to food?
with food

Second dose of diuretic should be given by
3pm

It is important to control __ and __ when storing loop diuretics
light, temperature

Give IV forms of loop diuretics slowly to prevent
ototoxicity

___ ___ should not be given for pregnant women with
pre-eclampsia

Patients in hepatic comas should not be given
loop diuretics

Digoxin toxicity can increase in likelihood when __ levels are low
potassium

NSAIDs may ___ effect of loop diuretics
decrease

Loop diuretics may increase occurrence of __ or __ toxicity
lithium, digoxin

Loop diuretics ___ effect of neuromuscular blocking agents
increase

Which type of diuretic is given to treat:
-hypertension
-edema caused by heart failure
-cirrhosis
-nephrotic syndrome
-hypokalemia
potassium-sparing

Prototype potassium-sparing diuretic
spironolactone

Spironolactone is a/an__ ___
aldosterone antagonist

Spironolactone, triamterene, and amiloride are
potassium-sparing diuretics

Triamterene and amiloride are not
aldosterone antagonists

Spironolactone acts on ___ ___ of nephron
distal portion

Spironolactone is a ___ diuretic
weak

Main use of spironolactone is with __ __ to __ __ .
another diuretic, save potassium

__ is a steroid and can cause abnormal hair __, voice __ ___, and menstrual __ in women and ___ in men.
spironolactone, growth, deepening, irregularities, gynecomastia

When taking spironolactone, patient should avoid potassium ___, salt ___ and large amounts of foods high in ___.
supplements, substitutes, potassium

Spironolactone should not be prescribed for
pregnant women

Giving a potassium sparing diuretic with ACE inhibitors, ARB, or direct renin blockers increases risk of
hyperkalemia

Four cardiac indications for use of cardiac glycosides (digoxin):
heart failure
atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia

Prototype (and only) cardiac glycoside
digoxin

__ __ increase calcium within heart cells and causes positive inotropic effect.
cardiac glycosides

Cardiac glycosides slow electrical conduction through AV node causing
decreased heart rate

Digoxin ___ cardiac output
increases

Vascular effect of digoxin
vasoconstriction

Nausea, vomiting, visual disturbances, and dysrhythmias are symptoms of
digoxin toxicity

Vomiting may cause ___ , which increases risk of digoxin toxicity
hypokalemia

Measure apical pulse for a full minute for digoxin patients and withhold drug if HR is __ bpm
<60

What is used for digoxin toxicity?
digoxin FAB

When giving digoxin, give over ___ minutes and monitor for ___
5, infiltration

Risk of __ __ is increased with erythromycin, antidysrhythmics, diuretics, ginseng
digoxin toxicity

___ increase cardiac output in severe heart failure but are only used short term
sympathomimetics

Prototype sympathomimetic
dobutamine

Dopamine and dobutamine are of the class
sympathomimetics

Dobutamine ___ contractility, ___ cardiac output, ___ kidney perfusion, and ___ fluid load.
increases, increases, increases, decreases

Cardio side effects of sympathomimetics include
tachycardia, dysrhythmia, angina

ECG should be monitored continuously when __ are given
sympathomimetics

If dysrhythmia or angina occur, prepare to discontinue use of
sympathomimetics

Dose of dobutamine is based on patient’s
weight

Dobutamine’s peak effect occurs after
10 minutes

Use a dedicated IV line when administering __ because many incompatibilities exist
dobutamine

Before administering dobutamine, correct __ __ defects
fluid volume

Dobutamine is contraindicated in patients with allergies to
sulfites

Phosphodiesterase inhibitors are used for short term treatment of
heart failure

Prototype phosphodiesterase
milrinone

Inamrinone and milrinone are of the class
phosphodiesterase inhibitors

__ works by increasing cAMP
Phosphodiesterase inhibitors

cAMP, increased by phosphodiesterase inhibitors, __ contractility and therefore __ __
increases, cardiac output

ECG rhythm is continuously monitored during infusion of __ inhibitors
phosphodiesterase

A __ IV is required when administering milrinone
dedicated

The class ___ are incompatible in solution with furosemide and procainamide
phosphodiesterase inhibitors

Two types of drugs used to treat coronary heart disease
antilipemics, antianginals

HMG-CoA reductase inhibitors are also known as
statins

Antilipemics include ___ and ___
statins, fibrates

Statins reduce __ and ___ and increase
LDL, VLDL, HDL

___ are recommended to reduce mortality in patients with type 2 DM
statins

___ can prevent heart attacks
statins

Prototype statin
atorvastatin

Typical ending for HMG-CoA reductase inhibiting drugs
-statin

Two serious adverse effects of statins
myopathy, liver toxicity

If muscle pain occurs while taking statins or fibrates, monitor
CPK

Regularly monitor __ __ when taking statins or fibrates
liver function

Time when statins should be taken
evening

Most statins can be taken (relative to food)
with or without

____ are category X and should never be given to pregnant females
statins

Patients with MS should not take s
statins

Family history of high cholesterol is a precaution for patients taking
statins

Concurrent use of statins and fibrates increases chance of ___ and ___ ___
myopathy, liver toxicity

CYP3A4 inhibitors increase blood levels of antilipemic drug class
statins

Chance for adverse effects of statins increases with large amounts of what food?
grapefruit juice

____ when taken with a statin, increases risk for bleeding and increased PT levels
warfarin

Fibrates work best to reduce __ and ___ and increase __.
triglycerides, LDL, HDL

Prototype fibrate
gemfibrozil

Gemfibrozil, fenofibrate, and fenofibric acid are of the class
fibrates

___ work by 1) activating substance present in adipose tissue and liver to decrease production of LDL and VLDL
2) increasing production of lipoproteins, which increases HDL
fibrates

Adverse effects of fibrates include GI symptoms, ___, ___, and __ __.
gallstones, myopathy, liver toxicity

Fibrates should be taken __ time(s) daily, 30 minutes ___ meals
2, before

Patient should report new intolerance of fried foods when taking
fibrates

Fibrates may cause __ when taken with anti diabetic drugs
hypoglycemia

Drugs used to treat angina include ___, ___ ___, and __ ___ __.
nitrates, beta blockers, calcium channel blockers

Indications for nitrates include treating and preventing
angina

IV ____ can be given for severe unstable angina, preoperative control of blood pressure, and treatment of heart failure after acute MI
nitroglycerin

Protoype nitrate
nitroglycerin

Amyl nitrate, isosorbide, and nitroglycerin are of the class
nitrates

Nitroglycerine acts on
enzymes

___ has the effects of dilating coronary veins and arteries, decreasing oxygen demand in stable angina, and increasing oxygen supply in variant angina
nitroglycerin

Monitor length and severity of headache with
nitrates

This condition is a hypotensive effect severe enough to cause a patient to lose consciousness.
First dose effect

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Diuretics Prevent reabsorption of sodium and water by the kidneys What are diuretics used to treat? Hypertension (high blood pressure) Congestive heart failure (CHF) Glaucoma WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY …

What are the side effects of ACE inhibitors cough, angioedema, rash, hypotension, hyperkalaemia How would you avoid hyperkalaemia? Conduct a blood test to monitor potassium levels before the administration of ACE inhibitors, and review after 1-2 weeks. Also avoid potassium …

This antihypertensive suffix is? Pril What is the prototype for the ACE inhibitor? Captopril (capoten) WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample What is the action of an …

Angina Pectoris chest pain caused by lack of oxygen reaching heart dilate arteries and veins Antianginal medications given sublingual, buccal, or IV take 1 want wait 5 minutes if pain occurs call EMS may take 2 more every 5 minutes …

What ate four types of RAAS supressants that support the treatmrnt of hypertension? Ace inhibitors Arbs Aldosterone antagonists Direct renin inhibitors Ace inhibitors treat ? Hypertension Heart failure Disbetic nephropathy Left ventricular dysfunction following MI WE WILL WRITE A CUSTOM …

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