pharm quiz 4

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Dysrhythmia

Abnormal heart rhythm

Anticoagulants

Disrupt the coagulation cascade, thereby suppressing the production of fibrin

Drugs used for Stage C heart failure

Diuretics, ACE/ARBs, Aldosterone antagonists, BetaBlockers, Digoxin, Isosorbide dinitrate/hydralazine

Unfractionated Heparin

-Enhances antithrombin to inactivate thromin and factor Xa -Rapid acting anticoagulant -Injection only -Antidote: Protamine Sulfate -Labs needed: aPTT

How are COPD patients breathing stimulated?

Low O2 levels (rather than high CO2)

The nurse is caring for a patient receiving amiodarone [Cordarone]. Which body system should the nurse assess for serious adverse effects of this medication?

Respiratory

Therapeutic level of heparine when aPTT is what?

1.5-2x normal

Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent?

"Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." Correct

The nurse is providing discharge teaching for a patient with a new prescription for a nitroglycerin transdermal patch. Which statement by the patient indicates a need for FURTHER teaching?

"I will limit my alcohol to one drink per day."

A patient with angina is being discharged with a prescription for nitroglycerin sublingual tablets. Which instruction should the nurse include?

"Store the tablets in the original container and tightly close it after use."

A patient with nonvalvular atrial fibrillation is to be discharged on dabigatran etexilate [Pradaxa]. Which statement should the nurse include in the discharge teaching?

"The medication must be stored in the manufacturer-supplied bottle.

What should the nurse include in the discharge teaching for a patient prescribed amiodarone [Cordarone]? (Select all that apply.)

"Wear sunblock and protective clothing when you are outdoors." "Check your pulse daily and report excessive slowing to your healthcare provider immediately." "Immediately notify your healthcare provider of shortness of breath, cough, or chest pain."

Low Molecular Weight Heparin

-Heparin preparations composed of molecules that are shorter than those found in unfractionated heparin -Uses: Prevention of DVT after surgery, Treatment of DVT, revents ischemic complications -2-3x longer than unfractionated and is more expensive -Antidote: Protamine sulfate

Beta Blockers

-LOL Only a few have been approved May cause fluid retention, fatigue, Hypotension, Bradycardia or heart block

3 Preparationa of heparin

1. Unfractionated 2. Low-molecular-weight 3. Fondaparinux

A patient with an acute myocardial infarction is prescribed an intravenous (IV) bolus of tenecteplase [TNKase]. The patient weighs 160 lb. The nurse will administer what dosage?

40 mg

What should the patinet alert their PCP about immediately over?

A patient who takes oral spironolactone [Aldactone] 25 mg daily and enalapril [Vasotec] 5 mg daily with a serum potassium level of 5.5 mEq/L

What is the most common sustained dysrhythmia among the U.S. population?

AFIB

In which part of the conduction pathway in a healthy heart is the electrical impulse delayed to provide time for the blood to fill the ventricles?

AV node

How does the heart compensate for CHF?

Activates the sympathetic nervous system, activates RAAS, and causes ventricular hypertrophy

A patient develops supraventricular tachycardia (SVT) and is hypotensive. Which medication should the nurse anticipate will be administered?

Adenosine [Adenocard] Correct

Class 3: Potassium Channel blockers

Amiodarone Use for life threateing ventricular dysrhythmias only, Recurrent VFIB, Ventricular tachycardia How does it work? Deduce the SA node, Reduce contractability, QRS widening, Prolongs PR and QT intervals

A patient is receiving isosorbide dinitrate [Isordil] 20 mg 3 times/day for management of newly diagnosed stable angina. Which assessment finding would require an immediate nursing intervention?

An increase in the resting heart rate to 110 beats/min from baseline rates of 68 to 72 beats/min

The nurse is preparing to administer a daily dose of Digoxin [Lanoxin]. What is the nurses primary intervention?

Analyze the heart rate and rhythm

Prevention of MI and Death

Antiplatelet drugs, cholesterol lowering drugs, Beta blockers, ACE inhibtors, antianginal agents, reducing risk factors

The home health nurse observes the patient for proper use of topical nitroglycerin ointment. Which action by the patient indicates the need for further teaching?

Applies the prescribed ribbon of ointment to the applicator paper and places it on the chest.

Left sided heart failure

Back up into the lungs

Which are the main types of drugs used to prevent or relieve anginal pain? (Select all that apply.)

Beta blockers, Nitrates, Calcium Channel blockers

A patient with heart failure has developed a cough while taking an angiotensin-converting enzyme (ACE) inhibitor. The health care provider discontinued the ACE inhibitor and prescribed an angiotensin II receptor blocker (ARB) as an alternative to the ACE inhibitor. The patient continues to have symptoms of heart failure despite using an ARB. Which medication should the nurse anticipate will be prescribed?

BiDil [Isosorbide Dinitrate and Hydralazine]

Class 2 antiarrhythmics

Blockage of adrenergic beta 1 receptor- Decrease the HR, AV conduction, and ventricular automaticity, increased PR interval

Theophylline

Bronchodilator given orally or IV(Emergency only) Dysrhythmias and seizures may occur wiht higher therapeutic levels

Left sided heart failure

CO decreases, Blood backs up in the pulmonary circulation, Causes left ventricular infarctoin, HTN, and stenosis. Manifests by pulmonary congestion, dyspnea, and activity intolerance

In which situation is dronedarone [Multaq] contraindicated?

Concomitant administration of Amitriptyline [Elavil]

How is heart failure treated

Diuretics, RASS inhibitors, Beta Blockers, Digoxin, Dopamine, hydralazine

COPD drugs

Corticosteroids- Decrease inflammation and mucous production in airways PHOSPHODIESTANCE

Beta Blockers for angina

Decrease O2 demand 1st line of defense for effort induced angina No effect on vasoplactic angina Adverse effects- Bradycadia, decreased AV condiction, asthmatic effects, use with caustion in patients with DM, depression, insomnia, sexual dysfunction

What is angina

Decrease of O2 supply and increase of demand

Adenosine (Adenocard)

Decreases automaticity in the SA node, Slows conduction through the AV node, Prolongd PR interval Used to terminate paroxymal SVT May cause Sinus bradycardia, dyspnea, Hypotension, facial flushing, chest discomfort

A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug?

Decreasing level of consciousness

The nurse is caring for a patient prescribed quinidine [Quinaglute] for a supraventricular dysrhythmia. What is a common adverse effect of this drug?

Diarrhea

Which medication is not associated with prolongation of the QT interval?

Diltiazem [Cardizem]

Which medication combination is useful in the treatment of variant angina?

Diltiazem [Cardizem] and isosorbide mononitrate [Imdur]

What is propranolol (Inderal) used for?

Dysrhythmias caused by excessice sympathetic stimulation and Supracentricular tachydysrhythmias

The nurse is planning care for a patient at risk for dysrhythmias. The nurse understands that the Cardiac Arrhythmia Suppression Trial (CAST) confirmed which finding?

Dysrhythmias should be treated only when they are symptomatically significant

Which patient symptoms should cause the nurse to be concerned about digoxin [Lanoxin] toxicity

Fatigue, Vomiting, Blurred vision.

A nurse gives oral digoxin. The apical pulse is 64 bp,. What should then nurse do?

Give the medication because it is normal.

Short acting bronchodilators

Great in emergency situations Constriction of airway Beta 2 agonists, anticholinergic,etc Dried mouth, blurred vision,

The nurse understands patients receiving nitroglycerin are at risk for which adverse effects? (Select all that apply.)

Headache, Dizziness, tachycardia

Four major determinants of Myocardial O2 demands

Heart rate, Contractile force, muscle mass, ventricular wall tension

PHOSPHODIESTANCE

Helps decrease ecasterbations Side affects- Mental changes Increased suicide rate flumilast

A patient with deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response?

Heparin suppresses coagulation by helping antithrombin perform its natural functions

3. A patient with emphysema may present with all of the following symptoms EXCEPT? A. Barrel chest B. Hyperinflation of the lungs C. Hypoventilation D. Hypercapnia

Hypoventilation

Albuterol

Inhaled, short acting beta 2 adrenergic agonist Prevents asthma episodes(exercise induced)

Antiplatelets

Inhibit platelet aggregration

VasoDilators (other than ACE and ARB)

Isosorbide- Selective dilation of Veins Hydralzine- Selective dilation of arterioles Nitroglycerin- Venous dilator Sodium nitroprusside [Nitropress]- Arteriole & venous dilator

The nurse knows that which statement is accurate for enoxaparin [Lovenox]?

It reduces the activity of factor Xa more than the activity of thrombin

A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What medication would be appropriate for this patient who has a history of heparin-induced thrombocytopenia (HIT)?

Lepirudin [Refludan]

Examples of sodium channel blockers

Lidocaine, Phenytoin, Mexiletine

Stage D heart failure

Marked S/S, Advanced structureal heart disease, Repeated hospitalizations Best treatment is a heart transplant How to manage: Control Fluid retention DO NOT USE BETA BLOCKERS

Class 1 C antiarrhythmics

Marked block of sodium channels- Prolonged QRS interval

Anticoagulants: Heparin and Derivatives

Mechanism of actionL Enhance activity of antithrombin

Class 1B antiarrhythmics

Mild block of sodium channels- Decrease in ventricular automaticity

Class 1A antiarrhythmics

Moderare block of sodium channels- DRS and QT intervals prolonged

The nurse is administering intravenous lidocaine [Xylocaine] to a patient with a ventricular dysrhythmia. What is the priority nursing intervention to prevent a potential complication with this drug?

Moniror ECG

Glycoprotein 11b/11a receptor antagonists

Most effective antiplatelet drugs "Super Asprin" Very expensive IV infusions Used for acute coronary syndromes and percutaneous coronary interventions

Antidysrhythmic Drug therapy

Need to balance the risk vs benefits Acure and long term treatment phases Minimizing risk

Drugs used for angina

Nitroglycerin, Beta Blockers, Calcium channel blockers, and ranolazine

Stage B heart failure

No S/S Manage by preventing development of symptomatic HF Treat with risk reduction and ACE/ARBs

Stage A heart failure

No symptoms, no structural or functional cardiac abnormalities Manage by reducing risk

The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate?

Notify the healthcare provider to discuss the reduction or withdrawal of heparin

Amiodarone [Cordarone] is prescribed for a patient with atrial fibrillation. What is the most important nursing intervention before administering this medication?

Obtain baseline serum thyroid and liver function studies

The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel?

Omeprazole [Prilosec]

Digoxin

Positive Inotropic action of the heart Increases the cardiac output Best for patients with 25% Ejection fraction or less May cause dysrhythmias, toxicity, and interacts with many other drugs

A nurse is caring for a patient who is taking spironolactone [Aldactone] and quinapril [Accupril] for heart failure. What finding indicates a potential interaction between these two drugs?

Potassium level of 5.7 mEq/L

Corticosteroids

Prednisone, Symbicore(Broncho dialater and steroid) Side effects- Bruising, thin skin AT RISK for hyperglycemia, infection, osteoporosis IF A PATIENT IS PRESCRIBED THE INHAILER OF BRONCHODILATER AND CORTICOSTEROID, TAKE BRONCHODILATOR FIRST TO OPEN UP THE AIRWAYS RINSE MOUTH

Fondaparinux [Arixtra] is not approved for use in which circumstance?

Prevention of ischemic complications in patients with unstable angina

Thrombolytics

Promote lysis of Fibrin, causing dissolution of thrombi

Class 2 beta blockers

Propranolol: nonselective Beta adrenergic antagonist that decreases automaticity of the SA node and decreases velocity of conduction through the AV node

Clot formation

Prothrombin activator is formed, Catlyzes conversion of prothrombin into thrombin, and then thrombin converts to fibrinogen into fibrin threads

The nurse is interpreting an electrocardiogram (ECG). Which component represents the depolarization of the ventricles?

QRS Complex

The nurse is monitoring a patient receiving ranolazine [Ranexa] for angina. Which assessment finding indicates an adverse effect of this drug?

QT prolongation on the electrocardiogram

Diuretics

Reduce fluid in the body causing the volume to lessen, helping lighten the work load. May cause Hypokalemia

Common supraventricular arrhythmias include

SVT, Atrial flutter, AFIB

Class 1: Soidium channel blockers

Slows the conduction through the system Blocks sodium and prevents depolarization Used to treat Ventricular arrhythmias

7. You are providing teaching to a patient with chronic COPD on how to perform diaphragmatic breathing. This technique helps do the following:

Strengthen the diaphragm

Thrombolytic Drugs

Streptokinase- Binds to plasminogen Used for MI, DVT, adn Pulmonary emboli Adverse effects include bleeding, hypotension and fever

How are nitrates administered?

Sublingually, SR tablets, Translingual spray, transdermal delivery, buccal tablets, topical ointments, IV infusion

Antiplatelet Drug

Suppress platelet aggregration 3 major groups: aprin, ADP receptor blockers, GP/11b/11a receptors

Stage C heart Failure

Symptoms are present, There are structural changes Main goals are to relieve symptoms, improve quality of life, prolong life, and slow the remodeling

In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The nurse understands increased sympathetic activity will produce which response?

Tachycardia

Complications with beta 2 adrenergic agonists

Tachycardia, angina, tremors

Tachydysrhythmia vs bradydysrhythmia

Tachydysrhythmias: HR is increased Bradydysrhythmias: HR is slowed

A nurse is caring for a patient receiving dronedarone [Multaq] for treatment of atrial fibrillation. What electrocardiogram (ECG) change indicates an adverse effect of this medication?

The QT-interval measurement changes from 400 to 520 msec.

What is heart failure?

The heart cannot pump effectively -Systolic or diastolic dysfunction and can be left or right sided

A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler. How should the patient take this medication?

The patient should use the Spiriva first and then 5 minutes later the Pulmicort.

Methylxanthines

Theophylline Type of bronchodilator Narrow therapeutic range(10-20mcg.ml) Can increase Digoxin Decrease dilatin and lithium

Asprin

Uses: Ischemic stroke, TIA, Stable angina, Coronary Stenting, MI, MAY CAUSE Bleeding

common ventricular arrhythmias

V-FIB, PVC, Digoxin indiced ventricular dysrthythmias, torsades de pointes

Atropine

Vagolytic drug, antiparrasympathetic, used to slow rhythms, and negates parasympathetic system

The nurse is caring for a patient receiving nitrates for relief of angina. What pharmacodynamic action is responsible for the relief of anginal pain with nitrates?

Vasodilation leads to decreased preload, which decreases oxygen demand

Nitroglcerin

Vasodilator Can cause headache, orthostatic hypotension, and reflex tachycardia Interacts with Hypotensice drugs, Phosphodieterase type 5 inhibiotors, betablockers, and alcohol

The heart undergoes cardiac remodeling during the initial phase of heart failure. What cardiac geometric change occurs during heart failure?

Ventricle wall thickening

Class 4: Calcium Channel blockers

Verapamil, Diltiazem Reduces SA node automaticity, Delays AV node conduction, Reduces Myocardial contractability Slows ventricular rare and rerminares SVT caued by AV node reentrant circuit Adverse effects :BradyCardia, Hypotension, AV block, Heart failure, Peripheral edema, constipation

Clot formation

Vessel gets injured, Vessel spasms, Platelets adhere to injury site and aggregates to form a plug, and insoluble fibtin strand forms and coagulates

The nurse is caring for a patient prescribed Digoxin [Lanoxin] for heart failure. Which finding would requore an immediate attention?

Vomiting and diarrhea

Long acting

Work the same but the effects last longer Spiriva

Direct Factor Xa Inhibitors

Xarelto: Binds directly with fctor Xa to cause inactivation Rapid onset Very few inteeractions Elliquis: Selective inhibition of Factor Xa NEITHER have Antidote

inotropic agents

activation of beta1-adrenergic receptors Increases the heart rate (Dopamine)

Formoterol

inhaled, long acting Used for long term control of asthma

Warfarin (Coumadin)

oral anticoagulant A vitamin K antagonist Used for a Long Term prophylaxis of thrombosis Adverse: Hemorrahge Many Drug interactions Antidote: Vitamin K

Which needle length and gauge should the nurse choose to administer subcutaneous heparin?

⅝ inch; 25 gauge

The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved?

70

RASS inhibitors (Captopril, Enalapril)

ACE inhibitors:-Prils Promote Arteriolar and venous dilation. May Cause hypotention, hyperkalemia, Cough, angioedema ARBS: Improve LV Ejection and reduce the HF S/S Block the action of angiotension 2 Aldosterone:Moderate- Severe symptoms, Block the receptors to stop fluid retention from occuring DRIS: Not approved for HF treatment yet Goals of these drugs: Make the pipes bigger so there is less pressure

Clopidogrel (Plavix)

Block P2y12 adp receptors on the platelet surface, prevents blockage of coronary artery stents, reduces thrombotic events in patients with acute coronary syndromes Use caution while combining with other drugs

What is the primary benefit of spironolactone [Aldactone] in patients with heart failure?

Blockage of aldosterone receptors

Class 3 antiarrhythmics

Blocks potassium channels- Prolongs ventricular repolarization, prolongs QT interval

Right sided heart failure

Blood backs up in the peripheral circulation, Causes pulmonary disease, left sided failure, and stenosis. Manifests by edema and weight gain

Class 4 antiarrhythmics

Calcium channel blockers in the AV and SA nodes, Decreases the HR and AV conduction, increase in PR interval

The nurse is caring for a patient who is receiving enteral feedings because of dysphagia. The healthcare provider prescribes isosorbide mononitrate [Imdur] 60 mg SR daily via the enteral tube. What is the most appropriate action by the nurse?

Call the healthcare provider about an alternate form of nitrate for administration

The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate?

Call the healthcare provider to increase the dose. Correct

Direct thrombin inhibitors Dabigatran (Pradaxa)

Direct inhibition of Thrombin Doesn't require monitoring of anticoagulants May Increase GI bleeds

Direct Thrombin Inhibitors Argatroban

Direct inhibition of thrombin IV anticoagulant Monitor aPTT and for allergic reactions

The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin?

Discolored urine

Calcium Channel Blockers

Relax coronary vasospasm, decrease heart rate, AV conduction, and contractability

right sided heart failure

causes swelling in extremities Edema, weight gain


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