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Pharm HESI
Pharmacology
| Question | Answer |
|---|---|
| Digoxin – positive inotrope and negative chronotrope does what? How do you assess for this? | (+)increases force of contraction (-) decreases heart rate Always take AP for a full minute! |
| • Client with long hx of daily digoxin and furosemide (Lasix) use; creates a high risk for | dig toxicity (Lasix can cause hypokalemia, which can lead to dig toxicity) |
| • Digoxin toxicity – know normal digoxin level | 0.5 – 2 ng/mL |
| serum potassium (K+) level | 3.5 to 5.0 mEq/L |
| ); low potassium or magnesium levels may increase risk for | digoxin toxicity |
| S/S of dig toxicity include | anorexia, bradycardia, headache, dizziness, confusion, nausea, and visual disturbances (blurred vision, yellow vision, and/or halo vision); |
| When should you hold Digoxin? | if AP less than 60 |
| • Labetalol (beta blocker) for? And when should you hold the med? | HTN: Notify prescriber for low pulse rate and do not give med |
| SE of Labetalol is | weight gain (fluid retention) |
| What is one of the best indicators for fluid gain or loss? | Monitor weight 1 kg (2.2 lb) = 1,000 mL |
| • Nitroglycerin transdermal patch for treating | chest pain (angina) |
| When should you remove the nitroglycerin patch? | remove at night to allow 8 hours without patch (can produce tolerance in 24 hours) |
| what should a pt do if he is having chest pain, but is already wearing a nitroglycerin patch? | may use SL nitro when wearing patch if patient having chest pain |
| • Why wear gloves when applying nitroglycerin paste or patch? | (severe vasodilation, ↓BP, intense HA |
| What can you give a pt who has a HA from the nitroglycerin patch? | give acetaminophen for HA |
| If an angina pt is having chest pain and is already wearing a nitroglycerine patch what should you do? | If vital are ok leave the patch on and administer nitro sublingual PRN |
| • Pt. in CCU/ICU on nitro drip; becomes hypotensive what should you do? | decrease rate of nitro drip |
| dipine affect | vessels only (vasodilation) |
| • Calcium channel blockers SE | dizziness, facial flushing, hypotension, edema, constipation. Verapamil (Calan) and diltiazem (Cardizem) also affect heart. |
| Nursing considerations for a pt on calcium channel blockers | Monitor BP, HR (↓). Avoid grapefruit juice |
| • Calcium channel blockers end in and include what other drugs? | dipine (like amlopidine) and verapamil (Calan) and diltiazem (Cardizem). |
| • MOA for Aliskiren (Tekturna) | direct renin inhibitor for HTN |
| • Aliskiren (Tekturna) pt teachings are | don’t take if pregnant (stop drug if become pregnant); don’t take with high fat meal. |
| Nursing considerations for Aliskiren (Tekturna) | May increase K+, so don’t take with other drugs that ↑ K+. |
| • MOA for Furosemide (Lasix) | loop diuretic; rapid acting; used for rapid diuresis in emergencies (pulmonary edema) |
| Nursing considerations for Furosemide (Lasix) | may produce hypokalemia (assess for muscle cramps, muscle weakness). Hypotension, F/E abnormalities, dehydration |
| Furosemide (Lasix) SE | dizziness, HA, tinnitus, N/V/D, ↓ K+, hyperglycemia, ototoxicity with aminoglycosides (-mycin drugs) |
| assess overall condition of the veins. Use large vein, like antecubital (AC) vein when administering potassium. Venous access is important because | IV potassium can irritate the vein. Have patient notify nurse immediately if burning at site. IV K+ extravasation can cause necrosis of tissues. |
| • IV potassium (KCl) considerations when administering | Don’t give IV push; infuse at a rate no greater than 20 mEq/hr; concentration no greater than 40 mEq/L. Always use infusion pump. Assess IV site every hour. |
| • MOA for Osmitrol (Mannitol) | osmotic diuretic; effectiveness determined by ↓ ICP. NOT used for peripheral edema; used to treat pt. with closed head injury; effective response is decreased ICP |
| • Spironolactone (Aldactone), amiloride (Midamor); triamterene (Dyrenium) have what MOA | potassium-sparing diuretic (can cause ↑K+). Blocks receptors for aldosterone. Inhibits sodium and water reabsorption. |
| when should a pt take potassium-sparing diuretic | Take in a.m. (diuretics in the morning if possible) |
| Nursing considertions for potassium-sparing diuretic (Spironolactone (Aldactone), amiloride (Midamor); triamterene (Dyrenium) | avoid salt substitutes, ACE inhibitors, ARBs. Often taken with other (thiazide) diuretics to treat edema, hypertension, heart failure. Can be taken with other meds that lower K+. |
| • Lab value for atorvastatin (Lipitor) | – HDL should increase; LDL and total cholesterol decrease |
| Other statin drugs include | rosuvastatin (Crestor), fluvastatin, lovastatin, simvastatin, pravastatin |
| What are the nursing considerations for a pt taking atorvastatin (Lipitor) | check LFTs routinely and CK for any c/o of muscle pain. |
| How do you evaluate effectiveness? | |
| Adrenergics/SNS Drugs & Adrenergic Blockers : alpha 1 stimulation IS | – vasoconstriction; beta 1 (one heart), beta 2 (two lungs) |
| • Mydriatics – agents used to produce | dilation of pupils for eye exams and ocular surgery |
| • Tamsulosin (Flomax) – alpha1 adrenergic blocker; MOA | ↓ smooth muscle contraction of prostate capsule and bladder neck. Used for treating sx of BPH. |
| • Effects of dopaminergic activation | causes dilation of renal vasculature; because of this we use it to treat shock; by dilating renal blood vessels, we can improve renal perfusion and reduce the risk of renal failure. Dopamine is the only drug available that can activate dopamine receptors. |
| when dopamine is given to treat shock, the drug also enhances what? | cardiac performance (because it actives beta1 receptors in the heart.) |
| Which Catecholamine drugs must be watched carefully for extravasation! | epinephrine, norepinephrine, dopamine, dobutamine, etc |
| How do you prevent sloughing and necrosis in ischemic areas, | the area should be infiltrated as soon as possible with 10 to 15 mL of saline solution containing 5 to 10 mg of Regitine (brand of phentolamine), an adrenergic blocking agent. A syringe with a fine hypodermic needle should be used, and the solution libera |
| • Epi-Pen (Epinephrine Auto Injector) SE: | increase in heart rate, stronger or irregular heartbeat, sweating, nausea or vomiting, difficulty breathing, paleness, dizziness, weakness, shakiness, headache, apprehension, nervousness or anxiety. These side effects may go away if patient rests. |
| Single dose of epinephrine that can be injected where? and what should you do after using it? | (IM) into the middle of the outer thigh (even through clothes). Seek emergency medical treatment immediately |
| • Remember that many decongestants and bronchodilators have what type of effects? | sympathomimetic effects (adrenergic effects) |
| decongestants and bronchodilators SE include | ↑ HR, nervousness, insomnia, etc. Bronchodilators that stimulate β2 receptors can also stimulate β1 if dose is high enough (loses selectivity). Don’t forget cardiac assessment. |
| • Pentoxifylline (Trental) for intermittent claudication (like cilastozal [Pletal]) treats? | treats ischemic pain. |
| What drug is an antiplatelet like clopidogrel (Plavix)? | Prasugrel (Effient) |
| • Prasugrel (Effient) is used primarily after interventional what? | radiologic procedures (like coronary stents) and for patients who do not respond to clopidogrel. |
| low molecular weight heparin | Enoxaparin (Lovenox) |
| 1st line therapy for treatment and prevention of DVT | Enoxaparin (Lovenox) |
| What labs and things do you need to watch for in pt using Enoxaparin (Lovenox) | . No routine lab to monitor, but watch CBC d/t thrombocytopenia. |
| Concentration of hep-lock solution is what two solutions? | 10 units/mL or 100 units/mL. |
| Heparin for injection is what 3 units of measurement? | 10,000 units/mL or 20,000 units/mL or even 50,000 units/mL. |
| heparin sodium for injection is it the same as hep-lock solution? | No, . They are NOT interchangeable |
| Heparin is high-alert medication, which means the nurse must do what action before administering the drug? | requires another nurse to check dosage |
| dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto) are what type of drugs? | New potent, oral anticoagulants |
| Do dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto) require monitoring of labs | do not require monitoring of labs; But ↑ risk of bleeding so teach pt S/S |
| Opioids (morphine, hydrocodone, oxycodone, hydromorphone [Dilaudid] codeine) can produce CNS__________________________ | depression (be aware of safety for patients attempting to ambulate) and respiratory depression; |
| antidote for Opioids (morphine, hydrocodone, oxycodone, hydromorphone [Dilaudid] codeine? | administer naloxone; (Narcan) reverses respiratory depression but also reverses analgesia; may need to titrate dose and give repeated doses to prevent sudden withdrawal (repeat dose at 2-3 minute intervals). |
| (opioid double dose – be aware of | LOC and RR). |
| • Opioids (morphine, hydrocodone, oxycodone, hydromorphone [Dilaudid] codeine) can produce what SE: | constipation, pruritus, urinary retention, ↓ BP, ↓ HR. |
| Remember naloxone has shorter half-life than | opioids |
| Relief of moderate to severe chronic pain, like cancer pain. Not for postop or short-term pain relief. Patch usually lasts 72 hours. Remove old patch before applying new one. is what drug? | fentanyl patch opioid analgesic |
| fentanyl patch opioid analgesic SE | CNS depression, confusion, sedation, weakness, dizziness, restlessness; apnea, respiratory depression; anorexia, constipation, dry mouth, nausea, vomiting |
| Considered one of safest opioid analgesics for patients with renal impairment | fentanyl patch opioid analgesic |
| What things should the pt avoid and monitor when taking fentanyl patch opioid analgesic? | Avoid MAOIs. Avoid grapefruit and grapefruit juice. Avoid other CNS depressants. Monitor RR!!! Notify MD if RR below 12. |
| What drug do you administer for fentanyl patch opioid analgesic OD | Reverse effects with naloxone. Reverses respiratory depression but also reverses analgesia; may need to titrate dose and give repeated doses to prevent sudden withdrawal |
| what important things do you need to remember about Epidural pump priority ? | monitor vital signs every 15 minutes; do not administer other sedatives; be sure feeling/function has returned to lower extremities before returning pt. to floor. Label epidural tubing as epidural only! |
| • Acetaminophen (Tylenol) is what type of drug? | Nonopioid analgesic. Not an NSAID |
| • Acetaminophen (Tylenol) Maximum daily dose | 4,000 mg; 3,000 mg for elderly and those with liver disease |
| LT use of Acetaminophen (Tylenol) can produce | nephrotoxicity |
| Overdose of Acetaminophen (Tylenol) can produce | hepatotoxicity |
| symptoms of hepatotoxicity include | jaundice, abdominal pain, clay-colored stools, dark urine. |
| • Ibuprofen (Advil) and other NSAIDs commonly taken with antacids to | decrease GI distress |
| Note: Gastrectomy patient needs vitamin B12 (normally absorbed in stomach). May need B12 intramuscular injections. Pernicious anemia. Lack of intrinsic factor (may be seen in elderly). | Note: Parenteral: Initial dose 1000 mcg IM once a day for 7 days. If no improvement, 1000 mcg IM qod day for 7 days, then once q3-4d for 2 to 3 weeks is recommended. Most patients require monthly injections of 100 to 1000 mcg IM for life. |
| used for treatment of several nodulocystic acne; severe photosensitivity (avoid sun); teratogenesis (preg. category X) | • Isotretinoin (Accutane) |
| depolarizing neuromuscular blocker (NMB) used during surgery may cause ventricular tachycardia/dysrhythmias; added NMB action with vancomycin. Resp. status. | • Succinylcholine (Anectine) |
| elevated trough signifies what? | toxicity |
| what medications do we test peak and trough levels for? | Vancomycin and aminoglycosides. |
| • Peak and trough schedule is | initially and then every 5 to 7 days |
| meds ordered after a meal –should be taken within what time frame? | 30-60 minutes after eating |
| • Taking medications on an empty stomach means you should take meds when? | 1 hour before or 2 hours after eating |
| administered to increase the WBC count in neutropenic pts. - white blood cells increase from 2,500/mm3 to 5,500/mm3 – means the desired effect is reached. Give before infection develops. | • Filgrastim (Neupogen) |
| Filgrastim (Neupogen) SE | include fever, muscle aches, bone pain, and flushing. Give nonopioid or opioid analgesic; stops when med D/C’d. |
| • Iron (Fe) [ferrous sulfate] administration | dilute PO liqu. dosage and sip through a straw to avoid discoloration of teeth; take PO iron w/ food to ↓GI upset. Take antacids or milk products 1-2 hours before or after dosage. Instruct pt to sit upright for 30 min. to minimize esophageal irritation |
| • Iron (Fe) [ferrous sulfate] . IM given via Z-track method, what helps absorption? | Vitamin C |
| increases RBC production; treats anemia in patients with ESRD (CKD – chronic kidney disease) or from HIV or chemotherapy. Need normal iron levels. Monitor H&H. Monitor for signs of bleeding and/or clotting, such as DVT. Teach diet high in iron. | • Epoetin alfa (Epogen, Procrit) |
| immunosuppressant drugs indicated for the prevention of organ rejection (kidney, liver, heart transplants). Cyclosporine can cause nephrotoxicity and post-transplant diabetes mellitus. Avoid grapefruit juice. | • Cyclosporine (Gengraf, Neoral, Sandimmune) |
| • Don’t forget: glucocorticoids (steroid drugs) decrease | the immune response – patient at increased risk of infection. |
| Antihypertensives (drugs that control BP) and low potassium (K+) have a more pronounced adverse effect in the elderly causing... | cause hypokalemia . Antihypertensive effects are more pronounced |
| Patient discharged on warfarin (Coumadin) discharge teaching are: | avoid bleeding: soft toothbrush, electric razor, don’t go without shoes, avoid activities that may cause bleeding. maintain vitamin K foods in diet (don’t increase or decrease) |
| warfarin (Coumadin) monitor? | PT/INR |
| Clopidogrel (Plavix) – 75 mg/day for all ages. What do you need to do with pt on this med. before surgery? | notify health care provider of drug regimen prior to surgery; may need to hold any anticoagulants/antiplatelet drugs |
| Aspirin (ASA) interacts with | with other antiplatelets, anticoagulants, NSAIDs, etc. (bleeding) |
| Pregabalin (Lyrica) nonopioid analgesic used for | fibromyalgia. |
| Ketorolac (Toradol) NSAID can cause? USed for treating? | (causes gastric irritation) should be given with meals or snack. postop pain (not used for chronic pain); do not give for more than 5 days. |
| NSAID therapeutic contraindicated | in renal impairment. |
| Diclofenac (Zipsor) can increase .... causing..... increased risks are.... | LFTs (hepatotoxicity), may increase risk of stroke and MI, including GI bleeding. |
| first-line therapy for treatment of gout, What are the other treatment options? | NSAIDs first-line therapy. Second-line agents include allopurinol, colchicine, probenecid. |
| Name the 3 short acting bronchodilators, and when should they be uses | - Albuterol (Proventil, Ventolin) - levalbuterol (Xopenex) - pirbuterol (Maxair) • should be used during acute asthmatic episodes, not long term use |
| when using Albuterol (Proventil) you should assess for | open airway, ease of breathing |
| Topical/inhaled adrenergics (decongestants) use no longer than | than 3-5 days; can produce rebound congestion. |
| 51. Fluticasone and salmeterol (Advair) inhaler use how often? | only BID (not more often; can ↑BP) |
| Tiotropium (Spiriva) –bronchodilator used in LT maintenance of | COPD; given by inhaler; |
| Tiotropium (Spiriva) important pt teaching: | rinse mouth after inhaler use |
| Pirbuterol (Maxair) inhalerused for treatment of.... Similar in effects to..... Use cautiously in pts. with ...... Avoid use with | asthma levalbuterol cardiovascular disorders, including ischemic heart disease. Beta Blockers |
| Teaching for use of inhaler with 2 puffs of same med; two different meds | • Wait 1-2 minutes before taking 2nd puff of same inhaler • If two different inhalers use the bronchodilator first. |
| Montelukast (Singulair) indicated for treatment of .... administered when? • Leukotriene modifiers/inhibitors also include ..... you should check pt's | asthma.... at bedtime...... zileuton (Zyflo), zafirlukast (Accolate). LFT's |
| Antihistamines (eg. diphenhydramine [Benadryl]) hve what MOA? | • decrease nasopharyngeal secretions by blocking H1 receptors; |
Created by:
Shenra83