pharmacology exam 2
explain what myopathy is
. Myopathy is a general term referring to any disease that affects the muscles that control voluntary movement in the body. Patients experience muscle weakness due to a dysfunction of the muscle fibers. Some myopathies are genetic and can be passed from parent to child.
What is the normal range for digitalis?
0.5 to 2 ng/mL
Which of the following medication can cause hyperkalemia?
ACE inhibitors and spironolactone
Which of the following tests are used to test heparin drug effectiveness?
Activated partial thromboplastin time (aPTT)
vitamin k1
Administer vitamin K1 to promote synthesis of coagulation factors VII, IX, X, and pro thrombin. Administer IV vitamin K1 slowly If vitamin K1 cannot control bleeding, administer fresh frozen plasma or whole blood
Which of the following is a nursing intervention for constipation?
Ambulation, increased fluids, and increased fiber diet
compare and contrast HDL and LDL
As a general rule, HDL is considered "good" cholesterol, while LDL is considered "bad." This is because HDL carries cholesterol to your liver, where it can be removed from your bloodstream before it builds up in your arteries. LDL, on the other hand, takes cholesterol directly to your arteries.
Which of the following would require further teaching?
Atropine is given for tachycardia episodes.
Beta 1 vs Beta 2 blockers
Beta-1 receptors located primarily in the heart mediate cardiac activity. Beta-2 receptors, with their diverse location in many organ systems, control various aspects of metabolic activity and induce smooth muscle relaxation found in bronchial and smooth muscles
A patient has atony of intestine after a GI surgery; abdomen soft. Which medication will the nurse anticipate to give?
Bethanechol
Which of the following ace inhibitors is not a prodrug?
Captopril
Which of the following is used for moderate heart failure?
Carvediolol
Atropine sulfate is the antidote for which of the following
Cholingergic Overdose
What is a potential adverse effect of nicotinic acid?
Cutaneous flushing
Which of the following is the antidote for digoxin?
Digoxin Immune Fab
A cholinergic-blocking agent will cause which of the following?
Dilation of the pupil (mydriasis)
Calcium Channel Blockers
Generic Name: -dipine Trade Names: Amlodipine, Felodipine, Nicardipine Mechanism of Action: Lower BP by stop calcium from entering the cells of the heart & arteries Therapeutic Uses: Used to treat hypertension, angina, abnormal heart rhythms Side Effects: Dizziness, tachycardia, fatigue, flushing, headache, swelling in the feet & lower legs Contradictions/Precautions: Sick sinus syndrome (except with artificial pacemaker) Hypotension, MI, pulmonary congestion Pregnancy Category B Nursing Interventions: Always check BP & HR before administration Patient Education: Educate patient on importance of healthy lifestyle choices which include regular exercise, weight loss, smoking cessation, and low-sodium diet to maximize the effect of antihypertensive therapy.
beta blockers
Generic Name: -olol Trade Names: Metoprolol, Propranolol, Bisoprolol Mechanism of Action: Block the effects of the hormone epinephrine, also known as adrenaline Therapeutic Uses: Treat high BP Side Effects: Bradycardia & hypotension, cold hands & feet, blurred vision, fatigue Contradictions/Precautions: - Bradycardia - Preexisting sick sinus syndrome - 2nd-3rd degree atrioventricular block, hypoglycemia Pregnancy Category C
Digoxin
Generic Name: -oxin Trade Names: Lanoxin, Toloxin Mechanism of Action: Increases the force of myocardial contraction Therapeutic Uses: Increased cardiac output & slowing of the heart rate Side Effects: Arrhythmias, bradycardia, anorexia, nausea, vomiting, fatigue Contradictions/Precautions: Uncontrolled ventricular arrhythmias AV block Known alcohol intolerance Use Cautiously In: hypokalemia, hyperkalemia, hypomagnesemia, Hypothyroidism, M Pregnancy Category C OB: monitor neonates for signs/symptoms of digoxin toxicity; may lead to increased risk of arrythmias during L&D Nursing Interventions: IV Monitor Apical Pulse, Monitor ECG & BP, Observe IV site for redness or infiltration, monitor I&Os Patient Education: Teach patient to take pulse Review signs & symptoms of digitalis toxicity with patient & family
Angiotensin-converting Enzyme (ACE) Inhibitors
Generic Name: -pril Trade Names: Lisinopril, Moexipril, Captopril, Benazepril, Perindopril Mechanism of Action: Management of Hypertension Ace inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II Therapeutic Uses: Lowering of BP in hypertensive patients Improved symptoms in patients with HF Side Effects: Hypotension, chest pain, tachycardia, taste disturbances Contradictions/Precautions: Hypersensitivity with previous ACE inhibitors Renal Impairment Black Patients with Hypertension Women of Reproductive potential Pregnancy Category C (first trimester) D (second & third trimester) Nursing Interventions: PO Monitor BP and Pulse Monitor frequency of prescription refills to determine adherence Monitor for signs of angioedema Patient Education: Avoid salt substitutes or foods containing high levels of potassium or sodium Notify HCP is rash, sores, swelling of hands or feet occur
Angiotensin II Receptor Blockers
Generic Name: -sartan Trade Names: Azilsartan, Candesartan, Irbesartan, Iosartan, Valsartan Mechanism of Action: Works by blocking receptors that the hormone acts on, specifically AT1 receptors, which are found in the heart, blood vessels and kidneys Therapeutic Uses: Used to treat high blood pressure and heart failure Side Effects: Dizziness, hypotension, angioedema, headache, fatigue Contradictions/Precautions: Low BP History of angioedema Anaphylaxis Hyperkalemia Acute kidney disease Pregnancy Category D SHOULD NOT BE USED DURING PREGANCY Nursing Interventions: PO Assess BP Monitor frequency of prescription refills Assess patient for signs of angioedema Patient Education: Avoid salt substitutes Avoid sudden changes in position May cause dizziness Notify HCP is swelling of the face, eyes, lips, or tongue occur
Epinephrine
Generic Name: Adrenalin Trade Names: EpiPen, Adrenaclick Mechanism of Action: It works by relaxing the muscles in the airways & tightening the blood vessels Therapeutic Uses: Bronchodilation Maintenance of BP & HR Side Effects: Angina, Arrythmias, Hypertension, Tachycardia, Restlessness, Nervousness, Tremors Contradictions/Precautions: Hypersensitivity to adrenergic amines Use cautiously in: Cardiac Disease, Hypertension, Parkinson's Disease, Lactating Mothers Pregnancy Category C Nursing Interventions: IM Monitor IV site Assess Lung Sounds, Respiratory Pattern, Pulse, & BP BEFORE administration & during peak of medication. Patient Education: Patients should always seek emergency medical treatment after you inject yourself with epinephrine DO NOT inject into the hands or feet only in the middle or outside of the thigh
AccuNeb, ProAir Respiclick, Proventil, Ventolin HFA, VoSpire ER.
Generic Name: Albuterol Trade Names: Proair Digihaler. Proair HFA, Proventil HFA Mechanism of Action: It works by relaxing the muscles in the airways Therapeutic Uses: Bronchodialation Side Effects: Chest pain, Palpations, Nervousness, Tremor, Restlessness Contradictions/Precautions: Cardiac Disease Hypertension Hypothyroidism Seizure disorder Hepatic Impairment This medication could increase toxicity & prolong the patient QT interval Pregnancy Category C Nursing Interventions: Nebulizer Assess Lung Sounds, BP, Pulse before administration & during peak of medication Observe for wheezing Patient Education: Administer with meals to minimize gastric irritation Teach inhaler education to patients
Carvedilol
Generic Name: Coreg, Coreg CR Trade Names: Mechanism of Action: Like other beta blockers, Carvedilol slows down your heart rate & making it easier for your heart to pump blood around your body. Therapeutic Uses: Decreased HR & BP, improved cardiac output, slowing progression of HF & decreased risk of death Side Effects: Bradycardia, HF, Pulmonary Edema, Stevens-Johnsons Syndrome, Toxic Epidermal Necrolysis, Hypersensitivity Reactions Contradictions/Precautions: History of hypersensitivity reactions, Pulmonary Edema, Cardiogenic Shock, Bradycardia, Heart Block No assigned Pregnancy Category Nursing Interventions: PO Monitor BP & Pulse frequently during dose adjustment period and periodically during therapy Patient Education: Abrupt withdrawal may precipitate life-threatening arrythmias, hypertension or MI. Discontinue over 1-2 week period
Nitroglycerin
Generic Name: Nitro- Trade Names: Nitro-Time, Nitrostat, Nitro-Bid, Nitrolingual Mechanism of Action: Increases coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions Therapeutic Uses: Relief or prevention of anginal attacks. Increased cardiac output. Reduction of BP. Side Effects: Hypotension, Tachycardia, Dizziness, Headache Contradictions/Precautions: Increased Intracranial pressure Severe Anemia Alcohol Intolerance Use Cautiously In: head trauma or cerebral hemorrhage, cardiomyopathy, cardioversion OB: may compromise maternal/fetal circulation Nursing Interventions: Buccal or Sublingual Tab Monitor BP & pulse, Assess location, duration, intensity, & precipitating factors of patient's anginal pain Patient Education: Avoid alcohol Headache is common side effect Notify HCP if blurred vision or dry mouth occurs
Serevent Diskus
Generic Name: Salmeterol Trade Names: Advair Diskus, AirDuo RespiClick Therapeutic Uses: Bronchodilation Side Effects: Palpations, Tachycardia, Headaches Contradictions/Precautions: Hypersensitivity to Salmeterol or milk proteins Use Cautiously in: cardiovascular disease, seizure disorders, hepatic impairment, hypothyroidism This medication could increase toxicity & prolong the patient QT interval Pregnancy Category C Nursing Interventions: Orally Inhaled Assess lung sounds, pulse, BP before administration & periodically during therapy Available in 2 forms: Inhalation Powder & an Inhalation Aerosol Patient Education: Patients taking salmeterol twice daily should NOT use additional doses for exercise-induced bronchospasms
Atenolol
Generic Name: Tenormin Trade Names: N/A Mechanism of Action: Blocks stimulation of Beta1(myocardial)-adrenergic receptors Therapeutic Uses: Decreased BP & HR, Decreased frequency of attacks of angina pectoris, Prevention of MI Side Effects: Fatigue, Weakness, Bradycardia, HF, Pulmonary Edema Contradictions/Precautions: Uncompensated HF, Pulmonary Edema Cardiogenic Shock Bradycardia or Heart Block Use Cautiously In: Renal & Hepatic Impairment, Sensitivity to Beta Blockers, Lactating Mothers OB: crosses the placenta & may cause fetal bradycardia, hypotension, or respiratory depression Pregnancy Category D Nursing Interventions: PO, IV Monitor BP, ECG, & Pulse during dose adjustment period Monitor I&O's & daily weights Assess routinely for HF Patient Education: Notify HCP is slow pulse, wheezing, difficulty breathing, coughing, or dizziness occurs Female patients must notify HCP is pregnancy is planned or suspected, or if breastfeeding
Lidocaine
Generic Name: Xylocaine Trade Names: Xylocaine, Xylocaine Viscous, Lidoderm Mechanism of Action: IV & IM: ventricular arrhythmias Local: topical anesthetic Transdermal: pain due to post-herpetic neuroglia Therapeutic Uses: Control of ventricular arrhythmias; local anesthesia Side Effects: Cardiac Arrest, Seizures, Anaphylaxis Contradictions/Precautions: Hypersensitivity, 3rd Degree Heart Block Use Cautiously in: cardiac or pulmonary disease, liver disease Pregnancy Category B OB: use only if the potential benefit justifies the potential risk to fetus Nursing Interventions: IV, IM Monitor BP & ECG during administration Anesthetic: assess degree of numbness Transdermal: monitor for pain intensity Patient Education: May cause dizziness & drowsiness Notify HCP if pregnancy occurs
Which of the following is a cholinergic therapeutic effect?
Increase in Bowel Sounds
Cevimeline causes which therapeutic effect?
Increased Salivation
general considerations for hypertension therapy
Lifestyle changes should be the initial approach to hypertension management and include dietary interventions (reducing salt, increasing potassium, alcohol avoidance, and multifactorial diet control), weight reduction, tobacco cessation, physical exercise, and stress management.
low molecular heparin (enoxaparin)
Mechanism of Action: -LMWH; antithrombotic that inhibits factor Xa by increasing inhibition rate of clotting proteases that are activated by antithrombin III -Generally does not increase PT or PTT Therapeutic Uses: Prevent deep-vein thrombosis (DVT) in clients who are postoperative •Treat DVT and PE •Prevent complications in angina, MI,STEMI Side Effects: -Hemorrhage -Neurologic damage from hematoma formed during spinal or epidural anesthesia -Heparin-induced (immune mediated) thrombocytopenia -Toxicity Black Box Warnings Epidural or spinal hematomas may occur in patients anticoagulated with low-molecular-weight heparin (LMWH) or heparinoids who receive neuraxial (epidural/spinal) anesthesia or spinal puncture Contradictions/Precautions: -Enoxaparin is category B pregnancy -Contraindicated in clients who have low platelet counts or uncontrollable bleeding -Should NOT be used in the following surgeries: eye(s), brain, or spinal cord; lumbar puncture or regional anesthesia -Uses cautiously in clients who have hemophilia, increased capillary permeability,dissecting aneurysm, peptic ulcer disease -Antiplatelet agents can increase risk for bleeding. -Garlic, ginger, glucosamine, or ginkgo biloba can increase risk of bleeding Nursing Interventions: -Monitor vital signs -Monitor platelet count -Assess insertion site for indications of hematoma formation (redness and swelling). -Monitor sensation and movement of lower extremities. -Notify provider of abnormal findings. -Rotate sites between right and left abdominal walls at least 2 inches fromumbilicus. Do not aspirate. Infect entire contents of syringe. Patient Education: -Observe for bleeding: increased HR, decreased BP, bruising, petechiae, hematomas, black tarry stools -Avoid aspirin
Vitiman K inhibitors (warfarin )
Mechanism of Action: Antagonizes vitamin K, thereby preventing the synthesis of four coagulation factors: factor VII, IX, X, and prothrombin Therapeutic Uses: -Prevention of venous thrombosis and PE -Prevention of thrombotic events for clients who have atrial fibrillation or prosthetic heart valves. -Reduction of the risk for recurrent transient ischemic attacks or myocardial infarction. Side Effects: -hemorage -hepatitis -toxicity -alopecia -Black Box Warning Warfarin sodium can cause major or fatal bleeding; bleeding is more likely to occur during the starting period and with a higher dose (resulting in a higher INR) Contradictions/Precautions: -Warfarin is pregnancy Risk category D for clients with mechanical heart valves and category X for other pregnant populations -Warn clients to try not to breastfeed while on this medication because it passes through the milk. -Contraindicated in clients who have low platelet counts -Contraindicated in clients who have vitamin K deficiencies, liver disorders, and alcohol use disorders = additive risk for bleeding -Use cautiously in clients who have hemophilia, dissecting aneurysm, peptic ulcer disease, severe hypertension Nursing Interventions: -Administer vitamin K1 to promote synthesis of coagulation factors VII, IX, X, and prothrombin. -Administration is usually oral, once daily, and at the same time each day. -Obtain baseline vital signs -Monitor PT levels and INR levels PT: 18 to 24 seconds INR: 2 to 3 (Most accurate) - hold dose and notify provider if these levels exceed therapeutic ranges. -Vitamin K1 = antidote -Watch for bleeding Patient Education: foods high in vitiman K can reduce anticoagulant effects garlic and ginger can increase risk for bleeding
heparin
Mechanism of Action: Heparin prevents clotting by activating antithrombin ->indirectly inactivating both thrombin and factor Xa ->inhibiting fibrin formation Therapeutic Uses: Stroke, pulmonary embolism (PE), massive deep-vein thrombus An adjunct for clients having open heart surgery or dialysis Low-dose therapy for prophylaxis against postoperative venous thrombosis (Ex: hip/knee or abdominal surgery) Treatment of disseminated intravascular coagulation •Prevent complications in angina, MI, STEMI Side Effects: -Hemorrhage secondary to heparin toxicity or other factors -Epidural or spinal hematoma -Heparin-induced thrombocytopenia -Hypersensitivity reactions (chills, fever,urticaria) Contradictions/Precautions: -pregnancy category C -Contraindicated in clients who have low platelet counts or uncontrollable bleeding -Should NOT be used in the following surgeries: eye(s), brain, or spinal cord; lumbar puncture or regional anesthesia -Uses cautiously in clients who have hemophilia, increased capillary permeability,dissecting aneurysm, peptic ulcer disease -Antiplatelet agents can increase risk for bleeding. -Garlic, ginger, glucosamine, or ginkgo biloba can increase risk of bleeding Nursing Interventions: -Administer protamine sulfate(should be administered slowly IV no faster than 20 mg/min or 50 mg in 10 min.) -Monitor activated partial thromboplastin time (aPTT)Keep value at 1.5 to 2 times the baseline -Stop infusion if hemorrhage occurs. -Stop heparin if platelet count is less than 100,000/mm3. -Cannot be absorbed by the intestinal tract - must be given IV or subcutaneous injection -monitor for bleeding Patient Education: advise client to observe for bleeding advise client to use an electric razor advise client to use a soft toothbrush
Digitalis
Mechanism of Action: It reversibly inhibits the ATPase resulting in increased intracellular sodium levels. The build-up of intracellular sodium leads to a shift of sodium extracellularly through another channel in exchange for calcium ions Therapeutic Uses: Used to treat congestive heart failure & heart rhythm problems Side Effects: Headache, malaise, insomnia, altered mental status, abdominal pain, nausea, & vomiting Contradictions/Precautions: Acute myocardial infarction Hypersensitivity to the drug Ventricular fibrillation Myocarditis Hypomagnesemia, Hypokalemia Wolf-Parkinson-White syndrome. Pregnancy Category C Nursing Interventions: IV, IM
Osmotic Diuretics
Mechanism of Action: Reduce intracranial pressure and intraocular pressure by raising serum osmolarity and drawing fluid back into the vascular and extraocular space Therapeutic Uses: -Prevents kidney failure ->hypovolemic shock and severe hypotension. -Decreases intracranial pressure (ICP) -Decreases intraocular pressure -Promotes sodium retention and water excretion in clients who have hyponatremia and fluid volume excess Side Effects: -heart failure -rebound intracranial pressure -fluid and electrolytes imbalances , metabolic acidosis Contradictions/Precautions: contraindicated in anuric patients and patients not responding to test doses. Mannitol and urea should not be used in patients with active cranial bleeding. Carbonic anhydrase inhibitors, thiazides and sulfonamide-based loop diuretics are contraindicated in patients allergic to sulfonamides. Nursing Interventions: -Administer by continuous IV infusion. -To prevent administering microscopic crystals -> use a filter needle when drawing from the vial and a filter in the IV tubing -Monitor patient's weigh -Monitor Blood pressure -Monitor ICP Patient Education:
Dopamine
Mechanism of Action: lowers blood pressure by acting on two receptor subtypes: dopamine 1 and dopamine 2 Therapeutic Uses: Treats low blood pressure low heart rate, & cardiac arrest Side Effects: Aggression, trouble controlling impulses, headache, chest pain, anxiety, palpitations, SOB, blue discoloration of hands & feet Contradictions/Precautions: should not be used in patients with Pheochromocytoma Uncorrected tachyarrhythmias Ventricular fibrillation Pregnancy Category C Nursing Interventions: IV Monitor BP, pulse, pulses every 15 minutes Monitor hourly urine output Monitor cardiac monitor Patient Education: Explain the purpose of Dopamine Notify nurse of HCP if chest pain, numbness, tingling, or burning if extremities occurs Advise females to notify HCP is pregnancy is planned or suspected
High celing loop diuretics
Medication Class/Dose: Generic Name: high-celing loop diuretics Trade Names: -Furosemide -Bumetanide Mechanism of Action: work in the loop of Henle Block reabsorption of sodium and chloride and prevent reabsorption of water Causes extensive diuresis even with severe renal impairment Therapeutic Uses: -used when there is an emergent need for rapid mobilization of fluid -Pulmonary edema caused by HF -Conditions not responsive to other diuretics Side Effects: Dehydration,hyponatremia, hypochloremia Hypotension Ototoxicity Hypokalemia Contradictions/Precautions: Loop diuretics are contraindicated in patients with hypokalemia (only to be administered after correction), severe hyponatremia, hypotension, azotemia, oliguria/anuria, and hepatic coma. It is also contraindicated in any situation where fluid depletion is foreseen, such as surgery. Nursing Interventions: -Avoid administrating medication late in the day to prevent nocturia. Usual dosing time is 0800 and 1400. -> Best time to take in the morning. -Obtain baseline data, including orthostatic blood pressure, weight,electrolytes, and location of edema. -Watch for patients on digoxin ->concurrent use can cause digoxin toxicity. -Watch for hypokalemia Patient Education: -Advise patients to change position slowly as they may experience orthostatic changes. -Patients should also report weight gain of more than three pounds in a day to their healthcare provider. -Patients should also be encouraged to enjoy potassium-rich foods during loop diuretic drug therapy.
Thrombolytics , -plase
Medication Class/Dose: Thrombolytics or fibrinolytic are a group of medications used to manage and treat dissolving intravascular clots. They are in the plasminogen activator class of drugs. Generic Name: thrombolytics, eminase, retavase, streptase Trade Names: (plase) anistreplase, reteplase Mechanism of Action: -Dissolve clots that have already formed Therapeutic Uses: -Treat Acute myocardial infarction (all three medications) -Treat massive PE (alteplase only) -Treat acute ischemic stroke (alteplase only) -Restore patency to central IV catheter (alteplase only) Side Effects: -BLEEDING! Contradictions/Precautions: A recent head injury. Bleeding problems. Bleeding ulcers. Pregnancy. Recent surgery. Taken blood thinning medicines such as Coumadin. Trauma. Uncontrolled (severe) high blood pressure. Nursing Interventions: -Limit venipunctures and injections -Apply pressure dressing to recent wounds -Monitor for changes in vital signs, alterations in LOC -Monitor aPTT and PT, Hgb and HCt -Client may require blood products -For severe bleeding fibrinolysis following alteplase can be reserved by aminocaproic acid IV Patient Education: -Instruct patient about procedures and their necessity prior to beginning thrombolytic therapy. -Instruct patient that frequent vital signs must be taken. -Instruct patient that activity will be limited during infusion and that pressure dressing may be needed to prevent any active bleeding.
Which of the following medications would be prescribed to a pregnant woman experiencing nonemergent hypertention?
Methyldopa
What is unstable angina?
New chest pain or chest pain felt for the first time
Which of the following is the antidote for atropine?
Physostigmine
Salmeterol is used for which of the following?
Prevention of asthma attacks given as an inhaler
A patient with type 2 diabetes who has protein in their urine is given lisinopril for which of the following reasons?
Renal protective effects
Carvedilol is a nonselective beta blocker. It can mask which of the following?
Signs and Symptoms of hypoglycemia
A patient has chest pain and a prescription for SL nitroglycerin. Which instructions should be included?
Sit immediately, then take first nitro
Which of the following requires further education from the nurse?
The student nurse is giving topical nitroglycerin without donning gloves.
Potassium sparing diuretics
Trade Names: (SPIRONOLACTONE) Mechanism of Action: Potassium-sparing diuretics block the action of aldosterone (sodium and water retention), which results in potassium retention and excretion of sodium and water Therapeutic Uses: Potassium-sparing diuretics are a type of diuretic that helps eliminate excess sodium and water from the body while retaining potassium at the same time. congestive heart failure, hypertension Side Effects: Hyperkalemia (increased levels of potassium in the blood) Nausea and vomiting. Abdominal discomfort. Headache. Drowsiness. Confusion. Ataxia (loss of control on bodily movements due to lack of coordination between muscles and brain) Kidney stones. Black Box Warnings Spironolactone has been shown to be a tumorigen in chronic toxicity studies in rats; use only for specified indications Contradictions/Precautions: -Hyperkalemia -Endocrine effects (deepened voice, impotence,irregularities of menstrual cycle) Nursing Interventions: Assess patients for sulfa allergies, as some diuretics are sulfonamide derivatives. -Monitor weight, intake, output, and serum electrolyte levels. - Monitor blood glucose levels (some agents may cause hyperglycemia) Patient Education:AVOID foods that are high in potassium to prevent hyperkalemia., take the medications at the same time each day , report weight gain
Adenosine
Trade Names: Adenocard Mechanism of Action: Restores normal sinus rhythm by interrupting re-entrant pathways in the AV node. Also produces coronary artery vasodilation Therapeutic Uses: Restoration of normal sinus rhythm Side Effects: MI, Ventricular Tachycardia, Seizes, Stroke, Hypersensitivity Reactions Contradictions/Precautions: Hypersensitivity 2nd-3rd degree AV block (unless a functional artificial pacemaker is present) MI Use Cautiously In: Patients with history of asthma (may induce bronchospasm) Pregnancy Category C Nursing Interventions: IV Monitor HR, BP, & asses respiratory status Patient Education: Change positions slowly to minimizes orthostatic hypotension Report any facial flushing, SOB, or dizziness Avoid drinks containing methylxanthine (caffeinated drinks, tea, carbonated drinks)
Centrally Acting Alpha 2 Agonists
Trade Names: Clonidine, Methyldopa, Guanfacine Mechanism of Action: Simulate alpha 2 adrenoceptors in the CNS Therapeutic Uses: Used to treat hypertension, withdraw from various substances Side Effects: Depression, bradycardia, nausea, vomiting, gastric upset, dry mouth Contradictions/Precautions: Hypertension Bradycardia Prostatic hyperplasia Anyone using medications that may also increase blood pressure. Use caution with anyone who has low blood pressure taking this medication Pregnancy Category B Nursing Interventions: Monitor respiratory rate, oxygen saturation, & lung sounds before & after administration Monitor ECG during administration Monitor BP & Heart Rate Patient Education: Vivid dreams
Digoxin Immune Fab (Digifab)
Trade Names: Digibind, DigiFab Mechanism of Action: binds to molecules of digoxin reducing free digoxin levels, which results in a shift in the equilibrium away from binding to the receptors, thereby reducing cardio-toxic effects Therapeutic Uses: Used to treat an overdose of digoxin or digitoxin Side Effects: fever, swollen glands, itching, joint pain, or not feeling well; a light-headed feeling, like you might pass out; heart problems, swelling, rapid weight gain, feeling short of breath Contradictions/Precautions: There are no known contradictions to the use of Digifab Pregnancy Category C Nursing Interventions: IV over at least 30 minutes
Phenytoin
Trade Names: Dilantin, Phenytek, Tremytoine Mechanism of Action: Limits seizure propagation by altering ion transport Therapeutic Uses: Diminished Seizure Activity Termination of Ventricular Arrhythmias Side Effects: Cardiac Arrest, Hypotension, Tachycardia, Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, Acute Hepatic Failure, Angioedema Contradictions/Precautions: OB: Pregnancy risk of hemorrhage in newborn if used at term Pregnancy Category D Hypersensitivity to Propylene Glycol, Alcohol Intolerance, Sinus Bradycardia ALL patients with suicidal thoughts, Hepatic or Renal Disease nursing interventions Injection Only Monitor closely for notable changes in behavior that could indicate the worsening of suicidal thoughts Assess for signs of hypersensitivity Patient Education: Avoid alcohol Notify HCP if suicidal thought occur Do NOT take with antiacids May cause fetal harm - female patients must be advised to use additional nonhormonal method of contraception Notify HCP is pregnancy occurs
thiazide
Trade Names: Hydrochlorothiazide Mechanism of Action: -Work in the early distal convoluted tubule -Blocks the reabsorption of sodium and chloride and prevents the reabsorption of water at the site -Promotes diuresis when renal function is not impaired Therapeutic Uses: mainly used to treat high blood pressure (hypertension). They are occasionally also used for heart failure. Side Effects: -Dehydration -Hypokalemia -Hyperglycemia -Hyperuricemia (high uric acid), -hypomagnesemia, increased lipids Contradictions/Precautions: -can cause calcium retention, so take care when using the drug along with calcium supplements or vitamin D. -Potassium-sparing diuretics should not be taken at the same time as another potassium-sparing diuretic to avoid the risk of hyperkalemia. Nursing Interventions: -works better in african americans Give the diuretic in the morning to prevent nocturia that might disturb the patient's sleep. Ask the patient to consult a dietician so that they can devise a potassium-rich diet to prevent hypokalemia. To keep the potassium levels within normal limits, administer supplements. Patient Education: Patients should be instructed to take these medications at the same time each day and notify their healthcare provider if they experience significant changes in weight. Thiazide diuretics may cause orthostatic changes so individuals should change positions slowly.
Amiodarone
Trade Names: Nexterone, Pacerone Mechanism of Action: Slows sinus rate, increases PR & QT intervals & decreases vasodialation Therapeutic Uses: Suspension of arrhythmias Side Effects: Acute Respiratory Distress Syndrome (ARDS), Pulmonary Fibrosis, Pulmonary Toxicity, HF, QT interval Prolongation, Bradycardia, Hypotension Contradictions/Precautions: Patients with cardiogenic shock Severe sinus node dysfunction Bradycardia Sensitivity to amiodarone or iodine Use Cautiously in: history of HF, Pulmonary or Liver Disease Pregnancy Category D OB: may cause fetal harm. Should only be used during pregnancy when arrhythmias are refractory Nursing Interventions: IV, PO Monitor ECG continuously during IV therapy Assess for signs of pulmonary toxicity Assess for neurotoxicity Patient Education: Monitor pulse daily & report any abnormalities Avoid grapefruit juice during therapy Photosensitivity Bluish discoloration of the face is a possible side effect' if this occurs call your HCP
Which of the following is an appropriate use of epinephrine?
acute asthma attacks
A patient has an apical pulse of 61 and is on digoxin. Which nursing intervention is appropriate?
administer the dose and document
Dopaminergic receptors
affect movement, emotions, and reward systems in the brain (pleasure , memory )
describe heart failure
also known as congestive heart failure , condition that develops when your heart doesnt pump enough blood for your bodies needs
Describe hemophilia
an inherited bleeding disorder in which the blood does not clot properly
protamine sulfate
antidote for heparin
Which adrenergic receptor causes bronchodilation?
beta 2
Describe anticholinergics
block the action of the neurotransmitter called acetycholite, this inhibits nerve impulse responsible for involuntary muscle movements and various bodily functions
Verapamil is in which drug class?
calcium channel blocker
describe Angina in your own words
chest pain or discomfort that keeps coming back, happens when heart doesnt get enough blood and oxygen
heart failure
chest pain, shortness of breath, diziness, lightheadness, swelling of legs, sudden weight gain, sudden fatigue or weakness, most often caused by another medical condition that damages your heart . may not cause symptoms right away
Describe a cholinergic crisis
clinical conditions that develops as a result as a result of over stimulation of nicotinic and muscarinic receptors at the neuromuscular junction and synapses, should be treated by withdrawing all anticholinrdterase medications , mechanical ventilation if required, and atropine IV for muscarinic effects of the overdose
Which of the following is within the CNA scope of practice?
collecting urine samples
Verapamil can cause which of the following adverse effects?
constipation
Which of the following is an adverse effect of fibric acid derivative?
diarrhea
Which of the following should a patient taking an ACE inhibitor report?
dry cough
Scopolamine patch could have which of the following side effects?
dry mouth
Which food is contraindicated in a patient on digoxin?
food high in fiber
A patient returns from surgery with an epidural. They have a routine order for enoxaparin. Which intervention?
hold medication and contact provider
Which adverse effect will the nurse look for in a patient on a loop diuretic?
hypokalemia
which is a therapeutic affect of dopamine
increased blood pressure
beta 2 adrenergic receptors
increased contractility and may lead to muscle tremors
beta 1 adrenergic receptors
increased heart rate and contactility , stroke volume and cardiac output will also increase
aplha-adrenergic receptors
increased resistance to the blood flow, increased workload on the heart , increased blood pressure
What does garlic cause in a patient who is taking warfarin?
increased risk of bleeding
Which of the following should be monitored during antilipedmic therapy?
liver dysfunction
A patient is on a cholestyramine powder. Which of the following should the patient avoid?
mixing powder with a carbonated beverage
general considerations for beta blockers
monitor the ecg closely, keep an eye on patient vital signs , some patients experience fatigue or weight loss, carry a risk for heart block
When is the best time to administer a diuretic?
morning
complications of antidysrythmic therapy
most common side effects - constipation, dizziness, excessive thirst, seizures, lethargy, confusion and coma, bradycardia, atrioventricular nodal block, ventricular fibrilation, altered mentation
Carvediolol is what type of beta blocker?
nonselective
A patient is on atenolol. Which of the following requires further education?
patient stops atenolol abruptly
What is the antidote for heparin?
protamine sulfate
describe what hypokalemia is
refers to a lower-than-normal potassium level in your blood stream. mild-,3-3.4 mmol/L,moderate 2.5-3 mmol/L, severe less than 2.5 mmol/L,normal potassium-3.5-5.2 mE1/L anything lower than 3 can be considered hypokalemia
Which of the following should a patient avoid if taking an ACE inhibitor?
salt substitutes
Which of the following is an adverse effect for lidocaine?
seizure
which of the following are signs and symptoms of heart failure
shortness of breath, ankle edema
explain what a platelet is
small, colorless fragments in our blood that form clots or prevent bleeding
Amiodarone is used for which of the following.
supraventricular dysrhythmias
Which of the following will dissolve the clot in a coronary artery?
thrombolytic
Describe digoxin toxicity
type of poisoning that occurs in people who take too much of the medication digoxin or eat plants such as foxglove that contains a similar substance Confusion, Irregular pulse, Loss of appetite, Nausea, vomiting, diarrhea, Palpitations, Vision changes (blind spots, blurred vision, changes in how colors look, or seeing spots), Decreased consciousness, Decreased urine output, Difficulty breathing when lying down, Excessive nighttime urination
Describe cholinergic medications therapeutic effects
work by stimulating the bodys nicotonic and muscarinic receptors and are involved in muscle tone, memory, analgesia, cognitive function, monitor control , arousal, and reward. stimulate the activation of the parasympathetic nervous system by activating receptors for acetycholine
Which of the following is a symptom of digoxin toxicity?
yellow and green colors around light