Pharmacology Exam 3 Study Guide

Blood pressure formula

(cardiac output) x (systemic vascular resistance) BP= CO x SVR

What needs to be obtained before giving a blood product?

-2 licensed personal must verify correct blood product and patient -Know what type of blood the patient has (type and screen) -Consent before hanging the blood

Adrenergic Blockers

-Bind to adrenergic receptors & inhibit or block stimulation of the sympathetic nervous system (SNS) -Have the opposite effect of adrenergic drugs -Also known as: adrenergic antagonists, alpha blockers, beta blockers, or alpha-beta blockers -Classified by type of adrenergic receptor they block: alpha 1 & 2 receptors; beta 1 & 2 receptors

Beta Blockers

-Block stimulation of beta receptors in the SNS -Compete with norepinephrine and epinephrine -Can be selective or nonselective

What vital sign would the nurse monitor for with diuretics?

-Blood pressure -Heart rate

Beta Blockers: Contraindications

-Bradycardia -Uncompensated heart failure -Severe pulmonary disease -Pregnancy

Stimulation of beta 2 adrenergic receptors on the airways

-Bronchodilation (relaxation of the bronchi)

Examples of Nonselective Beta Blockers:

-Carvedilol -Labetalol -Propranolol -Timolol -Sotalol

Mechanism of Action of Alpha Blockers:

-Cause both arterial and venous dilation, reducing peripheral vascular resistance and blood pressure (BP) -Used to treat hypertension

Mechanism of Action of Nonselective beta blockers:

-Cause same effects on heart as cardioselective beta blockers -Constrict bronchioles, resulting in narrowing of airways and shortness of breath -Mask signs of hypoglycemia

What precautions need to be taken when administering a blood product?

-Check patient's vitals -Monitor the patient to minimize the chance of an adverse reaction during transfusion

0.9% Normal Saline

-Class: Crystalloid -Classified as an isotonic solution -Works as a volume expander -Most commonly used crystalloid, along with LR -Used for fluid volume deficit when fluid and sodium are lost equally -Compatible with almost everything -Only solution that can be hung with blood products

Simvastatin (Zocor)

-Class: HMG-CoA Reductase Inhibitor (statin) -Uses: lower total cholesterol, LDL, and triglyceride levels; increase HDL -Contraindications: pregnancy, liver disease -Nursing Considerations: limit grapefruit juice, usually dosed in the evening to correlate with natural rhythm of cholesterol production, monitor liver enzymes, pregnancy category X -Other: Atorvastatin (Lipitor)

Dextran

-Class: colloids -Solution of glucose -Actions similar to those of human albumin in that it expands the plasma volume by drawing fluid from the interstitial space into the intravascular space -IV form only -Contraindications: hypersensitivity, heart failure, renal insufficiency, extreme dehydration

Albumin

-Class: colloids -Uses: volume expander to pull fluid back into vessels; also for shock, burns, and can be used when a patient has a lot of edema -Derived from human donors -Only given IV (close monitoring) -Contradiction: heart failure, renal insufficiency, severe anemia

3% or %% Normal Saline

-Class: crystalloid -Classified as a hypertonic solution -Brings fluid out of the cells and back into the vessels -Commonly used in severe hyponatremia (<120) and cerebral edema -Decreases intracranial pressure -Administer slowly, as too rapid of an infusion can cause irreversible brainstem damage -May cause fluid volume overload and pulmonary edema -Contraindicated in dehydration

1/2 Normal Saline- 0.45% NS

-Class: crystalloid -Classified as hypotonic solution (into the cell) -Brings fluids out of vessels and into the cells -Less concentrated than 0.9% normal saline -Commonly used for maintenance fluids & prevention of dehydration -0.25% normal saline is also hypotonic

Crystalloids are used a maintenance fluids to:

-Compensate for insensible fluid losses -Replace fluids -Manage specific fluid and electrolyte disturbances -Promote urinary flow

aPTT normal range

25-35 or 38 seconds

Epinephrine

Class: Adrenergic Agonist Mechanism of Action: increases heart contraction force, increases BP, vasoconstriction, bronchodilation in lungs Uses: Emergency situations (cardiac life support protocols & anaphylactic shock) Two IV strengths: -1mg/mL -0.1mg/mL

Carvedilol (Coreg)

Class: Beta Blocker -Nonselective beta blocker -Uses: heart failure, hypertension, and angina -Slows progression of heart failure and to decrease the frequency of hospitalization in patients with mild to moderate (class II or III) heart failure -Most commonly added to digoxin, furosemide, and angiotensin-converting enzyme inhibitors when used to treat heart failure

Cholestyramien (Questran)

Class: Bile Acid Sequestrant Uses: lower LDL along with statins; treatment for loose bowel movements Adverse effects: constipation, nausea, bloating, heartburn, headache, -GI adverse effects tend to disappear over time -Increasing dietary fiber and fluid intake may relieve constipation and bloating Contraindications: biliary obstruction, pregnancy considerations Nursing considerations: must be given 1 hour before or 4-6 hours after other medications

Gemfibrozil

Class: Fibrate -Uses: decreases triglycerides and increases HDL -Adverse effects: abdominal discomfort, blurred vision, headache, increased risk of gallstones, prolonged prothrombin time, increased liver enzymes -Contradictions: gallbladder disease, renal and liver disease -Interactions: oral anticoagulants & Statins (risk of myositis, myalgias, and rhabdomyolysis is increased)

Norepinephrine (Levophed)

Class: adrenergic agonist MOA: vasoconstriction (no bronchodilation) Uses: treatment of hypotension and shock Administered by continuous IV infusion

Prazosin (Minipress)

Class: alpha blocker MOA: arterial and venous dilation Uses: hypertension Adverse effects: orthostatic hypotension (esp with first dose), dizziness, headache, weakness, palpitation

Phentolamine (Regitine)

Class: alpha blocker MOA: arterial and venous dilation Uses: most commonly used to treat the extravasation of vasoconstriction drugs such as norepinephrine, epinephrine, and dopamine. Also used for high blood pressure.

Metoprolol (Lopressor, Toprol XL)

Class: beta blocker -Most commonly used beta 1 blocker (cardioselective) Uses: hypertension, MI, angine Contraindications: bradycardia, pregnancy Routes: oral and injectable

Propranolol (Inderal)

Class: beta blocker -Prototypical nonselective beta 1 and beta 2 blocking drug -Uses: angina, hypertension, dysrhythmias, post-MI, migraines, tremor -Contradictions: bronchiole asthma -Oral and injectable form -Adverse effects: low blood pressure, bradycardia, bronchconstriction, blood sugar can be low

Digoxin

Class: cardiac glycoside increase myocardial contractility and decreases heart rate changes electrical conduction of heart to improve efficiency decrease in dyspnea, cough, and cyanosis improved symptom control, quality of life, and exercise tolerance Uses: HF and Atrial fibrillation

Atenolol & Metoprolol

Class: cardioselective beta 1 adrenergic receptor blocker -Safe to give to someone with asthma Indication: prophylactic treatment of angina pectoris -reduces mortality rate in patients after MI and in treating angina -Extended and immediate release for of Metoprolol

Furosemide (Lasix)

Class: loop diuretic -Most commonly used loop diuretic Uses: pulmonary edema, heart failure, cirrhosis, nephrotic syndrome, ascites, and hypertension Adverse effects: -Fluid and electrolyte loss -Dizziness, headache, n/v/d -Photosensitivity -Nephrotic and neurotic properties Nursing Considerations: -take in the morning -change positions slowly -monitor weight daily -teach patients to eat more potassium-rich foods

Mannitol (osmitrol)

Class: osmotic diuretics Uses: reduce cerebral edema and intracranial pressure, prevent kidney damage during acute renal failure, reduce intraocular pressure, excrete toxic substances Administration: always given as IV infusion with a filter (can crystalize at lower temperatures) Adverse effects: convulsions, thrombophlebitis, pulmonary congestion Contraindications: several renal disease, intracranial bleeding, pulmonary edema (use loop diuretic instead) Often used in the ICU setting

Calcium Channel Blockers

MOA: blocking of calcium channels in vessels (vasodilation) and blocking of calcium channels in myocardium (decreasing HR) Primary use: HTN and angina Adverse effects: -orthostatic hypotension -bradycardia -peripheral edema -constipation *Amlodipine is the CCB mostly used for HTN; will learn more about other drugs with angina

Digitoxin Immune Fab

Digoxin toxicity Antibody that inactivates free digoxin when digitoxin toxicity is a concern (antidote) Uses: used to treat digitoxin toxicity when: -hyperkalemia occurs -cardiac dysrhythmias -life threatening overdose (adult level over 10)

Remaining 5% to 10% of sodium is reabsorbed here. Regulated by aldosterone.

Distal convoluted tubule (distal tubule)

unstable angina

Early stages of progressive CAD (often leads to MI in later years) Severe/sudden onset; usually not predictable

What diet considerations should you educate the patient on when taking Spironolactone?

Eat foods low in potassium

What symptoms would someone have with fluid volume excess?

Edema, crackles, ascites

Anticoagulants: Patient Education

Education should include: oImportance of regular laboratory testing oSigns of abnormal bleeding oMeasures to prevent bruising, bleeding, and tissue injury oWearing a medical alert bracelet oConsistent intake of foods high in vitamin K (tomatoes, dark leafy green vegetables) oConsulting physician before taking other drugs or over-the-counter products, including herbals

Why may telemetry be ordered for a client that is taking diuretics?

Effects potassium which effects the heart

Examples of ACE Inhibitors:

End in "PRIL" -Captopril -Enalapril -Lisinopril

The nurse is caring for a patient experiencing severe anaphylactic reaction after a dose of an antibiotic. The nurse expects to give what drug first? What will this drug do?

Epinephrine- broncho dilation and helps the patient breathe better

Diuretics

First line antihypertensives for treatment of hypertension Decrease plasma and extracellular fluid volumes Overall effect: decreases workload of the heart and decreases BP Thiazide diuretics are the most commonly used diuretics for hypertension.

What foods are high in chloride?

Foods with higher amounts of chloride include seaweed, rye, tomatoes, lettuce, celery, and olives.

Measures how well the kidneys function

Glomerular filtration rate (GFR)

Adverse effects of Adrenergic Agonists:

HTN, headache, restlessness, insomnia, chest pain, palpitations, N/V

Contraindication for Adrenergic Agonists:

Hypertension

Nitroglycerin Instructions

If anginal pain occurs: ØStop activity and sit or lie down and take a sublingual tablet. ØIf there is no relief in 5 minutes, call 911 or emergency services immediately and take a second sublingual tablet. ØIf there is no relief in 5 minutes, take a third sublingual tablet. ØDo not try to drive to the hospital.

Initial filtering of blood takes place where?

In the glomerulus

Fresh-frozen plasma (FFP)

Increase clotting factor levels

Potassium Supplements

Indications: -treatment or prevention of potassium depletion when dietary means are inadequate -stop irregular heartbeats Teaching: -oral forms should be taken with 4-8oz of cold water and taken with food -extended release tablet can be broke in half or absorbed in water Contraindications: -patient taking ACE inhibitors (can cause hyperkalemia) Adverse effects: -diarrhea, nausea, vomiting, GI bleeding, ulceration

What foods are high in potassium?

Leafy greens, beans, nuts, dairy foods, and starchy vegetables like winter squash are rich sources. -Dried fruits (raisins, apricots) -Beans, lentils. -Potatoes. -Winter squash -Spinach, broccoli. -Beet greens. -Avocado. -Bananas. -Oranges -Tomatoes

20% to 25% of sodium is reabsorbed here through active chloride reabsorption.

Loop of Henle (ascending)

Name 3 interventions a nurse will complete for a client with Furosemide?

-assess for edema -monitor blood pressure -monitor labs

Beta-Adrenergic Agonist Responses

-bronchial, gastrointestinal (GI), and uterine smooth muscle relaxation -cardiac stimulation

Calcium Channel Blockers

-cause coronary artery vasodilation -cause peripheral arterial vasodilation, thus decreasing systemic vascular resistance -reduce the workload of the heart -dysrhythmias: depression of the automaticity of and conduction through the sinoatrial and AV nodes

Hypokalemia causes

-corticosteroids -laxative misuse -thiazide and loop diuretics -diarrhea/vomiting

What medical conditions do diuretics assist with treatment?

-hypertension -heart failure -edema -liver and renal disease

What do diuretics do?

-increase in urine output -help pull fluid off -lower BP

Stimulation of beta 1 adrenergic receptors in the heart

-increased force of contraction -increased heart rate -increased conduction through AV node

Heart Failure Definition

-Complex syndrome resulting from any functional or structural impairment to the heart, specifically ejection of blood or ventricular filling -The heart is unable t pump blood in sufficient amounts from the ventricles to meet the body's metabolic needs

Bile Acid Sequestrants

-Considered second line choice after statins to lower LDL -May be used along with statins -Prevent resorption of bile acids from small intestine -Bile acids are necessary for absorption of cholesterol -Overdose can cause obstruction because the bile acid sequestrants are not absorbed -Treatment of overdose includes restoring gut motility

What foods are high in calcium?

-Dairy products. Products like milk, yogurt, and cheese are rich in calcium and also tend to be the best absorbed sources of it. -Soybeans -Dark green, leafy vegetables -Canned Salmon -Figs -Flour Tortillas -Canned baked beans

You are going to administer 10 mEq of diluted Potassium Chloride over an hour to a patient. What would you want to do before administering and what would you inform you patient of?

-Dilute your solution before giving it -Check potassium levels/Check vitals -Monitor for pain and swelling at injection site -Flush the IV if they have been complaining about it -Tell patient that it is an irritating solution -Tell patient to report if heart is beating fast or if they have chest pain

7 Main Drugs to Treat Hypertension

-Diuretics -Adrenergic drugs (alpha & beta blockers) -Vasodilators -Angiotensin-converting enzyme (ACE) inhibitors -Angiotensin II receptor blockers (ARBs) -Calcium channel blockers (CCBs) -Direct renin inhibitors

Diuretics Overview

-Diuretics are classified according to their sites of action within the nephron, their chemical structure, and diuretic potency. -Treat hypertension and heart failure -Arteriole dilation -Reduce extracellular volume, plasma volume, & cardiac output

What would you do if you were scheduled to administer Spironolactone and saw the client's potassium lab result come back at 5.6 mEq/L?

-Do not give medication -Assess the patient -Call the provider

Examples of Adrenergic Agonists

-Dopamine -Epinephrine -Norepinephrine -Phenylephrine -Dobutamine

Antilipemic Drugs

-Drugs used to lower lipid levels or fat in the body and blood -Used as an adjunct to diet therapy

Which labs would the nurse monitor for with diuretics?

-Electrolytes (potassium and sodium) -Blood sugar (glucose) with thiazides

Unknown cause of hypertension

-Essential, idiopathic, or primary hypertension -90% of cases

Role of Kidneys

-Filters toxic waste products and conserves essential substances -This balance is maintained by the nephron

Statin Indications:

-First line drug therapy for hypercholesterolemia -Reduces LDL levels by up to 50% -Increases HDL levels by 2% to 15% -Reduces triglycerides by 10% to 30%

Potassium Chloride (IV Potassium)

-High-alert medication -Can cause deadly effects on the heart -Should ALWAYS be diluted -NEVER to be given as an IV push or bolus infusion cuz cardiac arrest can occur -Should not be given more than 10mEq/hr when not on a cardiac monitor -Can be given 20mEq/hr when on a cardiac monitor -Monitor IV site, pain at injection site, and phlebitis (inflammation of vein)

ACE Inhibitors: Indications

-Hypertension -HF -Slow progression of left ventricular hypertrophy after myocardial infarction (MI) -Renal protective effects in patients with diabetes

HMG-CoA Reductase Inhibitors (Statins): Mechanism of Action

-Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol -Lower the rate of cholesterol production

Thiazide and Thiazide-Like Diuretics: Mechanism of Action

-Inhibit tubular resorption of sodium, chloride, and potassium ions -Action primarily in the distal convoluted tubule -Result: water, sodium, and chloride are excreted -Potassium is also excreted to a lesser extent -Dilate the arterioles by direct relaxation -Thiazides should not be used if creatinine clearance is less than 30 to 50 ml/min (normal is 125ml/min)

Diuretic Nursing Implications

-Instruct patients to take in the morning, change positions slowly, monitor weight. -Patients taking diuretics along with a digitalis preparation should be taught to monitor for digitalis toxicity. -Patients with diabetes mellitus who are taking thiazide or loop diuretics should be told to monitor blood glucose and watch for elevated levels. -Instruct patients to notify their PCP if they experience rapid heart rates of syncope (reflects hypotension or fluid loss) Monitor for therapeutic effects: -reduction of edema -reduction of fluid volume overload -improvement in manifestations of HF -reduction of hypertension -return to normal intraocular pressures

Types of Anemia

-Iron-deficiency anemia -Thalassemia (genetic) -Sickle cell anemia

Atherosclerotic Plaque Formation

-Lipids and lipoproteins from atherosclerotic plaque leading to development of Coronary Heart Disease -When serum cholesterol levels are elevated, circulating monocytes adhere to smooth endothelial surfaces of coronary vasculature, leading to atherosclerosis

Diuretic Types

-Loop diuretics -Osmotic diuretics -Potassium sparing diuretics -Thiazide and thiazide like diuretics

Examples of Cardioselective Beta Blockers:

-Metoprolol -Atenolol

Statin Adverse Effects:

-Mild, gastrointestinal (GI) disturbances -Headache -Elevations in liver enzymes or liver disease -Myopathy (muscle pain), possibly leading to the serious condition rhabdomyolysis (breakdown of muscle protein; damaging the kidneys)

Anticoagulants

-also known an anti thrombotic drugs -have no direct effect on a blood clot that is already formed -prevent intravascular thrombosis by decreasing blood coagulability, esp with: MI, unstable angina, atrial fibrillation, indwelling devices, such as mechanical heart vales, major orthopedic surgery -used prophylactically to prevent: clot formation and an embolus

Antihypertensives: Nursing Implications

-Monitor BP during therapy; instruct patients to keep a journal of regular BP checks -Instruct patients that these drugs should not be stopped abruptly because this may cause a rebound hypertensive crisis and perhaps lead to stroke -Oral forms should be given with meals so that absorption is more gradual and effective -Remind patients that this medications is only part of therapy. Encourage patients to watch their diet, stress level, weight, and alcohol intake. Encourage exercise. -Instruct patients to avoid smoking and eating foods high in sodium. -Teach patients to change positions slowly to avoid syncope from postural hypotension. -Instruct patients to report unusual shortness of breath; difficulty breathing; swelling of the feet, ankles, face, or around the eyes; weight gain or loss; chest pain; palpitations; and excessive fatigue. -Male patients who take these drugs may not be aware that impotence is an expected effect, and this may influence compliance with drug therapy. -Hot tubs, showers, or baths; hot weather; prolonged sitting or standing; physical exercise; and alcohol ingestion may aggravate low BP, leading to fainting and injury; patients should sit or lie down until symptoms subside.

Examples of crystalloids

-Normal saline (0.9% sodium chloride) -Half NS (0.45% sodium chloride) -Hypertonic saline (3% sodium chloride) -Lactated Ringer's solution -Dextrose 5% in water (D5W) -Dextrose 5% in Normal Saline (D5 NS)

Statin Interactions:

-Oral anticoagulants -Grapefruit juice

Loop Diuretics: Mechanism of Action

-Possess renal, cardiovascular, and metabolic effects -Dilate blood vessels and reduce peripheral vascular resistance -Act directly on the ascending limb of the loop of Henle to inhibit chloride and sodium resorption -Useful treatment of edema

Loop Diuretics: Drug Effects

-Potent/rapid diuresis and subsequent loss of fluid -The more sodium and water they inhibit for resorption, the greater the amount of diuresis and greater the potency -Decreased fluid volume, causing a reduction in BP and vascular resistance -Potassium and sodium depletion (hypokalemia & hyponatremia) Indications: -Edema associated with HF, liver, or renal disease; hypertension, hypercalcemia

Osmotic Diuretics

-Produce rapid diuresis (inhibit tubular resorption of water and solutes) -Reduces intracranial pressure of intraocular pressure by drawing fluid back into the vascular and extravascular space -NOT used for peripheral edema because it doesn't excrete enough sodium (only slight loss in electrolytes)

Colloids

-Protein substances that move fluid from interstitial compartment to plasma compartment by pulling fluid into the blood vessels -Maintain plasma volume for longer than crystalloids and less likely to cause edema; though much more expensive -Indications: when patient requires plasma volume expansion Primary use: as fluid replacement with hypovolemic shock from hemorrhage, surgery, severe burns Contradictions: hypervolemia, hypertension

Mechanism of Action of Cardioselective beta blockers:

-Reduce SNS stimulation of the heart -Slows conduction through AV node -Decreases myocardial oxygen demand -Decrease heart rate

Renal Protective Effects of the ACE Inhibitors

-Reduce glomerular filtration pressure -Decrease proteinuria -Cardiovascular drugs of choice for patients with diabetes -Standard therapy for diabetic patients to prevent progression of diabetic nephropathy

Angiotensin-Converting Enzyme (ACE) Inhibitors

-Reduce production of angiotensin II by blocking the conversion of angiotensin I to angiotensin II, resulting in: vasodilation and excretion of sodium and water and retention of potassium -Large group of safe and effective drugs -Often used as first-line drugs for HF and hypertension -May be combined with thiazide and diuretic or calcium channel blocker

Adrenergic-Blocking Drugs: Nursing Implications

-Remember that alpha blockers may cause hypotension -Remember that some beta blockers may cause bradycardia, hypotension, heart block, heart failure, and bronchoconstriction -Teach patients to change positions slowly to prevent or minimize postural hypotension -Instruct patients to avoid caffeine (excessive irritability) -Instruct patients that these medications should never be stopped abruptly (stopping beta blockers abruptly can cause rebound hypertension or chest pain) -Monitor for therapeutic effects (decreased chest pain in patients with angina and return to normal BP and heart rate)

Known cause of hypertension

-Secondary hypertension -10% of cases

Most potent LDL reducers (Statins)

-Simvastatin (Zocur) -Atorvastatin (Lipitor) -Rosuvastatin (Crestor) -Lovastatin (Mevacor)

What food are high in sodium?

-Smoked, cured, salted or canned meat, fish or poultry including bacon, cold cuts, ham -Frozen breaded meats and dinners, such as burritos and pizza -Canned entrees, such as ravioli, spam and chili -Salted nuts -Beans canned with salt added

Crystalloids

-Solutions containing fluid and electrolytes that are normally found in the body -Better for treating dehydration rather than expanding plasma volume -Do NOT contain proteins (colloids) -Safe and effective means of replacing fluid

Indications for Alpha Blockers:

-Used to control and prevent hypertension -Raynaud's disease

Stimulation of alpha-adrenergic receptors on smooth muscles

-Vasoconstriction of blood vessels -Relaxation of GI smooth muscles (decreased motility) -Constriction of bladder sphincter -Contraction of pupillary muscles of the eye (dilated pupils)

When does the nurse hold metoprolol and notify the provider?

-When the patient notices low BP (<100/60) -When the nurse sees a heart rate of less than 60

What foods are high in magnesium?

-Whole grains and dark-green, leafy vegetables -Low-fat milk and yogurt -Dried beans and legumes (such as soybeans, baked beans, and peanuts) and nuts (such as almonds and cashews) provide magnesium.

Potassium-Sparing Diuretics

-Work in collecting ducts and distal convoluted tubules -Block the action of aldosterone (sodium and water retention), which results in potassium retention and excretion of sodium and water -Used in combination with other diuretics for potassium sparing effects when treating hypertension and edema

Digoxin adverse effects:

-low potassium levels increase its toxicity -electrolyte levels must be monitored -poor renal function increases toxicity eyes: visual changes-yellow/green halo around objects, flickering lights cardio: dysrhythmias, bradycardia, tachycardia gastrointestinal: anorexia, nausea, vomiting, diarrhea CNS: headache, fatigue, malaise, confusion, convulsions

Cardiac Glycosides

-one of the oldest groups of cardiac drugs -no longer used as first line treatment -originally obtained from digitalis plant, foxglove -used in HF and atrial fibrillation -digoxin is the prototype

Blood products

-only class of fluids that are able to carry oxygen -increase tissue oxygenation -most expensive and least available fluid because they require human donors -increase peripheral volume -increase colloid osmotic pressure and plasma volume -pull fluid from extravascular space into intravascular space (plasma expanders) -red blood cell products also carry oxygen -increase body's supply of various products (clotting factors, hemoglobin)

Hyperkalemia causes

-potassium supplements -ACE inhibitors -potassium-sparing diuretics -renal failure -infections

Cardioprotective Effects of Ace Inhibitors

-reduce BP by decreasing SVR -drug choice for hypertensive patients with HF -Prevent sodium and water resorption -Diuresis: decreases blood volume and return to the heart -Used to prevent complications after MI

Alpha-Adrenergic Agonist Responses

-vasoconstriction -CNS stimulation

"quarter normal" saline

0.25%

"half normal" saline

0.45%

Digoxin drug levels

0.5-2 ng/mL very narrow therapeutic window

AntiXa normal range

0.6-1

normal concentration of sodium chloride (isotonic) and is referred to as "NS"

0.9%

Each kidney has how many nephrons?

1 million

Normal specific gravity

1.005-1.030

Normal magnesium levels

1.2-2.5 mEq/L

Normal triglyceride level

10-150mg/dL

Potassium Chloride 20 mEq is to used as an IV additive. How many mL would the RN draw up from the current vial? Could this be pushed if it was not added to an IV solution?

10ml/ No it cannot be pushed and need to be diluted.

PT normal range

11-13 seconds

Life span of red blood cells

120 days

Normal sodium levels

135-145 mEq/L

hypertonic saline percentage

3% or 5%

Normal potassium level

3.5-5.0 mEq/L

Beta Blockers: Adverse Effects

4 Bs: -Bradycardia -Blood pressure (low) -Bronchoconstriction -Blood sugar Others: -Withdrawal- must be stopped slowly or angina or rebound HTN can occur -dry mouth -drowsiness -constipation -impotence -depression -edema -headache

What is edema? What does it mean to be 1+, 2+, 3+, 4+, and weeping?

4+ edema is the worst Wheezing is when clear liquid oozes out

Normal High-density lipoprotein (HDL)

40-60mg/dL

Normal protein level

6-8 or 6.5-8.5

What percent of the human body is water?

60%

Normal Low-density lipoprotein (LDL)

70-130mg/dL

Normal calcium levels

9-11 mg/dL

Normal chloride levels

95-105 mEq/L

Normal total cholesterol level

<200 mg/dL

The patient is being discharged home with furosemide (Lasix). When providing discharge teaching, which instruction will the nurse include? A.Avoid prolonged exposure to the sun. B.Avoid foods high in potassium content. C.Stop taking the medication if you feel dizzy. D.Weigh yourself once a week and report a gain or loss of more than 1 pound.

A

Which of the following lab values is most closely monitored while on heparin? a) aPTT b) PT c) INR d) Platelets

A

Which of the following should the nurse include when providing dietary teaching for the patient receiving warfarin (Coumadin) therapy? A.Avoid eating large amounts of food high in Vitamin K. B.Cranberry juice will provide you with needed nutrients while taking Coumadin. C.You must never eat spinach. D.You can only eat lettuce once a month.

A

The nurse caring for a patient who is receiving a beta 1-agonist drug therapy needs to be aware that these drugs cause which effect? Select all that apply. a)Increased cardiac contractility b)Mydriasis (dilation of pupil) c)Increased heart rate d)Vasoconstriction e)Increased GI tract motility

A and C

The patient presents to the clinic with suspected digoxin toxicity. Which of the following assessment findings would be consistent with this diagnosis? SATA A. Anorexia B. Yellow halos around lights C. Vomiting D. Jaundice E. Irregular heartbeat

A, B, C, E

What blood type is the universal recipient?

AB positive

If a diabetic patient has hypertension which class of antihypertensives would be the best choice and why?

ACE inhibitors because of renal protective properties.

Risk Factors for Hypertension:

Age Weight Diet Exercise Genetics Gender Smoking, alcohol, drugs Race

Antidysrhythmic Drugs

Amiodarone: -one of the most effective drugs for controlling supraventricular and ventricular dsyrhthmias Adenosine: -given for supra ventricular tachycardia (HR 160-200) -commonly causes asystole (flatline) for seconds before reducing HR -half life is 10 seconds- given as fast IV push

Iron

Anemia Drug Uses: prevention and treatment of iron-deficiency syndromes -Administration of iron alleviates the symptoms of iron-deficiency anemia, but the underlying cause of the anemia should be corrected Adverse effects: N/V/D, constipation, stomach cramps/pain, black tarry stools Routes: oral iron preparation are available as ferrous salt; parenteral route

Cyanocobalamin (Vitamin B12)

Anemia Drug Uses: vitamin B12 deficiency, pernicious anemia, megaloblastic anemias Routes: oral, intranasal, IM

Epoetin alfa

Anemia drugs Erythropoiesis-Stimulating Agent Uses: anemia with end stage renal disease, chemo-induced anemia Contraindications: HTN and Hgb levels greater than 10-11 due to risk for thrombosis Adverse effects: hypertension, fever, headache, arthralgia, and infection site reaction Route: IV or Subcutaneous injection only

Beta Blockers: Indications

Angina- decreases demand for myocardial oxygen Cardioprotective- inhibits stimulation from circulating catecholamines and is used in patients who have had a MI to protect heart Dysrhythmias- slows conduction & allows ventricles time to fill Antihypertensive- ability to reduce SNS stimulation of the heart, reducing heart rate and force of myocardial contraction Heart Failure Migraine Glaucoma (topical use)

When administering a loop diuretic to a patient, it is most important for the nurse to determine if the patient is also taking which drug? A.Lithium (Eskalith) B.Acetaminophen (Tylenol) C.Penicillin D.Theophylline

Answer: A Use of loop diuretics with lithium can increase the risk of lithium toxicity.

A nurse is preparing to transfuse a unit of packed red blood cells (PRBCs) to a patient who has severe anemia. Which of the following interventions can prevent an acute hemolytic reaction? A) Ensure the client has a patent IV before obtaining the blood product B) Obtain help from another nurse to confirm the correct client and blood product C) Take a complete set of vital signs before beginning transfusion and periodically during the infusion D) Stay with the client for the first 15 to 30 minutes of the transfusion

Answer: B

A patient is hypokalemic and will be receiving IV potassium. The patient is not on a heart monitor. How should the nurse administer the potassium replacement? A.IV push B.No more than 10 mEq/hour C.No more than 20 mEq/hour D.40 mEq/hour

Answer: B

While assessing the patient, the nurse notes edema of the hands and feet at 3+ from third spacing. The patient is having signs and symptoms of intravascular dehydration, and the total protein laboratory result is 4.6 g/dL. The nurse anticipates the health care provider will prescribe which IV solution for this patient? a)Whole blood b) 5% albumin c) Normal saline d) Lactated Ringer's solution

Answer: B

While preparing an infusion of mannitol (Osmitrol), the nurse notices small crystals in the IV tubing. What is the most appropriate action by the nurse? A.Administer the infusion slowly. B.Discard the solution and obtain another bag of medication. C.Obtain a filter and then infuse the solution. D.Return the fluid to the IV bag to dissolve the crystals.

Answer: B

A patient who is severely anemic also has acute heart failure with severe edema due to fluid overload. The prescriber wants to raise the patient's hemoglobin and hematocrit levels. The nurse anticipates that the patient will receive which blood product? a)Fresh frozen plasma b) Albumin c) Packed red blood cells d) Whole blood

Answer: C

The nurse starts an intravenous line to administer fluids in a patient who has fluid volume deficit. The order states, "3% sodium chloride to infuse at 100 mL/hour." The client's most recent serum sodium level is 135 mEq/L (135 mmol/L). What action should the nurse take? a)Hang sodium chloride 0.9% injection at 100 mL/hour. b)Begin infusing 3% sodium chloride injection at a keep-vein-open rate. c)Start the 3% sodium chloride injection as ordered. d)Notify the HCP and obtain an order for appropriate IV fluids.

Answer: D

Inhibit the action or formation of clotting factors Prevent clot formation

Anticoagulants

Aminocaproic acid (Amicar)

Antifibrinolytic drug Prevents and controls excessive bleeding that results from surgery or overactivity of fibrinolytic system Oral or parenteral

Promot blood coagulation

Antifibrinolytic or hemostatic drugs

Inhibit platelet aggregation Prevent platelet plugs

Antiplatelet drugs

Clopidogrel (Plavix)

Antiplatelet-prevents platelet adhesion Increase risk for GI bleeds

Chronic stable angina (classic or effort angina)

Atherosclerosis (thickening/hardening of arteries) is primary cause Triggered by exertion, stress, cold (caffeine, alcohol, and tobacco use can also exacerbate) Is relieved with rest

A patient is in the emergency department with an unspecified supraventricular dysrhythmia. The physician orders a dose of diltiazem (Cardizem) IV push. While the nurse administers the medication through the IV lock, the patient says she feels something wet spilling on her arm. Her heart rate was unchanged. What will the nurse do next? A.Assess the patient for diaphoresis. B.Check the IV lock to see if it is functioning properly. C.Repeat the dose of diltiazem (Cardizem). D.Restart the IV in another location.

B

A patient is mowing his lawn on a hot Saturday afternoon. He begins to notice chest pain. What should his first action be? A.Take his nitroglycerin tablet. B.Stop mowing and sit or lie down. C.Go inside the house to cool off and get a drink of water. D.Call 911.

B

A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. What is the nurses' best response? A."The medication is better absorbed at this time." B."This timeframe correlates better with the natural diurnal rhythm of cholesterol production." C."There will be fewer adverse effects if taken at night instead of with the morning meal." D."This timing reduces the incidence of myopathy."

B

Nursing considerations for conversion of IV heparin to oral warfarin (Coumadin) therapy will include A.immediate discontinuation of IV heparin and administration of oral warfarin (Coumadin) therapy only. B.overlapping therapy of IV heparin and warfarin are for at least 5 days. C.monitoring the INR and stopping the IV heparin when the INR is 1.0.

B

The nurse is obtaining a medication history on a patient presenting with chest pain. What drug classification would necessitate the nurse informing the provider before beginning the prescribed nitroglycerin? A.Proton pump inhibitor B.Phosphodiesterase inhibitors (erectile dysfunction medications) C.Inhaled beta blocker D.Aspirin

B

The nurse knows that the adverse effects of a nonselective beta blocker are likely to be the most immediately life threatening in which patient? A.Patient with type I diabetes B.Patient with asthma C.Patient with gastroesophageal reflux disease D.Patient with hypertension

B

When administering an alpha blocker for the first time, it is most important for the nurse to assess the patient for the development of what adverse effect? A.Renal failure B.Hypotension C.Blood dyscrasia D.Dysrhythmias

B

What education should you provide to the patient before administering a blood product?

Benefits and risks of transfusion, nurse must get consent from patient

What class of antihypertensives would we want to avoid in diabetics and why?

Beta Blockers because they mask hypoglycemia symptoms

Antianginal Beta Blockers

Block beta1 receptors on the heart Decrease heart rate, resulting in decreased myocardial oxygen demand and increased oxygen delivery to the heart Decrease myocardial contractility, helping to conserve energy or decrease demand •After an MI, a high level of circulating catecholamines irritates the heart, causing an imbalance in supply and demand ratio and even leading to life-threatening dysrhythmias. •Beta blockers block the harmful effects of catecholamines, thus improving survival after an MI. •Examples: Atenolol, Metoprolol, Propranolol, Nadolol

Does metoprolol affect BP, HR, or both?

Both

A 72-year-old woman is taking an over-the-counter multivitamin that contains ginkgo. Her physician has recommended that she start taking low-dose aspirin therapy as part of her treatment for transient ischemic attacks. What is the concern with taking these two drugs together? A.Increased risk of gastric ulcer B.Decreased action of the aspirin because of the interaction with the ginkgo C.Increased risk of bleeding because of the ginkgo D.Antagonism of the action of the aspirin because of the multivitamins

C

A 75-year-old man fell at home and hit his head against a table. His wife reports to their daughter that he does not have cuts or scratches, but there is a small lump on his upper scalp. She does not see any blood. He is taking warfarin and an antidysrhythmic as part of his treatment for chronic atrial fibrillation. What is the main concern at this time? A.Pressure should be applied to the lump for 3 to 5 minutes. B.He will need to take two doses of warfarin tonight to prevent blood clotting. C.He needs to be examined for possible internal bleeding from the fall. D.As long as there is no bleeding, there is no concern.

C

A patient asks how to apply transdermal nitroglycerin. What is the nurse's best response? a)"Always apply the transdermal patch over the area of your chest where your heart is." b)"Keep the previous patch on for 1 full day so you always have two patches on at a time." c)"Apply the patch to hairless areas of the body." d)"First apply petroleum jelly to your body; then apply the transdermal patch."

C

A patient has been ordered the powdered form of the bile acid sequestrate colestipol. Which of the following does the nurse identify as true? a)The nurse should have the patient swallow the dose of the colestipol powder one teaspoonful at a time. b)The powder should be dissolved and immediately administered. c)The colestipol should be administered 1 hour before or 4 to 6 hours after any other oral medication. d)The colestipol should be administered with meals.

C

A patient is receiving an IV infusion of heparin and was started on warfarin therapy the night before. Which statement is most correct? A.The patient is receiving a double dose of anticoagulants. B.The heparin therapy was ineffective, so the warfarin was started. C.The heparin provides anticoagulation until therapeutic levels of warfarin are reached. D.The heparin and warfarin work together synergistically to provide anticoagulation.

C

A patient is receiving digoxin 0.25mg/day as part of treatment for HF. The nurse assesses the patient before medication administration. Which assessment finding would be most of concern? A.Apical heart rate of 58 beats/min B. Ankle edema +1 bilaterally C. Serum potassium level of 2.9 mEq/L D. Serum digoxin level of 0.8 ng/mL

C

A patient with a known history of angina was walking his dog and developed chest pain. The patient immediately stops walking and sits down. He continues to experience chest pain when sitting down. When should he call 911? A.Immediately B.If the pain becomes more severe C.If one sublingual tablet does not relieve the pain after 5 minutes D.If the pain is not relieved after three sublingual tablets, taken 5 minutes apart

C

A patient with type 2 diabetes is taking a beta blocker as part of treatment for hypertension. The nurse needs to monitor for which potential complication? A.Dehydration B.Hyperkalemia C.Hypoglycemia D.Angina

C

To assess for a potentially serious adverse effect to HMG-CoA reductase inhibitors, the nurse should monitor which laboratory results? a)Serum electrolytes b) Urine specific gravity c) Liver function studies d) Complete blood count

C

Which is the most common electrolyte finding resulting from the administration of furosemide (Lasix)? A.Hypocalcemia B.Hypophosphatemia C.Hypokalemia D.Hypomagnesemia

C

Which statement about ARBs does the nurse identify as being true? A.Hyperkalemia is more likely to occur than when using ACE inhibitors. B.Cough is more likely to occur than when using ACE inhibitors. C.Chest pain is a common adverse effect. D.Overdose is usually manifested by hypertension and bradycardia.

C

Adverse effects of Crystalloids:

Can leak out of plasma into tissues and cause edema

Clonidine (Catapres)

Centrally Acting Adrenergic Drug Uses: hypertension, opioid withdrawal Routes: oral and patch Adverse effects: orthostatic hypotension, fatigue, dizziness Nursing considerations: do not stop abruptly (rebound HTN may occur)

Angina Pectoris

Chest Pain -when the supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart, the heart muscle "aches" Angina could potentially cause MI

Captopril (Capoten)

Class: ACE inhibitor Uses: HTN, heart failure -Improves patient's chance of survival after an MI and reduces incidence of HF -Taken 3 or 4 times a day for short half-life -SEROUS adverse effect: Neutropenia (may need to monitor CBC for 3 months) -Contraindications: Pregnancy and lactation, hyperkalemia; not as effective in African Americans

Enalapril (Vasotec)

Class: ACE inhibitor Uses: Heart failure and HTN -Improves patients chance of survival after an MI Contraindications: pregnancy, lactation, hyperkalemia; not as effective in African Americans -If patient is also taking potassium-sparing diuretics, it is especially important to monitor potassium -Only ACE inhibitor available in both oral and parenteral preparations

Losartan (Cozaar)

Class: ARB Uses: hypertension and HF Adverse effects: chest pain, fatigue, weakness, anemia, hypoglycemia, diarrhea, UTI, hyperkalemia Contradictions: pregnancy and lactation; caution with renal or hepatic impairment

Dopamine

Class: Adrenergic Agonist Low dosages: can dilate blood vessels in the brain, heart, kidneys, and mesentery, which increases blood flow to these areas Higher infusion rates: improve cardiac contractility and out put Highest doses: vasoconstriction -Given an continuous IV infusion -Assess site frequently & use large vein to reduce extravasation, which can cause tissue necrosis -If extravasation occurs, administer phentolamine to counter act.

Spironolactone (Aldactone)

Class: potassium sparing diuretic Uses: edema, hypertension, HF, ascites, hyperaldosteronism Route: oral form only Adverse effects: dizziness, headache, urinary frequency, weakness, hyperkalemia, abdominal cramping, nausea, diarrhea, irregular menses, gynecomastia Contraindications: hyperkalemia, renal failure, anuria (zero urine output-complete renal failure) Interactions: ACE inhibitors (hyperkalemia), lithium (toxicity)

Hydrocholorothiazide (Microzide) aka HCTZ

Class: thiazide diuretic Uses: hypertension, edema Adverse effects: hypokalemia, hyponatremia, hyperglycemia, dizziness (common from fluid shift), headache, decreased libido, impotence (erectile dysfunction) Contraindications: severe renal failure Teaching: change positions slowly, encourage potassium-rich food

Hydralazine (Apresoline)

Class: vasodilator, anti-hypertensive Routes: oral for routine cases of essential hypertension and injectable for hypertensive emergencies Adverse effects: dizziness, headache, orthostatic hypotension, anxiety, tachycardia, edema, dyspnea; uncommon: systemic lupus erythematosus

Final pathway of nephron structure

Collecting duct

Symptoms of severe hyponatremia

Confusion, lethargy (lack of energy)

What might cause fluid volume excess?

Congestive heart failure, renal failure, cirrhosis (liver failure)

Hypertension is a major risk factor for what two diseases?

Coronary Artery Disease (CAD) and Cardiovascular Disease (CVD)

A patient has received an IV dose of adenosine, and almost immediately the heart monitor shows asystole. What should the nurse do next? A.Check the patient's pulse. B.Prepare to administer cardiopulmonary resuscitation. C.Set up for defibrillation. D.Continue to monitor the patient.

D

A patient is in the emergency department with new-onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect? A.Digoxin 0.25 mg PO daily B.Digoxin 1 mg PO now; then 0.25 mg PO daily C.Digoxin 0.5 mg IV push daily D.Digoxin 1 mg IV push now; then 0.25 mg IV daily

D

A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her physician has never told her that she has hypertension. What is the best explanation for this order? A.The doctor knows best. B.The patient is confused. C.This medication has cardioprotective properties. D.This medication has a protective effect on the kidneys for patients with diabetes.

D

A patient with extremely high blood pressure (BP) is in the emergency department. The physician will order therapy with nitroglycerin to manage the patient's BP. Which form of nitroglycerin is most appropriate? A.Sublingual spray B.Transdermal patch C.Oral capsule D.IV infusion

D

The nurse is administering morning medications to a client admitted with heart failure. The medications due at this time are metoprolol and digoxin. The vital signs for this client are: ■BP 105/70, HR 96 and irregular, RR 18, O2 sat 95% RA, and Temp. 99.1 F ■What nursing intervention is appropriate at this time? ■ A. Hold the metoprolol but administer the digoxin. B. Hold the digoxin but administer the metoprolol. C. Hold both medications and notify the provider. D. Administer both medications and obtain vital signs in one hour.

D

The patient accidentally takes too much of the prescribed warfarin (Coumadin) and is readmitted to the hospital with bleeding. Which drug can the nurse anticipates administrating? A.Protamine sulfate B.Alteplase (Activase, Cathflo Activase) C.Reteplase (Retavase) D.Vitamin K

D

When converting from IV heparin to oral warfarin (Coumadin) therapy, the prescriber monitors which of the following to determine the next appropriate dose of warfarin? A.Platelet levels B.aPTT C.Red blood cell count D.PT/INR

D

Will potassium increase or decrease with the administration of Furosemide?

Decrease

What labs would you look at for fluid volume excess?

Decreased specific gravity, decreased hemoglobin and hematocrit

Nitroglycerin

MOA: dilate blood vessels (esp. coronary arteries) Uses: angina treatment (rapid acting) or angina prevention (long acting) Adverse effects: headache, postural hypotension, reflex tachycardia, and tolerance Interactions: CCBs, beta blockers (add to hypotension) Contraindications: hypotension and use erectile dysfunction drugs Teaching: change positions slowly

Warfarin (Coumadin)

MOA: inhibits production of vitamin K dependent clothing factors, which prevents clot formation Uses: clot prevention (esp in those with A. Fib or prosthetic valve), MI Adverse effects: bleeding, muscle pain, purple toe syndrome Interaction: MANY! Amiodarone, sulfonamide antibiotics, fluconazole Strongly contraindicated during pregnancy Antidote: Vitamin K Eat a consistent diet with leafy greens Monitor PT and INR labs

What medications are given immediately for an MI?

MONA -Morphine -Oxygen -Nitroglycerin -Aspirin

Hyperkalmia

Manifestations: muscle weakness, parethesia, paralysis, cardiac rhythm irregularities (leading to possible ventricular fibrillation and cardiac arrest) Treatment of severe: -IV calcium gluconate, sodium bicarbonate, dextrose with insulin -Causes a rapid intracellular shift of potassium ions, reducing the serum potassium level -Often followed by administration of oral or rectal Sodium polystyrene sulfonate (Kayexalate)

Beta blockers used for HF:

Metoprolol Carvedilol

Hemoglobin

More than 1/3 of a RBC is made of hemoglobin Heme: red pigment, contains iron Globin: protein chain

Myocardial Infarction (MI)

Necrosis, or death, of cardiac tissue Disabling or fatal

Diuretics exert their effect in the ?

Nephron

Isosorbide dinitrate

Nitrate Uses: Angina Rapid acting and long-acting forms available

What solution can blood products be hung with?

Normal saline (0.9%)

What blood type is the universal donor?

O negative

Iron: Administration Considerations

Oral Administration •Liquid oral preparations may stain teeth; take liquid iron preparations through a straw to avoid •For liquid iron preparations, follow the manufacturer's guidelines on dilution and administration. •Oral forms of iron should be taken between meals for maximum absorption •Oral forms should be given with juice but not with milk or antacids •Patients should remain upright for 15 to 30 minutes after oral iron doses to avoid esophageal irritation Injectable forms cause pain upon injection •Administer deeply into a large muscle mass using the Z-track method.

Foods that enhance iron absorption

Orange juice Fish DO NOT take iron with milk.

Increases heart rate

Positive Chronotropic drugs

Accelerate cardiac conduction

Positive Dromotropic Drugs

Increase the force of myocardial contraction. Increases heart contraction and makes the heart stronger.

Positive Inotropic Drugs

Drug Therapy for HF

Positive inotropic drugs (increase contraction force) Cardiac glycosides ACE inhibitors Angiotensin receptor blockers (ARBs) Beta blockers Diuretics

Angiotensin II Receptor Blockers (ARBs)

Potent vasodilators that decrease after load Uses: HF or HTN (alone or in combination with other drugs such as diuretics) Examples: Valsartan, Losartan

Returns 60% to 70% of sodium and water from the filtered fluid back to the bloodstream. Passive reabsorption of chloride and water.

Proximal convoluted tubule (proximal tubule)

Whole blood

Same as for PRBCs, except that whole blood is more beneficial in cases of extreme (greater than 25%) loss of blood volume because whole blood also contains plasma Contains plasma proteins, which help draw fluid back into blood vessels from surrounding tissues

vasospastic angina

Spasms in smooth muscle of heart Often occurs at rest with no cause, but often follows a pattern (same time of day)

Rapid onset Nitroglycerin

Sublingual tabs (under the tongue) -must be in original container; exposure to light and moisture can inactivate Aerosal spray IV (continuous)

Symptoms of Hypertension:

Tachycardia Headache Dizziness Blurry vision

Excess dietary potassium is excreted via what?

The kidneys - impaired kidney function lead to higher serum levels, possibly toxicity

Packed red blood cells (PRBCs)

To increase oxygen-carrying capacity in patients with anemia, in patients with substantial hemoglobin deficits, and in patients who have lost up to 25% of their total blood volume

Long acting Nitroglycerin

Topical -patches: remove at night to decrease tolerance -ointment: use paper to apply Oral -large first pass effect; much is taken in by the liver before it can help; is not near as effective

How many nurses need to administer blood products?

Two

Alteplase

Uses: MI, DVT, PE, Ischemic stroke, thrombosis, occlusion of shunts or central lines Admin: should be given within 3-4hrs of symptom onset (get baseline labs, weight, and diagnostics prior to admin); head CT done prior Adverse effects: bleeding, nausea, vomiting, hypotension, cardiac dysrhythmias Considerations: short half life of 5 mins

Heparin

Uses: clot prevention (DVT prophylaxis) and treatment; central line catheter maintenance Routes: subcutaenous and IV Adverse effects: bleeding, easier bruising, heparin induced thrombocytopenia (HIT) Contraindications: acute bleeding, indwelling epidural catheter Interactions: Aspirin, NSAIDS Antidote: Protamine Sulfate

Sodium Polystyrene Sulfonate (Kayexalate)

Uses: to treat hyperkalemia Routes: oral, nasogastric tube, or as enema -Works in intestine -Closely monitor electrolytes Adverse effects: -Electrolyte imbalances (hypernatremia, hypokalemia, hypocalcemia, hypomagnesia) -Nausea & vomiting -Serious GI events (bleeding, perforation) Contraindications: do not give to patients who do not have normal bowel function

located primarily in the heart

beta 1 adrenergic receptors

located in smooth muscle of the bronchioles, arterioles, and visceral organs

beta 2 adrenergic receptors

Diltiazem (Cardizem)

calcium channel blocker MOA: blocking of calcium channel in vessels (vasodilation) Uses: Angina, HTN Adverse effects: -hypotension -peripheral edema -constipation Other: Amlodipine

What S/S would you see in someone experiencing fluid volume deficit?

dehydration, dizziness, hypotension, high heart rate, dry mucous membranes, dry skin, increased skin turgor, low urine output

Thrombolytic Drugs

drugs that break down, or lyse, clots reastablish blood flow to the heart muscle via coronary arteries, preventing tissue destruction Current drugs: Alteplase and Reteplase

Common symptoms of HF

dyspnea fatigue fluid retention and pulmonary edema

Deep Vein Trombosis (DVT)

embolus goes to a vein in the leg

Pulmonary emboli

embolus in the pulmonary circulation

Myocardial infarction (MI)

embolus lodges in coronary artery

Stroke

embolus obstructs a brain vessel

another name for red blood cells

erythrocytes

Metoprolol succinate:

extended release, usually ordered once daily

Hematopoiesis

formation of new blood cells -red blood cells (RBCs) -white blood cells (WBCs) -platelets

Platelets

help with blood clotting

Coagulation

hemostasis that occurs because of the physiologic clotting of blood

How would you know someone has fluid volume excess?

high blood pressure, increased heart rate

Cause water to move out of the cells and can cause cells to shrink

hypertonic solutions

cause water to move into the cells, which can cause them to burst

hypotonic solutions

Metoprolol tartrate:

immediate release, usually ordered twice daily

Total body water is composed of:

intracellular and extracellular fluid

Cause no net fluid movement

isotonic solutions

Cryoprecipitate

management of acute bleeding

Fibrinolysis

mechanism by which formed thrombi are lysed to prevent excessive clot formation and blood vessel blockage

dabigatran, rivaroxaban, apixaban

newer anticoagulants that inhibit thrombin and prevents clot formation no monitoring required with these medications

Is Carvedilol selective or non selective?

non selective

INR normal range

normal is 1 2-3 is therapeutic range

What symptoms of hyperkalemia do you educate your patient to watch for?

palpitations, chest pain, muscle weakness, SOB

Antidote for dopamine

phentolamie (Regitine)

ACE Inhibitors

prevent sodium and water resorption by inhibiting aldosterone secretion -diuresis results, which decreases preload and the work of the heart Uses: hypertension, HF, and acute MI Adverse effects: dry cough, hyperkalemia Examples: lisinopril, elanapril, captopril

Where are RBCs produced?

produced in bone marrow

Left sided HF symptoms

pulmonary edema, coughing, SOB, dyspnea

Beta blockers Intended Effects:

reduce heart rate, myocardial contractility

Immature red blood cells are called

reticulocytes

Is Metoprolol selective or non-selective?

selective

measures concentration of urine

specific gravity- the greater the number the more dehydrated you might be

Right sided HF symptoms

systemic venous congestion, pedal edema, jugular venous distension, ascites, and hepatic congestion

Thrombus

technical term for a blood clot

Lyse (break down) existing clots

thrombolytic drugs

Embolus

thrombus that moves through blood vessels

Anemias

underlying causes of anemia are red blood cell (RBC) maturation defects and factors secondary to excessive RBC destruction

What might cause fluid volume deficit?

vomiting, excessive sweating, diarrhea, excessive bleeding

Antiplatelet drugs

work to prevent platelet adhesion at the site of blood vessel injury platelets normally flow through blood vessels without adhering to their surfaces

Nursing Implications for Angina

•Nitroglycerin •Instruct patients in proper technique and guidelines for taking sublingual nitroglycerin for anginal pain. •Never chew or swallow the sublingual form. •A burning sensation felt with sublingual forms indicates that the drug is still potent. •Keep a fresh supply of sublingual medication on hand; potency is lost in about 3 months after the bottle has been opened. •Medications should be stored in an airtight, dark glass bottle with a metal cap and no cotton filler. •Instruct on proper application of nitrate topical ointments and transdermal forms, including site rotation and removal of old medication. •To reduce tolerance, the patient may be instructed to remove topical forms at bedtime and apply new doses in the morning, allowing for a nitrate-free period. •Instruct patients to take as-needed nitrates at the first hint of anginal pain. •Monitor vital signs frequently during acute exacerbations of angina and during IV administration. •If experiencing chest pain, the patient taking sublingual nitroglycerin should lie down to prevent or decrease dizziness and fainting that may occur because of hypotension.

Nursing Implications for Beta Blockers

•Patients taking beta blockers should monitor their pulse rates daily and report any rate lower than 60 beats/min or symptoms of relative bradycardia. •Instruct patients to report dizziness or fainting. •Inform patients that these medications should never be abruptly discontinued. •Inform patients that these medications are for long-term prevention of angina, not for immediate relief.

HF Drugs: Nursing Implications

■Assess clinical parameters, including: -BP -Apical pulse for 1 full minute ■Hold dose/notify provider if pulse less than 60 or greater than 100 -Heart sounds, breath sounds -Weight, input, and output measures -Electrocardiogram -Serum labs: potassium, sodium, magnesium, calcium, renal, and liver function studies ■Hold dose and notify prescriber if the patient experiences signs or symptoms of toxicity. -Anorexia, nausea, vomiting, diarrhea -Visual disturbances (blurred vision, seeing green or yellow halos around objects) ■Monitor for therapeutic effects: -Increased urinary output -Decreased edema, shortness of breath, dyspnea, crackles, fatigue -Improved peripheral pulses, skin color, temperature

ACE Inhibitors: Adverse Effects

■Dry, nonproductive cough (which reverses when discontinued) ■First dose hypotension ■Hyperkalemia ■Fatigue ■Dizziness ■Headache ■Mood changes ■Impaired taste

Angiotensin II Receptor Blockers (ARBs)

■MOA: Block the action of Angiotensin II, resulting in: -Vasodilation -Excretion of sodium and water (decrease release of aldosterone) ■End in "Sartan" ■Difference: ARBs block the actions of angiotensin II and ACE inhibitors block the formation of angiotensin II -don't cause dry cough