Pharm 1062 Exam One
What is the antidote to NMS?
Dantrolene
What is the serum value of potassium?
3.5 to 4.5
How are Arterial Clots formed?
Initiated by platelets, fibrin formation occurs, RBC are trapped in fibrin mesh
During the administration of total parenteral nutrition - TPN, an assessment of the client reveal a bounding pulse, distended jugular veins, dyspnea, and cough. What is the priority nursing intervention?
Interrupt the client's infusion and notify the HCP
Medications that lower heart rate
Negative Chronotropes - Beta Blockers Negative Dromotropes - CCB
What is the action of anti platelet meds?
Prevent repeat MI, Prevent Throbosis in the arteries by suppressing platelet aggregation
What is the action of anticoagulants?
Prevent the formation of clots that inhibit VENOUS circulation
Anti Platelet Prophylaxis Includes...
Prevention of MI or Stoke inpatients with a family history Prevention of repeat MIs or stroke Prevention of a stroke for patients having a TIA
What is the antidote for Heparin?
Protamine Sulfate
What are Colloids?
Proteins that keep fluid side of the veins, low albumin levels can result in peripheral edema
What are the four Extrapyramidal Syndrome components?
Psuedoparkinsonism Acute Dystonia Akathisia Tardive Dyskinesia
Lovenox is contraindicated in which types of patients?
Patients with Hx or current stroke, peptic ulcers, blood abnormalities and Patients with eye, brain or spinal surgeries
What is the action of Thrombolytics?
"CLOT BUSTER" - Converts plasminogen to plasmin
Client with a dysrhythmia is admitted to telemetry for observation. In the morning the client asked for a cup of coffee. What is the nurse's best response?
"Coffee has caffeine that can affect your heart, It should be avoided."
RN is teaching the nursing student about the interventions to be followed while caring for a client undergoing treatment with anxiolytic drugs. Which statement made by the nursing student indicated the need for further teaching?
"I should encourage the client to change position quiclkly"
Phenothiazines all end in...
- AZINE
What do Atypical meds end in?
-APINE
Beta Blockers end in ?
-LOL
What do benzos end in?
-PAMS
Calcium Channel Blockers end in?
-PINE
What do Ace Inhibitors end in?
-PRILS
What do ARBs end in?
-SARTANS
What are the 4 steps of Heparin action?
1) Binds with antithrombin III 2) inactivate thrombin 3) Inhibits conversion of fibrinogen to fibrin 4) Clot prevention
Magnesium Serum Levels
1.5 - 2.5
LDL Normal Range - bad cholesterol
130 and under
Sodium Serum Levels
135 - 145
What is the serum value of Sodium?
135 - 145
Triglycerides Normal Range
150
Total Cholesterol Normal Range
200 and under
Phosphorus Serum Levels
3.0 - 4.5
Potassium Serum Levels
3.5 - 5.0
HDL Normal Range - good cholesterol
50 and over
Calcium Serum Levels
9.0 - 10.5
What is the serum value of calcium?
9.5 - 10
A client is on antipsychotic therapy for schizophrenia. During a follow-up visit, the nurse suspects acute akathisia. Which symptoms in the client support the nurse's suspicion
Agitation, Anxiety, and Restless movement
Phenothiazines include the following:
Aliphatics Piperazines Piperadines
What are some examples of benzos?
Alprazolam Lorazepam - Ativan Clonazepam
What is an example of a Thrombolytic?
Altepase TpA - Activase
Action of Ace Inhibitors?
Angiotensin converting enzyme causes decreased peripheral vascular resistance without causing increased cardiac output, rate or contractability
What class is Heparin?
Anticoagulant
Acova
Anticoagulant -- Direct Thrombin Inhibitor -- IV
Pradaxa
Anticoagulant -- Direct Thrombin Inhibitor -- ORAL -- Does not require coag testing
What is the action of Thrombolytics?
Attack and dissolve blood clots that have already been formed
What are two types of Anxiolytics?
Benzodiazepines and Azapirones
What is an example of a negative Inotrope?
Beta Blockers - Decreases contractions
Medications that reduce the "squeeze"
Beta Blockers, Adrenergic Blockers, CCB, ARBs, ACE Inhibitors and Direct-Acting Vasodilators
What is the action of Azapirones?
Binds to serotonin and dopamine Treats PTSD and GAD
What are side effects of Heparin?
Bleeding
What type of precautions should patients on "protection" medications be on?
Bleeding Precautions
What is the action of typical anti psychotic meds?
Block Norepinephrine and dopamine causing hypotension and sedation as well as EPS symptoms
Beta Blockers Action
Block beta-receptors in the heart and cause decreased heart rate, decreased force of contraction, and decreased rate of AV conduction. Blocks the release of Epinephrine.
What is the action of atypical anti psychotic meds?
Block solely dopamine. Have less EPS side effects than typical meds
What is the action of anti psychotic meds?
Block the action of dopamine
Action of Calcium Channel Blockers?
Blocks calcium access to cells causing decreased contractability, decreased conductivity and decreased oxygen demand
S/S of hypocalcemia
Bone fractures, anxiety, tetany Numbness and tingling in muscles
Side Effects of Beta Blockers
Bradycardia, CHF, Lethargy, LOW BLOOD PRESSURE, GI upset, depression
What is an example of Azapirones?
Buspirone May take 1-2 weeks to take effect
Potassium can lead to which type of problems?
CARDIAC ARRHYTHMIAS
S/S of Hyperkalemia
Can be caused by renal disease Temp fix can be a laxative Numbness, tingling and respiratory problems
What happens if you correct hypo or hypernatremia too quickly?
Can damage the Central Nervous System
How are thrombi formed?
Caused by decreased circulation, platelet aggregation on vessel walls and blood coagulation
S/S of Hypokalemia
Caused by nausea, vomiting and diarrhea Muscle Weakness and Fatigue
What happens when Isotonic solutions are given?
Cell stays the same
What happens when hypertonic solutions are given?
Cells shrink and release water
What happens when hypotonic solutions are given?
Cells swell and pull in water
What is an example of Aliphatics and Side Effects?
Chlorpromazine (Thorazine) SE: Orthostatic Hypotension and Moderate EPS
What are examples of atypical antipsychotics?
Clozapine, Olanzapine, Quetapine - Seroquel* and Respiradone
What do Dromotropes affect?
Conduction of the AV node -speed
What do Inotropes affect?
Contractions
What are the side effects of Atypical antipsychotics?
Decreased EPS s/s compared to typical. May cause weight gain?
Client presents to the ER with weakness and dizziness. The blood pressure is 90/60 mm HG, pulse 92 and weak, and body weight reflects a 3 lb - 1.4 kilogram- loss in two days. The weather has been hot. Which condition should the nurse conclude is the priority;
Deficient fluid volume
Client is treated with lorazepam for status epilepticus. What effect of lorazepam does the nurse consider therapeutic?
Depresses the central nervous system - CNS
What is an example of a positive Inotrope?
Digoxin - Increases contractions
What are examples of a negative Chronotropes?
Digoxin and Beta Blockers - decrease heart rate
What are the side effects of Ace Inhibitors?
Dizziness, orthostatic hypertension, COUGH, headache, GI upset
XA Inhibitors ...
Do not require routine coag testing. Given QDay or BID
What is an example of a Low Molecular Weight Heparin?
Enoxaprin Sodium (Lovenox)
What is the action of Benzodiazepines?
Enhance the effects of GABA
What are the S/S of Akathisia?
FEET ARE IN CONSTANT MOVEMENT Restlessness, trouble standing still, Jittery, Pacing the floor
What is indicated for patients that experience acute bleeding?
FFP -- Fresh Frozen Plasma
Sympathetic Nervous Response
Fight or Flight - Alpha and Beta receptors are affected by both epi and norepi but the receptors have a preference as to which they are affected by more
S/S of hypercalcemia
Flabby muscles, pain over bony areas, kidney stones Excessive thirst, nausea
What is an adverse affect of Diuretics?
Fluid Volume Deficit and Low Electrolyte Values
What are Crystalloids and when are they administered?
Fluids you can see through - Used to replace fluids from vomiting or diarrhea and patients who aren't eating or drinking
What is the antidote to Benzos?
Flumazenil
What medication does the nurse expect to administer to actively reverse the overdose sedative effects of benzodiazepine?
Flumazenil
What is an example of Piperazines and Side Effects?
Fluphenazine (Prolixin) SE: Antiemetic and Severe EPS, Low sedation and ANTICHOLINERGIC s/s
Lovenox
Given QDay or BID, not continuous like Heparin,
Total Parenteral Nutrition -TPN
Given via Central Line Contains more than 10% Dextrose
Peripheral Parenteral Nutrition - PPN
Given via Peripheral Line Contains less than 10% dextrose
What is contraindicated in CCBs?
Grapefruit
What is an example of Nonphenothiazines and what is it used for?
Haloperidol - Haldol Treats acute and chronic psychosis
Which organ has only beta 1-receptors?
Heart
What do Chronotropes affect?
Heart Rate
What is Oncotic Pressure?
Helps keep fluid in the intravascular space through large molecules like proteins
What is the main concern with prescribing Benzos?
High risk for dependency and overdose
What are side effects of ARBs?
INCREASED POTASSIUM, low blood pressure
Potassium Chloride
IVPB - NO PUSH - NO RECONSTITUTION Limit 40 meq per 1 L - peripheral IV Limit 100 meq per 1 L - Central IV CAUSTIC to VESSELS
When is Haldol Contraindicated?
In patients with Blood Dyscrasias
What are some side effects of diuretics?
Increased urination, headache, lightheadedness, can worsen high cholesterol, gout and DM. Timing is necessary. Patients can be a fall risk if given close to HS, may cause incontinence or nocturia.
What is the action of Coumadin - Warfarin Sodium?
Inhibits Vitamin K -- Mainly to prevent thromboembolic conditions that can lead to stroke
Side effects of CCBs?
LOW BLOOD PRESSURE, headache, bradycardia, flushing, peripheral edema and may cause AV block
What are the side effects of Buspirone?
Less sedation then Benzos Less risk for dependency than Benzos Drowsiness, headache Interaction with GRAPEFRUIT
Heparin Monograms...
Match the aPTT to the chart.. Repeat the bolus and/or increase or decrease the infusion rate
What is common teaching for patients on Antipsychotic medications?
May turn urine pink to red brown in color May take several weeks to take effect Do not use alcohol, narcotics or other CNS depressants Do not stop abruptly, may cause seizures
What are Nursing Interventions for patients of Antipsychotic medications?
Monitor for EPS s/s Check for "Pocketing" or "Cheeking" Meds Give Oral drugs with food or milk Give IM by Z track method DO NOT keep meds in syringe for long periods, these meds are caustic and will breakdown plastic
Heparin
Most commonly prescribed to prevent DVT or PEs after abdominal or orthopedic surgeries - VENOUS
S/S of Hypernatremia
Muscle weakness, excess thirst, dry mouth, seizures Myoclonic Jerks
When are Thrombolytics used?
Myocardial Infarctions, Thrombolic strokes, PE, DVT, and arterial occlusion
What is Neuroleptic Malignant Syndrome - NMS and the S/S?
NMS is a rare condition that can be caused by anesthesia or psychosis. Predisposing factors include excess agitation, exhaustion and dehydration. S/S include MUSCLE RIGIDITY, SUDDEN FEVER, HIGH BP
Can you push Electrolyes?
NOOOOOOOOOO
What are labs you want to monitor with patients on Coumadin?
PT -- 1.25 to 2.5 INR -- 2 to 3
What are the therapeutic values associated with Heparin?
PTT - 1.5 to 2 APTT. - 30 t 85 seconds Anti XA tests are administered
Why are Beta Blockers given?
Patients with Heart Failure, to mainly decrease the "squeeze" of the heart
What are the types of typical meds?
Phenothiazines and Nonphenothiazines
How are Venous Clots formed?
Platelet aggregation with fibrin that attaches to RBCs
What are examples of Anti Platelets?
Plavix - Aspirin - Epitifibatide - Integrillin
Give two examples of anti platelet meds
Plavix and Aspirin - ARTERIAL Meds
Nurse administers sodium polystyrene sulfonate to a client with chronic renal failure. Which finding provides evidence that the intervention is effective?
Potassium decreases to 4.2 mEq/L
What is the action of anti-platelets?
Prevent platelet aggregation
What are the S/S of ACUTE Dystonia?
REMEMBER that it is ACUTE Muscle spasms of the tongue, neck and back, laryngeal spasms, facial grimacing. * Patients trunk arches forward
What are the S/S of Tardive Dyskinesia?
REMEMBER this is CHRONIC *Can be permanent with long term use* Protrusion and rolling of the tongue, sucking and smacking of the lips, chewing motion and facial dyskinesia, involuntary body movements
RAAS
Renin stimulates production of angiotensin II and releases aldosterone. Causes the retention of sodium and water. Increases blood pressure. VASOCONSTRICTION
What are some side effects of Benzos?
Sedation, dry mouth, dizziness, confusion
Client with schizophrenia, undifferentiated type, is receiving a typical antipsychotic/neuroleptic. The nurse will assess for which extrapyramidal effects?
Shuffling gait, tremors, and restlessness
What is the action of Aspirin?
Suppressing platelet aggregation by inhibiting Cyclooxygenase - Used long term in a low dose
What are the S/S of Pseudoparkinsonism?
TREMORS AT REST Shuffling gait, stooped posture, Rigidity, Bradykinesia, PILL ROLLING MOTION OF THE HANDS
Nurse is assessing an adolescent after the administration of epinephrine. Which side effect is most important for the nurse to identify?
Tachycardia
Client diagnosis of schizophrenia is given one of the antipsychotic drugs. The nurse understands that antipsychotic drugs can cause extrapyramidal side effects. Which effect may be irreversible?
Tardive dyskinesia
What is the action of Potassium Sparring Diuretics - spironolactone?
Targets collecting of the kidney, allows for sodium and water secretion and spares potassium
What is the action of Thiazide - HCTZ?
Targets the distal tubule and treats HYPERTENSION
What is the action of Loop Diuretics - lasix?
Targets the loop of Henle and treats edema
Haloperidol 100 mg intramuscularly (IM) stat has been prescribed for a client who is battered and agitated after a street brawl. What does the nurse conclude after reviewing the prescription?
The does is more than recommended
What is an example of Piperadines and Side Effects?
Thioridazine HCl - Mellaril SE: Few EPS s/s
What is the main action of Diuretics?
To increase the amount of urine excreted. Increase water and sodium output. Goal is typically to decrease edema
What is the action of Angiotensin Receptor Blockers - ARBs?
Treat conditions such as increased blood pressure and heart failure. Relaxes the blood vessels - vasodilator
What are the benefits of Atypical Meds?
Treats schizophrenia and is effective for people who are intolerant of the side effects that come with the TYPICAL antipsychotic meds.
What are the S/S of withdrawal?
Tremors, anorexia, sweating, insomnia and seizures Taper these slowly
What are the two subclasses of anti psychotic meds?
Typical and Atypical
What is an example of a negative Dromotrope?
Verapamil - decreases the speed
What is the antidote to Coumadin?
Vitamin K
S/S of Hyponatremia
Weakness, change in level of consciousness, confusion and irritability Seizures
Client receiving the medication buspirone is admitted to the hospital with the diagnosis of possible hepatitis. The nurse identifies the athe client's sclerae look yellow. What will be the nurse's initial action?
Withhold the medication
Xa Inhibitors have what in the name?
XA!! Xarelto and ApiXAban - Eliquis