Adrenergic Antagonists
Student Nurse Aimee is reviewing for her licensure exam. She would be right to pick which drug pairing (classification and corresponding example)?
A. alpha1-selective adrenergic blocking agent: phentolamine
B. nonselective adrenergic blocking agent: labetalol
C. nonselective alpha-adrenergic blocking agent: doxazosin
D. nonselective beta-adrenergic blocking agent: metoprolo
Answer: B. nonselective adrenergic blocking agent: labetalol
A 65-year-old male patient is prescribed an ACE inhibitor for the treatment of hypertension. Which medication below is an ACE inhibitor?
A. Metoprolol
B. Benazepril
C. Losartan
D. Amlodipine
The answer is B. Benazepril is an ACE Inhibitor. Remember ACE Inhibitors end in PRIL.
You’re teaching a patient about how angiotensin II receptor blockers (ARBs) work. Which statement below BEST describes how these medications work on the body?*
A. “They prevent Angiotensin II Type I Receptors from binding with Angiotensin II.”
B. “These medications prevent the activation of Angiotensin II Type II Receptors from binding with Angiotensin II.”
C. “They inhibit angiotensin-converting-enzyme (ACE) from converting an Angiotensin I to Angiotensin II.”
D. “These medications prevent Angiotensin II Type I Receptors from binding with angiotensin-converting-enzyme (ACE).”
The answer is A. ARBs prevent Angiotensin II Type I Receptors from binding with Angiotensin II. Remember ACE Inhibitors inhibit angiotensin-converting-enzyme (ACE) from converting Angiotensin I to Angiotensin II.
Beta 1 receptors can be found in the? Select all that apply:*
A. GI tract
B. Uterus
C. Heart
D. Lungs
E. Kidneys
The answers are C and E. Beta 1 receptors can be found in the HEART and KIDNEYS.
Your patient is prescribed a calcium channel blocker. As the nurse you know that these medication works to block calcium channels in what areas of the body? Select all that apply:*
The answers are B, C, and E. Calcium channel blockers work to block the L-type calcium channels in the vascular smooth muscle, cardiac myocytes, and cardiac nodal tissue. When the calcium channels of these areas are blocked they will decrease contraction of these cells, which will provide vasodilation, decrease in heart rate, and decrease in strength of heart contractions. Remember there are different types of calcium channel blockers, and some are more selective to the vascular smooth muscle, while some are more selective to the myocardium.
Which of the following drugs can improve urine flow in males?
A. prazosin
B. nebivolol
C. labetalol
D. amiodarone
Prazosin, a selective alpha1-receptor adrenergic antagonist, can improve urine flow in male patients and are used as treatment for benign prostatic hypertrophy (BPH). This is because they can block smooth muscle receptors in the genitourinary tract which leads to relaxation of prostate and bladder.
Which statements below CORRECTLY describe how ACE Inhibitors work? Select all that apply:
A. This group of medications inhibits the renin-angiotensin-aldosterone system (RAAS).
B. ACE Inhibitors prevent the conversion of Angiotensin I to Angiotensin II.
C. ACE Inhibitors prevent Angiotensinogen from converting to Angiotensin I.
D. ACE Inhibitors have a positive chronotropic and negative inotropic effect on the heart.
The answers are A and B. ACE inhibitors inhibits the renin-angiotensin-aldosterone system (RAAS), which will prevent the conversion of Angiotensin I to Angiotensin II. Options C and D are false statements about these medications.
A physician writes a new medication order for a patient who has cardiovascular disease. The medication is an angiotensin II receptor blocker (ARB). What new medication on the patient’s scheduled medication list is an ARB?*
A. Metoprolol
B. Losartan
C. Lisinopril
D. Nicardipine
The answer is B. Remember ARBs end with "SARTAN". Losartan is an ARB.
Beta 2 receptors can be found in the? Select all that apply:*
The answers are B, C, E, and F. Beta 2 receptors can be found in the lungs (bronchioles), GI system, vascular smooth muscle, skeletal muscle and even the ciliary body of the eye (not listed).
Which type of calcium channel blockers below are considered non-dihydropyridines and can provide anti-arrhythmic effects? Select all that apply:*
The answers are B and D. Verapamil and Diltiazem are calcium channel blockers that are non-dihydropyridine. They are more selective to the myocardium when compared to dihydropyridine (Nifedipine and Amlodipine), which are more selective to the vascular system. Therefore, non-dihydropyridines can provide anti-arrhythmic effects.
Nurse Sam is taking care of a patient on carvedilol therapy. Which parameter should he monitor regularly to assess for possible dose adjustment?
A. serum sodium level
B. hemoglobin and hematocrit
C. SGPT
D. BUN
Carvedilol has been associated with hepatic failure related to its effects on the liver.
Angiotensin-converting enzyme (ACE) performs what roles in the body? Select all that apply:*
The answers are A and D. ACE inactivates bradykinin by breaking it down and converts Angiotensin I to Angiotensin II. Option C describes the role of aldosterone, which is influenced by Angiotensin II, and option D describes how ACE Inhibitors work….remember they block the actions of ACE.
Select all the pharmacodynamic effects of angiotensin II receptor blockers (ARBs):*
The answers are A, D, and F. ARBs prevent Angiotensin II Type I Receptors from binding with Angiotension II. This leads to vasodilation of vessels and decreases the release of aldosterone, which leads to sodium and water excretion (potassium is conserved…so watch out for hyperkalemia).
Select all the beta blocker medications listed below that affect ONLY beta 1 receptors:*
The answers are B, C, D. Atenolol, Metoprolol, and Esmolol are selective and affect ONLY beta 1 receptors, which are found in the heart and kidneys. Timolol is a nonselective beta blocker and affects both beta 1 and beta 2 receptors.
Which calcium channel blockers below are known as the dihydropyridines and are known to be more vascular selective? Select all that apply:*
The answers are B, C, and E. Remember the "dipine" medications are known as the dihydropyridines, and they are more vascular selective. This is why they are great at treating hypertension because they cause vasodilation due to inhibiting the calcium channels in the vascular smooth muscle. This leads to the relaxation of these vessels and in turn decreases arterial blood pressure.
Mrs. Smith, a 40-year-old patient, came in due to acute hypertensive episode. Her chart says she is asthmatic. Which of the following drugs would be safest to give?
A. nebivolol
B. timolol
C. propranolol
D. atenolol
Atenolol is a selective beta-blocker and it does not block the receptors responsible for bronchodilation. All other options are nonselective beta-blockers and may cause bronchoconstriction and spasms.
Fill in the blanks: Angiotensin II causes ___________ of the vessels and triggers the release of ____________.*
The answer is C. Angiotensin II causes vasoconstriction of the vessels and triggers the release of aldosterone.
What conditions are Angiotensin II Receptor Blockers (ARBs) used to treat? Select all that apply:*
The answers are A, C, and E. ARBs can treat hypertension, diabetic nephropathy in type 2 diabetics (which is kidney disease in type 2 diabetics), and heart failure.
At 1000 your patient is scheduled to take a dose of Atenolol. What finding below would require you to hold the scheduled dose and notify the physician?*
The answer is C. In option C, the patient is showing signs and symptoms of uncompensated heart failure (beta blockers are not used when uncompensated heart failure presents, but they can be sometimes be used when the patient is in compensated/stable heart failure). The reason is because beta blockers slow down the heart rate and decrease the strength of contractions (negative inotropic effect), which can lead to heart failure in SOME patients, and this is why the nurse must monitor for this.
Your patient is taking Verapamil. When helping the patient make a lunch selection, the nurse should encourage the patient to choose items that are?*
The answer is B. Verapamil can cause constipation. The patient should choose to eat foods that are high in fiber to help prevent this side effect.
Which of the following drug is used for diagnosis of pheochromocytoma?
A. amiodarone
B. phentolamine
C. tamsulosin
D. acebutolol
Answer: B. phentolamine
A patient is prescribed an ACE Inhibitor after experiencing a myocardial infarction. What effects on the body will this medication achieve? Select all that apply:*
The answers are A, C, and D. ACE inhibitors will cause the opposite effects of Angiotensin II, which is a major vasoconstrictor and triggers the release of aldosterone (remember this substance will cause the kidneys to keep sodium and water and excrete potassium). However, ACE Inhibitors will perform the opposite effects by decreasing the blood pressure via vasodilation of vessels (which decreases SVR) and causes the kidneys to excrete water and sodium and retain potassium (hence the nurse must monitor for hyperkalemia).
As the nurse you know to tell the patient that the best way to PREVENT rebound hypertension while taking an Angiotensin II Receptor Blocker (ARB) is to?*
The answer is B. The patient should NEVER just quit taking the medication because rebound hypertension can occur.
Which category of beta blockers block beta 1 and beta 2 receptors?*
The answer is B. Nonselective beta blockers BLOCK beta 1 and beta 2...therefore they're not selective. Selective beta blockers block ONLY beta 1 receptors and are sometimes referred to as cardioselective.
A patient is prescribed a calcium channel blocker and Digoxin. Which findings would require the nurse to hold further doses of these medications and to immediately notify the physician? Select all that apply:*
The answers are A and D. Calcium channel blockers can increase Digoxin level. Therefore, the patient's Digoxin levels should be monitored closely. A normal Digoxin level is 0.5-2 ng/mL. Signs and symptoms of Digoxin Toxicity is nausea, vomiting, vision changes (seeing yellowish/green halos, blurred vision etc. Option B is an expected side effect from calcium channel blockers and option C is normal.