Cardiac Meds, Chemo Essentials, and Blood Reactions

Mrs. Smith

Welcome to the Pharmacology Study Guide Podcast - Part 2. I know we are all prepping for the comprehensive final next week, so I created this podcast to go over some key topics. Today’s topics include cardiac meds, some crucial chemotherapy education, and blood transfusion reactions—so, a lot to cover. Jessie, want to kick us off with ACE inhibitors?

Jessie

Absolutely. ACE inhibitors. I know they're used for hypertension and heart failure. But I keep mixing up the side effects. Damon, can you give us that analogy you used before? The one about the radio?

Damon Salvator

Of course. So, think of ACE inhibitors as turning down a radio that's blasting too loud—so it lowers blood pressure by decreasing angiotensin II, helping vessels relax. But, like we’ve mentioned before, sometimes turning the radio down too much—so lowering the pressure too much—can cause dizziness, or severe hypotension. And then there's that classic dry cough. But what really gets me is angioedema. Huge, puffy swelling—like, sudden lips and tongue—or even throat. That's rare but it's a medical emergency. Airways can close, and you need advanced intervention straight away. Always teach patients to report any swelling immediately.

Mrs. Smith

And students, don’t forget, ACE inhibitors usually end in "-pril"—like lisinopril. If a patient has even mild swelling, like the lips, the medication is stopped—no exceptions. Safety comes first. Speaking of patient safety, let’s move to beta blockers.

Jessie

Beta blockers confuse me on vitals. I mean—they’re used to slow the heart, right? Which vital signs do I check before giving them, and how do I spot toxicity?

Mrs. Smith

Always check the heart rate and blood pressure. If the heart rate is below 60 or blood pressure is low, hold the dose and let the provider know. Early toxicity signs are bradycardia, really low blood pressure, dizziness, sometimes even fainting. Fatigue’s also common.

Damon Salvator

And to add, always ask about asthma, too. Beta blockers can worsen airway issues and can cause bronchoconstriction. Especially non-selective beta-blockers like propranolol. Metoprolol is a Beta 1 selective blocker, so the risk isn't as high, but it is still important to use caution in patients with asthma.

Jessie

Alright, what about antilipemics? Like statins. When do you usually give those?

Damon Salvator

Statins are best at night—that's when the liver works hardest producing cholesterol. You're watching for muscle pain—think “myopathy”—since it could be a sign of rhabdomylosis, which is pretty serious. Patients can also start experiencing cola colored urine due to the muscle breakdown. Rhabdomylosis means muscles start breaking down, releasing stuff that can knock out kidneys if you’re not careful. Patients with existing liver disease or heavy alcohol use, they should avoid statins. And make sure you’re monitoring liver enzymes during therapy because these medications are really hard on your live.

Mrs. Smith

And with niacin, patients get that “niacin flush”—it’s like this sudden warm, red skin. You can prevent that by pre-medicating with aspirin, about 30 minutes before taking niacin. Just a tip your patients will appreciate. Okay—I think we’ve dug deep into cardiac meds. Let’s pivot to cancer therapies.

Jessie

Can we talk chemo side effects for a sec? I’ve heard you, Mrs. Smith, say fever’s always a big deal with these patients. Why is that?

Mrs. Smith

Right, fever is a huge red flag. Chemo knocks out the immune system—think super low white blood cells—so even a mild fever could mean a dangerous infection. And if you ever see a chemo patient with a cough, or unexplained bleeding, get on the phone to the provider right away. There’s no “wait and see” with those warning signs.

Damon Salvator

Absolutely. And that’s where filgrastim comes in. It’s a, um, colony-stimulating factor—it helps the body make more neutrophils, that’s a type of white cell to fight infection. Give it after chemo, not before, and make sure you’re not giving it within 24 hours of a chemo dose. Otherwise, you can cause issues with the meds counteracting each other. Watch for bone pain as a side effect—it means it’s working, but you don’t want it to get unbearable.

Jessie

So like—at home—if a patient’s getting filgrastim, what do we tell them to look for? And what would make you worry it’s actually a severe complication?

Mrs. Smith

Bone pain is normal, but sudden trouble breathing, chest pain, or really high fever—those need urgent care. Tell patients to keep a thermometer nearby, check every day, and if they see anything unusual, don’t wait to call. Oh—and one more anecdote: I had a patient who was fine, just bone pain, but then one night spiked a fever of 101.5. That was neutropenic fever, so off to the hospital—fast. Timing is everything when patients are neutropenic.

Damon Salvator

And let’s not forget, always practice good hygiene—hand washing, avoiding large crowds, avoid raw fruits and vegetables, live vaccines, fresh flowers or plants. Their immune system's on holiday. Patients should know when to call for help: fever, sore throat, or any unusual bleeding or bruising. That’s a really important patient teaching point.

Jessie

That’s super helpful. Now let's transition to blood transfusions—I know these will be on the final exam.

Damon Salvator

Yes, absolutely, Jessie. So, let’s talk transfusion reactions. The big one is hemolytic—patient’s immune system attacks the transfused blood. Classic symptom is sudden lower back pain—feels like kidney pain. It’s a sign things are going sideways rapidly. You’ll also see fever, chills, flushing, chest pain, maybe hypotension. And because this can knock out the kidneys, time is everything—stop the transfusion at the first sign.

Mrs. Smith

And there’s also fluid volume overload—think shortness of breath, crackles in the lungs, high blood pressure. Happier kidneys, but unhappy lungs, if you will. Lots of students mix up these two. With hemolytic, you’re seeing those rapid, severe signs. With volume overload, it builds up more slowly.

Jessie

So if you walk in on a patient and they’re complaining of back pain during a transfusion—that’s an emergency, right?

Damon Salvator

You got it, Jessie. Immediate response: stop the transfusion, keep the IV line open with saline, and notify the provider and blood bank. Do not throw away the blood bag—send it back for testing. And don’t forget to document—all vital signs, symptoms, interventions. You will obtain blood samples and urine samples to assess for hemolysis and kidney damage. You want to prepare the patient for possible ICU transfer due to the concern of DIC and shock.

Mrs. Smith

One thing I always teach is, before the transfusion, make sure you explain to the patient what symptoms to report—fever, chills, hives, back pain, trouble breathing. If they feel “off,” you want to know right away.

Jessie

That’s reassuring. Sometimes I feel like there’s so much to remember with transfusions, but if you stick to safety steps, it’s manageable. Thanks, Mrs. Smith and Damon. Seriously, these real-world tips help me remember—like back pain means “bad,” call for help fast.

Damon Salvator

Glad to hear it, Jessie. And your questions always make these sessions better—keeps us on our toes. We’ve covered a ton today—cardiac meds, chemo agents, and blood products. That’s some high-yield revision for everyone.

Mrs. Smith

Absolutely—everyone listening, go review your notes, and don’t forget to check out Part 1 of the Pharmacology Review Podcast. Thank you for listening!

Jessie

Good luck everyone!