Pharmacology Exam 2
The patient states to the nurse, "My friend said nitroglycerin relieves angina pain by reducing preload. What is preload?" Which statement by the nurse explains preload to this patient? A. "It is the blood return to the heart." B. "It is the oxygen demand of the heart." C. "It is the pressure against which the heart must pump." D. "It is dilation of the arteries and veins throughout."
A. "It is the blood return to the heart."
The nurse is teaching a group of nursing students about the use of antipsychotic drugs for antiemetic purposes. The nurse will explain that, when given as antiemetics, these drugs are given a. in smaller doses. b. less frequently. c. with anticholinergics. d. with antihistamines.
ANS: A Antipsychotic medications have antiemetic properties in smaller doses.
The nurse is caring for an African-American patient who has been taking a beta blocker to treat hypertension for several weeks with only slight improvement in blood pressure. The nurse will contact the provider to discuss a. adding a diuretic medication. b. changing to an ACE inhibitor. c. decreasing the beta blocker dose. d. doubling the beta blocker dose.
ANS: A African Americans do not respond well to beta blockers and ACE inhibitors, but do tend to respond to diuretics and calcium channel blockers. Changing to an ACE inhibitor or altering the beta blocker dose are not indicated. Hypertension in African-American patients can be controlled by combining beta blockers with diuretics.
1. The nurse is caring for a patient recently diagnosed with mild emphysema and provides teaching about the disease and medications for treatment. Which statement by the patient indicates understanding of the medication regimen? a. I should use albuterol when my symptoms worsen. b. I will need to take oral prednisone on a daily basis. c. My provider will prescribe prophylactic antibiotics. d. My symptoms are reversible with proper medications.
ANS: A Albuterol is used to treat bronchospasm during symptom flares. Oral prednisone is given for acute flares but not generally on a daily basis until symptoms are chronic and severe because of the risk of adrenal suppression. Prophylactic antibiotics are not given regularly because of the risk of antibiotic resistance. Symptoms of emphysema are not reversible.
The nurse is preparing to administer the first dose of digoxin (Lanoxin) to a patient and notes that the dose ordered is much higher than the usual recommended dose. Which action will the nurse perform? a. Administer the dose as ordered. b. Give the dose and monitor for toxicity. c. Hold the dose until reviewing it with the provider. d. Refuse to give the dose.
ANS: A Digoxin requires a loading dose when first prescribed.
The nurse is instructing a patient who will take psyllium (Metamucil) to treat constipation. What information will the nurse include when teaching this patient? a. The importance of consuming adequate amounts of water b. The need to monitor for systemic side effects c. The onset of action of 30 to 60 minutes after administration d. The need to use the dry form of Metamucil to prevent cramping
ANS: A Insufficient fluid intake can cause the drug to solidify in the gastrointestinal tract. Psyllium is not digestible, so it does not have systemic side effects. Onset of action for psyllium is between 10 and 24 hours. The dry form can cause cramping.
The nurse is teaching an overweight patient to administer subcutaneous heparin. Which statement by the patient indicates understanding of the teaching? a. I should insert the needle and inject the medication without aspirating for blood. b. I should put firm pressure on the injection site to decrease the risk for bleeding. c. I will insert the needle at a 10-degree angle when injecting. d. The subcutaneous route is used because absorption is faster this way.
ANS: A Patients giving subcutaneous medication should be taught not to aspirate after inserting the needle. They should not apply pressure. The needle should be inserted at a 45- to 90-degree angle. Absorption is slower with this route than with the intramuscular and intravenous routes.
A patient will begin using ipratropium bromide (Atrovent), albuterol (Proventil), and an inhaled glucocorticoid medication (steroid) to treat chronic bronchitis. When teaching this patient about disease and medication management, the nurse will instruct the patient to administer these medications in which order? a. Albuterol, ipratropium bromide, steroid b. Albuterol, steroid, ipratropium bromide c. Ipratropium bromide, albuterol, steroid d. Steroid, ipratropium bromide, albuterol
ANS: A Patients who use a beta agonist should be taught to use it 5 minutes before administering ipratropium bromide, and ipratropium bromide should be given 5 minutes prior to an inhaled glucocorticoid. This helps the bronchioles to dilate so the subsequent medication can be deposited in the bronchioles for improved effect.
The nurse is caring for a 70-year-old patient who has recently begun taking amlodipine (Norvasc) 5 mg/day to control hypertension. The nurse notes mild edema of the patients ankles, a blood pressure of 130/70 mm Hg, and a heart rate of 80 beats per minute. The patient reports flushing and dizziness. The nurse will notify the provider and a. ask to decrease the dose to 2.5 mg/day. b. discuss twice daily dosing. c. request an order for a diuretic. d. suggest adding propranolol to the regimen.
ANS: A This patient is experiencing side effects of the medication. Elderly patients often require lower doses, so the nurse should ask about a dose reduction. Older adults generally require 2.5 to 5.0 mg/day. Twice daily dosing is not recommended. Unless edema persists, a diuretic is not indicated.
The nurse is performing an assessment on a patient who will begin taking propranolol (Inderal) to treat hypertension. The nurse learns that the patient has a history of asthma and diabetes. The nurse will take which action? a. Administer the medication and monitor the patients serum glucose. b. Contact the provider to discuss another type antihypertensive medication. c. Request an order for renal function tests prior to administering this drug. d. Teach the patient about the risks of combining herbal medications with this drug.
ANS: B Patients with chronic lung disease are at risk for bronchospasm with beta blockers, especially those like propranolol which are non-selective. Beta blockers, with the exception of carvedilol, also decrease the efficacy of many oral antidiabetic medications. The nurse should discuss a change in medications to one that does not carry this risk.
A patient has been receiving intravenous heparin. When laboratory tests are drawn, the nurse has difficulty stopping bleeding at the puncture site. The patient has bloody stools and is reporting abdominal pain.The nurse notes elevated partial thromboplastin time (PTT) and activated partial thromboplastin time (aPTT). Which action will the nurse perform? a. Ask for an order for oral warfarin (Coumadin). b. Obtain an order for protamine sulfate. c. Request an order for vitamin K. d. Suggest that the patient receive subcutaneous heparin.
ANS: B Protamine sulfate is given as an antidote to heparin when patients clotting times are elevated. Oral warfarin will not stop the anticoagulant effects of heparin. Vitamin K is used as an antidote for warfarin. Administering heparin by another route is not indicated when there is a need to reverse the effects of heparin.
Which antacid is likely to cause acid rebound? a. Aluminum hydroxide b. Calcium carbonate c. Magnesium hydroxide d. Magnesium trisilicate
ANS: B While calcium carbonate is most effective in neutralizing acid, a significant amount can be systemically absorbed and can cause acid rebound. The other antacids do not have significant systemic absorption.
The nurse understands that a medication such as carvedilol (Coreg) may not be effective in an African- American patient because of its effects on a. cardiac contractility. b. heart rate. c. renin release. d. vascular resistance.
ANS: C African Americans are more likely to be susceptible to low-renin hypertension. Beta blockers reduce heart rate, contractility, and renin release, and there is a greater hypotensive response in patients with higher renin levels. Changes in heart rate, contractility, and vascular resistance explain why there is some response in this group.
5. A provider has prescribed ipratropium bromide/albuterol sulfate (Combivent) for a patient who has chronic obstructive pulmonary disease (COPD). The nurse explains that this combination product is prescribed primarily for which reason? a. To be more convenient for patients who require both medications b. To improve compliance in patients who may forget to take both drugs c. To increase forced expiratory volume, an indicator of symptom improvement d. To minimize the side effects that would occur if the drugs are given separately
ANS: C Combivent is more effective and has a longer duration of action than if either agent is used alone, and the two agents combined increase the FEV1. While it is more convenient and may improve compliance, this is not the primary reason for using it. The combination does not alter drug side effects.
13. The nurse is performing a medication history on a patient who reports long-term use of montelukast (Singulair) and an albuterol metered-dose inhaler (Proventil). The nurse will contact the provider to discuss an order for which laboratory tests? a. Cardiac enzymes and serum calcium b. Electrolytes and a complete blood count c. Liver function tests and serum glucose d. Urinalysis and serum magnesium
ANS: C The beta2 agonists can increase serum glucose levels and montelukast can elevate liver enzymes, so these should be monitored in patients taking these medications.
The nurse is caring for a patient who has postoperative nausea and vomiting. The surgeon has ordered promethazine HCl (Phenergan). Which aspect of this patients health history would be of concern? a. Asthma b. Diabetes c. GERD d. Glaucoma
ANS: D Promethazine is contraindicated in patients with glaucoma since it is an anticholinergic medication. It should be used with caution in patients with asthma. The other two conditions are not concerning with this medication.
A patient is diagnosed with heart failure, and the prescriber has ordered digoxin. The patient asks what lifestyle changes will help in the management of this condition. The nurse will recommend which changes? a. Aerobic exercise and weight lifting 2 or 3 times weekly b. Changing from cigarette smoking to pipe smoking c. Consuming 2 teaspoons or less of salt every day d. Having no more than one alcoholic beverage per day
ANS: D Alcohol should either be completely avoided or restricted to no more than one per day. Mild exercise, such as walking, is recommended. All nicotine deprives the heart of oxygen. Salt should be limited to no more than one teaspoon per day.
A patient who has atrial fibrillation is taking digoxin. The nurse expects which medication to be given concurrently to treat this condition? a. Hydrochlorothiazide (HydroDIURIL) b. Inamrinone (Inocor) c. Milrinone (Primacore) d. Warfarin (Coumadin)
ANS: D Digoxin is given for atrial fibrillation to restore a normal heart rhythm. To prevent thromboemboli, warfarin is given concurrently. Hydrochlorothiazide is a diuretic medication. Inamrinone and milrinone are inotropic agents that would be used instead of digoxin.
The nurse is teaching a patient about using sublingual nitroglycerin at home. Which statement by the patient indicates understanding of the teaching? a. I may put the tablet in food if I dont like the taste. b. I may take a sip of water after placing the tablet in my mouth. c. I will place the tablet between my cheek and gum. d. I will place the tablet under my tongue and let it absorb.
ANS: D Drugs given sublingually should be placed under the tongue. No foods or fluids should be given, since the tablet must remain under the tongue until it is fully absorbed. Medications ordered to be given buccally should be placed between the cheek and gum.
3. A patient will be discharged home with albuterol (Proventil) to use for asthma symptoms. What information will the nurse include when teaching this patient about this medication? a. Failure to respond to the medication indicates a need for a higher dose. b. Monitor for hypoglycemia symptoms when using this medication. c. Palpitations are common with this drug even at normal, therapeutic doses. d. Overuse of this medication can result in airway narrowing and bronchospasm.
ANS: D Excessive use of an aerosol drug can occasionally cause severe paradoxical airway resistance, so patients should be cautioned against overuse. Excessive use can also lead to tolerance and loss of drug effectiveness, but patients should not increase the dose because of the risk of bronchospasm and the increased incidence of adverse effects such as tremors and tachycardia. Hyperglycemia can occur. Palpitations are common with increased doses but not at therapeutic doses.
10. The nurse provides teaching for patient who will begin taking montelukast sodium (Singulair). The patient reports sensitivity to aspirin. Which statement by the patient indicates a need for further teaching? a. I will need to have periodic laboratory tests while taking this medication. b. I will not take ibuprofen for pain or fever while taking this drug. c. I will take one tablet daily at bedtime. d. I will use this as needed for acute symptoms.
ANS: D Montelukast and other leukotriene receptor antagonists are not used to treat acute symptoms. Because they can affect liver enzymes, periodic liver function tests should be performed. Patients taking this drug should not use ibuprofen or aspirin for pain or fever if they have an aspirin sensitivity. Patients will achieve maximum effectiveness if the drug is taken in the evening.
The nurse is administering 0900 medications to a client diagnosed with PUD (peptic ulcer disease). Which medication should the nurse question? A. Metronidazole B. Bismuth subsalicylate C. Lansoprazole D. Sucralfate
ANSWER: D. Sucralfate (Carafate) is a mucosal barrier agent and must be administered on an empty stomach for the medication to coat the stomach lining. The nurse should question the time the medication is scheduled for and arrange for the medication to be administered at 0730. RATIONALE WHY THESE AREN'T THE ANSWERS: A. Metronidazole (Flagyl), a gastrointestinal anti-infective, is administered in combination with Pepto Bismol, Prevacid, and one other antibiotic to treat PUD. The nurse would not question this medication. B. Bismuth subsalicylate (Pepto Bismol), an antimicrobial, is administered in combination with Flagyl, Prevacid, and one other antibiotic to treat PUD. The nurse would not question this medication. C. Lansoprazole (Prevacid), a PPI, is administered with a combination of antibiotics to treat PUD. The nurse would not question this medication
Heparin
Action -Bind with antithrombin III -Inhibit action of thrombin -Inhibit conversion of fibrinogen to fibrin -Inhibit clot formation Use -Prevent venous thrombosis Administration of heparin -Subcutaneously, intravenously Heparin laboratory values -PTT 1.5 to 2 times control value (control 60 to 70 seconds) -aPTT 30 to 85 seconds (control 20 to 35 seconds) Side effects -Bleeding -If bleeding occurs, mouth, gums, GI, could be in poop or pee, check rectum, nose, ears, conjunctiva of eye, mucous membranes -Use safety razor and soft tooth brush when taking Heparin Antidote -Protamine sulfate
Administration of Heparin
Administration of Heparin i. Subcutaneously ii. Intravenously o Like insulin, prescribed in unit dosages. o High alert medication o Requires two nurses for administration Bulk-Forming Laxative Administration i. Mix in glass of water or juice ii. Stir iii. Drink immediately iv. Follow 1 glass water (prevent clumping in stomach) Administration of IV furosemide i. Administer IV slowly, permanent hearing loss may occur with rapid injection. Phosphodiesterase Inhibitors Administration ii. Administer IV no longer than 48 to 72 hours to avoid severe cardiac dysrhythmias iii. High alert medication Nitrates Administration i. Sublingual, translingual, topical, aerosol spray, IV ii. Position patient sitting or lying down when administering a nitrate for the first time.
You are providing discharge teaching to a patient taking Sucralfate (Carafate). Which statement by the patient demonstrates they understand how to take this medication?* A. "I will take this medication at the same time I take Ranitidine." B. "I will always take this medication on an empty stomach." C. "It is best to take this medication with antacids." D. "I will take this medication once a week."
Ans: B
During an admission assessment, a patient states that she takes amlodipine. The nurse should inquire about which signs and symptoms to determine whether the patient has any common side effects of a calcium channel blocker? (Select all that apply.) a. Insomnia b. Dizziness c. Headache d. Angioedema e. Ankle edema f. Hacking cough
Ans: B, C, E.
A patient who has symptoms of peptic ulcer disease will undergo a test that requires drinking a liquid containing 13C urea and breathing into a container. The nurse will explain to the patient that this test is performed to A. Assess the level of HCl B. Detect H. pylori antibodies C. Measure the pH of gastric secretions. D. Test for the presence of 13CO2
Ans: D When H. pylori is suspected, a noninvasive test is performed by administering 13C urea, which in the presence of H. pylori, will release 13CO2. The test does not measure the amount of HCl acid or the pH and does not detect H. pylori antibodies.
Which of these approaches should the nurse take when administering sucralfate (Carafate) to a patient who has a duodenal ulcer? a. Crush the tablet into a fine powder before mixing it with water. b. Administer the tablet with sips of water one hour before meals. c. Allow the tablet to dissolve in water before administering it. d. Administer the tablet with an antacid for maximum benefit.
Ans: b. Administer the tablet with sips of water one hour before meals. (Sucralfate acts through a compound that is a sticky gel adhering to an ulcer crater, creating a barrier. Administration is best on an empty stomach. The tablet form will not dissolve in water when crushed. Crushing sucralfate could lead to decreased effectiveness of the drug. Sucralfate acts under mildly acidic conditions; antacids raise gastric pH above 4 and may interfere with the effects of sucralfate.)
A client has a prescription to take guaifenesin (Mucinex). The nurse determines that the client understands the proper administration of this medication if the client states that he or she will: 1. Take an extra dose if fever develops. 2. Take the medication with meals only. 3. Take the tablet with a full glass of water. 4. Decrease the amount of daily fluid intake.
Answer: 3. Take the tablet with a full glass of water. Rationale: Drinking plenty of water while taking guaifenesin may help loosen mucus or phlegm in the lungs alongside guaifenesin's outcomes as a expectorant.
The client tells the nurse that she has a bad cold, is coughing, and feels like she has "stuff" in her lungs. What should the nurse do? a. Administer dextromethorphan. b. Administer guaifenesin. c. Encourage the client to drink fluids hourly. d. Administer fluticasone (Flonase).
Answer: Administer guaifenesin.
A client receiving chemotherapy experiences significant nausea and vomiting. To best manage these symptoms, the nurse administers phenothiazine antiemetics A.As requested by the client B.1 hour after chemotherapy administration C.The night before treatment, the day of treatment, and for 24 hours after treatment D.The day of treatment
Answer: C
A patient with a gastric ulcer is ordered sucralfate. This medication works to A. Calm the patient to reduce acid production B. Block the H2 receptors C. Neutralize the gastric acids D. Coat the gastric lining
Answer: D. coat the gastric lining Rationale: Sucralfate (Carafate) is a mucosal protective drug. It forms a viscous substance that covers the ulcer and protects it from acid and pepsin.
Sucralfate (Chapter 43 ppt slides)
Antiulcer Drug • Pepsin inhibitors • sucralfate (Carafate) Action • Combines with protein to form thick paste covering ulcer, protects from acid and pepsin • Ulcer attachment lasts up to 6 hours, also called mucosal protectant Side effects • Constipation • Also, dizziness, drowsiness, headache, nausea, flatulence, dry mouth, rash, pruritus. Adverse reactions • Hyperglycemia • Hypophosphatemia Nursing Interventions • Given 30 min before meals and bedtime • Must be given on an empty stomach so med can coat stomach lining Contraindications Hypersensitivity • Renal impairment, DM, dysphagia, pregnancy, breastfeeding, older adults. Drug-Lab-Food Interactions • Drug: Decreased effects with tetracycline (Abx), phenytoin (anticonvulsant), digoxin (cardiac glycoside); altered absorption with fluoroquinolones, antacids, ketoconazole (antifungal), furosemide(diuretic), lansoprazole (PPI), thyroid hormones Pharmacokinetics • Absorption: PO: Minimal absorption (5%) • Distribution: Protein binding: unknown • Metabolism: T1/2: 6-20h • Excretion: Urine Pharmacodynamics: • PO: onset: 1-2h • Peak: Unknown • Duration: 6h Therapeutic effects • To prevent gastric mucosal injury from drug inducing ulcers (aspirin, NSAIDs); to treat duodenal ulcers. • Mode of action: In combination with gastric acid, forms a protective covering on the ulcer surface.
Which statement by the patient demonstrates a need for further education regarding nitroglycerin (Nitrostat) sublingual tablets? A. "I should keep my nitroglycerin in a cool, dry place." B. "I can take up to four tablets at 5-minute intervals for chest pain." C. "If I get a headache, I should keep taking my nitroglycerin and use Tylenol to relieve my headache." D. "I should change positions slowly to avoid getting dizzy from the drug's effect on my BP."
B. "I can take up to four tablets at 5-minute intervals for chest pain."
The patient asks the nurse, "How should sublingual nitroglycerin be stored when I travel?" What is the nurse's best response? A. "You can protect it from heat by placing the bottle in an ice chest." B. "It's best to keep it in its original container away from heat and light." C. "You can put a few tablets in a resealable bag and carry it in your pocket." D. "Keep it in the glove compartment of your car to prevent exposure to heat."
B. "It's best to keep it in its original container away from heat and light."
A patient receiving IV nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mmHg, HR of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's best action? A. Assess the patient's lung sounds. B. Decrease the IV nitroglycerin by 10 mcg/min C. Increase the IV nitroglycerin by 10 mcg/min D. Recheck the patient's vital signs in 1 hour
B. Decrease the IV nitroglycerin by 10 mcg/min
The nurse is teachin treatment o acute chest pain for a patient prescribed nitroglycerin (Nitrostat) sublingual tablets. Which instruction should the nurse include? A. Take five tablets every 3 minutes for chest pain. B. Sit or lie down before taking medication. C. Chest or swallow the tablet for quickest effect D. Keep the tablets locked in a safe place until you need them.
B. Sit or lie down before taking medication.
Which dosage form of nitroglycerin has the longest duration of action? A. Sublingual tablet B. Transdermal patch C. Intravenous (IV) infusion D. Immediate-release tablet
B. Transdermal patch
Patient Education - Inhaler Use (Textbook Pg. 235)
BOX 10.5 Correct Use of a Metered-Dose Inhaler 1. Explain what a metered dose is, and warn the patient about overuse and side effects of the drug. 2. Explain the steps for administering drug using a squeeze-and-breathe metered-dose inhaler (MDI), and demonstrate the steps when possible. Consult a pharmacist for details if necessary. 3. Insert the medication canister into the plastic holder. 4. If a spacer is used, insert the MDI into the end of the spacer. 5. Shake the inhaler vigorously five or six times before using. Remove the cap from the mouthpiece. 6. Have the patient breathe out through the mouth and exhale. 7. An MDI may be positioned in one of two ways: a. With the mouth closed around the MDI with the opening toward the back of the throat b. With the device positioned 1 to 2 inches from the mouth c. If a spacer is used, the patient closes the mouth around the mouthpiece of the spacer. Avoid covering the small exhalation slots with the lips. 8. With the inhaler properly positioned, have the patient hold the inhaler with the thumb at the mouthpiece and the index finger and middle finger at the top (see Fig. 10.8). 9. Instruct the patient to take a slow, deep breath through the mouth and during inspiration, to push the top of the medication canister once. 10. Have patients hold the breath for 10 seconds then exhale slowly through pursed lips. 11. If a second dose is required, wait 1 to 2 minutes, and repeat the procedure by first shaking the canister in the plastic holder with the cap on. 12. When it is first used or if it has not been used recently, test the inhaler by spraying it into the air before administering the metered dose. 13. If a glucocorticoid inhalant is to be used with a bronchodilator, wait 5 minutes before using an inhaler that contains a steroid. 14. Teach patients to self-monitor their pulse rate. 15. Caution against overuse because side effects and tolerance may result. 16. Teach patients to monitor the amount of medication remaining in the canister. Advise patients to ask a health care provider or pharmacist to estimate when a new inhaler will be needed based on the dosing schedule. 17. Teach patients to rinse their mouth after using an MDI. This is especially important when using a steroid drug. Rinsing the mouth helps to prevent irritation and secondary infection to oral mucosa. 18. Advise patients to avoid smoking. 19. Teach patients to do daily cleaning of equipment; this should include (1) washing the hands; (2) taking apart all the washable parts of the equipment and washing them with warm water; (3) rinsing; (4) placing the parts on a clean towel and covering them with another clean towel to air dry; and (5) storing the parts in a clean plastic bag once completely dry. Alternate two sets of washable equipment to make this process easier.
To prevent the development of tolerance to nitroglycerin (Nitro-Bid) transdermal patch, the nurse instructs the patient to perform which action? A. Apply a new nitroglycerin patch every other day. B. Use the nitroglycerin patch for acute episodes of angina only. C. Apply the nitroglycerin patch in the morning and remove it at night for 8 hours. D. Switch to sublingual nitroglycerin when the systolic blood pressure is greater than 140 mm.
C. Apply the nitroglycerin patch in the morning and remove it at night for 8 hours.
Which instruction should be included in the discharge teaching for a patient with a transdermal nitroglycerin (Nitro-Dur) patch? A. "If you get chest pain, apply a second patch next to the first patch." B. "If you get a headache, remove the patch for 4 hours and then reapply." C. "Make sure to rub a lotion or cream on the skin before putting on a new patch." D. "Apply the patch to a hairless, nonirritated area of the chest, upper arm, back or shoulder."
D. "Apply the patch to a hairless, nonirritated area of the chest, upper arm, back or shoulder."
Beta-adrenergic blockers
Drug class: Sympatholytics (sympathetic depressants), Anti-dysrhythmics Class II • Reduce cardiac output by diminishing sympathetic nervous system response • Antihypertensives, can be used in combination with diuretics Nonselective beta blockers •Inhibit beta1 (heart) and beta2 (lungs) receptors •Propranolol and carvedilol • Cause bronchospasm due to blocking beta2 receptors Mainly used for hypertension, heart failure and dysrhythmia Cardioselective beta blockers •blocks beta1 receptors • Preferred because less bronchoconstriction than nonselective beta blockers •Acebutolol, atenolol, betaxolol, bisoprolol, and metoprolol (metoprolol, atenolol most common) Mainly used for hypertension, stable angina Side effects ➢hypotension, bradycardia, dizziness ➢Insomnia, nightmares, fatigue ➢Depression, erectile dysfunction • Beta blockers cross placental barrier, excreted in breast milk *nonselective beta blockers have more side effects: • Bronchospasms • Inhibit liver function --> hypoglycemic symptoms (caution with DM patients) Contraindications: • Do not give beta blockers to patients with 2nd or 3rd degree AV block or sinus bradycardia • Don't give nonselective beta blockers to COPD patient (bc bronchospasms) Nursing process: • Assessment: o Check liver and renal function • Can cause elevated BUN, creatinine, AST, LDH • Patient teaching: o Herbs can interfere o Do not discontinue abruptly because of reboounf HTN, angina, dysrhythmias, and MI
H. Pylori
H. Pylori (Helicobacter Pylori) • What is it? − A gram-negative bacillus − Linked with the development of peptic ulcer and is known to cause gastritis, gastric ulcer, and duodenal ulcer − H. Pylori can infect the gastric mucosa • Diagnosis − If a pt has recurrent peptic ulcer even after antiulcer therapy, and the ulcer is not a result of NSAIDs (ex: aspirin or ibuprofen), the pt should be tested for H. Pylori − In the past, endoscopy and a biopsy of the gastric antrum were needed to diagnosis − Now, a noninvasive breath test- the Meretek UBT (urea breath test)- can detect Meretek urea breath test: − Consists of drinking a liquid containing 13C urea and breathing into a container − If H. Pylori is present, the bacterial urease hydrolyzes the urea, releasing 13CO2, which is detected by a spectrometer − 90-95% effective in detecting H. Pylori − Blood test may also be used to test for antibodies and a stool test may be done to check for antigens to determine whether the immune system has been triggered to fight H. Pylori • Treatment − Various protocols for treatment − Antibacterial agents are the treatment of choice − Using only one antibacterial agent is not effective for eradicating H. Pylori because the bacterium can readily become resistant to that drug − Treatment includes dual-, triple-, or quadruple-drug therapy − Treatment may include amoxicillin, tetracycline, clarithromycin, omeprazole, lansoprazole, metronidazole, or bismuth subsalicylate on a 7-14 day treatment plan − A common treatment protocol is the triple therapy of metronidazole (or amoxicillin), omeprazole (or lansoprazole), and clarithromycin (MOC) → eradicates more than 90% of peptic ulcers caused by H. Pylori − PPI (proton pump inhibitors), such as omeprazole or lansoprazole, are frequently used because they suppress acid secretion by inhibiting the enzyme hydrogen or potassium adenosine triphosphatase (ATPase), which makes gastric acid − If triple therapy is unsuccessful, quadruple therapy is used, which combines 2 antibiotics, a PPI, and a bismuth or histamine2 (H2) blocker − After treatment, 6 weeks of standard acid suppression (such as H2 blocker therapy) is recommended − Dosage for pharmacological agents used for treatment in Table 43.2 (pg. 569)
Ipecac
IPECAC (emetic) OTC • Action: Induces vomiting after toxic substance ingestion, stimulates CTZ & acts directly on gastric mucosa o Vomiting occurs in 15-30 minutes o If vomiting does not occur, give activated charcoal o If vomiting does not occur, Gastric lavage may be needed to clean stomach (ngtube) • Administration: alert 60 min post ingestion (no longer than 60 mins since substance would be in GI) o Use IPECAC SYRUP (not fluid extract since contains alcohol) o Take with water or fluid i. Not w/ milk or carbonated beverage • Caution: o Avoid vomiting if substance is caustic or petroleum o if vomiting is contraindicated give Activated charcoal -> absorbs toxins in the system o When not to use ipecac ex) bleach should not be vomited, use activated charcoal to absorb
Guaifenesin - expectorant
• Loosens up surfactant on lungs • Drink with water to loosen up secretions • Should produce a productive cough • Interactions can occur with alcohol • Nursing considerations/Pt teaching o Pt should swallow tablet whole (should not be crushed/cut/chewed) o Should not be taken for more than 1 week • Side effects: o Dizziness o Headaches o Nausea/vomiting • Examples: o Mucinex o Mucus Relief o Expectorant Cough Syrup o Refenesen
Theophylline
Name: Methylxanthine derivative Used for: asthma, relaxes smooth muscle of bronchi ^ cAMP promotes bronchodilation Responsibilities: monitor vital signs, provide adequate hydration, regular intervals= sustained therapeutic levels 5-15 mcg/ml Side effects: dizziness, headache, irritability, restlessness, tachy, hypotension, dysrhythmias Education: take med with full glass of water on empty stomach 1 hr before or 2 hr after a meal
Laxatives
laxative- promote soft stool; cathartic- soft to watery stool with cramping; purgatives- watery stool with cramping o Types: • osmotic (saline); (polyethylene glycol (goLYTELY) & Lactulose (chronulac) • Therapeutic Use: treat constipation; Bowel preparation for diagnostics or surgery • Action: o Hyperosmolar salts pull water into colon and increase water in feces to increase bulk, which stimulates peristalsis and defecation. o Produces semi-formed to watery stool • Contraindications o Undiagnosed abdominal pain o Inflammatory disorders of the GI tract • Appendicitis • Diverticulitis • Ulcerative Colitis o Spastic colon o Bowel obstruction o Pregnancy • Toxic/side effects o Fluid and electrolyte imbalances o Hypotension, weakness, cramps o Nausea, vomiting, flatulence, diarrhea • Intervention o Monitor fluid intake and output. o Note evidence of fluid and electrolyte imbalance resulting from watery stools. o Encourage patient to increase water intake. o Advise patient to avoid overuse of laxatives. o Warn patient that the drug is not for long-term use o Inform patient to consume foods high in fiber. • Safe Dose • stimulant (irritants); phenolphthalein (Ex-Lax, Correctol) & bisacodyl (Dulcolax) • Therapeutic Use: treat constipation; Bowel preparation for diagnostics or surgery • Action: o Increase peristalsis by irritating sensory nerve endings in intestinal mucosa o Produce a watery stool • Contraindications o Undiagnosed abdominal pain o Inflammatory disorders of the GI tract • Appendicitis • Diverticulitis • Ulcerative Colitis o Spastic colon o Bowel obstruction o Pregnancy • Toxic/side effects o Abdominal cramps, nausea o Reddish brown urine, diarrhea (GG said see questions about this often) o Fluid and electrolyte imbalances • Intervention: o Results • Orally 2 to 8 hours, • Rectally 15 to 60 minutes o Monitor fluid intake and output. o Note evidence of fluid and electrolyte imbalance resulting from watery stools. o Encourage patient to increase water intake. o Advise patient to avoid overuse of laxatives. o Warn patient that the drug is not for long-term use o Inform patient to consume foods high in fiber. • Safe Dose • bulk-forming; psyllium hydrophilic mucilloid (Metamucil) & calcium polycarbophil (Fiber-Con) • Therapeutic Use: treat constipation • Action o Absorb water into intestines o increase bulk and peristalsis • Contraindications o Undiagnosed abdominal pain o Inflammatory disorders of the GI tract • Appendicitis • Diverticulitis • Ulcerative Colitis o Spastic colon o Bowel obstruction o Pregnancy • Toxic/side effects o Abdominal cramps o Excess laxative • Nausea • Vomiting • Gas • Diarrhea • Intervention o Results • 8-12 hr o Administration • Mix in glass of water or juice • Stir • Drink immediately • Follow with 1 glass water o Monitor fluid intake and output. o Note evidence of fluid and electrolyte imbalance resulting from watery stools. o Encourage patient to increase water intake. o Advise patient to avoid overuse of laxatives. o Warn patient that the drug is not for long-term use o Inform patient to consume foods high in fiber. • Safe Dose • emollient (stool softeners); Docusate (Colace) • Therapeutic Use: treat constipation; Reduces straining post surgery or myocardial infarction • Action: o Lowers surface tension o Promotes water accumulation in intestine o Emulsifies and lubricates feces for easier passage • Contraindications: o Undiagnosed abdominal pain o Inflammatory disorders of the GI tract • Appendicitis • Diverticulitis • Ulcerative Colitis o Spastic colon o Bowel obstruction o Pregnancy • Toxic/side effects o Throat irritation o Abdominal cramping o Nausea o Vomiting o Diarrhea • Intervention o Monitor fluid intake and output. o Note evidence of fluid and electrolyte imbalance resulting from watery stools. o Encourage patient to increase water intake. o Advise patient to avoid overuse of laxatives. o Warn patient that the drug is not for long-term use o Inform patient to consume foods high in fiber. • Safe Dose • Chloride Channel Activators- Lubiprostone (Amitiza Pro) • Therapeutic Use o Idiopathic constipation • Action o Activate chloride channels in the lining of the small intestine, o leading to an increase in intestinal fluid secretion and motility • Contraindications o Undiagnosed abdominal pain o Inflammatory disorders of the GI tract • Appendicitis • Diverticulitis • Ulcerative Colitis o Spastic colon o Bowel obstruction o Pregnancy • Toxic/Side Effects o Nausea, diarrhea, flatus, abdominal distention o Headache • Intervention o Monitor fluid intake and output. o Note evidence of fluid and electrolyte imbalance resulting from watery stools. o Encourage patient to increase water intake. o Advise patient to avoid overuse of laxatives. o Warn patient that the drug is not for long-term use o Inform patient to consume foods high in fiber. • Safe Dose
Nitroglycerin
o AKA nitro, nitrostat, o Vasodilation o For angina, "elephant sitting on their chest" o Types of angina: • Classic (stable) • Occurs with predictable stress or exertion • Unstable (preinfarction) • Occurs frequently with progressive severity unrelated to activity; unpredictable regarding stress/exertion and intensity • Variant (Prinzmetal, vasospastic) • Occurs during rest • Spasms within arteries and veins o Pt should be seated when taking this, can cause vasodilation, low BP (hypotension) o Always wear gloves when administering it (can cause nurse to faint) o Administer sublingually o Nitrate o Action • Promote vasodilation • Decrease preload and afterload o Side effects and adverse reactions • Headache, hypotension • Dizziness, weakness, syncope • fast heart rate • nausea • vomiting • flushing (reddening and warming of your skin) • Rash • Headache is often a sign that this medication is working. o Routes of administration • Sublingual, translingual, topical, aerosol spray (inhalation), IV • Buccal and oral extended-release capsule and tablet o Caution • Do not abruptly discontinue. (could cause an angina attack) o Always wear gloves when handling this drug, this drug will cause you to have a dramatic systemic effect, no pressure going through the body, blood isn't perfusing to the head, you fall and can get a traumatic brain injury that can kill you
Spironolactone- only K+ sparing diuretic
o Action • block action of aldosterone • Promote Na+, H2O excretion, and K+ retention • Used for o Edema due to heart failure o Cirrhosis of the liver • Side effects o Hyperkalemia o Hyperuricemia- collection of uric acid in the blood o Dizziness, HA, weakness, o GI distress o Parenthesis- tingling/prickling feeling o Photosensitivity o Muscle cramps NURSING PROCESS: • Concept o Elimination • Assessment o Assess vital signs, serum electrolytes, weight, and urinary output for baseline levels. • Patient problems o Fluid overload, hyperkalemia • Planning o Patient's blood pressure will be decreased. o Patient's electrolytes will be within normal range. • Nursing interventions o Monitor urinary output. o Record vital signs and report abnormal changes. o Observe for signs and symptoms of hyperkalemia. o Administer spironolactone in the morning to avoid nocturia. o Advise patients with high serum potassium levels to avoid foods high in potassium (don't use salt substitutes) • Evaluation
Amlodipine
o Ca+2 channel blockers which block the calcium channel in the vascular smooth muscle --> promoting vasodilation. Used for hypertension • Also blocks Ca+2 channels in the heart --> decrease contractility o Peripheral edema may occur because of its vasodilator effect, so persons with edema may need to take another type of antihypertensive drug o beta blockers are not prescribed with calcium blockers, because both drugs decrease myocardium contractility
Diazepam
o Diazepam is used to treat anxiety disorders, alcohol withdrawal symptoms, or muscle spasms. o Diazepam is sometimes used with other medications to treat seizures. o You should not use this medicine if you are allergic to diazepam or similar medicines (Klonopin, Xanax and others), or if you have myasthenia gravis, severe liver disease, narrow-angle glaucoma a severe breathing problem, or sleep apnea.
Nasal Decongestants
o Ex: pseudoephedrine (Sudafed) o Use: sinusitis, rhinitis, nasal congestion, common cold o Can get rebound nasal congestion (from vasodilation) if prolonged use for more than 3 days o Action: Nasal decongestants (sympathomimetic amines) stimulate the alpha-adrenergic receptors to promote vasoconstriction of the capillaries within the nasal mucosa. The result is shrinking of the nasal mucous membranes and a reduction in fluid secretion (runny nose). This decreases the amount of swelling and formation of mucus in the nose from the common cold, sinusitis, and upper respiratory allergies. o Administration → nasal spray, drops, tablets, capsules, or liquids o Side effects → HTN, drowsiness, dizziness, headache, blurred vision, restlessness, insomnia, palpitations, dysrhythmia, tachycardia, photosensitivity, GI distress o Contraindicated in HTN patients, cardiac disease, hyperthyroidism, DM • As with any alpha-adrenergic drug such as decongestants - BP and blood glucose levels can increase o Interactions → • Beta-blockers - decreases effect of beta blockers • MAOIs (anti-depressives) - can increase HTN or cardiac dysrhythmias • Caffeine - increases side effects of restlessness and palpitations
Montelukast Patient Education
o Medications that end in -ast o Montelukast (singulair) and Zafirlukast are Leukotriene Receptor Antagonists -> it prevents inflammation and bronchoconstriction. o Leukotriene receptor antagonists stops leukotrienes from starting inflammatory process, decrease in bronchoconstriction o Montelukast is considered a PROPHYLACTIC treatment. Used as a preventative for exercise induced asthma o Uses for Montelukast: allergic rhinitis and asthma prevention. o Side effects: o Dizziness, headache, confusion, GI distress, depression, weakness, infection o Contraindications: o Hypersensitivity, severe asthmatic attack, acute bronchospasm, not used for acute asthma attacks* o Caution: o Hepatic disease o Depression, suicidal ideation o Breastfeeding, pregnancy o Corticosteroid withdrawal o Alcoholism o Older adults Patient education: it takes 1-2 weeks to reach therapeutic range. Let px know that this is not a rescue medication for asthma. *shake inhaler, wait 1-5 min between pumps. Rinse mouth and spit after inhaler use - prevent candida (thrush)
Antacids
o Neutralize acid in stomach o Liquid or tablet form o Contain bases such as aluminum, calcium, magnesium, or sodium bicarbonate to counteract stomach acid and neutralize pH o Can decrease effectiveness of medications. If so, take antacid med 1 hour before or after taking OTHER MEDS. o Take 1hr prior to eating or 2 hrs after o Uses o Acid reflux aka GERD (gastroesophageal reflux disease) o Dyspepsia (indigestion) o Side effects o Directly related to ingredients (calcium, magnesium, etc) o Constipation o Diarrhea o Nausea o Vomiting o High blood levels of ingredient (calcium, magnesium, sodium bicarbonate) o Drug Examples o Milk of magnesia o Tums --> when consumed in high doses for a long time may cause acid rebound. o Ex-lax o Gas-X
Digoxin Toxicity
o Overdose or accumulation of digoxin causes digitalis toxicity o Signs and symptoms: anorexia, diarrhea, nausea, vomiting, bradycardia (below 60bpm), premature ventricular contractions, cardiac dysrhythmias, headaches, malaise, blurred vision, visual illusions (white, green, or yellow halos around objects), confusion, and delirium). Report symptoms immediately to the HCP. o Older adults are more prone to toxicity o Cardiotoxicity is a serious adverse reaction to digoxin, which result in ventricular dysrhythmias. o Three cardiac-altered functions can contribute to digoxin-induced ventricular dysrhythmias: • (1) suppression of AV conduction • (2) increased automaticity • (3) a decreased refractory period in ventricular muscle. • The antidysrhythmic phenytoin and lidocaine are effective in treating digoxin- induced ventricular dysrhythmias. Lidocaine should be limited to short-term treatment. o Many of the potent diuretics such as furosemide (Lasix-loop diuretic) and hydrochlorothiazide, promote the loss of potassium (hypokalemia) from the body, which increases the effect of digoxin. o Patients who take digoxin along with a potassium-wasting diuretic of a cortisone drug should consume foods rich in potassium or take potassium supplements to avoid hypokalemia and digitalis toxicity. o Monitor serum potassium levels (normal range is 3.5-5.0 mEq/L), and report is hypokalemia (<3.5 mEq/L) is present. Antidote -> Digoxin-immune Fab (Digifab, Digibind)
Heparin laboratory values
o PTT (Partial thromboplastin time) 1.5 to 2 times control value (control 60 to 70 seconds) o aPTT (activated partial thromboplastin time) 30 to 85 seconds (control 20 to 35 seconds) o Used to detect deficiencies of certain clotting factors o May increase with AST, ALT o Decrease diet rich in vitamin K o Heparin increased effect with aspirin, NSAIDS, thrombolytics, probenecid, antibiotics, SSRIs; decreased effect with nitroglycerin, protamine sulfate o Side effects • Bleeding o Antidote • Protamine sulfate o Low-Molecular Weight Heparin o Frequent lab monitoring is not required. • It does not have the standard effect of heparin • Inactivates the Xa factor, but it is less able to inactive thrombin
Safety with Heparin
• Don't take aspirin concurrently • Frequent lab monitoring is not required • Labs
Phenothiazine antiemetics
• A group of antipsychotic meds and a dopamine antagonist • Action: o Blocks dopamine receptors in the cerebral cortex (CTZ) • Use: o Postoperative nausea, vomiting from chemotherapy, radiation sickness, anesthetics • Use in smaller doses as an antiemetic b/c it is primarily an antipsychotic • Side effects: o Moderate sedation o Orthostatic hypotension o Extrapyramidal symptoms (EPS): muscle spasms in neck & muscle stiffness o CNS effects: mild anticholinergic symptoms (can't see b/c dry eyes, can't spit b/c dry mouth, can't pee b/c no urine, can't shit b/c dried up poop/constipation) • Contraindicated: o Droperidol (Inapsine) in patients with QT prolongation • promethazine (Phenergan): Is also an antihistamine. Inhibits CTZ and blocks H1 receptor sites. Its uses are same as above. It is metabolized by the liver and excreted in urine and feces. Side effects include: o Drowsiness, dry mouth, blurred vision, urinary retention, constipation o Tachycardia, photosensitivity, EPS o Tardive dyskinesia: repetitive, involuntary movements like grimacing and eye blinking d/t long-term use of neuroleptic drugs o Acute dystonia: involuntary contractions of muscles in extremities, face, neck, abdomen, pelvis, larynx --> abnormal movements or postures o Akathisia: muscle quivering, restlessness, inability to sit still • prochlorperazine maleate (Compazine): given rectally to people with vomiting • chlorpromazine/Thorazine: may use to decrease anxiety associated with chemo
Antihypertensives - ACE Inhibitors, Beta Blockers, Calcium Channel Blockers
• Abrupt discontinuation of antihypertensive drugs may cause rebound hypertension o ACE Inhibitors → end in -pril • Action: inhibits formation of Angiotensin II, blocks the release of aldosterone • Side effects: • Acronym "ACE" • A - angioedema • C - cough (nonproductive) • E - Electrolyte imbalances (hyperkalemia) • Other side effects: • NVD, hypotension, tachycardia, insomnia, headache, orthostatic hypotension • Contraindications: *Do not give with spironolactone (K-sparing diuretics) b/c of risk of hyperkalemia, avoid administering to pregnant patients ➢ African Americans and older adults do not respond to ACE inhibitors... but when taken with a diuretic, blood pressure will usually be lowered. ➢ Patients with renal insufficiency, reduction of the drug dose (except for fosinopril) is necessary ➢ Advice patients to avoid foods high in potassium because risk of hyperkalemia o Calcium Channel Blockers • Ex: Amlodipine, Diltiazem, verapamil, felodipine • Action → blocks CA channels in vascular smooth muscle cells, promoting vasodilation • Side effects: • Flushing, headache • Dizziness, blurred vision • Peripheral edema, fatigue • Nausea, constipation • Bradycardia, hypotension • ED → Calcium blockers lower blood pressure better in African Americans than other antihypertensives o Beta Blockers → end in -lol • Non-selective: inhibit beta1(heart) and beta2(bronchial) receptors, and can potentially block the release of insulin • Inhibits liver's ability to convert glycogen --> glucose in response to hypoglycemia, should be used with caution in patients with diabetes mellitus • Affects many beta receptors in multiple areas, i.e. heart, lungs (bronchospasm), pancreas (impairing release of insulin —> hyperglycemia) • Heart rate slows, blood pressure & heart rate decrease, bronchoconstriction occurs. • Ex: → propranolol, carvedilol • Cardioselective: mainly blocks beta1 receptors • Most preferred because they act mainly on beta 1 -rather than the beta 2 receptors and bronchoconstriction is less likely to occur • Ex: → atenolol, metoprolol, acebutlol, betaxolol, bisoprolol • Do not give to asthma pt's due to bronchoconstriction • 3 B's for side effects: • Bradycardia (do NOT give if pt's HR is less than 60bpm!) • Bronchoconstriction • Bottomed out BP (hypotension) • Other side effects → nightmares, insomnia, ED (erectile dysfunction)
Aluminum hydroxide
• Antiulcer, antacid medication - treats hyperacidity, gastric and duodenal ulcer, and reflux esophagitis; also to reduce hyperphosphatemia (from poor renal function) • Nonsystemic antacid composed of an alkaline salt (aluminum) • Small degree of systemic absorption - calcium carbonate is most effective antacid in neutralizing acid, but 1/3 to 1/2 of drug can be systemically absorbed and can cause acid rebound • Aluminum and calcium can cause constipation with long term use • Magnesium hydroxide has greater neutralizing power than aluminum hydroxide • A combo of aluminum and magnesium can be used to balance the diarrhea caused by magnesium and constipation caused by aluminum - magnesium hydroxide and aluminum hydroxide often used together • Neutralizes gastric acid, including hydrochloric acid, and increases pH of gastric secretions - increases pH inactivates pepsin • Onset of action fairly rapid, but duration of action varies depending on if it's taken with food o After meal - duration of action may be up to 3 hours bc food delays gastric emptying time o Empty stomach - 30-60 minutes before passing into duodenum o Ideal dosing interval for antacids is 1-3 hours after meals (max acid secretion occurs after eating) and at bedtime • Liquid antacids should be taken w water to ensure it gets to stomach, but no more than 4oz bc water quickens gastric emptying time • Only small amount is absorbed from GI tract (and excreted as urine) - it is primarily bound to phosphate and excreted in feces • Prolonged use of aluminum hydroxide can cause: hypophosphatemia, osteoporosis, nephrolithiasis, and osteomalacia • In patients with renal insufficiency/failure aluminum salt can cause encephalopathy from accumulation of aluminum in the brain
Albuterol (Proventil) or Levalbuteral
• This drug is a bronchodilator: selective beta 2-adrenergic agonist • Used: For chronic asthma, acute bronchospasm. First rescue inhaler (rapid onset of action) and should be used when symptoms worsen. Bronchospasm prophylaxis. • Mechanism of Action: o Activates Beta2 in the lungs, which dilates bronchi resulting in increased airflow o Longer duration of action o It also activates Beta 1 which increases HR. • Side effects: lightheaded, tremors, tachycardia, hyperglycemia, palpitations, excitability, rhinitis, headache • contraindications: avoid beta blockers (-lol) --> bronchospasms, NSAIDS like Naproxen and Ibuprofen which can worsen asthma. • Overuse of the medication can result in airway narrowing and bronchospasm. Px should be cautious not to overuse the medication
Cardiac Glycosides
• This group of drugs inhibit the sodium-potassium pump, --> increase in intracellular sodium. o This increase leads to an influx of calcium, which causes the cardiac muscle fibers to contract more efficiently. • Cardiac Glycosides include digoxin and phosphodiesterase inhibitors o Digoxin § Action: • Positive inotropic -- slow down and SQUEEZE HARDER!! o Increases myocardial contraction stroke volume • Overtime, heart is going to increase in size o Decreases preload o Increases blood flow • Negative chronotropic o Decreases heart rate • Demands less oxygen • Negative dromotropic o Decreases conduction of heart cells • Decreases oxygen demands decrease dyspnea (a.k.a. breathing will improve) • NOTE: Therapeutic range of digoxin = 0.5-2 ng/mL o Any value higher than 2 ng may mean toxicity 0.5-1: heart failure target 0.8-2: dysrhythmias target § Side effects/adverse effects • Bradycardia, cardiac dysrhythmias o Do NOT give meds if patient's heart rate is low o Warfarin (coumadin) may be used to prevent thromboemboli • Anorexia, nausea, vomiting, diarrhea o Lose appetite due to funny taste in mouth • Headache, dizziness o Watch for orthostatic hypotension • Blurred or yellow vision** • Confusion, weakness • Antidote for digitalis toxicity = digoxin immune fab § Drug interactions • Diuretics o Hypokalemia • Digoxin has inverse relationship with potassium. The MORE potassium, the LESS effective digoxin is. The LESS potassium, the MORE effective digoxin is • Cortisone o Sodium retention • Antacids o Decrease digitalis absorption • Licorice promotes potassium loss, increase digoxin effects • Ginseng, st johns wort, Ginger, ginko can influence effects • Patient Education • Instruct patient to report side effects • Adhere to drug therapy • Avoid OTC drugs without consulting healthcare provider first • Keep drugs out of reach of children • Teach patients and caregivers to check the pulse rate • Possible herb-drug interactions • Mild exercise, no smoking, no alcohol, and salt to less than one teaspoon/day (nonpharmacologic methods) can be done in conjunction to taking meds o Phosphodiesterase inhibitors § Ex. Milrinon lactate § Action • Inhibit enzyme phosphodiesterase • Promote positive inotropic effects increase perfusion • Increase stroke volume, cardiac output, and vasodilation § Caution • Administer IV no longer than 48-72 hrs to avoid severe cardiac dysrhythmias • High alert medication
Nitroglycerin
☺ Antianginal nitrate drug o Nitrates were the first agents used to relieve angina o Causes generalized vascular and coronary vasodilation which increases blood flow through coronary arteries to the myocardial cells • Acts directly on the smooth muscle of blood vessels, causing relaxation and dilation. • Decreases cardiac preload and afterload which reduces myocardial O2 demand. o Reduces myocardial ischemia but can cause hypotension o Most commonly taken sublingual (SL) nitroglycerin tablet, which is absorbed under the tongue, it is not swallowed because it undergoes first-pass metabolism by the liver, which decreases its effectiveness. o Side effects: Headache (most common) --> due to vasodilation, dizziness, hypotension, faintness because of peripheral vasodilation. o Contraindications: Viagra and systolic BP below 90-100 or if we see a drop by 30mmhg in systole. These factors will lead to dangerously low BP. o Some signs and symptoms of low BP include lack of coordination, irritability, sweating and pallor. o CAUTION: wear gloves when handling Nitro! If the tablet is broken and you pick it up with bare hands, you can absorb Nitro through your skin • Experience massive systematic vasodilation effect, brain loses perfusion, tunnel vision o Patient education: teach px to get up slowly to prevent dizziness or falling due to orthostatic hypotension that the medication may cause. o CAUTION: When nitroglycerin ointments or patches are discontinued, the dose should be tapered over several weeks • Helps prevent the rebound effect of severe pain caused by myocardial ischemia (lack of blood supply to the heart muscle) o IV nitroglycerin may antagonize the effects of heparin
Digoxin
☺ Cardiac Glycoside o SE/ Adverse effects: • Bradycardia, cardiac dysrhythmias • Anorexia, nausea, vomiting, diarrhea • Headache, dizziness • Blurred or yellow vision • Confusion, weakness o Drug Interactions: • Diuretics can cause hypokalemia • Cortisone can cause sodium retention • Antacids decrease digitalis absorption o Action: • Positive Inotropic (strengthening the heart's contractions, so it can pump more blood with fewer heartbeats) ▫ Increase myocardial contractility ▫ Increase stroke volume- blood pumped out of the left ventricle during systole ▫ Decrease preload- volume of blood in ventricles at the end of diastole ▫ Increase blood flow • Negative Chronotropic (affects HR) ▫ Decrease heart rate • Negative Dromotropic (affects the conduction speed) ▫ Decrease conduction of heart cells o Medication used for heart failure or A. Fib o Can be administered orally or by IV o In patients with HF, digoxin increases contractility of the heart, but decreases conduction through the AV node which ultimately decreases heart rate. o Long half-life (30-40 hours) --> Because of long half-life, drug accumulation can occur o 30% is metabolized in the liver; 70% is excreted in the kidney • Kidney dysfunction can affect excretion of digoxin, since it is mostly secreted in the kidneys. o Apical pulse should be taken for a full minute and should be greater than 60 beats/min before administering this medication. o Digoxin therapeutic serum level for patients with dysrhythmias is 0.8-2.0 ng/mL • Therapeutic serum level for patients in heart failure is 0.5-1.0 ng/mL