Drugs cardio, hematology, and respiratory - Pharm 3307

oral prednisone, fluticasone

2 drugs used for tx DDI pulmonary fibrosis Glucocorticoids - "sone" anti-inflammatory Suppress inflammation by suppressing the immune system • ADR: candidiasis (inhaled), adrenal suppression, osteoporosis, hyperglycemia, PUD, immunosuppression, fluid/electrolyte imbalances, epistaxis (intranasal) • Inhaled: use spacer, rinse mouth • Oral: give with food • Monitor: weight, electrolytes, glucose, s/s of infection, GI bleed, or adrenal suppression, nose bleeds • Always taper dosing • Stress dosing oral prednisone- lowest dose first hyperkalcemia hypernatremia

zileuton/zafirlukast

ADR: neuropsychiatric symptoms, HA(headache), liver damage, depression, suicidal ideations • Monitor liver function, abdominal pain, anorexia, jaundice • Give 2 hours prior to activity for EIB • Increases effects of warfarin (PTINR)

Captopril (Capoten)

*class*: ACE Inhibitor, antihypertensives *Indication*: hypertension, management of CHF, decrease progression of DM neuropathy *Action*: block conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation *Nursing Considerations*: - can cause neutropenia - check WBCs regularly - use cautiously with potassium supplements and potassium sparing diuretics. - use cautiously with diuretic therapy - administer 1 hour before meals - monitor blood pressure often - monitor weight and fluid status - monitor renal profile - monitor CBC frequently - May lead to Rhabdomyolysis - Dry cough

When administering antihypertensive medications to Asian Americans, it is most important for the nurse to

- monitor blood pressure carefully Asian Americans are twice as sensitive as whites to beta blockers and other antihypertensives. A reduction in antihypertensive dosing is frequently needed. Native Americans have a reduced or lower response to beta blockers compared with whites. Monitoring blood pressure and drug dosing should be an ongoing assessment for these cultural groups

oral prednisone

-can be used as a long-term asthma med -rash isn't an expected adverse effect of oral glucocorticoids -pt should NOT stop taking or other glucocorticoids abruptly if taking ____ for >10 days; dosage should be decreased gradually to prevent w/drawal syndrome during long-term therapy -glucocorticoids can cause significant GI distress & lead to ulcer formation; pt should not take steroids on an empty stomach -some of the adverse effects caused by long-term glucocorticoid therapy, such as suppression of the adrenal gland, can be avoided by using alternate-day therapy -oral glucocorticoids, are not used as rescue meds; pt might need a short-acting bronchodilator if acute distress occurs

What are the risk factors for developing asthma?

1) 2nd or 3rd hand smoke exposure 2) Family history 3) Aspirin or NSAID allergy 4) RSV bronchiolitis infection 5) Strenuous exercise in areas of high ozone (pollution)

guaifenesin (Mucinex) Expectorant

Action: ↓ viscosity of secretions by ↑ respiratory tract fluid; Mobilization & expectoration of mucus Indication: Coughs associated c viral URT infections RN Considerations: Assess lung sounds (frequency/type of cough), characteristics of bronchial secretions; Teach maintaining fluid intake of 1.5-2 L/day Effectiveness: Easier mobilization & expectoration of mucus • Treats cold, upper respiratory infections, and bronchitis to remove secretions • Action: Thins mucus making it easier to drain out • ADR: Dizzy, drowsy, headache, N/D, allergic reaction (rash) • Encourage to change position slowly, increase fluid intake • If fever or worsening cough, notify MD-could develop pneumonia • Give PRN, which can be tablets or sustained-release • Contraindications: known sensitivity to phenylketonuria (aspartame content) • Caution: cough lasting longer than 1 week, diabetes (sugar component), or receiving disulfiram (alcohol content) • No significant drug-drug interactions

Iosartan (Cozaar)

Angiotensin II Receptor Blocker (ARB) .Treat HTN, used to prevent CVA/stroke (especially losartan), & they can be used to manage diabetic nephropathy. They're also used off label for migraines. • S/E: Hypotension, Dizziness, angioedema (less risk), CNS Effects (Insomnia, HA) • PO only, can give with or without food • Losartan is available in combination with hydrochlorothiazide, a diuretic, & is called Hyzaar • Contraindications: Pregnant women • Caution with: Diuretics, hyperkalemia, liver disorder

ipratropium (Atrovent)

Anticholinergic • Blocks acetylcholine, causing bronchodilation & reducing secretions• Used as preventative • ADR: dry mouth, IOP, CNS effects, hypotension• Beta-2 agonists enhance bronchodilation effects • 5 minutes in between other inhalants urinary retention rinse mouth afterward because of bitter taste and thrush safety alert- not a rescue inhaler- preventive-only

Eplerenone (Inspra)

Antihypertensive; Diuretic, Potassium Sparing; Aldosterone Receptor Antagonist • Treats HTN and symptoms of heart failure • Action: Blocks aldosterone receptors resulting in sodium + water excretion & potassium retention • S/E: Hyperkalemia- potassium sparing effects • Monitor for signs of hyperkalemia • Monitor K+ (do not give if level is >5.0, BUN/CREAT • Make sure client is not taking a potassium sparing diuretic • PO only, Max therapy may take 4 weeks

albuterol/ipratropium

Beta2 -Adrenergic Agonists - (Proventil HFA, Ventolin HFA Stimulates beta-2 receptors causing bronchodilation• ADR: tachycardia, palpitations, angina, tremors, nervousness• Administer prior to glucocorticoid Short-acting short-term (acute) long-term (COPD) hypoglycemic

What is asthma?

Constricting of the airway due to inflammation and muscular contraction of the bronchioles. Also called Reactive Airway Disease

acetylcysteine Mucolytic

Decreases viscosity of mucous secretions • Reverses acetaminophen (Tylenol) overdose • ADR: GI distress, nausea/vomit • Has a rotten egg smell • Monitor: respiratory status, breath sounds, encourage client to expectorate secretions and not swallow them, clean equipment well after treatments to prevent pulmonary infections • Given through nebulizer or direct instillation through the trach tube • Do not use in those at risk or have a current gastric bleed • Caution with asthma, history of bronchospasm, severe respiratory insufficiency • When given an IV for an overdose, caution with an anaphylactic reaction

Fluticasone (nasal)

Flonase watch for nose bleeds higher dose and work it down

The nurse is teaching a client who has a prescription for zileuton. Which of the following instructions should the nurse include?

Have laboratory tests performed at regular intervals. Zileuton, a leukotriene modifier, can cause liver injury. The nurse should monitor liver function once a month for 3 months, then every 2 to 3 months during the first year of treatment.

A patient is ordered to receive digoxin to treat congestive heart failure. The nurse is most concerned about which assessment finding? A. Heart rate 56 beats/min B. BP 138/90 mm Hg C. RR 18 breaths/min D. 1+ pitting edema of the lower extremities

Heart rate 56 beats/min

Class III/ Potassium Channel Blocker Prototype: amiodarone (Cordarone), sotalol (Betapace)

Manages life-threatening VT, VF • Can treat AFIB • These medications are used on the electrical system of the heart, which slows the conduction of the heart • Can widen the QRS Complex, prolong PR, QT Intervals • S/E: GI (N,V, constipation), ARDS, pulmonary toxicity (long term or high doses), dizzy, fatigue, malaise, could experience a blue-gray discoloration of skin with frequent sun exposure • Monitor pulmonary status during course of medication • Can be given oral or IV • Correct the low K+ or Mag levels prior to administering medication

Class II, Beta Adrenergic Blockers • Prototype: propranolol (Inderal LA), acebutolol, esmolol, sotalol

Non- selective beta blocker- blocks both Beta1 and beta 2 adrenergic receptors • S/E: Bradycardia, heart failure, PAD (increased sensitivity to cold), CNS effects (drowsiness, confusion, fatigue) • If stopped abruptly, could cause rebound effects: angina, MI • Monitor HR, heart failure, monitor pulses • Taper dose off if needed • Hold medication is SBP is less than 90 or HR less than 60 • If given IV-give over 1 min, given infusion- infuse 15- 20 mins • Clients who are diabetic and take a beta-blocker- will not experience tachycardia with hypoglycemia- monitor for other signs/symptoms

A nurse is preparing to administer digoxin to a patient. Which laboratory result is the nurse most concerned about?

Potassium 3.0 mEq/L

A nurse should identify that dextromethorphan can have which of the following effects when combined with morphine?

Potentiation of depression of CNS actions Combining dextromethorphan with an opioid, such as morphine, increases the risk for decreased respirations and other depressed CNS responses.

Beclomethasone

QVAR RediHaler Glucocorticoids - "sone" anti inflammatory Suppress inflammation by suppressing immune system • ADR: candidiasis (inhaled), adrenal suppression, osteoporosis, hyperglycemia, PUD, immunosuppression, fluid/electrolyte imbalances, epistaxis (intranasal) • Inhaled: use spacer, rinse mouth • Oral: give with food • Monitor: weight, electrolytes, glucose, s/s of infection, GI bleed, or adrenal suppression • Always taper dosing • Stress dosing

HMG-CoA Reductase Inhibitors- Statins • Prototype: atorvastatin (Lipitor)

Reduce LDL, triglycerides • Increase HDL • Decreases risk of Cardiovascular Disease • Adverse Effects: Myopathy (muscle pain), hepatotoxicity • Monitor for Creatine Kinase (CK) is unexplained muscle pain, check liver functions • Monitor for abdominal pain, jaundice, fatigue (liver dysfunction) • Taken in the evening with or without food • Warfarin increases bleeding risks with Statins • Do not take with large amounts of grapefruit juice (Increases risk for adverse effects)

A nurse who is administering atorvastatin calcium realizes the importance of monitoring for which serious adverse reaction?

Rhabdomyolysis

Which statement will the nurse include when teaching a patient about loop diuretics?

Rise slowly from a lying or sitting to standing position to prevent dizziness.

Class IV/ Calcium Channel Blockers Prototype: verapamil (Calan), diltiazem (Cardizem)

Slows the automaticity of the SA node and slows the conduction through the AV node • Converts SVT to SR • Slows the heart rate of AFIB, Aflutter • S/E: hypotension(IV or overdose of oral), bradycardia, heart failure (assess for BLE edema, SOB), lightheaded, dizziness (vasodilator) • When given IV- administer over 2-3 mins (monitor VS, rhythm), give oral dose with food • Hold dose for SBP less than 90 or HR less than 60 (notify provider) • Educate client to take medicine as prescribed and to not increase dose on own • Contraindication: serious heart block, SSS, cardiogenic shock • BB given with these medications increase risk for bradycardia, heart failure

Inotropic Agents Prototype: digoxin (Lanoxin)

Treats Afib, Aflutter, PAT • S/E: cardiac dysrhythmias esp AV Block (can happen with Dig toxicity-early signs include N/V/Anorexia) Blurred vision, halo around objects, yellow tinged vision, fatigue • Monitor: Take apical pulse for 1 minute before administering & hold for <60, Monitor digoxin levels, Monitor K levels- big risk for toxicity if low. Will need to correct, Monitor heart rhythm • Educate on Digoxin Toxicity (N/V, anorexia, fatigue, confusion, HR<60 or even irregular) • Administered: PO or IV • If given IV, give slowly over 5 minutes, monitor IV site • Contraindications/precautions: pts with uncontrolled ventricular dysrhythmias, AV block, severe heart disease. Be cautious in pts with hypokalemia or hypercalcemia, or if taking diuretics

Potassium- Sparing Diuretics Prototype: spironolactone (Aldactone)

Treats HTN, edema, cirrhosis of the liver, nephrotic syndrome, hypokalemia • S/E: hyperkalemia, it could lead to testosterone & progesterone like effects: dysmenorrhea, deepened voice, & abnormal hair growth in women, gynecomastia & impotence in men • Monitor: K+, symptoms of hyperkalemia- dysrhythmias, palpitations • Educate to avoid excessive potassium intake (salt substitutes, high potassium foods) • Given PO with food to increase absorption • Contraindications/precautions: teratogenic, Avoid in renal failure, Risk of hyperkalemia increases with many of our other HTN drugs - ACE inhibitors, ARBs, renin blockers, & with K containing salt substitutes, Can potentiate antihypertensive effects of other blood pressure drugs

Thiazide Diuretics Prototype: hydrochlorothiazide (HCTZ)

Treats HTN, heart failure, liver cirrhosis, renal failure • S/E: fluid and electrolyte imbalance (hypokalemia), hyperglycemia, hyperuricemia (gout pts) • Monitor electrolyte levels, glucose levels, uric acid levels • Can be given PO or IV • Best to give with food to eliminate GI symptoms

A nurse is teaching a client about ipratropium. The nurse should include that this drug has which of the following adverse effects. Select all that apply Muscle tremors Urinary retention Dry mouth Insomnia Tachycardia

Urinary retention Dry mouth

An African-American patient is to be treated with initial monotherapy to control hypertension. The nurse expects the patient to receive

alpha-adrenergic blockers African Americans do not respond well to diuretics as the initial monotherapy for controlling hypertension. This group is susceptible to low-renin hypertension; therefore, they do not respond well to beta blockers and ACE inhibitors. The antihypertensive drugs that are effective for African Americans are alpha1 blockers and calcium channel blockers.

Diphenhydramine (Benadryl)

antihistamine First Generation Antihistamine - Sedating • ADR: drowsiness, dizziness, dry mouth, constipation, urinary hesitancy • Administration: Do not crush medication if it is enteric coated • If you are giving for motion sickness, give at least 30mins before .• Instruct to take medication around bedtime, increase fluid and fiber intake • Any difficulty urinating= notify provider ASAP • Best to avoid driving, operating dangerous machinery, activities that require mental alertness • Contraindications: Narrow Angle Glaucoma, children/infants under 2yr, breastfeeding, urinary retention, acute exacerbation of asthma

Cetirizine (Zyrtec)

antihistamine Second Generation Antihistamine - Non-sedating Fewer side effects compared to sedating antihistamines • Available OTC • Used for: allergic rhinitis, chronic idiopathic urticaria (rash and hives that occur from unknown cause) • ADR: drowsiness, fatigue, dry mouth, nose and throat • Monitor: drowsiness, fatigue, !!fluid intake (1500-2000mL/Day) !! • Administer: with or without food, decrease dose if they have compromised liver/kidney functions • Interactions: Theophylline-reduces the clearance of medication leading to toxicity

A patient is receiving an angiotensin II receptor blocker. It is most important for the nurse to assess the patient for

dizziness

A patient with hypertension is ordered to receive an angiotensin- converting enzyme inhibitor. The nurse identifies a common benign side effect of this class of medications as

dry cough

A patient is receiving furosemide. It is most important for the nurse to monitor the patient for the development of

hypokalemia

A nurse is teaching a client who is beginning fluticasone propionate/salmeterol therapy. Which of the following instructions should the nurse include?

increase weight-bearing activity

theophylline Methylxanthine

inhibits PDE (cAMP --> AMP blocked)- increased cAMP= bronchodilation • Relaxes smooth muscles of bronchi in chronic asthma • ADR: CNS effects(- restlessness, insomnia), GI, seizures, dysrhythmias • Monitor blood levels and VS activated charcoal, monitor HR and rhythms • Avoid caffeine- toxic level = seizures, dysrhythmias caution- tobacco, marijuana (stimulants)

Montelukast(Singulair)

leukotriene receptor antagonist • ADR: neuropsychiatric symptoms, HA • Give 2 hours prior to activity for Exercise-Induced Bronchospasm

The nurse should teach the patient to report which of the following to the health care provider immediately if experienced after taking nitroglycerin?

persistent pain

Before administering the alpha-adrenergic blocker prazosin, it is most important for the nurse to assess the patient for a history of

renal disease

A nurse is caring for a client who is taking codeine. The nurse should identify that which of the following assessments is priority to make?

respirations

parasympathetic nerves

the division of the autonomic nervous system that calms the body, conserving its energy Constrict pupils stimulate saliva Slow Heart rate constrict airway stimulate the activity of the stomach stimulate gallbladder stimulate the activity of intestines contract bladder the rest and digest

A patient is receiving an angiotensin II receptor blocker. Which does the nurse recognize as an angiotensin II receptor blocker?

valsartan

Loop Diuretics Prototype: furosemide (Lasix)

• Powerful diuretics that help to treat pulmonary edema in heart failure, edema caused by renal, hepatic, or cardiac failure and HTN that is not controlled by other diuretics • S/E: Fluid, Electrolyte imbalance, orthostatic hypotension, ototoxicity, hyperglycemia, hyperuricemia • Monitor for electrolyte imbalances, monitor BP readings • Educate pt on dietary intake of potassium: bananas, prunes, spinach, raisins, baked potatoes & • lots of other foods have high potassium (since hypokalemia is side effect) • can give PO, IM, IV. If giving IV, push slowly to prevent ototoxicity. • - Give last dose by afternoon to prevent nocturia

Fibrates • Prototype: gemfibrozil (Lopid), fenofibrate

• Reduces high levels of plasma triglycerides • Increases HDL, NO effect on LDL • Adverse effects: GI (nausea, abdominal pain, diarrhea) • Can increase the risk for gallstones, liver toxicity, myopathy • The risk for Myopathy greatly increases when taking a statin and fibrate together! • Taken 2x day (30 mins before meals) • Warfarin will increase bleeding risks when taken with fibrates

Inotropic Sympathomimetics Prototype: dobutamine, dopamine (Intropin)

• Sympathomimetics increase cardiac output in severe heart failure but are ONLY used on a short-term IV basis in the hospital setting • S/E: tachycardia, dysrhythmias, angina • Monitor: Cardiac Rhythms-continuous tele monitoring, VS esp. BP • Be prepared to treat any cardiac dysrhythmias or decrease or D/C for tachydysrhythmias or angina • Given in hospital setting with tele monitoring • Initial dose is given by weight base and is titrated based on EKG, VS, urine output, cardiac output, or pulmonary wedge pressure • PEAK effect is 10 mins • Is incompatible with many medications. Do not infuse with other meds • Monitor: BP, HR, correct fluid volume deficits prior to giving • MAOIs may cause toxicity and increase risk for tachydysrhythmias

Centrally Acting Alpha 2 Agonists • Prototype: clonidine (Catapres)

• Treats HTN, can be given epidural injection for pain, could be used to treat ADHD in those who may not respond to typical psychostimulants • S/E: CNS Effects (drowsy, dizzy, dry cough) • Rebound HTN can occur when stopped abruptly- could cause a dangerous rise in BP • Given PO or transdermal patch • Contraindications: avoid in pts with bleeding disorder or with pts on anticoagulant therapy • Interactions: will increase sedative effects of other CNS depressants (opioids, alcohol, antihistamines). • Antihypertensive effects are reduced with MAOIs, tricyclics, amphetamines

Alpha/Beta Blockers Prototype: carvedilol (Coreg)

• Treats HTN, heart failure (with digoxin, ACE, diuretics), often given to patients after an MI • S/E: Dizzy, hypotension, bradycardia, life threatening heart block, exacerbation of asthma • Monitor for HR less than 60 (hold if necessary) • Contraindications: unstable heart failure, asthma, heart block, bradycardia, pregnancy • Drug Interactions: when taking digoxin with medication, can increase bradycardia

Beta Blockers Prototype: atenolol (Tenormin), metoprolol (Lopressor)

• Treats: HTN, angina, dysrhythmias, MI, heart failure, can be used off label for migraines, anxiety • S/E: Bradycardia • Monitor BP, HR, worsening heart failure (or new onset) • Do not stop abruptly • PO and IV routes • Contraindications: severe HF, heart block, bradycardia, COPD/asthma, renal/liver disorders, hyperthyroid, DM, depression, adrenal tumors • Interactions: antacids interfere with absorption, Hypoglycemics may increase r/o hypoglycemia, Anticholinergics may decrease efficacy, Other antihypertensives will increase their effects

The nurse should instruct a patient to not suddenly stop taking antihypertensives in order to avoid

rebound hypertension

A nurse is teaching a client who has a prescription for albuterol via inhaler and fluticasone/salmeterol via inhaler for asthma management. For which of the following reasons should the nurse instruct the client to use the albuterol inhaler before using the fluticasone inhaler?

Albuterol will increase the absorption of fluticasone. Albuterol, an inhaled, short-acting beta2 agonist, causes bronchodilation, which will increase the absorption of fluticasone, an inhaled glucocorticoid.

codeine - Opioid - dextromethorphan (Delsym) - Non opioid OTC

Antitussives • ADR: drowsy, sedation, N/V, dizzy, constipation, respiratory depression • Have the client change positions slowly • Take with food or milk to avoid GI upset • Encourage a high fiber diet, increase fluids • Given PRN, a short time frame • Men with prostatic hypertrophy could develop urinary retention non-productive cough resp. below 12 administer Narcan

sympathetic nerves

Autonomic nerves that activate responses in times of stress; heartbeat, respiration, and blood pressure are affected. dilate pupils

Anticholinergic toxidrome

Blind as a bat (Mydriasis) Mad as a hatter (Altered mental status) Red as a beet (vasodilation, flushed) Hot as a hare (febrile) Dry as a bone (no secretions/diaphoresis) Bowel and bladder lose their tone Heart runs alone (tachycardia) Atropine, antihistamines, scopalamine, antipsychotics

Class 1A/ Sodium Channel Blockers • Prototype: quinidine and procainamide

Broad spectrum Antidysrhythmic to treat A-Fib, SVT, ventricular tachycardias • Adverse Effects: GI Symptoms (N,V,D), hypotension, Widen QRS complex, prolonged QT intervals, ventricular dysrhythmias (toxicity), arterial embolism- stroke or pulmonary emboli (AFIB), Speed Shock if given too quick in IV • S/E of quinidine: cinchonism (tinnitus, visual disturbance, headache, N/V) • S/E of procainamide: systemic lupus erythematosus-like syndrome

A nurse is administering digoxin, 0.125 mg, to a patient. Which nursing interventions will the nurse implement? (Select all that apply.)

Checking the apical pulse rate before administration. Monitoring the patient's serum digoxin level. Instructing patient to report pulse rate less than 60.

Class 1B/ Sodium Channel Blocker • Prototype: lidocaine (Xylocaine)

Controls ventricular dysrhythmias caused by myocardia infarction, cardiac surgery/procedures/ digoxin toxicity • S/E: CNS effects (confusion, drowsy, restless, paresthesia, muscle twitch, tremors, seizures, respiratory arrest • When given in high doses: hypotension, bradycardia, heart block • Monitor client closely after administering- CNS effects, VS, cardiac rhythm • Given IV for dysrhythmias - MUST say IV use only • Instruct client to mention any numbness of lips, unusual sensations, paresthesia • DO NOT use in clients with Supraventricular dysrhythmias, untreated bradycardia, heart block • Can interact with beta blockers

Nitrates • Prototype: nitroglycerin (NitroStat) SL tabs

Nitro-Dur (transdermal patch), isosorbide (oral) long-acting nitrate, IV nitroglycerin • Nitroglycerin is a vasodilator- decreases the oxygen demand of the heart which helps relax the spasms in the coronary artery • Adverse Effects: HEADACHE (can take Tylenol to help), orthostatic hypotension, tachycardia • ALWAYS check BP before and after giving Nitro. • If given with active angina at home, ok to give Nitro SL q 5mins x 3 doses. If not resolved after 5 mins, call 911 (might be having a myocardial infarction) then take another dose! • Avoid touching the nitro paste when applying- easily absorbed through skin=bad headache • DO NOT take erectile dysfunction medications while on Nitro (severe hypotension)

Phenylephrine (Neo-Synephrine) (nasal)

Sympathomimetic • Reduces nasal congestion from allergic rhinitis, sinusitis, the common cold • ADR: Systemic vasoconstriction, tachycardia, heart palpitations, increased blood pressure. • Caution not to overuse to avoid rebound congestion • Do not use longer than 3-5 days (avoid rebound congestion) • These are not meant to be used long term! • Notify provider if excessive CNS Stimulation ( agitation, insomnia, anxiety) • Prolonged tachycardia/palpitation could indicate an overdose • Interaction: MAOI potentiates the effects of sympathomimetics (do not give within 3 weeks of each other), Beta2-adrenergic agonist can potentiate HTN effects

aliskiren (Tekturna)

Treats HTN • Action: binds to renin, disabling it from activating angiotensin I, leading to vasodilation + urinary excretion of sodium + water • S/E: GI symptoms, hyperkalemia, cough, angioedema (possible but not as common) • Monitor K+, BUN/Creat, BP • Make sure they are not using salt substitutes • PO only, avoid high fat meals when taking med- it affects absorption • May take 2 weeks for Max Therapy • Contraindications: Pregnant women, hyperkalemia, hypercalcemia • Interactions: decreases furosemide levels (diuretic), increases levels of some statins

doxazosin (Cardura)

Treats HTN • Action: they block alpha-1 receptors. Remember that stimulation of alpha-receptors causes vasoconstriction so by blocking them we'll cause the opposite effect, vasodilation which will reduce blood pressure. • S/E: orthostatic hypotension, HA, dizziness, reflex tachycardia • Check orthostatic BP (Client lying, sitting, standing, 1-3 mins between reading) • PO only and is given at bedtime • Interactions: will interact with sildenafil (Viagra) or other phosphodiesterase inhibitor • NSAIDs decrease efficacy of these

Class 1C/ Sodium Channel Blockers Prototype: flecainide (Tanbocor), propafenone (Rythmol)

Treats life threatening supraventricular and ventricular tachydysrhythmias that are not controlled by other less toxic medications • S/E: Dizziness, dyspnea, visual disturbance (blurred vision, difficulty focusing), can worsen heart failure, cause edema • Can widen the QRS complex and prolong the QT, PR interval -Could cause First Degree AV Block or higher degree heart blocks • Multiple dysrhythmias could occur while given medication • Always monitor client- report visual changes, edema, weight gain, crackles in lungs • Monitor the plasma trough levels to detect early signs of toxicity

Direct Acting Vasodilators • Prototype: hydralazine (Apresoline)

Treats moderate to severe HTN • Can be given IV for HTN crisis • S/E: reflux tachycardia, dizzy, weakness, fatigue, headache • Do not stop abruptly • Monitor for systemic lupus erythematosus: facial rash, joint pain, fever, nephritis, pericarditis (can occur when given in high doses) • Best to give with food to enhance absorption • Administered: PO, IV, IM • PO given at low dose first to minimize side effects • Caution with severe renal/hepatic impairments

Inotropic Phosphodiesterase Inhibitors Prototype: milrinone

Treats very severe heart failure • S/E: ventricular dysrhythmias, hypokalemia, hypotension, angina • Monitor: K+ levels, VS, cardiac rhythm, angina • Dose may need to be adjusted for dysrhythmia, hypotension • Given IV, loading dose infused over 10 minutes, then continuous rate based on weight • Incompatible with other medications-infuse in line alone • Contraindications Aortic or pulmonary valve disorders, acute MI • Precaution with renal impairment, Aflutter, or A-fib • Do not administer IV furosemide into the same line as it will precipitate

A patient is scheduled to receive gemfibrozil. It is most important for the nurse to assess for concurrent use of which medication?

Warfarin,

A nurse is teaching a client about the use of cromolyn sodium to prevent bronchospasm. The nurse should explain that the drug has which of the following therapeutic effects

reduces inflammation Cromolyn sodium, a mast cell stabilizer, reduces inflammation by inhibiting the inflammatory response.

Cromolyn

mast cell stabilizer; used for asthma before exercise prophylactically is allergen is causative agent, MDI; maximal effects may take several weeks before clinical response; NSAID that inhibits the IgE mediated release of anti-inflammatory mediators from mast cells; not used to tx acute bronchospasm • Suppress inflammation • Preventative only in mild to moderate asthma • ADR: rare - cough, bronchospasm • Administer 10-15 minutes prior to exposure for exercise-induced bronchospasm (EBI) • Not effective in acute asthma attacks • May take several weeks to achieve therapeutic effects preventive-only never taken in acute episode

Before administering triamterene, it is most important for the nurse to determine if the patient is also receiving

potassium chloride

A nurse is teaching a client about the use of antihistamines to treat allergic rhinitis. The nurse should explain that these drugs are effective because they perform which of the following actions?

prevent histamine from binding to receptors