Summary
NSG 251 Exam 4 Medications Summary
- Course
- NSG 251
- Institution
- Marian University
This is a comprehensive and detailed summary on;Exam 4 Medications. *An Essential Study Material!!
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NSG 251: Pharmacology Exam 4 MedicationsBeta blockers - all end in “lol”
Cardioselective Beta Blocker: atenolol (Tenormin)
Nonselective Beta Blocker: propranolol (Inderal)
Mechanism of Action ● Sympatholytic: Block the effects of norepinephrine and epinephrine at adrenergic Beta 1 or Beta 2 receptors
in different organs and tissues
● Stimulating factors
○ Stress, trauma, surgery, infection, exercise
Uses ● Management of hypertension
● Treatment of angina
● Cardioprotective blockade of norepinephrine and epinephrine post myocardial infarction
● Acute treatment of supraventricular tachycardia
● Treatment of heart failure
● Prevention of migraine headaches and some essential tremors
● Open-angle glaucoma
Interactions/Contraindication ● Decompensated systolic heart failure
● Cardiogenic shock
● Heart block or bradycardia
● Pregnancy
● Pulmonary disease
● Peripheral vascular disease
● FDA: BOX WARNING: do NOT abruptly stop, taper off over a period of 1-2 weeks
● Abrupt withdrawal can lead to angina, myocardial infarction, rebound hypertension
● INTERACTIONS: decreased absorption with antacids, decreased beta blocker effect with anticholinergics,
bradycardia with digoxin, diuretics and alcohol add to hypotensive effect
Adverse Effects ● Bradycardia
● Depression
● Impotence
● Nausea, vomiting, Constipation
● Fatigue
● Delay recovery from hypoglycemia (type 1 diabetic)
● Heart failure
● Dizziness
● Low WBCs and platelets
, ● Hyperlipidemia
● Alopecia
● Wheezing
● Dry mouth
Nursing Process ● Management of overdose:
○ IV fluids and vasopressors: increase BP
○ Atropine for bradycardia
○ Dialysis, for severe overdose
● Complete proper history and physical exam
○ History of pulmonary disease
○ Heart failure, bradycardia, dysrhythmias, hyper or hypotension, angina
■ Assess blood pressure and heart rate prior to administration
● Count apical heart rate for one full minute
● Report rate less than 60 beats/minute to HCP
● HOLD DOSE
○ If heart rate is greater than 100 beats/min, contact the HCP
■ Orthostatic blood pressures: lying and standing
● Report dizziness, fainting, lightheadedness, or systolic pressure less than 90 mm Hg
to HCP
● HOLD DOSE
○ Assess weight, intake and output, breath sounds, and blood glucose levels
○ Assess for sexual dysfunction issues
○ Assess adherence to therapy
● Rinse mouth, oral care, suck on sugarless candy for dry mouth
● If given IV: ECG monitoring is recommended
● In hospital and Teach patient at home to:
○ Record weight daily and monitor for edema
■ Call HCP for gain of 2 lb. in 24 hours or 5 lb. in one week
○ Take and record BP at home
○ Monitor pulse
○ Report muscle weakness, chest pain, dizziness, shortness of breath, edema of the lower extremities
(for ambulatory patients) such as tightness of shoes/socks
● Teach not to abruptly stop, drug MUST be weaned
● Take exactly as directed, do not skip doses, do not double doses
, ● May be taken with or without food
● Do not run out of medications: have automatic refill through pharmacy
● Wear a medic alert bracelet, and carry medication list at all times
● Avoid caffeine and other stimulants
● Avoid alcohol (causes vasodilation leading to risk of sudden hypotension)
● Change position slowly to prevent dizziness and falls
● Increase fiber in diet, and increase fluids (as allowed) to prevent constipation
● Implement stress management techniques
● Engage in HCP approved aerobic exercise regimen (decreases BP)
● Avoid extreme heat, hot tubs, saunas, and heated pools as vasodilation causes sudden hypotension
● Eye exam every 6 months to monitor hypertension effect on retinal vessels
Angiotensin converting enzyme inhibitors (ACE) - captopril
All ACE inhibitors end in “pril”
Mechanism of Action ● Block angiotensin converting enzyme (ACE) preventing the conversion and activation of angiotensin II and
aldosterone
○ Relaxation of blood vessel tone reducing afterload
○ Excretion of sodium (and water passively) into the urine reducing preload
○ Retention of potassium
● Prevent breakdown of bradykinin and substance P (both are vasodilators)
Uses ● Management of hypertension
● Management of heart failure
● Prevention of left ventricular hypertrophy following MI
● Renal protective: reduced glomerular filtration pressure
● Prevent proteinuria and progression of diabetic nephropathy
Interactions/Contraindication ● Liver disease
● Pregnancy: Class C/D: FDA: BOX WARNING: fetal toxicity
● Lactation
● Children
● Angioedema
● hyperkalemia
● Persons of Black race do NOT respond to ACE inhibitors for BP management
● Renal artery stenosis
● INTERACTIONS: NSAIDS: decrease BP effect, risk of renal failure; risk of lithium toxicity; risk of hyperkalemia
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