Drugs affecting Cardiovascular and Renal

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Afterload

pressure or resistance ventricles must overcome to eject blood from the heart

Angina

Accute myocardial pain. Can be stable, unstable, or vasospastic.

Atrial Fibrillation

uncoordinated contractions of atrial myocardium.

Bradycardia

Slow heart rate. <60 BPM

Chronotropic

Descriptor used to describe how drugs affect the heart rate.

Congestive heart failure

when heart muscle weakens, enlarges and loses its ability to pump blood effectively

Contractility

force of cardiac contraction independet of preload

Depolarization

when the heart is contracting; sodium and calcium ions are released

Diuresis

increased urine flow

Diuretic

drug producing diuresis

Essential hypertension

most common cause of hypertension; exact cause is normally unknown because it is multi-factorial

Fibrinolysis

clot breakdown

High-density lipoproteins

Good cholesterol; should be >60

Hypercapnia

increased CO2 in the blood tissue

Hyperlipidemia

excess of one or more lipids in the blood

Hypertension

increase in BP such that systolic is >140 and diastolic is >90

Hypokalemia

low potassium levels

Hypoxia

lack of O2 in body tissue

Inotropic

Decriptor that is used to describe the force of heart contraction

INR

lab test that is most commonly used to report PT time

Low Density Lipoproteins

Bad cholesterol. Recommended to be <100 for somone with moderate to high risk factors.

Myocardial Ischemia

insufficient O2 is suppplied to meet heart demand

Preload

blood flow force that stretches ventricles at the end of diastole.

Primary hypertension

most common cause of hypertension. Cause is unknown.
Also referred to as essential hypertension

PT

lab test that measures the time it takes blood to clot in presence of certain clotting factors. Used for testing therapuetic levels of coumadin.

PTT

lab test used to detect deficiences in clotting time. Used for testing therapeutic levels of heparin.

Repolarization

resturn of myocardial cell membrane potential to resting after depolarization

Secondary hypertension

hypertension resulting from another disease.

Tachycardia

rapid heart rate

Therapeutic serum level

desired level to keep drug in order to effectively treat prescribing condition

Thrombolytics

clot busting drugs

Thrombosis

formation of a clot in an arterial or venous vessel

ACE Inhibitors

drug class that block the release of aldosterone which in turn lowers blood pressure

Alpha Blockers

drug class that blocks the alpha receptor which causes vasodilation and in turn lowers blood pressure

Antilipemic

drug class used to lower blood lipid levels

Anitplatelet

drug class that is used to prevent platelet thrombosis in the artery by supressing platelet aggregation.

Beta Blockers

Blocks the beta receptors and reduces cardiac contractiliity. Used as anitanginal treatment.

Calcium Channel Blockers

Drug class that is used to block the influx of calcium ions into the heart and therfore reducing contractility to control anginal attacks.

Cardiac glycosides

Drug class that inhibits sodium-potassium pump which slows the release of calcium and therfore increases contractility.

HMG-CoA reductase inhibitors

A reductase inhibitor that binds to bile to reduce lipid levels.

Loop Diuretic

inhibit Na reabsorption in the Loop of Henle; ie, Lasix. Can cause osteoporosis due to loss of calcium.

Low Molecular Weight Heparin

Used to prevent venous thromboembolism with a lower risk of bleeding and produces a more stable response at recommended dose.

Nitrates

Drug class that cause generalized vascular and coronary vasodilation, which increases blood flow to the myocardial cells to reduce anginal attacks.

Osmotic Diuretic

Drug class that increases the osmolality and sodium reabsorption in the proximal tubule and loop of Henle

Phosphodiesterase inhibitors

Drug class that increase cAMP which enhances the entry of calcium into myocardial cells to increase contractile function. Used for acute heart failure.

Potassium sparing diuretic

Mild diuretic, such as Spironolactone, that does not excrete potassium.

Thiazide diuretic

Diurectic that acts on the distal tubules. Sodium and potassium are lost and calcium is retained; ie, hydrochlorothiazide

Thrombolytic

Drug class used to treat existing clots

Alteplase

Thrombolytic drug that must be administered within a short time after first symptoms appear to be effective.

Asprin

Most commonly prescribed antiplatelet drug used to prevent MI and repeat MI.

Captopril

ACE inhibitor that decreases potassium excretion so it is nomally combined with hydrochlorothiazide.

Coumadin

Only only anticoagulant. Inhibits synthesis of Vitamin K to prevent clot formation. PT test is used to determine therapeutic levels.

Digoxin

Cardiac glycoside used to increase force of heart, negative chronotrope and dromotrope. Competes with potassium.

Digoxin Immune Fab

used as an antedote for Dig toxicity that is noted by high digoxin serum levels due to a displacement of potassium which is typically related to kidney failure

Furosemide

Loop Diuretic which acts upon the Loop of Henle.

Heparin

Anticoagulant with short half life used to treat acute thromboembolic disorders. Protamine is used as an antidote.

Kayexalate

Used as an antedote for hyperkalemia. Exchanges Na for K. ECG should be monitored closely for any changes.

Atorvastatin (Lipitor)

HMG-CoA reductase inhibitor used to lower LDL.

Lovenox

Low-Molecular Weight Heparin that inhibits activated factor X and formation of thrombin. Has a longer half-life than Heparin.

Nitroglycerin

Antianginal which acts directly on smooth muscle to decrease preload, afterload and O2 demand.

Potassium Chloride

Antidote for hypokalemia. ECG must be monitored closely.

Spironolactone

Potassium sparing diuretic which blocks the action of aldosterone and inhibits the sodium-potassium pump. Has been prescribed by cardiologists for clients with cardiac disorders becauseof its potassium-retaining effect, which makes the heart rate more regular.

Triamterene

Potassium sparing diuretic that is useful in the treatment of edema caused by HF or cirrhosis.

Verapamil

Calcium channel blocker used as an anti-anginal.

The nurse is providing education to help reduce cardiovascular risks for adults at a community health fair. Which statement made by a participant indicates understanding of the health education?

A) I can't do anything about my disease risk because it is in my genes

B) I will take my blood pressure medication only when I have symptoms.

C) I will start walking on the treadmill each day when I watch my favorite TV show

D) I don't need to stop smoking because damage to my blood vessels is irreversible.

C) I will start walking on the treadmill each day when I watch my favorite TV show

A client reports "not feeling well for the past week" after taking digoxin (Lanoxin), which was prescribed a month ago. Which statement by the client indicates possible digoxin toxicity?

A. "I am short of breath and my hands are swollen."

B. "I have chest pain and tingling in my fingers."

C. "I have double vision and feel sick to my stomach."

D. "I am constipated and have trouble sleeping."

C. "I have double vision and feel sick to my stomach."

An older adult taking digoxin and furosemide (Lasix) for chronic heart failure is admitted to the emergency department (ED) with an apical pulse of 52. A family member states that the client has fallen four times this week. What is the nurse's first action?

A.Call the ED physician immediately.

B. Draw a serum digoxin level.

C. Assess for signs of hypokalemia.

D. Establish the client's airway

B. Draw a serum digoxin level.

A client who recently had a heart valve replacement is taking warfarin (Coumadin) as prescribed. What health teaching will the nurse include before the client is discharged?

A. "Take your pulse every day and call your doctor if it is below 60."

B. "Weigh yourself every day in the morning using the same scale."

C. "Purchase a home kit to monitor your blood pressure every day."

D. "Avoid foods that are high in vitamin K, such as kale and spinach."

"Avoid foods that are high in vitamin K, such as kale and spinach."

A client diagnosed with atherosclerosis has been prescribed simvastatin (Zocor). Which statement by the client indicates a need for further teaching?

A. "I have to eat more fruits and vegetables in my diet."

B. "I'll follow up with my nurse practitioner to check my lipid levels."

C. "I only smoke a half-pack of cigarettes a day so I won't need to quit."

D. "I'll report any leg cramps to my nurse practitioner immediately."

C. "I only smoke a half-pack of cigarettes a day so I won't need to quit."

A client is prescribed a hydrochlorothiazide for control of hypertension. What health teaching will the nurse provide before the client begins therapy?

A. "You may develop a slower pulse rate."

B. "You may notice some swelling in your feet."

C. "You may develop a nagging cough."

D. "Your diet should include foods high in potassium."

D. "Your diet should include foods high in potassium."

The nurse is providing care to a client at high risk for deep vein thrombosis. What health teaching will the nurse provide to the client related to home management of low-molecular weight heparin?

A. "You must have your partial thromboplastin time checked every 2 weeks."

B. "Massage the injection site after the heparin is injected."

C. "Notify your health care provider if your stools appear tarry."

D. "You will have an IV catheter placed for intermittent injection of the heparin."

C. "Notify your health care provider if your stools appear tarry."

A client is being discharged home on warfarin (Coumadin) after being treated for deep vein thrombosis. What priority instruction will the nurse include in the client's discharge teaching?

A. "Take one extra Coumadin the day before a blood test."

B. "Eat a diet high in protein and green leafy vegetables."

C. "Use a soft-bristled toothbrush to prevent bleeding of the gums."

D. "Weigh yourself daily at the same time to monitor fluid balance."

C. "Use a soft-bristled toothbrush to prevent bleeding of the gums."

An older client has a history of stable angina. Which modifiable risk factors will the nurse assess to guide the client's teaching plan? Select all that apply.

A. Older age

B. Tobacco use

C. Activity level

D. Serum lipid levels

E. Family history

F. Weight

B. Tobacco use
C. Activity level
D. Serum lipid levels
F. Weight

A client who had thrombolytic therapy is receiving a continuous infusion of sodium heparin. In the past hour, the client's blood pressure changed from 122/74 to 98/46 mm Hg. His pulse is rapid and weak. What is the nurse's first action at this time?

A. Assess for signs of bleeding.

B. Slow the heparin infusion rate.

C. Document the blood pressure change.

D. Stop the heparin infusion immediately.

D. Stop the heparin infusion immediately.

How does aspirin interfere with blood clotting?

A. Prevents vitamin K synthesis

B. Inhibits the activation of platelets

C. Increases the rate of platelet destruction

D. Prevents fibrin molecules from assembling into long strands

B. Inhibits the activation of platelets

Which blood pressure readings require further prehypertensive assessment? (Select All that apply)

A) 125 mmHg systolic
B) 139 mmHg systolic
C) 115 mmHg systolic
D) 60 mmHg diastolic
E) 100 mmHg diastolic

A) 125 mmHg systolic
B) 139 mmHg systolic
E) 100 mmHg diastolic

A patient is being discharged with a prescription for warfarin (Coumadin). Which test does the nurse instruct the patient to routinely have done for follow-up monitoring?

A) Prothrombin time (PT) and International Normalized Ratio (INR)
B) Partial thromboplastin time (PTT)
C) Complete blood count and platelet count
D) Sodium and potassium levels

D

A) Prothrombin time (PT) and International Normalized Ratio (INR)

A patient is prescribed diuretics for treatment of heart failure. Because of this therapy, the nurse pays particular attention to which laboratory test level?

A) Peak and trough of medication
B) Serum potassium
C) Serum sodium
D) PT and PTT

B) Serum potassium

An older adult patient is taking digoxin for treatment of hear failure. What is the priority nursing action for this patient related to the medication therapy?

A) Give the medication in conjunction with an antacid.
B) Keep the patient on the cardiac monitor and observe for ventricular dysrhythmias.
C) Check that the dose is in the lowest possible range for therapeutic effect
D) Advise the patient that there is increased mortality related to toxicity.

C) Check that the dose is in the lowest possible range for therapeutic effect

A patient is receiving digoxin therapy for heart failure. What assessment does the nurse perform before administering the medication?

A) Auscultate the apical pulse rate and rhythm
B) Assess for nausea and abdominal distention
C) Auscultate the lungs for crackles
D) Check for increased urine output

A) Auscultate the apical pulse rate and rhythm

The nurse is reviewing the ECG of a patient on digoxin therapy. What early sign of digitalis toxicity does the nurse look for?

A) Tachycardia
B) Peaked T wave
C) Atrial fibrillation
D) Loss of P wave

D) Loss of P wave

Which laboratory test monitors for potential cardiac problems and digoxin toxicity?

A) Complete blood count
B) BUN and creatinine level
C) Serum potassium level
D) Prothrombin time and INR

C) Serum potassium level

Long-term anticoagulant therapy for a patient with valvular heart disease and chronic atrial fibrillation include which drug?

A) Heparin
B) Warfarin (Coumadin)
C) Diltiazem (Cardizem)
D) Enoxaparin (Lovanox)

B) Warfarin (Coumadin)

A patient is prescribed atorvastatin (Lipitor). The nurse instructs the patient to watch for and report which side effect?

A) Nausea and vomiting
B) Cough
C) Headache
D) Muscle cramps

D) Muscle cramps

Which are risk factors for hypertension? (Select All that Apply)

A) Age greater than 40 years
B) Family history of hypertension
C) Excessive calorie consumption
D) Physical inactivity
E) Excessive alcohol intake
F) Hypolipidemia
G) Hgh intake of salt or caffeine
H) Increased intake of potassium, calcium, or magnesium

B) Family history of hypertension
C) Excessive calorie consumption
D) Physical inactivity
E) Excessive alcohol intake
G) Hgh intake of salt or caffeine

A middle-aged patient with no health insurance has tried lifestyle modifcations to control uncomplicated hypertension, but continues to struggle. What is considered a first drug of choice for this patient?

A) Calcium channel blocker
B) Alpha blocker
C) Thiazide-type diuretic
D) Angiotensin-converting enzyme (ACE) inhibitor

C) Thiazide-type diuretic

The nurse is teaching a patient about taking hydrochlorothiazide (HydroDIRIIL). Which food does the nurse instruct the patient to eat in conjunction with the use of this drug?

A) Bananas and oranges
B) Milk and cheese
C) Cranberries and prunes
D) Cabbage and cauliflower

A) Bananas and oranges

The nurse is reviewing antihypertensive medication orders for a patient with asthma. The nurse questions the use of which type of medication?

A) Cardioselective beta blockers because they reduce cardiac output
B) Non-cardioselective beta blockers because they may inhibit bronchodilation
C) ACE inhibitors because they cause a nagging cough
D) Thiazide diuretics because they promote potassium excretion

B) Non-cardioselective beta blockers because they may inhibit bronchodilation

The nurse prepares to teach a patient recovering froma myocardial infarction (MI) about combination drug therapy based on "best practice" for controlling hypertension. Which drugs does the nurse include in the teaching plan? (Select All that Apply)

A) Beta blockers
B) ACE inhibitors or ARBs
C) Aldosterone antagonists
D) Central alpha agonists
E) NSAIDs
F) Aspirin

A) Beta blockers
B) ACE inhibitors or ARBs
C) Aldosterone antagonists
F) Aspirin

What is the recommended therapeutic range for the International Normalized Ratio (INR) that is done along with prothrombin time in a patient receiving warfarin (Coumadin)?

A) 0.5 to 1.0
B) 1.0 to 1.5
C) 1.5 to 2.0
D) 2.0 to 3.0

D) 2.0 to 3.0

The nurse is teaching a patient about the side effects and potential problems associated with taking warfarin (Coumadin). Which statement by the patient indicates a correct understanding of the nurse's instructions?

A) If I notice bleeding of the gums, I should skip one or two doses of the medication.
B) I should eat a lot of cabbage, cauliflower, and broccoli to prevent bleeding
C) For injury and bleeding, I should apply direct pressure and seek medical assistance
D) I should avoid going to the dentist while I am taking this medication.

C) For injury and bleeding, I should apply direct pressure and seek medical assistance

The nurse is instructing a patient and caregiver on warfarin (Coumadin) therapy at home. Which items does the nurse include in the teaching plan? (Select All that Apply)

A) Avoid eating large portions of foods rich in Vitamin K such as broccoli and spinach
B) Avoid beta-blockers and ACE inhibitors
C) Inform your dentist of taking warfarin prior to treatment
D) East small amounts of oranges and bananas
E) Avoid NSAIDs

A) Avoid eating large portions of foods rich in Vitamin K such as broccoli and spinach
C) Inform your dentist of taking warfarin prior to treatment
E) Avoid NSAIDs

The nurse is interviewing a patient reporting chest discomfort that occurs with little to no exertion. The patient describes the pain as "increasing over time with little relief even while at rest." Based on the patient's description of symptoms, what does the nurse suspect in this patient? (Select All that Apply)

A) Chronic stable angina
B) Unstable angina
C) Acute cronary syndrome
D) Acute myocardial infarction
E) Coronary Artery Disease

B) Unstable angina
E) Coronary Artery Disease

A patient with angina is prescribed nitroglycerin tablets. What information does the nurse include when teaching the patient about this drug? (Select All that Apply)

A) If one tablet does not relieve the angina after 5 minutes, take two pills.
B) You can tell the pills are active when your tongue feels a tingling sensation
C) Keep your nitroglycerin with you at all times
D) The prescription should last about 6 months before a refill is necessary
E) If pain doeesn't go away, just wait; the medication will eventulally take effect
F) The medication can cause a temporary headache or a flushed face

B) You can tell the pills are active when your tongue feels a tingling sensation
C) Keep your nitroglycerin with you at all times
F) The medication can cause a temporary headache or a flushed face

The nurse has just given a patient two doses of sublingual nitroglycerin for anginal pain. The patient's blood pressure is typically 130/80 mmHg. Which finding warrants immediate notification of the health care provider?

A) Patient reports a headache
B) Systolic pressure is 140 mm Hg
C) Systolic pressure is 90 mm Hg
D) Anginal pain continues but is somewhat relieved

C) Systolic pressure is 90 mm Hg

A patient is hypertensive and continues to have angina despite therapy with beta blockers. The nurse anticipates which type of drug will be prescribed for this patient?

A) Calcium Channel blocker
B) Digoxin
C) ACE inhibitor
D) Dopamine

A) Calcium Channel blocker

A patient with angina is taking calcium channel blockers. What does the nurse monitor for?

A) Wheezes
B) Peripheral edema
C) Bradycardia
D) Forgetfulness

B) Peripheral edema

An older adult taking digoxin and furosemide for chronic heart failure is admitted to the emergency department (ED) with an apical pulse of 52. She is disoriented to time and place and states that she "can't see very well." What is the nurse's first action?
A. Call the ED physician immediately.
B. Draw a serum digoxin level.
C. Assess for signs of hypokalemia.
D. Establish the client's airway.

A. Call the ED physician immediately.

A client with chronic stable angina receives discharge teaching from the nurse. Which statement by the client indicates a need for further teaching?
A. "I need to take my nitroglycerin tablets to prevent any serious problems."
B. "At the first sign of chest discomfort, I will stop any activity and sit down."
C. "I will call 911 if my chest discomfort continues after taking 3 nitroglycerin tablets."
D. "I understand I must follow up with my health care provider regularly."

A. "I need to take my nitroglycerin tablets to prevent any serious problems."

The nurse prepares to administer digoxin to a client with heart failure and notes the following information:
Temperature: 99.8
Pulse: 48 and irregular
Respirations: 20
Potassium level: 3.2 mEq/L

What action does the nurse take?

A) Give digoxin; reassess the heart rate in 30 minutes.
B) Give the digoxin; document assessment findings in the medical record.
C) Hold the digoxin, and obtain a prescription for an additional dose of furosemide.
D) Hold the digoxin, and obtain a prescription for a potassium supplement.

D) Hold the digoxin, and obtain a prescription for a potassium supplement.

A client with heart failure has furosemide (Lasix). Which finding would concern the nurse with this new prescription?
A) Serum sodium level of 135 mEq/L
B) Serum potassium level of 2.8 mEq/L
C) Serum creatinine of 1.0 mg/dL
D) Serum magnesium level of 1.9 mEq/L

B) Serum potassium level of 2.8 mEq/L

The nurse caring for the client with heart failure is concerned that digoxin toxicity has developed. For which signs and symptoms of digoxin toxicity does the nurse notify the provider? Select all that apply.
A) Hypokalemia
B) Sinus bradycardia
C) Fatigue
D) Serum digoxin level of 2.5
E) Anorexia

B) Sinus bradycardia
C) Fatigue
E) Anorexia

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