Patient fully understands hyperlipidemia treatments when he says (choose all that apply):

A) Grapefruit juice will inhibit the statin so that I get a reduced impact of the statin

B) I will take the bile acids with plenty of fluids

C) I should take my fibric acid & bile acid resins together at meal time. 

D) a 325mg aspirin 30 minutes before niacin should alleviate flushing

E) I need to maintain optimum weight, eat lots of apples, broccoli, and beans; plus exercise

only B), D), E) are correct.  Specifics:

A) Wrong [grapefruit juice reduces metabolism, taking statin to toxic levels (see p. 293, ri sd, "Teach...")]

B) Good [same ref. as "A)"];        

C) Wrong [Bile acid resins s/b taken B4 meals w/ plenty fluid, 1 hr B4 or 4 hr af. other meds [same ref. as "A)", plus p. 289]

D) Good [See p. 290, bot. ri. parag.]

E) Good [see p.286, ri sd nr top]

A), C), D) are correct. A) is critical, due to rhabdomyolysis danger of statin w/ azole antifungals [or macrolide antibiotics, cyclosporine, or niacin].  Also note digoxin jump 20% w/statin, and statin jump 40% w/erythromycin. [p. 290]

B) is bile acid resin need w/ oth. meds, not Lipitor v. food.

E) is aspirin need w/ niacin, not statin v niacin transition

Prescribed: Zocor (simvastin) and Zetia (ezetimibe) for high cholesterol.  Nurse should (choose all that apply):

A) Issue the drugs.

B) Issue the statin, advise client that Zetia is a sequestrant that can promote rhabdomyolysis when issued with a statin, and call provider.

C) Call the provider prior to issuing either drug

D) advise client that replacing dietary sat. fat and cholesterol with beans, oat bran, and apples is a priority for concurrent success of drug therapy.  

E) seek cliet understanding and commitment for exercise 

A), D), E) are correct.  Zetia (p. 287t) has no serious side effects and is commonly issued with simvastatin (Zocor).   

rhabdomyolysis is a concern with niacin + statin, not statin + sequestrants (bile acid resins) nor ezetimibe (which is not a bile acid resin, but does bind in the sm. intestine to excrete cholesterol)

Nurse has tanked the teaching when (choose all that apply):

A) Client says fatty foods will screw up my gemfibrozil (Lopid) effectiveness.

B) I don't sweat my gallstones with Lopid

C) Lopid will work great with the statin from my other dr.

D) It's good you didn't mention the liver, 'cause mine is borderline.

E) We will need to call the provider about gemfibrozil, because I have renal function problems.

Patient's hyperlipidemia calls for more than just a statin.  Which of the following are appropriate combinations?

A) Lipitor and Fibric acids

B) Questran and nicotinic acid

C) a sequestrant and a provider-reduced Atorvastatin (80% dosage) for a digoxin patient

D) Zocor & Zetia

E) Grapefruit juice, channel blocker, and Lipitor

B), C), and D) are supposed to be correct (290-292). 

A) Statins and fibric acids are a rhabdomyolysis risk.  B) (bile acid resins & fibric acid agents) is okay as near as I can tell.  The point on C) is that statins jack up digoxin by 20%, so a provider reduced dosage at 80% of regular for statin plus a sequestrant (bile acid resin or ezetimibe) could be a good thing.

D) is ezetimibe (Zetia) & simvastatin (Zocor); a common combination

E) is absurd: grapefruit juice will jack up the channel blocker, inhibit statin (leading to toxicity); none of which helps the statin.

Patient is a former basketball player with muscle cramps and weakness in all extremities, which she attributes to rigorous work-outs to get back into the sport after gaining 52 lbs. in a sedentary year.   Which of the following are correct?

A) She should have renal & hepatic evaluation before using a statin to reduce lipids

B) she should have stanols & sterols to help reduce cholesterol 

C) she should have a beta blocker to stop myopathy

D) she should have lithium during March Madness

E) if her training camp coincided with initiation of hyperlipidemia treatment with a statin, she needs an immediate evaluation for rhabdomyolysis.

For a patient on Questran, what are the priority assessments?  Pick all that apply.

A) Questran - a cholestyramine - is a bile acid resin that is contra for total biliary obstruction

B) Pain management related to drug effects

C) tarry stools or yellowing of sclera

D) LFT & lipid profile 

E) The patient's ability to receive and understand instruction

For tryglycerides at 555 mg/dL, HDL at 33, and total lipids over 257, what would we suggest to the provider as alternative to poorly tolerated statin therapy?  Pick all that apply.

A) An aspirin 1 hour B4 or 4 hr after bile acid resins

B) Add fibric acid agent gemfibrozil (Lopid) to the statin therapy

C) Start nicotinic acid in place of statins to address all 3 lipid problems.

D) Add thiazide therapy.

E) An aspirin 30 minutes before niacin to reduce flushing discomfort. 

C) & E) are correct [p. 290, ri sd, bot 2 parag.]  Nicotinic acid (niacin) reduces triglycerides and LDL while increasing HDL.  Bile acid resins s/b taken 1 hr B4 or 4 hr after other meds, and s/b tkn w/ plenty fluids B4 meals.

What would be priority teaching for a patient on HMG CoA reductase inhibitor therapy?  Pick all that apply.

A) It is important to jack up your dietary fiber, maintain ideal weight, and get regular lipid level measurment in support of HMG CoA reductase inhibitor therapy.

B) Keep your sodium intake down

C) The effect will be to reduce cholesterol production.  In response, the liver will produce LDL receptors that take LDL out of the bloodstream, too.

D) Your cholesterol will have dropped substantially within 2 days.

E) You may have flushing and hot flashes initially.

What would a nurse infer with triglycerides at 333, LDL at 120, HDL at 75, and overall cholesterol levels at 243 (all units in mg/dL) ?  Pick all that apply.

A) triglycerides and cholesterol overall are very high risk.

B) HDL is good, LDL is near but above optimal

C) triglycerides and cholesterol overall are high risk

D) HDL is low, LDL is optimal

E) triglycerides are very high risk and cholesterol overall is high risk.

Correct answers are B) & C).  From chart on p.286:

Tot chol <200 good, >239 = high risk

LDL <100 optimal, >190=high risk,

HDL<40 =low; >60 good,

Triglycerides <150 goal; 200-499 = high risk

>500 = very high risk

Patient being treated with lisinopril (Prinivil, Zestril) and thiazide diaretic is showing less than typical response, dysrrythmia, and complains of gastric distress and black tarry stools.  What might the priority assessments be?

A) Patient has too much Fe in the diet 

B) Patient is eating red beets

C) is patient self medicating with aspririn?

D) pain management

E) hypokalemia secondary to thiazide use

C) aspirin overuse will cause gastric distress & bleeding due to antiplatelet activity; dysrrythmias are a side effect of hypokalemia, E).

Patient is in pain relative to thrombosis and lessened perfusion:  heparin (Heplock) is prescribed.  Choose all that apply.

A) Heparin can disolve clots and prevent thrombocytopena

B) Heparin would be contra for patients self medicating on aspirin due to bleeding considerations

C) Heparin can prevent clots and cause thrombocytopenia

D) Heparin may induce life-threatening thromboses 

E) The short half life of heparin allows quick recovery of platelets upon withdrawal of the drug

B) & C) & D) are correct (p.375).  Heparin-induced thrombocytopenia (HIT) is a serious complication 4up to 30% of patients; causing an increase in adverse thromboembolic events.  

Despite the 90 mnt half life of heparin, a week may be required for platelets to completely recover.  

Hypertension is (choose all that apply):

A) a systolic arterial BP that is consistently over 140 mmHg over a period of time and several readings

B) defined by afterload, preload and contractility of the heart

C) a function of peripheral resistence, blood volume, and cardiac output 

D) the most common of CVD's and most severe among the elderly

E) targets the retina, brain, heart, and kidneys

Only B) is incorrect.  [See p. 297-8] HTN is the consistent elevation of systemic arterial blood pressure; 140+ systolic or diastolic 90-99 mmHg.   

3 factors: 1) cardiac o/pt - volume / stroke X strokes/minute = blood pumped / mnt (+/-: pre- & after-load, contractility, SNS, ParaSNS, epinephrine);  2) blood vol - us'y about 5L (less w/ dehydr'n, more w/ aldosterone or ADH);  3) peripheral resistance - friction in arteries & diameter of arterioles (+/-: sympathetic NS activity, renin/angiotensin II, blood viscosity).

HTN can cause dizzy, less urine formation; 4 target organs = heart, brain, kidneys & retina.  HTN w/o cause is primary, idopathic or essential (v. 2ndary HTN Cushing's, hyper-thyroidism, or chronic renal disease).

How does the body regulate blood pressure? Check all that apply.

A) peripheral resistance sensed in the hypothalmus causes the kidneys to excrete or retain water

B) low Na⁺ or BP causes the kidneys to release renin, launching the RAAS system

C) chemoreceptors in the aorta regulate oxygen, pH, and CO₂ factors of blood pressure

D) the vasomotor center of the medulla oblongata, reacting to sensors in the aorta & internal carotid regulate BP

E) ADH influences BP with its impact upon vasoconstriction and blood volume

B), D), & E) are correct.  A) is absurd.  C) Chemoreceptors are sensors not regulators.  Vasomotor center - Neurons in medulla oblongata regulating blood pressure from baroreceptors in aorta & internal carotid.  Chemoreceptors - O₂, CO₂, pH. 

Emotions (anger & stress).  Antidiuretic hormone (ADH) = vasoconstrictor that can also increase blood volume.  renin-angiotension-aldosterone system

Tell me all that apply:

A) HF is a compelling indication for anti-HTN therapy at Stage I

B) Prehypertension is treated with 1st line HTN drugs such as thiazides.

C) BP of >160 / >100 (systolic / diast.) is Stage II. 

D) hypertension is syst./dias. of 120-139 / 80-89

E) Diastolic of 90-99 reflects a need for anti-HTN medication

What are the effects of HTN?  Choose all that apply.

A) HF due to pulmonary congestion and excessive workload

B) Ischemic attacks and cerebral vascular accidents

C) Hyperlipidemia

D) Progressive loss of renal function

E) Rupture of vessels in the retina; blindness

Patient has developed dysrrythmias and orthostatic hypotension on a loop diuretic regimen.  What would be the priority assessments? (Choose all that apply) 

A) Suspect hypokalemia, an adverse of furosemide (Lasix)

B) BP may be quite low

C) Lasix removes lots of fluid by preventing the reabsorption of Na+ & Cl- which can cause an electrolyte depletion

D) digoxin toxicity

E) HTN

A) is priority, B) & C) are correct. [p. 330] Lasix (furosemide) is a loop type diuretic 4 HF & HTN; removes lots of fluid starting w/n 5 mnt; prevents reabsorption of Na⁺ & Cl^- in the loop of Henle; particular comparative advantage is application when cardiac / renal output is low.

sd ef: electrolyte imbal. - especially hypokalemia (can cause dysrhythmia); dehydration, hypotension.

Contra: hepatic coma, anurea, electrolyte depletion.

Tell me about grapefruit juice.  Choose all that apply.

A) Inhibits the absorption of statins allowing them to reach toxic levels.

B) Enhances electrolyte retention in bile acid therapy

C) May enhance the absorption of Ca channel blockers

D) Helps maintain the 3.5 mEq/L K level when used with furosemide (Lasix) loop diuretic.

E) Has to be 2 hr B4 or 5 hr after antibiotics (erythromycin) or antifungals (Sporanox) to keep from lowering the intestinal enzyme activity that breaks down the meds.

A) good [p.290]; C) good [p.308]; E) good [p.20].  Answers B) & D) are absurdities, but D) does show the minimum serum K level in the blood [p. 438].

Use of a Ca channel blocker with a β-blocker will: (choose all that apply)

A) Result in better anti-hypertensive results with fewer side effects

B) Inrease the potential for CHF

C) Reduce renal impairment

D) Male sexual dysfunction

E) Increase the potential for toxicity or bradycardia with digoxin

Only B) & D) are correct [p.334 & 308].  The side effects reduction of A) is with other combinations, NOT this one.  Renal impairment s/b unaffected.  Metoprolol (Lopressor) can effect abnormal sexual dysfunction which is not a listed dysfunction of nifedipine (Adalat).

Ca channel blocker drug for HTN / angina (variant or vasospastic) on myocardial & vascular smooth muscle (eg., relaxes coronary arteries, too); so, less O₂ use by heart & higher cardiac output, fall in BP.  Better 4 blacks & elderly.

sd ef: headache, dizziness, peripheral edema, flushing.  Gradual discontinuation to avoid rebound hypotension.

CCB is contra with β-blocker: risk of CHF.  Also digoxin bradycardia / toxicity; alcohol syncope. 

Grapefruit juice may enhance absorption of Calcium Channel Blocker.  

A HF patient with diabetes and significant breathing problems 2nd'y to asthma has been prescribed Metoprolol (Lopressor, ToprolXL).  Choose all that apply:

A) Beta-adrenergic blockers may enhance the hypoglycemic effects of insulin

B) Dysrhythmias secondary to hypokalemia may result with digoxin

C) angiodema, neutropenia and agranulocytosis are adverse effects

D) is contra for diabetes mellitus

E)  The nurse should withhold the Lopressor and call the provider.

The nurse nailed the hypertension teaching when the patients says:  (choose all that apply)

A) Alcohol, cholesterol in food, and tobacco need to get gone

B) I need to limit stress, sodium, and sat. fat

C) I need regular lipid measurements

D) Aerobic exercise, optimum weight, fruits & veggies need to be a regular part of my days 

E) I need lots of fiber in my diet

What are the influences that drive HTN?  Choose all that apply:

A) hyperthyroidism, Cushing's Syndrome, hyperthyroidism

B) dehydration, aldosterone, ADH

C) Sympathetic NS, P'symp. NS, epinephrine

D) resistance in kidney arterioles

E) friction in the arteries & arteriole diameters

All but D) are correct [p.297].  

3 factors: 1) cardiac o/pt - volume / stroke X strokes/minute = blood pumped / mnt (+/-: pre- & after-load, contractility, SNS, ParaSNS, epinephrine);  2) blood vol - us'y about 5L (less w/ dehydr'n, more w/ aldosterone or ADH);  3) peripheral resistance - friction in arteries & diameter of arterioles (+/-: sympathetic NS activity, renin/angiotensin II, blood viscosity).

HTN can cause dizzy, less urine formation; 4 target organs = heart, brain, kidneys & retina.  HTN w/o cause is primary, idopathic or essential (v. 2ndary HTN Cushing's, hyper-thyroidism, or chronic renal disease).

What is the most important focused assessment the nurse must make for a patient with HTN who suffered HF and is now on a Ca channel blocker?

A) Hypotension; check pulse regularly

B) Electrolyte levels; especially for hypokalemia driven dysrhythmia

C) monitor for signs of HF: severe SOB, frothy sputum, profound fatigue, swelling in extremities

D) hypersensitivity (allergic rxn)

E) an increase in anginal pain

What is the doxazin (Cardura) mechanism of action on the body to decrease blood pressure?

A) Alpha₂ adrenergic agonist slowing of heart rate and conduction velocity, and dilation of arterioles

B) orthostatic hypertension

C) reduction of oxygen demand in coronary arteries and smooth muscle

D) Alpha₁ adrenergic antagonist selective for vascular smooth muscles, dilating arterioles and muscle around prostrate gland 

E) blocking the angiotensin converting enzyme

D) is the answer, though B) can occur [p. 316].  A) describes α₂ adrenergic agonists.  C) describes CCB's.  E) describes ACE inhibitors.  Doxazosin (Cardura), α₁ adrenergic blocker drug for HTN & BPH (benign prostatic hyperplasia) is selective for vascular smooth muscle (arterioles); so preferred over non-selective β-blockers; dilates arteries & veins, capable of rapid fall of BP (initial serious orthostatic hypotension).  Relaxes smooth muscle around prostate gland (good 4 Benign Prostatic Hyperplasia), relieving dysuria.  

sd ef: headache, dizziness.     D-D: additive effects w/ other anti-HTN drugs.

Under what circumstances can enalapril (Vasotec) be issued to a pregnant patient?  

A) When the life-saving need over-rules the documented risk to the fetus (Category D).

B) never (Category X)

C) Category C (there are no studies in pregnant women)

D) Category A - enalapril is safe.

What can you tell me about β blockers?  Select all that apply.

A) Usually combined w/ other agents, especially ACE Inhibors

B) β blockers of sympathetic NS to slow HR & BP 

C) contra for asthma, cardiogenic shock, hrt blk >1, overt cardiac fail

D) adverse is flushing & hot flashes

E) is a negative inotrope

A), B), C) & E) are all correct [p. 330 & 334].  B) is mechanism of action.  Adverse effects of D) are for niacin not β blockers.

Blocking sympathetic NS slows HR & BP; w/therapy, hrt may return to normal; dramatic reduction of deaths.  Usually combined w/ other agts, esp'y ACE I. Inotropic effect refers to the contractility (force of contraction) of the heart [p.325]. "Negative inotrope" means it reduces the contractility.  

Patient is on  metoprolol (Lopressor).  Choose all that apply.

A) Metoprolol is a 1st line, stand alone drug for HF.

B) Lopressor is a cardiac glycoside that acts directly to increase the force and slow the rate of heart contractions

C) Lopressor is a negative inotrope

D) Lopressor may cause abnormal sexual function

E) metoprolol may enhance the hypoglycemic effects of insulin 

C), D) & E) are correct [p.331 & 334]. A) is false: beta blockers are rarely used as monotherapy [p.331, bot. ri.].  B) is describing digoxin, not Lopressor.  Metoprolol is β₁ negative inotrope; β₂ @ higher doses in bronchial smooth muscle.  Preferred as selective for respiratory pbm w/ HF.

sd ef: fatigue, drowsy, insomnia, sexual dysfunction

contra: asthma, cardiogenic shock, hrt blk >1, overt cardiac fail

D-D-: digoxin -> bradycardia; oral con'ceptv ups effect, alcohol down effect.  

How does HTN lead to heart failure?  Select all that apply.

A) HTN causes a breach in the myocardial septum

B) HTN causes irregular brain waves to interfere with the atrial sinus.

C) Chronic HTN damages renal & retinal vessels causing progressive dysfunction of these organs

D) Damage to blood vessels for the brain from HTN can result in transient ischemic attacks and strokes

E) The heart has to work harder to pump blood to organs and tissues, leading to HF and lung congestion

What are common signs of digoxin (Lanoxin) toxicity?

 A) nausea and visual disturbances, especially yellows and greens 

B) constipation and bloating

C) hypersalivation 

D) dysrhythmias, especially when hypokalemia is present 

E) bradycardia

What interactions may occur when a patient takes Lanoxin and Lasix together?  Select all that apply.

A) hypokalemia

B) a reduction in serum levels of magnesium

C) dysrhythmias

D) hyperkalemia

E) renal impairment

What is a common side effect of lisinopril (Zestril) that should be reported to the physician?  Select all that apply.

A) orthostatic hypotension

B) headache

C) hyperkalemia

D) dizziness

E) angioedema

All answers are correct [p.329].  However, the priority report would be E) angioedema.  Hyperkalemia & ortho'hypotension are serious but 2nd concerns.  

ACE Inhibitor D- for HF & HTN; inhibits angiotensin-converting enzyme which decreases both a-II and aldosterone prdn -> BP down & cardiac /o-put increased.

sd ef: cough, headache, dizzy, ortho'hypotension, rash, hyperkalemia. Potential hyperkalemia w/ K-sparing diuretics.

Angioedema - an allergic skin disease characterized by patches of circumscribed swelling involving the skin and its subcutaneous layers, the mucous membranes, and sometimes the viscera—called also angioneurotic edema, giant urticaria, Quincke's disease, Quincke's edema 

A patient with CHF is taking Lasix and Lanoxin 

When do you know the medication is effective?  Select all that apply.

A) Respiratory congestion & / or peripheral edema (if present) is improved.

B) Electrolytes are in balance

C) Urine output returns to or is within normal limits

D) No bradycardia nor visual changes are present

E) HR & BP return to or remain w/n normal limits

The most critical answer is E) [p.332]; secondary considerations would be A) & C) [p.332].  However, since furosimide (Lasix) - loop diuretic - is involved, C) would be of high interest.  B) & D) are nursing considerations that would confirm the success.

Normal urine output = 0.5ml/kg body weight/hr. or about 30 to 40 ml per hour for an adult.

Your patient is taking Lasix

What are signs of low K+ that you should know?  Select all that apply.

A) Dizziness & syncope

B) orthostatic hypotension

C) nausea

D) Dysrhythmias

E) dehydration

D) is the primary answer.  The effectiveness of loop diuretics makes dehydration and hypovolemia (orthostatic hypotension) important, too.

Normally, blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L). A very low potassium level (less than 2.5 mmol/L) can be life-threatening and requires urgent medical attention [Mayo Clinic]

Explain the mechanics of action: cardiac glycosides, diuretics, β blockers, ACE inhibitors

*Cardiac glycosides increase cardiac output by increasing the force of contraction.

*Diuretics lower blood volume

*beta blockers lower heart rate

*ACE inhibitors lower peripheral vascular resistance and blood volume. 

Can atenolol (Tenormin) be stopped abruptly or must it be tapered? 

Some people who have suddenly stopped taking similar drugs have had chest pain, heart attack, and irregular heartbeat. If your doctor decides you should no longer use this drug, he or she may direct you to gradually decrease your dose over 1 to 2 weeks.  [WebMD]

atenolol (Tenormin) [p.347]

NO!  sildenafil (Viagra) and the like can cause life-threatening hypotension & cardiovascular collapse with organic nitrates [p. 344].  Nitroglycerin primarily relaxes both arterial & venous smooth muscles, as well as coronary arteries (critical for vasospastic angina, not for stable angina); can dilate cerebral vessels -> headache [p. 342 & 344].  Tolerance problem solved by w/holding @ night.

Sustained release forms are contra for glaucoma; may increase intraocular pressure.

Common side effects of diltiazem (Cardizem): choose all that apply.

A) Dysrhythmias / heart block with β blocker

B) bradycardia

C) hypotension

D) Acute angina upon abrupt w/drawal of drug

E) Edema of ankles & feet

Nitroglycerine transdermal patch application

*always wear gloves when applying or removing a patch 

*write date and time on patch before applying to chest

*apply patch in different location on chest each time.

For a patient experiencing chest pain after ambulating, what is your first intervention? 

For a patient experiencing chest pain after ambulating remember your first intervention after helping the patient to bed is applying O2. Then you begin a focused assessment and intervention

I am not sure if we discussed application of O2 as the first nursing intervention for a patient having angina while in the hospital

{So, A) put to bed; B) O₂; C) focussed assessment; D) intervention }

Your patient is receiving amiodarone (Cordarone).

Can this patient also take Digoxin?

Cordarone is a K+ channel blocker (p.365, Ch 26) that will increase serum digoxin levels up to 70%; and radically jacks up anticoagulants (warfarin must be cut in half) and sinus bradycardia w/ CCB's or β blockers.  amiodarone can double or triple phenytoin levels.

adverse: pneumonia-like syndrome in lungs, blurred vision, photosensitivity, hypotension

adverse: angiodema, neutropenia, agranulocytosis

other side effects: hyperkalemia; hypotension, especially 1st dose orthostatic are most likely. [Ch 23, p.312]

Dysrhythmias all have a defect in the generation or conduction of electrical impulses (action potentials) across the myocardium [Ch 26; p.355].  Total time for action potential across the heart is .22 second.

[p. 356:] automaticity of SA node; 60-100 bpm sinus rhythm; 40-60 bpm impulse through AV node optimizing output by complete atrial emptying when SA unable. Bundle of HIS to Purkinje fibers, which cause the simultaneous firing of all ventricular cells; 30 bpm backup. Ectopic foci – extraneous other source of bpm

[Ch 26; p.364:] diminished libido & impotence.

 [Chart; p. 315:] agranulocytosis, Stevens-Johnson syndrome.  Abrupt w/dwl of drug: palpitations, rebound HTN, dysrhythmias, MI

p.360 @dysrryth, p. 343 @ adverse & MI & angina. at? 

Heparin is to prevent new thrombi formation following MI.

[p. 375, Ch 27 coagulation:] natural substance found in liver & lining of blood vessels; its normal function is to prolong coagulation time to prevent excessive clotting in blood vessels.

What is your primary nursing goal for patients who are receiving Heparin IV?

[Ch 27; p374t:] anticoagulant

[p.375:] prevents the enlargement of existing clots and the formation of new ones; does not dissolve existing clots.

p.376 Nursing Proc.

Your patient is receiving enoxaparin (Lovenox), a low molecular weight heparin (LMWH).  You will give this medication SQ in the stomach.

We did not discuss this in class  Check online & ask classmates.

See unique discussion on p349, ri sd, last Para, Ch 25; and Ch 27, p. 373, bot. ri.  

What?  Heparin is to prevent new thrombi formation following MI.  

 Administration should be alternated between the left and right anterolateral and left and right posterolateral abdominal wall.  (RxList.com & Lovenox.com)

What are potential adverse effects of enalapril (Vasotec)?

Hyperkalemia. Poss rapid fall in BP w/ 1st dose – orthostat. Hypertension.

Ace Inhib (“-pril”): life threat angiodema, neutropenia, agranulocytosis   Ch 23, p312