Pharmacology Exam 2

A nurse is assessing a client who is taking digoxin to treat heart failure. Which of the following findings is a manifestation of digoxin toxicity? a. bruising b. report of metallic taste c. muscle pain d. report of anorexia

D

A nurse is caring for a client who is prescribed isosorbide mononitrate for chronic stable angina and develops reflex tachycardia. Which of the following medications should the nurse expect to administer? a. furosemide b. captopril c. ranolazine d. metoprolol

D

A nurse is teaching a client who is taking digoxin and has a new prescription for colesevelam. Which of the following instructions should the nurse include in the teaching? a. "take digoxin with your morning dose of colesevelam" b. "your sodium and potassium levels will be monitored periodically while taking colesevelam" c. "Watch for bleeding or bruising while taking colesevelam" d. "Take colesevelam with food and at least one glass of water"

D

Low-molecular-weight heparin (LMWH)

Dalteparin, Enoxaparin, Tinzaparin Action Inactivates Xa factor Use Prevent DVT and acute PE after orthopedic or abdominal surgery Thin blood until therapeutic levels of Warfarin obtained

Beta2 receptors

Decreases GI tone and motility Bronchodilation Increases blood flow in skeletal muscles Relaxes smooth muscles of uterus Activates liver glycogenolysis Increases blood glucose

Brain natriuretic peptide (BNP)

Desired value: less than 100 pg/mL Positive value: greater than 100 pg/mL

What has less hypotension side effects than other Ca+ Channel blockers?

Diltiazem

Catecholamines

Directly stimulates adrenergic receptor Produce sympathetic response

Nursing education for "-statins"

Do not abruptly discontinue It may take several weeks before blood lipid levels decline Have annual eye examinations and report changes in visual acuity

Alpha Adrenergic Antagonists

Drugs that inhibit a response at alpha-adrenergic receptor site Decrease symptoms of BPH, PVD, Raynaud's Doxazosin, Prazosin, Terazosin, ***Phentolamine (for catecholamine extravasation)

Nursing Considerations Adrenergic Agonists

Dysrhythmias, tissue necrosis, sleep patterns

*Definitive diagnostic tool:

ECHO

Endogenous Catecholamines

Epinephrine, norepinephrine, dopamine

Cholesterol Absorption Inhibitor-

Ezetimibe Acts on the cells in the small intestine to inhibit cholesterol absorption to reduce LDL

Fibrates-

Fenofibrate, Gemfibrozil Reduces triglycerides and VLDL

Anticoagulants examples

Heparin

Side effects of Adrenergic Agonists

Hypertension, anxiety, increased heart rate, insomnia, headaches

Contraindication Adrenergic Agonists

Hyperthyroidism, glaucoma, diabetes, seizures, CVD, hypokalemia(?)

Beta1 receptors

Increases cardiac contractility, heart rate Increases renin secretion and increases BP

Alpha1 receptors

Increases cardiac contractility, vasoconstriction Dilates pupils, decreases salivary gland secretion Increases bladder and prostate contraction

Alpha2 receptors

Inhibits norepinephrine release Promotes vasodilation and decreased BP Decreases GI motility and tone

Synthetic catecholamines

Isoproterenol, dobutamine

Understand the nursing interventions when using anticoagulants, antiplatelet, and thrombolytics as part of your treatment

Monitor for pt INR for warfarin and PTT for heparin Examine patient's nose, mouth, skin and urine for bleeding Teach patient to inform dentist they are taking anticoagulant

Nicotinic Acid-

Niacin Improves levels of LDL and Triglycerides

Calcium Channel Blockers-

Nifedipine, Verapamil, Diltiazem (Diltiazem has less hypotension side effects than other Ca+ Channel blockers) Action Relax coronary artery spasm Used in treatment of Variant angina Cause negative inotropic effect Reduce cardiac workload and oxygen demands

Classic angina treatment

Nitrates + Beta blockers + calcium blockers then coronary artery bypass graft

Nitrates-

Nitro SL (nitro-stat), Nitro ointment (nito-bid), Patch (nitro-dur), Isosorbide mononitrate (Imdur) Action Promote vasodilation Decrease preload and afterload

beta blockers CHRONIC STABLE ANGINA-

Nitroglycerin dilates veins and decreases venous return, which decreases cardiac oxygen demand

beta blockers VARIANT ANGINA-

Nitroglycerin prevents/reduces coronary artery spasm, thus increasing O2 supply. O2 demand is not decreased

Heparin laboratory values

PTT 1.5 to 2 times control value (60-70 sec) aPTT 30 to 85 seconds

Beta Blockers Nonselective-

Propranolol, Carvedilol Inhibits beta1 and beta2 receptors

Reduce fats

Reduce saturated fats and cholesterol in diet Reduce total fat intake to 30% or less of caloric intake Reduce cholesterol intake to 300 mg/day or less Exercise Stop smoking

Beta1 Adrenergic Agonists

Reduces cardiac contractility Decreases pulse

Albuterol (Selective)

Selective Noncatecholamines Acts on beta2-adrenergic receptors Promotes bronchodilation Uses -Treats bronchospasm, asthma, bronchitis, COPD

Noncatecholamines

Stimulate adrenergic receptors Most have longer duration of action than endogenous and synthetic Phenylephrine, metaproterenol, albuterol

mixed acting adrenergic agonists

Stimulates adrenergic receptor sites and stimulates release of norepinephrine from terminal nerve endings Ephedrine

Antiplatelets

Suppress platelet aggregation. I. Used : Prevent thrombosis in the arteries Prevention of myocardial infarction or stroke for patients with familial history Prevention of a repeat myocardial infarction or stroke Prevention of a stroke for patients having transient ischemic attacks

antidote for Adrenergic Agonist/Catecholamine infiltration (extravasation)

The antidote for IV extravasation of dopamine is phentolamine mesylate (Regitine) 5 to 10 mg, diluted in 10 to 15 mL of saline infiltrated into the area

Explain the goal of treatment for Angina

We need to relieve symptoms and slow progression of disease. Management to prevent MI, pain, and death

Side effects Beta blockers causes SOB, rapid breathing, wheezing because it inhibits cardiac output and slows down the heart rate

causes SOB, rapid breathing, wheezing because it inhibits cardiac output and slows down the heart rate

Nitroglycerin contraindicated in

clients who have severe anemia, close-angle glaucoma, traumatic head injury It can increase intracranial pressure

Direct acting adrenergic agonists

directly stimulates adrenergic receptors epinephrine, norepinephrine, dopamine

Inhibitors of PDES5 for erectile dysfunction administered with nitroglycerin can

intensify the nitroglycerin-induced vasodilation and result in LIFE THREATENING HYPOTENSION

The normal range for LDL

less than 100.

Dopaminergic receptors

located in the renal, mesenteric, coronary, and cerebral arteries Vasodilation Increases blood flow

Variant angina treatment

nitrates or calcium blockers > nitrates and calcium channel blockers > coronary artery bypass graft

indirect acting adrenergic agonists

stimulates release of norepinephrine from terminal nerve endings amphetamine

HMG COA REDUCTASE INHIBITORS-

"STATIN" - Inhibit the enzyme HMG CoA reductase in cholesterol biosynthesis - Decreases LDLs, slightly increases HDLs

Carbonic Anhydrase Inhibitors-

- Acetazolamide, Methazolamide, Brinzolamide Block action of enzyme carbonic anhydrase Excretes sodium, potassium, bicarbonate

Normal VLDL levels

2 to 30 mg/dL

Atrial natriuretic peptide (ANP)

20 to 77 pg/mL; 20 to 77 ng/L (SI units)

The normal range for HDL

45 to 60

A nurse is caring for a client who received IV verapamil to treat supraventricular tachycardia (SVT). The client's pulse rate is now 98 beats/min and his blood pressure is 74/44 mmHg. The nurse should anticipate a prescription for which of the following IV medications? a. calcium gluconate b. sodium bicarbonate c. potassium chloride d. magnesium sulfate

A

A nurse is preparing to administer a transfusion of 300 mL of pooled platelets for a client who has severe thrombocytopenia. The nurse should plan to administer the transfusion over which of the following time frames? A. Within 30 min/unit B. Within 60 min/unit C. Within 2 hr/unit D. Within 4 hr/unit

A

A nurse is providing information to a client who has a new prescription for hydrochlorothiazide. What should the nurse include? A. Take the medication with food B. Plan to take the med at bedtime C. Expect edema in the ankles D. Limit fluid intake in the morning

A

A nurse is providing teaching to a client who is starting simvastatin. Which of the following information should the nurse include in the teaching? a. take this medication in the evening b. change position slowly when rising from a chair c. maintain a steady intake of green leafy vegetables d. consume no more than 1L/day of fluid

A

A nurse is teaching a client who has a new prescription for nitroglycerin transdermal patch for angina pectoris. Which of the following instructions should the nurse include? a. remove the patch each evening b. cut each patch in half if angina attacks are under control c. take off the nitroglycerin patch for 30 minutes if a headache occurs d. apply a new patch every 48 hours

A

A nurse is teaching a client who has a new prescription for verapamil to control hypertension. Which of the following instructions should the nurse include? a. increase the amount of dietary fiber in the diet b. drink grapefruit juice daily to increase Vitamin C intake c. decrease the amount of calcium in the diet d. withhold food for 1 hour after the medication is taken

A

a nurse is reviewing the health record of a client who asks about using propranolol to treat hypertension. The nurse should recognize which of the following conditions is a contraindication for taking propranolol? a. asthma b. glaucoma c. hypertension d. tachycardia

A

a nurse is teaching a client who has a new prescription for digoxin to treat heart failure. Which of the following instructions should the nurse include in the teaching? a. contact provider if heart rate is less than 60 beats/min b. check pulse rate for 30 seconds and multiply result by 2 c. increase intake of sodium d. take with food if nausea occurs

A

a nurse is teaching a client who has angina how to use nitroglycerin transdermal ointment. The nurse should include which of the following instructions? a. "Remove the prior dose before applying a new dose" b. "Rub the ointment directly into your skin until it is no longer visible" c. "Cover the applied ointment with a clean gauze pad" d. "Apply the ointment to the same skin area each time"

A

A nurse is taking a medication history from a client who has angina and is to begin taking ranolazine. The nurse should report which of the following medications in the client's history that can interact with ranolazine? (select all that apply) a. digoxin b. simvastatin c. verapamil d. amlodipine e. nitroglycerin transdermal patch

A, B, C

A nurse is transfusing a unit of packed red blood cells (PRBCs) for a client who has anemia due to chemotherapy. The client reports a sudden headache and chills. The client's temperature is 2° F higher than her baseline. In addition to notifying the provider, which of the following actions should the nurse take? (Select all that apply.) A. Stop the transfusion. B. Place the client in an upright position with feet down. C. Remove the blood bag and tubing from the IV catheter. D. Obtain a urine specimen. E. Infuse dextrose 5% in water through the IV.

A, C, D

What should a nurse do when providing furosemide IV for peripheral edema? A. Assess for tinnitus B. Report urine output 50 ml/hour C. Monitor serum potassium levels D. Elevate head of bed before ambulation E. Reccommend eating a banana daily

A, C, D, E

A nurse is providing teaching to a client who has a new prescription for digoxin. The nurse should instruct the client to monitor and report which of the following adverse effects that is a manifestation of digoxin toxicity? (Select all that apply) a. fatigue b. constipation c. anorexia d. rash e. diplopia

A, C, E

Intrinsic sympathomimetic activity (ISA)

Ability of certain beta blockers to bind with a beta receptor to prevent strong agonists from binding to that receptor producing complete activation

Selective blocker with ISA

Acebutolol

Epinephrine (Adrenaline, nonselective)

Action -Alpha1 increases blood pressure. -Beta1 increases heart rate. -Beta2 promotes bronchodilation. Vasoconstrictor/bronchodilator/Inotropic Uses -Anaphylaxis, anaphylactic shock -Bronchospasms, status asthmaticus -Cardiogenic shock, cardiac arrest

Anticoagulants

Action:Prevent new clots from forming Use: DVT, PE, MI, artificial heart valves, stroke

Cardio selective beta blockers

Atenolol, Bisoprolol, Metoprolol Blocks beta1 receptors

3. A nurse is planning to administer IV alteplase to a client who is demonstrating manifestations of a massive pulmonary embolism. Which of the following interventions should the nurse plan to take? A. Administer IM enoxaparin along with the alteplase dose. B. Hold direct pressure on puncture sites for up to 30 min. C. Administer aminocaproic acid IV prior to alteplase infusion. D. Prepare to administer alteplase within 8 hr of manifestation onset.

B

A nurse is administering a dopamine infusion at a low dose to a client who has severe heart failure. Which of the following findings is an expected effect of this medication? a. lowered heart rate b. increased myocardial contractility c. decreased conduction through the AV node d. vasoconstriction of renal blood vessels

B

A nurse is planning to administer subcutaneous enoxaparin 40 mg using a prefilled syringe of enoxaparin 40 mg/0.4 mL to an adult client following hip arthroplasty. Which of the following actions should the nurse plan to take? A. Expel the air bubble from the prefilled syringe before injecting. B. Insert the needle completely into the client's tissue. C. Administer the injection in the client's thigh. D. Aspirate carefully after inserting the needle into the client's skin.

B

A nurse is preparing to transfuse a unit of packed red blood cells (PRBCs) for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction? A. Ensure that the client has a patent IV line before obtaining blood product from the refrigerator. B. Obtain help from another nurse to confirm the correct client and blood product. C. Take a complete set of vital signs before beginning transfusion and periodically during the transfusion. D. Stay with the client for the first 15 to 30 min of the transfusion.

B

A nurse is teaching a client who has angina pectoris and is learning how to treat acute anginal attacks. The client asks, "What is my next step if I take one tablet, wait 5 minutes, but still have anginal pain?" Which of the following responses should the nurse make?" a. "Take two more sublingual tablets at the same time" b. "Call the emergency response team" c. "Take a sustained-release nitroglycerin capsule" d. "wait another 5 minutes then take a second sublingual tablet"

B

a nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other medications. The nurse should recognize that concurrent use of which of the following medications places the client at risk for digoxin toxicity? a. phenytoin b. verapamil c. warfarin d. aluminum hydroxide

B

A nurse is planning caring for a client who has a new prescription for toresmide. The nurse should plan to monitor for which of the following adverse reactions of this medication? (select all that apply) a. respiratory acidosis b. hypokalemia c. hypotension d. ototoxicity e. ventricular dysrhythmias

B, C, D, E

A nurse is monitoring a client who takes aspirin 81 mg PO daily. The nurse should identify which of the following manifestations as adverse effects of daily aspirin therapy? (Select all that apply.) A. Hypertension B. Coffee-ground emesis C. Tinnitus D. Paresthesias of the extremities E. Nausea

B, C, E

A nurse is caring for a client who has a new prescription for niacin to reduce cholesterol. The nurse should monitor for which of the following findings as an adverse effect of niacin? (select all that apply) a. muscle aches b. hyperglycemia c. hearing loss d. flushing of the skin e. jaundice

B, D, E

A nurse is planning to administer a first dose of captopril to a client who has hypertension. Which of the following medications can intensify first dose hypotension? (select all that apply) a. simvastatin b. hydrochlorothiazide c. pheytoin d. clonidine e. aliskiren

B, D, E

a nurse is assessing a client who has taken procainamide to treat dysrhythmias for the last 12 months. The nurse should assess the client for which of the following adverse effects of this medication? (Select all that apply) a. hypertension b. widened QRS complex c. narrowed QT interval d. easy bruising e. swollen joints

B, D, E

*Definitive Blood Test:

BNP

Non-selctive Beta Adrenergic Agonists

Blocks beta1 Decrease BP and pulse Blocks beta2 Bronchoconstriction Use with caution in patients with COPD or asthma Example- Propranolol HCl , nadolol Angina, cardiac dysrhythmias, hypertension, heart failure

Selective Beta Adrenergic Agonists

Blocks beta1 only Example- Metoprolol, atenolol, bisoprolol

Beta2 Adrenergic Agonists

Bronchoconstriction Contracts uterus Inhibits glycogenolysis Leads to hypoglycemia

4. A nurse is caring for a hospitalized client who has an activated partial thromboplastin time (aPTT) greater than 1.5 times the expected reference range. Which of the following blood products should the nurse prepare to transfuse? A. Whole blood B. Platelets C. Fresh frozen plasma D. Packed red blood cells

C

5. A nurse is caring for a client who has atrial fibrillation and a new prescription for dabigatran to prevent development of thrombosis. Which of the following medications is prescribed concurrently to treat an adverse effect of dabigatran? A. Vitamin K1 B. Protamine C. Omeprazole D. Probenecid

C

A nurse in a provider's office is monitoring serum electrolytes for four older adult clients who take digoxin. Which of the following electrolyte values increases a client's risk for digoxin toxicity? a. calcium 9.2 mg/dL b. calcium 10.3 mg/dL c. potassium 3.4 mEq/L d. potassium 4.8 mEq/L

C

A nurse in an acute care facility is caring for a client who is receiving IV nitroprusside for hypertensive crisis. The nurse should monitor the client for which of the following adverse reactions to this medication? a. intestinal ileus b. neutropenia c. delirium d. hyperthermia

C

A nurse is assessing a client during transfusion of a unit of whole blood. The client develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications? A. Epinephrine B. Lorazepam C. Furosemide D. Diphenhydramine

C

A nurse is assessing a client who is taking amiodarone to treat atrial fibrillation. Which of the following findings is a manifestation of amiodarone toxicity? a. light yellow urine b. report of tinnitus c. productive cough d. blue-gray skin discoloration

C

A nurse is caring for a client who has a new prescription for captopril for hypertension. The nurse should monitor the client for which of the following adverse effects of this medication? a. hypokalemia b. hypernatremia c. neutropenia d. bradycardia

C

A nurse is caring for a hospitalized client who is receiving IV heparin for a deep-vein thrombosis. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer? A. Vitamin K1 B. Atropine C. Protamine D. Calcium gluconate

C

A nurse is collecting data from a client who is taking gemfibrozil. which of the following assessment findings should the nurse identify as an adverse reaction to the medication? a. mental status changes b. tremor c. jaundice d. pneumonia

C

A nurse is preparing to administer propranolol to a client who has a dysrhythmia. Which of the following actions should the nurse plant to take? a. hold propranolol for an apical pulse greater than 100 beats/min b. administer propranolol to increase the client's blood pressure c. assist the client when she sits up or stands after taking this medication d. check for hypokalemia frequently due to the risk for propranolol toxicity

C

a nurse is caring for a client who has increased intracranial pressure and is receiving mannitol. Which of the following findings should the nurse report to the provider? a. blood glucose 150 mg/dL b. urine output 40 mL/hour c. dyspnea d. bilateral equal pupil size

C

a nurse is completing a nursing history for a client who takes simvastatin. The nurse should identify which of the following disorders as a contraindication to adding ezetimibe to the client's medications? a. history of severe constipation b. history of hypertension c. active hepatitis C d. type 2 diabetes mellitus

C

a nurse is monitoring a client who is receiving spironolactone. Which of the following findings should the nurse report to the provider? a. serum sodium 144 mEq/L b. urine output 120 mL in 4 hours c. serum potassium 5.2 mEq/L d. blood pressure 140/90 mmHg

C

Nonselective beta blockers with ISA

Carvedilol, penbutolol, and pindolol

Bile-Acid Sequestrants-

Cholestyramine, Colesevelam, Colestipol - Reduce LDL cholesterol levels by binding with bile acids in the intestine - Used in conjunction with diet modification