Nursing Pharmacology: Cardiovascular Drugs (University)

What is the prototype ACE inhibitor (-pril) and its mechanism?

Answer: Lisinopril. Blocks conversion of angiotensin I to angiotensin II, causing vasodilation and decreased aldosterone (less Na/water retention). Used for HTN and heart failure.

Before giving lisinopril, what should the nurse check, and what is the signature side effect?

Answer: Check BP and potassium (hyperkalemia risk). Signature side effect: persistent dry cough (bradykinin buildup); also watch for angioedema — stop drug immediately if facial/airway swelling occurs.

What is the prototype ARB (-sartan), and how does it differ from ACE inhibitors?

Answer: Losartan. Blocks angiotensin II receptors directly instead of blocking its formation — same hemodynamic benefits as ACE inhibitors but without the bradykinin-mediated dry cough.

What labs should be monitored with losartan, and what teaching is essential?

Answer: Monitor potassium (hyperkalemia risk) and renal function. Teach to avoid potassium supplements/salt substitutes, report dizziness, and avoid pregnancy (teratogenic, like ACE inhibitors).

What is the prototype beta blocker (-olol), and what must be checked before giving?

Answer: Metoprolol. Check apical pulse and blood pressure; hold and notify provider if HR <60 bpm or BP is significantly low.

What are the signature risks of beta blockers and the key teaching point?

Answer: Can cause bradycardia, bronchospasm (caution in asthma/COPD), and mask hypoglycemia symptoms in diabetics. Teach: never stop abruptly — rebound HTN/tachycardia; taper the dose.

What should the nurse check before giving amlodipine, and what is its signature side effect?

Answer: Check blood pressure (causes vasodilation). Signature side effect: peripheral/ankle edema, flushing, headache, and reflex tachycardia.

How do diltiazem and verapamil differ from amlodipine in nursing checks and effects?

Answer: They slow AV node conduction and decrease heart rate/contractility — check apical pulse and BP; risk of bradycardia and heart block. Avoid grapefruit juice (raises drug levels).

What is the prototype loop diuretic, and what labs must be checked before administration?

Answer: Furosemide. Check potassium (hypokalemia risk) and blood pressure; assess for hypotension and dehydration.

What is the signature toxicity of furosemide and a key teaching point?

Answer: Ototoxicity (tinnitus, hearing loss), especially with rapid IV push. Teach: take in the morning to avoid nocturia, eat potassium-rich foods, rise slowly to prevent falls.

What is the prototype thiazide diuretic, and what electrolyte imbalances does it cause?

Answer: Hydrochlorothiazide. Causes hypokalemia, hyponatremia, hypercalcemia, and hyperglycemia; monitor potassium and glucose. Ineffective with very low renal function.

What teaching should the nurse give a patient on hydrochlorothiazide?

Answer: Report muscle weakness or cramps (signs of hypokalemia), monitor blood sugar if diabetic, take in the morning, and rise slowly to prevent orthostatic hypotension.

What is the prototype potassium-sparing diuretic, its key risk, and teaching point?

Answer: Spironolactone. Risk of hyperkalemia — check potassium before giving. Teach patient to avoid potassium supplements and salt substitutes; may cause gynecomastia.

What must be checked before giving nitroglycerin, and what is its signature side effect?

Answer: Check blood pressure (causes vasodilation/hypotension). Signature side effect: headache from cerebral vasodilation, plus orthostatic hypotension.

What key teaching applies to sublingual nitroglycerin for chest pain?

Answer: Take 1 tablet; if no relief in 5 min, call 911; may repeat up to 3 doses 5 min apart. Store in dark glass. Never combine with PDE5 inhibitors (severe hypotension).

What must the nurse check before administering digoxin?

Answer: Apical pulse for one full minute — hold and notify provider if <60 bpm (adult). Also check potassium and digoxin level (therapeutic range 0.5–2.0 ng/mL).

What are signs of digoxin toxicity, and what worsens the risk?

Answer: Nausea/vomiting, visual disturbances (yellow-green halos), bradycardia, and arrhythmias. Hypokalemia increases toxicity risk. Antidote: digoxin immune Fab (DigiFab).

What should be monitored with amiodarone, and what is its signature toxicity?

Answer: Monitor QT interval, thyroid, liver, and pulmonary function. Signature toxicity: pulmonary fibrosis and blue-gray skin discoloration with long-term use.

What teaching is important for a patient starting amiodarone?

Answer: Use sunscreen/protective clothing (photosensitivity), report new cough or shortness of breath (pulmonary toxicity), avoid grapefruit juice, and attend regular thyroid/liver/eye exams.

How is adenosine given, and what should the patient be warned about?

Answer: Rapid IV push (1–2 sec) followed by saline flush, used for SVT. Warn patient of brief flushing, chest pressure, and a few seconds of asystole/sense of doom — transient and expected.

In what condition is adenosine contraindicated, and why?

Answer: Second- or third-degree heart block or sick sinus syndrome (without a pacemaker) — it further slows AV conduction and can cause prolonged asystole or severe bradycardia.

What is the prototype statin, key lab to monitor, and signature side effect?

Answer: Atorvastatin. Monitor liver function tests and creatine kinase. Signature side effect: myopathy/rhabdomyolysis — report unexplained muscle pain or dark urine. Avoid grapefruit juice; take in the evening.

What lab monitors heparin therapy, what's the therapeutic range, and the antidote?

Answer: aPTT, therapeutic range 1.5–2.5x control value. Antidote: protamine sulfate. Considered safe in pregnancy (does not cross placenta).

What serious adverse reaction should the nurse monitor for during heparin therapy?

Answer: Heparin-induced thrombocytopenia (HIT) — monitor platelet counts; a drop >50% means stop heparin immediately and switch to a non-heparin anticoagulant.

What lab monitors warfarin therapy, the therapeutic range, and its antidote?

Answer: INR, therapeutic range usually 2–3 (higher for mechanical valves). Antidote: vitamin K (phytonadione); fresh frozen plasma for rapid reversal.

What teaching should a nurse give a patient starting warfarin?

Answer: Maintain consistent vitamin K intake (leafy greens), avoid NSAIDs/aspirin, use a soft toothbrush/electric razor, report bleeding or bruising, and attend regular INR monitoring.

How is enoxaparin administered, and what monitoring differs from heparin?

Answer: Given subcutaneously (abdomen, do not aspirate or rub site); routine aPTT monitoring is not required due to predictable dosing. Still monitor platelets for HIT risk.

What should the nurse assess with clopidogrel, and what is the key teaching point?

Answer: Assess for bleeding/bruising; hold 5–7 days before surgery. Teach patient to take with food, use a soft toothbrush, and report black/tarry stools or unusual bruising.

What are key contraindications and the signature risk of alteplase?

Answer: Contraindicated with active internal bleeding, recent surgery/trauma, or recent stroke. Signature risk: severe bleeding. Must give within time window (e.g., 3–4.5 hr for ischemic stroke); monitor neuro status closely.

What must the nurse monitor with norepinephrine, and what is the major administration risk?

Answer: Continuously monitor blood pressure and heart rhythm; give via central line. Extravasation causes tissue necrosis — antidote is phentolamine injected locally if it occurs.

A patient on lisinopril develops a dry cough — what should be done?

Answer: Notify the provider; the cough is a known ACE inhibitor effect from bradykinin accumulation. The provider will likely switch to an ARB (e.g., losartan), which does not cause this cough.

Why is hypokalemia dangerous for a patient taking digoxin?

Answer: Low potassium increases digoxin binding to cardiac cells, raising the risk of digoxin toxicity and arrhythmias even at normal digoxin levels — monitor potassium closely.

In which conditions should beta blockers be used cautiously or avoided?

Answer: Asthma/COPD (bronchospasm), severe bradycardia or heart block, and decompensated heart failure; use cautiously in diabetics since they mask hypoglycemia symptoms like tachycardia.

How do dihydropyridine CCBs (amlodipine) and non-dihydropyridine CCBs (diltiazem, verapamil) differ in cardiac effect?

Answer: Dihydropyridines mainly cause peripheral vasodilation with reflex tachycardia; non-dihydropyridines slow AV conduction and heart rate, risking bradycardia/heart block — avoid combining with beta blockers.

How do warfarin and heparin differ in onset and monitoring?

Answer: Heparin: immediate onset, IV/subQ, monitored by aPTT, used short-term/acute. Warfarin: delayed onset (days), oral, monitored by INR, used long-term; often bridged with heparin initially.