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Nurs 330 - Test #3

Pharmacology for Nursing

What is Excitability? The ability to be stimulated to depolarize
What is Automaticity? The ability to depolarize spontaneously (pacemaker cells)
What do arrhythmias arise from? Failure of impulse initiation, failure to travel from atria to ventricles, abnormal automaticity, re-entry phenomena
What is the mechanism of antiarrhythmic drugs? Act primarily to change ion flux in cardiac cell—alter the action potential.
Why do we care about a prolonged QT? Client can enter V-tach, (whatever that french one was)
Why do we give antiarrhythmic drugs? Decrease automaticity, increase threshold potential, prolong refractory period
What do we want to monitor with **Quinidine? HR (may slow heart rate), ECG (widen QRS complex, prolong QT interval)
What are some adverse effects of **Quinidine? Diarrhea—up to 30% can’t tolerate, cinchonism—toxicity, tinnitus, ototoxicity—deafness, H/A, blurred vision
What is **Lidocaine (Xylocaine) used for? (Class I-B) Acute Rx ventricular dysrhythmias, especially in diseased heart (CHF, MI) IV only--bolus followed by drip **No decreased contractility **Little effect on BP, pulse
When do you treat ventrical dysrythmias with beta blockers? After an MI --> prophylactic use to prevent cell death?
What do nurse need to monitor when administering **Propranolol (Inderal) for post MI tx? Monitor BP—hold for systolic <100 Monitor P—hold for pulse <60 (50) Observe for S/S CHF Greater risk with calcium channel blockers
What is **Propranolol (Inderal) used for in regards to cardiac dysrhythmias? Prophylactically after MI Digitalis-induced dysrhthmias Slows ventricular rate with atrial fibrillation
What is the primary use for **Amiodarone (Cordarone)? Ventricular tachycardia and fibrillation (long term therapy)
What do we monitor for with **Amiodarone (Cordarone)? Bradycardia common—also, monitor for dyspnea, cough, chest pain; hypotension with IV use-give slowly
What is **Diltiazem (Cardizem, Ziac) (calcium channel blocker?) used for? Treat supraventricular tachycardias, slow ventricular rate in atrial fibrillation & atrial flutter
What do we monitor when giving **Diltiazem (Cardizem, Ziac) (calcium channel blocker?) for supraventricular tachycardia? CHF, bradycardia, hypotension Give slowly iv, with cardiac monitoring Monitor BP—hold for systolic < 100 Monitor P—hold for pulse < 60
What is **Adenosine (Adenocard) used for? Very specifically: to convert supraventricular tachycardia. Must push IV FAST, resets the heart.
What should a nurse monitor when pushing (quickly) adenosine? ***Cardiac monitoring, may see chest pressure, nausea, short term asystole (usually 5-6 seconds)
What class of drug is **Heparin? Anticoagulant (not a blood thinner!!)
What test(s) do we monitor with **Heparin? **aPTT--activated partial thromboplastin time—used for monitoring...or PTT if that's what your lab has. AFFECTS OTHERS AS WELL
When monitoring aPTT during heparin administration, what kind of values are you looking for? Goal is 1&1/2 to 2Xs as high a the [labs] control value.
When should we monitor aPTT for heparin administration? Daily (in IV therapy), with changes in dose, if bleeding noted
What drug is administered to neutralize heparin activity? ***Protamine Sulfate
What are adverse effects of Heparin? Normals: sting, small bruising at injection site, elevated liver function tests. Not great things: uncontrolled bleeding.
What happens in HIT—Heparin-Induced Thrombocytopenia? (also called white clot syndrome) Clots due to platelet aggregation, immune reaction to heparin--can embolize organs
What is the nursing intervention for HIT—Heparin-Induced Thrombocytopenia? • D/C heparin → esp. drop platelets by 50% **monitor platelet counts, may have to use alternative anticoagulants
What are the nursing implications for **Enoxaparin (Lovenox)? (low molecular weight heparin) Given SQ—watch for bruising (on abdomen) report drop in platelets, teach safety
What shot the nurse monitor for (adverse effects) of **Enoxaparin (Lovenox)? Bleeding, thrombocytopenia--monitor platelet count, can elevate AST, ALT
What is the most important test for ***Coumadin, Warfarin? Prothrombin; aPTT - takes 72 hours or more to reach adequate anticoagulation - effected by dietary intake of vitamin - K
What tests should be monitored with a client taking ***Coumadin, Warfarin? ***Monitor Prothrombin Time: 1.5 - 2 x control ****FOCUS ON****INR--(International Normalized Ratio—goal is 2.0--3.0)
What are the adverse effects of Coumadin? Usually due to OD--but may have existing lesion ~10% of people very sensitive—require low doses. Others are rare (GI, N,V,D, cramps, etc)
What kind of teaching should a nurse do w/ a client taking Coumadin ( Warfarin)? Safety (bleeding), diet (vit K), meds (none w/o MD approval), d/c prior to surgery, no pregnancy
What is used to reverse Coumadin toxicity (exceedingly prolonged PT/INR)? Vitamin K (Phytonadione—Aquamephyton); PO (for INR 5-8); IV (>8 or if vomiting)
What are some safety considerations for anti-coagulents? Prevent injury, no bare feet, reduce clutter, night lights, electric razors, soft tooth brush, ice to bruise, ER visit for issues w/ bleeding
How can we monitor for bleeding? GI-guaic stools; GU-hematest urine; IV sites-direct pressure > 5 minutes; any new symptom
What is the most common adverse effect of **Abciximab (Reopro)? (platelet aggregation inhibitor) Rash, GI upset, bleeding disorders
What are the nursing implications for **Abciximab (Reopro)? Given IV after MI, angioplasty, stent placement—prevent occlusion
What do nurses assess with clients taking ***Acetylsalicylic Acid—Aspirin (ASA) as an anticoagulant? Allergies, and GI bleeding
What can ***Acetylsalicylic Acid—Aspirin (ASA) be used for? In small doses, to prevent stroke, MI in high risk patient
What is the difference between **Heparin, and **tPA – (Alteplase, Activase)? Heparin is an anticoagulent (prevents clotting); and tPA is for thrombolysis; used in PE, stroke, MI
What would a nurse monitor for when giving tPA? Therapeutic response (you want ST elevation to come down), not worried about dysrhythmias, s/s of bleeding (often given with ASA, or heparin)
What are important contradictions of tPA? Surgery within 10 days, trauma, CPR, GI bleed within 3 months, hypertension, Uncontrolled (Diastolic > 110), or any increased risks for bleeding
What are the two main purposes of respiratory drugs? RESPIRATORY DRUGS **Prevent or treat bronchospasm **Ease removal of secretions
What respiratory issues indicate the use of **Epinephrine? Acute allergic reaction, Anaphylaxis, Bronchospasm
What are the adverse effects of using **Epinephrine? Increases heart rate, BP, blood glucose, angina with CAD, nervousness, anxiety, tremor
What are the nursing implications for **Epinephrine? Monitor therapeutic effects—wheezing, dyspnea, monitor BP, P, teach caution with over use of OTC inhaler--cardiac effects
Whay are Beta 2 Selective agents better than non-selective (Beta 1 + 2) ? ➢ Fewer cardiac effects ➢ Lose specificity with high doses
What is **Albuterol (Proventil, Ventolin) used for? (Inhaler: selective Beta 2 agent) used to prevent asthma attack; or in response to exercise, or exposure to allergen (use 20 minutes before); also used to tx bronchospasm
T/F? The LABA (long-acting beta agonist) **Salmeterol (Serevent) is commony used as a rescue inhaler?. False; 50x as selective as Albuterol 12 hour protection; DO NOT USE FOR RESCUE
T/F? It is normal for a person with Asthma to have an O2 sat lower than 90%. False. Asthmatics will adjust ventilation to facilitate O2 sats move 90%. If someone with asthma has low O2 sats, there are on the verge of respiratory failure.
How do corticosteroids like ***Triamcinolone (Azmacort) affect our respiratory system? Inhibit airway inflammation, decrease hyper-reactivity. Prophylaxis--takes several weeks to kick in
Whare are expected side effects of corticosteroids like ***Triamcinolone (Azmacort)? Systemic absorption from swallowed drug when inhaling Worse with higher doses Oropharyngeal candidiasis (Thrush) →rinse mouth after using
T/F? When using glucocorticoids along with Beta agonist, take Beta agonist first, wait 15 minutes, then take glucocorticoid True. Also, always follow Glucocorticoid with oral care
What should a nurse teach a client taking the combo corticosteroid ? Oral care after corticosteriods, long acting inhalers are NOT rescue inhalers, etc.
What might a nurse expect to see when administering the anticholinergic agent **Ipratropium (Atrovent)? Very few; not absorbed well by the lungs, little tachycardia, cardiac effects, little effect on glaucoma, unless sprayed in eyes
List the steps of using an MDI? *Use spacer-device or Hold mouthpiece 2 inches from mouth, inhale, exhale fully,, discharge med while inhaling fully, hold breath 10 seconds, wait 1 - 2 minutes between inhalations
What is the difference between using a dry powder inhaler vs. an MDI? Do NOT use spacer-device (or hold 2 inches from face) when using dry powders.
What is a nutritional source of Theobromine? Chocolate yo!
What is a source of **Theophylline and derivatives? Strong black tea...think hot toddy
What are adverse effects of **Theophylline and derivatives? CNS stimulation--nervous, insomnia, tachycardia, tremor OR WORSE: dysrhythmia, agitation, seizures, confusion
What are some adverse effects of **Zafirlukast (Accolate)? GI upset, Some psychiatric reactions (agitation, depression, suicidal thoughts)
What would a nurse administering a mast cell stabilizer want to teach the client? Use of inhaler, use daily, not for rescue
What is the rule of dosage when administering systemic corticosteroids for acute bronchospasm? ***Use smallest dose possible / shortest time possible (suppresses the adrenal cortex)
What is the rule of d/c-ing systemic corticosteroids? **Taper off--prevent Addisonian crisis (adrenal insufficiency)
T/F? Asthma is an appropriate indication for antihistamines? Fasle; do NOT administer antihistamines tho a client with asthma; dries out secretions.
Why would some with Glaucoma not want to take **Diphenhydramine (Benadryl)? Because it has anti-cholinergic effects; contraindication in Glaucoma.
**Diphenhydramine (Benadryl) is commonly the ______ agent in treating anaphylaxis. Second; the first is Epinephrine.
Why do first generation H1 histamine antagonists (antihistamines; e.g. Benadryl) cause more sedation? They cross the BBB; second generation do not.
What is ***Guaifenesin (Robitussin, ,Mucinex) used for? Expectorent. (not as good as humidity and hydration).
Which brands/type of insulin is considered "rapid acting?" (5-15 min) **Insulin Lispro (Humalog)...and others
What should a nurse teach a client receiving a SQ injection of the rapid onset **Insulin Lispro (Humalog) TEACH—Must eat within 15 minutes of injection—or Rapid Hypoglycemia!
Which insulin(s) come cloudy? Intermediate Acting Insulins: NPH
What is the commonly used intermediate acting (2-4 hr onset) insulin? ***NPH or Lente (old name)
List the onset, peak, and duration times for SQ injection Lispro, Aspart (Humalog)? 5-15 min/30-90 min/2-4 hours
List the onset, peak, and duration times for SQ injection of Regular insulin (Humulin)? 30-60 min/2-3 hours/ 3-6 hours
List the onset, peak, and duration times for SQ injection of NPH? 2-4 hours/ 4-12 hours /12 - 18 hours
List the onset, peak, and duration times for SQ injection of Glargine (Lantus)? 1-2 hours/flat /24 hours; remember also that it is clear even though long acting
List the onset, peak, and duration times for a 70/30 mix of NPH/Regular insulin injection, SQ? 30-60 min/4-8 hours/ 24 hours
Which type of insulin can be given IV? **Short-acting Insulins; Regular (Humulin)
How may units are in 2mL of U-100? 100 units/cc --> thus (usually) 100units/mL --> thus 200
What are the nursing implications for insulin administration? • MUST know the Concentration and the Form!! (U-100?? Regular? NPH?) • Patient teaching of diet and insulin is critical • Proper injection technique is critical o **dose, site, not too shallow o 90 degrees for SQ if enough fat
T/F: A minor hyperglycemic episode is considered more critical than a hypoglycemic episode? False: Hypoglycemic may me harder to counteract, and is more dangerous.
What is considered the best hypoglycemic agent? Diet and exercise
What is super bad to mix with ***Glipizide—Glucotrol? Sulfonylureas—Agents (2nd Generation) are contraindicated with alcohol use --> MAJOR HYPOGLYCEMIA
What kind of teaching should an RN given a client starting on ***Glipizide—Glucotrol? • Take at same time daily • Avoid alcohol • Medical ID bracelet, carry sugar • Report sore throat, bleeding, mouth lesions • Diet, exercise are critical • Blood glucose testing still required
What is super-sweet about ***Metformin (Glucophage)? Does NOT cause hypoglycemia (Antihyperglycemic); also, may lose weight, and improve lipid panels
What does ***Metformin (Glucophage) do? First line use for Type 2 diabetics). Improves glucose use in tissues, decrease glucose production in liver
Scenario: Jake is going to get a CT scan. He is taking ***Metformin (Glucophage). What instructions should Jake receive prior to the procedure? Must d/c around 24-48 hours (at least) prior to contrast (contraindicated).
What do we want to watch for when administering **Rosiglitazone (Avandia)? Liver enzymes, S/S hepatic damage, cholesterol, anemia, edema → worsen CHF
What teaching should be done with administration of **Rosiglitazone (Avandia)? Monitor Glucose levels—insulin needs may decrease gradually Take with food—improves absorption Report S/S liver damage Monitor for edema
WTF is **Exenatide (Byetta)? Injectable medication for Type II Diabetes - used with metformin &/or sulfas
What are important symptoms for a client taking **Exenatide (Byetta) to report? Nausea, vomiting, abdominal pain (s/s of pancreatitis)
What antihypoglycemic can we teach a family to give an IM injection of in a hyperglycemic crisis? **Glucagon (from pancreas’ alpha cells)
Which insulin(s) are appropriate for infusion use? ***REGULAR INSULIN ONLY - btw: check BG q.4.h
What are some things to monitor for when taking **Levothyroxine Tachycardia, restlessness, insomnia, psychosis, angina, myalgia, diarrhea...hyperthyroidism
Why would one be taking **Levothyroxine? Hypothyroidism
Jason is taking **Levothyroxine for his hypothyroid issues. What should we be sure to teach Jason about his medication? Must take continuously, monitor rapid pulse (and other s/s hyperthyroidism), T3/T4 levels, don't take w/antacids, and don't switch brands.
What is the preferred drug for hyperthyroidsim? **Methimazole (Tapazole)--
What are some nursing implications for **Methimazole (Tapazole)? Observe for s/s Agranulocytosis--sore throat, fever Teach to report early signs.
What are some nursing implications of **Lugol’s Solution, Saturated Solution of Potassium Iodide (SSKI)? Take w/juice (tastes bad)
What are adverse reactions to**Lugol’s Solution, Saturated Solution of Potassium Iodide (SSKI)? acute hypersensitivity Angioedema, skin lesions, serum sickness
What is **Radioactive Sodium Iodide (I-131) used for? Used to partially or totally destroy thyroid gland with hyperthyroidism
What are adverse effects of **Radioactive Sodium Iodide (I-131)? • Permanent hypothyroidism (10-13%) • Rx with thyroid hormone • May take several months to be effective • Irritate mouth/throat—saline gargle • Thyroiditis, parotiditis—fades in 3-4 days
What should a nurse monitor with a client taking **Radioactive Sodium Iodide (I-131)? Nursing—observe for S/S hypo or hyperthyroidism Observe for mouth/throat irritation, parotiditis, thyroiditis Teach how to take, saline gargle Often given with PTU Contraindicated in pregancy or lactation
What do we use to tx hypoparathyroidism? Ca+ or Calcium
What do we use to tx hypercalcemia? **Calcitonin (salmon)
What are some adverse of **Calcitonin (salmon)? Nausea, vomiting, flushing, itching (mild) Nasal—nasal irritation, epistaxis, HA, muscle pain
What is some important teaching associated with **Caclitonin? Proper use of nasal form—MDI, alternate nostrils each day
Liz is taking **Alendronate (Fosamax) for inhibition of normal & abnormal bone resorption (osteoporosis). What should we teach her about her meds? ➢ Take on empty stomach, full glass of water, stay upright for 30 minutes ➢ Teach to report jaw/mouth pain ➢ Must supplement Ca+, vitamin D
What kind of adverse effects should we expect to see from **Alendronate (Fosamax)? Gas, reflux, gastric & esophageal irritation Rare—Osteonecrosis of jaw
John is illegally taking **Growth Hormone to improve his weight lifting performance. What should we teach John about his illegal use of this drug? Acromegaly—increase size of facial bones, hands, feet, osteoporosis, cardiac failure, diabetes, impotence (oops), amenorhhea (lame for John)
What are the nursing implications for taking growth hormone? ➢ Adverse: acromegaly ➢ Given SC 3 x weekly—painful ➢ Must rule out pituitary tumor ➢ Can’t use if epiphyses closed Monitor growth, BP, BG
What is **Octreotide (Sandostatin) used for? Similar to Somatostatin—GH inhibiting hormone; Inhibit GH, insulin, glucagon Lower levels of GH in Acromegaly--adjunct to surgery, radiation
What are the nursing implications of **Octreotide (Sandostatin)? Given SC or IV—irritating Adverse Reactions: Diarhhea, GI distress, HA, dysrhythmias, in acromegaly can see high or low glucose, monitor blood glucose, cardiac rhythm with IV use
What is an adverse effect of the ADh **Desmopressin (DDAVP)? Excess water retention—Rx with fluid restriction
What is **Desmopressin (DDAVP)? It is an Antidiuretic Hormone, use for tx of DI.
Jake is taking the potent vasoconstrictor **Vasopressin (Pitressin) because of his esophageal varicose. What should Jake's nurse monitor while he takes this medication? monitor BP—risk of HTN Fluid status, I & O, urine specific gravity
What kind of steroid is ***Fludrocortisone (Florinef)? "Mineralocorticoid"--affects minerals - Na+ and H20
What do the glucocorticoids Cortisone, and Prednisone do? Seriously, review the notes. WAY too many to list. (Hint: think adrenal suppression; immunosuppression, GI irritation)
T/F: the adverse effects of corticosteroids are dose dependent? True; and often reversible...except cataracts...and osteoporosis...
What are the dangers of abrupt withdrawal of corticosteroids? Stimulates Addisonian crisis—life threatening cardiovascular collapse
***Chronic use of corticosteroids suppresses ____________*** ***Adrenals***
Created by: scottheadrick