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Pharmacology Final 0

Pharm final

QuestionAnswer
Drugs that have vasodilatory effects: nitroglycerin, hydralacine (apresoline), and captopril(capoten)
Most effective drugs for the suppression of gastric acid in the treatment of GERD Proton Pump inhibitors
Ferrous sulfate is prescribed for iron deficiency anemia. patient should expect which harmless side effect? black stool
Which group of patients should use antacids containing sodium with extreame caution? Patients with heart failure
Antidote for Coumadin Vitamin K
Antidote for Heparin Protamine sulfate
Antidote for Digoxin Digibind
Insulin Lispro (Humalog) 15-30min; 0.5-2.5 hours; 3-6.5 hours
Insulin Aspart (NovoLog) 10-20min; 1-3hrs; 3-5hrs
Insulin glulisine (Apidra) 10-15mins; 1-1.5hrs; 3-5hrs
Humulin R 30-60mins; 1-5hrs; 6-10hrs
Levemir None; 6-8hrs; 12-24hrs
Humulin N 60-120mins; 6-14hrs; 16-24hrs
Lantus Insulin 70min; none; 24hrs
Which of the following antibiotics may be used to treat gastric or duodenal ulcers linked to h. pylori infection? Amoxicillin, clarithromycin, tetracycline, bismuth, and metronidazole
A prokinetic agent that suppresses nausea & vomiting and increases upper GI motility? Reglan
Signs and symptoms of Digitoxicity would include Nausea, vomiting, confusion, blurred or yellow vision, digoxin level of 3.2ng/dl
A patient taking nitroglycerin for angina pectoris reports the development of a headache after taking more than one tab. what information should be given to the patient? Headache is common because of the vasodilatory effects of this medication
The bestresponse for the thrombolytic therapy occurs when it is: started within 4-6 hrs of the onset of symptoms.
A nurse counsels a patient who is starting and oral iron for anemia. which agent should the nurse advise the patient not to take at the same time as the supplement? antacids
Patients on warfarin (coumadin) should limit their intake of? Collard greens
Which class of drugs is the treatment of choice for acute anginal attacks? organic nitrates
A patient applies a transdermal nitroglycerin patch at 0800. what information would be good to know before applying the patch? the patients blood pressure.
Beta blockers may be useful in the treatment of what? heart failure, hyoertension, angina & glaucoma
A patient with excess fluid volume returning to the heart is said to have an increased _______. This may be treated with _________. Pre-load and treated with HCTZ
A patient receiving a "statin" drug might have to stop therapy f they are experiencing Sever muscle pain & weakness or signs of hepatotoxicity.
Levothyroxine(stnthroid) is used to lower thyroid hormone levels. (true or false) False
A women has been treated with an A2RB for the past 2 years. She has just discovered that he is 6 weeks pregnant. The RN refers the patient to the nurse practitioner in order to: get the drug stopped now, although no fetal damage has likely occurred at this point.
Heparin is used to treat: Non-hemorrhagic stroke patients, patients with deep vein thrombosis & pulmonary embolism
The RN counsels a patient beginning therapy on the angiotensin II receptor blocker, Valsartin (Diovan). A side effect that should be included in drug education would be? angioedema
A patient comes into the ER stating "I accidentally took 3 times my normal prescribed dosage of Coumadin." THe RN finds no evidence of bleeding. What should the RN's next intervention be? Draw blood for PT and INR levels.
If a patient is experiencing nausea, vomiting, and abdominal cramps the laxative of choice is? Nothing; no laxative should be given under these circumstances.
The RN is preparing to administer and ACE for the first time to and 89 year old, an ambulatory patient. THe RN would know that specifically with the first dose, the patient teaching is needed to decrease the risk of what? falls
If you are preparing to administer Hydralazine (apresoline) to a patient. You as the RN would know to observe for? muscle and joint pain
The RN about to administer nitroglycerin via transdermal patch to the client diagnosed with MI. Which intervention should the nurse implement? Date and time the transdermal patch prior to applying to clients skin.
Arterial pressure is regulated by what? The RAAS, The ANS, and the kidneys.
Which medication should the RN question administering? Furosemide (lasix) to a client complaining of leg cramps.
ACE inhibitors, such as ______, have their primary effects in the ______, often resulting in ______. Lisinopril; lungs; a dry cough
The RN preparing to administer a CCB, loop diuretic, and a beta blocker to a patient diagnosed with arterial hypertension would need to do what? Check the clients BP
What are the common side effects of verapamil therapy? dizziness may occur, so caution should be used while ambulating. Constipation is common and can be minimized by increasing fiber and fluids.
A B vitamin that is also used to lower cholesterol and lipid levels - may cause facial flushing. Niacin
A physician has prescribed an ACE inhibitor, Lisinopril (zestril), to a patient being discharged after and MI. Which instruction should be given to the patient? Discuss the need to rise slowly from a lying to a standing position.
ACE inhibitors and angiotensin receptor blocker both work to decrease blood pressure by: preventing the utilization of angiotensin II.
Which medication should the RN question administering to the client with stage C heart failure? Ibuprofen (Motirn), a NSAID
Which class of anti hypertensive medications would be least likely administered to a 77 year old with the following diagnoses: gouty arthritis; hemorrhoids, asthma, and peripheral vascular disease? beta blockers
Verapamil SR (Calan SR) should be: swallowed whole & never crushed.
The major goals of treatment of stage C heart failure would include: removal of fluid from the lungs and the body, possibly with a thiazide diuretic.
The patient diagnosed with coronary artery disease is prescribed Lipitor, and HMG-CoA reductase inhibitor, What would warrant them to notify physician right away? I am feeling pretty good, except I am having muscle pain all over my body.
Once concern about all antidysrhythmic drugs is that they: can worsen existing dysrhythmias or cause new ones.
RN caring for a newly diagnosed patient with hypertension. According to the treatment algorithm for hypertension, RN would give which drug first. HCTZ
In stable angina the objective of drug therapy with calcium channel blockers is the relieve pain by? dilating arterioles and decreasing afterload which, in turn, decreases the work of the heart.
This lab report is drawn on a patient who is taking an aldosterone antagonist, such as spironolactone (aldactone). What is happening in your patients body? Na+ - 136 K+ - 6.0 (H) CI - 97 (L) CO2 - 30 Electrolytes are being reabsorbed by the kidney causing levels to be too high.
How would the nurse expect calcium channel blockers to physiologically effect the function for the heart? Decrease AV nodal conduction and the force of contraction.
Hypokalemia causes the patient on digoxin to have? and increased incidence of dysrhythmias.
Patients taking NSAID's and anti-hypertensice meds should me instructed to monitor their? B/P
55 year old patient prescribed captppril (capoten) for high blood pressure should be instructed to do what? Get up slowly when getting out of the bed.
RN caring for a client that has progressed through the stages of hypertension would have administered the following drugs in which order? 1)HCTZ 2)HCTZ & Captropril 3)HCTZ, Captropril, & Diovan 4) Lasix, Lisinopril & verapamil 5) Lasix, Lisinopril, Verapamil & Diovan
When assessing a patient for signs and symptoms of congestive heart failure, the RN would look for what? No symptoms in the early stages, but later the RN would look for dyspnea, fatigue, and jugular venous distention.
Factors that may affect cardiac preload include: systemic filling pressure, and total circulating blood volume.
Lisinopril (Zestril; Captopril (capoten) Ace Inhibitors used to treat hypertension, angina, and heart failure
Verapamil (Calan); Diltiazem (cardizem) Calcium channel blockers used to treat hypertension and angina
Losartan (cozaar); Valsartan (diovan) Angiotension II receptor blockers used to treat hypertension
Nifedipine (procardia) Dihydropyridine used to lower BP - May cause reflex tachycardia
Nitroglycerin Organic nitrate used to treat anginal pain
Hydralazine (Apresoline) Vasodilator used to lower BP
Metoptolol (lopressor) Beta Blocker used to lower BP
Furosemide (lasix); HCTZ; Sprionolactone (alactone) diuretics
Sodium Nitroprusside (nitropress) Very potent vasodilator - drug of choice for hypertensive emergencies.
Digoxin Slows and strengthens the heart rate used in heart failure.
Quinidine; lidocaine; procainamide (procan SR) Antidysrhythmics
Atorvastatin (lipitor), pracastatin (pravachol), Simvastatin (Zocor) Used to lower LDL cholesterol.
A nurse should question and order for a calcium channel blocking agent in a patient with: hypotension
What assessment data should the RN obtain prior to administering a calcium channel blocker? The clients BP
Because of the vasodilatory effects of nitroglycerin on vessels, this drug primarily changes: preload & lessens oxygen demand requiring close monitoring of BP
Drugs that effect the heart rate are said to be: Chronotrophic
The client with essential hypertension is prescribed the beta blocker, Metoprolol (lopressor). Which assessment data would make the nurse question administering this medication? the clients apical pulse is 56.
Generic name ending in: -pril ACE inhibitors
Generic name ending in: -sartan Angiotensin II Receptor Blockers (ARB's)
Generic name ending in: -pine (block of pine) Ca at the begining of the trade name Calan & Cardizem Calcium Channel Blockers
Generic name ending in: -statin Cholesterol lowering agent
Generic name ending in: -parin Low molecular weight heparins or heparin
Generic name ending in: -kinase thrombolytics
Generic name ending in: -cillin penicillins
Generic name ending in: -cycline tetracyclines
Generic name ending in: -azole antifungals
Generic name ending in: -vir antivirals
Generic name ending in: -dine H-2 receptor blockers
Generic name ending in: -olol beta blockers
Generic name ending in: -ol beta-2 agonists
Generic name ending in: -oxacin fluoroquinolone antibiotics
Generic name ending in: -mide or -zide diuretics
Generic name ending in: -osin alpha blockers
Generic name ending in: -zine anti emetics
Hemodynamics is the study of the movement of blood throughout the circulatory system, along with the regulatory mechanisms and driving forces involved
The primary functions of the circulatory system are: 1)delivery of oxygen, nutrients, hormones, electrolytes, and other essential substances to the cells, & 2)removal of CO2, metabolic wastes, and other debris from cells, as it helps fight infection.
pulmonary circulation Delivers blood to the lungs
systemic circulation (or peripheral circulation Delivers blood to all other tissues
The major components of hemodynamics are: 1)Cardiac output & 2)Arterial pressure
Cardiac output the amount of blood pumped by the heart every minute. In the average adult this is about 5 liters/min. To measure this we use the equation: CO= HR X SV (Heart rate multiplied by stroke volume)
Determinants of cardiac output: The heart rate is increased by the sympathetic nervous system and decreased by the parasympathetic nervous system. Drugs affecting heart rate are said to be chronotropic.
Stroke volume, or the amount of blood ejected by the left ventricle with each heartbeat, is affected by: 1)Myocardial contractility-the force with which the ventricles contract 2)Cardiac afterload & 3)Cardiac preload
Preload is essentially the force of venous return, or how much will the ventricles have to stretch to accommodate the amount of blood coming into the heart.
Preload is determined by 2 factors: 1)the amount of venous return to the ventricles, & 2)the blood left in the ventricles after contraction. The portion of blood ejected by the ventricles with each contraction is the ejection fraction. Normally, this should be between 60-75% of the blood.
Afterload is the load against which the heart must exert its force to eject this blood, and it is affected by the compliance of the arteries and by the effectiveness of the cardiac pump.
Regulation of AP the driving force that moves blood through the arterial side of systemic circulation. Drugs affecting the force of contraction are said to be inotropic.
Major factors of AP 1)Peripheral resistance 2)Cardiac output
Arterial pressure is regulated by: 1)the autonomic nervous system (ANS) 2)the Renin-Angiotensin-Aldosterone system (RAAS) 3)the kidneys
The ANS regulates arterial pressure through: 1)tonic control of the heart rate and peripheral resistance and 2)the baroreceptor reflex—short term control—increases pressure and/or heart rate when fluid volume is sensed to be low & decreases pressure and/or heart rate when volume is high.
The RAAS supports AP by causing: 1)constriction of arterioles and veins by angiotensin II, and 2)retention of water by the kidneys mediated in part by aldosterone
Kidneys: provide more long term control of AP by regulating blood volume
Frank Sterlings Law States that as preload increases, cardiac contractility will increase
toxicity of furosemide OH DANG! Ototoxicty, Hypokalemia, Dehydration, Allergy, Nephritis (interstitial), Gout
toxicities of ACE inhibitors CAPTOPRIL: cough, angioedema, proteinuria, taste changes, hypOtension, preggers problems, rash, increased renin, lower angiotension II. Also hyperkalemia.
Beta Blockers are used for what heart conditions? Hypertension, some tachy arrhythmias and angina
What are side effects of Beta Blockers? Bradycardia, complete heart block, hypotensin, Raynaud's phenomenon, insomnia
What do all clients need to do before taking a Beta Blockers? Check pulse, do not take if <60 bpm.
What is the action of Beta Blockers? Block catecholamines and cause peripheral vasodilation
What is the action of calcium channel blockers? decrease AV conductivity and SA & AV automaticity
CCBs are used for what heart conditions? Angina, SVTs, Hypertension
What are side effects of CCBs? Hypotension, Palpitations, Tachycardia, rash & flushing, peripheral edema
CCBs are contraindicated with what heart condition? AV node dysfunction
What are important teaching topics for clients taking CCBs? Take BP and pulse and watch for orthostatic hypotension
CO x PR = Blood Pressure
SV X HR = Cardiac output
Normal BP <120 <80
Prehypertension 120-139 80-89
Stage 1 hypertension 140-159 90-99
Stage 2 hypertension >160 >100
What is the action of centrally acting adrenergics? stimulate alpha 2 receptors, inhibits alpha 1 (decreases sympathethic activity)
What is the action of ACE inhibitors? blocks the conversion of angiotensin I to angiotensin II and blocks release of aldosterone
ACE inhibitors decrease ? preload
What diuretic can cause ototoxicty when admin too fast with IV infusion? Lasix (furosemide)
What group of diuretics is commonly combined with ACE inhibitors? Thiazide diuretics
What are common electrolyte imbalances with thiazide diuretics? Hypokalemia, hypomagnesemia, hypercalcemia
Thiazides are contraindicated in what patients? renal faliure patients
What are signs of hypokalemia to teach patients? muscle weakness, leg cramps, dysrhythmias
What else must you teach clients taking thiazides to do or watch for? Take BP, watch for orthostatic hypotension, use sun block, eat foods rich in potassium
Loop diuretics are more potent than thiazides as diuretics, why are not not prescribed as often? less effective as antihypertensives
What drug does loop diuretics have a major interaction with? Digoxin --> can cause digoxin toxicity
Potassium sparring diuretics should not be taken with what class of heart medications? ACE inhibitors (both can cause hyperkalemia)
What is the action of vasodilators? act directly on arteriole smooth muscle; decrease stroke volume resistance = decreases afterload
When are vasodilators used? hypertensive emergenices and acute heart failure
Name the 3 vasodilators and what form are they admin in? hydralazine (apresoline) oral, minoxidil (oral) and sodium nitroprusside (Nipride) IV - for malignant hypertension
What do platelet inhibitors do? inhibit aggregation of platelets (decrease clotting)
What are side effects of platelet inhibitors? uncontrolled bleeding
What platelet inhibitor is commonly given after and acute MI? aspirin
What is a common drug from the IIB IIIA inhibitors? colpidogrel (Plavix)
The IIB IIIA drugs are contraindicated for clients with what conditions? bleeding ulcer or intracranial hemorrhage
What is the action of antiplatelets? interrupt clotting process
When are anticoagulants used? after MI, PE, DVT and ischemic CVA
What is a posible serious side effect of heparin and LMWHs? Herparin indiced thrombocytopenia, platelet count below 150,000
Name a common LMWH. enoxaparin (Lovenox)
What are some advantages to LMWHs? no need to monitor PTT, once day dosing, lower incidence of HIT
What lab do you monitor for Heparin? aPTT
What labs are monitored for Coumadin (warfarin) PT or INR
What should PT be? 1.5 - 2.5 X control
What should INR be? 2.0 - 3.0
Clients taking anticoagulants need to report what s/s to MD petechiae, bruising, tarry stools, epistaxis, expectoration of blood
What foods must clients taking anticoagulants avoid? green leafy veggies, fish, liver, coffee, tea (all rich in vitamin K)
What do thrombolytics do? directly break up clots
What is the antidote for thrombolytics? aminocaproic acid (Amicar) it is given to stop bleeding
What are some s/s of thrombolytics? itching, ever, flushing, hives, dyspnea, bronchospasm, hypotension
What dtugs must must be avoided when taking thrombolytics? NSAIDs
Total cholesterol level goal <200
What are serious side effects of statins? elevation of liver enzymes and rhabdomylosis
How long does it take for full therapeutic effect take for statins? 2-4 weeks
What can happen if client abruptly stop taking statins? 3 fold rebound effect on cholesterol; can cause death from AMI
What food must be avoided when taking statins? Grapefruit and grapefruit juice
What is the combination drug that decreases synthesis if cholesterol in the liver and decreases serum lipid levels? Vytorin (ezetimbie/simvastatin)
Digoxin is contraindicated when? HR is <60 bpm
This electrolyte imbalance increases the effect of digoxin Hypokalemia
Nitrates action vasodilation
Nitrates are used for what? Angina
Side effects of nitrates headache, hypotension, dizziness, syncope, circulatory collapse
Nitroglycerin comes in what forms sublingual, transdermal patch, extended release tablet, translingual spray
How is nitrogylcerin stored? dark, glass bottle (not child proof)
How is nitro taken for angina? can take one tablet under tongue every 5 minutes for a total of 3 doses
What s/s may the client have after taking nitro? headache, dizziness, syncope, - client can take Tylenol for headache
What is the action of sodium channel blockers? decreases the rate of conduction in Purkinjie Fibers
Flecaindide (Tambocor) and propafenone (Rythmol) are used for what heart rhythms? life threatening ventricular dysrhythmias
Angiotensin II potent vasoconstrictor - will raise BP
When the Kidneys sense that BP is down what does it secrete? Renin which converts angiotensinogen to Angiotensin I which is then converted to Angitensin II by Angiotensin Converting Enzyme (ACE) in the lungs.
ACE Inhibitors (-pril) Uses: Hypertension (HTN) Heart Failure (HF) Diabetic Nephropathy MI Prevention of CV events (MI & stroke)
ACE Inhibitors (-pril) adverse effects: 1st dose hypotension Dry cough Hyperkalemia Renal failure Fetal injury Angioedema
ACE Inhibitors (-pril) Drug interactions: Diuretics Anti-hypertensives K+ supplements K+-sparing diuretics Lithium NSAIDS
ACE Inhibitors (-pril) Drugs to Know Generic: Brand: Captopril (Capoten) Enalapril (Vasotec) Lisinopril (Zesteril, Prinivil) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik)
Angiotensin II Receptor Blockers (-sartan) Uses: HTN HF Diabetic nephropathy
Angiotensin II Receptor Blockers (-sartan) Adverse effects: Angioedema Fetal harm Renal failure
Angiotensin II Receptor Blockers (-sartan) Drug interactions: Other anti-hypertensives
Angiotensin II Receptor Blockers (-sartan) Drugs to know: Losartan (Cozaar) Valsartan (Diovan) “-sartan drugs”
Aldosterone Antagonists Uses: HTN HF
Aldosterone Antagonists Adverse effects: Hyper-kalemia
Aldosterone Antagonists Drug Interactions: K+ supps K+- sparing diuretics Lithium Antifungals
Aldosterone Antagonists Drug to know: Eplerenone (Inspra)
**Verapamil (Calan) Calcium Channel Blocker (-pine)(Ca) Uses: Angina Pectoris Essential hypertension Cardiac dysrhythmias Migraine h/a
**Verapamil (Calan) Calcium Channel Blocker (-pine)(Ca) Adverse effects: Constipation Dizziness Facial flushing h/a edema of feet and ankles compromised cardiac function
**Verapamil (Calan) Calcium Channel Blocker (-pine)(Ca) Drug interactions: Digoxin Beta blockers
**Diltiazem (Cardizem) Calcium Channel Blocker (-pine)(Ca) Uses: Angina pectoris Essential hypertension Cardiac dysrhythmias
**Diltiazem (Cardizem) Calcium Channel Blocker (-pine)(Ca) Adverse effects: essentially the same as Verapamil, but with less constipation
**Diltiazem (Cardizem) Calcium Channel Blocker (-pine)(Ca) Drug interactions: Digoxin Beta blockers
**Nifedidpine (Procarida) Calcium Channel Blocker (-pine)(Ca) Uses: Angina pectoris Hypertension
**Nifedidpine (Procarida) Calcium Channel Blocker (-pine)(Ca) Adverse effects: reflex tachycardia rapid-acting Verapamil can cause increased mortality in patients with MI and unstable angina. Other side effects the same as Verapamil but without constipation
**Nifedidpine (Procarida) Calcium Channel Blocker (-pine)(Ca) Drug interactions: Beta blockers may be given with this drug to prevent reflex tachycardia.
The primary indications for most vasodilators are: Essential hypertension Hypertensive crisis Angina pectoris Heart failure & MI
Types of vasodilators: ACE Inhibitors: Captopril; Lisinopril A2RB's: Losartan; Valsartan CCB's: Verapamil; Cardizem; Procardia Alpha Blockers: Prazosin Organic nitrates: Nitroglycerin Hydralazine (Apresoline
Primary (Essential) Hypertension HTN with no identifiable cause
Secondary Hypertension HTN brought on by an identifiable cause, such as renal disease.
Consequences of uncontrolled HTN: Damage to essentially every body organ.
**Digoxin (Cardiac Glycoside) Drugs for Heart failure Actions: causes increased force of systolic contractions, Slows heartbeat and improves circulation.
**Digoxin (Cardiac Glycoside) Drugs for Heart failure Adverse effects: Anorexia, nausea, vomiting, diarrhea, abdominal pain, slow pulse<60, Irregular rate and rhythm or sudden change in pulse, headache, drowsiness, or blurred/yellow vision.
**Digoxin (Cardiac Glycoside) Drugs for Heart failure Contraindictions: Severe myocarditis, heartblock, ventricular tachycardia. Hypokalemia & Major hyperclacemia increase risk of possible toxicity. Antacids may Incompatibilities decrease absorption.
**Digoxin (Cardiac Glycoside) Drugs for Heart failure Nursing Implications: Count apical pulse for one full minute prior to administration. If heart rate<60 (adult) or<90-100 (child), hold medications and notify physician.
**Procainamide (Pronestyl, Procanbid) (Sodium Channel Blockers class 1A) Antidysrhythmic drugs Actions: Used as a broad suppression of ventricular and supraventricular dysrhythmias.
**Procainamide (Pronestyl, Procanbid) (Sodium Channel Blockers class 1A) Antidysrhythmic drugs Adverse effects: Systemic Lupus Erythematosus-like Syndrome (sle), pain and inflammation of the joints, pericarditis, unexplained fever, and hepatomegaly-liver enlargement, soreness of mouth, throat and gums.
**Procainamide (Pronestyl, Procanbid) (Sodium Channel Blockers class 1A) Antidysrhythmic drugs Contraindictions: because of many serious adverse reactions its use as a long term treatment is limited
**Procainamide (Pronestyl, Procanbid) (Sodium Channel Blockers class 1A) Antidysrhythmic drugs Nursing implications: Monitor the ECG for beneficial changes. Plasma drug levels should be kept between 3 and 10mcg/mL.
**Lidocaine (Xylocaine; Lidocaine) Sodium Channel Blockers-Class 1B Antidysrhythmic drugs Actions: Acute management of Ventricular dysrhythmias
**Lidocaine (Xylocaine; Lidocaine) Sodium Channel Blockers-Class 1B Antidysrhythmic drugs Adverse effects: High therapeutic doses can cause drowsiness, confusion and paresthesias. Toxic doses may produce convulsions and respiratory or cardiac arrest.
**Lidocaine (Xylocaine; Lidocaine) Sodium Channel Blockers-Class 1B Antidysrhythmic drugs Contraindications: Stokes-Adams syndrome, Wolff-Parkinson-White syndrome, and severe degrees of SA, AV or intraventricular block in the absence of electronic pacing. Also patients with hepatic dysfunction or impaired hepatic blood flow.
**Lidocaine (Xylocaine; Lidocaine) Sodium Channel Blockers-Class 1B Antidysrhythmic drugs Nursing Implications: Continous ECG monitoring, Plasma drug levels should be kept between 1.5 and 5 mcg/mL. Excessive doses can cause convulsions and respiratory arrest. Equipment for resuscitation should be available.
**Statins: HMG-CoA Reductase Inhibitor Lovastatin Trade: Mevacor Simvastatin Trade: Zocor Atorvastatin Trade: Lipitor Pravastatin Trade: Pravachol Actions: Blocks the production of cholesterol, which decreases LDL cholesterol, total cholesterol, very low-density lipoprotein (VLDL) cholesterol, and triglycerides. These inhibitors also increase HDLlevels.
**Statins: HMG-CoA Reductase Inhibitor Lovastatin Trade: Mevacor Simvastatin Trade: Zocor Atorvastatin Trade: Lipitor Pravastatin Trade: Pravachol Adverse effects: myopothy and rhabdomyolysis ( a fatal disease involving skeletal muscle destruction)
**Statins: HMG-CoA Reductase Inhibitor Lovastatin Trade: Mevacor Simvastatin Trade: Zocor Atorvastatin Trade: Lipitor Pravastatin Trade: Pravachol Nusing implications: Monitor CPK levels for early detection of rhabdomyolysis. Obtain baseline liver function before iniating therapy, again 6 and 12 weeeks, and at 6 month intervals there after.
**Niacin (Niacor/niaspan is extended release) HMG-CoA reductase inhibitor Actions: decrease production VLDLs levels. SinceLDLs are byproducts of VLDLs degradation the fall in VLDL levels causes LDL levels to fall as well. Drug of choice for lowering TG levels in patients at risk of pancreatitis
**Niacin (Niacor/niaspan is extended release) HMG-CoA reductase inhibitor Adverse effects: include flushing, itching and GI tract, gastric upset, nausea, vomiting, diarrhea, Intense flushing of the face, neck and ears occurs in practically all patients
**Niacin (Niacor/niaspan is extended release) HMG-CoA reductase inhibitor Nursing Implications: lipid levels, liver function studies, and CBC periodically.
**Nitroglycerin (Nitrostat, Nitroquick) Vasodilator Actions: reduces Anginal pain by decreasing cardiac oxygen demand-since the cardiac muscle does not spasm available oxygen is increased
**Nitroglycerin (Nitrostat, Nitroquick) Vasodilator Adverse effects: Headache, hypotension, reflex tachycardia
**Nitroglycerin (Nitrostat, Nitroquick) Vasodilator Nursing implications: B/P before & during administration
What clinical finding would necessitate holding a dose of Digoxin? If heart rate<60 (adult) or <90-100 (child), hold medication and notify physician
What are the signs and symptoms of Digoxin toxicity (Digitoxicity) & which of these symptoms might the RN see first? nausea & vomiting, fatigue and dysrhythmias, bradycardia, Blurred or yellow vision.
What adverse reactions might necessitate stopping therapy with the statin drugs? Severe muscle pain or weakness or significantly elevated liver enzymes.
List the signs and symptoms of heart failure. In the early stages HF is asymptomatic. by fatigue, shortness of breath, exercise intolerance and/or volume overload resulting in venous distention, peripheral and pulmonary edema.
In the initial phase of HF the ventricles dilate and the walls of the ventricles become thicker. Remodeling of the heart, Once the changes begin they continue resulting in further declination of the hearts capability to pump and eventual death.
DRUGS USED TO TREAT THROMBOEMBOLIC DISORDERS: These drugs fall into 3 main classes: 1)anticoagulants 2)antiplatelet drugs & 3)thrombolytic drugs
Anticoagulants: disrupt the coagulation cascade and suppress the production of fibrin.
Antiplatelet drugs: inhibit platelet aggregation.
Thrombolytic drugs: promote the lysis of fibrin and dissolve the thrombus. promote the lysis of fibrin and dissolve the thrombus.
Anticoagulant Drug: Heparin is a rapid acting anticoagulant administered only by injection
Anticoagulant Drug: **Heparin Uses: Heparin is the preferred for use during pregnancy and in situations that require rapid onset of anticoagulation, such as Pulmonary embolism, Stroke, Massive DVT, May also be used during open heart surgery and renal dialysis
Low dose Heparin therapy is used to: prevent postoperative venous thrombosis
Anticoagulant Drug: **Heparin Adverse effects: Hemorrhage
Anticoagulant Drug: **Heparin Warnings: Heparin must be used with extreme caution in patients with: Hemophilia Increased capillary permeability Dissecting aneurysm Peptic ulcer disease Severe hypertension Threatened abortion Severe liver or kidney disease
Anticoagulant Drug: **Heparin Lab monitoring: Heparin is monitored with PTT levels-therapeutic levels will be 1.5 to 2 times the norm. > than 2 times the norm can produce bleeding problems and the dose should be corrected quickly. < 1.5 times the norm, the dosage needs to be increased.
Low-Molecular-Weight Heparins: “-parin” drugs Uses: Prevention of DVT following abdominal surgery, hip replacement, or knee replacement surgery, multiple trauma, or general surgery Treatment of established DVT Prevention of ischemic complications in patients with unstable angina or Q-wave MI
Low-Molecular-Weight Heparins: Adverse effects: Bleeding Thrombocytopenia Severe neurologic injury in patients undergoing lumbar puncture or spinal or epidural anesthesia
Low-Molecular-Weight Heparins: Enoxaparin (Lovenox) Dalteparin (Fragmin) Tinzaparin (Innohep)
Warfarin (Coumadin): suppresses coagulation by acting as an antagonist of Vitamin K.
Warfarin (Coumadin): Uses: long-term prophylaxis of thrombosis. Specific indications: Prevention of venous thrombosis and associated pulmonary embolism Prevention of thromboembolism of patients with prosthetic heart valves Prevention of thrombosis during atrial fibrillation
Warfarin (Coumadin): Lab monitoring Prothrombin time (PT). To standardize results, this test may also be reported in terms of an internation normalized ratio (INR). An INR of 2-3 is appropriate for most patients, although for some, the target may be an INR of 3-4.5.
Warfarin (Coumadin): Adverse effects: Hemorrhage Fetal hemorrhage and teratogenesis from use during pregnancy
Warfarin (Coumadin): Warnings: like Heparin, Warfarin is contraindicated for patients with: Severe thrombocytopenia Uncontrollable bleeding The need for lumbar puncture or spinal or epidural anesthesia Vitamin K deficiency Liver disease Alcoholism Liver disease Pregnancy and la
Antiplatelet Therapy: Plavix prevents platelets from sticking together.
Antiplatelet Therapy: Asprin cyclooxygenase and suppresses platelet aggregation.
Indications for antiplatelet therapy: Primary prevention of first MI Secondary prevention of MI Prevention of stroke in patients with a history of transischemic attacks (TIA’s)
Antiplatelet Therapy: adverse effects: GI bleeding Increases the risk of hemorrhagic stroke
Other Antiplatelet drugs: Clopidogrel (Plavix) Ticlopidine (Ticlid) ASA and dipyridamole (Aggrenox)
THROMBOLYTIC DRUGS: Streptokinase: Uses: Acute coronary thrombosis (acute MI) DVT Massive pulmonary emboli Embolic stroke (non-hemorrhagic)
THROMBOLYTIC DRUGS: Results are very time-sensitive; usually needs to be given w/in 4-6 hours of the offending event.
THROMBOLYTIC DRUGS: Adverse effects: Bleeding
Alteplase (tPA): Very similar to Streptokinase. Risk of intracranial bleeding is higher with tPA, but there is no risk of allergic reaction and does not tend to cause hypotension. May also be slightly better for the treatment of MI than Streptokinase.
Deficiency Anemias: Iron preparations & Vitamin B-12 require an acidic pH in the stomach to be properly absorbed when taken orally, therefore antacids or drugs like Pepcid & Zantac must be give 1 hour before or 2 hours after Iron & B-12.DO NOT give with acid lowering drugs.
Type I Diabetes: Insulin levels are reduced very early in the disease and fall to zero later.
Type II Diabetes: symptoms result from insulin resistance and impaired insulin secretion.
Long-Term complications of DM: Macrovascular damage: Cardiovascular disease-increased risk of HTN, heart disease, and stroke resulting from atherosclerosis, resulting from a combination of hyperglycemia and altered lipid metabolism
Long-Term complications of DM: Microvascular damage: Retinopathy, Nephropathy, Sensory and motor neuropathy, Autonomic neuropathy: gastroparesis—nausea, vomiting, delayed gastric emptying, and abdominal distention secondary to gastric atony Amputations Erectile dysfunction/ impotence
Diagnosis of DM: Fasting blood sugar: levels of 126 or higher indicative of DM 2hr post-prandial or casual glucose test: levels of 200 or higher indicate DM Oral glucose tolerance test: If 2hr levels are 200 or higher, DM is indicated
Symptoms of DM: Polyuria Polydipsia Ketonuria Rapid weight loss Elevated blood sugar levels
Treatment of DM: Proper diet—controlled carbohydrates and fats Tight glycemic control Insulin replacement for Type I Oral hypoglycemics for Type II
Common symptoms of Hyperglycemia: Classic Symptoms: Polyphagia (frequently hungry) Polyuria (frequently urinating) Polydipsia (frequently thirsty)
Common symptoms of Hyperglycemia: Other Symptoms: Blurred vision Fatigue Weight loss Poor wound healing (cuts, scrapes, etc.) Dry mouth Dry or itchy skin Impotence (male) Recurrent infections such as vaginal yeast infections, groin rash, or external ear infections (swimmers ear)
Common Symptoms of Hypoglycemia: nervousness, sweating, intense hunger, trembling, weakness, palpitations, and trouble speaking, and confusion
with extreme hypoglycemia: Common symptoms: seizures coma death
Oral hypoglycemics: Biguanides: Metformin** Glucophage Glucophage XR Fortamet Glumetza
Oral hypoglycemics: Uses: Glycemic control Prevention of Type II DM—in high-risk individuals Polycystic ovary syndrome
Oral hypoglycemics: Adverse effects: Decreased appetite Nausea Diarrhea Decreased absorption of Vitamin B-12 and folic acid
Oral hypoglycemics: Toxicity: Lactic acidosis---hyperventilation, malaise, myalgia, and unusual somnolence
Oral hypoglycemics: Drug interactions: Alcohol increases the risk of lactic acidosis
Thiazinolides: Glitazones---decrease insulin resistance
Common signs & symptoms of hyperthyroidism: Palpitations Heat intolerance Nervousness Insomnia Breathlessness Increased bowel movements Light or absent menstrual periods Fatigue Fast heart rate Trembling hands Weight loss Muscle weakness Warm moist skin Hair loss Staring gaze
Treatment of hyperthyroidism: Radioactive Iodine Therapy PTU Surgical Removal of all or part of thyroid gland
Treatment of hyperthyroidism: Many people who have been treated for hyperthyroidism will get too much of a good thing & develop hypothyroidism for life requiring thyroid hormone replacement therapy with a drug like Levothyroxine (Synthroid)
Symptoms of Hypothyroidism: Fatigue, Weakness, Weight gain, Coarse dry hair, dry pale skin, Hair loss, Cold intolerance, Muscle cramps and frequent muscle aches, Constipation, depression, Irritability, Memory loss, Abnormal menstrual cycles, Decreased libido
Treatment of hypothyroidism: Levothyroxine (Synthroid)
**Phenergan; Promethizine ANTI-EMETICS Indications/clinical benefits: Sedation, suppression of anticipatory emesis, and production of anterograde amnesia. May help control extrapyramidal reactions caused by phenothiazine antiemetics.
**Scopolamine; Dramamine DRUGS FOR MOTION SICKNESS Indications/clinical benefits: Relief of nausea, vomiting, and cold sweats.
**Diphenoxylate (Lomotil) ANTI-DIARRHEALS Indications/clinical benefits: Only indication is diarrhea.
**Metoclopramide (Reglan) PROKINETIC AGENTS Indications/clinical benefits: Suppresses postoperative nausea and vomiting, as well as emesis associated with cancer chemotherapy, radiation therapy, toxins, and opioids.
Selective toxicity The ability of a drug to injure a target cell or target organism without injuring other cells or organisms that are in intimate contact with the target.
Steps in determining the most appropriate antibiotic to use , three principal factors must be considered: (1) the identity of the infecting organism (2) drug sensitivity of the infecting organism, and (3) host factors, such as the site of infection and the status of host defenses.
Cipro: Class: Fluoroquinolones Therapeutic Use: a broad spectrum antibiotic with a wide variety of clinical applications drug of choice for treatment and/or prophylaxis of anthrax***
Cipro: Class: Fluoroquinolones Drug Interactions: Cationic compounds, theophylline, and Warfarin Adverse Effects: mild GI reactions (nausea, vomiting, diarrhea, abdominal pain) and central nervous
Cipro: Class: Fluoroquinolones Nursing Implications: Don’t give concurrently with theophylline, cationic compounds, and Warfarin.
Flagyl: Class: Antibacterial & anti-protozooal drug*** Therapeutic Use: infections of the CNS, abdominal organs, bones and joints. Is employed for prophylaxis in surgical procedures associated with a high risk of infection by anaerobes.
Flagyl: Class: Antibacterial & anti-protozooal drug*** Drug Interactions: Alcohol &Disulfiram, Warfarin, Phenytoin, Lithium, Fluorouracil, Cyclosporine, Cholestyramine
Flagyl: Class: Antibacterial & anti-protozooal drug*** Adverse Effects: Nausea, headache, dry mouth, and an unpleasant metallic taste. Stomatitis, vomiting, diarrhea
Flagyl: Class: Antibacterial & anti-protozooal drug*** Nursing Implications: Avoid use during the first trimester during pregnancy. Also avoid if alcoholic or on any of the above drugs.
Herpes simplex viruses and shingles: Drug of Choice: Acyclovir
Cytomegalovirus: Drug of choice: Ganciclovir
Hepatitis C: Drug of choice: Interferon Alfa Preparations
Hepatitis B: Drug of choice: Interferon Alpha and Lamivudine (Epivir)
Influenza: Drug of choice: Amantadine (Symmetrel)
HIV: Drug of choice: Reverse transciptase inhibitors: Zidovudine (AZT***) Protease inhibitors: Crixivan*** HIV fusion inhibitors: Ritonavir
Pneumocystis pneumonia: Drug of chioce: Bactrim/BactrimDS***
CMV Retinitis: Drug of choice: Fluconazole
Created by: Heather Trinkle Williams Heather Trinkle Williams on 2009-12-06



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