NCLEX Pharmacology: Cardiac Medications

What is the primary mechanism of action for ACE inhibitors like lisinopril, and what are two common side effects nurses should monitor for?

ACE inhibitors block the conversion of angiotensin I to angiotensin II, leading to vasodilation and decreased aldosterone. Common side effects include a persistent dry cough and hyperkalemia. Angioedema is a rare but serious side effect.

How do Angiotensin Receptor Blockers (ARBs) like valsartan differ from ACE inhibitors, and when are they typically prescribed?

ARBs block the binding of angiotensin II to its receptors, achieving similar effects to ACE inhibitors but without the bradykinin-related cough. They are typically prescribed when a patient cannot tolerate the cough associated with ACE inhibitors.

Explain the primary action of beta-blockers (e.g., metoprolol) on the heart and name a key contraindication or caution.

Beta-blockers decrease heart rate, myocardial contractility, and blood pressure by blocking beta-adrenergic receptors. They are contraindicated or used with extreme caution in patients with severe bradycardia, AV block, or uncompensated heart failure, and can exacerbate asthma or COPD.

What are the main cardiovascular effects of non-dihydropyridine calcium channel blockers like diltiazem and verapamil, and what must nurses monitor closely?

These CCBs decrease heart rate and contractility, slow AV node conduction, and cause vasodilation. Nurses must closely monitor heart rate and blood pressure due to the risk of bradycardia and hypotension.

What is the primary action of dihydropyridine calcium channel blockers (e.g., nifedipine, amlodipine), and what common side effect distinguishes them?

Dihydropyridine CCBs primarily cause peripheral vasodilation, making them effective for hypertension and angina. A common distinguishing side effect is peripheral edema.

How do loop diuretics (e.g., furosemide) work, and what are two major electrolyte imbalances nurses must monitor for?

Loop diuretics inhibit sodium and chloride reabsorption in the ascending loop of Henle, leading to potent diuresis. Nurses must monitor for hypokalemia and hyponatremia. Ototoxicity is another important consideration with rapid IV administration.

Describe the mechanism of action for thiazide diuretics (e.g., hydrochlorothiazide) and one significant metabolic side effect.

Thiazide diuretics inhibit sodium reabsorption in the distal convoluted tubule. A significant metabolic side effect is hyperglycemia, and they can also cause hyperuricemia.

What is the mechanism of action for potassium-sparing diuretics like spironolactone, and what is the primary electrolyte imbalance to watch for?

Spironolactone blocks aldosterone receptors, increasing sodium and water excretion while retaining potassium. The primary electrolyte imbalance to watch for is hyperkalemia.

What is the therapeutic effect of digoxin on the heart, and what are key signs of digoxin toxicity?

Digoxin increases myocardial contractility (positive inotropic effect) and decreases heart rate (negative chronotropic effect). Key signs of toxicity include yellow-green halos, nausea, vomiting, and bradycardia.

What is the primary action of nitroglycerin in treating angina, and what important patient education should be provided regarding sublingual administration?

Nitroglycerin causes vasodilation, primarily of venous vessels, reducing cardiac preload and oxygen demand. Patients should be taught to take one tablet every 5 minutes for up to three doses, calling emergency services if pain persists after the first dose. Headache and hypotension are common.

How do statins (e.g., atorvastatin) work to lower cholesterol, and what are two crucial adverse effects to monitor for?

Statins inhibit HMG-CoA reductase, an enzyme essential for cholesterol synthesis in the liver. Two crucial adverse effects to monitor for are myopathy (muscle pain/weakness) and hepatotoxicity (liver damage), often requiring liver enzyme monitoring.

What class of antiarrhythmic is amiodarone, and name two significant long-term adverse effects nurses should be aware of?

Amiodarone is a Class III antiarrhythmic. Two significant long-term adverse effects include pulmonary fibrosis and thyroid dysfunction (hypo- or hyperthyroidism). Ocular toxicity (corneal microdeposits) and skin discoloration (blue-gray) are also notable.

What is the mechanism of action for warfarin, what lab test monitors its therapeutic effect, and what is its antidote?

Warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X). Its therapeutic effect is monitored by the International Normalized Ratio (INR). The antidote is Vitamin K.

What is the mechanism of action for heparin, what lab test monitors its therapeutic effect, and what is its antidote?

Heparin enhances the activity of antithrombin, rapidly inactivating clotting factors, particularly thrombin and Factor Xa. Its therapeutic effect is monitored by the activated partial thromboplastin time (aPTT). The antidote is protamine sulfate.

How do antiplatelet medications like aspirin and clopidogrel primarily work, and what is their main side effect to monitor?

Antiplatelet medications inhibit platelet aggregation, preventing clot formation, especially in arterial circulation. Their main side effect to monitor is bleeding.