Mechanisms of Action
What is the MOA of ACE inhibitors?
Block conversion of angiotensin I to II, causing vasodilation and reduced blood volume.
A patient on lisinopril develops a persistent cough. What caused this?
Increased bradykinin levels due to ACE inhibition.
Before giving metoprolol, the nurse should:
Check apical pulse; hold if <60 bpm.
Grapefruit juice should be avoided with which cardiovascular drugs?
Calcium channel blockers (e.g., verapamil).
A patient reports chest pain and uses 3 nitroglycerin tablets with no relief. What’s next?
Call 911—possible MI
How do beta-blockers lower blood pressure?
Decrease heart rate and myocardial contractility by blocking beta-1 receptors.
A serious effect of statins to watch for is:
Rhabdomyolysis (muscle pain, weakness, elevated CK).
When is the best time to administer statins?
At night, when cholesterol synthesis is highest.
A diabetic on beta-blockers is at risk for:
Masked signs of hypoglycemia.
A patient’s INR is 5.0 while on warfarin. What is the priority?
Hold warfarin and notify provider; risk of bleeding.
What is the function of calcium channel blockers?
Relax smooth muscle and reduce peripheral resistance by blocking calcium influx.
What side effect is common in calcium channel blockers like amlodipine?
Peripheral edema.
A patient on a nitrate patch complains of a headache. The nurse should:
Reassure; it's a common effect—do not stop med abruptly.
Combining spironolactone and an ACE inhibitor increases the risk for:
Hyperkalemia.
A patient on amiodarone complains of vision changes. What should the nurse do?
Report immediately—can indicate toxicity.
What is the action of nitrates like nitroglycerin?
Vasodilate arteries and veins, reducing preload and afterload, relieving angina.
What are signs of digoxin toxicity?
Yellow vision, nausea, bradycardia, confusion.
What labs are monitored for warfarin therapy?
PT/INR.
What interaction occurs between digoxin and loop diuretics?
Hypokalemia from loop diuretics increases digoxin toxicity risk.
A client is on furosemide and develops leg cramps. What lab value is most concerning?
Low potassium.
How do loop diuretics lower blood pressure?
Inhibit sodium and chloride reabsorption in the loop of Henle, causing diuresis.
What happens if beta-blockers are stopped abruptly?
Rebound hypertension or tachycardia.
Which diuretic may cause hyperkalemia and should not be given with ACE inhibitors?
Spironolactone.
NSAIDs decrease the effectiveness of:
Diuretics and antihypertensives.
A patient on propranolol develops wheezing. What is the first action?
Hold the medication and assess for bronchospasm.