PHARM EXAM
hydrochlorothiazide effects what labs
MAY INCREASE: SERUM GLUCOSE, CHOLESTEROL, BILIRUBIN, TRIGLYERIDE, AND CALCIUM LEVELS. MAY DECREASE: SERUM MAGNESIUM, POTASSIUM, SODIUM LEVELS
mixing dig with other meds causes what
MIXING WITH DIURETICS CAN CAUSE HYPOKALEMIA AND INCREASE RISK OF DYSRHYTHMIAS. USE WITH ACE INHIBITORS (SPIRONOLACTONE OR POTASSIUM SUPPLEMENTS) CAN LEAD TO HYPERKALEMIA AND DECREASED THERAPEUTIC ACTION OF DIGOXIN MIXING WITH OTHER INOTROPIC DRUGS CAN CAUSE ADDITIVE BRADYCARDIA. ANTACIDS AND CHOLESTEROL-LOWERING DRUGS CAN DECREASE THE ABSORPTION OF DIGOXIN IF CALCIUM IS ADMINISTERED IV WITH DIGOXIN, IT CAN INCREASE RISK OF DYSRHYTHMIAS. QUINIDINE, VERAPAMIL, AMIODARONE, AND ALPRAZOLAM WILL DECREASE THE DISTRIBUTION AND EXCRETION OF DIGOXIN, THUS INCREASING THE RISK OF DIGOXIN TOXICITY
Hyperkalemia
dysrhythmias, heart block, muscle twitching, fatigue, paresthesias, dyspnea, cramping, and diarrhea. A potassium level greater than 5 mEq/L
nursing interventions and teaching r/t propranolol
-ABRUBT DISTONTINUATION MAY CAUSE MI, SEVERE HTN, AND VENTRICULAR DYSRHYTHMIAS. -SWALLOW EXTENDED RELEASE TABS WHOLE- DO NOT CRUSH OR CHEW CONTENTS. - IF PULSE IS LESS THAN 60 BPM, NOTIFY THE HEALTHCARE PROVIDER -DIMINISHED LIBIDO AND IMPOTENCE MAY RESULT IN NON-ADHERENCE -USE CAUTIOUSLY IN PTS WITH DIABETES -DO NOT DOUBLE DOSE IF MISSED DOSE, CALL DOC IF MISSED MORE THAN 1 DAY DUE TO ILLNESS -ADOPT A HEALTHY LIFESTYLE, LOWFAT CHOICES, INCREASED EXERCISE, DECREASE CAFFEINE AND ALCOHOL CONSUMPTION AND SMOKING CESSATION. -TAKE PERIPHERAL PULSE FOR 1 FULL MINUTE -BE CAUTIOUS OF ORTHOSTATIC HYPOTENSION - IMMEDIATELY REPORT SHORTNESS OF BREATH, FROTHY SPUTUM, PROFOUND FATIGUE, SWELLING OF EXTREMETIES (THESE EFFECTS MAY INDICATE HF OR PULMONARY TOXICITY) -REPORT WEIGHT GAIN > 1KG IN 24 HR -REPORT VISION CHANGES PROMPTLY - WEAR PROTECTIVE CLOTHING AND APPLY SUNSCREEN OUTSIDE
ALBUTEROL
-BRONCHODILATOR -BETA2-ADRENERGIC AGONIST -SHORT ACTING USED TO RELIEVE THE BRONCHOSPASM OF ASTHMA -WHEN INHALED 15-3O MIN PRIOR TO PHYSICAL ACTIVITY IT CAN PREVENT EXERCISE-INDUCED ASTHMA SERIOUS ADVERSE EFFECTS ARE UNCOMMON BUT: PALPATIONS, HEADACHES, THROAT IRRITATION, TREMOR, NERCOUSNESS, RESTLESSNESS, TACHYCARDIA. INSOMNIA, DR MOUTH, CHEST PAIN. PARADOXICAL BRONCHOSPASM AND ALLERGIC REACTIONS UNCOMMON. -PATIENTS SHOULD AVOID MAOI'S WITHIN 14 DAYS OF BEGINNING THERAPY.
K-dur
used to treat low amounts of potassium in the blood do not lie down 10 minutes after taking Generic Name Potassium Chloride Trade Name K-Dur Classification Mineral/electrolyte Replacement/Supplement Action Maintain acid-base, electrolyte and isotonic balance with in cell Route/Dose PO IV Indications (use) Tx of potassium depletion-hypokalemia Adverse Reactions Arrhythmias, abd pain, diarrhea, N/V Contraindications Hyperkalemia, severe renal impairment Interactions Potassium-sparring diuretics, ACE inhibitors, Angiotensin II receptor antagonists Nursing Implications Monitor BP, P, ECG, monitor for sx of hyperkalemia, monitor potassium serum levels
retavase administration
"DISSOLVES BLOOD CLOTS. THROMBOLYTIC" RECONSTITUTE DRUG IMMEDIATELY PRIOR TO USE WITH DILUTENT PROVIDED BY MANUFACTURER. SWIRL, DO NOT MIX OR SHAKE!!! DO NOT GIVE ANY OTHER DRUG SIMULTANEOUSLY THROUGH THE SAME IV LINE! RETEPLASE AND HEPARIN ARE INCOMPATIBLE AND SHOULD NEVERRRRR BE COMBINED IN THE SAME SOLUTION SHOULD BE GIVEN AS SOON AS POSSIBLE AFTER THE ONSET OF MI SYMPTOMS: ADMINISTERED BY IV BOLUS AND USUALLY ACTS WITHIN 20 MINUTES. A SECOND BOLUS MAY BE INJECTED AFTER THE FIRST , IF NEEDED TO CLEAR THROMBUS. AFTER CLOT IS RESOLVED, THERAPY W/HEPARIN OR ALTERNATIVE ANTICOAGULANT IS STARTED TO PREVENT FUTURE THROMBIS.
Adverse effects of amiodarone and how to treat them
(it"s an antidysrhythmic) THE MOST SERIOUS EFFECT IS PULMONARY TOXICITY. MAY CAUSE BLURRED VISION, RASH, PHOTOSENSITIVITY, NAUSEA, VOMITING, ANOREXIA, FATIGUE, DIZZINESS, AND HYPOTENSION. -MAY PRODUCE NEW DYSRHYTHMIAS OR WORSEN EXISTING ONES, BRADYCARDIA, PNEUMONIA-LIKE SYNDROME!!!, -ADVERSE EFFECTS MAY BE SLOW TO RESOLVE! take peripheral pulse for 1 full minute before admin. drug. notify healthcare provider if hr is outside of 60-100 bpm notify healthcare provider is bp is 90/60 or below weigh self daily. report weight gain of 1 kg in a 24 hour period for overdose: treat with vasopressors, atropine, isoproternol
How do you administer digoxin?
- TAKE THE APICAL PULSE FOR 1 FULL MINUTE NOTING RHYTHM, RATE, AND QUALITY. - IF PULSE IS BELOW 60 BPM, HOLD THE DRUG AND NOTIFY THE PROVIDER. - DURING DIGITALIZATION, MONITOR EKG - CHECK FOR RECENT SERUM DIGOXIN LEVELS BEFORE ADMINISTERING -DIGITALIZATION CAN BE ACCOMPLISHED RAPIDLY WITH IV DOSE
DRUG-DRUG INTERACTIONS FOR LASIX
-COMBINATION THERAPY WITH DIGOXIN MUST BE CAREFULLY MONITORED BECAUSE HYPOKALEMA CAN CAUSE DYSRHYTHMIAS IN PATIENTS TAKING CARDIAC GLYCOSIDES -Concurrent use with CORTICOSTEROIDS, AMPHOTERICIN B, OR OTHER POTASSIUM DEPLETING DRUGS, can result in hypokalemia -When givin with LITHIUM, elimination of lithium is decreased, causing a higher risk of toxicity. -furosemide may diminish the hypoglycemic effects of sulfonylureas and insulin.
HERBAL/FOOD LASIX
-HAWTHORN can result in additive hypotensive effect -GINSENG may decrease the effectiveness of loop diuretics -high SODIUM intake can reduce the effectiveness of diuretics.
Contraindications of Lasix:
-Hypersensitivity to furosemide or sulfonamides -anuria -hepatic coma -severe fluid or electrolyte depletion
nursing interventions for milrinone
-MONITOR POTASSIUM, BP, AND EKG BECAUSE LOW POTASSIUM CAUSES HYPOKALEMIA, AND HYPOKALEMIA CAUSES DYSRHYTHMIAS.
Adverse effects of Lasix:
-Potential electrolyte imbalances, most importantly HYPOKALEMIA -Fluid loss must be monitored to prevent DEHYDRATION AND HYPOTENSION -ORTHOSTATIC HYPOTENSION -SYNCOPE -OTOTOXICITY is rare but may result in PERMANENT HEARING DEFICIT
Dig levels
0.5-2.0 is therapeutic range
what do you do to the patient when giving potassium IV
1. When giving IV potassium must be administered slowly, since bolus injections can overload the heart and cause cardiac arrest. 2. Avoid extravasation and infiltration 3. NEVER administer IV push or in concentrated amounts, and do NOT exceed an IV rate of 1omEq/h 4. Check BP 5. Check HR for 1 full minute 6. You have to give it diluted with something else. Can not be given alone. 7. Double check dose before administration 8.
16. What is the primary action of an antitussive? a. Suppress the cough reflex b. Dry bronchial secretions c. Block histamine release d. Reduce the viscosity of bronchial secretions
A
20. A patient taking aminoglycosides should be monitored for: a. Nephrotoxicity b. Pulmonary toxicity c. Hypertension d. Dysrhythmias
A
22. The client has been prescribed oxymetazoline (Afrin) nasal spray for seasonal rhinitis. The nurse will provide which of the following instructions? a. Limit use of this spray to 5 days or less b. The drug may be sedating so be cautious with activities requiring alertness c. The drug should not be used in conjunction with antihistamines d. This is an OTC drug and may be used as needed for congestion.
A
23. A 65-year-old client is prescribed ipratropium (Atrovent) for the treatment of asthma. Which of the following conditions should be reported to the health care provider before giving this client the ipratropium? a. A reported allergy to peanuts b. A history of intolerance to albuterol (Proventil, VoSpire) c. A history of bronchospasms d. A reported allergy to chocolate
A
3)A pt has been prescribed Spironolactone, the nurse knows the teaching has been effective when the pt A) I will not experience the greatest effect for 3 days B) I can continue this med through my pregnancy C) I should not take this at night before bed D) No worries! I have palpations,but this is normal
A
A pt is prescribed HCTZ for hypertension. The nurse should instruct the patient to avoid what herb that can cause high BP? A) Gingko Biloba B) Kova Kova C) Folic Acid D) Ginseng
A
9. The nurse evaluates the effectiveness of dopamine therapy for a client in shock. Which of the following may indicate treatment is successful? (Select all that apply). a. Improved urine output b. Increased blood pressure c. Breath sounds are diminished d. Slight hypotension occurs e. Peripheral pulses are intact
A, B
The nurse suspects the pt is experiencing adverse effects of Nifedipine when she states she has the following symptoms (select all that apply) A) Flushing B) Headache C) Dizziness D) Abdominal Discomfort E) Itching Feet
A, B, C
2. Which of the following assessment findings in a client who is receiving atenolol (Tenormin) for angina would be cause for the nurse to hold the drug and contact the provider? a. Heart rate of 50 beats/minute b. Heart rate of 124 beats/minute c. Blood pressure 86/56 d. Blood pressure 156/88 e. Tinnitus and vertigo
A, C
24. A client is receiving treatment for asthma with albuterol (Proventil, VoSpire). The nurse teaches the client that while serious adverse effects are uncommon, the following may occur. (Select all that apply) a. Tachycardia b. Sedation c. Temporary dyspnea d. Nervousness e. Headache
A, D, E
how fast does lasix work
IV: STARTS IN 5 MINUTES PO: 30-60 MINUTE ONSET
what are signs of dig toxicity
ABDOMINAL PAIN, ANOREXIA, NAUSEA, VOMITING, BRADYCARDIA, VISUAL DISTURBANCES, DYSRHTHMIAS
allergic rhinitis and its treatment
ALLERGIC RHINITIS- OR HAYFEVER, IS INFLAMMATION OF THE NASAL MUCOSA DUE TO EXPOSURE TO ALLERGENS. ALTHOUGH NOT LIFE THREATENING, IT'S A CONDITION AFFECTING MILLIONS OF PATIENTS. PHARMOCOTHERAPY IS USUALLY NECCESSARY TO CONTROL SYMPTOMS AND TO PREVENT SECONDARY COMPLICATIONS PREVENTERS ARE USED FOR PROPHYLAXIS AND INCLUDE ANTIHISTAMINES, INTRANASAL CORTICOSTEROIDS, AND MAST CELL INHIBITORS RELIEVERS ARE USED TO PROVIDE IMMEDIATE, THOUGH TEMPORARY, RELIEF FOR ACUTE ALLERGY SYMPTOMS ONCE THEY HAVE OCCURED. RELIEVERS INCLUDE THE ORAL AND NASAL DECONGESTANTS, USUALLY DRUGS FROM THE SYMPOTHETIC CLASS. ANTIHISTAMINES BLOCK THE ACTIONS OF HISTAMINE AT THE H1 RECEPTOR. THEY ARE WIDELY USED OTC.
doxazosin is a
ALPHA-ADRENERGIC BLOCKER DRUG FOR HTN AND BPH BLOCKS SYMPATHETIC RECEPTORS
contraindications for hydralazine
ANGINA, MI, TACHYCARDIA, LUPUS!! This drug will worsen lupus symptoms, RHEUMATIC HEART DISEASE
accolate
ANTIINFLAMMATORY DRUG FOR ASTHMA/LEUKOTRINE MODIFIER -USED FOR PERSISTENT, CHRONIC ASTHMA -PREVENTS AIRWAY EDEMA AND INFLAMMATION BY BLOCKING LEUKOTRINE RECEPTORS IN THE AIRWAY -GIVEN BY ORAL ROUTE -LONG ONSET/1 WEEK -DO NOT USE TO TERMINATE ACUTE ASTHMA ATTACKS! -LESS EFFECTIVE THAN CORTICOSTEROIDS AS ASTHMA PROPHYLAXIS - HEADACHE IS MOST COMMON COMPLAINT AND NAUSEA DIARRHEA ARE REPORTED BY SOME -DON'T TAKE THIS IS YOU HAVE HEPATIC IMPAIRMENT -MAY INCREASE SERUM ALT VALUES -TAKE ON AN EMPTY STOMACH!! -ASPIRIN CAN INCREASE LEVELS OF THIS DRUG -WARAFIN MAY INCREASE PROTHROMBIN TIME
differences between high and low dose dopamine
AT LOW DOSES- THE DRUG SELECTIVELY STIMULATES DOPAMINERGIC RECEPTORS, ESPECIALLY IN THE KIDNEYS, LEADING TO VASODILATION AND INCREASED BLOOD FLOW THROUGH THE KIDNEYS. THIS MAKES DOPAMINE HIGH VALUE IN TREATING HYPOVOLEMIC AND CARDIOGENIC SHOCK. AT HIGH DOSES- DOPAMINE STIMULATES BETA1-ADRENERGIC RECEPTORS, CAUSING THE HEART TO BEAT MORE FORCEFULLY AND INCREASING CARDIAC OUTPUT. ANOTHER BENEFICIAL EFFECT OF DOPAMINE IN HIGHER DOSES IS ITS ABILITY TO STIMULATE ALPHA ADRENERGIC RECEPTORS, THUS CAUSING VASOCONSTRICTION AND RAISING BLOOD PRESSURE.
dextran 40 ACTIONS AND USES:
Action: Raises the osmotic pressure of the blood, thereby causing fluid to move from the interstitial spaces of the tissues to the intravascular space (blood). When given as an IV, it can expand plasma volume within minutes of administration. Increases BP, Increases CO, and improves venous return to the heart Indicated for patients experiencing hypovolemic shock due to hemorrhage, surgery or severe burns. When given for SHOCK, it is infused as rapidly as possible until blood volume is restored. Reduces platelet adhesiveness and improves blood flow through its ability to reduce blood viscosity. USED TO PREVENT DVT (BLOOD CLOTS) AND POSTOPERATIVE PULMONARY EMBOLI
what do you give if you have too much dig on board
Administer digibind
A pt has been prescribed potassium chloride to treat mild alkalosis. What precaution should the nurse use? A) Place the pt is supine position B) Crush tablets to increase absorption C) Be sure not to exceed IV rate of 10 mEq/hr D) Use concentrated form for NG tube administration
C
1. The client is being discharged with nitroglycerin (Nitro-stat) for sublingual use. While planning client education, what instruction will the nurse include? a. "Swallow three tablets immediately for pain and call 911" b. "Put one tablet under your tongue for chest pain. If pain does not subside, you may repeat in 5 minutes, taking no more than three tablets" c. "Call your health care provider when you have chest pain. He will tell you how many tablets to take." d. "Place three tablets under your tongue and call 911"
B
14. The nurse is administering procainamide (Procanbid) for acute tachycardia. The nurse will assess for which unusual adverse effect that can affect 30% to 50% of patients? a. Stevens-Johnson Syndrome b. Lupus c. Lymphoma d. Aplastic anemia
B
4)A pt presents to the hospital with hypotensions and severe fluid and electrolyte loss from an overdose of Lasix. Treatment for the patient would include replacement of fluid/electrolyte balance, and administration of what drug? A) HCTZ B) Vasopressin C) Human Regular Insulin D) Metformin
B
4. Erectile dysfunction drugs such as sildenafil (Viagra) are contraindicated in clients taking nitrates for angina. What is the primary concern with concurrent administration of these drugs? a. They contain nitrates, resulting in overdose. b. They decrease blood pressure and may result in prolonged and severe hypotension when combined with nitrates. c. They will adequately treat the patient's angina as well as erectile dysfunction. d. They will increase the possibility of nitrate tolerance developing and should be avoided unless other drugs can be used.
B
7. The nurse is administering epinephrine: 0.25 mL of 1:1,000, every 10 min. Which of the following should the nurse monitor to prevent overdose from the drug? a. Hypoglycemia b. Hypertension c. Bronchospasm d. Diarrhea
B
A nurse would question an order for Metoprolol in which pt? A) Diabetic pt B) Pt with asthma C) Pt with Hep C D) Pt already taking Lisinopril
B
The nurse is preparing to give the first dose of enalapril (Vasotec). What are potential adverse effects of this medication? (Select all that apply) A) Reflex hypertension B) Hyperkalemia C) Persistent cough D) Angioedema E) Hypotension
B, C, D, E
A client has been admitted for heart failure has been receiving HCTZ . Which lab test should the nurse monitor? (select all that apply) A) Platelet count B) WBC C) Potassium D) Sodium E) Uric Acid
C, D, E
adverse effects of plasbumin
BECAUSE ALBUMIN IS A NATURAL BLOOD PRODUCT, THE PATIENT MAY HAVE ANTIBODIES TO THE DONOR ALBUMIN AND ALLERGIC REACTIONS ARE POSSIBLE. HOWEVER, COAGULATION FACTORS, ANTIBODIES, AND MOST OTHER BLOOD PROTEINS HAVE BEEN REMOVED; THEREFORE, THE INCIDENCE OF ALLERGIC REACTION ISN'T HIGH. SIGNS OF ALLERGY INCLUDE: FEVER, CHILLS, RASH, DYSPNEA, AND POSSIBLY HYPOTENSION. PROTEIN OVERLOAD MAY OCCUR IF EXCESSIVE AMOUNTS OF ALBUMIN ARE INFUSED. INFUSE HIGHER CONCENTRATIONS MORE SLOWLY.
side effects of delsym, afrin, benadryl
BENADRYL- SIGNIF. DROWSINESS, DRY MOUTH, TACHYCARDIA, MILD HYPOTENSION, PHOTOSENSITIVITY DELSYM- EFFECTS ARE RARE BUT: DIZZINESS. DROWSINESS, AND GI UPSET. IN ABUSE SITUATIONS, DRUG CAN CAUSE CNS TOXICITY SLURRED SPEECH, ATAXIA, HYPEREXCITABILITY, STUPOR, RESPIRATORY DEPRESSION, SEIZURES, COMA, AND TOXIC PSYCHOSIS. AFRIN-
beta blockers and sexual dysfunction
BETA BLOCKERS CAN LEAD TO ERECTILE DYSFUNCTION IF HE STOPS TAKING BETA BLOCKER IMMEDIATELY, HE CAN GET DYSRHYTHMIAS
10. A client is receiving PlasmaLyte for treatment of hypovolemic shock. When monitoring for therapeutic effects, which of the following will the nurse expect to occur? a. Breath sounds are clear b. Potassium, glucose, and sodium levels remain within normal range. c. Blood pressure returns to within normal range and urine output increases. d. The pulse rate and ECG return to normal rate and pattern.
C
11. Verapamil (Calan, Covera-HS, Verelan) should be used with extra caution or is contraindicated in clients with which cardiovascular condition? a. Hypertension b. Tachycardia c. Heart Failure d. Angina
C
15. A patient taking sumatriptan (Imitrex) likely suffers from which of the following? a. Sleep disorders b. Seizures c. Migraines d. Schizophrenia
C
19. Patients taking zafirlukast (Accolate) or montelukast (Singulair) should be taught that they will see improvements within what time frame? a. 2 hours b. 2 days c. 1 week d. 1 month
C
2)The client has heart failure and is ordered Lasix. The nurse is aware that furosemide (Lasix) is what kind of drug? A) Thiazide diuretic B) Osmotic diuretic C) Loop Diuretic D) Beta Blocker
C
5. Why is captopril (Capoten) prescribed for patients who have experienced a recent myocardial infarction (MI)? a. To restore blood supply to the damaged myocardium b. To increase myocardial oxygen demand c. To reduce post-MI mortality d. To reduce acute pain associated with MI
C
6. Following an acute MI, metoprolol (Lopressor) is infused slowly until which of the following occurs? a. The clot is dissolved b. Blood pressure falls to 100/70 mmHg c. A target heart rate of 60 to 90 beats per minute is reached d. The pain is relieved
C
8)What should the nurse closely monitor in a patient who is taking Diltiazem , a calcium channel blocker? A) Ototoxicity B) CBC C) BP, I&O, Pulse D) Resp Distress
C
8. Antiplatelet agents are primarily prescribed to do which of the following? a. Lower blood cholesterol b. Dissolve thrombi c. Prevent thrombi from forming d. Prevent migraines
C
how do calcium channel blockers and beta blockers work, who they are contraindicated with, and how/when to administer
CALCIUM CHANNEL BLOCKERS- RELEIVE ANGINA BY DILATING THE CORONARY VESSELS AND REDUCING THE WORKLOAD ON THE HEART. THEY ARE DRUGS OF FIRST CHOICE FOR TREATING VASOSPASTIC ANGINA.
how to admin nasal sprays, inhalers, multiple inhalers
CLEAR NASAL PASSAGES, AND THEN ADMINISTER THE SPRAY. AFTER WAITING A PERIOD OF 5-10 MINUTES, USE ADDITIONAL SPRAY IF ORDERED. ANY EXCESS THAT DRAINS INTO THE MOUTH SHOULD BE SPIT OUT AND NOT SWALLOWED. -LIMIT USE TO 3-5 DAYS UNLESS OTHERWISE ORDERED, TO AVOID REBOUND CONGESTION. -NASAL PASSAGES SHOULD BE CLEARED BY BLOWING, FOLLOWED BY THE NASAL SPRAY WITH INHALERS- SHAKE THE INHALER OR LOAD THE INHALER W/ TAB OR POWDER -IS USING BRONCHODILATOR AND CORTICOSTEROID INHALER, USE BRONCHODILATOR FIRST AND THEN WAIT 5-10 MINUTES BEFORE USING CORTICOSTEROID -RINSE MOUTH AFTER USING INHALER -RINSE INHALER AND SPACER AND ALLOW TO AIR DRY
what do crystalloids do
CRYSTALLOIDS REPLACE LOST FLUIDS AND ELECTROLYTES IV SOLUTIONS THAT CONTAIN ELECTROLYTES RESEMBLING THOSE OF PLASMA. CAN READILY LEAVE THE BLOOD AND ENTER CELLS. USED TO REPLACE FLUIDS AND PROMOTE URINE OUTPUT.
DURING HYPOVOLEMIC SHOCK,
CRYSTALLOIDS REPLACE LOST FLUIDS AND ELECTROLYTES. COLLOIDS EXPAND PLASMA VOLUME AND MAINTAIN BLOOD PRESSURE. WHOLE BLOOD MAY BE INDICATED IN CASES OF MASSIVE HEMORRHAGE
Calcium Channel Blockers Action:
Calcium channel blockers prevent calcium from entering cells of the heart and blood vessel walls, resulting in lower blood pressure. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. Some calcium channel blockers have the added benefit of slowing your heart rate, which can further reduce blood pressure, relieve chest pain (angina) and control an irregular heartbeat.
Lasix administration alerts:
Check the patients serum potassium levels BEFORE administering the drug. If potassium levels are below normal, notify the health care provider. use with caution in premature infants and neonates OLDER ADULTS MAY REQUIRE LOWER DOSES
12. A client with type 1 Diabetes on insulin therapy reports that he takes propranolol (Inderal) for his hypertension. The nurse will teach the client to check glucose levels more frequently because of what concern? a. The propranolol can produce insulin resistance b. The two drugs used together will increase the risk of ketoacidosis c. Propranolol will increase insulin requirements by antagonizing the effects of the receptors , d. The propranolol may mask symptoms of hypoglycemia
D
13. Which of the following is NOT an expected adverse effect in a patient taking propranolol (Inderal)? a. Diminished sex drive b. Hypotension c. Bradycardia d. Tachycardia
D
17. Gingival hyperplasia is a common side effect of which of the following drugs for epilepsy? a. Valproic acid (Depakote) b. Phenobarbital c. Clonazepam (Klonopin) d. Phenytoin (Dilantin)
D
18. The nurse should teach the patient that long-term treatment with oral corticosteroids may cause which serious adverse effect? a. Rebound congestion b. Hypertension c. Cancer d. Adrenal atrophy
D
21. The nurse is teaching a client about the use of dextro-methorphan with guaifenesin (Robitussin-DM) syrup for a cough accompanied by thick mucus. Which instruction should be included in the client's teaching? a. "Lie supine for 30 minutes after taking the liquid" b. "Drink minimal fluids to avoid stimulating the cough reflex." c. "Take the drug with food for best results" d. "Avoid drinking fluids immediately after the syrup but increase overall fluid intake throughout the day."
D
25.The pt is ordered Doxazosin (Cardura). The nurse knows this drug is a A) Benzodiazepine B) Barbituate C) Colloid D) Alpha, Andrenergic Blocker
D
3. The nurse is caring for a client with chronic stable angina who is receiving isosorbide dinitrate (Isordil). Which of the following are common adverse effects of isosorbide? a. Flushing and headache b. Tremors and anxiety c. Sleepiness and lethargy d. Light-headedness and dizziness
D
A pt with a history of HF will be started on spironolactone (Aldactone). Which of the following drug groups should not be used, or be used with extreme caution in patients taking a potassium sparing diuretic? A) NSAID's B) Corticosteroids C) Loop diuretics D) ACE inhibitors/ARB's
D
Your patient is scheduled to get Digoxin. His pulse is 52 bpm. What should the nurse do? A) Withhold dose till HR gets to 80 bpm B) Give him his dose and return in an hour C) Give prescribed dose D) Withhold dose and contact physician
D
dextran 40 IV the nurse monitors what lab values
DEXTRAN 40 MAY PROLONG BLEEDING TIME, SO THE NURSE SHOULD MONITOR PT/INR (THESE MONITOR CLOTTING TIME)
action of diuretics, ace inhibitors, vasodilators, calcium channel blockers
Diuretics- Inhibit reabsorption in the kidneys ace inhibitors- An ACE inhibitor is a type of vasodilator that dilates (widens) the blood vessels to improve the amount of blood the heart pumps. An ACE inhibitor also increases blood flow, which will help decrease the amount of work the heart has to do and may also decrease your blood pressure. An ACE inhibitor also prevents the production of harmful substances (angiotensin II) that are produced as a result of heart failure. An ACE inhibitor is a core therapy in treating systolic heart failure. Systolic dysfunction occurs when the heart muscle doesn't contract with enough force, decreasing the amount of oxygen-rich blood pumped throughout the body. An ACE inhibitor may be prescribed for the treatment of heart failure with preserved left ventricular function (diastolic dysfunction). This condition occurs when the heart contracts normally, but the left ventricle doesn't relax properly so less blood enters the heart. Your doctor can discuss which condition is present in your heart. Calcium Channel Blockers- Inhibition of the influx of calcium through slow channels in the vascular smooth muscles and myocardial tissue during depolarization. This results in systemic and coronary artery vasodilation, decreased myocardial contractility, and sinoatrial (SA) and atrioventricular (AV) nodal depression.
ACE inhibitors side effects
Dry cough SEVERE HYPOTENSION (FIRST DOSE PHENOMENON) SYNCOPE, ANGIOEDEMA, BLOOD DYSCRASIAS Increased blood-potassium level (hyperkalemia) Fatigue Dizziness Headaches Rapid heartbeat Fainting In rare cases — but more commonly in blacks and in smokers — ACE inhibitors can cause some areas of your tissues to swell (angioedema) can cause birth defects
mucolytics, expectorants
EXPECTORANTS- INCREASE BRONCHIAL SECRETIONS. REDUCE THICKNESS AND VISCOSITY OF SECRETIONS, INCREASING MUCOUS FLOW THAT CAN BE MORE EASILY REMOVED BY COUGHING. THE MOST EFFECTIVE ONE IS GUAIFENSIN (MUCINEX). MOST EFF. IN TREATING DRY, NONPRODUCTIVE COUGH BUT MAY ALSO BENEFIT PATIENTS W/ PROD. COUGH MUCOLYTICS- HELP LOOSEN THICK BRONCHIAL SECRETIONS. BREAK DOWN THE CHEMICAL STRUCTURE OF MUCUS MOLECULES. MUCOUS BECOMES THINNER AND CAN ME REMOVED EASIER BY COUGHING. ACETLYCYSTEINE (MUCOMYST) IS ONE OF THE FEW DRUGS AVAILABLE TO DIRECTLY LOOSEN THICK, VISCOUS MUCUS. DORNASE ALFA (PULMOZYME) ALSO IS A MUCOLYTIC.
dextran 40 Administration alerts:
Emergency administration may be given 1.2 to 2.4 g/min Non-emergency administration should be infused no faster than 240 mg/min DISCARD unused portions once opened because dextran contains no preservatives Pregnancy category C
side effects for beta blockers
Fatigue Cold hands Headache Upset stomach Constipation Diarrhea Dizziness Shortness of breath Trouble sleeping Loss of sex drive/erectile dysfunction Depression
bicarbonate IV
GIVE BICARBONATE IV IN CASES OF ACUTE DISEASE (ACIDOSIS). IT CAUSES URINE TO BECOME MORE ALKALINE AND SPEEDS EXCRETION OF ACIDIC SUBSTANCES. * LESS ACID IS REABSORBED IN THE RENAL TUBULES, SO MORE ACID AND ACIDIC MEDICINE IS EXCRETED. THIS IS CALLED ION TRAPPING. IMMEDIATE ONSET W/ IV ADMIN. IV CONCENTRATIONS RANGE FROM 4.2%-8.4%
enalapril adverse effects
HEADACHE, DIZZINESS, ORTHOSTATIC HYPOTENSION, RASH, COUGH, ANDIODEMA, ACUTE RENAL FAILURE, FIRST-DOSE PHENOMENON
NaCl contraindications
HYPERNATREMIA, HF, IMPAIRED RENAL FUNCTION
foods to increase electrolytes
INCREASE POTASSIUM- STRAWBERRIES, BANANAS, PRUNES, GRAPEFRUIT, BEANS, FRESH MEATSHigh potassium foods from natural food sources like beans, dark leafy greens, potatoes, squash, yogurt, fish, avocados, mushrooms, and bananas, are considered safe and healthy. The current daily value for potassium is 3.5 grams. INCREASE SODIUM- TABLE SALT, SPORTS DRINKS High magnesium foods include dark leafy greens, nuts, seeds, fish, beans, whole grains, avocados, yogurt, bananas, dried fruit, dark chocolate, and more. The current daily value (DV) for magnesium is 400mg. SODIUM BICARBONATE- BAKING SODA
How does Digoxin work?
INCREASES CONTRACTILITY OF THE HEART (A POSITIVE INOTROPIC ACTION) THE RELEASE OF CALCIUM IONS PRODUCES A MORE FORCEFUL CONTRACTION OF THE MYOCARDIAL FIBERS. INCREASES CARDIAC OUTPUT which alleviates symptoms of HF and improves exercise intolerance. INCREASED URINE PRODUCTION DESIRABLE REDUCTION IN BLOOD VOLUME AFFECTS IMPULSE CONDUCTION OF THE HEART SOMETIMES USED TO TREAT DYSRHYTHMIAS BECAUSE IT HAS THE ABILITY TO SUPRESS THE SA NODE AND SLOW THE CONDUCTION THROUGH THE AV NOSE.
what do you do for the different types of shock
INITIAL TREATMENT FOR SHOCK INVOLVES ADMINISTRATION OF BASIC LIFE SUPPORT (AIRWAY BREATHING CIRCULATION), REPLACEMENT OF FLUID LOST, AND MAINTENANCE OF BLOOD PRESSURE. VASOPRESSOR FOR SEPTIC SHOCK
differences between potassium sparing and loop diuretics
LOOP DIURETIC (EX:LASIX) INCREASES EXCRETION OF POTASSIUM POTASSIUM SPARRING DIURETIC (SPIRONOLACTONE) INCREASES SODIUM AND CALCIUM EXCRETION
side effects of loop diuretics
LOOP DIURETICS ARE POSTASSIUM WASTING WHICH LEADS TO HYPOKALEMIA WHICH LEADS TO DYSTHYTHMIAS. -DEHYDRATION, DRY MOUTH, WEIGHT LOSS, HEADACHE, HYPOTENSION, DIZZINESS, FAINTING, POTASSIUM DEPLETION, DYSRHYTHMIAS The salt balance in the bloodstream sometimes being upset, which can cause a low blood level of potassium, sodium, and magnesium, and a high level of calcium. These effects may cause weakness, confusion and, rarely, abnormal heart rhythms to develop. You may be advised to have a blood test to check for these problems. If you have diabetes or gout, these conditions may be made worse by diuretics. An upset stomach Dizziness on standing - due to too low blood pressure (hypotension).
hydrochlorothyiazide effects what electrolyte and interacts with what herbs
MAY INCREASE CALCIUM LEVELS DECREASE MAGNESIUM, POTASSIUM, AND SODIUM GINKGO AND HAWTHORNE
adverse effects of epi
MOST COMMON ADVERSE EFFECTS ARE: NERVOUSNESS, TREMORS, PALPITATIONS, DIZZINESS, HEADACHES, AND STINGING/BURNING AT SITE OF APPLICATION. WHEN ADMINISTERED PARENTERALLY- HTN AND DYSRHYTHMIAS MAY OCCUR RAPIDLY. THEREFORE, PAITENT SHOULD BE MONITORED CAREFULLY FOLLOWING THE INJECTION
LAB TESTS FOR LASIX
May increase BLOOD GLUCOSE, BLOOD UREA NITROGEN (BUN), SERUM AMYLASE, CHOLESTEROL, TRIGLYCERIDES, AND SERUM ELECTROLYTES
Hypokalemia
Muscle weakness, lethargy, anorexia, dysrhythmias, and cardiac arrest. A potassium level less than 3.5 mEq/L *Frequent adverse effect resulting from loop diuretics
nifedipine adverse effects
NIFEDIPINE- ADVERSE EFFECTS ARE RELATED TO VASODILATION SUCH AS HEADACHES, DIZZINESS, PERIPHERAL EDEMA, FLUSHING, IMMEDIATE ACTING FORMS CAUSE TACHYCARDIA, REBOUND HYPOTENSION. RAREEEEE PARADOXICAL INCREASE IN ANGINAL PAIN POSSIBLY RELATED TO HYPOTENSION OR HF. MYALGIA, ARTHRALGIA, IMPOTENCE, SEXUAL DYSFUNCTION, EDEMA, LIGHT-HEADEDNESS, ARTHRALGIA, WEAKNESS
for LASIX overdose:
OVERDOSE WILL RESULT IN HYPOTENSION AND SEVERE FLUID AND ELECTROLYTE LOSS. TREATMENT IS SUPPORTIVE, WITH REPLACEMENT OF FLUIDS AND ELECTROLYTES, AND THE POSSIBLE ADMINISTRATION OF VASOPRESSORRRRRRR!!!
s/s of respiratory acidosis, s/s of metabolic acidosis
Occurs when the pH level falls below 7.35 The most PROFOUND symptoms affect the CNS LETHARGY, CONFUSION, and CNS DEPRESSION LEADING TO COMA!!! A deep, rapid respiration rate indicates an attempt by the lungs to rid the body of excess acid.
s/s of respiratory alkalosis S/S of metabolic alkalosis
Occurs when the pH level rises above 7.45 The CNS is greatly affected. SYMPTOMS OF CNS STIMULATION INCLUDE: NERVOUSNESS, HYPERACTIVE REFLEXES, AND CONVULSIONS. In metabolic alkalosis, slow, shallow breathing indicates that the body is attempting to compensate by retaining acid and lowering internal pH.
orthostatic hypotension
Orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when you stand up from sitting or lying down. Orthostatic hypotension can make you feel dizzy or lightheaded, and maybe even faint.
who can't have a beta blocker
PATIENTS WITH RESPIRATORY AND HEPATIC IMPAIRMENT AND HEART BLOCK
dextran 40 therapeutic class: pharmacologic class:
Plasma volume expander Colloid
sudafed and HTN
Pseudoephedrine (Sudafed) is a specific decongestant that can increase blood pressure
dextran 40 Contraindicated in patients w/:
RENAL FAILURE SEVERE HYDRATION SEVERE CONGESTIVE HEART FAILURE (COF) HYPERVOLEMIC DISORDERS
what do you do for a patient in heart failure with a weight gain
REPORT A WEIGH GAIN OR LOSS OF 1 KG ( 2 LB) OR MORE IN A 24 HOUR PERIOD. WEIGHT GAIN OR EDEMA MAY SIGNAL IMPENDING HF WITH REDUCED ORGAN PERFUSSION, STIMULATING RENIN RELEASE
vasodilators can relieve symptoms of HF by:
Reducing preload and decreasing cardiac workload. Nesiritide (Natrecor) is a newer vasodilator approved for treatment of HF.
how do you administer and monitor levophed (NOREPINEPHRINE)
START AN INFUSION ONLY AFTER ENSURING THE PATENCY OF THE IV. MONITOR THE FLOW RATE CONTINUOUSLY. IF EXTRAVASATION OCCURS, ADMINISTER PHENTOLAMINE TO THE AREA OF INFILTRATION AS SOON AS POSSIBLE. DO NOTTTTT ABRUBTLY DISCONTINUE THE INFUSION. PREG CAT D. IT IS GIVEN IV ROUTE AND HAS AN IMMEDIATE ONSET. IT HAS A DURATION OF ONLY 1 OR 2 MINUTES AFTER THE INFUSION IS TERMINATED.
HOW DOES NITROGLYCERIN WORK?
TAKEN WHILE AN ACUTE ANGINA EPISODE IS IN PROGRESS OR JUST PRIOR TO PHYSICAL ACTIVITY. CAN DILATE CEREBRAL BLOOD VESSELS. ANTIANGINAL DRUG ORGANIC NITRATE, VASODILATOR
Enalapril effects
TREATS HTN AND HF PROVEN TO SLOW THE PROGRESSION OF HF is used to treat high blood pressure (hypertension), congestive heart failure, kidney problems caused by diabetes, and to improve survival after a heart attack. It is an ACE (angiotensin converting enzyme) inhibitor.
know how to administer nitro in all forms, its side effects and how it works
SUBLINGUAL, PO, LINGUAL, TRANSMUCOSAL, TRANSDERMAL, TOPICAL, EXTENDED RELEASE SUBLINGUAL- REACHES PEAK IN 2-4 MINUTES TRANSDERMAL AND EXTENDED-RELEASE FORMS ARE FOR PROPHYLAXIS ONLY!!! BECAUSE OF SLOW ONSET FOR IV ADMINISTRATION, USE A GLASS (IV) BOTTLE AND SPECIAL IV TUBING BECAUSE PLASTIC ABSORBS NITRATES SIGNIFICANTLY, THUS REDUCING THE PATIENT DOSE. COVER THE IV BOTTLE! TO REDUCE THE DEGRADATION OF NITRATES DUE TO LIGHT EXPOSURE USE GLOVES WHEN ADMINISTERING NITRO PASTE OR OINTMENT TO PREVENT SELF ADMINISTRATION *TAKE BLOOD PRESSURE BEFORE AND 5 MINUTES AFTER GIVING THE DOSE. HOLD THE DRUG IF BP IS LESS THAN 90/60 OR PULSE IS OVER 100 *CONTINUE MONITORING BP, ECG, AND PULSE *WHEN TAKEN SUBLINGUAL, REMAIN SEATED OR LIE DOWN TO AVOID DIZZINESS OR FALLS. ONSET 2-5 MINUTES AND PEAK 4-10 MINUTES BUCCAL TOPICAL OINTMENT 12 HOURS
sodium ion channel blocker
Sodium channel blockers are called so because they cause decreased influx of Na+ in cardiac cells, during phase 0. This is why they are also called membrane stabilizing drugs. 1a and 1b drugs have more affinity for channels which are refractory or depolarized (damaged myocardial cells). More frequently the channels are opened; more will be the effects of drugs.
Epinephrine/ EpiPen
Subcutaneous or IV use for anaphylaxis. It can reverse the distressing symptoms within minutes. NONSELECTIVE ADRENERGIC AGONIST. BP RISES due to stimulation of alpha receptors. opens airway. CO increases. administer epipen in the anterolateral aspect of the thigh. may need to administer through clothing. hold injection in place for 5-10 seconds. exp. date should be checked periodically.
benedryl
TREATS MINOR SYMPTOMS OF ALLERGIES AND THE COMMON COLD -OFTEN USED WITH AN ANALGESIC, DECONGESTANT OR EXPECTORANT IN OTC COLD AND FLU PRODUCTS. -ADMIN. TOPICALLY TO TREAT RASHES -ADMIN IM TO TREAT SEVERE ALLERGIC REACTIONS -CAN ALSO BE USED FOR PARKINSON'S DISEASE. MOTION SICKNESS, AND INSOMNIA - THERE IS AN INCREASED RISK OF ANAPHLYACTIC SHOCK WHEN THIS DRUG IS ADMIN. PARENTERALLY DRUG SHOULD BE DISCONT. 4 DAYS PRIOR TO SKIN ALLERGY TEST, OTHERWISE MAY PRODUCE A FALSE NEGATIVE RESULT ADVERSE EFFECTS: dry mouth, headache, dizziness, urinary retention, thickening of bronchial secretions, nausea, vomiting PARADOXICAL EXCITATION, SEDATION, HYPERSENSITIVITY, HYPOTENSION, RESPIRATORY DEPRESSION
dextran 40 Drug-Drug Interactions: Lab Tests:
There are no known drug interactions DEXTRAN 40 MAY INCREASE BLEEDING TIME
lasix Actions and Uses:
Treatment of acute HF because it has the ability to remove large amounts of fluid from the patient in a short period. WHEN GIVEN IV, DIURESIS BEGINS WITHIN 5 MINUTES, GIVING PATIENTS QUICK RELIEF FROM THEIR SYMPTOMS. prevents the reabsorption of sodium and chloride in the loop of henle region of the nephron. Lasix is particularly beneficial when CO and RENAL FLOW are severely diminished.
drug interactions for atrovent
USE WITH OTHER DRUGS IN THIS CLASS (BRONCHODILATOR/ANTICHOLINERGIC) SUCH AS ATROPINEEEEEEEE MAY LEAD TO ADDITIVE ANTICHOLINERGIC SIDE EFFECTS!!!!
side effects of hydrochlorothiazide
USUALLY WELL TOLERATED AND EXHIBITS FEW SERIOUS ADVERSE EFFECTS. electrolyte imbalances,minor hypokalemia, fatigue SIGNIFICANT HYPOKALEMIA, ELECTROLYTE DEPLETION, DEHYDRATION, HYPOTENSION, HYPONATREMIA, HYPERGLYCEMIA, COMA, BLOOD DYSCRASIAS MAY PRECIPITATE GOUT ATTACKS due to its tendency to cause hyperuricemia. BECAUSE HYPOKALEMIA MAY OCCUR, PATIENTS ARE USUALLY INSTRUCTED TO INCREASE THEIR POTASSIUM INTAKE AS A PRECAUTION
dextran 40 Adverse effects:
Vital signs should be monitored continuously during infusions to prevent HYPTERTENSION caused by plasma volume expansion. Signs of fluid overload include tachycardia, peripheral edema, distended neck veins, dyspnea, or cough. A small percentage of patients are alergic with URTICARIA being the most common sign.
How do beta blockers work?
Works against neurotransmitters and slows electrical impulses of heart. Beta blockers, also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. When you take beta blockers, the heart beats more slowly and with less force, thereby reducing blood pressure.
SIDE EFFECTS OF NITROGLYCERIN
headache, postural hypotension, flushing of face, dizziness, rash (transdermal patch), tolerance, ANAPHYLAXIS, CIRCULATORY COLLAPSE DUE TO HYPOTENSION, SYNCOPE DUE TO ORTHOSTATIC HYPOTENSION. VENOUS DILATION CAN OCCASSIONALLY CAUSE REFLEX TACHYCARDIA. SOME HEALTH CARE PROVIDERS PRESCRIBE A BETA-BLOCKER TO DIMINISH THIS UNDESIRABLE INCREASE IN HR. MANY OF THE SIDE EFFECTS ARE NOT LIFE THREATENING AND DIMINISH AFTER A FEW DOSES. DON'T USE WITH ALCOHOL
potassium levels
normal range is 3.5-5.0
ACE INHIBITORS END IN
pril
