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NUR 203 Pharm Test

This drug prevents angiotensin I from converting to angiotensin II (which usually ^ bp by retained na+ and h20)... ACE Inhibitors
What are some examples of an ACE inhibitor? enalapril, lisinopril, quinapril, Monopril
What are some side effects of ACE inhibitors? dry cough and reduced sense of taste
What is a benefit to taking Angiotensin-receptor blockers (ARB) rather than ACE inhibitor? less likely to have a cough.
True or false: ARBS and ACE inibitors have the same effect on the kidneys to prevent HTN. True
What are some examples of ARBS? Cozaar (lasartan), Avapro, olmesartan, valsartan
Spironolactone is also known as _________. The type of diuretic it is, is ____________. Aldactone; potassium-sparing.
True or False: Aldactone inhibits the action of aldosterone thereby causing the kidneys to excrete salt and fluid in the urine while retaining potassium. True
Thiazide is another type of diuretic used to decrease h2o in body to increase urination. Use to treat _____ and high _____ . edema; high blood pressure
When is the best time to take thiazide in the day? Early in the morning becauze it increases urination.
Should you take Thiazide with food? why or why not? Yes; because it will decrease stomach upset
What will Thiazide do to your insulin dosage? will alter your insulin dosage by making you hyperglycemia
What are some examples of Thiazide medications? hydrochlorothiazide; diuril
This diuretic is used to increase urine production. It is used to treat or prevent medical conditions that are caused by an increase in body fluids/water. Mannitol
This diuretic is given with along with other diuretics (e.g., furosemide, chlorothiazide) and/or IV fluid replacement. Mannitol
Mannitol is given by form of: po, sub-q, IM, or IV IV!
Examples of Loop Diuretics Lasix aka Furosemide
What do you do if you are on a loop diuretic and cannot void? cannot take this medication - tell doctor immediately.
What are some side effects and precautions for loop diuretics? photophobia (wear sun screen), cannot take if pregnant, cannot take simultaneously with ABOX (can cause hearing loss)
How should Lasix be stored? Light-sensitive container! (opaque covering)
What is a concern with patients taking loop-diuretic and blood lab values? May need to take potassium supplements or foods high in potassium such as banana.
These drugs block epinephrine from binding to beta receptors on nerves... Beta blockers
How many types of Beta blockers are there are there and label which types affect which body part the most. 3 types. Beta-1: heart... Beta-2: lungs, GI... Beta-3: fat cells
These drugs dilate blood vessels which will do what to the heart rate and blood pressure? decrease both.
What will beta blockers do to the air passages? Since it dilates the blood vessels it may constrict the air passages and stimulate the muscles that surround it to contract.
What do we use beta blockers to treat? Abnormal Heart Rhythms, hypertension, prevention of migraines
Describe Metoprolol BB. Selective (Beta-1 receptors) -- mostly affects heart
Describe Propanolol BB. Nonselective (Beta-1 and Beta-2 receptors) -- affects heart and lungs
Describe Labatelol BB. Nonselective (Beta-1 and Beta-2 receptors) AND alpha-receptors so adds to the blood vessels dilating effects.
Name a Beta-2 only selective beta blocker.. Butaxamine!
What is the purpose of Calcium channel Blockers forreal? They just want to make a heart's life easier. They dilate the arteries, which decreases the pressure IN the arteries (right?), which makes it EASIER for the HEART to PUMP BLOOD. What does this mean?? The heart needs less oxygen to do the job :)
Can CCB help relieve/prevent angina? AB-SOL-UTELY. When the heart needs less O2, because CCBs are decreasing the pressure in arteries and making the heart work less hard to fulfill it's duty, it relieves and/or prevents angina (to those pts. this applies to)
What is CCB's used to treat? Hypertention (high blood pressure).... also, abnormal heart rates (because it decreases the heart rate..BOOM!)
What time of juice do you not want to take with CCB's.... and WHY? Grapefruit.. do not take with calcium channel blockers. This is bc it could elevate the serum levels (yikes)
what are some examples of CCB's? Cardizem (Diltiazem), or verapamil (Calan).. also when you see a drug ending in "-dipines"... I usually think it is in the class of calcium channel blockers.
Beta Adrenergic Blockers (nursing considerations) *Do not discontinue abruptly *Take with meals *Provide rest periods *For diabetic patients, blocks normal signs of hypoglycemia (sweating, tachycardia); monitor blood glucose *Medications have antianginal and antiarrhythmic actions *HR <60 do not giv
Beta Adrenergic Blockers (SE and contraindications) Beta1 Blockers - bradycardia, decreased cardiac output, AV block, orthostatic hypotension, gastric pain, tachycardia, impotence, nightmares, depression, dizziness Beta 2- bronchospasm
Angiotensin-Converting Enzyme (ACE) Inhibitors (Nursing considerations) *Decreased absorption if taken with food - give 1 hr before or after *Small frequent meals *Frequent mouth care *Change position slowly *Can be used with thiazide diuretics
Angiotensin II Receptor Blockers (ARBs) (nursing considerations) *Change positions slowly *Monitor for edema *Instruct client to notify provider in edema occurs
Calcium Channel Blockers (Contraindications) Medication/Food Interactions: grapefruit juice can lead to toxicity, beta-blockers, digoxin
Calcium Channel Blocker (nursing considerations) *Contraindicated in heart block *Monitor for signs of HF. *IV push, admin slowly over 2 – 3 minutes
True or false: CCB's make it more difficult for liver to excrete Tegretol (carbamazepine).. True
Beta Blockers are (- or +) inotrope and (- or +) chronotrope. - inotrope (decreased muscle contractility, - chronotrope (decreased HR)
Alpha-Adrenergic Blockers (examples/uses) Hypertension prazosin (Minipress) doxazosin mesylate (Cardura) methyldopa (Aldomet)
Alpha Adrenergic Blockers (Nursing Considerations) *Administer first dose at bedtime to avoid fainting *Change positions slowly *Monitor BP, weight, BUN/Creatinine, edem
Examples and uses of Nitrates Angina, HF, perioperative BP control (decreases cardiac o2 demand) IV nitroglycerin SL nitroglycerin (Nitrostat), isosorbide dinitrate (Imdur)
Nitrates (Side effects) Side/Adverse Effects: Headache, orthostatic hypotension, reflex tachycardia, tolerance, dizziness
Nitrates (Contraindications) Medication Interactions: antihypertensives can contribute to hypotensive effect, sildenafil (Viagra)
Nitrates (nursing considerations - sublingual tablet) *Check expiration date *Discard unused med after 6 months
Nitrates (sustained-release and sublinqual tablets) *Take sublingual tablets under tongue or in buccal pouch; tablet should "fizzle" or burn *Take sustained-release tablets with water, don't chew them.
Nitrate Translinqual spray *Administer translingual spray into oral mucosa; do not inhale *Withdraw medication gradually over 4-6 weeks *Provide rest periods *Teach to take medication when chest pain anticipated *May take q 5 min X 3 doses
Nitrates (applying transdermal or transmucosal) *Transdermal -skin free of hair, do not apply to distal extremity, remove before defib or cardioversion. *Transmucosal tablets btwn lip/gum above the incisors or between the cheek/gum, do not chew.
Nitrates (applying topically) Topically over 6 X 6 inch area using applicator, cover with plastic wrap, rotate sites.
What is an example of a Cardiac Glycosides? Digoxin (Lanoxin)
What is Digoxin used for? HF, dysrhythmias (increases cardiac output and blood flow to the kidneys)
Digoxin (Nursing Considerations) Use caution to elderly/ppl w/ renal insufficiency. *Monitor renal function & electrolytes. *Instruct clients to eat high-k+ foods (low K+ ^ risk of dig. toxicity) *Take apical pulse for 1 full min before admin; notify physician if AP less than 60
What is the antidote for Digoxin? Digibind
Therapeutic range of Digoxin 0.5-2.0
Maintenance dose of Digoxin 0.125 - 0.5
Toxic blood levels of Digoxin greater than 2 is toxic!
Antidysrhythmic Drugs (examples) procainamide (Pronestyl) lidocaine amiodarone (Cordarone) adenosine (Adenocard) ibutilide (Corvert)
Statin drugs (HMG-CoA reductase inhibitors) Examples and what does it do?? Decreases LDL levels -- lovastatin (Mevacor) pravastatin (Pravachol) Simvastatin (Zocor) Atorvastatin (Lipitor) Fluvastatin (Lescol) Rosuvastatin (Crestor)
Statin drugs - (nursing considerations) *Take with food; avoid alcohol *Grapefruit juice must be avoided *Contact physician if unexplained muscle pain occurs; esp with fever or malaise *Take at night *Give with caution to clients with decreased liver function
What is Niacin? Decreases total cholesterol, LDL & triglycerides; increases HDL
Nursing Considerations for Niacin *Flushing occurs several hours after med is taken, will decrease over 2 weeks *Also used for pellagra and peripheral vascular disease *Avoid alcohol
Name uses for Heparin anticoagulant thrombotic strokes, pulmonary embolism, deep vein thrombosis (DVT) and DVT prophylaxis, DIC, MI
Side effects of Heparin hemorrhage/BLEEDING, heparin induced thrombocytopenia (HIT), hypersensitivity reactions, anemia, fever
Heparin (Nursing Considerations) *Monitor for signs of bleeding. Stop heparin if platelet count is less than 100,00/mm3 *Monitor therapeutic PTT at 1.5-2.5 times the normal (68-80 sec) *Use IV pump; deep SQ (never IM) *Antidote (protamine sulfate)
When should Statin drugs be given (AM or PM)? PM because the body makes cholesterol mostly at night so it would best lower these levels if given at this time.
What is Wafarin (Coumadin) used for? Antagonizes vitamin K, preventing the synthesis of four coagulation factors: VII, IX, X and prothrombin (PT) Uses: prevention of thrombosis in clients with atrial fibrillation and prosthetic heart valves
Side effects of Wafarin Hemorrhage/BLEEDING, diarrhea, rash, fever
Wafarin (Coumadin) Nursing Considerations *Monitor PT at 1.5-2.5 times normal (18-24 seconds) *Monitor INR at 2.0-3.0 *Teach measures to avoid venous stasis *Emphasize importance of regular lab testing *Patient should avoid foods high in Vitamin K
What is the antidote for wafarin?? *Antidote: Vitamin K, whole blood, plasma
Adenosine diphosphate (ADP) receptor antagonists -- what is it and name a brand Antiplatelet agent (prevent platelets from clumping together (aggregating) by inhibiting enzymes and factors that normally lead to clotting) clopidogrel (Plavix)
What is the max dose for Lapetalol? 300 mg per dose!
What drug is broken down into metabolic byproducts, such as cyanide and thiocyanate? When or why would you test a patient to see if they have these byproducts in the blood? Nipride (Nitroprusside)
What is the rate at which you can give Lasix direct IV? Direct Intravenous: Rate: Administer at a rate of 20 mg/min
What is the rate at which you can give Lasix for intermittent Infusion? (MG/MIN) Intermittent Infusion: Rate: Administer at a rate not to exceed 4 mg/min to prevent ototoxicity
What are some lab values to check with lasix? and the norms? BUN/creatinine levels (norms: BUN 10-20, creatinine 1-2)
What kind of covering would you use for Lasix and Nipride? brown paper bag or dispense out of an amber bottle
Nitroglycerin - type of bottle and how to prepare the tubing glass bottle; Prime tubing with Saline. Use special tubing - Polyethylene Tubing
Digoxin Toxicity Signs & symptoms abd pain, anorexia, VISUAL DISTURBANCES (yellow halo) fatigue, changes in mental status, PCVs noted -- EARLY signs: bradycardia and loss of p wave on ECG.
Digoxin levels (maint., toxic, therapeutic) Maintanence: 0.125 - 0.5..... Therapeutic 0.5 - 2...... Toxic > 2.5
Lithium levels (acute mania level, maint, toxicity) Acute Mania: 1 - 1.5.... Maintanence: 0.6 - 1.2 .... Toxicity: symptoms begin at levels > 1.5
Lithium toxicity symptoms??? Blurred vision, ataxia, tinnitus, tremors, confusion, seizures, coma, MI
What concentrations of epinephrine are used with IV and sQ injections for Epinephrine? IV: 1:10,000 sQ: 1:1000 (anaphylaxis mgmnt)
How do you use Adenosine? Used to convert SVT to NSR. Given as rapid bolus... throws you to asystole for a few seconds... monitor HR and BP.. give 6mg RAPID bolus... if no results, repeat 1-2 min later as 12 mg rapid bolus.. if no result repeat 12 mg bolus again.(6/12/12)
What is the Digoxin tropic effects? Positive (+) inotrope, Negative (-) Chronotrope and discuss WHY!
Statin drugs - what is a negative side effect..? Muscle aches and joint aches.
Heparin and Coumadin antidotes.. Heparin: protamine sulfate; Coumadin: Vitamin K
What drug do you use for 2nd or 3rd degree Heart blocks or brady dysrhythmias? Verapamil (Calan) ... CCB!!!
What is a "no-no" route in giving Potassium? IV PUSH!
Name the 7 rights. Right: drug, dose, patient, documentation, route, time, refuse
what is Cardizem used to treat (specific heart block) AV block
Dopamine and Dobutamine are better given in what type of IV placement..... central IV line
what is the generic name for Levophed and when do you usually give this? Norepinephrine given as a last resort to improve cardiac output (severe hypotension and shock)
How do you convert grains to mg... multiply by 60
1 gram = __ grains XV
i grain = ___ mg 60
15 mg = ___ grains gr 1/4
Celcius to Fahrenhiet coversion F = (Cx1.8)+32
Fahreinheit to celcius conversion C = (F-32)/1.8
With Coumadin -- what do you monitor (labs) PTT and INR (mainly)
Can you give heparin and coumadin together? When do you stop taking Heparin? yes. when Heparin is at level
Propofol - when to use long acting? it is short acting (goes away within minutes after stopping) and long acting only in ICU setting with ET and mech. ventilation... it is a general anesthetic
What is used to treat infiltration around the sight of IV of vasopressor drugs (dopamine, dobutamine, levophed, neo) Regitine for reversal of extravasation & necrosis...if occurs infiltrate site liberally with 10–15 mL of 0.9% NaCl containing 5–10 mg of phentolamine
Cardizem (CCB) and Amiodarone (antiarrhythmic) can be given over drip - true or false? Cardizem drip should be titrated based on pts HR response and BP response... amiodarone Teach pts to monitor pulse daily and report abnormalities
Narcan (naloxone) is the antidote for what? opioids
intradermal Injection (needle size/degree) 5-15deg / 25 or 26 gauge
intramuscular Injection (needle size/degree) 90deg / 19, 20, 21, 22
subcutaneous Injection (needle size/degree) 45-90deg / 23, 25, or 25 gauge
Phenytoin aka Dilantin and what is it used for? anticonvulsant
Phenobarbital is what drug class? barbituate, anticonvulsant/sedative
Regular and NPH insulin.. discuss how to mix these (order, air injecting)... what type of bottle to use for insulin.. glass bottle, air into NPH first, remember R to N mixing!!!
What is a short-acting insulin? times and peaks. Regular... onset 30-60 mins and peaks 2-4 hrs
What is a fast-acting insulin? Novulin and Humulin... onset within 15mins and peaks 1-2 hrs
Pitocin is a vasopressin and antiduretic.. TRUE or false. TRUE
Haldol is what type of antipsychotic med? When do you not use it.. typical, not used with sedation or comatose
Name atypical antipsychotics... Geodon, Zyprexa, Seraquil, Abilify
MAOIS you want to avoid high tyramine diet... aged cheese, wine, raisons, yogurt, sour cream, avocado, bananas
Nardil is what type of drug? MAOI
Anaframil, Elavil, Imipramine are all what.. tricyclic antidepressants
Brethine is used with caution why? fetal and mother HR can increase (dangerous!!) watch these... brochodilator
Mag Sulfate is used to stop ___ in pregnancies contractions. monitor DTR, serum Mg level, monitor I&O, monitor neuro status.
What is thrombolytics used for and some examples? Dissolve clots that have already formed; t-PA and streptokinase (Streptase)
Created by: Sarahmarie001
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