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PHARMACOLOGY EXAM 2
| Question | Answer |
|---|---|
| What medication class does Calcium Channel Blockers fall into? | Anti-hypertensives |
| What are the therapeutic uses for Calcium Channel Blockers? | Treats hypertension, stable angina, dysrhythmias |
| What are the side effects for Calcium Channel Blockers? | Orthostatic hypotension, dizziness, flushing, headache, peripheal edema, constipation |
| What is the most common side effect of Anti-hypertensives ? | Orthostatic hypotension |
| With antihypertensives, why can't you suddenly stop the medication? | can cause rebound hypertension, needs to be tapered. |
| Can you drink grapefruit juice with Calcium Channel Blockers? | No, this can cause severe hypotension |
| Calcium Channel Blockers can cause constipation, what would you educate your patient about including in their diet? | Fluids, fiber, and fruit F's fill up the toilet! |
| What are Calcium Channel Blockers medications? | amlodipine, verapamil, diltiazem |
| What is the TRADE NAME for amlodipine? | Norvasc |
| What is the TRADE NAME for verapamil? | Calan, Verelan |
| What is the TRADE NAME for diltiazem? | Cardizem |
| What is the medication class for HMG-CoA Reductase Inhibitors (statins)? | antihyperlipidemics, lipid-lowering agents |
| What is the therapeutic use for statins? | Treats hyperlipidemia (lowers cholesterol) |
| What is the therapeutic response for statins? | increased HDL, decreased LDL and total cholestrol |
| What is the normal level for HDL? | greater than 40 mg/dL we want Happy HIGH numbers! |
| What is the normal level for LDL? | less than 100 mg/dL we want LOW numbers |
| what is the normal level for TG? | less than 150 mg/dL |
| What is the normal level for total cholestrol? | less than 200 mg/dL |
| What are adverse reactions for statins? | Rhabdomyolysis--> muscle pain, tenderness. or weakness. Accompanied by malaise or fever. DARK urine color. Can cause KIDNEY damage. Hepatic Dysfunction-->check liver function before administration, monitor liver enzymes (ALT, AST) |
| what do statins effect the most? | kidneys, muscles, and liver |
| When is the best time to take statins? | take the medication in the evening or at bedtime to promote maximal effectiveness. Statins before Sleep! |
| What is some patient education for statins? | report any signs of muscle aches or weakness Sore muscle Toxic liver (AST, ALT) Avoid grapefruit & st john wort Take at night |
| what are HMG-CoA reductase inhibitors (statins) medications? | atorvastatin |
| what is the trade name for atorvastatin? | Lipitor |
| what medication class is Heparin categorized in ? | anticoagulants |
| what are the therapeutic uses for Heparin? | Prevents new clots or prevents current clots from getting bigger, treats DVTs, treats pulmonary embolism, treats angina/MI |
| what does Warfarin and Heparin NOT do? | Does not break down or dissolve the preexisting clot. |
| How would Heparin be administered? | IV or SubQ |
| What is the antidote for Heparin? | Protamine Sulfate |
| What are LMWH drugs? | Dalteparin, enoxaparin |
| what is the trade name for enoxaparin? | Lovenox |
| What is the therapeutic range for Heparin? | PTT 60-80 |
| Is Heparin safe during pregancy? | Yes |
| Would you stop the infusion of Heparin if bleeding is seen? | yes |
| What would we educate the patient about when using Heparin? | Bleeding Precautions |
| What medication class is Warfarin in? | anticoagulants |
| what are the therapeutic uses for Warfarin? | suppresses coagulation by interfering with the production of Vitamin K, prevents new clots or prevents current clots from getting bigger, treats AFib, artificial heart valves, and those with history of thrombosis |
| What is the administrative route for Warfarin? | Oral |
| What is the trade name for warfarin? | Coumadin |
| what is the antidote for warfarin? | Vitamin K *during WAR vitamin K Kills WARfarin |
| Does Warfarin or Heparin work faster? | Warfarin Works slowly (48-72 hours to take effect) Heparin Happens fast *both medications will be given for several days until warfarin (INR) reaches therapeutic levels |
| Is warfarin safe during pregnancy? | No |
| What is the Therapeutic Range for Warfarin? | PT/INR is 2-3 |
| What should we teach the patient about Warfarin? | educate on bleeding precautions, educate to be consistent with Vit K intake, take the medication at the SAME TIME everyday, frequent blood tests to monitor therapeutic levels |
| What are food examples for Vitamin K? | Liver & Dark leafy green veggies (broccoli, spinach, brussel sprouts, cabbage) BUT MAKE PT LIMIT THEIR INTAKE |
| what is the medication class for Beta-adrenergic Blockers (beta blockers)? | antihypertensive |
| what are the therapeutic uses for Beta Blockers? | Treats hypertension, treats stable angina, treats chronic/compensated heart failure, treats dysrhythmias |
| The B's of Beta Blockers | Bradycardia & heart blocks **Breathing problems-->bronchospasm or bronchoconstriction (NO for asthma patients) Bad for heart failure patients Blood sugar masking--> MASKS SIGNS OF HYPOGLYCEMIA Blood pressure lowered |
| what are Beta Blockers drugs? | metoprolol, propanolol |
| what is the trade name for metoprolol? | Lopressor |
| What is the trade name for propanolol? | Inderal |
| What is the most common beta blocker? | propanolol |
| Is propanolol selective or non-selective? | non-selective |
| Is metoprolol selective or non-selective? | selective |
| What does metoprolol work on? | Beta-1, the heart |
| What does propanolol work on? | Beta-2, the lungs |
| what is the main prototype for BB? | metoprolol |
| If a patient overdoses on CCB, what would we give? | Calcium gluconate |
| What drug is a first line agent for African Americans? | Calcium Channel Blockers |
| What is a first line agent for hypertension? | ACE inhibitor |
| Do DHP meds affect HR? | no |
| Do non-DHP meds affect HR? | yes |
| What patients would we not use a CCB? | CHF patients--> causes muscle to relax more when the heart is already failing |
| What systems would we assess if we give a patient a BB that has both Beta-1 and Beta-2? | cardiac and respiratory |
| What organ is Beta-1 drugs associated with? | heart |
| What organ is Beta-2 drugs associated with? | lungs |
| What is the difference between Alpha and Beta drugs? | Alpha drugs constrict, Beta drugs dialates |
| General overview of Lipid Panels | fast for at least 12 hours before LP; levels in LP DO NOT change quickly-->change is minimal, at least four weeks to see an actual change |
| What medication class do ACE-i fall into? | Antihypertensives (-PRIL) |
| What are the therapeutic uses for ACE-i? | Reduces systemic hypertension, prevents renal failure in DIABETICS, prevents remodeling, prevents progression of HF, prevents stroke and MI |
| What are some drugs that are ACE-i? | lisinopril |
| What is the trade name for lisinopril? | Prinivil |
| What are the side effects for ACEs? | Think "ACE"-->Angioedema, Cough (dry), and Elevated K+ also orthostatic hypotension, dizziness |
| What do we have to monitor with a patient on an ACE-i? | Monitor renal values (BUN and CREATININE) becauase ACE inhibitors are excreted by the KIDNEYS and can worsen kidney failure |
| Are ACE-i safe for pregnancy? | no |
| What foods should you avoid if you're on an ACE? | potassium containing foods and potassium pills |
| When on Lisinopril and the patient experiences a bothersome dry cough, would you change and the drug? If so, what drug? | Yes, Losartan |
| What do ACE-I act as? | vasodialators |
| What is a special indication for ACE-I? | Diabetics-->used to protect the kidneys |
| What pathway do ARBs and ACEs work in? | Renin-angiotensin-aldosterone system |
| What is the difference in symptoms between ACEs and ARBs? | ACEs produce a dry cough |
| Why don't we start patients on an ARB? | Very expensive |
| Are we able to use ACEs and ARBs together? Why or why not? | No!!! They work on the same pathway |
| What would we monitor for ARBs? | monitor potassium levels |
| Is amlodipine a DHP or non-DHP? | DHP |
| Is verapamil a DHP or non-DHP? | non-DHP |
| Is dialtiazem a DHP or non-DHP? | non-DHP |
| What are some JNC8 compelling indications for CCB? | we should know that we are giving the right med to the right group of people: diabetics, kidney disease, pregnant |
| What are the two types of CCB? | non-DHP and DHP |
| What is the most common side effect of amlodipine? | Lower extremity edema but more commonly ANKLE edema |
| What drug can we combo with amlodipine? | HCTZ, spironolactone |
| What is the main function of a BB? | blocks SNS receptors, HR and BP decrease |
| What drug can be used for migraines and anxiety? | propanolol |
| What are Post MI Bundle medications? | statins, BB, Plavix, Aspirin |
| What would we give a patient if they come in with a MI? | think MONA!! Morphine, Oxygen, Nitroglycerin, Aspirin |
| What are the Post MI Bundle meds that we would send a patient HOME with? | Aspirin, ACE-I (prevents cardiac remodeling), high intensity statin, BB (works on cardiac remodeling), P2Y2 inhibitor (Plavix) |
| What drug would we not send a Post MI patient home with? | a calcium channel blocker |
| What is the main purpose of Thrombolytics? | breaks down the clots |
| If patient is on a thrombolytic, what would we monitor for? | Bleeding-->abdominal pain, coffee ground emesis, hematuria, coughing up blood, black tarry stool |
| What medication do TPAs fall into? | Thrombolytics, Fibrinolytics |
| What are the therapeutic uses for TPAs (thrombolytics)? | Clot busters, ischemic stroke, acute MI, Pulmonary Embolism |
| What is an example of a thrombolytic drug? | alteplase |
| What is the trade name for alteplase? | Activase |
| What is the main purpose of digoxin? | Slows and stregthens the heart, does mechanical and electrical effects on the heart |
| What would we monitor a patient for when on digoxin? | monitor levels of digoxin when they have S+S of toxicity |
| what are the signs of digoxin toxicity? | Nausea and vomiting (first sign usually), yellow halo, blurry vision, headache, drowsiness, confusion |
| What should the nurse do before giving digoxin? | Check HR (rate and rhythm) |
| What is the antidote for Digoxin? | Digibind and Digifab |
| What is the therapeutic range of digoxin? | 0.5-2.0 more than 2 is toxic |
| What is a MUST before administering digoxin? | The apical pulse must be assessed for ONE MINUTE before administering digoxin |
| When would we hold digoxin? | HR is lower than normal for age group |
| What are causes of digoxin toxicity? | think "DIG"--> Decreased potassium, Injured kidneys, GFR decreased |
| What are the therapeutic uses for Digoxin? | Treats HF!!! treats cardiogenic shock, dysrhythmias, AFib |
| What is an (+) inotropic effect? | increased cardiac output |
| what is a (-) chronotropic effect? | decreased heart rate |
| what is the trade name for digoxin? | Lanoxin |
| what medication class is digoxin in? | cardiac glycoside |
| what is the time of administration window for a thrombolytic? | 30 mins, time is tissue |
| When would you not use a thrombolytic? | brain hemorrhage or uncontrolled hypertension |
| what does lidocaine treat? | Ventricular arrhythmias |
| what's lidocaine also used for? | local anesthetic, used in codes |
| what does Amioderone treat? | treats resistant ventricular arrhythmias |
| what does amioderone work on? | potassium channels |
| what do you monitor when your patient is on amioderone? | monitor potassium levels, check thyroid and liver enzymes (it is bound to iodine) |
| If you give your patient a higher dose of amioderone, what are they at risk for? | corneal effects |
| What medication class is Adenosine in? | Antiarrhythmics |
| what are the therapeutic uses for adenosine? | SVT |
| What is SVT? | rapid rhythm of >150/min |
| what are the trade names for adenosine? | Adenocard, Adenoscan |
| How do you administer adenosine? | Have the patient bear down, administer as close to the heart as possible, rapid administration, followed by a saline flush, brief period of asystole may be seen |
| what would you monitor your patient for when they're on adenosine? | flushing, dizziness, hypotension, bradycardia, chest pain or palpatations Monitor heart on monitor |
| What medication class are Nitroglycerides in ? | Antianginals |
| What are therapeutic uses for Nitros? | treats angina, prevents angina attacks, treats acute coronary syndrome |
| what is the trade name for nitroglycerin? | Nitrostat, Nitro-bid |
| What drug do you NOT take Nitros with? Why? | Phosphodiesterase inhibitors AKA erectile dysfunction drugs. Causes dangerously low blood pressure resulting in death |
| what are EXPECTED signs and symptoms of Nitros? | think three H's!! Headache, Hot flashes, Hypotension |
| what are ALARMING signs and symptoms of Nitros? | dizziness and lightheadedness |
| What is the administration education to give when Nitro is given as topical or a transdermal patch? | -remove prior dose, rotate sites, place over a clean/hairless area, and wear gloves -do not rub nitro ointment into the skin, can cause rapid absorption!!!! |
| what is the administration education to give when Nitro is given sublingually or as a spray? | -1 tablet/ spray sublingual every 5 minutes, up to 3 doses -if angina is not relieved or is worse 5 mins after the first dose, call 911 |
| What is the administration education to given when Nitro is given sublingually or buccally? | -Place BUCCAL tablet between cheek and gum -Place SUBLINGUAL under the tongue -Rinse with water before placing the tablets in your cheek |
| Where would we keep Nitros? | Keep in original container (dark vile) in a cool, dry place. |
| What does Fenofibrate target? | Triglycerides |
| If muscle pain doesn't go away with treatment while on atorvastatin, what med would we switch them to? | ezetimibe |
| What medication needs a 2 nurse check? | Heparin |
| What is the most common side effect of heparin? | bruising |
| What medication class is aspirin in? | antiplatelet |
| what does aspirin prevent? | platelet aggregation by inhibiting the binding of ADP to P2Y12 platelet receptor |
| what are the side effects of aspirin? | GI upset and bleeding |
| What is the trade name for clopidogrel? | Plavix |
| If a patient has MI, coronary bypass, stent formation, what med will the patient be on? | clopidogrel (Plavix) |
| What are the uses of clopidogrel? | given to prevent post OP bleeding, given to prevent DVTs |
| what are the administration directions for clopidogrel? | do not crush or use 5 days prior to surgery, do not use for active bleeding |
| What are examples of hematology meds? | Iron, Vitamin B12, and Erythropoietin |
| What is Iron (Ferrous Sulfate) used for? | used to treat iron deficiency anemia |
| What are nursing considerations for Iron? | when administered orally, give with Vitamin C, give with stool softener |
| What is the diet for patients with iron deficiency anemia? | red meat, fish, poultry, whole-grain cereals, pastas |
| What does Fenofibrate target? | Triglycerides |
| If muscle pain doesn't go away with treatment while on atorvastatin, what med would we switch them to? | ezetimibe |
| What medication needs a 2 nurse check? | Heparin |
| What is the most common side effect of heparin? | bruising |
| What medication class is aspirin in? | antiplatelet |
| what does aspirin prevent? | platelet aggregation by inhibiting the binding of ADP to P2Y12 platelet receptor |
| what are the side effects of aspirin? | GI upset and bleeding |
| If a patient has MI, coronary bypass, stent formation, what med will the patient be on? | clopidogrel (Plavix) |
| What are the uses of clopidogrel? | given to prevent post OP bleeding, given to prevent DVTs |
| what are the administration directions for clopidogrel? | do not crush or use 5 days prior to surgery, do not use for active bleeding |
| What are examples of hematology meds? | Iron, Vitamin B12, and Erythropoietin |
| What is Iron (Ferrous Sulfate) used for? | used to treat iron deficiency anemia |
| What are nursing considerations for Iron? | when administered orally, give with Vitamin C, give with stool softener, teeth staining with oral liquid |
| What is the diet for patients with iron deficiency anemia? | red meat, fish, poultry, whole-grain cereals, pastas |
| What would we monitor for a patient that is on Iron? | H&H |
| What are side effects of Iron? | black tarry stools |
| What is Vitamin B12 used for the most? | Vitamin B12 deficiency anemia |
| What kinds of patients recieve vitamin B12? | Bariatric surgery patients, elderly patients, Vitamin B12 anemic pts. |
| What helps absorbs Vitamin B12? | Intrinsic factor |
| How is Vitamin B12 given? | IM, SubQ, NASAL |
| What would be monitored when given Vit B12? | Monitor MCH, MCV--> will both be increased |
| What are other uses for Vitamin B12? | Pernicious anemia (disorder or impaired DNA synthesis), it is essential in maintaining integrity of neuro system, and energy production |
| What are the causes of Vitamin B12 Deficiency? | poor diet, decreased production of instrinsic factor, Crohn's disease, gastric resection |
| What are clinical improvements for Vitamin B12? | increased alertness, appetite, cooperation |
| What medication class is Epoetin Alfa in? | Erythropoiesis-stimulating agents |
| What is the main indication to give Erythropoietin? | anemia of chronic disease (renal failure) |
| What is the main function of erythropoietin? | causes bone marrow to make more RBCs |
| what is the trade name for epoetin alfa? | Epogen, Procrit |
| What are adverse reactions and contradictions for erythropoietin? | HYPERtension and venous thromboembolism |
| What is administration education for erythropoietin? | DO NOT shake vile |
Created by:
mkozej001
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