Pharmacology Info for Test 1
elimination of a drug from the body
excretion
the transport of drug molecules within the body
distribution
•Drugs are carried to sites of action by body fluids •Affects metabolism and excretion rates •Requires adequate circulation •Affected by protein binding, blood brain barrier, pregnancy, and lactation
distribution
activation of receptors in the kidney cause the renal blood vessel to dilate, this increases renal perfusion and reduces the risk of renal failure
dopamine receptors
Problems related to IV routes
irritating to veins, use proper needle/syringe for drug, faster onset
Teaching needs for patient education
1. financial and personal resources 2. be aware of disabilities 3. make sure pt can read 4. follow dosage instructions 5. assess cognition/memory 6. could someone assist the pt/ give reminders 7. notify all providers of all medications 8. economic factors/ access
nursing implications for ACE inhibitors
1. first dose precaution (orthostatic hypotension, dizziness) 2. stop diuretics 3-5 days before starting 3. BP before giving and monitor for 2 hr after 4. monior K and WBC
complications of osmotic diuretics
-HF, pulmonary edema-rebound ICP -fluid & electrolyte imbalances, metabolic acidosis -lithium excretion through the kidneys is increased
digoxin requirements
-always check HR beforehand (if below 60 don't administer) -given with diuretic, ACE inhibitor -taken on an empty stomach -reduced dosage for renal failure
complications of direct renin inhibitor
-angioedema, rash, cough -hyperkalemia -diarrhea -hypotension -pregnancy risk D
complications of ARBs
-angioedema-fetal injury-hypotension-dizziness, lightheadedness-increased risk for lithium toxicity
purpose of nifedipine
-blocks calcium channels in blood vessels leading to vasodilation -acts on arterioles (veins are not significantly affected)
complications of beta-adrenergic blockers
-bradycardia -decreased CO -AV block -orthostatic hypotension -rebound myocardium excitation -bronchoconstriction -glycogenolysis is inhibited
normal kidney function labs
-creatinine: 0.6-1.3 mg/dL (males) 0.5-1.1 mg/dL (females) -urine output: 30 ml/hr -BUN levels: 10-20 mg/dL
complications of loop diuretics
-dehydration -hyponatremia -hypochloremia -hypotension -ototoxicity-hypokalemia -decrease HDL & incrase LDL
3 important nursing assessments/actions to take when caring for patients receiving diuretics are
-dehydration -monitor K -monitor I&O
complications of aldosterone anatgonists
-hyperkalemia & hyponatremia -flu-like manifestations -endocrine changes (gynecomastia, menstrual irregularities, deepened voice) -dizziness & fatigue-pregnancy risk B
complications of potassium-sparing diuretics
-hyperkalemia-endocrine effects (gynecomastia, deepened voice, hirsutism) -drowsiness, metabolic acidosis -prototype is pregnancy risk C
medications affecting urinary output
-loop diuretics -thiazide diuretics -potassium-sparing diuretics -osmotic diuretics
signs of digoxin toxicity
-n/v-life threatening HR disturbances -vision disturbances (sign of hypokalemia) -abdominal discomfort -loss of appetite -mental changes and muscle weakness
complications of verapamil & diltiazem
-orthostatic hypotension & peripheral edema -constipation (mostly verapamil) -suppression of cardiac function -dysrhythmias -acute toxicity
alpha adrenergic blockers (-azosin)
-prazosin: prototype -doxazosin -terazosin
complications of nifedipine
-reflex tachycardia -acute toxicity -orthostatic hypotension & peripherial edema
therapeutic uses of loop diuretics
-used when there is an emergent need for rapid mobilization of fluid -pulmonary edema caused by HF -conditions not responsive to other diuretics -hypercalcemia (unlabeled use)
Goals of treatment in overdose
1. decrease absorption 2. increase elimination 3. stabilize patient 4. support vital processes 5. administration of anitdotes 6. ensure airway is patent and put patient on O2 if indicated 7. gain IV access, give IVF if ordered
what are some issues with valerian
1. drowsiness that may worsen with prolonged use 2. can cause dependence 3. not safe in pregnancy or breast feeding 4. potentiates effects of CNS depressants
What are the therapeutic levels of digoxin?
0.5-2 ng/ml elderly- 0.5-1.3 ng/ml
When should captopril be taken?
1 hour before meals
Hypertension is typically defined as a systolic value greater then _____ and a diastolic value greater than _____
1. 130 2. 80
What are the 4 processes of pharmacokinetics?
1. Absorption 2. Distribution 3. Metabolism 4. Excretion
ARBs uses
1. HTN 2. HF 3. prevents stroke 4. manages diabetic neuropathy
3 sources of medications
1. naturally occurring substances 2. semi-synthetic substances 3. synthetic substances
what are some uses of st johns wort
1. mild depression 2. affects serotonin 3. some use as an antiinflammatory and an antiinfective
-pril
ACE inhibitor
-prils are..
ACE inhibitors
-sartan
ARB
-sartans are...
ARBs
-one drugs
Aldosterone antagonists
-azosin
Alpha blockers (adrenergic antagonists)
3 Phases of Pharmacology
1. pharmceutics 2. pharmacokinetics 3. pharmacodynamics
what are some uses for ginkgo biloba
1. possible effectiveness for cerebral insufficiency, headaches, and macular degeneration
adverse effects of garlic
GI symptoms, bad breath and body odor
can block platelet aggregation, can block a factor that causes migraines, can decrease the number and severity of migraine headaches but does not treat an existing migraine
feverfew
can cause increased risk of bleeding in clients taking NSAIDS, heparin and warfarin. Discontinue 2 weeks before elective surgery.
feverfew interactions
when drugs are extensively metabolized in the liver, with only part of the drug dose reaching the systemic circulation for distribution to sites of action
first pass effect
complications of alpha adrenergic blockers
first-dose orthostatic hypotension & pregnancy risk C
-ine drugs
Calcium channel blockers
ACE inhibitor prototype
Captopril (Capoten)
centrally acting alpha 2 agonists
Clonidine- prototype -guanfacine -methyldopa
causes of HF
HTN and MI
ARBs Prototype drug
Losartan (Cozaar)
fluid goes into interstitial skin and pt's extremities look cool and swollen
infiltrations
the middle, or second innermost, layer of the walls of the vessels of the heart
intima
Digoxin is classified as an _________ _________
introphic agent
Non-ST-elevation myocardial infarction. Type of heart attack where a noticable change is not seen in the ST segment on an EKG. Less damage to the heart than normal heart attack
NSTEMI
blocking of calcium channels in blood vessels lead to vasodilation, decreased contraction, HR, and slowing rate of conduction through the AV node
Purpose of Verapamil and diltiazem
positive inotrope effect: increased force of myocardial contractions negative chronotropic effect: at therapeutic levels it decreases HR and slow the rate of SA node depolarization and the rate of impulses treats HF
digoxin
incident where myocardial ischemia occurs, which leads to necrosis of the heart tissues, ST elevation shown on the EKG. Clinical diagnosis of an MI
STEMI
True or False. The formula for determining cardiac output (CO): Heart rate x stroke volume= cardiac output.
True
True or False. When teaching a patient about taking losartan (Cozaar), it is important to instruct females not to become pregnant while taking the drug.
True
A nurse is caring for a client who is taking acetaminophen and codeine for pain relief. These analgesic drugs interact with one another to cause an additive effect. The nurse should identify that which of the following are characteristics of additive drug interactions (Select all that apply) a. clients can achieve desired effects with the use of lower dosages b. taking the two drugs together can reduce the effects of one or both drugs c. taking the two drugs together can potentiate the effects of one or both drugs d. the two drugs can produce an action neither would have produced alone
a, d
A nurse is reviewing drugs in a drug reference. The nurse should identify the drugs in the same class share which of the following similarities? a. they have similar mechanisms of action b. they have the same half life c. they are administered by the same route d. they have similar availability
a. they have similar mechanisms of action
Stimulation of the alpha1 receptors in the peripheral blood vessels causes a. vasoconstriction b. vasodilation c. ventricular hypertrophy d. ventricular dysrhythmias
a. vasoconstriction
movement of drug from site of administration into the bloodstream
absorption
this process occurs from the time a drug enters the body to the times it enters the bloodstream to be circulated
absorption
•Begins when the drug enters the body •Ends when medication reaches body fluids for transport •Affected by dosage form, presence/absence of food, route, circulation, GI function •Varies depending on age/health of the client
absorption
the total effects of two or more drugs are as expected
additive effects
-olol
beta blocker
While talking with a client who is taking captopril to treat hypertension, which instructions do you include to help her manage the drug's adverse effects? a. check your heart rate prior to taking the drug b. wear sunscreen and protective clothing while outdoors c. dont use salt substitutes to season your food d. take the drug with a meal
c. dont use salt substitutes to season your food
pharmacologic effects on the heart specifically used in beta blocking agents
cardioselectivity
A nurse is teaching a client about the adverse effects of digoxin. Which of the following statements should the nurse include in the teaching? a. "adverse effects are the intended effects of the medication" b. " Adverse effects indicate a severe allergy to the medication" c. "Decrease your medication dose if the adverse effects occur" d. "Contact your provider if adverse effects occur"
d. "Contact your provider if adverse effects occur"
It is important to teach patients taking calcium channel blockers about the danger of consuming a. green leafy vegetables b. salt substitutes c. milk d. grapefruit juice
d. grapefruit juice
medication at the site of application (topical, vaginal, rectal, inhaled, ophthalmic drops, etc.)
local
_________ diuretics are the diuretics of choice when rapid effects are required and when renal function is impaired.
loop
the myocardium tissue of the heart. The largest layer contains cardiac muscle fibers, loose connective tissue and capillaries
media
the change of a drug into a more or less potent or more soluble form after it passes through the liver, kidneys, intestinal mucosa, or other body part
metabolism
the method by which drugs are inactivated or biotransformed by the body
metabolism
•The process by which drugs are inactivated or bio-transformed by the body •Organs involved •Liver •Lungs •Kidneys GI system
metabolism
Problems related to oral routes
n/v, presence of NG tube, can patient tolerate, DR/ER, food, pH
medications that are made of plants or animals
naturally occurring substances
In HF, digoxin exerts a _________ chronotropic effect that improves contractility and pumping ability of the heart
negative
cause a decrease in heart rate. Ex. digoxin, acetylcholine and metopropolol
negative chronotropy
the time it takes for a drug to demonstrate a therapeutic response
onset of action
Time it takes a drug to demonstrate a full therapeutic effect
peak drug level
•Refers to phase in which a drug dissolves in the body •Must change to, or be in, soluble liquid form •Oral meds reach this phase in GI tract •Parenteral meds are already in liquid form
pharmaceutics
drug actions on target cells and the resulting alterations (what the drug does to the body)
pharmacodynamics
the study of gene mutations that produce changes in structure and function of drug metabolizing enzymes
pharmacogenetics
drug movement through the body (what the body does to the drug)
pharmacokinetics
Hydrochlorothiazide is an example of a __________ diuretic.
thiazide
when the body becomes accustomed to a particular drug over time so that larger doses must be given to produce the same effects
tolerance
results from excessive amounts of a drug and may damage the body tissues
toxicity
the point in time when a drug is at its lowest level in the body
trough drug level
It is important to monitor for heart failure when giving mannitol to a patient. True or false
true
Spironolactone (Aldactone) can cause gynecomastia in males and abnormal hair growth in females. True or false
true
Sprionolactone effects occur slowly and may take several days before the therapeutic effects are seen. True or false
true
True or false. When arterial blood pressure is elevated, the kidneys excrete less fluid (decrease in urine output)
true
True or false: Alpha1 cells are responsible for contraction; therefore increasing BP
true
True or false: Essential HTN has a large number of unidentified causes
true
when do allergic reactions to medications occur?
usually have occurs after more than one dose
contraindications of ACE inhibitors
1. pregnancy 2. previous angioedema due to ACE 3.kidney failure
what are some uses of valerian
1. reduces insomnia and anxiety
patient education for ARBs
1. report minor swelling of mouth or throat to provider 2. report frequent headaches/ insomnia 3. report fainting or dizziness 4. dont take if pregnant or breast feeding
interactions of ACE inhibitors
1. potassium supplements 2. other anti HTNs and diuretics (additive effects) 3. lithium toxicity 4. NSAIDs may decrease effects
what are some uses for chamomile
1. helping people fall asleep
what are some uses for melatonin
1. thought to be effective for inducing sleep
reduce ICP and IOP by raising serum osmolality & drawing fluid back into the vascular & extravascular space-prevents kidney failure in hypovolemic shock & severe hypotension-promotes sodium retention & water excretion
purpose of osmotic diuretics
a Nurse is caring for a client who has a new prescription for aliskiren to treat hypertension. The nurse should monitor the client for which of the following findings as an adverse effect of the drug? Select all that apply a. hyperkalemia b. throat swelling c. constipation d. cough e. joint pain
a,b,d
A nurse is caring for a client who is about to begin captopril therapy. Which of the following adverse effects should the nurse instruct the client to report because it can indicate a need to discontinue drug therapy. Select all that apply a. rash b. distorted taste c. swelling of tongue d. photosensitvity e. dry cough
a,b,c,e
A nurse is preparing to teach a client how to take care of a newly created colostomy. The nurse should identify that which of the following factors can decrease the client's abililty to learn? Select all that apply a. impaired cognitive level b. language barrier c. discomfort d. repetition of teaching e. unreadiness to learn
a,b,c,e
Patients receiving potassium-sparing diuretics should be encouraged to use salt substitutes. True or false
false
True or false: 101/55 is considered a normal blood pressure
false
when two drugs taken together have an increased effect
additive effects
antidote to digoxin toxicity
digavine
Spironolactone (Aldactone) is the prototype for what kind of diuertic?
potassium sparing
directly related to filling of the ventricles. At the end of diastole. Involved with the stretching of sacromeres in cardiac muscle cells. Defined by the amount of blood in the ventricles at the end of diastole. Increase in hypervolemia and heart failure
preload
beta adrenergic blocker that controls atrial and ventricular tachycardia
propranolol (Inderal)
contraindications of ARBs
1. pregnancy 2. allergy to losartan 3. children younger than 6 4. children older than 6 with very low creatine clearance
high lipid levels in the blood. These can restrict blood flow and cause a risk of heart attack or stroke because of the particles depositing in vessles
hyperlipidema
Statin drugs
hyperlipidemia drugs that reduce cholesterol by blocking the enzyme necessary for cholesterol production in the liver; HMG-CoA reductase inhibitor drugs
Digoxin toxicity is related to diuretic-induced ____________
hypokalemia
complications of digoxin
-dysrhythmias, cardiotoxicity-GI effects- CNS effects (vision changes- blurred vision, yellow-green or white halos around objects)
variables affecting medication response
1. age,weight, race, health 2. tolerance 3. dosage, route, frequency 4. drug to food interactions 5. drug related variables
2 types of pharmacodynamics
1. alteration in cellular function 2. alteration in cellular enviornment
adverse drug reactions of ARBs
1. angioedema 2. headahce 3. dizziness 4. hypotension 5. insomnia
what are 4 types of drugs that do not bind to receptors
1. antacids 2. osmotic diuretics 3. some chemo drugs 4. metal chelating agents
interactions with ARBs
1. antiHTN drugs increase risk of hypotension 2. NSAIDs decrease effectiveness of ARBs 3. increase risk of renal complications
Mechanism of action of ARBs
1. block angio 2 2. decrease arterial blood pressure 3. decrease SVR
ACE inhibitor mechanism of action
1. blocks angio 1 and 2 2. blocks vasoconstriction 3. inhibits aldosterone secretion 4. slows breakdown of bradykinin (prolongs vasodilation)
Uses for ACE inhibitors
1. decrease BP 2. heart failure 3. decrease HF risks post MI
What are the 10 rights of drug administration
1. right pt 2. right drug 3. right dose 4. right route 5. right time 6. right assessment 7. right to refuse 8. right patient education 9. right evaluation 10. right documentation
Patient education of ACE inhibitors
1. slow position changes 2. lay down if dizzy or weak 3. no salt substitutes 4. notify Dr. and stop med for cough, rash, angioedema, taste changes, infection 5. teach for s/sx of hyperkalemia
When asking at patient about medication history, what nonpharmalogical products need to also be mentioned
1. supplements, vitamins, enhancers 2. natural cures/ therapies 3. teas 4. products vaped or smoked or patches 5. why the substance is used
nursing interventions of ARBs
1. treat severe angioedema with IV epi 2. discontinue if angioedema 3. monitor for and report CNS effects 4. monitor BP before dose 5. manage severe hypotension by expanding volume using IV fluid therapy
what are some uses for Kava
1. used by some as an antianxiety medication/ sedative
what are some uses for marijuana
1. used for nausea, chronic pain, anxiety, depression, some eye problems 2. derivatives have been used in prescription nausea meds, especially for cancer/ AIDS patients
what are some uses for cranberry
1. used in supplements to promote urinary health 2. has been shown to possibly decrease UTI's (freq, and severity) 3. may prevent bacteria from adhering to bladder wall 4. reduces pH in urine and decreases urinary odor
what are some uses for feverfew
1. used to reduce frequency/ severity of migraines and as antipyretic
In general, diuretics should not be given past what time of day?
3pm
opposite or atypical response to a drug
idiosyncratic
A nurse is administering hydrochlorothiazide to a client gouty arthritis. The nurse should monitor the client which of the following findings that indicates an adverse effect of this drug? a. hyperuricemia b. hypernatremia c. hyperkalemia d. hypoglycemia
a. hyperuricemia
Loop diuretics are ten times more efficient at removing ________ than thiazide diuretics.
sodium
A client is taking bumetanide and spirolactone. You explain to the client that using these drugs together may reduce the risk of which adverse effects? a. hypokalemia b. hyponatremia c. hyperglycemia d. hypocholermia
a. hypokalemia
A nurse is assessing a client who is taking loop diuretics and is experiencing a thready, irregular pulse, orthostatic hypotension, and confusion. The nurse should identify that these manifestations indicate which of the following adverse affects a. hypokalemia b. hypoglycemia c. hypouricemia d. hyponatremia
a. hypokalemia
A primary care provider prescribes captopril to treat the client's hypertension and also helps alleviate his heart failure. It is essential for a health care provider to make sure a client understands that he should not take which of the following over the counter drugs while taking captopril a. ibuprophen (Advil, Motrin) b. acetaminophen (Tylenol) c. calcium carbonate (Tums) d. diphenhydramine (Benedryl)
a. ibuprophen (Advil, Motrin)
poor blood flow to the heart from the vessels. seen when the individual when they do activity or are under stress
stable angina
A nurse is providing teaching for a client who has a new prescription for a drug with a high potential for toxicity. Which of the following information should the nurse include? (select all that apply) a. periodic laboratory tests are essential to measure serum drug levels b. monitoring for indications of toxicity is important c. taking the drug with an inducing agent will increase the possibility of toxicity d. taking the smallest effective dose is crucial e. increasing fluid intake is recommended to avoid toxicity
a,b,d
A nurse is caring for a client who arrived at an emergency department following a bee sting. Which of the following findings indicates an anaphylactic reaction. Select all that apply a. low blood pressure b. wheezing c. bradycardia d. peripheral edema e. difficulty swallowing
a,b,e
Digoxin is effective in treating heart failure due to which pharacological actions? Select all that apply a. exerts positive inotrophic action b. decreases cardiac output c. decreases sympathetic tone d. increases vascular constriction e. increases myocardial contractility
a,c,e
What are possible side effects when taking beta blockers a. postural hypotension b. agitiation c. memory loss d. hyperglycemia
a. postural hypotension
The release of aldosterone causes: a. dehydration b. the release of sodium and water c. the retention of sodium and water d. low calcium levels
b. the release of sodium and water
A nurse is caring for a client who has a history of renal insufficiency and is taking lithium. The nurse should monitor the client for which of the following? a. tolerance to the drug b. drug interaction c. drug toxicity d. dependence on the drug
c. drug toxicity
A nurse is caring for a client who is having difficulty remembering to take their prescribed drug three times each day. The nurse should identify that which of the following alternate forms of the drug can help to promote adherence to the prescribed dosage? a. liquid suspension b. immediate release capsule c. extended release capsule d. powder form
c. extended release capsule
A nurse is caring for a client who is taking carvedilol and has a prescription for an antidiabetic drug to manage their new diagnosis of type 2 diabetes mellitus. By taking both drugs concurrently, the nurse should identify that the client is at an increased risk for which of the following conditions? a. hyperglycemia b. bradycardia c. hypotension d. hypoglycemia
d. hypoglycemia
A nurse is caring for a client who has a new prescription for verapamil to treat atrial fibrilation. The nurse should instruct the client to avoid drinking grapefruit juice while taking verapamil because it can cause the client to experience which of the following conditions a. tachycardia b. dehydration c. diarrhea d. hypotension
d. hypotension
You are administering lidocaine, 50 mg via IV boluss, to a client with a ventricular dysrhythmia. You monitor the client for which adverse reactions to lidocaine? a. metabolic alkalosis b. hypertension c. tachycardia d. paresthesias
d. paresthesias
one drug blocks the receptors needed by another drug
displacement
allows part of a drug dose to be stored and released as needed
protein binding
block the action of angiotensin II in the body resulting in vasodilation & excretion of sodium & water (by decreasing release of aldosterone)
purpose of ARBs
reduce blood volume by blocking aldosterone receptors in the kidney, thus promoting excretion of sodium and water Used for: HTN, heart failure, premenstrual syndrome, polycystic ovary syndrome, acne in young females
purpose of aldosterone antagonists
-act within teh CNS to decrease sympathetic outflow resulting in decreased stimulation of the adrenergic receptors of the heart & peripheral vascular system -treats HTN & manages ADHD
purpose of alpha 2 agonists
selective alpha 1 blockade results in venous & arterial dilation & smooth muscle relaxation of the prostatic capsule & bladder neck primarily treats HTN
purpose of alpha adrenergic blockers
-decrease HR (negative chronotropic action) -decreases myocardial contractility (neg inotropic) & CO -decreased rate of conduction through AV node (neg dromotropic actiontreats HTN (unknown mechanism), angina, tachydysrhythmias, HF, & MI
purpose of beta-adrenergic blockers
binds with renin to inhibit production of angiotensin 1, thus decreasing production of both angiotensin II and aldosterone relieves HTN when use alone or with another antihypertensive med
purpose of direct renin inhibitor
-block the action of aldosterone (sodium & water retention) -combined with other diuretics (loop & thiazide) for potassium-sparing effects to treat hypertension & edema *effects can take 12-48 hrs
purpose of potassium-sparing diuretics
sodium channel blocker that treats supraventricular and ventricular dysrhytmias
quinidine
what are some uses for aloe vera/aloe
1. burns, decreases scar formation, healing, antiinfective 2. sometimes ingested to aid in constipation or digestive problems
A nurse is caring for a client who has a new prescription for a drug. After receiving the first dose of the drug, the client experiences anaphylaxis. The nurse should identify that anaphylaxis represents which of the following results of the drug? a. adverse effect b. paradoxical effect c. therapeutic effect d. toxicity
a. adverse effect
A nurse is providing teaching to a client who has a new prescription for losartan to treat hypertension. The nurse should instruct the client that which of the following findings could indicate an adverse reaction to the drug and needs to be reported a. facial edema b. sleepiness c. peripheral edema d. constipation
a. facial edema
A nurse is caring for a client who is taking amiodarone to treat atrial fibrillation. Which of the following should the nurse instruct the client to avoid while taking the medication a. grapefruit juice b. milk c. foods high in vitamin K d. NSAIDs
a. grapefruit juice
When reviewing a list of drugs in a drug handbook, a nurse can identify the generic name for a drug in which of the following ways a. it begins with a lowercase letter b. it is listed in parentheses along with the trade name c. there are both letters and numbers in the name d. the chemical name is listed in parentheses before the generic name
a. it begins with a lowercase letter
A nurse is caring for a client who is taking atorvastatin and has a new prescription for gemfibrozil. The nurse should recognize that this drug combination places the client at an increased risk for which of the following adverse effects? a. myopathy b. hypoglycemia c. irregular pulse d. kidney failure
a. myopathy
a nurse is caring for a client who is taking a diuretic. The nurse should instruct the client to include which of the following foods in their diet to increase potassium intake? a. raisins b. cabbage c. cheese d. eggs
a. raisins
any undesired response to a drugs' administration
adverse effects
problems related to topical routes
affected by lotions/oils and poor circulation, dosing problems
pressure that the heart works against in systole trying to eject blood. If this is low, more blood is ejected with each contraction. The resistance has to overcome so blood can circulate. Increase in hypertension and vasoconstriction
afterload
Activation of receptors stimulates a function
agonist
activation of receptors in arterioles of skin, viscera and mucous membranes, and veins leads to vasoconstriction(mydriasis- pupil dilation)
alpha 1 receptors
using a non mainstreamed practice in place of a conventional medicine
alternative medicine
potassium channel blocker that treats ventricular fibrilation and ventricular tachycardia
amiodarone (Cordarone)
Blocking of receptors inhibits a function
antagonist
a drug that can be given to antagonize the toxic effects of another drug
antidote
It is important to give IV furosemide slowly (over 1-2 minutes) due to the risk of
autotoxicity
A client is about to start taking hydrochlorothiazide for hypertension. To assess for adverse effects of this drug, you monitor for which during drug therapy? Select all that apply a. ototoxicity b. hyponatremia c. hypokalemia d. dehydration e. hypoglycemia
b,c,d
A nurse is teaching a client who has a new prescription for gemfibrozil. Which of the following instructions should the nurse include. Select all that apply a. taking the drug with food b. report any new intolerance to fried foods c. report muscle tenderness d. expect periodic liver functioning tests e. take the drug once each day
b,c,d
One serious side effect of ACE inhibitors is: a. inability to void b. angioedema c. decreased appetite d. vision problems
b. angioedema
A nurse is caring for a client who is taking spironolactone to treat hypertension. The nurse should recognize that which of the following client laboratory values requires immediate intervention a. sodium 140 mEQ/L b. potassium 5.2 mEq/L c. chloride 100 mEq/L d. magnesium 1.9 mEq/L
b. potassium 5.2 mEq/L
A nurse is reviewing a drug handbook prior to administering a drug to a client who has kidney diseas. The handbook states that the drug can be administered but identifies certain risks. Which of the following terms descrives these risks a. contrindications b. precautions c. paradoxical effects d. adverse effects
b. precautions
You are caring for a client whose atrial dysrhythmia fails to respond to other antidysrhytmia therapies. You anticipate that the primary care provider might try which drugs whose off label use includes refractory atrial dsrhythmias a. propranolol (Indera) b. lidocaine (Xylocaine) c. flecainide (Tambocor) d. amioderone (Cordarone)
c. flecainide (Tambocor)
You are helping a client learn how to give himself an insulin injection. Which of the following is the best method for evaluating effective learning a. verbally quiz a family member b. instruct the client to complete a written test c. have the client demonstrate an insulin injection d. ask the client several key questions about its procedure
c. have the client demonstrate an insulin injection
A nurse is preparing to administer a drug to a client. In which of the following sections of the drug handbook should the nurse look to determine if the drug has more than one use a. adverse effects b. indications c. pharmacokinetics d. nursing implications
c. pharmacokinetics
A client starts drug therapy, but the following day he reports that he is having palpitations. His ECG at the emergency department indicates frequent premature ventricular contractions, so the primary care provider prescribes a stat dose of lidocaine, 50 mg via IV bolus. A health care professional who administers the drug monitors the client for which adverse reactions of lidocaine? a. metabolic alkalosis b. hypertension c. tachycardia d. paresthesias
d. paresthesias
Lab work that should be monitored in patients receiving aldosterone antagonists is: a. complete blood count (CBC) b. arterial blood gases (ABG) c. blood cultures d. potassium levels
d. potassium levels
A nurse is caring for a client who has a glomerular filtration rate of 10 mL/min and a reduced urine output. The nurse should clarify a presciption for hydrochlorothiazide for this client because of which of the following characteristics of the drug a. the drug can cause hypoglycemia in clients who have low urine output b. the drug does not reduce blood pressure for clients who have a low urine output c. the drug can increase the risk of pulmonary edema for clients who have renal insufficiency d. the drug does not promote diuresis for clients who have renal insufficency
d. the drug does not promote diuresis for clients who have renal insufficency
when a second drug binds to a protein removing the first drug increasing the effects of the first drug
displacement
The movement of a drug by the circulatory system to the intended site of action
distribution
involves the use of drugs to prevent, diagnose, or treat signs/symptoms of disease processes
drug therapy
the length of time the drugs therapeutic effect lasts
duration of action
when crushed forms the enzyme allicin, blocks LDL cholesterol and raises HDL cholesterol, lowers triglycerides, suppresses platelet aggregation and disrupts coagulation, acts as a vasodilator (can lower BP)
garlic
blocks reabsorption of sodium and chloride, and prevents the reabsorption of water at this site promotes diuresis when renal function is NOT IMPAIRED .first choice medication for HTN
purpose of thiazide diuretics
Scheduled drug class that is defined by no acceptable use in humans
schedule 1
natural substances that have been chemically altered
semi synthetic substances
the interaction between drugs results in greater effects
synergism
Clients receiving potassium-sparing diuretics should be encouraged to use salt substitutes. True or false
false; salt substitutes have a lot of potassium in them
Dobutamine, an inotropic sympathomimetic, is given to decrease cardiac output in severe heart failure. True or false
falsee
when complementary approaches are coordinated with conventional treatments, the focus becomes emphasizing a holistic and client focused approach to health care
integrative health
what are some issues that can occur with ginger/ginger root
1. excessive use can cause heart problems, CNS depression, bleeding 2. can enhance antiplatelet activity when used with anticoagulants 3. watch for nosebleeds or bruising 4. unknown for pregnancy
what are some uses for ginger/ginger root
1. frequently used as non pharmacological approach to treating nausea 2. may lower cholesterol 3. possibly antibacterial and antiinflammatory properties
Difference between generic and brand medication names
1. generic= based on chemical composition 2. brand= manufacturer name
2 types of effects of medication
1. local 2. systemic
complications of thiazide diuretics
-dehydration & hyponatremia -hypokalemia & hypochloremia -hyperglycemia -hyperuricemia, hypomagnesemia, increased lipid
What are the medications that treat BP?
-diuretics -ACE inhibitors -ARBs -Beta adrenergic blockers
complications of alpha 2 agonists
-drowsiness & sedation -dry mouth -rebound HTN if abruptly discontinuted -pregnancy risk C
what are some issues that can occur with the use of cranberry
1. can cause GI upset 2. should not replace medical treatment
what are some issues that can occur with the use of feverfew
1. can cause rash-> anaphylaxis 2. possible interaction with anticoagulation 3. observe for abnormal bleeding 4. not safe in pregnancy
what are some issues with melatonin
1. cause decreased reflexed, mental acuity 2. may cause headache, depression, possible addiction, may interact with alcohol 3. avoid hazardous activity 4. can interfere with conception/fertility 5. not for long term use
Adverse reactions of ACE inhibitors
1. dry cough 2. angioedema 3. hyperkalemia 4. neutropenia
what are some issues that can occur with the use of chamomile
1. dyspepsia, gas, diarrhea 2. possible anaphylaxis 3. ragweed (frequent allergen) 4. increase effects of anticoagulants 5. not to be used in pregnancy or children
what are some issues with St. Johns Wort
1. may cause GI discomfort, rash, headache 2. not to be taken if on antidepressants (can cause serotonin syndrome) 3. decreases effectiveness of many drugs, including birth control and some chemo meds 4. should avoid sun exposure while taking
what are some issues that can occur with marijuana
1. may cause anxiety or panic 2. affects differently depending on type used (ingested, smoked)
what are some issues that can occur with ginkgo biloba
1. may cause increased frequency, severity of headaches, dizziness, heart palpitations and allergic dermatitis 2. not to be taken with antidepressants or anticoagulants 3. discontinue at least 2 weeks before surgery 4. watch for rash
what are some issues that can occur with Kava
1. may cause scaly rash, visual disturbances 2. may be habit forming 3. causes liver damage 4. not to be used longer than 3 months 5. not safe in pregnancy
activation of receptors in the arterioles of the heart, lungs, and skeletal muscles leads to vasodilation, delays preterm labor,bronchodilation, raises blood glucose
beta 2 receptors
the portion of a dose of a drug that reaches the systemic circulation and is available to act on body cells
bioavailability
A nurse is caring for a client who will begin using transdermal nitroglycerin to treat angina pectoris. When speaking to the client about the drug, which of the following instructions should the nurse include. Select all that apply a. "apply a new patch at the onset of anginal pain" b. "apply the patch to dry skin and cover the area with a plastic bag" c. "apply the patch to a hairless area and rotate sites" d. "apply ta new patch when you start your day" e. "remove patches for 10-12 hours each day"
c,d,e
A nurse is caring for a client who is newly admitted to the facility for chest pain. At which of the following times should the nurse begin teaching about drugs and discharge planning? a. after the client has a definitive diagnosis b. on the day of discharge c. when the clients family members are present d. as soon as possible
d. as soon as possible
A nurse is speaking to a client who is taking sertraline and reports drinking grapefruit juice. The nurse explains that grapefruit juice inhibits an enzyme in the liver that is used to metabolize sertaline. The nurse should recognize the client's risk for which of the following? a. reduced drug absorption b. drug dependence c. altered drug distribution d. drug toxicity
d. drug toxicity
Cardinal manifestations of HF are_______ and fatigue that can lead to intolerance and fluid retention resulting in pulmonary congestion and peripheral edema
dyspnea
an irregular heart rhythm-- premature heartbeats of the atria or ventricles
ectopy
when two drugs with different sites or mechanisms of action produce greater effects when taken together
synergism
medications that are developed and produced in labs
synthetic substances
Medications are distributed via the circulatory system to sites of action
systemic
poor blood flow to the heart from the vessels. the heart is not getting enough blood or oxygen and can be a precursor to a heart attack
unstable angina
calcium channel blockers that treat subpraventricular tachycardia and atrial fibrilation or flutter
verapamil (Calan)
common medication errors
■Administration of incorrect medication or dose ■Giving medications without an order ■Withholding a medication without documentation ■Not notifying providers when meds are omitted/held ■Errors frequently involve heparin, insulin, and warfarin
A nurse is obtaining a client's health history and discovers that the client takes loratadine, an over the counter drug. The nurse should identify that which of the following is correct regarding over the counter drugs. Select all that apply a. they do not require supervision of a nurse b. they can interact with other drugs c. they should be included in the clients drug history assessment d. they are less effective than prescription drugs e. they do not cause toxicity
a,b,c
A client who has a peanut allergy comes the the ED with a suspected anaphylactic shock. Which of the following actions should you anticipate taking. Select all that apply a. Initiate oxygen therapy to support respiratory function b. administer epinephrine to increase blood pressure c.give diphenhydramine to stop histamine release d. establish and maintain an open airway to ensure oxygenation e. administer a drug agonist to neutralize the allergic reaction
a,b,c,d
A nurse is teaching a client who has a prescription for a drug that has a receptor agonist effect. Which of the following information should the nurse include in the teaching? a. "This will increase the effects of normal cellular functions" b. "This prevents cells in your body from performing certain actions" c. "This prevents hormones in your body from attaching to cell receptor sites" d. "This minimizes the risk that the medications you take will become toxic'
a. "This will increase the effects of normal cellular functions"
A nurse is teaching a client who has a new prescription for quinidine. Which of the following statements should the nurse include? a. "monitor your pulse rate and report changes" b. "remain upright for 30 minutes after taking this medication" c. "this medication can decrease digoxin levels" d. "this medication can cause urinary incontinence"
a. "monitor your pulse rate and report changes"
A nurse is reviewing new prescriptions with a client who has heart disease. The nurse should instruct the client that which of the following drugs is prescribed to treat hypercholesterolemia? a. Simvastatin b. Furosemide c. Losartan d. Nitroglycerin
a. Simvastatin
True or false: nutritional or dietary substances are regulated by the FDA
false-they are not
A nurse is caring for a client who has a depressive disorder and requires a prescription drug to treat hypertension. The nurse should recognize that which of the following antihypertensive drugs is contraindicated for this client? a. reserpine b. captopril c. hydralazine d. eplernone
a. reserpine
A nurse is caring for a client who is taking diphenhydramine for insomnia and reports drowsiness. The nurse should identify that drowsiness indicates which of the following a. therapeutic effect b. adverse reaction c. contraindication d. precaution
a. therapeutic effect
A nurse is caring for a patient who is taking digoxin and develops changes on their ECG tracing and other manifestations that indicate the client has severe digoxin toxicity. Which of the following drugs should the nurse expect to administer to treat this complication? a. acetylcysteine b. flumazenil c. antigen-binding fragments d. deferoxamine
c. antigen-binding fragments
garlic interactions
can increase risk of bleeding in clients taking NSAIDs, warfarin, or heparin, decreases levels of saquinavir (med for HIV) and cyclosporine
•Process of elimination of drugs/substances from the body •Requires adequate function of •Kidneys •Bowel •Respiratory and circulatory systems •Skin
excretion
Medications are grouped according to..
1. effects on the body 2. therapeutic uses 3. chemical characteristics 4. opiods according to effect and potential for abuse/dependence
What are some issues that can occur with the use of aloe vera
1. may caused delayed healing 2. source of infection if it contains impurities 3. if taken longer than 1-3 weeks, can cause cramping or abdominal pain
True or false: Risk factors for HTN are not considered when taking care of patients with HTN
false
A nurse is teaching a client about naproxen enteric coated tablets. Which of the following statements should the nurse include in the teaching? a. "Drug absorption occurs in the stomach" b. "You should expect immediate absorption of the drug" c. "You should allow the tablet to dissolve in your mouth" d." Do not crush or chew the tablet"
d." Do not crush or chew the tablet"
A nurse is caring for a client who is post partum and breastfeeding. The client asks the nurse about the effects that taking over the counter drugs will have on her newborn. Which of the following should the nurse consider when recommending a drug for the client. Select all that apply a. the newborns weight b. how much breast milk the newborn consumers each day c. whether or not the benefits to the client outweigh the risks to the newborn d. the properties of the drug e. the route of administration
a,b,c,d
PCP's prescribe drug dosages for children using which of the following information. Select all that apply a. body surface area b. age c. weight d. developmental level e. drug properties
a,b,c,e
You are caring for a client who is taking oral amiodarone to treat atrial fibrillation. Recognizing the adverse effects of amioderone, you advise the client to watch for and report which of the following? Select all that apply a. cough b. blurred vision c. dizziness d. sore throat e. fever
a,b,c,e
a nurse should recognize that milrione is contraindicated for a client who has which of the following conditions a. acute myocardial infarction b. peripherial vascular disease c. ulcerative colitis d. ventricular tachycardia
a. acute myocardial infarction
A nurse is teaching a client who has a new prescription for nitroglycerin. The nurse should instruct the client that which of the following manifestations is a potential adverse effect of this drug? a. headache b. constipation c. hypertension d. hyperglycemia
a. headache
A nurse is caring for a client who was prescribed an antidepressant based on its ability to prevent the reuptake of neurotransmitters. The nurse should identify that which of the following terms describes why this drug was prescribed for the client a. pharmacologic action b. chemical stability c. route d. adverse effects
a. pharmacologic action
An older client may be at risk for drug toxicitiy due to which of the following physiological changes associated with aging? a. reduced hepatic flow b. increased glomerular filtration rate c. reduced body fat d. increased gastric motility
a. reduced hepatic flow
A client with glaucoma asks you about taking oxybutyin, a muscarinic antagonist, to manage an overactive bladder. You explain that glaucoma is a contraindication for taking oxybutyin. Primary care providers should not prescribe contraindicated drugs because of their potential for which of the following? a. serious adverse effects b. drug tolerance c. drug dependence d. interactions with other drugs
a. serious adverse effects
condition brought on by a blockage or reduction of blood flow to the heart. It comes on suddenly and is typically caused by a plaque or clot formation
acute coronary syndrome
A nurse is caring for a client who has a new prescription for dobutamine. The nurse should clarify the prescription with the provider if the client is receiving which of the following types of drugs. Select all that apply a. ACE inhibitor b. MAOI c. general anesthetic d. tricyclic antidepressant e. beta blocker
b,c,d,e
A client asks you about the difference between a generic drug and a trade or brand name drug. Which of the following are true regarding generic drugs. Select all that apply a. have the potential for abuse and dependence b. have the same chemical composition as the brand name drug c. may have several brand names d. may have several generic names e. are usually cheaper than a brand name drug
b,c,e
A nurse is preparing to administer a drug to a client. In which of the following sections of a drug handbook should the nurse look to determine if the client can receive the drug? a. adverse reactions b. contraindications c. implementations d. black box warning
b. contraindications
You are talking with a client who is taking losartan for hypertension. She asks you about stopping contraception and starting a family. You inform the client that losartan is unsafe to take during pregnancy due to what risk? a. macrosomia b. fetal injury c. gestastional diabetes d. thromboembolic disease
b. fetal injury
A nurse is providing teaching to a client who is taking simvastatin. The nurse should instruct the client to report which of the following manifestations as an indication of a serious adverse reaction that could require discontinuing drug therapy a. bronchoconstriction b. muscle pain c. limb numbness d. somnolence
b. muscle pain
A nurse should identify that which of the following drugs is used only for the short term treatment of a cardiac dysrhytmia because of the serious adverse effects associated with long term use a. quinidine b. procainamide c.nitroglycerin d. verapamil
b. procainamide
A nurse is preparing to teach a client about a newly prescribed drug. Prior to providing teaching, the nurse should review the precautions section of a drug handbook for which of the following reasons a. to determine drug-food interactions b. to determine if dosage modification is indicated c. to determine how the drug is absorbed d. to determine availability
b. to determine if dosage modification is indicated
heart stimulation leads to increased HR, increased myocardial contractility, and increased rate of conduction through the AV node, improving cardiac performance activation of receptors in the kidney lead to release of renin
beta 1 receptors
Atropine is used in the management of _________ or conduction defects
bradycardia
-alpha receptors - vasoconstriction -beta 1- increase HR, contractility, and improve tissue perfusion -beta 2- brochodilation
epinephrine
adrenergic agonists
epinephrine, dopamine, dobutamine, isoproterenol, terbutaline, norepinephrine, albuterol, ephedrine
aldosterone antagonists (-one)
eplerenone (prototype) spironolactone
A nurse is obtaining a clients health history. The client reports no allergies but has experienced mild itching while taking amoxicillin in the past. Which of the following responses should the nurse make? a. "Itching is an expected adverse effect of amoxicillin" b. "Itching can indicate amoxicillin toxicity" c. "Itching can indicate a hypersensitivity to amoxicillin" d. "Itching can result from dry skin, which is often caused by amoxicillin"
c. "Itching can indicate a hypersensitivity to amoxicillin"
A nurse is caring for a client who has a new prescription for propranolol to treat a tachydysrhythia. The nurse should instruct the client to avoid taking which of the following types of over the counter medications while taking propranolol a. antihistamines b. potassium supplements c. NSAIDs d. Vitamin C
c. NSAIDs
you note that a PCP prescribed morphine sulfate, an opiod agoinst, to relieve a client's postoperative pain. Which of the following actions describes the action of an agonist on a receptor? a. destroys the receptor b. competes with the receptor c. activates the receptor d. blocks the receptor
c. activates the receptor
While instructing a client about using isosorbide to treat angina, you advise the client to avoid which of the following? a. milk b. caffeine c. alcohol d. grapefruit juice
c. alcohol
You are talking with a client about taking tetracycline along with an antacid. You tell the client not to take these two drugs at the same time because the antacid can reduce the absorption of tetracycline. When one drug reduces the effect of another drug it is a. an allergic reaction b. a synergistic effect c. an antagonistic effect d. an adverse reaction
c. an antagonistic effect
ACE inhibitors exert their effects by blocking production of a. renin b. aldosterone c. angiotensin II d. potassium
c. angiotensin II
A primary care provider then prescribes quinidine gluconate as an oral antidysrhythmic agent. A health care professional should question the use of quinidine for a client taking digoxin, due to a possible drug interaction that can result in which adverse effect? a. liver toxicity b. quinidine toxicity c. digoxin toxicity d. cardiotoxicity
c. digoxin toxicity
Recognizing the potential for a drug interaction between the diurectic, furosemide, and the cardiac glycoside, digoxin, the primary care provider plans to monitor this client for which adverse effects a. hyperkalemia b. ototoxicity c. digoxin toxicity d. hypoglycemia
c. digoxin toxicity
A client is about to start taking aliskiren to treat hypertension. Which of the following should you tell the client to avoid to ensure optimal absorption of this drug a. soy sauce b. green, leafy vegetables c. fatty foods d. foods high in carbohydrates
c. fatty foods
A nurse is caring for a patient who has a new prescription for verapamil. The nurse should clarify the presciption with the provider if the client has a history of which of the following conditions? a. migraine headaches b. pacreatitis c. second degree AV block d. angina pectoris
c. second degree AV block
A nurse is caring for a client who is receiving nitroglycerin IV and is switching to the oral form of the drug. The nurse should identify that the oral dose will be higher than the IV dose for which of the following reasons? a. the IV form crosses the blood brain barrier b. the oral form has a decreased half life c. the oral form has decreased bioavailablity because of the first pass effect d. the oral form has an increased rate of excretion
c. the oral form has decreased bioavailablity because of the first pass effect
beta-adrenergic blockers (-olol)
cardioselective: -metoprolol -atenolol -esmolol nonselective: -propranolol -nadolol alpha & beta blockers -carvedilol -labetalol
hormones made by your adrenal glands, which are located on top of your kidneys. Examples include dopamine; norepinephrine; and epinephrine
catecholamines
using non mainstreamed practice together with conventional medicine
complementary medicine
A drug that has a positive inotropic effect has the ability to increase __________ of the heart
contractility
transient vasoconstriction of the coronary artery that leads to ischemia to heart tissues. Can be reversible
coronary artery vasospasm
small blood vessels in the heart begin to narrow, so it decreases the supply of blood and oxygen that is being delivered to the heart
coronary heart disease
may be seen in patients with decreased liver or kidney function, or with certain drugs (chemo)
cumulative effects
A nurse is providing teaching to a pregnant client who is taking captopril, an ACE inhibitor, to treat hypertension. The nurse informs the client that captopril is a teratogenic drug. The nurse should explain that teratogenic drugs can cause which of the following? a. maternal bleeding b. maternal blood clots c. gestational diabetes mellitus d. fetal malformation
d. fetal malformation
the removal of the drug or its metabolites through the kidneys, GI tract, skin, or lungs
excreation
aloe vera interactions
interacts with digoxin, diuretics, corticosteroids and antidysrhythmic
one drug interferes with the metabolism or excretion of another
interference
when one drug affects the metabolism of a second drug causing intensified effects of the second drug
interference
-work in the loop of Henle -block reabsorption of sodium & chloride & prevent reabsorption of water -causes extensive diuresis even with severe renal impairment
purpose of loop diuretics
Scheduled drug class that is defined by high potential for abuse (includes opoids and amphetamines)
schedule 2
Scheduled drug class that is defined by lower potential for abuse (includes lower dose narcotics and anabolic steroids)
schedule 3
Scheduled drug class that is defined by lower potential abuse. Benzodiazepines and some muscle relaxers
schedule 4
Scheduled drug class that is defined by low potential for abuse (includes drugs with low concentrations of narcotics)
schedule 5
a laboratory measurement of the amount of a drug in the blood at a particular time
serum drug level
■Provides information on the amount of drug in the body ■Affected by dosage, absorption, half-life, metabolism and excretion rates ■Minimum Effective Concentration (MEC) is level of drug required for desired effects ■Toxic levels can be reached by frequent small doses, one large dose, decreased metabolism or excretion ■Know the half-life of the drug
serum drug level
the time required for the serum concentration of a drug to decrease by 50%
serum half life
Visual disturbances and yellow halos around objects are signs of digoxin toxicity. True or false
true