Cardiovascular System Drugs ATI

Cardiovascular System Drugs
question="What is the brand/trade name of the angiotensin-converting enzyme

(ACE) inhibitor drug whose generic name is captopril?"
Capoten
<question question="What is the brand/trade name of the
adrenergic neuron blocker drug whose generic name is reserpine?"
answer="Serpalan, Sk-Reserpine"/>
aldosterone antagonist drug whose generic name is spironolactone? "
answer="Aldactone"/>
alpha1 adrenergic blocker drug whose generic name is doxazosin?"
answer="Cardura"/>
alpha/beta blocker drug whose generic name is carvedilol? " answer="Coreg"/>
angiotensin receptor blocker (ARB) drug whose generic name is losartan?"
answer="Cozaar"/>
<question question="What are the brand/trade names for
the beta adrenergic blocker drugs whose generic names are atenolol and
metoprolol? " answer="atenolol (Tenormin); metoprolol (Lopressor)"/>
calcium channel blocker (dihydropyridine) drug whose generic name is
nifedipine?" answer="Adalat, Procardia"/>
cardiac glycoside drug whose generic name is digoxin? " answer="Lanoxin"/>
centrally acting alpha2 agonist drug whose generic name is clonidine? "
answer="Catapres"/>
<question question="What are the brand/trade names of
the class IA/sodium channel blocker drugs whose generic names are quinidine
and procainamide? " answer=" quinidine (Apo-Quinidine, Novo-Quinidine);
procainamide (Pronestyl)"/>
class IB/sodium channel blocker drug whose generic name is lidocaine? "
answer="Xylocaine"/>
the class IC/sodium channel blocker drugs whose generic names are flecainide
and propafenone?" answer="flecainide (Tambocor); propafenone (Rythmol)"/>
class II/beta adrenergic blocker drug whose generic name is propranolol? "
answer="Inderal"/>

class III/potassium channel blocker drug whose generic name is amiodarone? "
answer="Cordarone"/>
class IV/calcium channel blocker drug whose generic name is verapamil? "
answer="Calan"/>
direct acting vasodilator drug whose generic name is hydralazine?"
answer="Apresoline"/>
fibrate drug whose generic name is gemfibrozil?" answer="Lopid"/>
HMG-CoA reductase inhibitor (statin) drug whose generic name is simvastatin? "
answer="Zocor"/>
loop diuretic drug whose generic name is furosemide? " answer="Lasix"/>
the nitrate drugs whose generic names are nitroglycerin and isosorbide
dinitrate?" answer="nitroglycerin (Nitrostat, Nitro-Dur, Nitro-Bid);
isosorbide dinitrate (Isordil)"/>
phosphodiesterase inhibitor drug whose generic name is milrinone?"
answer="Primacor"/>
potassium-sparing diuretic drug whose generic name is spironolactone? "
answer="Aldactone"/>
sympathomimetic drug whose generic name is dobutamine?" answer="Dobutrex"/>
thiazide diuretic drug whose generic name is hydrochlorothiazide? "
answer="HydroDIURIL"/>
direct renin inhibitor whose generic name is aliskiren?" answer="Tekturna"/>
</chapter>
<chapter ChapterName="Generic Drugs">
<question question="What is the generic name of the
angiotensin-converting enzyme (ACE) inhibitor drug whose brand/trade name is
Capoten?" answer="captopril"/>
adrenergic neuron blocker drug whose brand/trade names are Serpalan and SkReserpine?" answer="reserpine"/>
aldosterone antagonist drug whose brand/trade name is Aldactone?"
answer="spironolactone"/>

alpha1 adrenergic blocker drug whose brand/trade name is Cardura?" answer="
doxazosin "/>
alpha/beta blocker drug whose brand/trade name is Coreg?" answer="carvedilol
"/>
<question question="What is the generic name of an
angiotensin receptor blocker (ARB) drug whose brand/trade name is Cozaar?"
answer="losartan"/>
<question question="What are the generic names for the
beta adrenergic drugs whose brand/trade names are Tenormin and Lopressor?"
answer="atenolol (Tenormin); metoprolol (Lopressor)"/>
calcium channel blocker (dihydropyridine) drug whose brand/trade names are
Adalat and Procardia?" answer="nifedipine"/>
cardiac glycoside drug whose brand/trade name is Lanoxin?" answer="digoxin"/>
centrally acting alpha2 agonist drug whose brand/trade name is Catapres?"
answer="clonidine "/>
<question question="What are the generic names of the
class IA/sodium channel blocker drugs whose brand/trade names are ApoQuinidine, Novo-Quinidine and Pronestyl?" answer=" quinidine (Apo-Quinidine,
Novo-Quinidine); procainamide (Pronestyl)"/>
class IB/sodium channel blocker drug whose brand/trade name is Xylocaine?"
answer="lidocaine"/>
class IC/sodium channel blocker drugs whose brand/trade names are Tambocor and
Rythmol?" answer=" flecainide (Tambocor); propafenone (Rythmol)"/>
class II/beta adrenergic blocker drug whose brand/trade name is Inderal?"
answer="propranolol "/>
class III/potassium channel blocker drug whose brand/trade name is Cordarone?"
answer="amiodarone "/>
class IV/calcium channel blocker drug whose brand/trade name is Calan?"
answer="verapamil "/>
direct acting vasodilator (hydralazine) drug whose brand/trade name is
Apresoline?" answer="hydralazine"/>
fibrate drug whose brand/trade name is Lopid?" answer="gemfibrozil "/>

HMG-CoA reductase inhibitor (statin) drug whose brand/trade name is Zocor?"
answer="simvastatin"/>
loop diuretic drug whose brand/trade name is Lasix?" answer="furosemide"/>
nitrate drugs whose brand/trade names are Minitran, Nitrocap, Nitro-Dur,
Nitrogard, Nitrodisc; and Isordil?" answer="nitroglycerin (Nitrostat, NitroDur, Nitro-Bid); isosorbide dinitrate (Isordil)"/>
phosphodiesterase inhibitor drug whose brand/trade name is Primacor?"
answer="milrinone"/>
potassium-sparing diuretic drug whose brand/trade name is Aldactone?"
answer="spironolactone"/>
sympathomimetic drug whose brand/trade name is Dobutrex?" answer="dobutamine
"/>
thiazide diuretic drug whose brand/trade name is HydroDIURIL?"
answer="hydrochlorothiazide"/>
direct renin inhibitor whose brand/trade name is Tekturna?"
answer="aliskiren"/>
</chapter>
<chapter ChapterName="Therapeutic Uses">
<question question="What are some of the therapeutic
uses for the angiotensin-converting enzyme (ACE) inhibitor captopril
(Capoten)?" answer="
</li><li> Hypertension
</li><li> Heart failure
</li><li> Diabetic nephropathy
</li></ul>"/>
uses for the adrenergic neuron blocker reserpine (Serpalan, Sk-Reserpine)?"
answer="<ul><li> Treats hypertension (not a first-line choice due to severe
adverse effects)"/>
uses for the aldosterone antagonist spironolactone (Aldactone)?"
answer="<ul><li> Treats hypertension
</li><li> Treats symptoms of heart failure following myocardial infarction"/>
uses for the alpha1 adrenergic blocker doxazosin (Cardura)?" answer="<ul><li>
Treats hypertension
</li><li> Treats benign prostatic hypertrophy"/>

uses for the alpha/beta blocker carvedilol (Coreg)?" answer="<ul><li> Treats
hypertension
</li><li> Treats heart failure along with digoxin, angiotensin-converting
enzymes (ACE) inhibitors, and diuretics
</li><li> Prolongs chance of survival following myocardial infarction
</li></ul>"/>
uses for the angiotensin receptor blocker (ARB) losartan (Cozaar)?"
answer="<ul><li> Treats hypertension
</li><li> Prevents stroke
</li><li> Manages diabetic nephropathy
</li></ul>"/>
uses for the beta adrenergic blockers atenolol (Tenormin) and metoprolol
(Lopressor)?" answer="<ul><li> Treats hypertension
</li><li> Treats angina pectoris
</li><li> Decreases mortality following myocardial infarction
</li><li> Treats cardiac dysrhythmias (investigational use)
</li><li> Treats heart failure
</li></ul>"/>
uses for the calcium channel blocker (dihydropyridine) nifedipine (Adalat,
Procardia)?" answer="<ul><li> Treats mild to moderate hypertension
</li><li> Treats stable (exertional) angina and variant (vasospastic) anginas
</li></ul>"/>
uses for the cardiac glycoside digoxin (Lanoxin)?" answer="<ul><li> Treats
mild to moderate hypertension
</li><li> Treats stable (exertional) angina and variant (vasospastic) anginas
</li></ul>"/>
uses for the centrally acting alpha2 agonist clonidine (Catapres)?"
answer="<ul><li> Hypertension
</li><li> Severe pain relief (administered by epidural infusion)
</li><li> Off-label uses: migraine headache (prevention); withdrawal from
alcohol, opioids, and nicotine; dysmenorrheal and menopausal hot flashes;
attention deficit hyperactivity disorder in children; Tourette's syndrome
</li></ul>"/>
uses for the class IA/sodium channel blocker drugs quinidine (Apo-Quinidine,
Novo-Quinidine) and procainamide (Pronestyl)?" answer="<ul><li> Broad spectrum
antidysrhythmics treat atrial fibrillation, supraventricular and ventricular

tachycardias.
</li><li> Quinidine is used more for long-term treatment while procainamide is
used only for short-term treatment due to severe adverse effects.
</li></ul>"/>
uses for the class IB/sodium channel blocker lidocaine (Xylocaine)?"
answer="<ul><li> IV: Controls only ventricular dysrhythmias caused by
myocardial infarction, cardiac surgery or procedures, digoxin toxicity
</li><li> Local: Provides local or regional anesthesia
</li></ul>"/>
uses for the class IC/sodium channel blockers flecainide (Tambocor) and
propafenone (Rythmol)?" answer="<ul><li> Treat serious supraventricular and
ventricular tachydysrhythmias not controlled by other antidysrhythmics
</li><li> Used long term for some supraventricular dysrhythmias
</li></ul>"/>
uses for the class II/beta adrenergic blocker propranolol (Inderal)?"
answer="<ul><li> Management of cardiac tachydysrhythmias, such as atrial and
ventricular tachycardia and tachycardia caused by exercise or emotion
</li><li> Treats hypertension alone or along with other drugs, such as
diuretics
</li><li> Prevents pain from angina pectoris
</li><li> Treatment to decrease mortality following myocardial infarction (MI)
</li><li> Used for prophylaxis against migraine headaches
</li></ul>"/>
uses for the class III/potassium channel blocker amiodarone (Cordarone)?"
answer="<ul><li> Manages life-threatening ventricular tachycardia or
fibrillation that is resistant to other drugs
</li><li> May treat some atrial dysrhythmias, such as atrial fibrillation
</li></ul>"/>
uses for the class IV/calcium channel blocker verapamil (Calan)?"
answer="<ul><li> Converts supraventricular tachycardia to a sinus rhythm
</li><li> Slows rate of atrial fibrillation and flutter
</li><li> Treats angina and hypertension
</li></ul>"/>
uses for the direct-acting vasodilator drug hydralazine (Apresoline)?"
answer="<ul><li> Moderate to severe hypotension
</li><li> Hypertensive crisis (IV form)
</li><li> Used with digitalis and other vasodilators to treat heart failure on
a short-term basis
</li></ul>"/>
uses for the fibrate drug gemfibrozil (Lopid)?" answer="<ul><li> Reduces high
levels of plasma triglycerides
</li><li> Reduces LDL cholesterol (less effectively than statins)
</li></ul>"/>
uses for the HMG-CoA reductase inhibitor (statin) drug simvastatin (Zocor)?"
answer="<ul><li> Reduces LDL and triglycerides
</li><li> Increases HDL cholesterol
</li><li> Recommended to reduce mortality in patients with type 2 diabetes
mellitus
</li></ul>"/>
uses for the loop diuretic furosemide (Lasix)?" answer="<ul><li> Treats
pulmonary edema in heart failure
</li><li> Treats edema caused by renal, hepatic, or cardiac failure not
affected by other diuretics
</li><li> Treats hypertension not controlled by other diuretics
</li></ul>"/>
uses for the nitrate drugs nitroglycerin (Nitrostat, Nitro-Dur, Nitro-Bid) and
isosorbide dinitrate (Isordil)?" answer="<ul><li> Treatment and prophylaxis of
angina pectoris
</li><li> Rapid-acting forms (only transmucosal tablets, translingual spray
and sublingual tablets treat an angina attack)
</li><li> Longer-acting forms, such as regular tablets, immediate release or
sustained release tablets/capsules, are used to prevent attacks from
occurring.
</li><li> IV nitroglycerin is used for severe unstable angina attacks and to
control blood pressure perioperatively and to treat heart failure after acute
myocardial infarction.
</li></ul>"/>
<question question="What is a therapeutic use for the
phosphodiesterase inhibitor drug milrinone (Primacor)?" answer="Short-term
treatment of low cardiac output in heart failure"/>
uses for the potassium-sparing diuretic drug spironolactone (Aldactone)?"
answer="<ul><li> Hypertension
</li><li> Edema caused by heart failure
</li><li> Cirrhosis of the liver
</li><li> Nephrotic syndrome
</li><li> Hypokalemia"/>
<question question="What is a therapeutic use for the

sympathomimetic drug dobutamine (Dobutrex)?" answer="Increases cardiac output
in severe heart failure (short-term use only)"/>
uses for the thiazide diuretic hydrochlorothiazide (HydroDIURIL)?"
answer="<ul><li> Used with other drugs, treats heart failure
</li><li> Treats cirrhosis of the liver and renal failure
</li><li> Treats hypertension
</li></ul>"/>
<question question="What is a therapeutic use of the
direct renin inhibitor aliskiren (Tekturna)?" answer="Hypertension"/>
</chapter>
<chapter ChapterName="Administration Considerations">
<question question="How should the angiotensinconverting enzyme (ACE) Inhibitor captopril (Capoten) be given?"
answer="<ul><li> Oral use only.
</li><li> Take two to three times daily for hypertension; three times daily
for heart failure.
</li><li> Give 1 hr before meals for adequate absorption."/>
<question question="How should the adrenergic neuron
blocker reserpine (Serpalan, Sk-Reserpine) be given?" answer="<ul><li> Oral
use only.
</li><li> Administer with food or milk to prevent gastrointestinal (GI)
symptoms.
</li></ul>"/>
<question question="How should the aldosterone
antagonist spironolactone (Aldactone) be given?" answer="<ul><li>Oral use
only.
</li><li> Give alone or combined with other antihypertensive drugs.
</li><li> Reduce dose for patients taking CYP3A4 inhibitors."/>
<question question="How should the alpha1 adrenergic
blocker doxazosin (Cardura) be given?" answer="<ul><li>Oral use only
</li><li> Give at bedtime - especially first dose; subsequent doses
individualized based on orthostatic blood pressure changes.
</li></ul>"/>
<question question="How should the alpha/beta blocker
carvedilol (Coreg) be given?" answer="<ul><li> Oral use only.
</li><li> Give with food to minimize orthostatic hypotension.
</li></ul>"/>
<question question="How should the angiotensin receptor
blocker (ARB) losartan (Cozaar) be given?" answer="<ul><li> ARBs are available
for oral administration only.
</li><li> Losartan is also available in combination with the thiazine diuretic
hydrochlorothiazide (Hyzaar).
</li><li> May be taken with or without food.
</li><li> Beginning dose is decreased for patients taking diuretics or with

liver failure.
</li></ul>"/>
<question question="How should the beta adrenergic
blockers atenolol (Tenormin) and metoprolol (Lopressor) be given?"
answer="<ul><li> Oral or IV use.
</li><li> Give IV initially and then orally for acute myocardial infarction.
</li><li> Give orally for hypertension.
</li><li> Atenolol is available in a tablet, which may be crushed or
swallowed.
</li><li> Metoprolol is available as an immediate-release tablet (Lopressor)
or in a sustained-release dose (Toprol XL) that must not be crushed and must
be swallowed whole.
</li><li> Absorption of metoprolol may be enhanced with food; take at
consistent time each day.
</li><li> Atenolol is best taken before meals or at bedtime.
</li></ul>"/>
<question question="How should the calcium channel
blocker (dihydropyridine) drug nifedipine (Adalat, Procardia) be given?"
answer="<ul><li> Available for oral use in capsules and sustained-release
tablets; sustained-release form is approved to treat hypertension.
</li><li> Sustained-release form must be swallowed whole, and not chewed or
crushed.
</li><li> To prevent reflex tachycardia, nifedipine may be combined with a
beta blocker.
</li></ul>"/>
<question question="How should the cardiac glycoside
digoxin (Lanoxin) be given?" answer="<ul><li> Available as oral tablets,
capsules and elixir as well as for IV use.
</li><li> Give oral form with or without food.
</li><li> Tablets may be crushed and mixed with food if necessary.
</li><li> IV form may be administered directly over at least 5 min; monitor
site carefully for infiltration, which may cause tissue damage.
</li></ul>"/>
<question question="How should the centrally-acting
alpha2 agonist clonidine (Catapres) be given?" answer="<ul><li> Available
orally or as transdermal patch to treat hypertension.
</li><li> Give oral dose at bedtime to prevent daytime sedation.
</li><li> Begin oral dosage low and gradually increase to prevent severe
hypotension.
</li><li> Apply transdermal patch to a dry, relatively hairless area of skin
on the upper outer arm or anterior chest once every 7 days.
</li><li> Rotate transdermal sites and monitor skin for inflammation,
irritation.
</li><li> Be sure to remove the old patch before applying a new patch.
</li></ul>"/>
<question question="How should the class IA/sodium
channel blocker drugs quinidine (Apo-Quinidine, Novo-Quinidine) and
procainamide (Pronestyl) be given?" answer="<ul><li> Available in oral, IM and
IV forms.
</li><li> Give oral dose 1 hr before or 2 hr after meals for best absorption;
give with food if gastrointestinal (GI) symptoms occur.
</li><li> Do not crush or chew extended-release tablets.
</li><li> If giving IV procainamide, wait 4 hr before administering an oral
dose.
</li><li> For IV doses, use an IV pump and infuse at recommended rate and
dilution.
</li><li> Multiple IV solution incompatibilities exist; avoid infusing with
other drugs or solutions.
</li></ul>"/>
<question question="How should the class IB/sodium
channel blocker lidocaine (Xylocaine) be given?" answer="<ul><li> Available
for IM, IV infusion (IV preferred for dysrhythmias; local administration for
anesthesia only).
</li><li> Add 1 g lidocaine to 250 or 500 mL dextrose 5% in water (D5W) and
infuse at 1 to 4 mg/min (per prescription)using an IV pump.
</li><li> Ensure that the correct lidocaine preparation is used for the
specific type of therapy (labeled for IV use only).
</li><li> Incompatible in solution or tubing with other drugs, such as some
antibiotics, phenytoin.
</li></ul>"/>
<question question="How should the class IC/sodium
channel blockers flecainide (Tambocor) and propafenone (Rythmol) be given?"
answer="<ul><li> Available for oral use only.
</li><li> Begin with low dose and increase gradually no more frequently than
every 4 days until maximum or desired dose has been reached.
</li></ul>"/>
<question question="How should the class II/beta
adrenergic blocker propranolol (Inderal) be given?" answer="<ul><li> Available
for oral or IV use.
</li><li> Use the IV route to treat life-threatening dysrhythmias.
</li><li> Take either with or without food at consistent times during the day
to minimize adverse effects.
</li><li> Take patient's blood pressure (BP) and pulse before administering
propranolol; withhold drug and notify provider if BP is below 90 mm/Hg
systolic or if pulse is slower than 60 beats/min.
</li><li> Give IV dose either directly by IV bolus over 1 min or give an
intermittent infusion over 15 to 20 min.
</li></ul>"/>
<question question="How should the class III/potassium

channel blocker amiodarone (Cordarone) be given?" answer="<ul><li> Oral and IV
use.
</li><li> Give oral amiodarone with or without food, but at consistent times
during the day.
</li><li> Infuse IV dose through central line catheter to prevent
thrombophlebitis of peripheral IV sites.
</li><li> Begin oral dosing with hospitalized patient.
</li><li> Correct low potassium or magnesium levels before beginning therapy.
</li></ul>"/>
<question question="How should the class IV/calcium
channel blocker verapamil (Calan) be given?" answer="<ul><li> Oral or IV use.
</li><li> Give oral dose with food to prevent gastrointestinal (GI) upset.
</li><li> Capsules may be opened and sprinkled on food, but not chewed or
dissolved in liquid.
</li><li> IV form: Give dose using recommended dilution over 2 to 3 min;
monitor cardiac rhythm and vital signs continuously.
</li></ul>"/>
<question question="How should the direct-acting
vasodilator (hydralazine) drug hydralazine (Apresoline) be given?"
answer="<ul><li> Oral, IM, or IV forms.
</li><li> Give oral dose with food to enhance effectiveness.
</li><li> Oral dosage usually begins low and is gradually increased.
</li><li> Administer IV form undiluted; do not add to other solutions.
</li></ul>"/>
<question question="How should the fibrate drug
gemfibrozil (Lopid) be given?" answer="<ul><li> Oral use only.
</li><li> Usually taken twice daily, 30 min before breakfast and evening
meals.
</li><li> Monitor periodic LDL, HDL, triglyceride, and total cholesterol
levels for improvement.
</li></ul>"/>
<question question="How should the HMG-CoA reductase
inhibitor (statin) drug simvastatin (Zocor) be given?" answer="<ul><li> Oral
use only.
</li><li> For greatest effectiveness, take in the evening with or without
food.
</li></ul>"/>
<question question="How should the loop diuretic
furosemide (Lasix) be given?" answer="<ul><li> Oral, IM, or IV use.
</li><li> Give oral form with food to prevent gastrointestinal (GI) symptoms.
</li><li> If prescribed more than once daily, give second dose by early
afternoon to prevent nocturia and sleep loss.
</li><li> Give IV form undiluted; administer slowly to prevent ototoxicity.
</li><li> Protect all forms from light; store oral solution in refrigerator
and other forms at controlled room temperature.
</li></ul>"/>
<question question="How should the nitrate drugs
nitroglycerin (Nitrostat, Nitro-Dur, Nitro-Bid) and isosorbide dinitrate
(Isordil) be given?" answer="<ul><li> Nitroglycerin is available as sublingual
tablets, sustained-release capsules or tablets, a translingual spray or
transmucosal tablets, transdermal ointment or patch, and IV form.
</li><li> Two types of isosorbide are available.
</li><li> Isosorbide dinitrate (Isordil) is available in regular, chewable,
sublingual, or sustained-release tablets.
</li><li> Place sublingual tablets under tongue to dissolve when chest pain
starts; if not relieved in 5 min, call 911, take a second tablet; take a third
tablet 5 min later if no relief.
</li><li> Sublingual sprays: Dose equals 1 or 2 sprays; as for sublingual
tablets, no more than 3 doses in a 15 min period.
</li><li> Patient should not swallow transdermal or transmucosal tablets; may
need to moisten mouth to help tablet dissolve.
</li><li> Store tablets in a dark, tightly closed container for no more than
24 months after opening.
</li><li> Transdermal patches are for prevention only; apply to a hairless
area and rotate sites.
</li><li> Remove patches for 10 to 12 hr daily to prevent tolerance; apply
patch in morning, remove at night.
</li><li> Topical ointment: Dosage measured as amount squeezed from tube (e.g.
2 inches = 30 mg); apply to dry skin and cover area with plastic wrap.
</li><li> When discontinuing long-acting forms, taper doses to prevent
increased chest pain (vasospasm).
</li><li> IV form is infused continuously in a glass bottle with special
tubing only.
</li></ul>"/>
<question question="How should the phosphodiesterase
inhibitor milrinone (Primacor) be given?" answer="<ul><li> IV infusion only.
</li><li> Give a loading dose over 10 min and then administer a dose based on
patient's weight by continuous infusion.
</li><li> Some solution incompatibilities exist; use dedicated IV line if
possible.
</li></ul>"/>
<question question="How should the potassium-sparing
diuretic spironolactone (Aldactone) be given?" answer="<ul><li> Oral use.
</li><li> Take with food to increase absorption.
</li><li> Tablets may be crushed and mixed with food or fluid if patient is
unable to swallow them whole.
</li></ul>"/>
<question question="How should the sympathomimetic drug

dobutamine (Dobutrex) be given?" answer="<ul><li> IV infusion only.
</li><li> Dose based on patient's weight and titrated based on continuous
monitoring of vital signs, ECG, urine output, and (if available) cardiac
output and pulmonary wedge pressures.
</li><li> Peak effect obtained about 10 min after infusion begins.
</li><li> Multiple infusion incompatibilities exist; use dedicated IV line for
infusion.
</li><li> Correct any fluid volume deficits before administering dobutamine.
</li></ul>"/>
<question question="How should the thiazide diuretic
hydrochlorothiazide (HydroDIURIL) be given?" answer="<ul><li> Available orally
alone and in fixed-dose combination with multiple other drugs, such as
potassium-sparing diuretics, angiotensin-converting enzyme (ACE) inhibitors,
angiotensin receptor blockers (ARBs), beta blockers and other antihypertensive
drugs.
</li><li> Give with food to minimize gastrointestinal (GI) effects.
</li><li> Give last dose of day by 3 p.m. to prevent nocturia and sleep loss.
</li></ul>"/>
<question question="How should the direct renin
inhibitor aliskiren (Tekturna) be given?" answer="<ul><li> Available in oral
form only.
</li><li> High-fat meals decrease absorption.
</li><li> Give at a consistent time daily relative to meals.
</li><li> Expect a full effect to take 2 weeks.
</li><li> Monitor for hypotension at beginning of therapy and after any dose
increase."/>
</chapter>
<chapter ChapterName="Common Side Effects">
<question question="What are some of the side and/or
adverse effects of the angiotensin-converting enzyme (ACE) inhibitor captopril
(Capoten)?" answer="<ul><li> Severe hypotension following first dose (most
likely in patients taking diuretics, with high blood pressure (BP), or who
have hyponatremia)
</li><li> Dry, nonproductive cough due to increase in bradykinin
</li><li> Rash and report of metallic taste in mouth
</li><li> Angioedema (swelling of mouth, throat [due to inhibition of kinase
II])
</li><li> Hyperkalemia
</li><li> Neutropenia (decrease in white blood cells with increased risk of
infection)
</li></ul>"/>
adverse effects of the adrenergic neuron blocker reserpine (Serpalan, Sk-
Reserpine)?" answer="<ul><li> Severe depression and risk for suicide, which

may linger after reserpine is discontinued
</li><li> Bradycardia and orthostatic hypotension
</li><li> Gastrointestinal symptoms: diarrhea, abdominal cramping
</li></ul>"/>
<question question="What is a side and/or adverse
effect of the aldosterone antagonist spironolactone (Aldactone)?"
answer="Hyperkalemia"/>
adverse effects of the alpha1 adrenergic blocker doxazosin (Cardura)?"
answer="<ul><li> Orthostatic hypotension -especially with first dose and with
dose increases
</li><li> Reflex tachycardia
</li><li> Headache
</li></ul>"/>
adverse effects of the alpha/beta blocker carvedilol (Coreg)?"
answer="<ul><li> Dizziness, hypotension
</li><li> Bradycardia due to blockade of beta1 receptors; may lead to reduced
cardiac output
</li></ul>"/>
adverse effects of the angiotensin receptor blocker (ARB) losartan (Cozaar)?"
answer="<ul><li> Angioedema (occurs less than with angiotensin-converting
enzyme (ACE) inhibitors, but still a potential risk)
</li><li> Headache, insomnia
</li><li> Severe hypotension may occur with overdose or in volume depletion
</li></ul>"/>
adverse effects of the beta adrenergic blockers atenolol (Tenormin) and
metoprolol (Lopressor)?" answer="<ul><li> Bradycardia due to blockade of beta1
receptors; may lead to reduced cardiac output
</li><li> Heart failure - shortness of breath, edema, coughing at night
</li><li> Rebound excitation causing angina pain or myocardial infarction (MI)
with sudden withdrawal of beta blocker in patient with coronary heart disease
(CHD)
</li></ul>"/>
adverse effects of the calcium channel blocker (dihydropyridine) drug
nifedipine (Adalat, Procardia)?" answer="<ul><li> Reflex tachycardia causing
increased angina pain in patients with angina; this effect is more likely with
faster-acting tablets than the sustained-release form
</li><li> Lightheadedness, dizziness (caused by vasodilation)
</li><li> Facial flushing, perception of heat (caused by vasodilation)
</li><li> Peripheral edema of feet and legs
</li><li> Hypotension, especially with overdose

</li><li> Gingival hyperplasia (growth of gum tissue, bleeding gums)
</li></ul>"/>
adverse effects of the cardiac glycoside digoxin (Lanoxin)?" answer="<ul><li>
Nausea, vomiting, anorexia (may be adverse effects or signs of early toxicity)
</li><li> Central nervous system symptoms: headache, visual disturbances, such
as yellow vision and blurred vision (these may be adverse effects or signs of
early toxicity)
</li><li> Cardiac dysrhythmias, especially likely with digoxin toxicity
(outside the very narrow therapeutic range of 0.5 to 0.8 ng/mL). Any
dysrhythmia may occur, with AV block being most common
</li></ul>"/>
adverse effects of the centrally acting alpha2 agonist, clonidine (Catapres)?"
answer="<ul><li> Central nervous system effects: drowsiness, dizziness
</li><li> Dry mouth
</li><li> Rebound hypertensive crisis
</li></ul>"/>
adverse effects of the class IA/sodium channel blocker drugs quinidine (ApoQuinidine, Novo-Quinidine) and procainamide (Pronestyl)?" answer="<ul><li>
Nausea, vomiting, diarrhea
</li><li> Tachycardia (more frequent with quinidine due to anticholinergic
effects)
</li><li> Hypotension (less severe with oral administration than IV)
</li><li> Widen the QRS complex and prolong QT interval
</li><li> Ventricular dysrhythmias occur due to toxicity; oral or IV therapy
(QRS too wide or QT interval too long)
</li><li> Arterial embolism (caused by dislodging small clots) if treating
atrial fibrillation
</li><li> Speed shock with too rapid IV infusion (flushing, headache,
irregular heart rate, severe hypotension, loss of consciousness, cardiac
arrest)
</li><li> Quinidine: Cinchonism (tinnitus, visual disturbances, headache,
nausea, vomiting)
</li><li> Procainamide: SLE (systemic lupus erythematosus) seen in 50% of
patients after a year of high dose oral therapy)
</li><li> Agranulocytosis (procainamide with continued use)
</li></ul>"/>
adverse effects of the class IB/sodium channel blocker lidocaine (Xylocaine)?"
answer="<ul><li> CNS effects (toxicity): confusion, drowsiness, restlessness,
paresthesias, muscle twitching or tremors, seizures, respiratory arrest
</li><li> Hypotension, bradycardia, heart block with high doses

</li></ul>"/>
adverse effects of the class IC/sodium channel blockers flecainide (Tambocor)
and propafenone (Rythmol)?" answer="<ul><li> Visual effects: blurred vision,
difficulty focusing
</li><li> Worsening of heart failure; edema
</li><li> Widen QRS complex; prolongs QT and PR intervals
</li><li> Potential for 1st degree atrioventricular (AV) block; multiple
dysrhythmias may occur
</li></ul>"/>
adverse effects of the class II/beta adrenergic blocker propranolol
(Inderal)?" answer="<ul><li> Bradycardia due to blockade of beta1 receptors;
may lead to reduced cardiac output
</li><li> Rebound excitation causing angina pain or myocardial infarction (MI)
with sudden withdrawal of beta blocker in patient with coronary heart disease
(CHD)
</li><li> Peripheral arterial insufficiency (similar to Raynaud's disease)
</li><li> Central nervous system (CNS) effects: confusion, fatigue, drowsiness
</li></ul>"/>
adverse effects of the class III/potassium channel blocker amiodarone
(Cordarone)?" answer="<ul><li>Nausea, vomiting, constipation
</li><li> Pulmonary toxicity with pneumonitis (causing fever, cough, shortness
of breath) - occur most frequently with long-term and/or high-dose use and may
lead to pulmonary fibrosis
</li><li> Visual effects: optic neuropathy with possible blindness and corneal
microdeposits, which may cause severe sensitivity to light, blurred vision
</li><li> Cardiac effects: bradycardia and hypotension (common with IV dose)
</li><li> Heart failure may be worsened by amiodarone therapy
</li><li> Blue-grey discoloration of skin
</li><li> CNS effects: dizziness, tremor, hallucinations"/>
adverse effects of the class IV/calcium channel blocker verapamil (Calan)?"
answer="<ul><li> Hypotension, especially with IV dose or overdose
</li><li> Bradycardia, especially with IV dose, but also with oral therapy
</li><li> Heart failure, peripheral edema of feet and legs
</li><li> Lightheadedness, dizziness (caused by vasodilation)"/>
adverse effects of the direct-acting vasodilator drug hydralazine
(Apresoline)?" answer="<ul><li> Headache and palpitations (especially in first
few hours following first dose, and usually subsiding spontaneously)
</li><li> Tachycardia
</li><li> A systemic lupus erythematosus (SLE)-like syndrome may occur (facial
rash, joint pain, fever, nephritis, pericarditis) - most likely with high
doses
</li><li> Fluid retention, edema
</li></ul>"/>
adverse effects of the fibrate drug gemfibrozil (Lopid)?" answer="<ul><li>
Nausea, vomiting, diarrhea
</li><li> Gallstones
</li><li> Myopathy (pain in muscles and joints)
</li><li> Liver toxicity
</li></ul>"/>
adverse effects of the HMG-CoA reductase inhibitor (statin) drug simvastatin
(Zocor)?" answer="<ul><li> Myopathy (pain in muscles and joints, which can
progress to rhabdomyolysis [breakdown of muscle protein causing kidney
damage])
</li><li> Liver toxicity"/>
adverse effects of the loop diuretic furosemide (Lasix)?" answer="<ul><li>
Electrolyte imbalance: hyponatremia, hypochloremia, severe fluid loss
(dehydration), and hypokalemia
</li><li> Hypotension
</li><li> Ototoxicity (all loop diuretics): temporary or permanent depending
on the specific drug
</li><li> Hyperglycemia (especially in patients who have diabetes mellitus)
</li><li> Increased uric acid levels (hyperuricemia) with possible gouty
arthritis in susceptible patients
</li></ul>"/>
adverse effects of the nitrate drugs nitroglycerin (Nitrostat, Nitro-Dur,
Nitro-Bid) and isosorbide dinitrate (Isordil)?" answer="<ul><li> Headache
(severe at first, reduced with treatment)
</li><li> Orthostatic hypotension
</li><li> Tolerance develops quickly to all forms (decreased effectiveness)
</li></ul>"/>
adverse effects of the phosphodiesterase inhibitor milrinone (Primacor)?"
answer="<ul><li> Hypokalemia
</li><li> Cardiac dysrhythmias, hypotension
</li><li> Anginal chest pain
</li></ul>"/>

adverse effects of the potassium-sparing diuretic spironolactone (Aldactone)?"
answer="<ul><li> Hyperkalemia
</li><li> Menstrual irregularities, abnormal hair growth (e.g. on face), and
deepening of voice may occur in women; gynecomastia (growth of breast tissue)
may occur in men
</li></ul>"/>
adverse effects of the sympathomimetic drug dobutamine (Dobutrex)?"
answer="<ul><li> Tachycardia, cardiac dysrhythmias, and possible angina
pain"/>
adverse effects of the thiazide diuretic hydrochlorothiazide (HydroDIURIL)?"
answer="<ul><li> Electrolyte imbalance: hyponatremia, hypochloremia, severe
fluid loss (dehydration), and hypokalemia
</li><li> Hyperglycemia (especially in patients who have diabetes mellitus)
</li><li> Increased uric acid levels (hyperuricemia) with possible gouty
arthritis in susceptible patients
</li></ul>"/>
adverse effects of the direct renin inhibitor aliskiren (Tekturna)?"
answer="<ul><li> Hyperkalemia
</li><li> Cough or angioedema (swelling of mouth, throat)
</li><li> Diarrhea, abdominal pain
</li></ul>"/>
</chapter>
<chapter ChapterName="Nursing Interventions">
<question question="What interventions should the
health care professional use when caring for a patient who is taking the
angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten)?"
answer="<ul><li> Start angiotensin-converting enzyme (ACE) inhibitors with low
dose and gradually increase to prevent hypotension.
</li><li> Diuretics may be temporarily stopped before first dose of ACE
inhibitor is given.
</li><li> Monitor blood pressure (BP) following first dose.
</li><li> Manage severe hypotension by expanding blood volume with IV fluid
therapy.
</li><li> Discontinue use if dry cough occurs.
</li><li> Report rash and metallic taste (ACE inhibitor may be discontinued).
</li><li> Treat severe angioedema with IV epinephrine.
</li><li> Discontinue use if angioedema occurs.
</li><li> Monitor potassium levels in a patient who is at risk, because the
drug can cause hyperkalemia.
</li><li> Monitor white blood cell counts with differential every 2 weeks for
first 3 months of therapy and then periodically, because the drug can cause
neutropenia and increase the risk for infection.
</li></ul>"/>
adrenergic neuron blocker reserpine (Serpalan and Sk-Reserpine)?"
answer="<ul><li> Report signs of depression and suicidal ideation to provider.
</li><li> Ensure that lowest possible dosage of reserpine is being given.
</li><li> Monitor pulse rate and orthostatic vital signs and report
bradycardia.
</li><li> Assist with ambulation.
</li><li> Report severe or prolonged gastrointestinal (GI) effects (diarrhea,
cramps).
</li></ul>"/>
aldosterone antagonist spironolactone (Aldactone)?" answer="<ul><li> Monitor
for signs of hyperkalemia.
</li><li> Monitor periodic potassium levels, BUN, and creatinine in patients
at risk for hyperkalemia.
</li><li> Ensure that patient is not taking potassium-sparing diuretics or
other drugs that raise potassium levels."/>
alpha1 adrenergic blocker doxazosin (Cardura)? " answer="<ul><li> Monitor
orthostatic blood pressure and pulse 2 to 6 hr after first dose or after dose
increases.
</li><li> Report drop of greater than 20 mm Hg systolic between lying/standing
to
provider.
Report tachycardia to provider.
</li><li> Report frequent headaches.
</li></ul>"/>
alpha/beta blocker carvedilol (Coreg)?" answer="<ul><li> Monitor blood
pressure.
</li><li> Report hypotension and dizziness.
</li><li> Report heart rate slower than 60 beats/min (or prearranged
parameter) to provider.
</li></ul>"/>
angiotensin receptor blocker (ARB) losartan (Cozaar)? " answer="<ul><li> Treat

severe angioedema with IV epinephrine.
</li><li> Discontinue use of any angiotensin receptor blocker (ARB) if
angioedema occurs.
</li><li> Monitor for and report CNS effects (headache, insomnia).
</li><li> Monitor blood pressure (BP) before administering losartan dose.
</li><li> Manage severe hypotension by expanding volume using IV fluid
therapy.
</li></ul>"/>
health care professional use when caring for a patient who is taking the beta
adrenergic blockers atenolol (Tenormin) and metoprolol (Lopressor)?"
answer="<ul><li> Report heart rate slower than 60 beats/min (or prearrange
parameter) to provider.
</li><li> Monitor for signs of heart failure and report to provider.
</li><li> Teach patient not to stop suddenly to prevent rebound excitation
causing angina pain or myocardial infarction in a patient who has coronary
heart disease.
</li><li> On discontinuation, taper dose slowly over 1 to 2 weeks.
</li></ul>"/>
calcium channel blocker (dihydropyridine) drug nifedipine (Adalat,
Procardia)?" answer="<ul><li> Give nifedipine along with beta blocker to
prevent tachycardia.
</li><li> Monitor heart rate.
</li><li> Report angina, lightheadedness, dizziness.
</li><li> Assist with ambulation as needed.
</li><li> Inform patient that facial flushing may occur.
</li><li> Report peripheral edema (a diuretic may be prescribed if edema
occurs).
</li><li> Monitor blood pressure carefully as starting dosage is established.
</li><li> Notify provider and withhold dose for blood pressure (BP) below 90
mm Hg systolic or for prearranged parameter.
</li><li> Inspect gingival tissue periodically for enlargement (nifedipine may
be discontinued).
</li><li> Advise regular dental care.
</li></ul>"/>
cardiac glycoside digoxin (Lanoxin)?" answer="<ul><li> Recognize that vomiting
may cause hypokalemia, which increases risk for digoxin toxicity.
</li><li> Report gastrointestinal (GI) symptoms
</li><li> Report central nervous system (CNS) effects
</li><li> Take apical pulse for a minute before administering digoxin;

withhold drug if pulse falls below prescribed parameters (such as 60 beats/min
in adults).
</li><li> Monitor digoxin levels frequently.
</li><li> Monitor serum potassium levels; administer potassium for low or
borderline low values.
</li><li> Monitor cardiac rhythm and treat dysrhythmias per protocol.
</li><li> For severe digoxin toxicity, digoxin immune FAB (Digibind) is
administered IV as an antidote to neutralize digoxin.
</li></ul>"/>
centrally acting alpha2 agonist clonidine (Catapres)?" answer="<ul><li>
Monitor patient for drowsiness, dizziness.
</li><li> Tell patient that this effect will decrease over first few weeks of
therapy.
</li><li> When discontinued, taper dose slowly over several days.
</li></ul>"/>
health care professional use when caring for a patient who is taking the class
IA/sodium channel blocker drugs quinidine (Apo-Quinidine, Novo-Quinidine) and
procainamide (Pronestyl)?" answer="<ul><li> Report gastrointestinal (GI)
nausea, vomiting, diarrhea.
</li><li> Monitor pulse rate because the drug can cause tachycardia.
</li><li> Monitor blood pressure because the drug can cause hypotension.
</li><li> Keep patient supine during IV therapy.
</li><li> Monitor ECG periodically with oral therapy or constantly with IV
therapy; if cardiac effects such as ventricular dysrhythmias occur, withhold
sodium channel blocker and notify provider.
</li><li> Monitor plasma drug levels to determine early toxicity.
</li><li> Warfarin may be administered for several weeks before and after
sodium channel blocker therapy.
</li><li> Monitor for signs of pulmonary embolism.
</li><li> Use an IV pump, do not exceed prescribed rates, monitor vital signs
and cardiac rhythm constantly, because the drug can cause speed shock with too
rapid IV infusion (flushing, headache, irregular heart rate, severe
hypotension, loss of consciousness, cardiac arrest).
</li><li> Report cinchonism (tinnitus, visual disturbances, headache, nausea,
vomiting).
</li><li> Report signs of systemic lupus erythematosus.
</li><li> Do not give procainamide on a long-term basis.
</li><li> Report indications of agranulocytosis.
</li><li> Monitor complete blood count."/>
IB/sodium channel blocker lidocaine (Xylocaine)?" answer="<ul><li> Monitor

confusion, drowsiness, restlessness, paresthesias, muscle twitching or
tremors, seizures, respiratory arrest; hold dose and notify provider if they
occur.
</li><li> Monitor vital signs and cardiac rhythm because high doses can cause
hypotension, bradycardia, heart block.
</li></ul>"/>
IC/sodium channel blockers flecainide (Tambocor) and propafenone (Rythmol)?"
answer="<ul><li> Report visual effects (blurred vision, difficulty focusing).
</li><li> Monitor for crackles in lungs, edema, and weight gain, and report
these effects to provider.
</li><li> Monitor periodic ECG; use ambulatory Holter monitor if needed to
monitor for dysrhythmias.
</li><li> Monitor plasma trough levels to detect early toxicity.
</li></ul>"/>
II/beta adrenergic blocker propranolol (Inderal)?" answer="<ul><li> Monitor
heart rate and report rate slower than 60 beats/min (or prearranged parameter)
to provider.
</li><li> Monitor for signs of heart failure and report to provider.
</li><li> Teach patient not to stop beta blocker suddenly.
</li><li> On discontinuation, taper dose slowly over 1 to 2 weeks.
</li><li> Monitor color, temperature, and pulses in extremities (pulses may be
present even if poor circulation exists) because the drug can cause peripheral
arterial insufficiency (similar to Raynaud's disease).
</li><li> Monitor for confusion, fatigue, drowsiness.
</li></ul>"/>
III/potassium channel blocker amiodarone (Cordarone)?" answer="<ul><li> Report
nausea, vomiting, constipation.
</li><li> Consider reducing dose for severe gastrointestinal (GI) symptoms.
</li><li> Test baseline chest X-ray and pulmonary function before starting
therapy because the drug can cause pulmonary toxicity with pneumonitis
(causing fever, cough, shortness of breath).
</li><li> Monitor pulmonary function testing results periodically.
</li><li> Auscultate breath sounds and report changes or adventitious sounds.
</li><li> Monitor for changes in vision, light sensitivity.
</li><li> Monitor pulse and blood pressure, and report vital signs below
prescribed parameters.
</li><li> Monitor cardiac rhythm constantly during infusion.
</li><li> Monitor for weight changes and edema for both IV and oral therapy.
</li><li> Monitor for blue-grey discoloration of skin.

</li><li> Report central nervous system (CNS) effects.
</li></ul>"/>
IV/calcium channel blocker verapamil (Calan)?" answer="<ul><li> IV form:
Monitor cardiac rhythm and vital signs continuously; keep patient supine for 1
hr following dose.
</li><li> Monitor blood pressure carefully as starting oral dosage is
established.
</li><li> Notify provider and withhold dose for BP below 90 mm Hg. systolic or
for prearranged parameter.
</li><li> Monitor heart rate; withhold dose for pulse rate slower than 60
beats/min or prescribed parameter and notify provider.
</li><li> Monitor for and report edema (a diuretic may be prescribed if edema
occurs).
</li><li> For hospitalized patient, monitor intake and output, and report low
output.
</li><li> Monitor for crackles in lungs.
</li><li> Monitor for and report lightheadedness, dizziness."/>
direct acting vasodilator (hydralazine) drug hydralazine (Apresoline)?"
answer="<ul><li> Advise patient that headache and palpitations may occur
following first dose.
</li><li> Monitor pulse and report tachycardia.
</li><li> A beta blocker may be added to decrease tachycardia; watch for
hypotension with additional antihypertensive agent.
</li><li> Monitor and report signs of a systemic lupus erythematosus-like
reaction (facial rash, joint pain, fatigue) to provider (hydralazine will be
discontinued).
</li><li> Monitor for edema, crackles in lungs.
</li><li> Hydralazine may be combined with a diuretic to minimize edema.
</li><li> Taper hydralazine slowly when discontinued."/>
fibrate drug gemfibrozil (Lopid)?" answer="<ul><li> Report nausea, vomiting,
diarrhea.
</li><li> Report symptoms of gall bladder disease.
</li><li> Report myopathy.
</li><li> Measure creatine phosphokinase (CPK) if muscle pain occurs.
</li><li> Monitor liver function tests and report impaired liver function.
</li></ul>"/>
health care professional use when caring for a patient who is taking the HMG-
CoA reductase inhibitor (Statin) drug simvastatin (Zocor)?" answer="<ul><li>

Monitor for and report myopathy.
</li><li> Measure creatine phosphokinase (CPK) if muscle pain occurs.
</li><li> Monitor liver function tests and report impaired liver function.
</li></ul>"/>
health care professional use when caring for a patient who is taking the loop
diuretic furosemide (Lasix)?" answer="<ul><li> Monitor serum electrolyte
levels periodically; notify provider for abnormal levels.
</li><li> Monitor carefully for signs of electrolyte imbalance and
dehydration.
</li><li> If hypokalemia occurs, monitor for cardiac dysrhythmias.
</li><li> If hypokalemia is a risk (e.g. patient also taking digoxin),
furosemide may be combined with a potassium-sparing diuretic.
</li><li> Monitor blood pressure frequently during treatment because the drug
can cause hypotension.
</li><li> Ensure that the patient does not take other ototoxic drugs (additive
effect)
</li><li> Monitor for hearing loss, tinnitus, vertigo.
</li><li> Monitor blood glucose periodically.
</li><li> Monitor blood glucose more frequently in a patient who has diabetes
mellitus; insulin or oral antidiabetic drug dosage may need to be increased.
</li><li> Monitor uric acid levels periodically.
</li></ul>"/>
nitrate drugs nitroglycerin (Nitrostat, Nitro-Dur, Nitro-Bid) and isosorbide
dinitrate (Isordil)?" answer="<ul><li> Caregivers should avoid touching
ointment when applying.
</li><li> Monitor length and severity of headache.
</li><li> Monitor baseline orthostatic blood pressure (BP) and pulse; check
again when nitrate form reaches its peak effect (e.g. 1 hr for transdermal
forms).
</li><li> Monitor heart rate in patients taking nitrates.
</li><li> Give beta blocker or calcium channel blocker, if prescribed, to
suppress tachycardia.
</li><li> Monitor for drug tolerance.
</li><li> Give any nitroglycerin form in smallest needed amount; use
intermittent scheduling for transdermal and long-acting forms.
</li></ul>"/>
phosphodiesterase inhibitor drug milrinone (Primacor)?" answer="<ul><li>
Correct fluid deficits and hypokalemia before beginning infusion.
</li><li> Monitor potassium levels and correct hypokalemia as needed during

infusion.
</li><li> Monitor vital signs and ECG rhythm continuously during infusion.
</li><li> Decrease dosage for dysrhythmias or blood pressure falling below
</li><li> Monitor for chest pain during infusion.
</li></ul>"/>
potassium-sparing diuretic spironolactone (Aldactone)?" answer="<ul><li>
Monitor serum potassium levels during treatment.
</li><li> If hyperkalemia occurs, monitor for cardiac dysrhythmias.
</li><li> Spironolactone may be combined with a thiazide or loop diuretic to
maintain normal potassium levels.
</li><li> Monitor and report menstrual irregularities, abnormal hair growth,
deepening of voice, gynecomastia.
</li></ul>"/>
sympathomimetic drug dobutamine (Dobutrex)?" answer="<ul><li> Monitor ECG
rhythm and vital signs continuously during infusion.
</li><li> Treat cardiac dysrhythmias and chest pain as needed, and prepare to
decrease or discontinue dobutamine for tachydysrhythmias.
</li></ul>"/>
thiazide diuretic hydrochlorothiazide (HydroDIURIL)?" answer="<ul><li> Monitor
serum electrolyte levels periodically; notify provider of abnormal levels.
</li><li> Monitor carefully for signs of electrolyte imbalance and
dehydration.
</li><li> If hypokalemia occurs, monitor for dysrhythmias.
</li><li> If hypokalemia is a risk (e.g. patient also taking digoxin).
hydrochlorothiazide may be combined with a potassium supplement or potassiumsparing diuretic.
</li><li> Monitor blood glucose periodically.
</li><li> Monitor blood glucose more frequently in a patient who has diabetes
mellitus; insulin or oral antidiabetic drug dosage may need to be increased.
</li><li> Monitor uric acid levels periodically.
</li></ul>"/>
direct renin inhibitor aliskiren (Tekturna)?" answer="<ul><li> Monitor for
signs of hyperkalemia.
</li><li> Monitor periodic potassium levels, BUN, and creatinine in a patient
at risk for hyperkalemia.
</li><li> Ensure that patient is not taking potassium-sparing diuretics or

other drugs that raise potassium levels.
</li><li> Report persistent cough.
</li><li> Report angioedema immediately.
</li><li> Treat moderate to severe angioedema with epinephrine.
</li><li> Report diarrhea and abdominal pain.
</li></ul>"/>
</chapter>
<chapter ChapterName="Patient Instructions">
<question question="What important instructions should
the health care professional give the patient who is taking the angiotensinconverting enzyme (ACE) inhibitor drug captopril (Capoten)?" answer="<ul><li>
Be aware that hypotension may occur following the first dose.
</li><li> Lie supine if lightheadedness occurs.
</li><li> Report dry cough.
</li><li> Report rash.
</li><li> Report metallic or decreased ability to taste foods associated with
decreased intake and weight loss.
</li><li> Report minor swelling of mouth, throat; call 911 immediately if
severe reaction occurs.
</li><li> Refrain from using potassium supplements and potassium-containing
salt substitutes.
</li><li> Report palpitations, muscle twitching, weakness or paresthesias in
extremities.
</li><li> Report sore throat or other signs of infection.
</li><li> Do not take if pregnant or breastfeeding.
</li></ul>"/>
the health care professional give the patient who is taking the adrenergic
neuron blocker drug reserpine (Serpalan, Sk-Reserpine)?" answer="<ul><li>
Report feelings of depression, including insomnia, and loss of appetite and
interest in daily activities.
</li><li> Do not perform dangerous activities, such as driving, until effects
are known.
</li><li> Move slowly from lying down to sitting and standing to prevent
falling.
</li><li> Report dizziness, syncope to provider.
</li><li> Report prolonged or severe gastrointestinal (GI) effects (diarrhea,
cramps).
</li></ul>"/>
the health care professional give the patient who is taking the aldosterone
antagonist drug spironolactone (Aldactone)?" answer="<ul><li> Do not take
potassium supplements or use potassium-containing salt substitutes or drugs

that raise potassium levels unless prescribed by the provider.
</li><li> Report palpitations, muscle twitching, weakness, or paresthesias in
extremities."/>
the health care professional give the patient who is taking the alpha1
adrenergic blocker drug doxazosin (Cardura)?" answer="<ul><li> Report
dizziness, syncope, rapid heartbeat, or palpitations.
</li><li> Take this drug at bedtime.
</li><li> Rise slowly from lying to sitting or standing to prevent injury.
</li><li> Do not perform hazardous activities, such as driving, for at least
12 hr following first dose and subsequent dosage increases.
</li><li> Report an increase in the frequency of headaches.
</li></ul>"/>
the health care professional give the patient who is taking the alpha/beta
blocker drug carvedilol (Coreg)?" answer="<ul><li> Report dizziness, syncope.
</li><li> Move slowly from lying to standing position to prevent falls.
</li><li> Do not perform hazardous activity, such as driving, until effects
are known.
</li><li> Check pulse rate daily before taking drug and report to provider for
pulse slower than 60 beats/min (or prearranged parameter).
</li></ul>"/>
the health care professional give the patient who is taking the angiotensin
receptor blocker (ARB) drug losartan (Cozaar)?" answer="<ul><li> Report minor
swelling of mouth, throat to provider; call 911 immediately if severe reaction
occurs.
</li><li> Report frequent headaches or insomnia.
</li><li> Report episodes of fainting, dizziness.
</li><li> Do not take if pregnant or breastfeeding.
</li><li> Tell provider if pregnancy is a possibility."/>
the health care professional give the patient who is taking the beta
adrenergic blocker drugs atenolol (Tenormin) and metoprolol (Lopressor)?"
answer="<ul><li> Check pulse rate daily before taking the drug and report a
pulse slower than 60 beats/min (or prearranged parameter).
</li><li> Report shortness of breath, extremity edema, night cough.
</li><li> Do not stop taking this drug abruptly; talk to the provider.
</li><li> Report increase in angina or new onset of chest pain.
</li></ul>"/>
the health care professional give the patient who is taking the calcium
channel blocker (dihydropyridine) drug nifedipine (Adalat, Procardia)?"

answer="<ul><li> Report rapid heartbeat, increase in angina pain.
</li><li> Do not perform hazardous activities such as driving, until effects
are known.
</li><li> Be aware that facial flushing may occur.
</li><li> Report swelling of feet and legs.
</li><li> Advise patient to take as prescribed and not to increase dosage.
</li><li> Report dizziness, syncope.
</li><li> Report bleeding gums, gum tissue growth.
</li><li> Obtain regular dental care.
</li></ul>"/>
the health care professional give the patient who is taking the cardiac
glycoside digoxin (Lanoxin)?" answer="<ul><li> Report nausea, loss of
appetite, or vomiting.
</li><li> Report headache, or visual disturbances.
</li><li> Report heart palpitations.
</li><li> Learn to monitor pulse rate and report decrease or increase beyond
</li><li> To decrease risk of toxicity or low serum levels, take digoxin at
the same time each day; do not skip or double a dose.
</li><li> Report signs of hypokalemia, such as muscle weakness.
</li></ul>"/>
the health care professional give the patient who is taking the centrally
acting alpha2 agonist drug clonidine (Catapres)?" answer="<ul><li> Take at
bedtime to minimize drowsiness, dizziness.
</li><li> Do not perform hazardous activities, such as driving, until effects
are known.
</li><li> Suck hard candies, chew sugarless gum, sip water to minimize dry
mouth.
</li><li> Be assured that dry mouth will diminish with time.
</li><li> Do not abruptly stop taking clonidine; when discontinued, taper
according to instructions.
</li></ul>"/>
the health care professional give the patient who is taking the class
IA/sodium channel blocker drugs quinidine (Apo-Quinidine, Novo-Quinidine) and
procainamide (Pronestyl)?" answer="<ul><li> Take with food if nausea,
vomiting, diarrhea occur.
</li><li> Report gastrointestinal (GI) symptoms to provider.
</li><li> Monitor pulse rate and report changes from prescribed parameters;
keep record of pulse rate.
</li><li> Avoid hazardous activities such as driving if hypotension occurs.

</li><li> Do not change prescribed dose or dosage intervals; take at fixed
times daily.
</li><li> Be aware that monitoring of blood, ECG occurs.
</li><li> Report sudden chest pain, dyspnea to provider; call 911 for severe
symptoms.
</li><li> Be aware of the reasons for use of the IV infusion pump, vital sign
equipment, and cardiac monitors.
</li><li> Report flushing, headache or feeling of faintness immediately.
</li><li> Report symptoms of cinchonism to provider.
</li><li> Report onset of rash, fatigue, muscle and joint pain.
</li><li> Report fatigue, weakness, easy bruising or infection.
</li></ul>"/>
IB/sodium channel blocker drug lidocaine (Xylocaine)?" answer="<ul><li> Report
numbness of lips, unusual sensations.
</li><li> Be aware that continuous cardiac monitoring and frequent vital sign
monitoring occurs during infusion.
</li></ul>"/>
IC/sodium channel blocker drugs flecainide (Tambocor) and propafenone
(Rythmol)?" answer="
</li><li> Report any visual changes (blurred vision, difficulty focusing).
</li><li> Have regular ophthalmic examinations.
</li><li> Report shortness of breath, edema.
</li><li> Comply with temporary use of Holter monitor if necessary.
</li></ul>"/>
the health care professional give the patient who is taking the class II/beta
adrenergic blocker drug propranolol (Inderal)?" answer="<ul><li> Check pulse
rate daily before taking drug and report pulse slower than 60 beats/min (or
prearranged parameter).
</li><li> Report shortness of breath, extremity edema, night cough.
</li><li> Do not stop taking this drug abruptly; talk to the provider.
</li><li> Report increase in angina or new onset of chest pain.
</li><li> Report sensations of cold, numbness in hands or feet.
</li><li> Protect extremities from severe cold.
</li><li> Report confusion, fatigue, drowsiness.
</li><li> Avoid hazardous activities, such as driving, until effects are
known.
</li></ul>"/>
III/potassium channel blocker drug amiodarone (Cordarone)?" answer="<ul><li>

Take with food or milk if nausea, vomiting, or constipation occur (but be sure
to take at consistent times during the day).
</li><li> Comply with chest x-ray and pulmonary function testing.
</li><li> Report fever, dry cough, shortness of breath or other respiratory
symptoms.
</li><li> Report sensitivity to light and changes in vision.
</li><li> Obtain regular ophthalmic checkups.
</li><li> Wear sunglasses when out in sunlight.
</li><li> For oral therapy, monitor pulse rate and report rates slower than 60
beats/min.
</li><li> Report weight gain and edema.
</li><li> Be aware that skin discoloration may occur.
</li><li> Report tremor, dizziness, hallucinations.
</li><li> Avoid hazardous activity such as driving if dizziness occurs.
</li><li> Due to long half-life of this drug, avoid pregnancy and
breastfeeding during therapy and for several months after therapy is
discontinued.
</li></ul>"/>
IV/calcium channel blocker drug verapamil (Calan)?" answer="<ul><li> Take as
prescribed; do not increase dosage.
</li></ul>"/>
the health care professional give the patient who is taking the direct-acting
vasodilator (hydralazine) drug hydralazine (Apresoline)?" answer="<ul><li>
Headache and palpitations may occur 2 to 4 hr following first dose; notify
provider if these do not subside.
</li><li> Plan to perform quiet, nonhazardous activities following first dose.
</li><li> Beginning with a low dose will minimize the first dose effects.
</li></ul>"/>
the health care professional give the patient who is taking the fibrate drug
gemfibrozil (Lopid)?" answer="<ul><li> Report nausea, vomiting, diarrhea.
</li><li> Report new inability to tolerate fried foods, upper abdominal
discomfort and bloating.
</li><li> Report muscle or joint pain.
</li><li> Report abdominal pain, jaundice, fatigue.
</li></ul>"/>
the health care professional give the patient who is taking the HMG-CoA
reductase inhibitor (statin) drug simvastatin (Zocor)?" answer="<ul><li>

Report muscle or joint pain.
</li><li> Report abdominal pain, jaundice, fatigue.
</li><li> Comply with periodic liver function testing.
</li></ul>"/>
the health care professional give the patient who is taking the loop diuretic
furosemide (Lasix)?" answer="<ul><li> Eat foods rich in potassium (if
indicated), such as citrus fruits, potatoes, bananas.
</li><li> Report signs of electrolyte imbalance, such as confusion, muscle
twitching or weakness, irregular pulse, nausea.
</li><li> Have blood pressure monitored frequently.
</li><li> Avoid hazardous activities, such as driving, until effects are
known.
</li><li> Report new onset of hearing loss, ringing in ears, or vertigo.
</li><li> Patients who has diabetes mellitus needs to carefully monitor blood
glucose levels and notify provider for persistent hyperglycemia.
</li><li> Be aware that uric acid levels may increase, usually without
symptoms.
</li><li> Patient with a history of gout needs to report symptom onset to a
provider."/>
the health care professional give the patient who is taking the nitrate drugs
nitroglycerin (Nitrostat, Nitro-Dur, Nitro-Bid) and isosorbide dinitrate
(Isordil)?" answer="<ul><li> Take over-the-counter analgesic for unrelieved
headaches (most subside spontaneously within 20 min).
</li><li> Move slowly from lying down to sitting or standing to prevent
injury.
</li><li> Do not perform hazardous activity, such as driving, if dizziness
occurs.
</li><li> Take pulse, and report tachycardia above prescribed parameters.
</li><li> Remove transdermal forms for part of each day.
</li><li> Take only as many sublingual tablets as needed.
</li></ul>"/>
the health care professional give the patient who is taking the
phosphodiesterase inhibitor drug milrinone (Primacor)?" answer="<ul><li> Be
aware that laboratory monitoring is ongoing before, during and after infusion.
</li><li> Be aware that ECG rhythm and vital sign monitoring is performed
continuously during infusion.
</li><li> Report chest pain during infusion.
</li></ul>"/>

the health care professional give the patient who is taking the potassiumsparing diuretic drug spironolactone (Aldactone)?" answer="<ul><li> Report
palpitations, irregular pulse, or other signs of hyperkalemia.
</li><li> Avoid potassium supplements, large amounts of high potassium foods,
and salt substitutes.
</li><li> Report menstrual irregularities, abnormal hair growth, deepening of
voice, gynecomastia.
</li></ul>"/>
the health care professional give the patient who is taking the
sympathomimetic drug dobutamine (Dobutrex)?" answer="<ul><li> Be aware that
continuous monitoring is performed during administration.
</li><li> Report chest pain immediately.
</li></ul>"/>
the health care professional give the patient who is taking the thiazide
diuretic drug hydrochlorothiazide (HydroDIURIL)?" answer="<ul><li> Eat foods
rich in potassium (if indicated), such as citrus fruits, potatoes, bananas.
</li><li> Report signs of electrolyte imbalance, such as confusion, muscle
twitching or weakness, irregular pulse, nausea.
</li><li> Patients who have diabetes mellitus need to carefully monitor blood
glucose levels and notify provider for persistent hyperglycemia.
</li><li> Be aware that uric acid levels may increase, usually without
symptoms.
</li><li> Patient with a history of gout needs to report symptom onset to a
provider.
</li></ul>"/>
the health care professional give the patient who is taking the direct renin
inhibitor aliskiren (Tekturna)?" answer="<ul><li> Do not take potassium
supplements, salt substitutes, or drugs that raise potassium levels.
</li><li> Report palpitations, muscle twitching, weakness, numbness, and
tingling.
</li><li> Report persistent cough.
</li><li> Report minor swelling of the mouth or throat; call 911 immediately
for a severe reaction.
</li><li> Report diarrhea and abdominal pain.
</li><li> Stop taking aliskiren if pregnant; fetal injury may occur after the
first trimester.
</li></ul>"/>
</chapter>
<chapter ChapterName="Contraindications">
<question question="What are some contraindications

that would make taking the angiotensin-converting enzyme (ACE) inhibitor drug
captopril (Capoten) risky for the patient?" answer="<ul><li> Pregnancy (risk
category D [fetal damage])
</li><li> Lactation
</li><li> Angioedema or allergy to ACE inhibitors
</li><li> Hypotension
</li><li> Liver disease with elevated liver enzymes"/>
that would make taking the adrenergic neuron blocker reserpine (Serpalan, SkReserpine) risky for the patient?" answer="<ul><li> Pregnancy (risk category
D)
</li><li> Lactation
</li><li> Previous allergy to rauwolfia alkaloids
</li><li> Depressive disorder
</li><li> Peptic ulcer or ulcerative colitis
</li><li> Use of MAOI antidepressants
</li><li> Child"/>
that would make taking the aldosterone antagonist spironolactone (Aldactone)
risky for the patient?" answer="<ul><li> Serum potassium above normal levels
(greater than 5.0 mEq/L)
</li><li> Type 2 diabetes mellitus with microalbuminuria
</li><li> Increased serum creatinine or decreased creatinine clearance
</li><li> Lactation"/>
that would make taking the alpha1 adrenergic blocker doxazosin (Cardura) risky
for the patient?" answer="<ul><li> Allergy to doxazosin or other alpha1
adrenergic blockers
</li><li> Hypotension; history of syncope
</li><li> Child"/>
that would make taking the alpha/beta blocker carvedilol (Coreg) risky for the
patient?" answer="<ul><li> Severe unstable heart failure
</li><li> Asthma or other chronic respiratory disorders
</li><li> Heart block or severe bradycardia
</li><li> Cardiogenic shock
</li><li> Lactation"/>
that would make taking the angiotensin receptor blocker (ARB) losartan
(Cozaar) risky for the patient? " answer="<ul><li> Pregnancy (risk category D
for second and third trimesters [fetal damage])
</li><li> Allergy to losartan
</li><li> Child younger than 6 years old
</li><li> Child older than 6 who has a very low creatinine clearance
</li></ul>"/>

that would make taking the beta adrenergic blockers atenolol (Tenormin) and
metoprolol (Lopressor) risky for the patient? " answer="<ul><li> Sinus
bradycardia or greater than first degree heart block
</li><li> Moderate to severe heart failure
</li><li> Atenolol: Peripheral vascular disease, Raynaud's disease
</li><li> Metoprolol: Child younger than 6 years old
</li></ul>"/>
that would make taking the calcium channel blockers (dihydropyridines)
nifedipine (Adalat, Procardia) risky for the patient?" answer="<ul><li>
Allergy to nifedipine
</li><li> Acute myocardial infarction
</li><li> Unstable angina
</li><li> Aortic stenosis
</li><li> Obstruction in gastrointestinal (GI) tract
</li><li> Child"/>
that would make taking the cardiac glycosides digoxin (Lanoxin) risky for the
patient?" answer="<ul><li> Ventricular fibrillation or tachycardia, unless
caused by heart failure
</li><li> Digoxin toxicity"/>
that would make taking the centrally acting alpha2 agonist clonidine
(Catapres) risky for the patient?" answer="<ul><li> Anticoagulant therapy
</li><li> Transdermal patch: Polyarteritis nodosa or scleroderma
</li></ul>"/>
that would make taking the class IA/sodium channel blocker drugs quinidine
(Apo-Quinidine, Novo-Quinidine) and procainamide (Pronestyl) risky for the
patient?" answer="<ul><li> Allergy to quinidine or quinine (quinidine)
</li><li> Allergy to procainamide or procaine or yellow dye #5 (procainamide)
</li><li> Bundle branch block or widened QT wave
</li><li> Severe heart block
</li><li> "Torsades de pointes" dysrhythmia
</li><li> Quinidine: Severe heart failure (HF), hypotension, thyrotoxicosis
</li><li> Procainamide: Low white blood cell count (WBC) or agranulocytosis,
myasthenia gravis, systemic lupus erythematosus
</li></ul>"/>
that would make taking the class IB/sodium channel blocker lidocaine
(Xylocaine)risky for the patient?" answer="<ul><li> Allergy to lidocaine or
amide anesthetics
</li><li> Supraventricular dysrhythmias
</li><li> Untreated bradycardia, heart block

</li></ul>"/>
that would make taking the class IC/sodium channel blockers flecainide
(Tambocor) and propafenone (Rythmol) risky for the patient?" answer="<ul><li>
Allergy to flecainide
</li><li> Second or third degree atrioventricular (AV) block
</li><li> Certain types of bundle branch block or prolonged QT interval
</li><li> Recent myocardial infarction (MI)
</li><li> Shock
</li><li> Electrolyte imbalance (correct before starting flecainide therapy)
</li></ul>"/>
that would make taking the class II/beta adrenergic blocker propranolol
(Inderal) risky for the patient?" answer="<ul><li> Sinus bradycardia or
second-to third-degree heart block
</li><li> Pulmonary edema
</li><li> Mitral or aortic valve disease
</li><li> Peripheral vascular disease, Raynaud's disease
</li><li> Asthma, severe COPD, or other chronic respiratory disorder
</li></ul>"/>
that would make taking the class III/potassium channel blocker amiodarone
(Cordarone) risky for the patient?" answer="<ul><li> Pregnancy (risk category
D)
</li><li> Lactation
</li><li> Allergy to amiodarone or benzyl alcohol
</li><li> Shock
</li><li> Bradycardia, heart block or sinus node dysfunction
</li><li> Severe hepatic disease"/>
that would make taking the class IV/calcium channel blocker verapamil (Calan)?
risky for the patient?" answer="<ul><li> Severe hypotension
</li><li> Second or third degree atrioventricular (AV) block
</li><li> Wolff-Parkinson-White syndrome
</li><li> Sick sinus syndrome
</li><li> Extended-release tablets are contraindicated for patients younger
than 18 years.
</li></ul>"/>
that would make taking the direct-acting vasodilator (hydralazine) drug,
hydralazine (Apresoline) risky for the patient?" answer="<ul><li> Mitral valve
dysfunction caused by rheumatic heart disease
</li><li> Myocardial infarction
</li></ul>"/>
that would make taking the fibrate drug gemfibrozil (Lopid) risky for the
patient?" answer="<ul><li> Gall bladder disease
</li><li> Liver dysfunction
</li><li> Severe renal impairment"/>
that would make taking the HMG-CoA reductase inhibitor (statin) drug
simvastatin (Zocor)risky for the patient?" answer="<ul><li> Pregnancy (risk
category X)
</li><li> Lactation
</li><li> Current liver disease, jaundice, elevated transaminase or greatly
elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT)
</li><li> Renal failure
</li><li> Rhabdomyolysis or myopathy
</li><li> Multiple sclerosis
</li><li> Child younger than 10 years old
</li></ul>"/>
that would make taking the loop diuretic furosemide (Lasix) risky for the
patient?" answer="<ul><li> Allergy to furosemide or sulfonamides
</li><li> Pre-eclampsia or eclampsia of pregnancy
</li><li> Hepatic coma
</li><li> Electrolyte imbalance or dehydration
</li><li> Increase in oliguria"/>
that would make taking the nitrate drugs nitroglycerin (Nitrostat, Nitro-Dur,
Nitro-Bid) and isosorbide dinitrate (Isordil) risky for the patient?"
answer="<ul><li> Allergy or tolerance to nitroglycerin or isosorbide
</li><li> Head injury, increased intracranial pressure
</li><li> Severe anemia
</li><li> Glaucoma (sustained-release forms)
</li><li> Gastrointestinal (GI) disease including hypermotility (sustained
release isosorbide)
</li><li> IV nitroglycerin: Hypotension, hypovolemia (correct before
administering)
</li><li> Constrictive pericarditis
</li></ul>"/>
that would make taking the phosphodiesterase inhibitor milrinone (Primacor)
risky for the patient?" answer="<ul><li> Allergy to phosphodiesterase
inhibitors
</li><li> Aortic or pulmonary valve disorder
</li><li> Acute myocardial infarction (MI)
</li></ul>"/>

that would make taking the potassium-sparing diuretic, spironolactone
(Aldactone) risky for the patient?" answer="<ul><li> Pregnancy (risk category
D)
</li><li> Renal failure and severe renal insufficiency, or increase in renal
impairment
</li></ul>"/>
that would make taking the sympathomimetic drug dobutamine (Dobutrex) risky
for the patient?" answer="<ul><li> Allergy to sympathomimetics or sulfites
</li><li> Ventricular tachycardia
</li><li> Hypertrophic aortic stenosis
</li><li> Dehydration
</li><li> Child younger than age 2
</li></ul>"/>
that would make taking the thiazide diuretic hydrochlorothiazide (HydroDIURIL)
risky for the patient?" answer="<ul><li> Allergy to thiazides or sulfonamides
</li><li> Greatly decreased urine output (anuria)
</li><li> Electrolyte imbalance"/>
that would make taking the direct renin inhibitor aliskiren (Tekturna) risky
for the patient?" answer="<ul><li> Pregnancy risk category D (second and third
trimesters) - fetal injury
</li><li> Lactation
</li><li> Allergy to aliskiren
</li><li> Hyperkalemia, hypercalcemia, or dehydration
</li><li> Child or adolescent younger than 18"/>
</chapter>
<chapter ChapterName="Precautions">
<question question="What factors increase the risk of
side or adverse effects and thus warrant precautions for a patient taking the
angiotensin-converting enzyme (ACE) inhibitor drug captopril (Capoten)?"
answer="<ul><li> Decreased renal function
</li><li> Bone marrow depression or use of other drugs that cause
immunosuppression
</li><li> Autoimmune disorders, such as rheumatoid arthritis
</li><li> Cardiovascular disease
</li><li> Cerebrovascular disease
</li><li> Hyponatremia
</li><li> Older adult"/>

adrenergic neuron blocker reserpine (Serpalan, Sk-Reserpine)?"
answer="<ul><li> Cardiac dysrhythmias or cerebrovascular disease
</li><li> History of peptic ulcer
</li><li> Chronic respiratory disease
</li><li> Older adult
</li><li> Epilepsy
</li><li> Gallstones
</li><li> Parkinson's disease
</li><li> Pheochromocytoma (adrenal gland tumor)"/>
aldosterone antagonist spironolactone (Aldactone)?" answer="<ul><li> Child
</li><li> Liver failure or disease
</li><li> Concurrent use of prescribed drugs that raise potassium levels"/>
alpha1 adrenergic blocker doxazosin (Cardura)?" answer="Renal or hepatic
disease"/>
alpha/beta blocker carvedilol (Coreg)?" answer="<ul><li> Child or adolescent
younger than 18 old
</li><li> Diabetes mellitus
</li><li> Renal or liver disorders
</li><li> Peripheral vascular disease
</li><li> Depressive disorders"/>
angiotensin receptor blocker (ARB) losartan (Cozaar)?" answer="<ul><li>
Concurrent diuretic use
</li><li> Liver or renal disorders
</li><li> First trimester of pregnancy
</li></ul>"/>
beta adrenergic blockers atenolol (Tenormin) and metoprolol (Lopressor)?"
answer="<ul><li> A patient with heart failure controlled by digitalis and
diuretics
</li><li> Asthma, COPD or other chronic respiratory disorder
</li><li> Myasthenia gravis
</li><li> Hyperthyroidism

</li><li> Major depression
</li><li> Pheochromocytoma (adrenal gland tumor)
</li></ul>"/>
calcium channel blockers (dihydropyridines) nifedipine (Adalat, Procardia)? "
answer="<ul><li> Heart failure
</li><li> Gastroesophageal reflex disease
</li></ul>"/>
cardiac glycosides digoxin (Lanoxin)?" answer="<ul><li> Hypokalemia
</li><li> Impaired renal function
</li><li> An infant, child or older adult
</li><li> Acute myocardial infarction (MI) and severe heart failure
</li><li> Dysrhythmias, such as incomplete heart block
</li></ul>"/>
centrally acting alpha2 agonist clonidine (Catapres)?" answer="<ul><li> Recent
myocardial infarction (MI), severe cardiac disease or cerebrovascular disease
</li></ul>"/>
class IA/sodium channel blocker drugs quinidine (Apo-Quinidine, NovoQuinidine) and procainamide (Pronestyl)?" answer="<ul><li> Impaired liver or
kidney function
</li><li> First degree heart block
</li><li> Electrolyte imbalance
</li><li> Asthma
</li><li> Procainamide: Heart failure (HF), myocardial infarction (MI),
digitalis-caused dysrhythmia, aspirin allergy
</li><li> Quinidine: Myasthenia gravis
</li></ul>"/>
class IB/sodium channel blocker, lidocaine (Xylocaine)?" answer="<ul><li>
Renal or liver disorders
</li><li> Respiratory depression or low blood oxygen levels
</li><li> Fluid volume deficits
</li><li> Family history of malignant hyperthermia

</li></ul>"/>
class IC/sodium channel blockers flecainide (Tambocor) and propafenone
(Rythmol)?" answer="<ul><li> Allergy to lidocaine and other amide anesthetics
</li><li> Atrial fibrillation
</li><li> Cardiac, renal or hepatic disease
</li></ul>"/>
class II/beta adrenergic blocker propranolol (Inderal)?" answer="<ul><li>
Hyperthyroidism or thyrotoxicosis
</li><li> Cerebrovascular disorders, stroke
</li><li> Diabetes mellitus, hypoglycemia
</li><li> Surgery
</li><li> History of allergy to stinging insects
</li><li> Pheochromocytoma (adrenal gland tumor)
</li><li> Wolff-Parkinson-White syndrome
class III/potassium channel blocker amiodarone (Cordarone)?" answer="<ul><li>
Any hepatic disease
</li><li> Any thyroid dysfunction
</li><li> Electrolyte imbalance or hypovolemia
</li><li> Pulmonary disease, such as COPD
</li><li> Heart surgery"/>
class IV/calcium channel blocker verapamil (Calan)?" answer="<ul><li> Liver or
kidney disfunction
</li><li> Duchennes muscular dystrophy
</li><li> Myocardial infarction (MI)
</li><li> Gastrointestinal obstruction or ileus, gastroesophageal reflux
disease, hiatal hernia
</li></ul>"/>
direct-acting vasodilator (hydralazine) drug hydralazine (Apresoline)?"
answer="<ul><li> Coronary heart disease
</li><li> Stroke
</li><li> Renal dysfunction
</li><li> Systemic lupus erythematosus (SLE)
</li></ul>"/>
fibrate drug gemfibrozil (Lopid)?" answer="<ul><li> Hypothyroidism
</li><li> Any renal impairment"/>
HMG-CoA reductase inhibitor (statin) drug simvastatin (Zocor)?"
answer="<ul><li> Family history of high cholesterol (homozygous familial
hypercholesterolemia)
</li><li> History of liver disorders
</li><li> Alcoholism
</li><li> Renal disorders
</li><li> Seizure disorders
</li></ul>"/>
loop diuretic furosemide (Lasix)?" answer="<ul><li> Renal or liver disorders
</li><li> Acute myocardial infarction (MI) with cardiogenic shock
</li><li> Ventricular dysrhythmias
</li><li> Diarrhea
</li><li> History of gout or systemic lupus erythematosus
</li><li> Diabetes mellitus"/>
nitrate drugs nitroglycerin (Nitrostat, Nitro-Dur, Nitro-Bid) and isosorbide
dinitrate (Isordil)?" answer="<ul><li> Hypotension
</li><li> Hypovolemia
</li><li> Liver disease
</li><li> Conditions that cause dry mouth (sublingual and transmucosal forms)
</li><li> Early myocardial infarction (MI)
phosphodiesterase inhibitor milrinone (Primacor)?" answer="<ul><li> Renal
impairment
</li><li> Atrial flutter or fibrillation

potassium-sparing diuretic spironolactone (Aldactone)?" answer="<ul><li>
Greatly increased BUN (blood urea nitrogen) levels
</li><li> Mild or moderate renal insufficiency
</li><li> Liver disease"/>
sympathomimetic drug dobutamine (Dobutrex)?" answer="<ul><li> Use with MAOI or
tricyclic antidepressants or with general anesthetics
</li><li> Heart disease, hypertension or tachycardia
</li><li> Angina pectoris"/>
thiazide diuretic hydrochlorothiazide (HydroDIURIL)?" answer="<ul><li> Heart
failure
</li><li> Cirrhosis of the liver
</li><li> Renal disorders
</li><li> History of gout or systemic lupus erythematosus
</li><li> Older adult
</li><li> Asthma"/>
direct renin inhibitor aliskiren (Tekturna)?" answer="<ul><li> Older adult
</li><li> Patient taking any drug that increases potassium levels, such as ACE
inhibitors
</li><li> Patient with low creatinine clearance
</li><li> History of angioedema
</li><li> Respiratory disorders or history of airway surgery"/>
</chapter>
<chapter ChapterName="Food & Drug Interactions">
<question question="What drugs or food have the
potential to interact with the angiotensin-converting enzyme (ACE) inhibitor
captopril (Capoten)?" answer="<ul><li> Potassium-sparing diuretics, potassium
supplements, or use of salt substitutes increase risk for hyperkalemia.
</li><li> Antihypertensive drugs, diuretics, and nitrates (such as
nitroglycerin) increase risk for hypotension.
</li><li> NSAIDs may decrease effectiveness.
</li><li> Food decreases absorption.
</li><li> ACE inhibitors may cause lithium toxicity."/>
potential to interact with the adrenergic neuron blocker reserpine (Serpalan
and Sk-Reserpine)?" answer="<ul><li> Use with MAOI antidepressants within 14

days may cause hypertensive crisis.
</li><li> Antihypertensive drugs may increase risk for hypotension.
</li><li> Digoxin increases risk for bradycardia.
</li><li> St. John's wort may increase risk for hypotension."/>
potential to interact with the aldosterone antagonist spironolactone
(Aldactone)?" answer="<ul><li> Drugs that inhibit CYP3A4, such as
ketoconazole, erythromycin, and verapamil may greatly increase risk for
toxicity and hyperkalemia.
</li><li> Drugs that raise potassium levels, such as angiotensin-converting
enzyme (ACE) inhibitors and potassium-sparing diuretics increase risk for
hyperkalemia.
</li><li> May cause lithium toxicity."/>
potential to interact with the alpha1 adrenergic blocker doxazosin (Cardura)?"
answer="Sildenafil (Viagra) and other phosphodiesterase inhibitors may
increase risk for hypotension."/>
potential to interact with the alpha/beta blocker carvedilol (Coreg)?"
answer="<ul><li> Increases risk for hypoglycemia with insulin or oral
hypoglycemic.
</li><li> May increase risk for digoxin toxicity.
</li><li> MAOI antidepressants cause bradycardia or hypotension.
</li><li> Cimetidine increases blood levels.
</li><li> Use with other antihypertensive drugs may increase risk for
hypotension.
</li></ul>"/>
potential to interact with the angiotensin receptor blocker (ARB) losartan
(Cozaar)?" answer="<ul><li> Antihypertensive drugs increase risk for
hypotension.
</li><li> Phenobarbital decreases serum levels of losartan.
</li></ul>"/>
potential to interact with the beta adrenergic blockers atenolol (Tenormin)
and metoprolol (Lopressor)?" answer="<ul><li> Use with other antihypertensive
drugs may increase effects.
</li><li> Antacids may decrease absorption.
</li><li> Digoxin has an additive effect and may increase bradycardia.
</li><li> Beta blockers with oral hypoglycemic agents may increase risk for
hypoglycemia.
</li><li> Beta blockers may increase effect of neuromuscular blockers.
</li><li> Antimuscarinic and anticholinergic drugs may decrease beta blocker
effects.
</li></ul>"/>
potential to interact with the calcium channel blocker (dihydropyridine)
nifedipine (Adalat, Procardia)?" answer="<ul><li> Use with beta blockers may
increase risk for heart failure; however, they can prevent reflex tachycardia.
</li><li> Melatonin increases blood pressure, pulse rate.
</li><li> Ginkgo biloba and ginseng increase blood levels.
</li><li> St. John's wort decreases blood levels.
</li><li> Grapefruit juice may increase blood levels.
</li></ul>"/>
potential to interact with the cardiac glycoside digoxin (Lanoxin)?"
answer="<ul><li> Erythromycin and some other antibiotics increase digoxin
levels.
</li><li> Other antidysrhythmics (verapamil, quinidine, amiodarone,
flecainide) increase digoxin levels; decrease digoxin dosage for concurrent
administration.
</li><li> Diuretics increase risk for digoxin toxicity by decreasing potassium
levels.
</li><li> Herbal ginseng increases risk of digoxin toxicity.
</li><li> St. John's wort decreases digoxin levels.
</li><li> This is not a complete list. Check for other interactions.
</li></ul>"/>
potential to interact with the centrally acting alpha2 agonist clonidine
(Catapres)? " answer="<ul><li> Central nervous system (CNS) depressants
increase CNS adverse effects.
</li><li> Tricyclic antidepressants (TCAs) may decrease effectiveness.
</li></ul>"/>
potential to interact with the class IA/sodium channel blocker drugs quinidine
(Apo-Quinidine, Novo-Quinidine) and procainamide (Pronestyl)?"
answer="<ul><li> Anticholinergic drugs cause increased anticholinergic
symptoms (such as tachycardia) ; cholinergic drugs may decrease therapeutic
effect.
</li><li> Antidysrhythmics may increase adverse or therapeutic effects;
amiodarone increases risk for heart block.
</li><li> Antihypertensives may increase risk for hypotension.
</li><li> Quinidine increases digoxin levels and risk for digoxin toxicity; it
also increases risk for warfarin toxicity.
</li><li> Large amounts of grapefruit juice may cause toxicity.
</li></ul>"/>
potential to interact with the class IB/sodium channel blocker lidocaine
(Xylocaine)?" answer="<ul><li> Beta blockers, procainamide and quinidine

increase lidocaine effects.
</li><li> Phenytoin increases hypotension, bradycardia.
</li></ul>"/>
potential to interact with the class IC/sodium channel blockers flecainide
(Tambocor) and propafenone (Rythmol)?" answer="<ul><li> Increases digoxin
levels.
</li><li> Beta blockers and calcium channel blockers potentiate cardiac
effects.
</li></ul>"/>
potential to interact with the class II/beta adrenergic blocker propranolol
(Inderal)?" answer="<ul><li> Use with other antihypertensive drugs may
increase risk for hypotension.
</li><li> Antacids may decrease absorption.
</li><li> Digoxin has an additive effect and may increase bradycardia.
</li><li> Beta blockers with oral hypoglycemic agents may increase risk for
hypoglycemia, and propranolol may mask tachycardia caused by hypoglycemia.
</li><li> Beta blockers may increase effect of neuromuscular blockers.
</li><li> Antimuscarinic and anticholinergic drugs may decrease beta blocker
effects.
</li></ul>"/>
potential to interact with the class III/potassium channel blocker amiodarone
(Cordarone)?" answer="<ul><li> CYP3A4 inhibitors, including grapefruit juice,
azole antifungal drugs, and erythromycin increase risk for toxicity.
</li><li> CYP34A inducers, such as St. John's wort, and phenytoin decrease
blood levels.
</li><li> Diuretics and drugs that increase QT interval increase risk for
dysrhythmias.
</li><li> Beta blockers and calcium channel blockers increase risk for
bradycardia.
</li><li> Amiodarone increases blood levels of quinidine, procainamide,
phenytoin, digoxin, diltiazem, warfarin, and some statin drugs.
</li></ul>"/>
potential to interact with the class IV/calcium channel blocker verapamil
(Calan)?" answer="<ul><li> Digoxin levels are increased and risk for
atrioventricular (AV) block increases with use of digoxin.
</li><li> Beta blockers increase risk for bradycardia and heart failure.
</li><li> With other antihypertensives, risk for hypotension is increased.
</li><li> IV calcium decreases effects.
</li><li> Levels of lithium and cyclosporine may be increased.
</li><li> Large amounts of grapefruit juice may increase blood levels.
</li></ul>"/>
potential to interact with the direct acting vasodilator (hydralazine) drug
hydralazine (Apresoline)?" answer="<ul><li> MAOI antidepressants may cause
severe hypotension.
</li><li> Other antihypertensive drugs may cause hypotension.
</li></ul>"/>
potential to interact with the fibrate drug gemfibrozil (Lopid)?"
answer="<ul><li> Statin antilipemics greatly increase risk for myopathy.
</li><li> Warfarin with fibrates increases risk for bleeding.
</li><li> Taken with antidiabetic drugs, fibrates increase risk for
hypoglycemia.
</li></ul>"/>
potential to interact with the HMG-CoA reductase inhibitor (statin) drug
simvastatin (Zocor)?" answer="<ul><li> Concurrent use of a fibrate or other
drug to lower cholesterol can increase risk for myopathy or liver toxicity.
</li><li> Drugs that inhibit CYP3A4, such as erythromycin, azole antifungal
drugs, and HIV protease inhibitors, increase blood levels of some statins
(especially lovastatin and simvastatin).
</li><li> Drinking large amounts of grapefruit juice also inhibits CYP3A4 and
can increase risk for adverse effects.
</li><li> Warfarin with a statin increases risk for bleeding and increased
prothrombin (PT) levels.
</li></ul>"/>
potential to interact with the loop diuretic furosemide (Lasix)?"
answer="<ul><li> Digoxin toxicity is a high risk with hypokalemia.
</li><li> Other diuretics increase the diuretic effect.
</li><li> NSAIDs may decrease diuretic effect.
</li><li> Neuromuscular blocking agents may have prolonged effect.
</li><li> Lithium toxicity may occur.
</li><li> Amphotericin B and corticosteroids increase risk for hypokalemia.
</li></ul>"/>
potential to interact with the nitrate drugs nitroglycerin (Nitrostat, NitroDur, Nitro-Bid) and isosorbide dinitrate (Isordil)?" answer="<ul><li>
Increased hypotension may result when used with other antihypertensive drugs
or with alcohol.
</li><li> PDE5 inhibitors, such as sildenafil (Viagra) may cause severe
hypotension.
</li><li> Beta blockers and calcium channel blockers decrease tachycardia
caused by nitroglycerin.
</li></ul>"/>

potential to interact with the phosphodiesterase inhibitor milrinone
(Primacor)?" answer="<ul><li> The antidysrhythmic drug disopyramide (Norpace)
may cause severe hypotension.
</li><li> Incompatible in solution with furosemide and procainamide.
</li></ul>"/>
potential to interact with the potassium-sparing diuretic spironolactone
(Aldactone)?" answer="<ul><li> Counteracts adverse effect (hypokalemia) of
loop and thiazide diuretics (may be the desired effect).
</li><li> Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor
blockers (ARBs), direct renin blockers, potassium supplements, salt
substitutes increase risk of hyperkalemia.
</li></ul>"/>
potential to interact with the sympathomimetic drug dobutamine (Dobutrex)?"
answer="<ul><li> MAOI and tricyclic antidepressants cause toxicity with
greatly increased risk for tachydysrhythmias (decrease dobutamine dosage).
</li><li> General anesthetics also may cause dysrhythmias.
</li><li> Beta blockers decrease effects of dobutamine.
</li></ul>"/>
potential to interact with the thiazide diuretic hydrochlorothiazide
(HydroDIURIL)?" answer="<ul><li> Lithium toxicity may occur.
</li><li> Increased risk of digoxin toxicity with potassium or magnesium
deficiency.
</li><li> Corticosteroids and amphotericin B increase risk for hypokalemia.
</li><li> Decreased absorption with cholestyramine (Questran) or colestipol
(Colestid).
</li><li> Increased blood glucose with insulin and oral sulfonylurea
antidiabetic drugs.
</li></ul>"/>
potential to interact with the direct renin inhibitor aliskiren (Tekturna)?"
answer="<ul><li> Other antihypertensive drugs have an additive effect with
aliskiren.
</li><li> Potassium-sparing diuretics and other drugs that increase potassium
levels increase the risk for hyperkalemia.
</li><li> The drug decreases the blood level of furosemide (Lasix).
</li><li> Atorvastatin (Lipitor) and ketoconazole (Nizoral) increase blood
levels.
</li><li> Irbesartan (Avapro) decreases blood levels.
</li></ul>"/>
</chapter>
</course>
</courses>

Cardiovascular System Drugs ATI

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Cardiovascular System Drugs

question="What is the brand/trade name of the angiotensin-converting enzyme

<question question="What is the brand/trade name of the

<question question="What is the generic name of the

<question question="What is the generic name of the

<question question="What are some of the therapeutic

antidysrhythmics treat atrial fibrillation, supraventricular and ventricular

<question question="What is a therapeutic use for the

</li><li> Beginning dose is decreased for patients taking diuretics or with

<question question="How should the class III/potassium

<question question="How should the sympathomimetic drug

Reserpine)?" answer="<ul><li> Severe depression and risk for suicide, which

</li><li> Hypotension, especially with overdose

</li><li> Hypotension, bradycardia, heart block with high doses

<question question="What are some of the side and/or

angiotensin receptor blocker (ARB) losartan (Cozaar)? " answer="<ul><li> Treat

</li><li> Take apical pulse for a minute before administering digoxin;

IB/sodium channel blocker lidocaine (Xylocaine)?" answer="<ul><li> Monitor

</li><li> Monitor for blue-grey discoloration of skin.

CoA reductase inhibitor (Statin) drug simvastatin (Zocor)?" answer="<ul><li>

</li><li> Monitor potassium levels and correct hypokalemia as needed during

</li><li> Ensure that patient is not taking potassium-sparing diuretics or

potassium supplements or use potassium-containing salt substitutes or drugs

channel blocker (dihydropyridine) drug nifedipine (Adalat, Procardia)?"

</li><li> Avoid hazardous activities such as driving if hypotension occurs.

III/potassium channel blocker drug amiodarone (Cordarone)?" answer="<ul><li>

reductase inhibitor (statin) drug simvastatin (Zocor)?" answer="<ul><li>

<question question="What important instructions should

<question question="What are some contraindications

<question question="What are some contraindications

</li><li> Untreated bradycardia, heart block

<question question="What are some contraindications

<question question="What factors increase the risk of

</li><li> Diabetes mellitus

</li><li> Family history of malignant hyperthermia

<question question="What factors increase the risk of

and Sk-Reserpine)?" answer="<ul><li> Use with MAOI antidepressants within 14

(Xylocaine)?" answer="<ul><li> Beta blockers, procainamide and quinidine

<question question="What drugs or food have the

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