Pharmacology Exam4

heparin sodium

Prophylaxes Monitor PTT (should be 2.5-3 times the control value) Side effects: HITT (critical decrease in platelets) Protamine sulfate is reversal agent

Enoxaparin (Lovenox)

Used prophylaxes Last longer hold sooner before surgery Risk of HIT Causes irritation at injection site (Think an X irritates me) Protamine sulfate is reversal agent

Contraindicated in in children under 12 due to the risk of Reye's syndrome

acetylsalicylic acid (Aspirin)

What causes HIT

heparin sodium enoxaparin (Lovenox) Think: HE HITs SO you know he doesn't LOVE you

These are examples of what sided heart failure? Pulmonary edema Dyspnea Cough Crackles in lungs

Left sided heart failure

furosemide (Lasix)

Loop diuretic - water follows sodium (inhibits absorption in loop of henle) VERY POTENT Used for Fluid overload Side effects: Hypokalemia, Digoxin toxicity (think eX's can not go together safely) ototoxicity when given IV (Think: someone talking in a loop because of hearing issues) Monitor Weight daily!! Monitor K+ (risk of hypokalemia, may be put on potassium supplement)

Selective Beta Blocker

Metoprolol Think: Me is selective and beta blockers end in metoprolol

Beta blocker antiarrhythmic drugs

Metoprolol (Selective; blocks beta 1 receptors) Propranolol (non-selective; blocks 1 & 2 beta receptors) Sotalol (non-selective; blocks 1 & 2 beta receptors) Think: you are going to block the beta if you are selective and you are probably a beta if you are non-selective so you have more options

Amiodarone patient teaching

Monitor BP and HR Avoid grapefruit Apply sunscreen

Antiarrhythmic beta blocking medication considerations

Monitor QT intervals strictly Monitor BP and HR

Hydrochlorothiazide (Hydro-Diuril)

Used for HTN Not effective for immediate results Encourage potassium (K+) rich foods Side effects: Hypokalemia, Hypotension, Hypersensitivity (photosensitivity, rash)

clonidine (Catapres)

Used for HTN and ADHD Vasodilates Can cause hypotension Monitor BP and HR Do NOT stop abruptly- rebound hypertension may occur

losartan (Cozaar)

Used for HTN or if captopril causes a cough Causes vasodilation ARB inhibitor (sounds like cat name think cats named ace and ARB) Side effect: Hypotension, Renal impairment, Hyperkalemia Avoid salt substitutes (Think: CAP they LOSt the SPRINt and they are SALTY) Contraindicated in pregnancy (think LOSt the baby)

digoxin (Lanoxin)

Used for Heart Failure and A. Fib. Increases cardiac output

nitroglycerin (Nitrostat)

Used for acute attack or prophylactically Relaxes vascular smooth muscle causing vasodilation Side effects: - headache -sweating -N/V -Hypotension -Palpitations Take one every 5 mins up to 3 doses then call 911 if it does not relieve chest pain Have PT sit down while taking Check expiration date Protect from light Contraindicated with Viagra

Afterload

The force or resistance against the contraction.

Preload

The volume of blood in a ventricle at the end of diastole How much blood it filled with during rest

Potassium

(K+) 3.5-5.0 3-5 bananas in a bunch we want .5 to be ripe so 3.5 to 5

Magnesium

1.7 -2.2

Sodium

135-145 mEq/L Think: people love salt so its the bigger number and most things are ending in 35 and 45

Normal INR

2.0-3.5

Phosphorus

2.5 -4.5

Calcium

8.6 - 10.3

Captopril (Capoten)

ACE inhibitor (ACE sounds like a gangster cats name and gangsters wear hats) Used for HTN and heart failure (gangsters shoot ppl so their hearts stop beating) Side effect: Dry cough, Hypotension, Hyperkalemia (CAP they LOSt the SPRINT and now they are salty) Avoid salt substitutes- can cause hyperkalemia

Potassium channel blockers antiarrhythmics

Amiodarone Class III antiarrhythmic Think: someone saying "am I 3rd class?" there are usually 3 bananas in a bunch and bananas have potassium

A client who had a myocardial infarction has runs of ventricular tachycardia. Which medication will the nurse prepare to administer? A. Digoxin B. Furosemide C. Amiodarone D. Norepinephrine

Amiodarone decreases the irritability of the ventricles by prolonging the duration of the action potential and refractory period. It is used in the treatment of ventricular dysrhythmias such as ventricular tachycardia. Digoxin slows and strengthens ventricular contractions; it will not rapidly correct ectopic beats. Furosemide, a diuretic, does not affect ectopic foci. Norepinephrine is a sympathomimetic and is not the medication of choice for ventricular irritability.

Digoxin Immune Fab (Digibind)

Antidote for digoxin toxicity Binds to digoxin molecules IV only Monitor K+ Monitor for s/s of worsening heart failure - decreased weight (that is a good thing removing excess fluid)

Antiarrhythmic beta blocking medication side effects

Arrhythmias due to lengthening QT Palpitations Hypotension Heart failure Bronchospasms (non-selective) Black box warning: drug induced arrhythmias

Arrhythmias can be caused by irregularities in the impulse

Automaticity -initiation of the impulse Excitability -how the heart responds to the impulse Conductivity -how the impulse is being transmitted Contractility -how the muscle contracts in response to the impulse

Dig toxicity- symptoms. What can contribute to toxicity

Bradycardia Arrhythmias GI upset Yellow halos Decreased renal function Decreased K+ Decreased Magnesium Increased Calcium

Potassium rich foods

Bananas Oranges Dates Fish Potatoes Veggies Meats Whole grains

Which laboratory value would the nurse use to determine whether a client is receive a therapeutic dose of intravenous heparin? A. INR between 2-3 B. PT is 2.5 times the control value C. APTT is 70 seconds D. ACT is in the range of 70-120 seconds

C. APTT is 70 seconds When a client is receiving intravenous heparin, the APTT should be 1.5 to 2 times the normal APTT of 40 seconds INR and PT are used to evaluate therapeutic levels of warfarin. ACT is not commonly used to monitor heparin, but ACT increases to a range of 150 to 200 seconds when at a therapeutic level.

Warfarin is prescribed for a client who has been receiving intravenous (IV) heparin for partial occlusion of the left common carotid artery. The client expresses concern about why both medications are needed at the same time. Which rationale would the nurse include to address the client's concerns? A. This permits the administration of smaller doses of each medication. B. Giving both medications allows clot dissolution while preventing new clot formation. C. Heparin provides anticoagulant effects until warfarin reaches therapeutic levels. D. Administration of heparin with warfarin provides immediate and maximum protection against clot formation.

C. Heparin provides anticoagulant effects until warfarin reaches therapeutic levels. Warfarin is administered orally for 2 to 3 days to achieve the desired effect on the international normalized ratio (INR) level before heparin is discontinued. These medications do not dissolve clots already present. Warfarin does not exert and immediate therapeutic effect.

Spironolactone (Aldactone)

COMPETITIVELY binds to aldosterone (Think: sprints are competitive and you compete to find wALDO first) Used for: HTN, edema (related to HF) Side effects: HYPERkalemia, dehydration, Hypotension, HYPERglycemia (Think: you need lots of sugar to sprint and only medication that causes HYPER) Avoid salt substitutes

Blood pressure is affected by what?

Cardiac output Peripheral resistance Blood volume

Dabigatran (Pradaxa)

Competitive thrombin inhibitor Used prophylaxes No test to measure clotting time Reversal agent is Idarucizumab (used in emergency situations)

Calcium channel blockers antiarrhythmics

Diltiazem Think: sounds like dill and I crave dill pickles and ice cream, ice cream has lots of calcium

Sildenafil is prescribed for a man w/ erectile dysfunction. Which side effects of this medication would the nurse mention in teaching? Select all that apply. A. Flushing B. Headache C. Dyspepsia D. Constipation E. HTN

Flushing Headache Dyspepsia

Protamine sulfate is the antidote for

Heparin

Medications that cause sensitivity

hydrochlorothiazide (Hydro-Diuril) diltiazem (Cardizem) gingival sensitivity (calcium channel blocker and you eat ice cream) Think: TIA is sensitive

BP and HR parameters

Hold parameters, HR <60 bpm BP <100

Cardiac output

How much blood is being pumped in a minute heart rate x stroke volume

Contraindications for fatal arrhythmias and antiarrhythmic medications

None, if it is a fatal arrhythmia. We will deal with any of the consequences after.

Rivaroxaban (Xarelto)

Prophylaxes CAN be used POST surgery No labs to monitor clotting time Reversal Andexxa (Think: AN EX) Can be slowed by activated charcoal

Acetylsalicylic Acid (Aspirin)

Prophylaxes Contraindicated in children under 12 due to REYE's syndrome No reversal agent Can cause ringing in ears

Warfarin (Coumadin)

Prophylaxes Warfarin is measured by INR 2-3.5 or PT Reversal agent: Vitamin K or fresh frozen plasma AVOID: alcohol, cranberries, and grapefruit (Think: at war with the most amount of foods) Eat a consistent balance diet Can be bridged with heparin (works quicker and stops working quicker)

antiarrhythmics do what?

Regulate heart rate and rhythm by manipulating the electrical signals to change the rate or sinus rhythm of the heart

These are examples of what sided heart failure? Peripheral edema Ascites Jugular vein distension Hepatic congestion

Right sided heart failure

What are the non-selective beta blockers

Sotalol and Propranolol Think: you would be SO PRO to block betas

Cardiac output is affected by

Stroke volume Heart rate

Diltiazem (Cardizem)

Used for arrhythmias, HTN, angina Decreases workload of the heart and increases O2 supply Side effects: Gingival sensitivity, hypotension, worsening heart failure Take everyday not only when having chest pain Avoid grapefruit Hold HR <50 Think: TIA was sensitive and we would eat grapefruit a lot at Connies

Digoxin (Lanoxin)

Used for heart failure or A. Fib. Increases cardiac output + Inotropic - Chronotropic - Dromotropic Digoxin toxicity - yellow halos -GI upset Hold if apical HR is <60 Digoxin level 0.8-2ng/mL K+ level 3.5-5 mEq/L (low levels increase risk of digoxin toxicity)

Clopidogrel (Plavix)

Used: AFTER MI or stroke Prophylaxes Side effects: headache, GI upset

What medication breaks down clots

alteplase (tPA)

What prototype breaks a clot?

alteplase (tPA)

avoid salt substitutes in

captopril (Capoten) losartan (Cozaar) spironolactone (Aldactone) Think: CAP they LOSt the SPrint and they are SALTY

What medications are antihypertensives

clonidine (Catapres) captopril (Capoten) losartan (Cozaar) Hint: CAT CAP COZ they get HYPER Also remember that ACE and ARB sound like they could be cat names

Medications used for HTN

diltiazem (Cardizem) clonidine (Catapres) captopril (Capoten) losartan (Cozaar)

Inotropic

force of contraction Hint: I kNOw FORCing people is wrong

Excessive vasodilation can lead to

hypotension Hint: all antihypertensives cause vasodilation so you are at risk for hypotension with every antihypertensive

What are arrhythmias

irregular heart rhythms

Long term antianginal

metoprolol

What antiarrhythmics are also used for angina

metoprolol (Lopressor) diltiazem (Cardizem) Think: ME because I get chest pains and diltiazem because DILl and calcium = ice cream or cardiac issues like chest pain

Heart rate

number of beats per minute

Chronotropic

rate of contraction Hint: chron reminds me of choreography and you get rated during dances

Dromotropic

rate of electrical conduction Hint: drom sounds like drone and those are electrical

Life threatening arrhythmias are treated with...

sotalol, amiodarone Think: who is life threatening, "SO AM I?"

Contractility

the muscles to shrink or contract

Stroke volume

the volume of blood pumped with each heartbeat