PPRA 3315 Test 3
metopolol ADE
-bradycardia -AV heart block -orthostatic hypertension -rebound myocardium excitation -decreased cardiac output
Verapamil and Diltiazem MOA
-calcium channel blocker -impact on heart and BV
Precautions of verapamil and diltiazem
-can cause digoxin toxicity when used with digoxin -both are CYP3A4 inhibitors -when used with beta blockers, can cause bradycardia and heart block
amlodipine pt education
-change positions slowly -maintain good dental hygiene -notify HCP if irregular heart beats, dyspnea, edema, or pronounced dizziness (progressing HF)
drug-drug interactions for levothyroxine
-cholestryramine -antacids -iron and calcium supplements -antiseizure and antidepressants can increase metabolism of drug -can increase effects of warfarin
cholestyramine ADE
-constipation -bloating -decrease absorption of fat soluble vitamins (A, D, E, K)
doxazosin pt education
-continue to take even if feeling better -check BP at least weekly and notify HCP of any significant changes -dont stop taking abruptly
methyldopa pt education
-continue to take even if you feel better -often prescribed for 2 or 3 doses a day, so take as prescribed -can make you feel sleep during initial treatment, do not drive if so
Uses of Non Aldosterone Antagonist
-counteract potassium loss caused by other diuretics -HTN -edema -commonly used in combination with thiazides
physiologic role of thyroid hormones as an adult
-critical for function of nervous, skeletal and reproductive systems -metabolism of carbs, fats, proteins and vitamins -can effect mood
non-aldosterone antagonists MOA
-disrupts sodium potassium exchange in the distal nephron
doxazosin ADE
-dizziness -depression -fatigue -abnormal vision -constipation -decreased libido -arthralgia -rash
gemfibrozil precautions
-do not take if pregnant or lactating -hepatic dysfunction -hypersensitivty
doxazosin monitoring parameters
-doses above 4 mg may cause orthostatic hypotension -monitor BP 2-6 hrs after initial dose or with any increases -monitor for therapeutic response
important information for IUDs
-efficacy rate higher than 99% -return to fertility within 30 days of removal -lasts up to 10 years -effective immediatly -may cause irregular periods for 3-6 months and heavier bleeding -contraindicated in patients with current (within the last 5 yrs) breast cancer
What needs to be monitored while taking thiazide diuretics
-electrolyte balances -renal function -dehydration -potassium levels -NO ototoxicity
ezetimibe pt education
-emphasize important of cholesterol lowering diet during therapy -drug can be taken with or without food -report any muscle pain, weakness, or tenderness
A patient is being started on nicotinic acid [Niaspan] to reduce triglyceride levels. The nurse is providing patient education and should include teaching about which adverse effects? (Select all that apply.) -facial flushing -constipation -hypoglycemia -gastric upset -itching
-facial flushing -gastric upset -itching
S&S of Hypothyroidism (Myxedema)
-fatigue -weight gain -dry, coarse skin -cold intolerance -delayed reflexes -constiaption -memory impariment -depression -heavy menses
amlodipine ADE
-flushed skin -headache -dizziness -peripheral edema -light-headedness -nausea -constipation -fatigue -sexual dysfunction
niacin ADE
-flushing (if occurs give aspirin) -hepatotoxicity -hyperglycemia -hyperuricemia -GI upset
sitagliptin ADE
-generally well tolerated -upper respiratory infection -little hypoglycemia
gemfibrozil ADE
-gi upset -myopathy -hepatotoxicity -avoid statins
metformin ADE
-gi upset, nausea, diarrhea -reduce appetite/weight loss -b12 deficiency in long term treatment -lactic acidosis (rare) -NO hypoglycemia
management of heparin therapy
-given SQ or IV not IM -advise patient use soft toothbrush and electric razor to minimize bleeding -do not take with aspirin, NSAIDs and other anticoagulants -monitor for bleeding -administer protamine sulfate to reverse effects
S/S of hyperthyroidism (Graves Disease)
-hair loss -frequent sweating -bulging eyes -enlarged thyroid -abnormal HR -enlarged liver -increased appetitie -vomiting or diarrhea -hand tremors -irregular menstration -nervousness -sleeplessness
pt education for propranolol
-have patient observe for signs of progressing heart failure -avoid sudden changes in position, rise slowly -don't stop taking abruptly
methyldopa ADE
-headache -muscle weakness -swollen ankles or feet -nausea, vomiting, diarrhea -gas, dry mouth
atorvastatin ADE
-headache, GI upset -Rare: myopathy/rhabdomyolysis, hepatotoxicity, new onset diabetes
rosuvastatin ADE
-headache, GI upset -dyspepsia -anemia -ecchymosis
benefit of no peak insulin
-help stabilize BG for a longer time -minimizes the amount of injections needed throughout the day
major ADE for heparin
-hemorrhage -throbocytopenia -hypersensitivity reactions
types of emergency contraceptives
-high dose POPs (plan B-1 tab or Next Choice-2 tabs)( use within 72 hours) -ulipristal acetate (Ella - take within 5 days) -copper IUD (can be used within 5 days after intercourse)
physiologic role of thyroid hormones in childhood
-higher levels are needed in childhood than adult hood -acts with growth hormone to stimulate bone growth
atorvastatin precautions
-hypersensitivity -active liver disease -unexplained elevation in AST or ALT
rosuvastatin precautions
-hypersensitivity -active liver disease -unexplained elevation in AST or ALT
Clonidine (precautions, contraindications)
-hypersensitivity -cannot be given through epidural -should not be used if the pt is on an anticoagulant or has a bleeding problem
ezetimibe precautions
-hypersensitivity -dont use in combination with HMG-CoA reductase inhibitors (Statins) in patients with active liver disease
doxazosin precautions
-hypersensitivity -hepatic dysfunction -gastrointestinal narrowing in extended release only
amlodipine precautions
-hypersensitivity -use cautiously in severe hepatic impairment, aortic stenosis, or history of HF
Uses of aldosterone antagonists
-hypertension -HF -edema -PCOS -acne in young women
Glipizide ADE
-hypoglycemia -weight gain
ACEi side effects
-hypotension -cough -angioedema (rare and life threatening) -hyperkalemia -renal failure -teratogenic
What to do if a CHC pill is missed?
-if 1 or more is missed in week 1: take the pill ASAP and continue, used back up for a week -if 1 or 2 pills in week 2: take 1 pill ASAP and continue active pills, skip placebos go straight to new pack -if 3 or more missed in week 2 or 3: follow 1 or 2 instructions: also used additional protection for a week
niacin pt education
-if extended release, do not split, chew or crush tablets -take missed dose as soon as remembered unless near time for next dose, do not double dose -use in combination of diet changes, exercise and weight control
What to do if NuvaRing falls out?
-if out for less than 3 hours, just reinsert -if out for longer than 3 hours, reinsert or start new depending on time in cycle and used a back up contraceptive for a week
Most effective conctraceptives (tier 1)
-implants -IUD -vasectamoy -sterilization
precautions when useing Combined Hormonal Contraceptives
-increased risk of throboembolism, stroke, and MI -increased triglyceride levels -increase BP
ACE inhibitors MOA
-inhibits angiotensin-converting enzyme -reduce levels of angiotensin II -increase levels of bradykinin -decrease release of aldosterone
mid level effective contraceptive (tier 2)
-injectables -pills -lactation amenorrhea method (only lasts 6 months)
Angiotensin Receptor Blockers MOA
-block access of angiotensin II -decrease release of aldosterone
MOA of aldosterone antagonists
-blocks aldosterone in the distal nephron -excretion of sodium; retention of potassium
metformin class and MOA
-biguanide -inhibits glucose production in the liver -sensitizes insulin receptors to increase glucose uptake in cells
A nurse is teaching an adolescent female patient about 28-day monophasic combination oral contraceptives. The provider has instructed the patient to begin taking the pills on the first Sunday after the onset of her next period. What will the nurse tell the patient?
"Protection from pregnancy will begin immediately if started within 5 days of menstruation."
A nurse is discussing the difference between stable and variant angina with a group of nursing students. Which statement by a student indicates the need for further teaching?
"Variant angina is the result of increased oxygen demand by the heart." -Variant angina is caused by coronary artery spasm, which reduces the oxygen supply to the heart. Beta blockers are not effective in variant angina but are useful with stable angina. Medications may be given to prevent anginal attacks in both types of angina. Vasodilators are used in variant angina to relieve coronary artery spasm and increase the oxygen supply to the heart.
A patient who takes nitroglycerine to treat stable angina reports having erectile dysfunction and states that he plans to ask his primary provider for a prescription for tadalafil [Cialis]. What will the nurse tell this patient?
"You should discuss another anti-angina medication with your provider or a different treatment for erectile dysfunction. -Use of nitroglycerin with any phosphodiesterase type 5 inhibitor, such as sildenafil or tadalafil, is absolutely contraindicated.
Why should beta blockers be used with caution in diabetics?
-beta blockers can alter signs of hypoglycemia, making it harder to tell if someone has low BS
Nitroprusside (Nitropress)
*class*: vasodilator, anti-hypertensive *Indication*: hypertensive crisis, cardiogenic shock *Action*: peripheral vasodilation of arteries and veins decreasing preload and afterload *Nursing Considerations*: - monitor HR, BP, and EKG continuously during therapy - may cause cyanide toxicity - sympathomimetics may decrease the effectiveness -significant hypotension, can be combated by infusing slower
Atorvastatin (Lipitor) MOA
- Inhibits HMG CoA reductase (an enzyme in the liver) thus causing less production of cholesterol - Decreases total cholesterol, LDL, triglycerides; Increases HDL (good cholesterol) -highest likelihood of reducing CV events
rosuvastatin MOA
- Inhibits HMG CoA reductase (an enzyme in the liver) thus causing less production of cholesterol - Decreases total cholesterol, LDL, triglycerides; Increases HDL (good cholesterol) -highest likelihood of reducing CV events
What does A1C measure?
- percentage of glycated hemoglobin in blood - average glucose control for the past 2-3 months
Diagnostic criteria for diabetes
-A1C>= 6.5% -Fasting blood glucose>= 126 mg/dl -2 hour plasma glucose >=200 mg -With signs of hyperglycemia, random glucose >=200 mg.
What are the two types of potassium-sparing diuretics
-Aldosterone antagonists -non aldosterone antagonists
sitagliptin class and MOA
-DPP-4 inhibitors -stimulate glucose dependent insulin release -suppress postprandial release of glucagon
ezetimibe ADE
-GI upset -myopathy -hepatotoxicity
liraglutide class and MOA
-GLP-1 agonist -stimulate glucose dependent insulin release -suppress post prandial release of glucagon -suppress appetite -decrease gastric emptying
therapeutic uses of ACEi and ARBs
-HTN -HF -MI -diabetic and non-diabetic nephropathy -prevention of MI and stroke in high risk pts
ADEs of Verpamil and Diltiazem
-Hypotension -dizziness -headache -edema -GERD -heartblock -bradycardia -gingival hyperplasia -constipation (verapamil)
important labs to monitor while taking warfarin
-International normalized ratio (INR -prothrombin time (PT)
liraglutide ADE
-N/V, diarrhea -injection site irritation -pancreatitis -little hypoglycemia
TSH levels in hypothyroidism
-Primary = high TSH, low T4 and T3 -Secondary = low TSH and T4/T3
empagliflozin class and MOA
-SGLT-2 inhibitors -block reabsorption of glucose in renal tubules
empagliflozin ADE
-UTI -yeast infection -increased urination -dizziness -little hypoglycemia
important labs to monitor while taking heparin
-activated partial throbmoplastin time (PTT) -normal is 60 to 100 seconds when taking heparin -antifactor Xa levels
methyldopa precautions
-active hepatic disease -liver disorders from previous therapy -hemolytic anemia -significant drug history of MAOI therapy -hypersensitivity
Important information for Depo-provera (injection)
-administered every 3 months in office -return to fertility avg 10 months after last injection -not immediately reversable -can cause weight gain
drug-drug interactions when taking clopidogrel
-agents that promote bleeding -proton pump inhibitors
cholestyramine precautions
-allergy 0biliary or bowel obstruction -phenylketonuria -pregnancy (category C)
rosuvastatin monitoring parameters
-assess for underlying cause of hypercholsterolemia and poorly controlled diabetes -recommend lifestyle changes prior to medication -pt who are 65+, have hypothyroidism or renal insufficiency have a greater likelihood of developing myopathy
monitoring parameters for Warfarin
-assess vitals -monitor for signs of bleeding -assess for signs of thrombosis -monitor INR and PT levels -evaluated hepatic function prior and during withhold dose if INR or PT are above range
What are the benefits of progestin only contraceptives?
-avoid estrogen ADEs (migraines, nausea, CV risk, HTN, and VTE) -decreases menstrual blood loss, cramps and pain -protection from endometrial cnacer -decrease risk of pelvic inflammatory disease -may be used by smokers over the age of 35 -may be used when breastfeeding
Pt education for extended-release medications
-instruct patients to not crush, chew, or split medications -take at the same time every day -if dose is missed, take as soon as remembered and alter the time of the next doses
choelstyramine monitoring parameters
-know fat consumption -monitor cholesterol and triglyceride levels for effectiveness
ezetimibe monitoring parameters
-know underlying cause of dyslipidemia -obtain baseline TG, cholesterol, LDL and HDL levels -monitor for muscle pain ,weakness or tenderness
important information for Nexplanon (implant)
-lasts 3 years -can cause irregular menstrual bleeding -return to fertility about 3-6 weeks after removal
TSH levels in hyperthyroidism
-low TSH -elevated T4 and T3
gemfibrozil MOA
-lowers triglycerides -increases HDL levels
metformin monitoring parameters
-monitor A1c -take with bigger meals (breakfast and dinner) -avoid alcohol -exercise and follow dietary guidlines -monitor and log glucose levels
liraglutide monitoring parameters
-monitor BG and A1c -rotate injection sites -administer at the same time every day -teach pts how to properly store injections -teach signs of hypoglycemia
amlodipine monitoring parameters
-monitor BP -monitor for orthostatic hypotension -monitior HR and dose related palpitations
niacin monitoring parameters
-monitor BP -monitor for therapeutic effect with serum levels -liver function results may become abnormally high
clonidine monitoring parameters
-monitor BP and hr -use cautiously in older patients, pts with AV block or sinus bradycardia -if severe bradycardia, administer atropine
gemfibrozil monitoring parameters
-monitor for myopahty -measure CPK if muscle pain occurs -monitor liver function -monitor serum levels for therapeutic effect
empagliflozin monitoring parameters
-monitor for signs of hypoglycemia -monitor for UTI -monitor A1c -make sure they know that this is not a cure for diabetes but something to help control hyperglycemia
Propranolol monitoring parameters
-monitor for signs of orthostatic hypertension -can cause bradycardia - if lower than 50 bpm then hold dose -use with caution in patient with diabetes -obtain a baseline ECG -don't stop abruptly, discontinue over 1 -2 weeks
methyldopa monitoring parameters
-monitor for therapeutic response -dizziness or fainting -orthostatic hypotension
Sitagliptin monitoring parameters
-monitor post prandial BG -monitor for decrease in A1c -monitor for s/s of HF -use in combination with diet and exercise -do not crush or split tablet
What are the three main classes of drugs use to treat angina-related pain?
-nitrates -beta-blockers -calcium channel blockers
metopolol monitoring parameters
-obtain baseline ECG -monitior for signs of worsening HF
monitoring parameters for heparin
-obtain platelet count evert 2-3 days -monitor for bleeding: gums, petechiae, black tarry stools, decrease in hematocrit -check for sing of decreaseing clots -monitor PTT and occult blood in stool
Precautions for propranolol
-patient with AV heart block -pts with COPD or asthma
types of CHCs
-phasic pills (mono, bi, tri and extended cycle) - nuva ring -patch (xulane or Twirla)
A patient is receiving continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? (Select all that apply.)
-platelets -activated partial thromboplastin time (aPTT)
signs and symptoms of type I diabetes
-polydipsia -polyuria -polyphagia -weight loss -loss of strength -headache -drowsiness -malaise -dry mouth
What needs to be monitored while taking nonaldosterone antagonists
-potassium levels -especially with ACEi and ARBs
what needs to be monitored when taking loop diuretics
-potassium levels -fluid balance (can cause hypovolemia) -electrolyte balances -renal function -blood pressure -can cause ototoxicity
monitoring for ARBs
-potassium levels -postural hypotension -angioedema
What needs to be monitored when taking aldosterone antagonists?
-potassium levels -When taken with ACE or ARBs potassium can become dangerously high -CYP3A4 > increase drug levels -endocrine effects (menstrual irregularities)
metopolol precautions
-pregnancy -pts with AV block or sinus bradycardia -pts with diabetes
indications for clopidogrel
-prevention of arterial thromboembolism to reduce the chance of a MI or stroke - prevent thrombi formation in patients with unstable angina or coronary artery stents -prevent DVT post operation -alternative to aspirin
Which types of hormonal contraceptives ar safest for patient who smoke or who have CV disease?
-progestin only contraceptives -emergency contraceptives
What are loop diuretics used for?
-pulmonary edema -edematous states -hypertension
Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? (Select all that apply.) -reduction of LDLs -elevation of HDLs -stabilization of plaque in coronary arteries -reduction of risk of cardiovascular events -improvement of liver function
-reduction of LDLs -elevation of HDLs -stabilization of plaque in coronary arteries -reduction of risk of cardiovascular events
monitoring for ACEi
-renal function: urine output, SCr, BUN -hyperkalemia: decrease/hold dose if K > 5 mEq/L -BP
gemfibrozil pt education
-report GI symptoms -inability to tolerate fried foods, bloating -notify of muscle/joint pain, jaundice, or fatigue -take 30 minutes before breakfast and 30 minutes before dinner -take next dose as soon as remembered unless nearly time for next dose
ARB side effects
-same as ACEi except no cough
metopolol pt education
-sit if dizzy -rise slowly, dont change positions quickly -dont stop taking abruptly
drugs used most commonly in hypertensive emergencies
-sodium nitroprusside -fenoldopam -labetalol -clevidinpine
When to start BC pills
-start on first day of period -if it is known that she is not pregnant then she can start right away no matter what -if started with 5 days after start of period protection is immediate -if started any other time then use back up for 7 days
atorvastatin pt education
-stop taking if pregnant or planning to be -dont consume alcohol -maintain a low cholesterol diet -NO Grapefruit juice -notify HCP if muscle pain or cramping
rosuvastatin pt education
-stop taking if pregnant or planning to be -dont consume alcohol -maintain a low cholesterol diet -NO Grapefruit juice -notify HCP if muscle pain or cramping
Glipizide class and MOA
-sulfonylurea -stimulates pancrease to release insulin
cholestyramine pt education
-take all other meds 1 hour before or 4-6 hours after bile sequestering agents -decreases Na and K levels -take 1 month to be effective -do not take if bile duct impairment
pt education for ARBs
-take as directed even if symptoms get better -notify HCP if signs of angioedema
clonidine pt education
-take at the same time every day even if feeling well -take the next dose as soon as remembered -warn pts with contacts that this medication may cause dry eyes -may decrease libido in men -do not stop taking abruptly
patient education points for ACEi
-take at the same time everyday -educate the it will not cure hypertension so therapy may need to be life long
how does nexplanon and IUDs differ from other types of contraceptives?
-they are implanted in the body (in uterus and in the arm) -they last for years (nexplanon - 3 years, IUD - 10 years)
When would some one switch from an ACEi to an ARB
-they cannot tolerate the ACEi cough -They experiences angioedema from ACEi and can no longer take ACEs
management of warfarin therapy
-to reverse effects administer vitamin K -educate pt on signs and symptoms of bleeding -avoid IM injections -dosage is adjusted based on INR -avoid food high in vitamin K -educate on signs of thromboembolism
niacin precautions
-used as last line for hyperlipidemia -hypersensitivity -monitor closely if pt is taking an anticoagulant -hepatic or renal failure -dont take if pregnant -active peptic ulcer disease
how to use nitroglycerin tablets for angina?
-used for acute angina attacks -place 1 tablet under the tongue or between the cheek and gum at first sing of attack -1 tablet every 5 minutes for 15 minutes (max 3 tablest) -to prevent angina from exercise or stress, use 1 tab 5 to 10 minutes before exercise
pt education for levothyroxine
-used for hypothyroidism -dosed once daily -administer before breakfast -avoid antacids or vitamins within 2 hours -awarenes of the product including what color the tablet is -effects within 2-4 wks -follow up with doctor 6-8 wks then yearly -therapy will be life long -ADE will occur if the dose is to high and might cause symptoms of hyperthyroidism
lifestyle changes to help hyperlipidemia
-weight loss -smoking cessation -low saturated fat diet -exercise -this is the first line in treatment
least effective contraceptives (tier 3)
-withdrawal -spermicide -male and female condoms -diaphragm -fetility awareness based methods
What are progestin only contraceptives?
1. oral options 2. injectable (depot medroxyprogesterone) 3. Implant (etonogestrel)(nexplanon) 4. IUD (levonorgestrel) (mirena/skyla/copper)
normal INR range for warfarin
2-3
A nurse working in a family planning clinic is teaching a class on intrauterine devices (IUDs). Which patient should be advised against using an IUD for contraception?
An 22-year-old woman who wishes to become pregnant in a year
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 -Because nitrates lower blood pressure, isosorbide dinitrate can activate the baroreceptor reflex, causing sympathetic stimulation of the heart; this negates the benefits of treatment with nitrates, because it increases the cardiac oxygen demand. For these reasons, addressing the tachycardia becomes the nurse's immediate priority
major ADE for warfarin
Bleeding Transient hypercoagulable state Skin necrosis -increased effect eith CYP inhibitors and antibiotics
A patient is scheduled to start taking insulin glargine [Lantus]. On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication?
Blood glucose control for 24 hours
cholestyramine MOA
Bile acid sequestrant/resin; binds bile acids in the intestine to decrease enterohepatic reabsorption and cause an increase in de novo bile acid synthesis from cholesterol -lowers LDL -used with statins or when pt is statin intolerant
Propranolol adverse effects
Bradycardia, AV heart block, heart failure, rebound cardiac excitation, bronchoconstriction, inhibition of glycogenolysis (increased BG), and CNS effects
Examples of ARBs
Candesartan Losartan
Examples of ACEi
Captopril Lisinopril
A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take?
Check the patient's capillary blood sugar
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 -An INR in the range of 2 to 3 is considered the level for warfarin therapy. For a level of 1.2, the nurse should contact the healthcare provider to discuss an order for an increased dose.
Examples of thiazide diuretics
Chlorothiazide (long acting) Hydrochlorothiazide (most common)
Best drug to lower triglycerides
Fibrates
Before administering metformin [Glucophage], the nurse should notify the prescriber about which laboratory value?
Creatinine (Cr) level of 2.1 mg/dL -Metformin can reach toxic levels in individuals with renal impairment, which is indicated by a rise in the serum creatinine level.
A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats/min and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A stat CBC shows a platelet count of less than 100,000 mm3. Which of the following is the BEST first action:
Discontinue the heparin and notify the provider. -This patient is showing signs of heparin-induced thrombocytopenia, so the heparin should be discontinued immediately and the provider should be notified. The purplish color of the fingertips is caused by thrombosis, not hypoxia, so oxygen is not indicated. This patient may need continued anticoagulation therapy, so a request for protamine sulfate is not correct.
clonidine ADE
Drowsiness, Dry mouth, Rebound hypertension, Potential for abuse
glipizide monitoring parameters
Efficacy: fasting blood blood glucose between 70 and 130 mg/dL, HbA1c < 7% Toxicity: Symptoms of hypoglycemia include nausea, sweating, and loss of consciousness. Seek medical attention if yellowing of skin or eyes, severe skin rash, unusual bruising, or bleeding
Examples of loop diuretics include:
Furosemide (Lasix) Bumetanide (Bumex) Torsemide
A nurse caring for a patient notes that the patient has a temperature of 104°F, and a heart rate of 110 beats/min. The patient's skin is warm and moist, and the patient complains that the room is too warm. The patient appears nervous and has protuberant eyes. The nurse will contact the provider to discuss possible:
Graves' disease.
signs and symptoms of type II diabetes
HYPERGLYCEMIA Gradual onset Dry mouth/thirst (polydipsia) Polyuria Headaches Nausea/abdominal pain Fatigue Weak rapid pulse Skin is warm and red
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 -Heparin is an anticoagulant that works by helping antithrombin inactivate thrombin and factor Xa, reducing the production of fibrin and thus decreasing the formation of clots.
A nurse obtaining an admission history on an adult patient notes that the patient has a heart rate of 62 beats/min, a blood pressure of 105/62 mm Hg, and a temperature of 96.2°F. The patient appears pale and complains of always feeling cold and tired. The TSH is elevated. The nurse will contact the provider to discuss tests for which condition?
Hypothyroidism
How to store nitroglycerin tablets
In dry, cool, dry environment and replace every 6 months- exposure to light deactivates tablets -keep in original glass bottle
MOA of loop diuretics
Inhibit Na+ & Cl- reabsorption
niacin MOA
Inhibits lipolysis in adipose tissue; reduces hepatic VLDL synthesis -raises HDL the most -lowers triglycerides -little effect on CV outcomes
A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body?
It promotes the passage of glucose into cells for energy.
The nurse knows that which statement is accurate for enoxaparin [Lovenox]?
It reduces the activity of factor Xa more than the activity of thrombin -Enoxaparin acts primarily on factor Xa and also, but to a lesser degree, on thrombin. Unfractionated heparin equally reduces the action of thrombin and factor Xa. Fondaparinux [Arixtra] causes selective inhibition of factor Xa. Low-molecular-weight (LMW) heparins, such as enoxaparin, have greater bioavailability and a longer half-life than unfractionated heparin.
3 main types of diuretics
Loop Thiazide K sparing
the physiologic role of thyroid hormones in utero
Low levels can cause: -stillbirth -low birth weight -abnormal fetal physical an dbrain development
intermediate acting insulins
NPH
The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the nurse she does not want to take medications while she is pregnant. What will the nurse explain to this patient?
Neuropsychologic deficits in the fetus can occur if the condition is not treated.
Labetalol (Trandate)
Non-selective B-blocker. Also block release of renin from kidney (less angiotensin = decreased BP). Decreases HR, decreases vascular resistance, = decreased BP. SE: Pts feel tired. -drug of choice for chronic hypertension in pregnancy
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] -Omeprazole and other proton pump inhibitors may reduce the antiplatelet effects of clopidogrel. Patients sometimes take them to reduce gastric acidity and the risk of gastrointestinal (GI) bleeding.
intermediate acting insulin onset and peak
Onset: 1-2 hours Peak: 4-12 hours
Rapid acting insulin onset and peak
Onset: 15 min Peak: 1 hour
clopidogrel MOA
P2Y12 ADP antagonist -block receptors on the platelet surface -reduced GP IIb/IIIa receptor activation -reduced binding with fibrinogen -reduced platelet aggregation -antiplatelet
risk factors of type 2 diabetes
Physically inactive, overweight or obese, genetically predisposed, ethnically predisposed
ezetimibe MOA
Prevent cholesterol absorption at small intestine brush border -lowers LDL
A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan?
Refer the patient to a diabetes educator because the result reflects poor glycemic control.
doxazosin MOA
Select alpha-1 adrenergic receptor antagonist
Examples of aldosterone antagonists
Spironolactone (Aldactone) Eplerenone (Inspra)
atorvastatin monitoring parameters
Total cholesterol, LDL-cholesterol, and triglycerides levels; HDL-cholesterol levels. -monitor liver function tests prior to initiation and indicated -monitor for muscle tenderness (sign of rare ADE)
A patient who takes warfarin [Coumadin] is brought to the emergency department after a self report of accidentally taking too much warfarin. The patient's heart rate is 78 beats/min, and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an order for:
a PT and INR -This patient does not exhibit any signs of bleeding from a warfarin overdose. The vital signs are stable; there are no hematomas or petechiae; and the patient does not have pain. A PT and INR should be drawn to evaluate the anticoagulant effects.
A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and:
administer the dose as ordered -This patient has an INR in the appropriate range, which is 2 to 3 for most patients and 2.5 to 3.5 for some, so no change in warfarin dosing is necessary. It is not correct to request an order to either decrease or increase the dose of warfarin
ADEs of clopidogrel
bleeding risk, premature discontinuation can increase risk of thrombosis, thrombotic thrombocytopenia purport (TTP) -hemorrhagic stroke
main MOA of diuretics
blockade of sodium and chloride reabsorption
Metopolol MOA
blocks beta-1 receptors (heart)
clonidine MOA and use
centrally acting alpha agonists. Decreases central sympathetic outflow used in HTN especially with renal disease - there is no decrease in blood flow to kidney If you miss a dose you will get rebound tachycardia
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 -The primary and most serious adverse effect of heparin is bleeding. Bleeding can occur from any site and may be manifested in various ways, including reduced blood pressure, increased heart rate, bruises, petechiae, hematomas, red or black stools, cloudy or discolored urine, pelvic pain, headache, and lumbar pain.
Site of action of thiazide diuretics
early segment of distal convoluted tubule -considerably less output
long acting insulins
glargine, detemir
A patient is taking a calcium channel blocker (CCB) for stable angina. The patient's spouse asks how calcium channel blockers relieve pain. The nurse will explain that CCBs:
help relax peripheral arterioles to reduce afterload -CCBs promote relaxation of peripheral arterioles, resulting in a decrease in afterload, which reduces the cardiac oxygen demand. CCBs do not improve coronary artery perfusion. CCBs reduce the heart rate and suppress contractility; they do not affect the QT interval.
therapeutic uses of thiazide diuretics
hypertension edema diabetes insipidus
MOA of thiazide diuretics
increase renal excretion of sodium, chloride, potassium and water
A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will anticipate an order to:
increase the dose of warfarin. -Carbamazepine is a powerful inducer of hepatic drug-metabolizing enzymes and can accelerate warfarin degradation. The warfarin dose should be increased if the patient begins taking carbamazepine. Decreasing the dose of carbamazepine is not indicated.
A nurse is reviewing a patient's medications and realizes that gemfibrozil [Lopid] and warfarin [Coumadin] are to be administered concomitantly. Which effect will the nurse anticipate in this patient?
increased anticoagulant effects -Gemfibrozil displaces warfarin from the plasma albumin, thereby increasing anticoagulant effects
Rapid acting insulins
lispro, aspart, glulisine
amlodipine MOA
long-acting dihydropyridine calcium-channel-blocking drug with potent arterial and coronary vasodilating properties.
propanolol MOA
non-selective beta blocker
long acting insulin onset and peak
onset 3-4 hours peak- none
short acting insulin onset and peak
onset: 30-60 min peak: 2-5 hrs
A patient asks a nurse how nitroglycerin works to relieve anginal pain. The nurse correctly states, "Nitroglycerin
promotes vasodilation, which reduces preload and oxygen demand -Nitroglycerin dilates the veins, which reduces venous return to the heart, which in turn decreases ventricular filling. The resulting decrease in preload reduces the oxygen requirements of the heart
main site of action of diuretics
proximal tubule
short acting insulins
regular
best drug to lower LDL
statins
methyldopa MOA
stimulate alpha 2 adrenergic receptors in brain -controls impulses along nerve pathways, relaxing BV
Lovastatin [Mevacor] is prescribed for a patient for the first time. The nurse should provide the patient with which instruction?
take lovastating with your evening meal -Statins should be taken with the evening meal, not before breakfast. Statins should not be taken on an empty stomach.
A patient will begin taking atorvastatin [Lipitor] to treat elevated LDL levels. The patient asks the nurse what to do to minimize the risk of myositis associated with taking this drug. What will the nurse counsel this patient?
take vitamin D and coenzyme Q supplements
site of action of loop diuretics
thick ascending loop of Henle
Examples of non-aldosterone antagonists
triamterene amiloride
