NR 566 Midterm Exam Review 2021 Advanced Pharmacology
1. Myocardial oxygen supply
- Supply is reduced by the following:
o Hemodynamic factors such as
... [Show More] increased resistance in coronary vessels,
hypotension, and decreased blood volume. ACE inhibitors, beta
blockers, direct renin inhibitors, and the dihydropyridine CCBs decrease
peripheral resistance through their vasodilatory actions.
o Cardiac factors such as decreases in diastolic filling time, increases in
heart rate, and valvular incompetence. Beta blockers and nondihydropyridine
CCBs decrease heart rate. The beta blockers have the
further advantage of preventing the recurrence of MIs.
o Hematological factors such as the oxygen content of the blood, the
acid-base status of the blood, and anemia.
o Systemic disorders, such as shock, which reduce blood flow or the
availability of oxygen.
2. Myocardial oxygen demand
- High systolic blood pressure, which increases the work the heart has to do to
move blood from the left ventricle to the systemic circulation. One focus of
anginal management is control of blood pressure. ACE inhibitors, beta blockers,
direct renin inhibitors, and both types of CCBs decrease blood pressure.
o Increased ventricular volume, which increases the work the heart has to
do because the left ventricle must move more blood. ACE inhibitors
reduce sodium and water retention.
o Increased thickness of the myocardium (ventricular hypertrophy). The
same mechanism that facilitated growth of the vessel walls in
atherosclerosis also increases the thickness of the myocardium. ACE
inhibitors play a major role here to decrease the remodeling. Beta blockers
can assist in prevention of ventricular hypertrophy but play a smaller
role.
o Increased heart rate resulting from exercise, stress, hyperthyroidism,
fever, anemia, hyperviscosity of the blood, or negative feedback
systems' response to decreased cardiac output. Beta blockers can assist
in decreasing heart rate resulting from conditions such as
hyperthyroidism and from negative feedback patterns secondary to
decreased cardiac output.
o Conditions that heighten the myocardium's contractile response. Beta
blockers and CCBs both have negative inotropic effects.
3. Bioavailability of bisphosphonate drugs and appropriate patient education
- Histamine2 blocking agents double alendronate bioavailability, but the
impact is unknown. Aspirin may decrease the bioavailability of tiludronate
by up to 50% when taken 2 hours after the tiludronate. Although
indomethacin increases the bioavailability of tiludronate by 2- to 4-fold, the
bioavailability is not significantly altered by diclofenac; therefore, each
NSAID must be considered individually.
4. Adverse effects associated with long-term use of bisphonates
- Etidronate has also been associated with fractures in patients with Paget's
disease when they are given high doses or when therapy lasted longer than
6 months. These patients must be carefully monitored with x-rays and
laboratory work to assess for these lesions. The development of a rare form
of subtrochanteric femur fracture in non-Paget's patients using
bisphosphonates is under close scrutiny and has contributed to movement
away from osteopenia prevention care to only osteoporosis therapy (FDA,
2010a).
5. Specifics about administration and education regarding pancreatic enzymes
- All doses are taken immediately before or with meals or snacks with a fatty
component. Fruit, hard candy, fruit juice like drinks, tea or coffee, or
popsicles do not require enzymes (CFF, 2009). Capsules may be opened and
sprinkled on food.
Capsules with enteric-coated beads should not be chewed. They may be
sprinkled on soft acidic food that is not hot and that can be swallowed
without chewing, such as applesauce or gelatin. Swallow immediately
because the proteolytic enzymes may irritate the mucosa. Following with a
glass of water or juice or eating immediately after taking the drug helps to
ensure that the medication is swallowed and does not remain in contact with
the mouth and esophagus for long periods. Pancrelipase is destroyed by
acid. Proton pump inhibitors, sodium bicarbonate, or aluminum-based
antacids may be used with preparations without enteric coating to neutralize
gastric pH. Calcium- and magnesium-based antacids should not be used for
this purpose because they interfere with drug action. Enteric-coated beads
are designed to withstand the acid pH of [Show Less]