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Parm Test 2
Cardiovascular
| Question | Answer |
|---|---|
| Drugs that influence the force or energy of muscular contractions, particularly contraction of the heart muscle. | Inotropic |
| T/F Positive Inotropic drugs increase myocardial contractility | True |
| Drugs that influence the rate of the heartbeat. | Chronotropic |
| Positive ___ drugs increase the heart rate, whereas negative ___ drugs decrease it. | Chronotropic |
| Drugs that influence the conduction of electrical impulses. | Dromotropic |
| Positive ___ drugs enhance the conduction of electrical impulses in the heart | Dromotropic |
| What is the drug of choice for Cardiac Glycosides? | Digoxin (Lanoxin) |
| How do cardiac glycosides help clients with systolic heart failure? | They help control the ventricular response to artirial fibrillation or flutter. The primary beneficial effect of cardiac glycoside is thought to be an increase in myocardial contractility. They decrease the velocity (rate) of electrical conduction. |
| Cardiac glycosides help prolong the refractory period in the conductions system. Cardiac cells remain in a state of depolarization longer & are unable to start another electrical impulse, which also reduces heart rate & improves cardiac effect. name drug | Digoxin (Lanoxin) |
| What are the 3 "tropic" effects of digoxin (Lanoxin)? | Positive inotropic-increased contrctility of heart. neg Chronotropic-heart rate-bradycardia is the adverse effect. neg Dromotropic-conduction |
| Digoxin (Lanoxin) Indications | systolic HF, supraventricular tachycardis. Artirial fibulation and flutter...with rapid rate....this med will help by slowing and making heart beat more regular. |
| What drug has a very narrow therapeutic window: normal level is 0.5-2ng/ml) | Digoxin (Lanoxin) |
| N&V, Anerexia, Bradycardia, colored vision, and halo vision are are classic adverse effects of what drug? | digoxin (Lanoxin) |
| What electrolyte imbalance increases digoxin toxicity? | hypokalemia (Potassium) |
| K+ wasting diuretics incease ___ toxicity and some antilipemics decrease absorption. In many situations, these drugs are given together. | Digoxin (Lanoxin) |
| Excessively slow pulse rate (60 beats/minute or less) may be a sign of _____ toxicity. | Digoxin (Lanoxin) |
| Monitor potassium level carefully. Take corrective action before hypokalemia occurs. Hyperkalemia may result from _____toxicity. | Digoxin (Lanoxin) |
| T/F Absorption of digoxin from liquid-filled capsules is superior to absorption from tablets or elixir. | True |
| Why check pulse for 1 full min prior to giving digoxin? | Excessively slow pulse rate (60 beats/min or less) may be a sign of digoxin toxicity |
| Drug-induced arrhythmias may increase the severity of heart failure and hypotension. T/F | True |
| CNS agitation, fatigue, generalized muscle weakness, hallucinations, dizziness, headache, vertigo. CV arrhythmias, heart block. Are signs of what? | An adverse reaction to digoxin |
| Action of ___: Inhibits NaK activated adenosine triphosphatase, promoting movement of Ca+ from extracellular to intracellular cytoplasm & strengthening myocardial contraction. Also acts on CNS to enhance vagal tone, slowing conduction through SA&AV nodes | Digoxin (Lanoxin) |
| Be sure to teach pt & a responsible family member about drug action, dosage regimen, how to take pulse, reportable signs, and follow up care with what drugs. | ALL including digoxin (lanoxin) |
| Tell pt to report pulses less than 60 beats/minute or more than 110 beats/min, or skipped beats or other rhythm changes: with what drug? | Digoxin (Lanoxin) |
| Instruct pt to report adverse reactions promptly, N, V, Diarrhea, appetite loss, and visual disturbances may be indicators of toxicity with what drug? | Digoxin (Lanoxin) |
| Be sure to encourage pt to eat potassium rich foods with ____. | Digoxin (Lanoxin) |
| Tell pt not to substitute one brand for another with what drug? | Digoxin (Lanoxin) |
| Advise pt to avoid use of herbal drugs or to consult his prescriber before taking one with what drug? | Digoxin (Lanoxin): All |
| What are the 3 classes of antianginal agents? | Nitrates, beta-blockers, and Ca++ channel blockers |
| What antianginal agent dilates all blood vessels, especially venous vascular beds? | Nitrates |
| What antianginal agent is a ***Potent dilating effect on coronary arteries? | Nitrates |
| What Nitrate is taken orally and used for prevention? | Isosorbide mononirtrate (Imdur) |
| What nitrate is applied topical and used for prevention? | Nitro-Bid |
| What nitroglycerin is given sublingual and is fast acting-potent vaso dilators (both arteries and veins) major effect on coronary arteries? | Nitrostat |
| The adverse effect of nitroglycerin is | low blood pressure |
| What should you check when giving Nitroglycerin? | blood pressure and the 5 rights of meds |
| Can nitroglycerin be given IV? | Yes |
| What do you do if you have already given Nitroglycerin and the BP is still high can you give another? | Give 1 wait 5 mins check BP if still high give another & repeat. May give up to 3 tabs if still high then morphine. |
| Adverse affect of nitrostat is? | pounding headache with other types initially may have but usually goes away |
| Long term use of nitro-bid will cause problems. To prevent the problems you do what? | To prevent problems the patch is removed at night. |
| Nitro-Bid is used to treat ______? | angina (Chest Pain) |
| T/F Nitroglycerin should be given to patients with aortic stenosis? | False don't give to pt with aortic stenosis |
| What is the MOA of a beta blocker? | Decrease myocardial O2 demands |
| What is the MOA of Ca++ channel blockers? | Blocks Ca++ in the excitation-contraction process of heart and vascular muscle cells->>promotes smooth relaxation of the heart & vessels (vasodialtion). Also decrases automaticity of & conduction thru SA&AV node. |
| Do Ca++ channel blockers decrease the heart rate? | Yes |
| What Ca++ channel blocker promotes dilation of arteries and is used for HTN? | diltiazem (Cardizem) |
| What drug promotes dilation of arteries used for HTN, Depresses the SA noode and slows AV conduction. Negative inotropic, cronotropic and dronotropic effect. It decreases the contractility of the heart. | diltiazem (Cardizem) |
| What are the adverse affects of Ca++ Channel Blockers? | Headache, decreased BP, Bradycardia, periferial edema, pulmonary edma, or heart failure. |
| Indications of Nitrates: ____ | Angina (prevention and treatment of chest pain) |
| Adverse effects of nitrates | Headache, reflex tachycardia (compensatory mechanism to increase cardiac output) |
| If nitrate-induced vasodilation occurs too rapidly, the cardiovascular system overcompensates and increases the heart rate, a condition referred to as _____? | reflex tachycardia. |
| What is Nitrate tolerance? | It is where the person's body no longer responds to that dose of nitrate. |
| What is mostly affective in treating of typical exertional angina (i.e. caused by exercise)? | Beta blockers (i.e. atenolon and metoprolol) |
| What is the first line drugs for the treatment of conditions such as angina, hypertension, and supraventricular tachycardia? | Ca++ Channel Blockers |
| T/F Ca++ Channel blockers are not as effective as Beta-blockers in blunting exercise-induced elevations in heart rate and blood pressure. | True Ca++ channel blockers are not as effective in treating exercise-induced elevations in heart rate and BP |
| Peripheral edma, bradycardia, and HF are the adverse effects for what and why? | Ca++ Channel Blockers because the CCBs are very limited and primarily relate to over expression of their therapeutic effects. |
| T/F CCBs shoud never be administered when sitting because the drug causes hypotension? | False CCBs shoud ALWAYS be administered when sitting becuase the drug causes hypotension |
| T/F CCBs should be taken ac w? 6oz of water when ordered. They should never be crushed-extended release meds, if they get a headache give tylonal? | True |
| If a med is to be given sublingual or between the check is it alright to swallow them instead? | NEVER swallow a sublingual or between check med. |
| It is important to keep meds in the original package and avoid light for what meds? | CCBs |
| What drug works by stimulating the Alpha 2 receptors which reduces CNS central vasomotor centers which reduces BP? | clonidine (Catapres) |
| Clonidine (Catapres); Captopril (Capoten); Losartan (Cozaar); Hydralazine HCl (Apresoline) are all what type of Meds. | They are all antihypertensive medications |
| What is the classification of clonidine (Catapres) | Adrenergic Agents |
| What is the classification of captopril (Capoten) | ACE Inhibitiors |
| How does an ACE Inhibitor work? | It prevents the conversion of angiotensin I to angiotension II->Aldosterone. It redcues BP and Prevents Na and Water reabsorbtion. |
| What drug inhibits vasoconstriction and aldosterone-secrting action of angiotensin II by blocking angiotensin II receptor on the surface of vascular smooth muscle and other tissue cells? | Losartan (Cozaar) |
| Name a drug of Angiotensin II Receptor Blockers (ARBs)-one of the newest classes of antihypertensives. | Losartan (Cozaar) |
| ____ drug is a vasodilator that acts directly on ateriolar and/or venous smooth muscle to cause relaxationa; they do not work through adrenergic receptors? | hydralazine HCl (Apresoline) |
| Name a Direct-Acting Vasodilator | hydralazine HCl (Apresoline) |
| Nursing implications of hydralazine HCl (Apresoline) | 1. Can be used to treat HTN 2. Tropical minoxidil is effective in restoring hair growth (topical) 3. used to manage hypertensive emergencies |
| What type of an agent is clonidine (Catapres) | Alpha II |
| Why do clients on Clonidine (Catapres) experience sedation ,orthostatic hypotension and drowsiness? | Clonidine (Catapres) inhibits the Central vasomotor centers, decrasing sympathetic outflow to the heart, kidneys, and peripheral vasculature, and lowering peripheral vascular resistance, blood pressure, and heart rate. |
| The most common adverse effects of ____ is bradycardia with reflex tachycardia, postural & postexercise hypotension, dry mouth, drowsiness, sedation, dizziness, edema, constipation, and sexual dysfunction. | Clonidine (Catapres) |
| Interactions of Clonidine (Catapres): Be careful with other CNS depressants, such as... | such as alcohol, benzodizaepines, and opioids. The additive effects of these combinations of drugs incrase CNS depression. |
| ACE INHIBITORS (the "prils") What is the RAAS? | Renin Angiotensin Aldosterone System |
| These drugs are very safe and efficacious and are often used as the first-line drugs in the treatment of both heart failure and hypertension. | ACE Inhibitors (the "prils") |
| T/F All ACE inhibitors have a detrimentral effect on th eunborn fetus and neonate | TRUE |
| HTN, stop progression of ventricular remodeling post MI is the indication for what drug? | captopril (Capoten) |
| Captopril (Capoten) is the drug of choice for what population? | They are the drug of choice for hypertensive patients with heart failure |
| What is the classic side effect of captopril (Capoten)? | persistant, non-productive cough |
| What are othe side effects of ACE inhibitors? | fatigue, dizziness, mood changes, headaches, dry non-productive cough |
| What does aldosterone do? | It stimulates sodium and water reabsorption, which can raise BP. |
| Hyperkalemia may occur when ACE inhibitors are given with K+ sparing diruretics or K+ supplements because? | Because sodium and water are already being excreated from the body, this means that the body is keeping the K+ and sparing other electrolytes out of the body. |
| T/F Angiotensin II Receptro Blockers (ARBs) Don't cause the classic cough like ACE-I do. | True |
| What is the most common adverse effect of ARBs? | Upper respiratory infections and headache |
| Vasodilators can be used to treat HTN; tropical minoxidil is effective in restoring hair growth (topical); Used to manage hypertensive emergencies. T/F | True |
| Dizzines, Headache, anxiety, tachycardia, edema, nasal congestion, dyspnea are all adverse effects of | vasodilators such as hydralazine (Apresoline) |
| · You are preparing to administer hydralazine (Apresoline) to your elderly client. What is important to assess first? | Monitor pt's blood pressure, pulse rate, and body weight frequently. |
| · Why assess respiratory status and K+ serum levels prior to giving captopril (Capoten)? | Respiratory needs to be assessed because adverse effect of dry, hacking, chronic cough, plus it can cause difficulty in breathing. ACE inhibitors tend to promote potassium reabsorption in the kidney and Na & water secreation in the kidney. |
| Abrupt withdrawal of meds is a serious concern because of ... | the risk for severe hypertensive rebound |
| T/F the advantage of a loop diuretics is that they can work even if creatinine clearance is low (<25ml/min; nl is 125 mL/min) | True |
| The most commonly used loop diuretic is | furosemide (Lasix) |
| Loop Diuretics such as Furosemide (Lasix) is primarily used in the management of pulmonary edema and the edema associated with | edema associated with heart failure, liver disease, nephrotic syndrome, and ascites (the accumulation of fluid in the peritoneal area). It has also been used in the treatment of hypertension, usually that is caused by heart failure. |
| Loop diuretics such as _____ are potent ____ with loss of fluid, which results in what? | Lasix is a potent diuretic with loss of fluid which results in: Major electrolyte losses including Na, K, and Ca. It inhibits Nacl reabsorption in the loop of Henle |
| Indications (ie what are they used for?) of Loop diurectics such as Lasix are: | Edema with HF and hepatic or renal disease, HTN |
| Adverse effects of ____ are Hypokalemia, Dizziness, headache, blurred vision, hyperglycemia, hyperuricemia, thrombocytopenia. | Loop diurectics such as Lasix can have an adverse effect of hypoglycemia, hypokalemia, etc |
| Lasix increases digoxin toxicity. T/F | True |
| Lasix when given with Sulfonylureas they ____ in glucose tolerance and can lead to ____ | decrease in glucose tolerance and can lead to hyperglycemia |
| What happens when Lasix is given with ibuprofen (NSAID)? | Inhibition of renal prostaglandins which results in Decreased diuretic activity |
| What happens when Lasix is given with digoxin? | Hypokalemia-which increases digoxin toxicity |
| What is your key drug of the Osmotic Diuretics? | Mannitol (Osmitrol)-it makes fluid more concentrated |
| The MOA of ___ Produces osmotic pressure in the glomerular filtrate->pulls fluid into tubules->diuresis, secretion and passage of large amount of urine | Osmotic Diuretics such as Mannitol (Osmitrol) |
| What is used to treat the early, oliguric phase of acute renal failure, increased in cranial pressure and cerebral edema? | Mannitol (Osmitrol) or Osmotic Diuretics |
| Adverse Effects: Convulsions, thrombophlebitis, pulmonary congestion. OF WHAT DRUG IS THIS? | Mannitol (Osmitrol) |
| Thrombophlebitis is | the inflammation of the intimal layer of a blood vessel, with clot formation |
| What is the key drug of Potassium-sparing diuretics? | Spironolactone (Aldactone) |
| MOA of _____ is: Binds to aldosterone receptors >>> blocks resorption of Na+ and water. | Spironolactone (Aldactone) |
| ___ is used to treat Hyperaldosteronism, HTN, and to reverse the Potassium loss caused by the potassium-wasting diuretics. | Spironolactone (Aldactone) |
| Use of this diuretic ___, can have an adverse effect of HYPERKALEMIA, Dizziness, headache, Cramps, nausea, vomiting, diarrhea, Urinary frequency, and weakness | Spironolactone (Aldactone) |
| When taking Spironolactone (Aldactone)The administration of ACE inhibitors or potassium supplements in combination with potassium-sparing diuretics can result in... | hyperkalemia |
| What is the key drug for Thiazides? | Hydrochlorothiazide (HydroDiural) HCTZ |
| The MOA of ___ is: Inhibit resorption of Na+, K+, Cl- >>> osmotic water loss. Direct relaxation of arterioles >>> reduces afterload. Works best w/ adequate creatinine clarance (>50ml/min) | Thiazides such as hydrochlorothiazide (HydroDiural) HCTZ |
| ___ are used to treate edematous states; idiopathic hypercalciuria, and diabetes insipidus, in addition to hypertension | Thiazides such as hydrochlorothiazide (HydroDiural) HCTZ |
| What are the electrolyte and metabolic disturbances associated with hydrochlorothiazide (HydroDiural) HCTZ? | loss of potassium so HYPOKALEMIA |
| Thizides have drug interactions with corticosteroids, digoxin and oral hypoglycemic meds. | may increase hypokalemia and other problems |
| When taking ____ be sure to check BP before and after dose, assess for fluid loss (weigh pt daily), assess K+ level and monitor for K+ imbalance | hydrochlorothiazide. Hint be sure to weigh pt on same scale in same clothes and record I&O accurately. |
| When do you want to call a physician with K+ imbalances? | <3.5 or >5mEq/L |
| What 3 things you'll do when giving hypochlorothiazides? | Dietary considerations, Administer diuretic in AM, and Teach the pt this and to report weight gain |
| Dietary considerations of hypochlorothiazide patients are? | No K+ salt substitutes KCl can cause them to be at risk for Hyperkalemia, Minimize Na+ intake |
| What do you teach the hydrochlorothiazide (HydroDiural) pt besides taking the drug in the AM and to report weight gain? | Teach them to avoid sudden posture changes and rise slowly to avoid dizziness, encourage sunblock to prevent photosensitivity reactions, take drug with food |
| citurs fruits, tomatoes, bananas, dates, and apricots are all foods high in ____? | potassium |
| Is it important for spironolactone taking patients to avoid potassium rich food? | YES, Spironolactone (Aldactone) is a POTASSIUM-SPARING DIURETIC |
| When giving ____ you want to tell the patient that he may feel thirst or have a dry mouth. Emphasize the importance of drinking only the amount of fluids ordered. | Mannitol |
| Antidysrhythmic key drugs are: | Lidocaine (Xylocaine) and amiodarone (Cordarone) |
| Lidocaine (Xylocaine) is what class drug? | Class 1b |
| Class 1b drug ____ increases blockade of sodium channel, accelerate repolarization, and +/- Action Potential Duration | lidocaine (Xylocaine) |
| Amiodarone is a Class ____ drug whose principle effect on cardiac tissue is to increase Action Potential duration | Class III |
| Antidysrhythmics are used to alter the action potential of cardiac cells, making them less responsive to | intrinsic electrical stimuli. Drugs such as lidocaine (Xylocaine) and amodarone (Cordarone) |
| What drug treats only ventricular (tachycardia) dysrhytmias and is only given IV and treats pain? | Lidocaine (Xylocaine) |
| What drug treats both ventricular tachycardia and supraventricular (atrial fibrillation) dysrhythmias? | Amiodarone (Cordarone) |
| lidocaine (Xylocaine): CNS toxicities like twitching, convulsions, confusion; respiratory depression or arrest; what are some CV effects? | cardiovascular effects of hypotension, bradycardia, and dysrhythmias. |
| Corneal microdeposits (which may cause visual halos, photophobia, and dry eyes). The most serious adverse effect of _____ is pulmonary toxicity. | Amiodarone (Cordarone) can also cause both Hypo/Hyperthyroidism |
| Lots of potential drug interactions when taking ___. Key to know: enhanced anticoagulant effect with anticoagulants and proarrhythmic effect with other antidysrhythmic agents | Amodarone(Cordarone) and Lidocaine (Xylocaine) |
| T/F Lidocaine (Xylocaine) and Amiodarone (Cordarone) may increase digoxin level 70-100% | TRUE |
| With lidocaine (Xylocaine), important to assess what systems? | Monitor cardiovascular and CNS - seizures |
| With amiodarone (Cordarone), important to assess what conditions? | Respiratory: acute respiratory distress syndrome, SEVERE PULMONARY TOXICITY LIFE |
| T/F Antidysrhythmics given IV should always be on an infusion pump. | True |
| T/F Amiodarone (Cordarone) may cause GI upset? | TRUE |
| Class I – What CNS-related effects will you look for? | SEIZURES, confusion, tremor, stupor, restlessness, lightheadness, lethargy, somnolence, anxiety, hallucinations, nervousness, paresthesia, muscle twitching |
| Class III – What CNS-related effects will you look for? | Assess pulmonary function tests and thyroid function |
| A cl is being dc w/ a prescription for amiodarone (cardarone) for treatment of ventricular dysrhythmias. Prior to hosp the cl was an avid golfer and enjoyed gardening. Knowing this, what would be important for the nurse to address w/ cl? | Advise pt to wear sunscreen or protective clothing to prevent sensitivity reaction to the sun. Monitor pt for skin burning or tingling, followed by redness and blistering. Exposed skin may turn blue-gray. |
| A pt taking lidocaine 2mg and he is getting 4 mg. He is confused and has a slight tremor in both hands WHY? | Because he is having an adverse reaction to lidocaine due an overdose of the drug being given to him. |
| Warfarin Sodium (Coumadin); Enoxaparin (Lovenox); and Heparin are all ...? | Anticoagulants |
| Asprin, Clopidogrel (Plavix), and Abciximab (reoPro) are alll...? | Anti Platelets, Don't Dissolve Clotts!!! |
| Thrombolytics Break down clots. NAME The Thrombolytic key drug. | Streptokinase (Streptase) |
| Anticoagulants do NOT _____ and are given prophylactically (i.e. to prevent _____ formation. | They do not dissolve clots and are given prophylactically to prevent clots. |
| a blood clot that adheres to the wall of a blood vessel or organ. In many cases it may obstruct the vessel or organ in which it resides, preventing the flow of blood. Anticoagulants are sued to prevent and treat this condition is a ... | Thrombus |
| A mass of undissolved matter present in a blood or lymphatic vessel and brought there by the blood or lymph. | Embolus |
| An obstruction of the pulmonary artery or one of its branches, usually caused by an embolus from thrombosis in a lower extremity. | Pulmonary Embolism |
| The formation of a thrombus in one of the deep veins of the body | Deep Vein Thrombosis (DVT) |
| If a chart has a lab result called PTT, what is the most likely medication that will appear on the MAR? | Heparin |
| What is the antidote for warfarin (Coumadin)? | Vitamin K |
| A nurse is monitoring INR to determine if the drug is at a thearapeutic level. What is the drug? | Warfarin |
| Do not give an IM following ____ | streptase |
| Where do anticoagulants impact the coagulation cascade? | They impact it by preventing blood clotting. |
| How does warfarin affect Vitamin K? | it inhibits vit K syntheis by bacteria in the GI tract |
| When do we want to prevent clots from forming? | MI, unstable angina, atrial fibrillation; to prevent DVT, PE, stroke or a heart attack |
| An adverse effect of anticoagulants is ____ and what very common drug increases this risk? | BLEEDING and the common drug that increases this risk is Aspirin/Anticoagulation therapy-HEPARIN |
| ____-induced thrombocytopenia (HIT): occurs in 5-15% pt, allergic response resulting in paradoxical thrombosis | HEPARIN |
| T/F Toxicity:hematuria, melena (blood in stool), petechiae, ecchymoses (bruise that has bleeding under the skin), and gum or mucous membrane bleeding. In the event of either heparin or warfarin toxicity, the drug should be discontinued immediately. | True |
| What is the reversal agent (antidote) for heparin? | Protamine sulfate |
| What is the reversal agent (antidote) for warfarin sodium (Coumadin)? | High doses of Vitamin K given IV |
| What is the normal INR w/o warfarin and with it? | 1.0 and with it it is 2-3.5 |
| What is the Normal PTT value of Heparin? | 1.5 anymore than that is toxic |
| Lovenoix and Heprine given sq is not checked very ofthen, but when given ____ it is always checked. | When Heparin is given IV it is always checked. |
| If a chart has a lab result called PTT, most likely what medication will appear on the MAR? | Heparin |
| What is the antidote for Coumadin | vitamin K given IV |
| A nurse monitor INR to determine if the drug .... is at appropriate levels. | Warfarin (Coumadin) |
| If an PTT level is dangeroulsy high what would be prescribed? | Protamine Sulfate |
| Drugs like acetaminophen, furosemide and aspirin increase the anticoagulant effects of | Warfarin and Heparin |
| T/F Warfarin (Coumadin) is the most prescribed oral anticoagulant | True |
| What labs do we assess with warfarin (coumadin)? | PT and INR |
| Is enoxaparin (Lovenox), low-molecular weigh heparin given IV, PO, or SC | SC |
| Heparin can be given ___ or ____. What is the onset of each route? | SC Onset is 20-60 mins Peak 2-4 hrs; dose dependant and IV is immediate |
| Antiplatelet agents, such as __,__, &___ are given prophylactically (to prevent clot formation). | aspirin, clopidogrel (Plavix), and abciximab (ReoPro) |
| * aspirin - effects last ____ days, results in dilation of the blood vessels and prevention of platelets from aggregating or forming a clot | 7 days |
| ____inhibits platelet aggregation by altering the platelet membrane so that it can no longer receive the signal to aggregate and form a clot | clopidogrel (Plavix) |
| T/F Plavix is worse than aspirin at reducing the number of heart attacks, strokes, and vascular deaths | FALSE IT IS Better than aspirin at reducing the number of heart attaks, strokes, and vascular deaths |
| ______blocks protein in platelet wall membrane, which is essential in clot formation. Only IV; used in cath lab with cardiac procedures. | abciximab (ReoPro) |
| ___ Inhibit the action of platelets in clinical situations such as what? | Aspirin; stroke prevention |
| ____is also used for reducing the risk for fatal and nonfatal thrombotic stroke, and is used for prophylaxis against transient ischemic attacks (TIAs) as well for post-MI thromboprevention. | Plavix |
| You can bet that if your client is taking 1 aspirin a day (81 mg to 325 mg), it is for | antithrombotic effects |
| When taking antiplatelets Why is there a contraindication of Vitamin K deficiency? GI ulcer? Traumatic injury? | Excessive bleeding |
| T/F The concurrent use of dipyridamole, with aspirin, clopidogrel, and/or nonsteroidal antiinflammatory drugs (NSAIDs) produces additive antiplatelet activity and increased bleeding potential. | True |
| T/F Antifibrinolytics promote clot formation | True |
| T/F Thrombolytics such as streptokinase (Streptase) break down pre-formed clots in the coronary arteries to prevent a MI | True |
| The natural fibrinolytic system takes days, whereas a thrombolytic agents breaks down a clot _____ | very quickly |
| Thrombolytics such as Streptase activates the conversion of plasminogen to plasmin, which _____ | lyses the clot |
| Clinical uses of _____:acute MI, arterial thrombosis, DVT, occlusion of shunts or catheters, PE, and acute ischemic stroke. | thrombolytic therapy (streptase) |
| The adverse effects of ___ is: * Bleeding, of course! Hypersensitivity, anaphylactoid reactions, N, V, hypotension, dysrhythmias. This medication is typically administered in the ER or cardiac cath lab, where clients are monitored closely! | Streptase |
| What are the implications associated with SK (Streptase) since it's made from a nonhuman source? | antigenic and may provoke allergic reactions, due to the body recognises this as a foreign sustance(an antigen) and launces an antibody against it, resulting in an antigen-antibody reaction. |
| T/F Streptase: The most common effect of drug interactions is an increased bleeding tendency resulting from the concurrent use of anticoagulant, antiplatelet, or other drugs that affect platelet function. | True |
| For all coagulation modifiers, assess: | CBC, Hgb, Hct, and various clotting studies. |
| Assess skin/areas prior to giving SC heparin and LMWHs. What areas should be avoided? | Avoid any areas within 2 inches of the umbilicus as well as open wounds, scars, open/abraded areas, incisions, drainage tubes, stomas, or areas of bruising/oozing because these sites are at higher risk for further tissue trauma w/ anticoaulate injections. |
| Pregnancy/lactation. What is the best anticoagulant to give | Heparin |
| * Aspirin, NSAIDs, and other antiplatelets should be withheld for ____ days prior to surgical procedures. | 5-7 days prior to surgery |
| Prior to giving a thrombolytic, be sure to ask about what clinical history? | Active internal bleeding, Hx of stroke, cerebral neoplasms, arteriovenous malformation, aneurysms, known bleeding disorders, severe uncontrolled hypertension, intracranial or intraspinal surgery or trauma w/in, for example, the past 2 months. |
| T/F anticoagulants/antiplatelets: Monitoring for bleeding is essential. Consider symptoms associated with internal bleeding, i.e. hypotension, tachycardia, change in LOC, unexplained restlessness. | True |
| When rapid anticoagulation is needed, __Heparin_ is the drug of choice, usually IV - quick onset of action! What is the reversal agent? | protamine sulfate |
| Your client is going home with Lovenox. What is the length of time he will be taking this drug? | 3 months |
| When a client is admitted to the hospital with a clot, they will be prescribed IV heparin plus warfarin sodium (Coumadin). Why? | This overlapping is done purposefully so that when the heparin is eventually dc, the blood levels of warfarin have been allowed for, and the therapeutic anticoagulation levels are achieved. The full therapeutic effect of warfarin doesn't occur until 4-5 |
| Your client is taking aspirin. What are 5 things you will assess for S&S of bleeding? | Epistaxis, hematuria, hematemesis, easy/excessive brusing, blood in the stools, and bleeding gums |
| Constant ringing in the ears (tinnitus) is a common toxicity sign for what coagulation modifier? | Aspirin |
| * For abciximab (ReoPro) and streptokinase (Streptase), you will want to avoid invasive procedures as much as possible. These clients are really at risk for bleeding. Monitor IV sites for bleeding. DO NOT GIVE IM INJECTIONS - they will bleed! Monitor for | bleeding. DO NOT GIVE IM INJECTIONS- they will bleed!! Monitor for bleeding - internal and external |
| PTT Heparin values should be | 1.5-2.5 x the control value |
| aPTT Heparin value should be | 1.5-2.5 x the control |
| PT Warfarin value should be | 1.5 x the control value |
| INR Warfarin value should be | 2.0-3.5 depending on clinical use |
| If INR for Warfarin is >4.5 | Hold warfarin and treat bleeding. Vit K |
| What antilipemics decrease LDL | all |
| What antilipemics increase HDL | all |
| What antilipemics decrease triglycerides | All except for 1 |
| HMG-CoA Reductase Inhibitos such as ______ (KEY DRUG IS?) | atorvastatin (Lipitor) |
| T/F HMG-CoA reductase is needed by the liver to produce cholesterol. By inhibiting this enzyme, cholesterol production is decreased. | true |
| Lipitor lowers the rate of cholesterol production and augment LDL recycling. When is it best to take it? | At night because cholesterol is formed at night. |
| Lipitor inhibits | the production of cholesterol |
| What is the 1st line drug for hypercholesterolemia? Hint it decreases LDL, increases HDL, and decreases triglycerides | atorvastatin (LIPITOR) |
| Contraindications for atorvastatin (lipitor)? | liver disease |
| most common adverse effect of ____ is: Mild, transient gastrointestinal disturbances, rash, and headache have been the most common problems | atorvastatin (Lipitor) |
| Liver enzymes may elevate is another adverse effect of | lipitor |
| What is rhabdomyolisis? | condition involving the breakdown of muscle proteing>myoglobinuria (muscle protein in urine)>severe strain on kidnesys>acute renal failure and even death |
| rhabdomyolisis is a side effect of ____ | atorvastatin (Lipitor) |
| Lipitor: Use cautiously with oral anticoagulants! Will increase clotting time. Why is grapefruit juice limited to 1 qt/day? | Because grapefruit juice has enzymes that may result in sustained levels of unmetabolized statin drug, which increases the risk for major drug toxicity (e.g. rhabdomyolysis) |
| Bile Acid Sequestrants Key drug is | cholestyramine (Questran) |
| MOA of cholestyramine (Questran) | Basically prevents the absorption of cholesterol by preventing resorption of bile acids from the small intestine. Bile acids are necessary for absorption & resorption of cholesterol. |
| ____ is the primary or adjunct therapy for hypercholesterolemia? HINT: it decreases LDL; Increases HDL; and INCREASES TRIGLYCERIDES | Cholestyramine (Questran) |
| The most common adverse effects of ____ is constipation, heartburn, nausea, belching, bloating, bleeding, headache, tinnitus, burnt odor of urine | Cholestyramine (Questran) |
| cholestyramine (Questran) nusing implications? | Take drug with meals to reduce the adverse effects. Increase dietary fiber and fluid intake because it may relieve constipation and bloating |
| Cholestyramine (Questran) Will reduce the absorption of concurrent drugs, so the nurse should do what? | The significant drug interactions associated with the use of bile acid sequestrants are limited to the absorption of concurrently administered drugs. All drugs should be taken at least 1 hour before or 4 to 6 hours after the administration of ion-exchange |
| Cholestyramine (Questran) will decrease absorption of vitamins _____ | A D E & K |
| NIACIN Key drug is | Niacin (Nicobid, Vitamin B3) |
| Niacin (Nicobin, Vit B3) MOA is unknown, But it is used to treat hypercholesterol because: | Decreases LDL & triglycerides while increases HDL |
| T/F Niacin can cause flushing, pruritus, and GI distress | true |
| Nursing Implications for Niacin | Small doses of asprin or NSAIDs taken 30 min before niacin minimizes cutaneous flushing. Start pt on low doses and slowly increase and have them take it with meals |
| Fibric Acid Derivatives Key drug is | gemfibrozil (Lopid) |
| gemifibrozil (Lopid) primarily affect ____ levels | triglyceride |
| gemfibrozil (Lopid) MOA is that the activate lipoprotein lipase, the enzyme that breaks down _____ | cholesterol. It also Suppress the release of free fatty acid from adipose tissue. Inhibit synthesis of triglycerides in liver. Increase the secretion of cholesterol into bile. |
| gemfibrozil (Lopid) ___ LDL, ____ HDL, ____ triglycerides | Decreases LDL & triglycerides and Increases HDL |
| gemfibrozil (Lopid) Most common side effects are abdominal discomfort, diarrhea, nausea, headache, blurred vision, increased risk for gallstones, and prolonged prothrombin time. What about Gallstones? | Yes because of its effect in the liver |
| T/F gemfibrozil does NOT enhance action of oral anticoagulants | False it does enhance the action of oral anticoagulants |
| Contraindications of gemfibrozil (Lopid) | hypersensitivities, biliary obstruction, liver dysfunction or disease. These can all be caused by it. |
| Is it important to assess alcohol intake in a pt on gemfibrozil (Lopid)? | Yes because of liver dysfunction is a potential |
| Consider supplemntal _____ vitamins, if long term use of gemfibrozil (Lopid) | Vit A, D, & K |
| A client newly diagnosed with hyperlipidemia, has been prescribed Questran. What is important to include in the teaching? | Take other meds 1 hour prior to taking it |
| How can someone reduce constipation? | incraseing fiber and fluids |
| Gemfibrozil powder or granule forms should be mixed how? | with liquid-no stirring-dissolve over 1 min |
| How many mL should a gemfibrozil (Lopid) pt be drinking a day? | 2000mL |
| T/F If patients are taking a bile acid sequestrant, make sure they contact their health care provider immediately should stools appear black and tarry. | True |
| HM-CoA reductase inhibitors or "statin" drugs should be taken with | 6 oz of water |
| Lipitor, Questrian, Lopid be sure to monitor for liver/renal dysfunction, measure total lipid profile and if there is no response after ____, the meds are generally withdrawn | 3 months |
| With anticoaagulants it is important to ask pt to limit alcohol intake? | yes |
| Niacin can cause Flushing, pruritis. T/F | True |
Created by:
cgwayland