Pharmacology Exam 3

A pt is prescribed enteric-coated aspirin for join pain management. Which statement does the nurse make to the patient while administering enteric-coated aspirin? "You should chew the tablet properly" "You should swallow the tablet with water" "You should crush the tablet and mix with food" "You should dissolve the tablet in water and then ingest"

"You should swallow the tablet with water"

Patient Teaching on Calcium Channel Blocker

*Assess heart rate/ bp before taking med *record any anginal attacks *do not crush or chew sustained release medication *keep a record of your blood pressure

Signs/ Symptoms 7L's of HYPOkalemia

*Lethargic: confusion *Low Shallow: respirations *Lethal Cardiac Cramps: ECG changes ST depression inverted T waves *Loss of Urine: Decreased urine output *Leg Cramps: Decreased tendon flexes *Limp Muscles; Flaccid paralysis *Low B/P and H/r: Weak pulse thready irregular

Lasix Patient Teaching::

- take as directed, take missed doses as soon as possible, do not double dose -contact doctor if more than 3 pounds are gained in a day -change positions slowly to minimize orthostatic hypotension -sunscreen/protective clothing to prevent photo sensitivity reactions -contact Hc provider if taking OTC meds or herbal products w/ this therapy

Calcium Channel Blocker mechanism of action

-Relax smooth muscle-coronary arteries -dilate- blood flow increases to ischemic (damaged) hear areas -increased supply/demand shifts back to normal.

osmotic diuretics are used for what?

-acute rental failure -promised excretion of toxic substances -reduce intracranial pressure -tx of cerebal edema (mannitol) -intraocular pressure

Therapeutic level of Digoxin

0.5-2 ng/mL

Which solution should the nurse administer w/ packed red blood cells?

0.9% Sodium Chloride

A client in the Emergency department has an acute Myocardial infarction. The HCP has prescribed thrombolytic therapy. Which assessment data should the nurse report immediately to the HCP? 1) Client has a hx of cerebral arteriovenous malformation 2) client is currently menstruating 3) client rates chest pain as 8 on a scale 0-10 4) current blood pressure is 170/92

1) Client has a hx of cerebral arteriovenous malformation

2 Actions of Mannitol

1) Diuresis: Increases the osmotic pressure of the glomerular filtrate, inhibiting tubular reabsorption of water and electrolytes, thus promoting diuresis and urinary elimination of certain drugs 2) In the brain the presence of mannitol in the cerebral vasculature creates an osmotic force that draws fluid out of the brain.

The patient is started on ezetimibe for elevated cholesterol. The nurse demonstrates understanding of the mechanism of action of this drug when including which statement in the pt education presentation? 1) this drug inhibits cholesterol synthesis in the liver 2) this drug inhibit cholesterol absorption in the bowel 3) this drug sequesters bile acids in the small bowel 4) This drug increases pancreatic secretion facilitating lipid breakdown

2) Extimibe is a cholesterol absorption inhibitor that acts on the cells In the small intestine to inhibit cholesterol absorption. It decreases cholesterol from dietary absorption, reducing serum cholesterol.

Which lab test should be checked before the pt receives a dose of potassium?

A potassium level should be drawn before administering a dose to prevent HYPERKALEMIA. Normal potassium range is 3.5-5 mEq/L

A client w/ a hx of heart failure calls the clinic and reports a 3 lb weight gain over the past 2 days and increased ankle swelling. The nurse reviews the client medications and anticipates the immediate need for dosage adjustment of which medication? a) Bumetanide b) candesartan c) carvedilol d) isosorbide

A) Bumetanide Most pts w/ heart failure are prescribed a loop diuretic to reduce fluid retention.

When administering a loop diuretic to a patient, it is most important for the nurse to determine if the patient is also taking which drug? a) Lithium b) acetaminophen c) penicillin d) Theophylline

A) Lithium

The nurse is monitoring a client who has been on clopidogrel therapy. which assessment are essential? Select ALL THAT APPLY: a) assess for bruising b) assess for tarry stools c) monitor intake and output d) monitor liver function tests e) minitor platelets

A)assess for bruising b) assess for tarry stools c) monitor platelets

A nurse is transfusing a unit of packed red blood cells for a client who has anemia due to chemotherapy. The client reports a sudden h/a and chills. the clients temperature is 2 degree higher than her baseline. in addition to notifying the provider, which of the following actions should the nurse take? a) stop the transfusion b) place the client in an upright position w/ feet down c) remove the blood bag and tubing from the client's IV catheter d) obtain a urine specimen from the client

A,C,D Stop the transfusion, the client may be having a hemolytic reaction to the blood or a febrile reaction The nurse should avoid infusing more into clients vein, should remove the blood and bag from the pts IV catheter. Urine specimen to check for hemolysis is standard procedure when the client has a reaction to blood transfusion.

A patient who has been taking antihypertensive drugs for a few months complains of having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?

Angiotensin-converting enzyme (ACE) inhibitors "Ace Cough"

Procainamide (pronestyl) class:

Antiarrhythmic

Digoxin Immune Fab (Digibind) what is it used for:

Antidote for SEVERE digoxin overdose Binds w/ molecules of digoxin in the blood, inactivating it. The molecules are then excreted by the kidney.

Which drug class is used for both hypertension and antidysrhythmias a) sodium channel blockers b) calcium channel blockers c) direct-acting vasodilators d) Alpha-adrenergic-blocking

B) Calcium Channel Blockers

Which assessment finding in a pt taking HMG-CoA reductase inhibitor will the nurse act on immediately. a) decreased hemoglobin b) elevated liver function tests c) elevated HDL d) elevated LDL

B) Elevated liver function tests Statins can cause Hepatic Toxicity; therefore necessary to monitor liver function tests.

The nurse is preparing to give a potassium supplement. Which lab test should be checked before the pt receives a dose of potassium? a) complete blood count b) serum potassium level c) serum sodium level d) liver function studies

B) Serum Potassium Level It is important to know the pt electrolyte levels before beginning electrolyte replacement therapy. Giving potassium supplements to a pt whose serum potassium levels are already high may cause worsening of the hyperkalemia.

For pts prescribed amiodarone, the nurse should monitor for which potential adverse effect of this drugs? (select all that apply) a) diarrhea b) visual halos c) hypothyroidism d) photosensitivity e) overgrowth of gum tissue f) blue gray skin discoloration

B, C, D,F visual halos hypothyroidism photosensitivity blue gray skin discoloration

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

B: All statins are generally dosed once daily, usually the evening meal or at bedtime to best coincide w/ the body's natural diurnal rhythm of cholesterol production.

What patient history would the nurse recognize as a contraindication for beginning Niacin therapy? A.Allergy to erythromycin B.Gout C.Coronary artery disease D.Hypothyroidism

B: GOUT

While preparing an infusion of mannitol, the nurse notices small crystals in the IV tubing. What is the most appropriate action by the nurse? a) administer the infusion slowly b) discard the solution and obtain another bag of medication c) obtain a filter and then infuse the solution d) return the fluid to the IV bag to dissolve the crystals.

B: Discard the solution and obtain another bag of medication even though a filter should always be used w/ this medication infusion, a solution w/ crystals present in the bag or tubing should never be infused. Discard & get a new one

A patient is taken to the trauma unite after a motorcycle accident. It is estimated that he has lost 30% of his blood volume and he is in hypovolemic shock. the nurse anticipates a transfusion with which blood product? A) PRBCs B) Whole Blood C) Cryoprecipitate D) FFP

B: Whole Blood whole blood is more beneficial in cases of extremely loss of blood volume (more then 25%)

Infusion of Lidocaine

Bc of its extensive hepatic metabolism, dosage reduction by 50% is recommended in patients w/ liver disease or any renal impairment

Blood Transfusion Pre Meds:

Benadryl Tylenol

A nurse is assessing a client during transfusion of a unit of whole blood. The pt develops a cough, SOB, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications? a) Epinephrine (adrenalin) b) lorazepam (Ativan) c) furosemide (lasix) d) diphenhydramine (Benadryl)

C) Furosemide (lasix) A loop diuretic may be prescribed to relieve manifestations of circulatory overload

s/e of Lidocaine infusion::

CNS toxic effects: twitching, convulsions, and confusion Respiratory: depression, or arrest, Cardiovascular; hypotension Use extremely caution when selecting proper lidocaine solution. Solution mixed w/ epinephrine should NEVER be used intravenously. document v/s prior to initiation of drug therapy

The nurse is preparing for a community education program on hypertension. Which of these parameters determine the regulation of arterial blood pressure?

Cardiac Output & Systemic Vascular Resistance

Platelets given for...

Cirrhosis of liver, low platelet count

What helps tolerance to transdermal nitroglycerin Therapy?

Common regimen w/ transdermal patches is to remove them at night for 8 hours and apply new patch in the morning. This has been shown to prevent tolerance to the beneficial effect of nitrates

What parameters determine the regulation of arterial blood pressure?

Controlled by the kidneys. Too much fluid causes the pressure to rise, too little fluid causes the pressure to drop. The two determinants of arterial bp are the volume of renal output and the amount of salt and water in the system.

lasix Drug interactions

Corticosteroid antihypertensives alcohol nitrates digoxin

A patient is receiving lidocaine by continuous intravenous infusion. The nurse understands this medication is prescribed for what condition? a) atrial fibrillation b) sinus bradycardia c) first-degree heart block d) ventricular dysrhythmias

D) Ventricular Dysrhythmias

A client w/ hypertension is prescribed lisinopril. the nurse instructs the pt to notify the HCP immediately if which adverse effect occurs when taking this medication? a) cough b) dizziness c) rapid-onset confusion d) swelling of the lips and tongue

D) Swelling of the lips and tongue Lisinopril adverse reaction of angioedema (Swelling of lips, tongue, throat, face, and larynx) Angioedema can lead to airway obstruction and possible death.

Which pt is the best candidate to receive nesiritide therapy? a) a pt w/ atrial fibrillation who has not responded to other drugs b) a patient needing initial treatment for HF c) a pt w/ reduced cardiac output d) a pt w/ acutely decompensated HF who has dyspnea at rest

D) a pt w/ acutely decompensated HF who has dyspnea at rest

Lasix s/e

Dehydration, hypokalemia, hypomagnesium, hypovolemia, metabolic acidosis

Dosage of Digoxin Immune Fab:

Dosed based on the patient's serum digoxin level in conjunction w/ his or her weight.

Lasix indications

Edema d/t heart failure, hepatic impairment, or renal disease; hypertension

fresh frozen plasma is used to treat what condition?

FFP is used for pts w/ low levels of clotting factors

S/Sx Transfusion Reactions:

Fever, SOB, Itching, Severe Low Back Pain

Niacin s/e & Adverse Effects

GI Distress, facial flushing, puritis, rash, temporary tingling of Hands and feet, hepatotoxicity hyperuricemia

Other s/sx of procainamide

GI effects such as nausea, vomiting, diarrhea. Other adverse effects include fever, leukopenia macularopapular rash, flushing, torsades de pointes resulting from prolongation of the QT interval.

Niacin Administration Considerations:

Given PO. Take aspirin or NSAID 30 min before each dose to reduce s/e such as flushing. NEED LARGE DOSES to achieve lipid-lowering effects

Packed Red Blood Cells Given For....

H&H is lower then normal Anemic

Niacin Contraindications:

HTN, Peptic Ulcer Disease, Liver Disease, active bleeding, GOUT

Undesirable effect of thrombolytic therapy

Internal, intracranial, and superficial bleeding. (others include hypersensitivity, anaphylactoid reactions, nausea, vomiting, hypotension) (induce cardiac dysrhythmias)

Uses of Mannitol

Mannitol may induce vasodilation; excellent drug for preventing kidney damage during acute renal failure. OFten used to reduce high intraocular or intracranial pressure/ edema.

Niacin Nursing Considerations

Monitor blood glucose, obtain baseline liver function tests, monitor liver and kidney function, BUN, Creatinine, I&O

Mannitol

Most common osmotic diuretic.

Side Effects of Statins

Most common side effect constipation and peptic ulcer. H/a, dizziness, blurred vision, fatigue, insomnia, diarrhea, nausea, myalgia, and skin rashes. GI s/e reduced buy increasing fluids and fiber in diet Increase liver enzymes; regular lab testing blood levels to insure w/in normal range

Adverse Effects of Statins

Myopathy (muscle pain) and rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle protein accompanied by myoglobinuria, which is urinary elimination of muscle protein. This can lead to renal failure and even death.

The nurse is reviewing the orders for a pt and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction w/ what other drug class?

NSAIDS

Nursing Implications for HMG-CoA::

Obtain liver enzymes baseline & monitor every 6 months Monitory CPK levels Avoid grapejuice timing w/ or w/o food varies w/ drug Instruct client to report any muscle tenderness, monitor dose limits when interacting medications prescribed.

Mannitol contraindications

PTs w/ unuria, severe dehydration, pulmonary congestion, or cerebral hemorrhage.

Lasix (furosemide) Action::

Reduces edema and increased urinary output

Whole Blood therapeutic uses

Replacement therapy for acute blood loss secondary to traumatic injuries or surgical procedures. Volume expansion in clients who have extensive burn injury, dehydration, shock

HMG-CoA Reductase Inhibitors

Statins, considered first line drugs in the management of hyperlipidemia They are potent drugs for lowering LDL and total cholesterol levels They also may improve HDL cholesterol and triglyceride levels.

Niacin Interactions:

Statins--increase risk for myopathy

Enteric-coated low dose aspirin is givens preventative for stroke

The enteric coating of the aspirin tablet prevents the release of the drug in the stomach; instead it dissolves in the duodenum. Preventing gastric ulceration.

When providing pt teaching to a patient who is taking a potassium-sparing diuretic such as spironolactone (aldactone), the nurse will include which dietary guidelines? a) there are no dietary restriction w/ this med b) the pt needs to consume foods high in potassium c) pt needs to avoid excessive intake of foods high in potassium d) pt needs to drink 1-2 oz of fluid per day

The pt needs to avoid excessive intake of foods high in potassium

Major wanting for Ibutilide

Torades de pointes (fast heart rhythm)

Continuous Infusion of lidocaine

Tx for ventricular dysrhythmias administered intravenously bc it has an extensive first-pass effect

Why is a thrombolytic agent given to a patient having an MI?

Underlying cause of acute MI was coronary artery occlusion. Marking the rapid growth in the use of thrombolytic drugs for each tx of each acute MI. Studies show early thrombolytic therapy could bring about 50% reduction in mortality.

Niacin Actions/uses

Used to decrease LDL cholesterol and triglyceride levels. Used for clients at risk for pancreatitis and elevated triglyceride levels.

Nesiritide: pharm class

Vasodilators: Used in the ICU setting as a final effort to treat severe, life threatening heart failure. (rarely used d/t worsened renal failure and increased mortality rate)

ADVERSE REACTIONS procainamide (pronestyl)

Ventricular dysrhythmias and blood disorders. It can cause a systemic lupus erythematous-like syndrome, which occurs in about 30% of pts on long term therapy.

Which are indications for the use of diuretics? (Select all that apply) A. To increase urine output. B. To reduce uric acid levels. C. To treat hypertension. D. To treat open-angle glaucoma. E. To treat edema associated with heart failure.

a,c,d,e increase urine output, treat hypertension, open angle glaucoma, to treat edema associated with HF

Niacin (Nicotinic Acid, Vit B3) Pharmacological Class:

Water Soluble Vitamins (lipid lowering agent)

Whole blood used to treat what percentage of blood loss? Who else would receive this product besides trauma?

When pt has lost 25% or more of blood volume. whole blood is most given to pts of trauma and surgery.

When monitoring lab results for patients receiving loop and thiazide diuretics, the nurse knows to look for? a) decreased serum levels of potassium b) increased serum levels of calcium c) decreased serum levels of glucose d)increased serum levels of sodium

a) decreased serum levels of potassium

a 62 y/o man is to receive lidocaine as a treatment for a symptomatic dysrhythmia. Upon assessment, the nurse notes that he has a history of alcoholism and has late-stage liver failure. The nurse will expect which adjustment to his drug therapy? a) the dosage will reduce by 50% b) A diuretic will be added to the lidocaine c) the lidocaine will be changed to an oral dosage form d) An increased dosage of lidocaine will be prescribed so as to obtain adequate blood levels.

a) dosage will be reduced 50% Lidocaine is metabolized in the liver, a reduction may be necessary in cases of liver failure, cirrhosis.

General diuretic teaching for a patient:

a)take med in Am to avoid interference w/ sleep b) maintain proper fluid volume status c) eat more potassium rich foods (only if drug is not potassium sparing) d) if taking w/ digoxin, monitor for toxcity e) reposition slowly to avoid orthostatic hypotension f) keep a log of daily weight g) s/sx fo hypokalemia

What enzyme is inhibited by the use of statin drugs? a) hsCRP b) HMG COA c) VLDL d) Cholesterol

b) HMG COA

The nurse is reviewing the classes of antidysrhythmic drugs. Amiodarone is classified on the Vaughn Williams classification as class III drug, which means it works by which mechanism of action? a) blocking slow calcium channels b) prolonging action potential duration c) blocking sodium channels and affecting phase 0 d) decreasing spontaneous depolarization and affecting phase 4

b) Prolonging action potential duration Class III drugs increase the action potential duration by prolonging repolarization in phase 3.

A pt has a new order for a daily dose of spironolactone (aldactone). which condition, if present, may be a contraindication to this drug therapy> select all a) HF b) renal failure c) DM d) DVT e) hyperkalemia

b,e renal failure, hyperkalemia

Signs of digoxin toxicity

bradycardia- h/a- dizziness- confusion-nausea- visual disturbances

A nurse is caring for a hospitalized pt who has an activated partial thromboplastin time (aPTT) greater than 1.5 times the expected reference range. which of the following blood products should the nurse prepare to administer? a) whole blood b) platelets c) fresh frozen plasma d) packed red blood cells

c) Fresh frozen plasma FFP is indicated for a pt who has elevated aPTT because it replaces coagulation factors and can help prevent bleeding.

Diltiazem (Cardizem)

calcium channel blocker control of rapid ventricular rates due to atrial flutter, atrial fibrillation, angina pectoris

Amlodipine

can cause edema to ankles (CHF pts to worsen) flushing, HA, reflex tachycardia. LONG HALF LIFE

SideEffects of Diltiazem

constipation, bradycardia, hypotension, heart block, edema, dizziness, dyspnea

clinical use of ibutilide

convert A-fib/ flutter only conversion only only available IV

What can occur in the mannitol solution?

crystallization, this can be reversed by running the bag under cold water although it is still vital that the medication is run through a micron filter Vials are often store in a warmer

When monitoring a pt for hypokalemia related to diuretic use, the nurse looks for which possible symptoms? a) nausea, vomiting, anorexia b) diarrhea and abdominal pain c) orthostatic hyptotension d) muscle weakness and lethargy

d) muscle weakness & leathery

What action is often recommended to help reduce tolerance to transdermal nitroglycerin therapy? a) omit a dose once a week b) leave the patch on for 2 days at a time c) cut the patch in half for 1 week until the tolerance subsides. e) remove the patch at bedtime, and then apply a new one in the morning

d) remove the patch at bedtime and then reapply in the mroning

S/ SX transfusion reaction

fever- SOB- itching- severe low bak pain

Loop Diuretics: how do they work:

furosemide, bumetanide, torsemide Drugs that increase the excretion of Na, water, and other electrolytes in the kidneys by increasing urinary output.

What to avoid with Calcium Channel Blockers(CCB)

grapefruit juice (can increase levels of some CCB)

Adverse Effects of Nesiritide:

hypotension, cardiac dysrhythmias, insomnia, headache, abdominal pain

Whole Blood Pharmacological action

increases circulating blood volume

Toxic level of Digoxin

levels >2ng/ml can cause cardiac dysrhythmias to appear. Critical Values for adults: >2.5ng/ml

low potassium/ magnesium w/ digoxin

may increase potential for toxicity, monitor electrolyte levels

Diltiazem Precautions

obtain baseline cardiac status (bp/ heart rate) use cautiously in pts w/ heart failure/ liver impairment. AVOID GRAPEFRUIT and herbal products

Drugs that induce diuresis by increasing the osmotic pressure of the glomerular filtrate, which results in rapid diuresis; mannitol is an example

osmotic diuretics

Ezetimibe(Zetia)

the only cholesterol absorption inhibitor available. Ezetimibe inhibits absorption of cholesterol in the small intestine which results in lower Total cholesterol, LDL, apolipoprotein B Level, and triglyceride levels. HDL levels have been shown to increase in pts taking ezetimibe. Drug effects are enhanced if given along w/ a statin drug

Statins (HMG-CoA Reductase Inhibitors)

used to lower LDL cholesterol levels. They also may improve total cholesterol, triglyceride, HDL.