Pharm exam 2- book q's and class review

30.3 Verapamil (Calan, Covera-HS, Verelan) should be used with extra caution or is contraindicated in patients with which cardiovascular condition?

heart failure

Crystalloids- D5W:

initially isotonic, but is quickly metabolized and becomes hypotonic. Fluid enters vascular spaces without affecting intracellular fluids

Anticoagulant- HEPARIN administration:

injected subcutaneously or continuously through IV; dose is weight-based and fluctuates; fast onset, short duration; monitor aPTT: Normal 30-40s, therapeutic 60-80s

13.1 following administration of phenylephrine (Neo-Synephrine), the nurse would assess for which adverse drug effects?

insomnia, nervousness, and hypertension

Crystalloids- 0.9 NaCl:

isotonic solution used to repleat extracellular fluid volume without affecting intracellular volume; monitor for fluid overload

30.1 The use of procainamide (Pronestyl) is limited to the treatment of life-threatening dysrhythmias because of what potential adverse effect?

it causes antinuclear antibodies (ANA) when given long-term, resulting in blood dyscrasias

39.6 Which of the following is the best advice that the nurse can give a patient with viral rhinitis who intends to purchase an over-the-counter combination cold remedy?

it is safer to use a single-drug preparation if you are experiencing one symptom

28.4 the nurse is caring for a patient with chronic stable angina who is receiving isosorbide dinitrate (Isordil). Which of the following are common adverse effects?

light-headedness and dizziness

39.1 the patient has been prescribed oxymetazoline (Afrin) nasal spray for seasonal rhinitis. Which instructions will the nurse provide?

limit use of this spray to 5 days or less

Antiplatelet- ASPIRIN (ASA):

long duration, prevents strokes, MI, and reduced inflammation; AVOID ALCOHOL; monitor hematocrit/PTT with high doses

Allergy/cold medications- antihistamines:

prevents histamines from binding to h1 receptor (anticholinergic effect: increases HR, urinary retention, constipation, dry mouth)

OPRELVEKIN

prevents severe thrombocytopenia by increasing platelet production; often prescribed in patients undergoing chemotherapy, decreases the need for platelet transfusion; GIVEN AS SUBCUTANEOUS INJECTION, MONITOR PLATELET LEVELS

25.5 A patient will be sent home on diuretic therapy and has a prescription for liquid potassium chloride (KCl). What teaching will the nurse provide before the patient goes home?

report any weakness, fatigue, or lethargy immediately

24.5 while planning for a patient's discharge from the hopsital, which teaching points would be included for a patient going home with a prescription for chlorothiazide (Diuril)?

report muscle cramping or weakness to the healthcare provider

Antidysrhythmic- Class I Na+ Channel Blockers

prevents depolarization, decreases automaticity and conduction

31.2 the patient receiving heparin therapy asks how the "blood thinner" works. What is the best response by the nurse?

"Heparin does not thin the blood but prevents clots from forming as easily in the blood vessels"

Indirect-acting (Cholinergic):

cholinesterase inhibitors, non selective

Anti-cholinergic (suppressors/antagonists):

competes with ACh for binding, when it binds, blocks cholinergic responses

Cholesterol drugs- statins:

HMG-CoA reductase inhibitors reduces synthesis of cholesterol

potassium sparing diuretics- CAUTION:

caution with other meds that increase K+ levels; CATEGORY C- DO NOT TAKE IF PREGNANT

12.5 the patient taking benztropine (Cogentin) should be provided education on methods to manage which common adverse effect?

constipation

Leukotriene antagonist- adverse effects:

hallucinations, SI, behavioral changes

Antitussives-adverse effects (non-opioid):

hallucinations, dizziness, slurred speech, drowsiness, euphoria

Antianginals- Beta-Blockers:

-Lols- a good choice for patients with HTN and CAD. Reduce the incidence of MI; preferred drugs for prophylaxis of stable angina; not used for variant angina, could worsen the condition; reduce workload by lowering HR and lowering contractility

Digoxin

0.5-2.0 ng/mL (narrow)

Anticoagulation therapy

1.5-2.5x the control (in seconds)

Sodium level

135-145

Platelets

150,000-400,000

INR

2.0-3.0 (therapeutic range)

potassium level

3.5-5.0 mEq/L

aPTT

30-40 sec (activated partial thromboplastin time)

PTT

60-70 sec (partial thromboplastin time)

thrombocytopenia

<100,000

Critical PTT

> 100 seconds

Critical aPTT

>70 seconds

Adrenergic receptor agonists:

Alpha1, Alpha2, Beta1, Beta2

Alpha 1 Antagonist/Blocker- TAMSULOSIN:

BPH, HTN

Thiazide diuretics action:

Blocks Na+, CL-, H2O reabsorption at DCT, lowers potassium

Adrenergic receptor agonist- Alpha 2 action:

CNS response, decrease release of NE/ACh, decrease insulin and platelets

Loop diuretics- USE CAUTION WITH:

Digoxin, nephrotoxic drugs, insulin, corticosteroids, Ginseng and Hawthorn

Bile acid sequestrants- adverse effects:

GI symptoms- constipation, bloating, gas, nausea

Calcium channel blocker adverse effects (anti-hypertensive):

HA, dizziness, edema, hypotension, N/V; DO NOT USE WITH BETA BLOCKERS; DO NOT USE WITH DIGOXIN

Statins- adverse effects:

HA, fatigue, muscle /joint pain, heartburn, severe rhabdomyolysis/myopathy (rare); watch for liver injury

Adrenergic receptor agonist- Beta 2 adverse effects:

HA, palpations, nervousness, throat irritation

28.3 Which assessment findings in a patient who is receiving atenolol (Tenormin) for angina would be cause for the nurse to hold the drug and contact the provider?

HR of 50BPM, BP of 86/56

Alpha 1 Antagonist/Blocker- DOXAZOSIN:

HTN

Beta 1 Antagonist/Blocker- PROPRANOLOL (nonselective)

HTN, arrhythmias, cardiomyopathy, manages MI, alcohol withdrawal, anxiety; DO NOT ABRUPTLY D/C

Beta 1 Antagonist/Blocker- ATENOLOL (selective)

HTN, preventing MI

Beta 1 Antagonist/Blocker- METOPROLOL (selective)

HTN, prevents MI, ventricular arrhythmias, tachycardia, migraine, prophylaxis

Alpha 1 Antagonist/Blocker- PRAZOSIN:

HTN; short half/life; care for the first dose (syncope); DO NOT TAKE AT NIGHT D/T HYPOTENSION SYNCOPE

Fluid replacement agents- HyperK+:

High K+ rich foods, supplements, potassium sparing diuretics, CKD

carbonic anhydrase inhibitor diuretic actions:

Inhibits reabsorption of bicarbonate at the PCT

Crystalloids- Lactated ringers:

Isotonic, has shorter duration to prevent fluid overload. Treats blood loss, dehydration

Anticoagulant- LOVENOX (enoxaparin)

LMWH, prevention of ischemic complications from unstable angina and NSTEMIs, prevents and treats DVTs and PEs; LESS LIKELY TO CAUSE THROMBOCYTOPENIA; fixed dosage based on weight

Fluid replacement agents- HypoK+:

Loop diuretics, strenuous muscular activity, severe V/D

Direct-acting (Cholinergic):

Muscarinic receptor agonist, selective

Methylxanthines- adverse effects:

N/V, CNS stimulation, dysrhythmias, nervousness, insomnia

HypoNa+- adverse effects:

N/V, anorexia, abdominal cramping, confusion, lethargy

Class I Na+ Channel Blockers- adverse effects:

N/V, hypotension, HA, CNF effects (psychosis, confusion), may produce new/worsen dysrhythmias

What kind of drug is Bethanechol?

Parasympathetic cholinergic (stimulator); direct-acting (selective, muscarinic receptor agonist);

Class IV Ca2+ Channel Blocker- Indications:

Paroxysmal SVT, supraventricular tachydysrhythmia

27.4 The teaching plan for a patient recieving hydralazine (Apresoline) should include what point?

Rising slowly to standing from a lying or sitting position

Osmotic diuretic actions:

Uses osmotic forces to pull H2O into nephron and decreases all electrolytes

Niacin- drug information:

Vitamin B complex occasionally used to lower lipid levels; not typically used for treatment due to more adverse effects; caution use in pts with DM, can increase glucose levels

12.3 Which factor in the patient's history would cause the nurse to question a medication order for atropine?

a 65-year-old man with benign prostatic hyperplasia

12.1 the nurse is preparing a plan of care for a patient with myasthenia gravis. Which outcome statement would be appropriate for a patient receiving a cholinergic agonist such as pyridostigmine (Mestinon) for this condition? The patient will exhibit:

a decrease in muscle weakness, ptosis, and diplopia

27.3 A patient with heart failure has an order for lisinopril (Prinivil, Zestril). Which condition in the patient's history would lead the nurse to confirm the order with the provider?

a history of angioedema after taking enalapril (Vasotec)

39.3 a man, age 67, reports taking diphenhydramine (Benadryl) for hay fever. Considering this patient's age, the nurses assesses for which findings?

a history of prostatic or urinary conditions

40.4 a 65-year-old patient is prescribed iprapropium (Atrovent) for the treatment of asthma. Which condition should be reported to the healthcare provider before giving this patient the drug?

a reported allergy to peanuts

Allergy/cold medications- Sympathomimetics:

activate the SNS (think adrenergic receptors)

31.1 A patient with DVT is receiving an infusion of heparin and will be started on warfarin (Coumadin) soon. While the patient is receiving heparin, which laboratory test will provide the nurse with information about its therapeutic effects?

activated partial thromboplastin time (aPTT)

Adrenergic receptor agonist- EPINEPHRINE:

acts on Alpha 1, Beta 1+2 receptors; vasoconstriction, increased HR, increased contractility, releases renin, bronchodilation, relaxes smooth muscle

Antiplatelet- CLOPIDOGREL:

acute coronary syndrome (STEMI, NSTEMI, unstable angina, PAD). ADP receptor blocker: typically prescribed with ASA; More than 50% inhibit Clopidogrel metabolism; MONITOR CBC FOR THROMBOCYTOPENIA AND NEUTORPENIA

Carbonic Anhydrase Inhibitor diuretic- adverse effects:

allergic reaction to Sulfa, fluid and electrolyte imbalances

Loop diuretic adverse effects:

allergic reaction to sulfa, hypokalemia, dehydration, hypotension, increased blood glucose and uric acid; CAUTION FOR OTOTOXICITY

31.4 A patient with a congenital coagulation disorder is given aminocaproic acid (aminar) to stop bleeding following surgery. The nurse will carefully monitor this patient for development of which adverse effects?

anaphylaxis, headache, hypotension

24.6 A patient with a history of heart failure will be started up on spironolactone (Aldactone). Which drug group should NOT be used, or used with extreme caution in patients taking potassium sparing diuretics?

angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers

25.3 the patient's serum sodium level value is 152 mEq/L. Which nursing interventions are most appropriate for this patient?

assess for inadequate water intake or diarrhea, notify the provider

25.6 The nurse weighs the patient who is on an infusion of lactated Ringer's postoperatively and finds that there has been a weight gain of 1.5kg since the previous day. What would be their nurse's next highest priority?

assess the patient for signs of edema and BP for possible hypertension

24.1 which action by the nurse is most important when caring for a patient with chronic kidney disease who has an order for furosemide (lasix)?

assess urine output and renal laboratory values for signs of nephrotoxicity

Beta 2 Adrenergic receptor agonist- ALBUTEROL

asthma, COPD (SABA)

39.4 The nurse is teaching the patient about the use of dextromethorphan with guaifenesin (Robitussin-DM) syrup for a cough accompanied by thick mucus. Which instruction should be included in the patient's teaching?

avoid drinking fluids immediately after the syrup but increase overall fluid intake throughout the day

28.5 What health teaching should the nurse provide for a patient receiving diltiazem (Cardizem)?

avoid driving or performing other activities requiring mental alertness until the effects of the drug are known, maintain adequate fluid and fiber intake to facilitate stool passage, report weight gain of 2kg or 5lbs in a week, rise slowly from prolonged periods of sitting or laying

Cholesterol drugs- Bile acid sequestrants:

bind to bile acids, increase exertion of cholesterol in the stool

Anticoagulants- adverse effects:

bleeding

Antiplatelets- adverse effects:

bleeding, rash, flu symptoms

Loop diuretics action:

block Na+, Cl-, H2O reabsorption at the ANL, lowers potassium

Calcium channel blocker action (anti-hypertensive):

block calcium ion channels, limits muscular contraction, including smooth muscle contraction

ARBs action (Anti-hypertensive):

blocks angiotensin 2 at the receptor, arteriolar dilation, increase in sodium secretion

ACE inhibitor action (anti-hypertensive):

blocks angiotensin 2 conversion, decreases peripheral resistance, decreases blood volume

Potassium sparing diuretics action:

blocks reabsorption of Na+ at collecting duct; increases potassium

26.1 the patient has been given a prescription of hydrochlorothiazide (Microzide) as an adjunct to treatment of hypertension and returns for a follow up check. Which is the most objective data for determining the therapeutic effectiveness of the furosemide?

blood pressure log notes blood pressure 120/70 mmHg to 134/88 mmHg since discharge

13.3 Propranolol (Inderal) has been ordered for a patient with hypertension. Because of adverse effects related to this drug, the nurse would carefully monitor for which adverse effect?

bradycardia

Class IV Ca2+ Channel Blocker- adverse effects:

bradycardia, hypotension, flushed skin

Beta 2 Antagonist/Blocker actions:

bronchoconstriction

Adrenergic receptor agonist- Beta 2

bronchodilation, relaxes smooth muscle

31.5 A patient is receiving a thromboembolic drug, alteplase (Activase), following an acute myocardial infarction. Which effect is most likely attributed to this drug?

bruising and epistaxis

Antianginals:

can reduce preload (vasodilation), slow HR, reduce contractility, reduce afterload (decreases BP)

24.3 which of the following clinical manifestations may indicate that a patient taking metolazone (Zaroxolyn) is experiencing hypokalemia?

cardiac dysrhythmias

Beta 1 Adrenergic receptor agonist- DOBUTAMINE:

cardiac stimulant by increasing contractility without increasing HR; IV ONLY

Thiazide diuretic- USE CAUTION:

caution with digoxin, Ginko Biloba, effectiveness of anticoagulants, sulfonylureas and insulin

What are the effects of parasympathetic drugs?

constricted pupils, decreased heart rate, decreased blood pressure, increased salivation, increased GI motility, bronchoconstriction, contracts bladder, erection

Allergy/cold medications- Antitussives:

dampen cough reflex by raising the cough threshold in the CNS

Beta 1 Antagonist/Blocker actions:

decrease HR and contractility, block renin release

Antidysrhythmic- Class II Beta Blockers:

decrease conduction velocity through AV node, decrease automaticity

Allergy/cold medications- Intranasal corticosteroids:

decrease secretion of inflammatory mediators

Allergy/cold medications- Expectorants mucolytic:

decrease thickness of mucous secretions

Antidysrhythmic- Class IV Ca2+ Channel Blockers:

decreases conduction velocity through AV node, decreases automatically in SA node

Antidysrhythmic- Class III K+ Channel Blockers:

delays repolarization, vasodilation, decrease sinus rate, inhibits adrenergic stimulation

What are the effects of sympathetic drugs?

dilates pupils, inhibits secretions, increases heart rate, increases contractibility and BP, dilates bronchioles, decreases GI motility, vasoconstriction, urinary retention, increased epinephrine and NE release, ejaculation/orgasm

Vasodilators action (anti-hypertensive):

direct relaxation of vascular smooth muscle

12.4 older adult patients taking bethanechol (Urecholine) need to be assessed more frequently because of which adverse affect?

dizziness

27.2 the patient is receiving hydralazine with isosorbide (BiDil) for heart failure. The nurse should monitor this patient for:

dizziness and rapid heart rate

26.5 the nurse is caring for a patient with chronic hypertension. The patient is receiving losartan (Cozaar) daily. Which patient manifestations would the nurse conclude is an adverse effect of this medication?

dizziness, hypoglycemia, angioedema

30.5 A patient is given a prescription for propranolol (Inderal) 40 mg bid. What is the most important instruction the nurse should give this patient?

do not stop taking this medication abruptly; the dosage must be decreased gradually if it is discontinued

Adrenergic receptor agonist- Alpha 2 adverse effects:

drowsiness, depression, dizziness

Antihistamines- adverse effects:

dry mouth, constipation, photosensitivity

adverse effects of anticholinergic drugs:

dry mouth, constipation, urinary retention, increased heart rate

Osmotic diuretic- adverse effects:

due to fluid shifts, could worsen edema; CHF, HA

HyperK+- adverse effects:

dysrhythmias, heart block, muscle twitching, fatigue, paresthesia, dyspnea, cramping, diarrhea

27.6 The patient who has not responded well to other therapies has been prescribed milirone (Primacor) for treatment of his heart failure. Which essential assessment should the nurse make before starting this drug?

electrolytes, especially potassium

Indirect thrombin inhibitors:

enhances activity of antithrombin III which inhibits thrombin

Fluid replacement agents- HypoNa+:

excessive ADH secretion, excessive sweating, severe burns, GI/kidney disorders

12.6 the patient or caregiver of a patient taking neostigmine (Prostigmin) should be taught to be observant for which adverse effect that may signal a possible overdose has occured?

excessive sweating, salivation, and drooling

NIACIN- adverse effect:

flushing, hot flashes, GI upset, hepatotoxicity, gout

Fluid replacement agents- HyperNa+:

from excessive salt intake, high net water loss, high doses of corticosteroids and estrogens

fibric acid drugs- adverse effects:

gallstones, changes in liver function, GI upset

27.5 Lisinopril (Prinivil) is part of the treatment regimen for a patient with heart failure. The nurse monitors the patient for the development of which adverse effects?

hyperkalemia, dizziness, cough

Potassium sparing diuretics- adverse effects:

hyperkalemia, fatigue, muscle weakness, bradycardia, hormone irregularities

Thiazide diuretic adverse effects:

hypokalemia, dehydration, increase glucose and uric acid

Class II Beta Blockers- adverse effects:

hypotension, N/V

Alpha 1 Antagonist/Blocker adverse effects:

hypotension, dizziness, reflex tachycardia, syncope, peripheral edema

30.4 common adverse effects of antidysrhythmic medications include which of the following?

hypotension, dizziness, weakness

ARBs adverse effects (Anti-hypertensive):

hypotension, hyperkalemia, hypoglycemia, dizziness, UTI, fatigue, anemia, AKI; FETAL INJURY AND DEATH

Nitrates- adverse effects:

hypotension, reflex tachycardia

13.4 the healthcare provider prescribes epinephrine (Adrenalin) for a patient who was stung by several wasps 30 minutes ago and is experiencing an allergic reaction. The nurse knows the primary purpose of this medication for the patient is to

increase a declining blood pressure and dilate constricting bronchi associated with anaphylaxis

NITROGLYCERINE- contraindications

increased intercranial pressure, hypotension, severe anemia, glaucoma

Adrenergic receptor agonist- Beta 1:

increases heart rate, increases contractility, releases renin

Cholesterol drugs- fibric acid drugs:

increases the breakdown of triglyceride rich particles

Corticosteroids- adverse effects:

inhaled: hoarseness, oral thrush Systemic: hyperglycemia, adrenal atrophy, peptic ulcers

Potassium sparing diuretic- SPIRONOLACTONE:

inhibits aldosterone secretion from adrenal cortex; GIVE WITH FOOD TO INCREASE ABSORPTION

Antiplatelets

prevents clotting formation in arteries by interfering with platelet aggregation

26.3 the patient is taking atenolol (Tenormin) and doxazosin (Cardura). What is the rationale for combining two hypertensive drugs?

lower doses of both drugs may be given with fewer adverse effects

Cholesterol drugs- NIACIN:

lowers VLDL, triglycerides, LDL

Statins- ATORVASTATIN:

lowers cholesterol, LDL, and triglycerides; increases HDLs; slows progression of coronary artery disease; administer with food d/t GI upset

Leukotriene antagonist- MONTELUKAST:

management and prevention of asthma. Manages seasonal allergies; DOES NOT TREAT ACUTE ASTHMA ATTACKS D/T DELAYED ONSET (24 HOURS)

Expectorant mucolytic- adverse effects:

minimal adverse effects, but some include drowsiness, HA, and GI upset

Anticoagulant- WARFARIN teaching:

missed dose: if they remember the same day, take does. Notify physician if dose missed for the day Monitor INR: normal 0.75-1.25, therapeutic 2-3 Antidote: Vitamin K or KCentra Avoid high intake of green leafy veggies; avoid cranberry juice, no alcoholic beverages ASSESS FOR PLATELET LEVEL, HOLD MED IF LESS THAN 5000

13.2 a patient is started on atenolol (Tenormin). Which is the most important action to be included in the plan of care for this patient related to this medication?

monitor apical pulse and blood pressure

13.6 A patient who is taking an adrenergic-blocker for hypertension reports being dizzy when first getting out of bed in the morning. The nurse should advise the patient to:

move slowly from the recumbent to the upright position

HypoK+- adverse effects:

muscle weakness, lethargy, anorexia, dysrhythmias, cardiac arrest

25.2 which nursing intervention is most important when caring for a patient receiving dextran 40 (Gentran 40)?

observe for signs of fluid overload

12.2 Anticholinergics may be ordered for which conditions?

peptic ulcer disease, bradycardia, IBS

ACE inhibitor adverse effects (anti-hypertensive):

postural hypotension, peripheral edema, persistent dry cough, hyperkalemia, angioedema, agranulocytosis

24.2 the patient admitted for heart failure has been recieveing hydrochlorothiazide (Microzide). Which laboratory levels should the nurse carefully monitor?

potassium, sodium, uric acid

Anticoagulant- WARFARIN:

prevents thromboembolic events after knee/hip surgeries, long-term indwelling catheter, decreased risk of repeat MI; PREGNANCY NOT OKAY; longer onset, longer duration

Anticoagulant- HEPARIN:

prevents thromboembolic events after open-heart surgery, vascular surgeries, dialysis, acute MI; treats DVT and PE; okay during pregnancy; HOLD MED IF PLTLTS LESS THAN 5000

39.2 A patient has a prescription for fluticasone (Flonase) for allergic rhinitis. Place the following instructions in order in which the nurse will instruct the patient on drug use

prime the inhaler for 1st use, clear the nose by blowing, instill one spray directed high into the nasal cavity, spit out an excess liquid that drains into the mouth

Adrenergic receptor agonist- Alpha 1 adverse effects:

prolonged use can cause rebound congestion

Adrenergic receptor agonist- Beta 1 CAUTIONS:

pts with HTN, MI, Afib, hypovolemia

Adrenergic receptor agonist- Alpha 1 contraindications:

pts with acute pancreatitis, heart disease, hepatitis, narrow-angle glaucoma

Adrenergic receptor agonist- Beta 2 CAUTIONS:

pts with cardiac disease, CAD, HTN

Anti-cholinergic drug contraindications:

pts with glaucoma (increases IOP), obstructive disorders, BPH, acute hemorrhage

Class II Beta Blockers- Contraindications:

pts with pulmonary edema, uncompensated HF, AV heart blocks

Bethanechol contraindications:

pts with respiratory disease, epilepsy, Parkinson's, PUD, bradycardia

Adrenergic receptor agonist- Alpha 2 contraindications:

pts with severe cardiac disease, renal insufficiency

Beta 1 Antagonist/Blocker adverse effects:

pulmonary edema, bradycardia, HF, ED, arrhythmias

Class III K+ Channel Blockers- adverse effects:

pulmonary toxicity, hypotension, bradycardia, cardiogenic shock, AV block, worsening arrhythmias, visual changes, blue/grey skin discoloration

30.2 When monitoring for therapeutic effect of any dysrhythmic drug, the nurse would be sure to assess which essential parameter?

pulse

28.1 the patient is being discharged with nitroglycerin (Nitrostat) for sublingual use. While planning patient education, what instruction will the nurse include?

put one tablet under your tongue for chest pain, if the pain doesn't subside, call 911.

Asthma- Leukotriene antagonist:

reduce inflammation and ease bronchoconstriction

Expectorant mucolytic- GUAIFENESIN (mucinex):

reduces thickness of bronchial secretions, mainly used to treat dry coughs

26.2 Nifedipine (Procardia XL) has been ordered for a patient with hypertension. In the care plan, the nurse includes the need to monitor for which adverse effects?

reflex tachycardia

Vasodilators adverse effects (anti-hypertensive):

reflex tachycardia, sodium/water retention, drug-induced lupus syndrome, palpitations, flushing, nausea, diarrhea

Antianginal- Nitrates:

relax arterial and venous smooth muscle, decrease preload, decrease heart workload

Antianginals- CCBs:

relax arteriolar smooth muscle, lower BP, lower afterload; preferred drug for treating variant angina

28.2 nitroglycerin patches have been ordered for a patient with a history of angina. What teaching will the nurse give to this patient?

remove the old patch and wait 6-12 hours before applying a new one

24.4 the nurse is providing teaching to a patient who has been prescribed furosemide (Lasix). Which of the following should the nurse teach the patient?

rise slowly from a lying or sitting position to standing

26.4 what health teaching should the nurse provide for the patient receiving nadolol (Corgard)?

rise slowly over prolonger periods of sitting or lying down

Class II Beta Blockers- ESMOLOL

seelctive for Beta 1- manages sinus tachy and SV arrhythmias

25.1 a patient is receiving intravenous sodium bicarbonate for treatment of metabolic acidosis. During this infusion, how will the nurse monitor for therapeutic effect?

serum pH

Heparin induced thrombocytopenia and osteoporosis antidote:

short term protamine sulfate

Nitrates- NITROGLYCERIN:

short-acting; dilates coronary arteries, lowers BP, increases cardiac output, treats acute angina or manages prophylactically long-term; NO MORE THAN 3 DOSES in 15 MINUTES. IF SYMPTOMS DO NOT RESOLVE, MI IS INDICATED

Anticoagulants:

slows clotting time and prevents thrombi from forming/enlarging in the veins

Cholinergic crisis:

sweating, hypersalivation, muscle twitching/weakness/difficulty breathing

adverse effects of direct-acting cholinergics:

sweating, salivation, abdominal cramping hypotension

Antitussive- DEXTROMETHORPHAN (cough syrup):

symptomatic relief of coughs caused by upper respiratory infection

OPRELVEKIN- adverse effects:

syncope, a-fib, pleural effusions, tachycardia

Adrenergic receptor agonist- Beta 1 adverse effects:

tachycardia, HTN, PVCs, arrhythmias, N/V, hypokalemia

40.1 A patient is reciving treatment for asthma with albuterol (Proventil). The nurse teaches the patient that while serious adverse effects are uncommon, the following may occur:

tachycardia, nervousness, headache

31.3 what patient education should be included for a patient receiving enoxaparin (Lovenox)?

teach the patient or caregiver to: give subcutaneous injections at home, not to take an over the counter medications without first consulting the provider, to observe for unexplained bleeding (such as pink, red, or dark brown urine or bloody gums), monitor for development of DVT

40.5 A patient who received a prescription for montelukast (Singulair) returns to his providers' office after 3 days, complaining that the drug is "not working". She reports mild but continued dyspnea and has had to maintain consistent use of her bronchodilator inhaler, albuterol. What does the nurse suspect is the cause of the failure of montelukast?

the drug has not has sufficient time of use to have full effects

26.6 A patient with significant hypertension unresponsive to other medications is given a prescription for hydralazine. An additional prescription of propanolol (Inderal) is also given to the patient. The patient inquires why two drugs are needed. What is the nurse's best response?

the hydralazine may cause tachycardia and the propranolol will help keep the hear rate within nomal limits

40.3 A patient has been using a flucticasone (Flovent) inhaler as a component of his asthma therapy He returns to his healthcare provider's office complaining of a sore mouth. On inspection, the nurse notices white patches in the patient's mouth. What is the possible explanation for these findings?

the patient has developed thrush as a result of fluticasone

25.4 A patient is recieving 5% dextrose in water (D5W). Which statement is correct?

the solution may be used to dilute mixed intravenous drugs

28.6 Erectile dysfunction drugs such as sildenafil (Viagra) are contraindicated in patients taking nitrates for angina. What is the primary concern with concurrent administration of these drugs?

they also decrease blood pressure through vasodilation and may result in prolonged and sever hypotension when combined with nitrates

HyperNa+- adverse effects:

thirst, fatigue, weakness, muscle, twitching, convulsions, AMS

27.1 the patient is prescribed digoxin (Lanoxin) for treatment of heart failure. Which statement by the patient indicates the need for further teaching?

this drug should cure my heart failure

31.6 A patient has started clopidogrel (Plavix) after experiencing a transient ischemic attack. What is the desired therapeutic effect of this drug?

to reduce risk of a stroke from a blood clot

Alpha 2 Adrenergic receptor agonist- CLONIDINE:

treats ADHD, cancer pain, HTN, lowers BP and pain

Anti-cholinergic drug- Atropine:

treats OD from indirect acting cholinergic, treats bradycardia, and used to dilate pupils

Antihistamine (second generation)- LORATADINE:

treats allergies, hives; AVOID DRIVING AND ALCOHOL, TAKE WITH MEALS

Antihistamine (first generation)- DIPHENHYDRAMINE:

treats anaphylaxis, seasonal allergies, motion sickness, insomnia, Parkinson's disease

Asthma- Methylxanthines:

treats asthma unresponsive to beta agonists and inhaled corticosteroids; bronchodilators chemically related to caffeine; infrequently prescribed d/t narrow safety margin

Anti-cholinergic drug- Ipratropium:

treats asthma, COPD by increasing bronchodilation; WAIT 2-3 MINUTES BETWEEN DOSES, BITTER TASTE, RINSE MOUTH; ASSESS FOR SOY/PEANUT ALLERGY

Osmotic diuretic- MANNITOL:

treats cerebral edema, increases IO pressure; IV ONLY

Bile acid sequestrants- CHOLESTYRAMINE

treats hyperlipidemia, although less effective than statins; mix with water, noncarbonated beverages, pulpy fruits to avoid GI upset

Class III K+ Channel Blocker- AMIODARONE

treats life threatening ventricular arrhythmias and atrial arrhythmias in pts with HF; available PO and IV; blocks potassium AND sodium channels; requires high loading dose for first 2-3 weeks

Thiazide diuretic- HCTZ:

treats mild-moderate HTN and edema from HF. Promotes renal Ca+ retention; ADMINISTER EARLY TO PREVENT NOCTURIA; ineffective in patients with AKI

Vasodilator- HYDRALAZINE

treats mild-moderate HTN. Can also decrease afterload in patient with HF. Typically prescribed with beta blockers or diuretics; INTERACTS WITH ALCOHOL, ANTIHYPERTENSIVES, AND NITRATES.

Anti-cholinergic drug- Scopalimine

treats motion sickness, IBS, Decrease GI motility; TRANSDERMAL ONLY

Anti-cholinergic drug- Tolterodine

treats overactive bladder; monitor for anaphylaxis

Colloids- ALBUMIN IV

treats significant fluid loss from sever burns and shock

Loop diuretic- FUROSEMIDE:

treats swelling, HTN, HF by increasing urine output; CONTAINS SULFA: CAN be prescribed to patients with kidney failure

40.6 Vilanterol and fluticasone (Breo Ellipta) has been ordered for a patient with COPD. Because of the combination of drugs, what adverse effects may be expected?

tremor and nervousness, dry mouth and hoarseness, oropharyngeal cadidiasis and increased risk of infections

Cholinergic drug- Bethanechol:

urinary retention/GI tract stimulates smooth muscle contraction

40.2 a patient with asthma has a prescription for two inhalers, albuterol and beclomethasone (Qvar). How should the nurse instruct this patient on the proper use of inhalers?

use the albuterol inhaler, wait 5-10 minutes, then use the beclomethasone inhaler

39.5 A patient has been prescribed fluticasone (Flonase) to use with oxymetazoline (Afrin). How should the patient be taught to use these drugs?

use the oxymetazoline first, then the fluticasone after waiting 5 minutes

ARB- LOSARTAN:

used for HTN, HF, often used to treat HTN when ACE inhibitors cause cough; BAD FOR DIABETES; USE FOR HISPANICS D/T GENETIC MAKEUP

Asthma- corticosteroids:

used for long-term prevention of asthma attacks. Increase Beta agonist sensitivity in bronchial smooth muscle

Alpha 1 Adrenergic receptor agonist- PHENYLEPHRINE:

used for nasal congestion, hypotension

ACE Inhibitor- LISINOPRIL

used to treat HTN and HF; NEPHROTOXIC, give within 24 hours of an MI to improve survival rates; can take 2-3 weeks to become effective; GOOD FOR DIABETES; USE FOR HISPANICS D/T GENETIC MAKEUP

Vasodilator- NITROPRUSSIDE:

used to treat hypertensive crisis, cardiac pump failure, or cardiogenic shock: WATCH FOR CYANIDE TOXICITY

Adrenergic receptor agonist- Alpha 1 action:

vasoconstriction, dilates pupils

Alpha 1 Antagonist/Blocker actions:

vasodilation, increased urine flow

13.5 to avoid the first-dose phenomenon, the nurse knows the initial dose of prazosin (Minipress) should be:

very low and given at bed time

30.6 a patient was admitted from the emergency department after receiving treatment for dysrhythmias. He will be started on amiodarone (Pacerone) due to the lack of therapeutic effects from his other antidysrhythmic therapy. When the nurse checks with him in the afternoon, he complains of feeling lightheaded and dizzy. What will nurses assess first.

whether the patient's pulse and blood pressure are within normal limits