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Drug Therapy/Circ
Safety in Med Admin - Drug Therapy/Circ - TAS, NP2, Test 1
| Question | Answer |
|---|---|
| angina pectoris | chest pain secondary to myocardial ischemia. Narrowing or blockage of the coronary arteries decrease blood flow and oxygen level. |
| Three categories of general drug treatment for angina pectoris... | nitrates beta blockers calcium channel blockers |
| stable angina | chest pain triggered by predictable events such as STRESS or exertion |
| treatment for stable angina | rest, nitro or both |
| unstable angina | unexpected and more severe, decrease blood to the heart secondary to narrowing of coronary arteries due to ARTHEROSCLEROSIS |
| treatment for unstable angina | depends on how much blockage, evaluation in the ER, observation on the heart unit |
| heart failure | unable to pump adequate blood through body, edema, decreased kidney ability to regulate Na+ and H2O |
| causes of heart failure | HTN, MI, artherosclerosis |
| treatment for heart failure | rest, diet, lifestyle change |
| categories of drug therapy for heart failure | ACE inhibitors beta-blockers digoxin diuretics |
| What does ACE inhibitors stand for? | Angiotensin Converting Enzyme Inhibitors |
| Define MAP | mean arterial pressure, the perfusion pressure experienced by organs in the body |
| Normal MAP range | 70-110 |
| Minimum MAP needed to perfuse vital organs | 60 |
| Normal blood pressure | systolic 140 or below, diastolic 90 or below |
| Equation to calculate MAP | systolic + (diastolic x 2)/3 |
| preload | volume of blood coming into the heart to stretch it before it beats |
| afterload | pressure created when the heart pumps out of left side also PVR or peripheral vascular resistance |
| contractility | forcefulness of the heart muscle |
| Cardiovascular agents decrease blood pressure by... | decreasing intravascular volume decrease venous return (preload) decrease afterload improve cardiac function |
| What does angiotensin II do in the body? | It is a potent vasoconstrictor. |
| In what organs does the conversion from angiotensin I to angiotensin II occur? | Kidneys |
| What cardiovascular agent prevents the conversion from angiotensin I to angiotensin II? | angiotensin-converting enzyme (ACE) inhibitors |
| What are the physiological responses to ACE inhibitors? | decreases pressure, vasodilator, decreases secretion of alderosterone, results in reduction in Na+, decreases water retention. |
| The indications for ACE inhibitors are... | mild to moderate hypertension, heart failure |
| What do the names of ACE inhibitors end in? | "pril" |
| Which cardiovascular agents operate without increasing the heart rate or contractility? | ACE inhibitors |
| What adverse reaction should be watched for with ACE inhibitors? | angioedema |
| If a client develops angioedema, what steps should be taken? | immediate evaluation, stop ACE inhibitors |
| What are the side effects of ACE inhibitors? | decrease PVR without increased cardiac output, increased cardiac output, increased cardiac contractility |
| What are the outward signs and symptoms of ACE inhibitor side effects? | dizziness, orthostatic hypertension, GI distress, non-productive cough. |
| What is the most common side effect of ACE inhibitors? | non productive cough |
| What is the importance of recording a daily weight for a client taking ACE inhibitors? | to assess for resolution of fluid overload indicated by sudden weight loss |
| What is the normal range of lab values for Na+ (sodium)? | 135-145 |
| What is the normal range of lab values for K+ (potassium)? | 3.5-5.0 |
| What is the normal range of lab values for Creatinine? | 0.5-1.1 |
| What is the normal range of lab values for BUN (blood urea nitrogen)? | 8-20 |
| Explain the "First Dose Phenomenon" concerning ACE inhibitors. | Some clients experience sudden decreased blood pressure, dizziness or fainting within the first couple of hours after the first dose. |
| Foods high in potassium | bananas, wheat bread, cantalope, orange juice, potato skins |
| What symptoms should a client report to the MD when taking ACE inhibitors? | rash, mouth sores, swelling of hands, feet, face and tongue, irregular heart beat |
| What is commonly included in the patient teaching for cardiac agents? | Take at the same time every day, do not stop abruptly, change position slowly, take pulse |
| Which cardiac agent can alter taste from a few days up to 12 weeks? | ACE Inhibitors |
| What are the indications for nitrates? | first line for prevention and relief of acute angina |
| What are the physiological responses to nitrates? | relaxation of arterial and venous smooth muscles, vasodilation, decreases preload, decreases blood volume in chambers so decreases cardiac output and decreases afterload. |
| What are the routes used to administer nitroglycerin for acute angina? | sublingually, IV |
| What are the routes used to administer nitroglycerin for chronic angina? | orally, buccal, transdermal |
| What are the physiological responses to nitroglycerin? | reduces vascular tension reducing volume of blood to be ejected, relaxes venous smooth muscle (primarily coronary vessels), vasodilation, reduces preload, reduces blood volume in the heart, increases coronary blood flow |
| What is the half life of nitroglycerin? | 1-4 min |
| List the possible side effects of nitroglycerin... | dizziness, headaches, tachycardia, HTN |
| What are the primary assessment nursing implementations for nitroglycerin? | Assess the pain, location, duration, intensity, and activity prior to the onset of pain. |
| What is the typical drug treatment for hypertension? | Beta Blockers |
| What should a nurse remember when administering nitroglycerin patches? | choose a hairless site, not distal extremities, rotate sites, do not massage, wear gloves, administer first dose while patient is sitting. |
| If a client does not have an order to keep a nitroglycerin patch on continuously, what guidelines should be followed for taking the patch off? | Remove for 12-14 hours, preferably at night when stress is low. |
| What patient teaching is required for clients using the nitroglycerin patch? | Change position slowly, Take tylenol or aspirin for headache, keep meds in original container with no exposure to air, heat, moisture, handling, excessive opening, and do not store close to body. |
| What should a client do next if chest pain persists after the third dose of nitroglycerin? | Call 911. |
| What name ending do beta blockers have? | "olol" |
| What are the common off-label uses for beta blockers? | migraines and anxiety |
| What are the indications for beta blockers? | HTN, angina, tachy-arrythmias, MI prevention, CHF management |
| What is the action of beta blockers? | blocks beta receptors in the heart, leads to decreased heart rate, decreased contraction force (saves heart), decreases rate of A-V conduction |
| What are the possible side effects with beta blockers? | bradycardia, lethargy, GI disturbance, CHF, decresed blood pressure, depression |
| How are the parameters for what is considered bradycardia with a patient taking beta blockers different from the normal accepted heart rate? | The lowest normal heart rate is usually 60 BPM, with beta blocker patients it is 50 BPM. |
| What is the most widely prescribed medication? | Diuretics |
| How do diuretics affect the body? | decreases intravascular volume by increasing urine production, decreases volume to the right ventricle, decreases overload to the left ventricle, heart contracts more efficiently and cardiac output increases. |
| What is the focus of a diuretic on urine production? | in the loop of the nephron |
| What are the indications of furosemide? | CHF and HTN |
| What are the side effects of furosemide? | dehydration and loss of electrolytes, which can lead to metabolic acidosis. |
| What precipitates Digoxin toxicity? | hypokalemia |
| What happens if furosemide is given too fast IV? | ototoxicity |
| With ACE inhibitors and Beta Blockers, WATCH... | Blood pressure and pulse. |
| With Nitrates, WATCH... | Chest pain and blood pressure. |
| With diuretics, WATCH... | electrolytes |
| Another term for therapeutic index is... | margin of safety. |
| What is a loading does? | When a higher dose is given first. |
| 1 kg equals... | 1 liter of fluid. |
| Which of the diuretics is faster acting? | furosemide |
| Which of the diuretics is slower acting? | HCTZ |
| What are the side effects with HCTZ? | adverse hypokalemia, hyperuricemia, increased serum cholestrol, increased LDL, increased triglycerides. |
| How do calcium channel blockers work? | blocks calcium entry into cells of vascular smooth muscle and myocardium, dilates coronary arteries, decreases AV conduction, systemic vasodilation, decreased blood pressure. |
| Name two common diuretics. | furosemide and HCTZ |
| Name one calcium channel blocker. | Diltiazem |
| DO NOT _________ time released meds. | CRUSH |
| Give an example of a cardiac glycoside. | Digoxin |
| What are the most concerning side effects with Digoxin? | bradycardia and arrythmias |
| What are the most commons signs and symptoms of Digoxin toxicity? | nausea and vomiting |
| Digoxin has a long half life and a ________ margin of safety. | narrow |
| The loading dose for Digoxin is administered over what time frame? | 12-24 hrs. |
| What must be monitored for a full minute before administering Digoxin? | Apical pulse |
| What should a nurse do if the apical pulse of a client scheduled to receive Digoxin is 58? | Hold the Digoxin. The apical pulse must be above 60 to receive Digoxin. |
| With Digoxin, WATCH... | pulse, creatinine, BUN, electrolytes |
| What is "yellow vision" a side effect of? | Digoxin |
| List two common anticoagulants... | Heparin and Coumadin |
| What is the most concerning side effect to watch for with anticoagulants? | bleeding |
| Heparin prevents the conversion of ______ while Coumadin interferes with the synthesis of ____. | prothrombin, vitamin K |
| What should be monitored before and throughout administering Heparin? | PTT |
| When a client is taking Heparin, a _______ _________ should be done every 2-3 days. | platelet count |
| What is the action of anticoagulants? | prevent clot formation, so prevents DVT, PE, embolism secondary to A-fib, stroke and MI. |
| When are anticoagulants contraindicated? | patients with anticoagulation disorders, ulcer disease, recent surgery, trauma, active bleeding |
| What kind of verification is needed before a nurse may administer anticoagulants? | the signatures of two licensed staff on the MAR |
| What is the half life of Heparin? | 2-6 hrs |
| What is the half life of Coumadin? | 0.5-3 days |
| What should be monitored when Coumadin is administered? | PT and INR |
| What PT range is acceptable with clients taking Coumadin? | 2-3 times the baseline |
| What are the normal ranges for INR? | less than two if the client is NOT on anticoagulants, 2-3 if client IS on anticoagulants. |
| T or F. Clients should avoid food high in vitamin K if taking Coumadin. | False. The client should eat normal, and the MD will adjust the Coumadin dose. |
| Antimicrobials that inhibit nucleic acid synthesis are typically use against... | viruses |
| "...cidal" means | kill |
| "...static" means | stop replication |
| What is the main definer of how antimicrobials are chosen? | culture and sensitivity |
| If a clients exhibits signs of urticaria and runny nose after receiving an antimicrobial, what should the nurse do? | stop med, give antihistamine |
| If a client exhibits low blood pressure, brochostriction, laryngeal edema or cardiovascular collapse after receiving antimicrobials, what should the nurse do? | stop med, epinephrine, oxygen, supportive care |
| What antimicrobial has the highest incident of allergic reaction? | Penicillin |
| If a client is sensitive to Penicillin, they are most likely also sensitive to... | Cephalosporins and Primaxin |
| What forms are Aminoglycosides available in? | IV and inhalation forms |
| Penicillins ________ Aminoglycosides. | inactivate. They should not be mixed. |
| The greatest risk associated with Aminogycosides is... | they are ototoxic and renal toxic. |
| When should peak levels be evaluated? | 30 min after infusion is complete. |
| When should trough levels be evaluated? | 30 min before next IV dose. |
| What reduces absorption of tetracyclines? | Food, especially dairy. Take on empty stomach. |
| Which drug binds to newly formed bone and teeth? | tetracyclines |
| Which antimicrobial has the least incidence of toxicity? | erythromycins |
| Erythromycins notoriously cause ____ ______, which is NOT considered a sensitivity. | GI upset |
| Which antimicrobial also helps with gastric emptying? | erythromycin |
| Which antimicrobial cause stones? | Sulfonamide |
| When administering sulfonamides, it is important for the nurse to ensure that the client does what? | drink at least 2-3 liters per day |
| What is aplastic anemia? | shut down of bone marrow, stops production of red and white cells. |
| Which antimicrobial has serious toxicity limits due the the possibility of aplastic anemia? | chloramphenicol |
| What are two brand names for quinolones? | ciprofloxacin and floxin |
| Quinolones are effect in treating... | psuedomonas |
| What antimicrobial must be given by IV slowly over 2-4 hrs, can cause shivers, lower electrolytes and be nephrotoxic? | antifungals |
| What antimicrobial is sensitive to light? | antifungals |
| Acyclovir | Antiviral, Primary use is herpes, give over one hour to prevent renal dysfunction and be sure client is well hydrated. |
| Gancyclovir | antiviral, used to mainly treat Cytomegalic Inclusion Virus, carcinogenic |
| Clindamycin | For bone infection, rapid IV administration can cause drop in BP |
| Primaxin | used with aminoglycosides to treat psuedomonas, can cause seizures in renal impaired patients |
| Vancomycin | Used to treat MRSA and C. Diff., can cause red man's syndrome, ototoxicity and nephrotoxicity. |
| Flagyl/Metronidazole | Good for GI perforations, Give IV over 1 hr. |
| Linezolid/Zyvox | Used to treat VRE, staph and strep penicillin resistant infections. Can cause C. Diff. |
| With Linezolid/Zyvox, monitor for... | diarrhea, nausea and vomiting, and bone marrow suppression |
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tiffiny090180
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