pharm quiz 4
Dysrhythmia
Abnormal heart rhythm
Anticoagulants
Disrupt the coagulation cascade, thereby suppressing the production of fibrin
Drugs used for Stage C heart failure
Diuretics, ACE/ARBs, Aldosterone antagonists, BetaBlockers, Digoxin, Isosorbide dinitrate/hydralazine
Unfractionated Heparin
-Enhances antithrombin to inactivate thromin and factor Xa -Rapid acting anticoagulant -Injection only -Antidote: Protamine Sulfate -Labs needed: aPTT
How are COPD patients breathing stimulated?
Low O2 levels (rather than high CO2)
The nurse is caring for a patient receiving amiodarone [Cordarone]. Which body system should the nurse assess for serious adverse effects of this medication?
Respiratory
Therapeutic level of heparine when aPTT is what?
1.5-2x normal
Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent?
"Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." Correct
The nurse is providing discharge teaching for a patient with a new prescription for a nitroglycerin transdermal patch. Which statement by the patient indicates a need for FURTHER teaching?
"I will limit my alcohol to one drink per day."
A patient with angina is being discharged with a prescription for nitroglycerin sublingual tablets. Which instruction should the nurse include?
"Store the tablets in the original container and tightly close it after use."
A patient with nonvalvular atrial fibrillation is to be discharged on dabigatran etexilate [Pradaxa]. Which statement should the nurse include in the discharge teaching?
"The medication must be stored in the manufacturer-supplied bottle.
What should the nurse include in the discharge teaching for a patient prescribed amiodarone [Cordarone]? (Select all that apply.)
"Wear sunblock and protective clothing when you are outdoors." "Check your pulse daily and report excessive slowing to your healthcare provider immediately." "Immediately notify your healthcare provider of shortness of breath, cough, or chest pain."
Low Molecular Weight Heparin
-Heparin preparations composed of molecules that are shorter than those found in unfractionated heparin -Uses: Prevention of DVT after surgery, Treatment of DVT, revents ischemic complications -2-3x longer than unfractionated and is more expensive -Antidote: Protamine sulfate
Beta Blockers
-LOL Only a few have been approved May cause fluid retention, fatigue, Hypotension, Bradycardia or heart block
3 Preparationa of heparin
1. Unfractionated 2. Low-molecular-weight 3. Fondaparinux
A patient with an acute myocardial infarction is prescribed an intravenous (IV) bolus of tenecteplase [TNKase]. The patient weighs 160 lb. The nurse will administer what dosage?
40 mg
What should the patinet alert their PCP about immediately over?
A patient who takes oral spironolactone [Aldactone] 25 mg daily and enalapril [Vasotec] 5 mg daily with a serum potassium level of 5.5 mEq/L
What is the most common sustained dysrhythmia among the U.S. population?
AFIB
In which part of the conduction pathway in a healthy heart is the electrical impulse delayed to provide time for the blood to fill the ventricles?
AV node
How does the heart compensate for CHF?
Activates the sympathetic nervous system, activates RAAS, and causes ventricular hypertrophy
A patient develops supraventricular tachycardia (SVT) and is hypotensive. Which medication should the nurse anticipate will be administered?
Adenosine [Adenocard] Correct
Class 3: Potassium Channel blockers
Amiodarone Use for life threateing ventricular dysrhythmias only, Recurrent VFIB, Ventricular tachycardia How does it work? Deduce the SA node, Reduce contractability, QRS widening, Prolongs PR and QT intervals
A patient is receiving isosorbide dinitrate [Isordil] 20 mg 3 times/day for management of newly diagnosed stable angina. Which assessment finding would require an immediate nursing intervention?
An increase in the resting heart rate to 110 beats/min from baseline rates of 68 to 72 beats/min
The nurse is preparing to administer a daily dose of Digoxin [Lanoxin]. What is the nurses primary intervention?
Analyze the heart rate and rhythm
Prevention of MI and Death
Antiplatelet drugs, cholesterol lowering drugs, Beta blockers, ACE inhibtors, antianginal agents, reducing risk factors
The home health nurse observes the patient for proper use of topical nitroglycerin ointment. Which action by the patient indicates the need for further teaching?
Applies the prescribed ribbon of ointment to the applicator paper and places it on the chest.
Left sided heart failure
Back up into the lungs
Which are the main types of drugs used to prevent or relieve anginal pain? (Select all that apply.)
Beta blockers, Nitrates, Calcium Channel blockers
A patient with heart failure has developed a cough while taking an angiotensin-converting enzyme (ACE) inhibitor. The health care provider discontinued the ACE inhibitor and prescribed an angiotensin II receptor blocker (ARB) as an alternative to the ACE inhibitor. The patient continues to have symptoms of heart failure despite using an ARB. Which medication should the nurse anticipate will be prescribed?
BiDil [Isosorbide Dinitrate and Hydralazine]
Class 2 antiarrhythmics
Blockage of adrenergic beta 1 receptor- Decrease the HR, AV conduction, and ventricular automaticity, increased PR interval
Theophylline
Bronchodilator given orally or IV(Emergency only) Dysrhythmias and seizures may occur wiht higher therapeutic levels
Left sided heart failure
CO decreases, Blood backs up in the pulmonary circulation, Causes left ventricular infarctoin, HTN, and stenosis. Manifests by pulmonary congestion, dyspnea, and activity intolerance
In which situation is dronedarone [Multaq] contraindicated?
Concomitant administration of Amitriptyline [Elavil]
How is heart failure treated
Diuretics, RASS inhibitors, Beta Blockers, Digoxin, Dopamine, hydralazine
COPD drugs
Corticosteroids- Decrease inflammation and mucous production in airways PHOSPHODIESTANCE
Beta Blockers for angina
Decrease O2 demand 1st line of defense for effort induced angina No effect on vasoplactic angina Adverse effects- Bradycadia, decreased AV condiction, asthmatic effects, use with caustion in patients with DM, depression, insomnia, sexual dysfunction
What is angina
Decrease of O2 supply and increase of demand
Adenosine (Adenocard)
Decreases automaticity in the SA node, Slows conduction through the AV node, Prolongd PR interval Used to terminate paroxymal SVT May cause Sinus bradycardia, dyspnea, Hypotension, facial flushing, chest discomfort
A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug?
Decreasing level of consciousness
The nurse is caring for a patient prescribed quinidine [Quinaglute] for a supraventricular dysrhythmia. What is a common adverse effect of this drug?
Diarrhea
Which medication is not associated with prolongation of the QT interval?
Diltiazem [Cardizem]
Which medication combination is useful in the treatment of variant angina?
Diltiazem [Cardizem] and isosorbide mononitrate [Imdur]
What is propranolol (Inderal) used for?
Dysrhythmias caused by excessice sympathetic stimulation and Supracentricular tachydysrhythmias
The nurse is planning care for a patient at risk for dysrhythmias. The nurse understands that the Cardiac Arrhythmia Suppression Trial (CAST) confirmed which finding?
Dysrhythmias should be treated only when they are symptomatically significant
Which patient symptoms should cause the nurse to be concerned about digoxin [Lanoxin] toxicity
Fatigue, Vomiting, Blurred vision.
A nurse gives oral digoxin. The apical pulse is 64 bp,. What should then nurse do?
Give the medication because it is normal.
Short acting bronchodilators
Great in emergency situations Constriction of airway Beta 2 agonists, anticholinergic,etc Dried mouth, blurred vision,
The nurse understands patients receiving nitroglycerin are at risk for which adverse effects? (Select all that apply.)
Headache, Dizziness, tachycardia
Four major determinants of Myocardial O2 demands
Heart rate, Contractile force, muscle mass, ventricular wall tension
PHOSPHODIESTANCE
Helps decrease ecasterbations Side affects- Mental changes Increased suicide rate flumilast
A patient with deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response?
Heparin suppresses coagulation by helping antithrombin perform its natural functions
3. A patient with emphysema may present with all of the following symptoms EXCEPT? A. Barrel chest B. Hyperinflation of the lungs C. Hypoventilation D. Hypercapnia
Hypoventilation
Albuterol
Inhaled, short acting beta 2 adrenergic agonist Prevents asthma episodes(exercise induced)
Antiplatelets
Inhibit platelet aggregration
VasoDilators (other than ACE and ARB)
Isosorbide- Selective dilation of Veins Hydralzine- Selective dilation of arterioles Nitroglycerin- Venous dilator Sodium nitroprusside [Nitropress]- Arteriole & venous dilator
The nurse knows that which statement is accurate for enoxaparin [Lovenox]?
It reduces the activity of factor Xa more than the activity of thrombin
A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What medication would be appropriate for this patient who has a history of heparin-induced thrombocytopenia (HIT)?
Lepirudin [Refludan]
Examples of sodium channel blockers
Lidocaine, Phenytoin, Mexiletine
Stage D heart failure
Marked S/S, Advanced structureal heart disease, Repeated hospitalizations Best treatment is a heart transplant How to manage: Control Fluid retention DO NOT USE BETA BLOCKERS
Class 1 C antiarrhythmics
Marked block of sodium channels- Prolonged QRS interval
Anticoagulants: Heparin and Derivatives
Mechanism of actionL Enhance activity of antithrombin
Class 1B antiarrhythmics
Mild block of sodium channels- Decrease in ventricular automaticity
Class 1A antiarrhythmics
Moderare block of sodium channels- DRS and QT intervals prolonged
The nurse is administering intravenous lidocaine [Xylocaine] to a patient with a ventricular dysrhythmia. What is the priority nursing intervention to prevent a potential complication with this drug?
Moniror ECG
Glycoprotein 11b/11a receptor antagonists
Most effective antiplatelet drugs "Super Asprin" Very expensive IV infusions Used for acute coronary syndromes and percutaneous coronary interventions
Antidysrhythmic Drug therapy
Need to balance the risk vs benefits Acure and long term treatment phases Minimizing risk
Drugs used for angina
Nitroglycerin, Beta Blockers, Calcium channel blockers, and ranolazine
Stage B heart failure
No S/S Manage by preventing development of symptomatic HF Treat with risk reduction and ACE/ARBs
Stage A heart failure
No symptoms, no structural or functional cardiac abnormalities Manage by reducing risk
The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate?
Notify the healthcare provider to discuss the reduction or withdrawal of heparin
Amiodarone [Cordarone] is prescribed for a patient with atrial fibrillation. What is the most important nursing intervention before administering this medication?
Obtain baseline serum thyroid and liver function studies
The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel?
Omeprazole [Prilosec]
Digoxin
Positive Inotropic action of the heart Increases the cardiac output Best for patients with 25% Ejection fraction or less May cause dysrhythmias, toxicity, and interacts with many other drugs
A nurse is caring for a patient who is taking spironolactone [Aldactone] and quinapril [Accupril] for heart failure. What finding indicates a potential interaction between these two drugs?
Potassium level of 5.7 mEq/L
Corticosteroids
Prednisone, Symbicore(Broncho dialater and steroid) Side effects- Bruising, thin skin AT RISK for hyperglycemia, infection, osteoporosis IF A PATIENT IS PRESCRIBED THE INHAILER OF BRONCHODILATER AND CORTICOSTEROID, TAKE BRONCHODILATOR FIRST TO OPEN UP THE AIRWAYS RINSE MOUTH
Fondaparinux [Arixtra] is not approved for use in which circumstance?
Prevention of ischemic complications in patients with unstable angina
Thrombolytics
Promote lysis of Fibrin, causing dissolution of thrombi
Class 2 beta blockers
Propranolol: nonselective Beta adrenergic antagonist that decreases automaticity of the SA node and decreases velocity of conduction through the AV node
Clot formation
Prothrombin activator is formed, Catlyzes conversion of prothrombin into thrombin, and then thrombin converts to fibrinogen into fibrin threads
The nurse is interpreting an electrocardiogram (ECG). Which component represents the depolarization of the ventricles?
QRS Complex
The nurse is monitoring a patient receiving ranolazine [Ranexa] for angina. Which assessment finding indicates an adverse effect of this drug?
QT prolongation on the electrocardiogram
Diuretics
Reduce fluid in the body causing the volume to lessen, helping lighten the work load. May cause Hypokalemia
Common supraventricular arrhythmias include
SVT, Atrial flutter, AFIB
Class 1: Soidium channel blockers
Slows the conduction through the system Blocks sodium and prevents depolarization Used to treat Ventricular arrhythmias
7. You are providing teaching to a patient with chronic COPD on how to perform diaphragmatic breathing. This technique helps do the following:
Strengthen the diaphragm
Thrombolytic Drugs
Streptokinase- Binds to plasminogen Used for MI, DVT, adn Pulmonary emboli Adverse effects include bleeding, hypotension and fever
How are nitrates administered?
Sublingually, SR tablets, Translingual spray, transdermal delivery, buccal tablets, topical ointments, IV infusion
Antiplatelet Drug
Suppress platelet aggregration 3 major groups: aprin, ADP receptor blockers, GP/11b/11a receptors
Stage C heart Failure
Symptoms are present, There are structural changes Main goals are to relieve symptoms, improve quality of life, prolong life, and slow the remodeling
In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The nurse understands increased sympathetic activity will produce which response?
Tachycardia
Complications with beta 2 adrenergic agonists
Tachycardia, angina, tremors
Tachydysrhythmia vs bradydysrhythmia
Tachydysrhythmias: HR is increased Bradydysrhythmias: HR is slowed
A nurse is caring for a patient receiving dronedarone [Multaq] for treatment of atrial fibrillation. What electrocardiogram (ECG) change indicates an adverse effect of this medication?
The QT-interval measurement changes from 400 to 520 msec.
What is heart failure?
The heart cannot pump effectively -Systolic or diastolic dysfunction and can be left or right sided
A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler. How should the patient take this medication?
The patient should use the Spiriva first and then 5 minutes later the Pulmicort.
Methylxanthines
Theophylline Type of bronchodilator Narrow therapeutic range(10-20mcg.ml) Can increase Digoxin Decrease dilatin and lithium
Asprin
Uses: Ischemic stroke, TIA, Stable angina, Coronary Stenting, MI, MAY CAUSE Bleeding
common ventricular arrhythmias
V-FIB, PVC, Digoxin indiced ventricular dysrthythmias, torsades de pointes
Atropine
Vagolytic drug, antiparrasympathetic, used to slow rhythms, and negates parasympathetic system
The nurse is caring for a patient receiving nitrates for relief of angina. What pharmacodynamic action is responsible for the relief of anginal pain with nitrates?
Vasodilation leads to decreased preload, which decreases oxygen demand
Nitroglcerin
Vasodilator Can cause headache, orthostatic hypotension, and reflex tachycardia Interacts with Hypotensice drugs, Phosphodieterase type 5 inhibiotors, betablockers, and alcohol
The heart undergoes cardiac remodeling during the initial phase of heart failure. What cardiac geometric change occurs during heart failure?
Ventricle wall thickening
Class 4: Calcium Channel blockers
Verapamil, Diltiazem Reduces SA node automaticity, Delays AV node conduction, Reduces Myocardial contractability Slows ventricular rare and rerminares SVT caued by AV node reentrant circuit Adverse effects :BradyCardia, Hypotension, AV block, Heart failure, Peripheral edema, constipation
Clot formation
Vessel gets injured, Vessel spasms, Platelets adhere to injury site and aggregates to form a plug, and insoluble fibtin strand forms and coagulates
The nurse is caring for a patient prescribed Digoxin [Lanoxin] for heart failure. Which finding would requore an immediate attention?
Vomiting and diarrhea
Long acting
Work the same but the effects last longer Spiriva
Direct Factor Xa Inhibitors
Xarelto: Binds directly with fctor Xa to cause inactivation Rapid onset Very few inteeractions Elliquis: Selective inhibition of Factor Xa NEITHER have Antidote
inotropic agents
activation of beta1-adrenergic receptors Increases the heart rate (Dopamine)
Formoterol
inhaled, long acting Used for long term control of asthma
Warfarin (Coumadin)
oral anticoagulant A vitamin K antagonist Used for a Long Term prophylaxis of thrombosis Adverse: Hemorrahge Many Drug interactions Antidote: Vitamin K
Which needle length and gauge should the nurse choose to administer subcutaneous heparin?
⅝ inch; 25 gauge
The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved?
70
RASS inhibitors (Captopril, Enalapril)
ACE inhibitors:-Prils Promote Arteriolar and venous dilation. May Cause hypotention, hyperkalemia, Cough, angioedema ARBS: Improve LV Ejection and reduce the HF S/S Block the action of angiotension 2 Aldosterone:Moderate- Severe symptoms, Block the receptors to stop fluid retention from occuring DRIS: Not approved for HF treatment yet Goals of these drugs: Make the pipes bigger so there is less pressure
Clopidogrel (Plavix)
Block P2y12 adp receptors on the platelet surface, prevents blockage of coronary artery stents, reduces thrombotic events in patients with acute coronary syndromes Use caution while combining with other drugs
What is the primary benefit of spironolactone [Aldactone] in patients with heart failure?
Blockage of aldosterone receptors
Class 3 antiarrhythmics
Blocks potassium channels- Prolongs ventricular repolarization, prolongs QT interval
Right sided heart failure
Blood backs up in the peripheral circulation, Causes pulmonary disease, left sided failure, and stenosis. Manifests by edema and weight gain
Class 4 antiarrhythmics
Calcium channel blockers in the AV and SA nodes, Decreases the HR and AV conduction, increase in PR interval
The nurse is caring for a patient who is receiving enteral feedings because of dysphagia. The healthcare provider prescribes isosorbide mononitrate [Imdur] 60 mg SR daily via the enteral tube. What is the most appropriate action by the nurse?
Call the healthcare provider about an alternate form of nitrate for administration
The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate?
Call the healthcare provider to increase the dose. Correct
Direct thrombin inhibitors Dabigatran (Pradaxa)
Direct inhibition of Thrombin Doesn't require monitoring of anticoagulants May Increase GI bleeds
Direct Thrombin Inhibitors Argatroban
Direct inhibition of thrombin IV anticoagulant Monitor aPTT and for allergic reactions
The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin?
Discolored urine
Calcium Channel Blockers
Relax coronary vasospasm, decrease heart rate, AV conduction, and contractability
right sided heart failure
causes swelling in extremities Edema, weight gain