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MED SURG II EXAM 2

Respiratory Medications Review

QuestionAnswer
Altepase Thrombolytic Drug. Used in patients with an acute PE who have hypotension and do not have contraindications of potential bleeding risk. Administered IV. Major risk if hemorrhaging, caution in patients with significant hepatic impairments. Contraindicated in uncontrolled HTN, aneurysm, internal bleeding, intracranial or intraspinal surgery, or trauma within the past three months. Monitor INR, aPTT, platelets, fibrinogen (BASELINE), ANTIDOTE IS AMINOCAPROIC ACID AND TRANEXAMIC ACID
Heparin Anticoagulant, inhibits the conversion of prothrombin into thrombin, and prevents thrombus formation. Reduced dose in those with renal and hepatic impairments. Side effects include hemorrhage, location irritation. CONTRAINDICATED in GI ulcerations, intracranial bleeding, aneurysms, blood dyscrasias, severe kidney or liver disease, severe HTN, polycythemia, and recent surgery of the eye, spinal cord, or brain. MONITOR aPTT, SHOULD BE 45-70 SECONDS. Monitor for HIT.
Warfarin Anticoagulant, No effect on circulating clots or platelet function, effects take about 3-5 days. Most common adverse effects are hemorrhage, followed by nausea, vomiting, abdominal pain, alopecia, urticaria, dizziness, and joint or muscle pain. CONTRADICTIONS include GI ulcerations, blood disorders, severe kidney or liver disease, severe hypertension, and recent surgery of the eye, spinal cord, or brain. CAUTION in alcoholism, PREGNANCY CATEGORY X. Monitor INR daily. MED SHOULD BE HELD IF OVER 30
Direct Thrombin Inhibitors Dabigatran, Lacks anticoagulant activity. Converts to active form within the body. Inhibts both free & fibrin bound thrombin. Given orally, peaks in 1 hour. Accumulates in patients with renal insufficiency. Adverse effects are bleeding, dyspepsia, abdominal pain, gastritis, and anemia. Contradictions include pathologic bleeding, mechanical heart valves. Teaching that discontinuing the med without approval can increase the risk of blood clots. ANTIDOTE IS IDARUCIZUMAB
Direct Factor Xa Inhibitors Rivaroxavin. Inhibits platelet activation and formation of fibrin. Should not be used with patients that have a creatinine clearance of less than 15 mL/min. Bleeding is the most common adverse effect. Intracranial, gastric, and retinal bleeding have been reported. Other possibilities are spinal or epidural hematomas in patients undergoing epidural anesthesia or spinal puncture. CONTRADICTED in pregnancy, as it has been associated with pregnancy-related hemorrhages, and risks to the fetus
Neuromuscular Blocking Agents Vecuronium and Succinylcholine, pancuronium. Suspend nerve impulses are neuromuscular junction. Maximum blockade occurs in 3-5 minutes, duration of action is 25-40 minutes. Helps facilitate easy tracheal intubation and mechanical ventilation. Relaxes vocal cords, jaw, & respiratory muscles. Adverse effects include allergy, rash. Nurses must maintain airway patency.
Diuretics Prevent fluid overload
Opioids and Benzodiazepines To reduce anxiety and nervousness
Train of Four Used to measure the level of neuromuscular blockade. Ensure to get a baseline response to stimulation. prevents overdose of paralytics
Furosemide Loop Diuretic. Given by IV push or continuous infusion for rapid effects. Once the patient is stable, they should be changed to oral diuretics. May excrete large volume of urine within minutes. Place bedside commode or indwelling catheter. BP, Intake and output, daily weights, serum electrolytes, and creatinine
Nitroglycerin or Nitroprusside Vasodilator/Organic Nitrates. May enhance symptom relief in pulmonary edema. Relaxes smooth muscle in blood vessels causing venous dilation (increasing preload) which decreases cardiac workload and oxygen demand. Coronary Artery dilation in higher doses, increasing flow to ischemic areas of the myocardium. Arteriole dilation lowers peripheral resistance (afterload) resulting in lower systolic BP and consequently reduced cardiac workload and balancing the supply and demand in the heart
Drugs for Hyperkalemia Kayexalate, Bicarb, Calcium Gluconate, Glucose & Insulin
Drugs for Constipation Sorbitol
Drugs for Renal Impairment Calcium
Drugs for Pulmonary Edema Lasix
Drugs for Renal or Hepatic Edema Lasix, Bumex, Hydrochlorothiazide, Spirolactone
Drugs for Fluid Excess Mannitol
Drugs for Anemia Epogen, Procrit
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