Cardiac- pharmacology

A client with hypertension is prescribed an angiotensin II receptor blocker (ARB). Which instruction will the nurse provide about this medication? Select all that apply. One, some, or all responses may be correct. 1. Monitor the blood pressure often." 2. "Discontinue treatment if a cough develops." 3. "Stop the medication if swelling of the mouth, lips, or face develops." 4. "Have blood drawn for potassium levels 2 weeks after starting the medication." 5. "Do not take nonsteroidal anti-inflammatory drugs (NSAIDs) concurrently with this medication." 6. "Notify other prescribers of new ARB prescription." 7."Report lightheadedness or dizziness upon standing to the provider." 8. "Serum levels will be drawn at least once a month to ensure therapeutic levels."

1, 3 , 4, 6, 7 The risk for hypotension is increased with ARB use, therefore the client should be educated on the signs and symptoms of a low blood pressure and the need to monitor blood pressure often. The medication should be stopped if angioedema occurs, and the health care provider should be notified. Electrolyte levels of potassium, sodium, and chloride should be obtained 2 weeks after the start of therapy and then periodically thereafter. ARBs may increase the effects of other medications such as antihypertensives and lithium, dosages may need to be adjusted accordingly. A dry cough may occur during treatment with ARBs; however, it is not necessary to discontinue the medication because the cough usually resolves. There is no need to avoid the use of NSAIDs while taking an ARB. Serum levels are not monitored with ARB use

A health care provider prescribes aspirin therapy for a client with arthritis. The nurse will advise the client to report which adverse effect immediately? Select all that apply. One, some, or all responses may be correct 1. Ongoing nausea 2. Diarrhea 3. Easy bruising 4. Decreased pulse 5. Sour stomach 6. Ringing in the ears 7. Trouble sleeping 8. Dry mouth

1-3, 6 Aspirin is a gastrointestinal irritant that can cause nausea, vomiting, and gastrointestinal bleeding. Salicylates can irritate gastric mucous membranes, leading to diarrhea. Salicylates decrease platelet aggregation, resulting in easy bruising and gastrointestinal bleeding. Tinnitus and hearing loss can occur as a result of the effects of the medication on the eighth cranial nerve. Salicylates may increase, not decrease, the heart rate. A sour stomach, trouble sleeping, and dry mouth are all known side effects of aspirin that do not require immediate medical attention

Digoxin is prescribed for a client with heart failure. The nurse will assess for which clinical manifestation that indicates digoxin toxicity? Select all that apply. One, some, or all responses may be correct 1. Headache 2. Nausea 3. Yellow vision 4. Dizziness 5. Irregular pulse 6. Increased urine output 7. Decreased respiratory rate

1-5 Signs and symptoms of digoxin toxicity include confusion, headache, nausea, bradycardia, visual disturbances (blurred vision or yellow vision), and dizziness. In addition, electrocardiogram (ECG) findings may include heart block, atrial tachycardia with block, or ventricular dysrhythmias, all causing an irregular pulse. Increased urine output is an expected effect of improved cardiac output. Changes in respiratory rate, slow or fast, are not associated with digoxin toxicity.

A client receiving morphine is being monitored by the nurse for adverse effects of the medication. Which clinical finding warrants immediate action by the nurse? Select all that apply. One, some, or all responses may be correct 1. Polyuria 2. Unconsciousness 3. Bradycardia 4. Dilated pupils 5. Bradypnea 6. Hypertension 7. Yawning 8. Lacrimation

2, 3, 5 the effect of morphine, if severe, can cause unconsciousness. The CNS depressant effect of morphine causes bradycardia and bradypnea. Morphine does not increase urine output. Morphine causes constriction of pupils. Along with bradycardia, morphine is associated with hypotension, not hypertension. Yawning, lacrimation, and rhinorrhea are symptoms associated with withdrawal from morphine or other opioids.

Nitroglycerin

Brand name: Nitrostat Class: Nitrates, antianginals Used for: angina, heart failure, MI MOA: dilates cornonary arteries improving flow to ischemic regions. Causes vasodilation. Therapeutic effects: decrease angina, increased cardiac output, decrease BP Contraindicated in: -Increased intracranial pressure -severe anemia - Pregnancy/lactation

A client receiving chemotherapy develops bone marrow suppression. The nurse will monitor for which thrombocytopenic effect? Select all that apply. One, some, or all responses may be correct 1. Fatigue 2. Pale skin 3. Deep vein thrombosis 4. Dizziness 5. Melena 6. Purpura 7. Emboli 8. Hematuria

5, 6, 8 Bone marrow suppression results in a reduced number of circulating white and red blood cells, as well as platelets. Black tarry feces caused by the action of intestinal secretions on blood are associated with bleeding in the gastrointestinal tract; bleeding is related to a reduced number of thrombocytes, which are part of the coagulation process. Hemorrhages into the skin and mucous membranes (purpura) may occur with reduced numbers of thrombocytes, which are part of the coagulation process. Blood in the urine (hematuria) may occur with a reduced number of thrombocytes, which are part of the coagulation process. Signs of reduced red blood cells, not platelets, include fatigue, pale skin, and dizziness. Deep vein thrombosis and emboli are effects of thrombocytosis

statin medication

A therapeutic response to statin medication includes a decrease in a clients LDL cholesterol, Total cholesterol, and triglyceride levels to within normal range. An increase in HDL cholesterol to within normal range is also an expected outcome Examples: Simvastatin, pravastatin

Lisinopril

ACE inhibitor, antihypertensive Brand names: Prinivil, Zestril, Qbrelis Used with other medication to manage hypertension and heart failure Therapeutic Effects: Lowers BP, decrease Symptoms pts with HF, increase survival after MI Contraindicated in: - hypersensitivity -pregnancy -Lactation -family history of angioedema Adverse Reactions/Side Effects: Hypotension Hyperkalemia angioedema dizziness, cough erectile dysfunctions, impaired renal functions Teaching: take lisinopril at the same time each day even if you are feeling better. If you miss a dose take as soon as possible. Do NOT double doses. Don't discontinue until you talk to a health care professional. Avoid salt and potassium in foods. Immediately notify healthcare profession if you have a rash, mouth sores, sore throat, fever, swelling of hands or feet, irregular heart beat, chest pain, dry cough, hoarseness, swelling of faces, eyes, lips or tongue, or if difficulty swallowing or breathing occurs.

Heparin

Anticoagulant, antithrombotics Therapeutic effect: prevention of thrombus formation, prevention of extension of existing thrombi. Contraindicated in: Uncontrolled bleeding history of heparin- induced thrombocytopenia pedi: avoid use of products containing benzyl alcohol in premature infants Adverse Reactions/Side Effects: Bleeding heparin induced thrombocytopenia anemia osteoporosis alopecia drug induced hepatitis Watch for signs of bleeding/bruising!! antidote: protamine sulfate

ARBs

Block angiotensin-2 type 1 receptors (AT1 receptor) Decrease BP via arteriolar and venous dilation Block aldosterone secretion (decreased Na2+ and H2O retention) Does NOT increase Bradykinin levels Decrease diabetic nephrotoxicity Metabolized and excreted in the liver. Side effects: Hypotension, acute renal failure, hyperkalemia, problems during pregnancy, dizziness, weakness, syncope, headache, cold, or flu like symptoms. Dont use with ACE inhibitors Used for hypertension, diabetic nephropathy, decreace of stroke in pts with hypertension and left ventricular hypertrophy.

Beta Blockers

Block sympathetic influence on the heart (esp B1 selective), reducing CO and thus BP; also block renin release, stopping RAAS system medications end in -lol Beta adrenergic antagonist Usually given in a low dose, slows the heart rate down, decreases heart rate contractility, causes bronchoconstrictions Use in caution of heartfailure and asthma patients. Should not be stopped abruptly, causes rebound effect, dysrhythmia, tachycardia Used for: Migraines, heartfailure, hypertension, glaucoma, anxiety, heart attack, cardia arrhythmias.

Atenolol

Brand name: Tenormin Class: Beta blocker Antihypertensive, antianginals Theraputic Effect: Decrease heart rate and BP, Prevention of MI, decrease frequency of attacks of angina Contraindicated in: - Uncompensated HF -Pulmonary edema -Cariogenic shock -bradycardia or heart block Metabolized and excreted by the liver Adverse reactions: - Arrhythmias -Bradycardia -heartfailure -pulmonary edema -anaphylaxis Toxicity and overdose: Monitor patients receiving beta blockers for sings of over dose (bradycardia, severe dizziness or fainting, severe drowsiness, dyspnea, bluish fingernails or palms, seizures) notify HCP immediately. Teaching: how to measure pulse and BP. report significant changes may increase sensitivity to cold if slow pulse, difficulty breathing, wheezing, cold hands and feed, dizziness, light headedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs call HCP.

Valsartan

Brand Name: Diovan Therapeutic Class: Angiotensin receptor blocker (ARB) Most Common Use: High blood pressure or heart failure treatment Contraindicated in: - Diabetes or moderate to severe renal impairment -pregnancy, may cause fetal harm -Lactation Adverse Reactions/Side Effects: Most common-dizziness Other AR/SE: Edema Hypotenstion pharyngitis, rhinitis, sinusitis Impaired renal functions Arthralgia Angioedema

Digoxin

Brand Name: Lanoxin, Toloxin Therapeutic Class: Cardiac glycoside antiarrhythmics, inotropics Most Common Use: Heart failure, atrial fibrillation MOA: targets heat, digoxin inhibits the potassium/sodium pump, which increase the intracellular sodium concentration, decreased the cytoplasmic potassium and calcium, and promotes myocardial contractility. Therapeutic Effects: Increased cardiac output(positive inotropic effect) and slowing of the heart rate (negative chronotropic effect) Digoxin levels: -Heart failure 0.5-0.9 -atrial fibrillation 0.5-2 Contraindicated in: uncontrolled ventricular arrhythmias AV block idiopathic hypertrophic subaortic stenosis constrictive pericarditis known alcohol intolerance(elixir only) This is a high alert medication, have to give appropriate dose or can cause harmful effects. Don't prescribe with calcium channels May have Visual disturbances, bright yellow, orange ting, hallucinations, halos ALWAYS get an apical pulse, if pt is at home have them do a radial pulse. Both must be done for 1 minute. Antidote: digoxine immune Fab Toxicity and Overdose: Therapeutic serum digoxin levels range from 0.5-2ng/ml. Serum levels are usually drawn before giving the next dose. Older adults are at increased risk for toxic effects due to age related decreased renal clearance. S/S of toxicity: abdominal pain, N/V, anorexia, visual disturbances, bradycardia, and other arrhythmias.

Spironolactone

Brand name: Aldactone class: Potassium Sparing Diuretic, aldosterone antagonist. Used for: Heartfailure, Hypertension, Edema also can be used for: acne, hormone therapy for transgender females(male to female) common ADR: hyperkalemia, gynecomastia, stevens johnson syndrome, epidermal necrolysis precautions: Do not use in pregnancy

Losartan

Brand name: Cozaar Class: Angiotensin II Receptor Blocker (ARB) Therapeutic Effects: Lower BP, decrease progression of diabetic nephropathy, decrease incidence of strokes Contraindicated: - pregnancy -Lactaction -renal artery stenosis -hypersensitivity Adverse Reactions/Side Effects: Most common- diarrhea Other AR/SE: hypotension edema hypoglycemia nasal congestion hyperkalemia myalgia angioedema fever Teaching: avoid high levels of salt and potassium in foods. avoid sudden changed in position to decrease orthostatic hypotention Discontinue losartan, after talking with a health care provider, when pregnancy is detected. notify HCP if swelling of ace, eyes, lips, or tongue or if difficulty swallowing or breathing occur.

Hydrochlorothiazide (HCTZ)

Brand name: Microzide, Urozide Class: Diuretics, Antihypertensives Used for: -Managing hypertension - edema associated with, HF, renal dysfunction, cirrhosis, glucocorticoid therapy, and estrogen therapy. Therapeutic effect: Lowers BP in hypertensive patients and diuresis with mobilization of edema Adverse reactions: -skin cancer - stevens johnson syndrome -pancreatitis -hypokalemia -hyperglycemia Monitor I/O and daily weights. Stop treatment if a rash is found, can be life threatening, steven johnson syndrome

Aspirin

Brand names: Bayer aspirin, Ecotrin... Class: Antiplatelet agents, Salicylates MOA: produces analgesia and reduces inflammation and fever by inhibiting the production of prostaglandins. Also decreases platelet aggregation Therapeutic effect: -decrease pain -reduce inflammation -reduce fever -decrease incidence of transient ischemic attacks, and MI Used for: -Rheumatoid arthritis, Osteoarthritis -mild-moderate pain -fever -Prophylaxis of transient ischemic attacks and MI Contraindicated in: - pregnancy >30 wks gestation -Pediatrics( reyes syndrome) -Bleeding disorders Adverse reactions: - GI bleeding - DRESS(drug reaction with eosinophilia and systemic symptoms) -Hypersensitivity reactions (anaphylaxis, laryngeal edema)

Morphine

Brand names: MS contin, Morphine HP or LP, Avinza.... Class: Opioid analgesics, opioid agonists Used for: - severe pain, around the clock pain - pulmonary edema - pain associated with MI Therapeutic effects: decrease heart workload, decrease pain. MOA: binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression. Route: PO, IM, Subq, rectal, IV, epidural Use caution in: - Increased intracranial pressure -head trauma -geriatrics, increase risk of respiratory depression

Pharmotherapeutics

How drugs prevent, treat, and diagnose diseases

Hydrophillic drugs

Move through active transport -kidney function important - lower distribution -Kidneys to clear/metabolize -highly charged

Atorvastin

Trade name: Lipitor Therapeutic effects: lows total and LDL cholesterol and slightly increases HDL cholesterol. This decreases the risk of MI and strokes. Contraindicated in: Preganancy Lactation Active liver disease or unexplained persistent elevations in AST and ALT Adverse Reactions/Side Effects: rash, rhabdomyolysis, hypersensitivity reaction, hyperglycemia, amnesia, bronchitis Teaching: notify HCP if unexplained muscle pain, tenderness, or weakness, especially if accompanied by fever or malaise, or signs and symptoms of liver injury (fatigue, anorexia, right upper abdominal discomfort, dark urine, jaundice)

Calcium Channel Blockers

agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation medications end in: -dipine, -zem, -amil Used for: "CHASMA" -Cerebral vasospasm/CHF - Hypertension -Angina -Supra-ventricular tachyarrhythmia -Migraines -Atrial flutter fibrillation African americans and older population, need a combination medication with this medication. Don't mix with grapefruit

Diuretics MOA

decrease sodium reabsorption and therefore decreased fluid reabsorption; this directly causes decreased levels of circulating sodium Hydrophillic Shorterm Monitor for falls Most of these medicines help your kidneys release more sodium into your urine. The sodium helps remove water from your blood, decreasing the amount of fluid flowing through your veins and arteries. This reduces blood pressure

Lipophillic drugs

more readily absorbed, better distributed, must be metabolized before elimination -liver -not charged

Anti-platelet medications

reduce ability of blood platelets to clot examples: Aspirin, Plavix, Brilinta

Anticoagulant medication

reduce clot formation and increase blood flow examples: Heparin, lovenox, coumadin, eliquis, Xarelto antidotes: Andexanet alfa

ACE inhibitors

reduce production of angiotensin, causing vasodilation, excretion of sodium and water, retention of K Metabolized and excreted in the Kidneys Monitor BUN lab values. Medications end in -pril Used often with HCTZ antihypertensive medications Hydrophilic medications Side effects: "CAPTOPRIL" C -cough(persistent dry cough) A- allergic reactions P- Potassium elevation/proteinuria T- Taste Change O- Oedema/angioedema P- photosensitivity R- renal failure I- indigestion L- low blood pressure

Thrombolytics

to convert plasminogen to plasmin, which digests fibrin and dissolves clots. Medications end in -ase Use cautiously because of possible severe bleeding

Pharmokinetics

what the body does to the drug

Pharmodynamics

what the drug does to the body