ACE Inhibitors
What is the mechanism of action of ACE inhibitors?
Block conversion of angiotensin I to II → vasodilation and sodium/water excretion
What is the mechanism of action of beta blockers?
Block beta-adrenergic receptors → ↓ HR, ↓ BP, ↓ myocardial O₂ demand
What is the mechanism of action of calcium channel blockers?
Inhibit calcium influx → vasodilation and ↓ contractility
What is the mechanism of action of amiodarone?
Prolongs repolarization and action potential duration
What lab value monitors heparin therapy?
aPTT
This common side effect is caused by increased bradykinin levels.
Persistent dry cough
ACE inhibitors block the enzyme that breaks down bradykinin. This leads to an increase in bradykinin levels in the airways. Bradykinin activates sensory nerves in the airways and can also cause bronchoconstriction
Why should beta blockers be used cautiously in asthma?
Non-selective beta blockers cause bronchospasm
What side effect is common with verapamil and can be managed with increased fiber?
Constipation
Ca Blockers can relax smooth muscle in the bowel leading to decreased peristalsis
Which organ system toxicity is most serious and requires baseline testing?
Pulmonary (fibrosis risk)
What is the antidote for warfarin?
Vitamin K
What serious adverse effect requires immediate discontinuation and emergency care?
Angioedema
When should a nurse hold metoprolol?
HR < 60 bpm or SBP < 90 mmHg
What fruit or fruit juice should be avoided for patients taking Ca Channel Blockers?
Grapefruit juice
Grapefruit juice contains compounds called furanocoumarins that inhibit an enzyme in the liver called CYP3A4. This enzyme plays a role in metabolizing and eliminating calcium channel blockers from the body. When grapefruit juice is consumed with calcium channel blockers, the enzyme is inhibited, leading to increased levels of the medication in the bloodstream
What are two key lab values to monitor with long-term amiodarone use?
Liver and thyroid function tests
What teaching is important for a patient on warfarin about diet?
Maintain consistent vitamin K intake
Which lab values should be monitored for patients taking lisinopril?
Potassium and renal function (BUN, creatinine)
ACE inhibitors are potent vasoconstrictors that increases blood pressure and glomerular filtration rate (GFR). They can increase potassium levels in the blood, which can be a concern in patients with kidney disease.
Which beta blocker is useful for migraine prevention?
Propranolol
Which adverse effect requires monitoring of ECG and HR?
Bradycardia
What skin-related teaching should be included?
Use sun protection; may cause blue-gray discoloration
Which anticoagulant has no routine lab monitoring and is reversed by andexanet alfa?
DOACs (rivaroxaban, apixaban)
A nurse recognizes notes swelling of the lips in a patient who takes captopril. What is the next appropriate nursing action?
Hold the medication, then notify the provider
A patient taking metoprolol reports increased fatigue and lightheadedness. The nurse takes vital signs and does a focused assessment on the client. What are the expected findings?
Low heart rate, low BP
The RN should hold the medication and notify the provider of the findings
A patient has presented to the ED with an irregularly irregular heart rhythm at a rate of 164. The provider elects to manage the patient with rate control. Which medication would the RN anticipate to be ordered?
Diltiazem
Diltiazem is a commonly used and effective medication for heart rate control in various conditions, particularly atrial fibrillation (AFib), atrial flutter, and supraventricular tachycardias. It is a non-dihydropyridine calcium channel blocker that works by slowing the heart rate and reducing myocardial contractility.
A patient is status post CABG x3 and reports feeling as though their heart is racing. They are pale, cool, and diaphoretic. The heart rate is 151. What heart rhythm does the nurse expect to find on the monitor?
Atrial fibrillation with rapid ventricular rate
A patient on heparin develops petechiae and low platelets. What is the concern and action?
Heparin-Induced Thrombocytopenia (HIT) → stop heparin, notify provider