Pharmacology Workbook: Pharmacology NR293
Course NR293 Pharmacology: ANSWER KEY
Exam Exam 2: Week 5- Chapters 22, 23, 24, 25, 26, 27, 28, 54…and concepts from preventing med
errors and patient education from class discussion & class ROK.
Key Concepts Chapters Student Notes
Antihypertensive Drugs Chapter
22
1. What should we consider when treating a pregnant hypertensive client with medication? Drug transfer to fetus through placenta:
ACE/ARBs are Category D during 2nd/3rd trimester. Commonly use methyldopa (Aldomet) as first choice; other classes may be used.
2. What medication(s) would be considered first line? Methyldopa commonly first line in pregnancy for HTN
What medication(s) would be contraindicated? ACE & ARBS are Cat D in 2nd/3rd trimester
3. List nursing considerations for hypertension treatment in the elderly? Start low; go slow!! Check for drug interactions, due to
elderly taking more medications (i.e. Polypharmacy risk!!). They may not tolerate drugs as well, given age and underlying medical
conditions. Counsel on increased risk for potential for orthostatic hypotension and increased risk possible falls: Frequently monitor
vital signs, especially blood pressure and pulse rate, when the patient is taking any of the adrenergic drugs because of their
cardiovascular and cerebrovascular effects. Use of Beta-Adrenergic Agonists in Elderly (Beta Blockers)…IMPORTANT!!!
***Baroreceptors do not work as effectively in the elderly patient. Reduced baroreceptor activity may lead to orthostatic
hypotension, and increase risk of falls, especially when blood pressure medications are taken, including Beta Blockers. Teach client
about these potential effects and safety measures to avoid falls.
• Several physiologic changes occur in the cardiovascular system of the older adult, including a decline in the efficiency and
contractile ability of the heart muscle, decrease in cardiac output, and diminished stroke volume. Stress, heat, and use of beta-
adrenergic agonists may lead to significant increases in blood pressure and pulse rate.
• Advise patients that any occurrence of chest pain, palpitations, headache, or seizures must be reported immediately to the
prescriber and/or emergency care accessed.
• Caution patients about the use of over-the-counter drugs, herbals, supplements, and other medications. This caution is
due to possible drug-drug interactions as well as the elderly person's increased sensitivity to many drugs
and other chemicals. (Lilley 303)
Briefly describe how each drug class generally works: The sampling of drugs we will be focusing on are listed below.
Drug class Brief: Mechanism of Action
Central Acting Alpha2Adrenergic Decrease SNS outflow from the brain: decrease the action of “flight or fright”, which actually
(Clonidine & Methydopa) starts in the brain when it recognizes danger or senses fear
Alpha blockers-peripheral acting Block alpha receptors in the blood vessels= vasodilation: more chance for orthostatic
(Prazosin, Doxasozin) hypotension due to the alpha blockade.
Beta Blockers- (Atenolol; Labetolol; Block beta receptors in the heart- decrease heart rate and contractility; also, block renin
Metoprolol) release (a vasoconstrictor) from the kidneys
Dual-Action Alpha1 & Beta receptor Blocks beta and alpha receptor (as above): more chance for orthostatic hypotension due to the
blocker (carvedilol; labetolol) alpha blockade, especially in the elderly.
Angiotensin-converting enzyme Inhibit the angiotensin converting enzyme, so that A1 doesn’t convert to A2; A2 is a
inhibitors (ACE inhibitors) vasoconstrictor and also stimulates release of Aldosterone, which causes Na+/H20 retention.
(Lisinopril) SO, THESE ACTIONS ARE BLOCKED.
Angiotensin II (A2)receptor blockers These drugs block Angiotensin 2 from activating cell receptor sites: A2 is a vasoconstrictor and
(ARBS) (Losarten) also activates Aldosterone, which causes Na+/H20 retention (overall effect is similar to ACE)
Calcium channel blockers Block the influx of calcium needed for smooth muscle contraction; thus you get smooth muscle
(Amlodipine, Dilitiazem, Procardia) relaxation & decrease in BP; they also act on the depolarization for cardiac conduction, so they
help with SVT/atrial dysrhythmias like Atrial fibrillation/A flutter.
Vasodilators Direct vasodilate the blood vessels= decreased blood pressure; more risk of orthostasis.
Diuretics ( Review Chapter 28)
0
8/20/17 References from textbook & study guide of: Lilley, L. L., Collins, S. R., Snyder, J. S. (2014). Pharmacology and the Nursing
Process, 7th Edition. Mosby.
, Nitropursside (hypertensive crisis) Used in ICU; Constant IV infusion that vasodilates arteries and veins
Put the following drug class into the appropriate indication: (not every column will be completely filled):
Diuretics Angiotensin converting enzyme inhibitors (ACE inhibitors) Alpha Blocker
Alpha1 & Beta receptor blockers-Dual-Action (ex. carvedilol & labetalol) Angiotensin II receptor blockers (ARB’s)
Calcium channel blockers Vasodilators Beta Blocker Nitrites
Hypertension Heart Failure Angina Antidysrhythmics
Diuretics A ACE or ARB Beta blockers Beta blockers
ACE B beta blocker Nitrites Calcium channel blockers
ARB C Cardiac glycosides Calcium channel blockers
Beta blockers D Diuretics (The rest are listed in classes I-IV)
Calcium channel
Alpha-beta receptor blocker
Alpha blocker
Beta blocker
Vasodilators
True/False: 1. The elderly population tolerate antihypertensive medication without any increase in side effects. T or F
Especially susceptible to orthostatic BP & risk of fall increases. Also, creatinine & K+ elevations may occur more often
2. Antihypertensive drugs that are most likely to cause a hypertensive crisis if abruptly stopped are clonidine & beta blockers. T or F
Educate clients carefully!
3. You will not need to monitor any lab values if taking an ACE or ARB blood pressure medication for hypertension. T or F
Monitor creatinine and potassium, which can rise. Also, monitor for decreased urine output, which may indicate kidney problems
4. Erectile dysfunction can occur with any antihypertensive medications, but is more common with beta blockers. T or F
5. Propranolol may be prescribed for migraines, hyperthyroidism, tremors, or anxiety, such as public speaking. T or F
ADRENERGICS Clonidine (Centrally Alpha Adrenergic) Labetolol; Atenolol; & Metoprolol
Methyldopa (Central alpha blocker) Carvedilol (Dual-Action Alpha & Beta blocker)
Drug Class & Clonidine: HTN; Opioid/ETOH abuse during Beta-blockers; (carvediolol has a dual action)
Indication(s) recovery HTN, CHF,MI, angina (Beta blockers also used: migraines,
Methyldopa: *Frequently used in pregnancy anxiety, tremor)
Contraindications *Asthma-CAUTION: can induce bronchospasm if non-
cardiac selective
* Heart block/ bradycardia
Common Adverse Drowsy, dizziness, fatigue, orthostatic hypotension Bradycardia, fatigue, insomnia, weakness, erectile
Effects dysfunction (impotence); depression; heart failure
(***think about the 6- B’s below)
Major Interactions
(ex. CYP450)
Nurse Considerations: *Educate client on potential for rebound *end in olol
(Examples: Age, hypertension if abruptly stopped; *teach to make *BOYS-More likely to cause erectile dysfunction;
renal/hepatic position changes slowly. *BP-Educate client on potential for rebound hypertension
precautions, safety * Avoid hot baths/showers & saunas. if abruptly stopped.
with administration, *Avoid alcohol *BLOOD GLUCOSE: May mask hypoglycemia in a diabetic
lab monitoring, client
teaching) *BRONCHOSPASM: May cause bronchospasm with
Asthma/COPD (monitor for shortness of breath)
*BRADYCARDIA: Teach client to check BP and pulse
*BAD MOOD: May develop depression & persistent fatigue
1
8/20/17 References from textbook & study guide of: Lilley, L. L., Collins, S. R., Snyder, J. S. (2014). Pharmacology and the Nursing
Process, 7th Edition. Mosby.
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