Pharmacology Lecture by Nurse Mike

Preliminary Information

• Access to free quiz and study guides available.
• Focus on pharmacology and NCLEX exam preparation.

Key Objectives

• Drain fluid and help the heart pump blood forward.
• Understand drugs that affect blood pressure and heart rate.

Main Points

Important Drug Characteristics

• All drugs: lower blood pressure and take workload off the heart (except digoxin).
  • Digoxin: Decreases heart rate only, not blood pressure; has toxic side effects, can cause dizziness.
  • NCLEX Tip: Orthostatic hypotension – "slow position changes when blood pressure is low".

Drug Classes

ACE Inhibitors and ARBs

• Function: Lower blood pressure only, not heart rate.
  • ACE Inhibitors: End in “-pril” (e.g., Lisinopril).
    • NCLEX Mnemonics: "A chill pill" = Low blood pressure
  • ARBs: Angiotensin Receptor Blockers, end in “-sartan” (e.g., Losartan).
    • NCLEX Mnemonics: "Relax man" or "retirement plan" = Lowers blood pressure

Usage Guidelines

• ACE Inhibitors & ARBs: Safe to use if heart rate is below 60 BPM. Hold only for low blood pressure.

Mechanism of Action

• Inhibit/block the RAAS (Renin-Angiotensin-Aldosterone System) system: Prevents fluid retention.
  • Result: Decreased sodium/water retention, increased potassium.
  • Side Effects: Hyperkalemia (High potassium).

Specific Side Effects and Precautions

• ACE Inhibitors:

  • A -> Avoid pregnant patients (baby toxic).
  • A -> Angioedema (swelling of face/tongue), airway risk.
  • C -> Cough.
  • E -> Elevated potassium (> 5.0).

• ARBs:

  • Sartans spare potassium.

• NCLEX Mnemonics: "Prils puff the tongue and add potassium."

• Patient Teaching: Avoid potassium-rich foods (leafy greens, avocados, melons, oranges, salt substitutes, liver).

Potassium and ECG Monitoring

• High Potassium: Monitor for muscle spasms, peaked T-waves, ST elevations.
• Key Action for Imbalance: Always use a cardiac monitor.

Summary for ACEs and ARBs

• A: Antihypertensive – Lowers blood pressure.
• A: Avoid in pregnancy.
• A: Adds potassium (hyperkalemia, > 5.0).

Special Notes

• First Dose Phenomenon: Don't leave the patient’s bedside with their first dose. Monitor closely for blood pressure drops.

Conclusion

• Free quiz and study materials available.
• Beta blockers and other heart medication details available in full video.
• Remember to subscribe and utilize provided resources for NCLEX preparation.