Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Pharm Exam 2
| Question | Answer |
|---|---|
| What is the equation for blood pressure? | BP= CO x SVR |
| What is CO? | Cardiac output |
| What is the equation to determine CO? | Stroke volume x heart rate |
| What is SVR? | Systemic vascular resistance |
| If you decrease SVR, what will you see a change in? | Cardiac output |
| What is one of the most common disease states? | Hypertension |
| Why do most people do not know they have hypertension? | Limited signs and symptoms |
| What is preload associated with? | Blood volume |
| What does Digoxin and calcium channel blockers affect? | Contractility |
| What does a diuretic effect? | Preload |
| What is systemic vascular resistance associated with? | Afterload |
| What does hypertension increase? | Afterload |
| What is a hypertensive systolic BP for 60 years or older? | Greater than 150 |
| What is hypertensive diastolic BP for 60 years or older? | Greater than 90 |
| What is hypertensive systolic BP for younger than 60 years or those who have chronic kidney disease or diabetes? | Greater than 140 |
| What is hypertensive diastolic BP for younger than 60 years or those who have chronic kidney disease or diabetes? | Greater than 90 |
| What should be prescribed first for hypertension? | Lifestyle change |
| How is drug therapy for hypertension prescribed? | Must be individualized |
| What will an antihypertensive do? | Decrease a systemic vascular resistance impacting cardiac output |
| What are the seven main categories of hypertension drugs? | Diuretics, adrenergic, vasodilators, ace inhibitors, ARBs, calcium channel blockers |
| What do hypertensive drugs do? | Decrease afterload |
| What are the symptoms for left sided heart failure? | Pulmonary edema, coughing, shortness of breath, dyspnea |
| What are the symptoms for right sided heart failure? | Systemic venous congestion, pedal edema, jugular venous distension, ascites, hepatic congestion |
| What are the common symptoms of heart failure? | Dyspnea, fatigue, fluid retention, pulmonary edema |
| What are the causes of heart failure? | Systemic hypertension, MI, CAD |
| What is the importance of treating hypertension? | Decreases the risk for heart failure |
| What does inotropic mean? | Contraction |
| What does positive inotropic mean? | Increase force/strength of myocardial contraction |
| What does negative inotropic mean? | Decrease force/strength of myocardial contraction |
| What does chronotropic mean? | Heart rate |
| What does positive chronotropic mean? | Increased heart rate |
| What does negative chronotropic mean? | Decreased heart rate |
| What is an example of a positive inotropic drug? | Cardiac glycosides |
| What is an example of a negative inotropic drug? | Beta blockers and calcium channel blockers |
| What is an example of a positive chronotropic drug? | Adrenergics |
| What is an example of a negative chronotropic drug? | Cardiac glycosides, beta blockers, calcium channel blockers |
| What do vasodilators do? | Decrease preload by dilating the artery so blood stays peripherally and reduces the amount of blood in the heart |
| What do vasodilators do? | peripheral vasodilation, decreased SVR, decrease preload, and decrease afterload |
| What is the goal of the vasodilators? | Increase supply and decrease demand on the heart |
| What are two examples of vasodilators? | Hydralazine and nitroprusside |
| When is a nitroprusside used for? | Hypertensive emergencies |
| What do vasodilators do? | peripheral vasodilation, decreased SVR, decrease preload, and decrease afterload |
| What do vasodilators do? | peripheral vasodilation, decreased SVR, decrease preload, and decrease afterload |
| What is the goal of the vasodilators? | Increase supply and decrease demand on the heart |
| What are the side effects of vasodilators? | Hypotension when first begin taking and a sudden drop in BP |
| What are two examples of vasodilators? | Hydralazine and nitroprusside |
| What is a side effect of nitroprusside? | Cyanide toxicity |
| When is a nitroprusside used for? | Hypertensive emergencies |
| What are the nursing implications for vasodilators? | Monitor Bp and hold if SBP is <100 and gradual position changes to avoid orthostatic hypotension |
| What is the route of nitroprusside? | Only via IV |
| What are symptoms of hypertensive emergencies? | Flushness, dizziness, and headache |
| What is the goal of the vasodilators? | Increase supply and decrease demand on the heart |
| What is the most prescribed drug for hypertension and heart failure? | ACE inhibitors |
| What are the side effects of vasodilators? | Hypotension when first begin taking and a sudden drop in BP |
| What are two examples of vasodilators? | Hydralazine and nitroprusside |
| What is the suffix of ACE inhibitors? | PRIL |
| What is a side effect of nitroprusside? | Cyanide toxicity |
| When is a nitroprusside used for? | Hypertensive emergencies |
| What are the nursing implications for vasodilators? | Monitor Bp and hold if SBP is <100 and gradual position changes to avoid orthostatic hypotension |
| What is the route of nitroprusside? | Only via IV |
| What is the most prescribed drug for hypertension and heart failure? | ACE inhibitors |
| What are symptoms of hypertensive emergencies? | Flushness, dizziness, and headache |
| What is the suffix of ACE inhibitors? | PRIL |
| What are the side effects of vasodilators? | Hypotension when first begin taking and a sudden drop in BP |
| What do ACE inhibitors do? | Decrease aldosterone secretion and reducing BP |
| What is a side effect of nitroprusside? | Cyanide toxicity |
| How doe ACE inhibitors reduce BP? | Decreases SVR and preload |
| What are the nursing implications for vasodilators? | Monitor Bp and hold if SBP is <100 and gradual position changes to avoid orthostatic hypotension |
| What are the indications for ACE inhibitors? | HTN, heart failure, MI, diabetic nephropathy |
| What is the most prescribed drug for hypertension and heart failure? | ACE inhibitors |
| What does angioedema mean? | Laryngeal swelling |
| What drugs can be combined with ACE inhibitors? | Thiazide diuretics or CCB |
| What is the suffix of ACE inhibitors? | PRIL |
| What are the adverse effects of ACE inhibitors? | Hypotension, hyperkalemia, dry nonproductive cough, angioedema, and hypotensive |
| What do ACE inhibitors do? | Decrease aldosterone secretion and reducing BP |
| What is a symptom of hyperkalemia? | Cardiac conduction |
| How doe ACE inhibitors reduce BP? | Decreases SVR and preload |
| What does angioedema mean? | Laryngeal swelling |
| What are the indications for ACE inhibitors? | HTN, heart failure, MI, diabetic nephropathy |
| How often does angioedema occur? | Rare but fatal |
| What drugs can be combined with ACE inhibitors? | Thiazide diuretics or CCB |
| What is the black box warning for ACE inhibitors? | Don't use during pregnancy |
| What are the adverse effects of ACE inhibitors? | Hypotension, hyperkalemia, dry nonproductive cough, angioedema, and hypotensive |
| What is given if ACE inhibitors cause a cough or isn't effective? | ARBS |
| What is a symptom of hyperkalemia? | Cardiac conduction |
| What is the suffix of ARBS? | Sartan |
| What does angioedema mean? | Laryngeal swelling |
| What is the MOA of ARBS? | Blocks receptors to lower aldosterone and lower blood pressure |
| How often does angioedema occur? | Rare but fatal |
| What are the indications of ARBS? | HTN, adjunct Tx of heart failure |
| What is the black box warning for ACE inhibitors? | Don't use during pregnancy |
| What are the side effects of ARBS? | Chest pain |
| What is given if ACE inhibitors cause a cough or isn't effective? | ARBS |
| What is less likely to occur with ARBS? | Hyperkalemia and cough |
| What is the suffix of ARBS? | Sartan |
| What is the MOA of ARBS? | Blocks receptors to lower aldosterone and lower blood pressure |
| What are the indications of ARBS? | HTN, adjunct Tx of heart failure |
| What are the side effects of ARBS? | Chest pain |
| What is less likely to occur with ARBS? | Hyperkalemia and cough |
| What is the black box warning of ARBS? | Don't use during pregnancy |
| What do diuretics do? | Decrease workload of the heart and BP |
| How does diuretics decrease workload of the heart? | Decreases plasma and extracellular fluid volume |
| What are the results of using a diuretic? | Decreases preload and total peripheral resistance |
| What is the MOA for loop diuretics? | Reduces sodium chloride reabsorption in the thick ascending limp of the loop of Henle |
| What diuretics are potassium wasting? | Loop and thiazide |
| What are the indications for loop and thiazide diuretics? | HTN, edema associated with heart failure, liver cirrhosis, pulmonary edema, and renal disease |
| What is the black box warning for loop diuretics? | Water and electrolyte depletion |
| What are the side effects of loop and thiazide diuretics? | Dehydration, hypotension, hypokalemia, hyponatremia |
| What is a specific side effect of furosemide? | Ototoxic |
| What does ototoxic mean? | Toxic to the ear |
| When should a pt notify their provider in regard to weight gain using a diuretic? | 2lbs or more in a day or 5lb in a week |
| What time should a diuretic be given? | AM |
| What should be assessed in a pt taking a diuretic? | Decreased edema, shortness of breath, dyspnea, crackles, and fatigue |
| When should a loop or thiazide diuretic be held? | SPB <100 or if potassium is <3.5 |
| What type of diuretic is usually prescribed first? | Loop |
| What diuretic is potassium sparing? | Aldosterone antagonist |
| What is an example of a thiazide diuretic? | hydrochlorothiazide |
| What is an example of an aldosterone antagonist? | Spironolactone |
| What is the MOA of aldosterone antagonist diuretics? | Blocks the effects of aldosterone |
| What are the side effects of aldosterone antagonist diuretics? | Dehydration and hypotension |
| What is the MOA for calcium channel blockers? | Prevent calcium from going in the calcium channels in the heart |
| What does decrease calcium in the heart do? | Decreases heart rate and vasodilation of blood vessels |
| What do calcium channel blockers do? | Improve blood flow to the heart and decrease force of contractions |
| What are the indications of calcium channel blockers? | Angina and hypertension |
| What condition causes angina? | CAD |
| What are the contraindications for calcium channel blockers? | Acute MI, second- or third-degree AV block, and hypotension |
| What are the adverse effects of calcium channel blockers? | Hypotension, bradycardia, and dyspnea |
| What HR are calcium channel blockers held? | Below 60 |
| What should you not give calcium channel blockers with? | Grapefruit juice |
| What is the suffix of a beta receptor blocking adrenergic drugs? | -olol |
| Where does alpha1 blockers act? | Peripherally |
| What is an example of peripherally acting adrenergic drug? | Doxazosin |
| What is the suffix of a alpha blocking adrenergic drug? | Osin |
| Where does alpha 2 blockers act? | Centrally |
| How do alpha 1 receptor blockers work? | Inhibits the activation of post synaptic alpha 1 receptors by norepinephrine causing blood vessel contraction |
| What is the overall result of taking a alpha1 receptor blocker? | Decreases systemic venous pressure and increase in cardiac output |
| What is two examples of a centrally acting alpha2 receptor agonist? | Clonidine and methyldopa |
| What is two examples of dual action alpha1 and beta receptor blockers? | Labetalol and carvedilol |
| What are the adverse effects of adrenergic drugs? | Orthostatic hypotension, first dose syncope, drowsiness, sedation, erectile dysfunction, and rebound hypertension if abrupt discontinuation |
| When should the first dose of an adrenergic be given? | At night |
| What are two examples of selective beta blockers? | Metoprolol and atenolol |
| What does selective beta blockers select for? | Heart |
| What are three examples of non-selective beta blockers? | Propranolol, labetalol, and carvedilol |
| Who cannot take non-selective beta blockers? | Pt with chronic lung disease or asthma |
| What is beta blockers MOA? | Decreases heart rate, myocardial oxygen demand, and myocardial contractility Increased oxygen delivery to the heart |
| What pt are commonly given beta blockers? | Heart failure |
| What are the indications of beta blockers? | Angina, antihypertensive, cardiac dysrhythmias, cardioprotective effects especially after MI, and heart failure |
| What are the contraindications of beta blockers? | Systolic heart failure, bronchial asthma, diabetes mellitus, and peripheral vascular disease |
| Why should a diabetic not take a beta blocker? | Can mask hypoglycemia induced tachycardia |
| What are the adverse effects of beta blockers? | Bradycardia, hypotension, dizziness, and impotence (erectile dysfunction) |
| How long should you check apical HR? | Full minute |
| What is black box warning for beta blockers? | Rebound tachycardia and hypertension |
| What is angina pectoris? | When supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart and the muscle "aches" |
| What does ischemia mean? | Poor blood supply to an organ |
| Is ischemia reversible? | Yes |
| What does a myocardial infarction do to the heart? | Necrosis of cardiac tissue |
| What is the MOA of nitrates? | Causes vasodilation |
| What are nitrates the most effective medication for? | Decreasing preload and afterload |
| What is an example of a nitrate? | Nitroglycerin |
| How do you know sublingual nitrate is working? | Stinging sensation under the tongue |
| How many sublingual nitrate tabs can you give? | 3 tabs 5 minutes apart |
| What is important to education pt on when using nitrate transdermal patches? | Remove patch at bedtime and apply a new patch in the morning to decrease tolerance |
| What is isosorbide dinitrate? | Rapid and long-acting nitrate |
| What is isosorbide mononitrate? | Long acting |
| What is the biggest side effect of nitrates? | Headaches |
| What causes headaches while using nitrates? | Vasodilation causing more pressure in skull |
| What are the side effects of nitrates? | Headaches, hypotension, reflex tachycardia, postural hypotension |
| What are contraindications of nitrates? | Severe anemia, closed angle glaucoma, hypotension, severe head injury, and use of erectile dysfunction drugs |
| When are loop diuretics used for? | To reduce symptoms of heart failure secondary to fluid overload |
| When are aldosterone inhibitors used for? | Added as heart failure progresses |
| When is digoxin used for? | Only used if loop diuretics and aldosterone inhibitors aren't working |
| What is the MOA for phosphodiesterase inhibitors? | Inhibit the enzyme phosphodiesterase to increase intracellular cAMP |
| What do phosphodiesterase inhibitors cause? | Positive inotropic response and vasodilation |
| What is the indication for phosphodiesterase inhibitors? | End stage heart failure |
| What are the side effects for phosphodiesterase inhibitors? | Dysrhythmia, hypotension, angina, hypokalemia, thrombocytopenia, headache, and elevated liver enzymes |
| What interacts with phosphodiesterase inhibitors? | Diuretics and digoxin |
| What should you monitor phosphodiesterase inhibitors? | BP, electrolytes, LFT, and platelets |
| What is an example of phosphodiesterase inhibitors? | Milrinone |
| What is the MOA of cardiac glycosides? | Increase intracellular sodium, increase contractility, and increase CO |
| What effects do cardiac glycosides have? | Inotropic and chronotropic effects |
| What is an example of a cardiac glycoside? | Lanoxin |
| When are cardiac glycosides used? | When other drugs are not effective for heart failure |
| What are the side effects of cardiac glycosides? | Bradycardia, visual changes (colored vision), |
| What is important to monitor for cardiac glycosides and why? | Potassium levels because low levels can increase toxicity |
| What does hemostasis mean? | Stops bleeding |
| What does coagulation mean? | Clotting of blood |
| What is a thrombus? | Blood clot |
| What is an embolus? | Thrombus that moves through blood vessels |
| What is fibrin? | A clot forming substance |
| What does fibrinolysis mean? | Mechanism where formed thrombi are lysed to prevent excessive clot formation and blood vessel blockage |
| What does fibrin bind to? | Plasminogen |
| What is plasminogen? | Circulating protein |
| What does plasminogen convert into? | Plasmin |
| What is plasmin? | A protein that breaks down the fibrin thrombus |
| What is the benefit of fibrinolytic system? | Keeps thrombus localized to prevent it from becoming an embolus |
| What is hemophilia? | A rare genetic disorder when the natural coagulation and hemostasis factors are limited/absent |
| Why is hemophilia such as severe condition? | Pt can bleed to death if they are not given a coagulation factor |
| Where is the location of embolus during an MI? | Coronary artery |
| Where is the location of the embolus during a stoke? | Brain vessels |
| Where is the location of the embolus during a pulmonary embolus? | Pulmonary circulation |
| Where is the location of the embolus during deep vein thrombosis? | Vein in the leg |
| What are the three risk factors for DVT? | Immobility, trauma to vessels, and increased coagulation |
| What do anticoagulants do? | Inhibit the formation of clotting factors to prevent clot formation |
| What do antiplatelets do? | Inhibit platelet aggregation (sticking together) to prevent platelet plugs |
| What do thrombolytic drugs do? | Breaks down existing clots |
| What does antifibrinolytic/hemostatic do? | Promotes blood coagulation |
| What do antiplatelet drugs do? | Prevent platelets from clumping together |
| What are the examples of antiplatelet drugs? | Aspirin (81mg) and clopidogrel (plavix) |
| What does a baby aspirin do? | Blocks the enzyme that produces compounds involved in platelet aggregation |
| What does clopidogrel (plavix) do? | Inhibits a receptor on platelets that responsible for binding together |
| What are the side effects of antiplatelet drugs? | Increased bleeding risk, gastrointestinal upset (aspirin can cause stomach irritation and ulcers) |
| What is the contraindication of antiplatelet drugs? | Don't give aspirin to children can cause Reyes syndrome |
| What should be monitored for pt taking antiplatelet drugs? | Signs of bleeding and bruising (especially in gums, stool, and nose) |
| What should nurse education pt on when taking an antiplatelet drug? | Importance of consistent dosing to maintain the effect |
| What do anticoagulant drugs do? | Prevents the formation of new blood clots |
| What does heparin do? | Prevents clotting factors from forming |
| What does warfarin do? | Prevents clotting factor from being released in the liver |
| What are the indications for anticoagulant drugs? | DVT, PE, atrial fibrillation, MI, stroke, indwelling devices (mechanical heart valves), and major orthopedic surgery |
| What are the side effects of anticoagulant drugs? | Increased bleeding risk and heparin induced thrombocytopenia |
| What is heparin induced thrombocytopenia (HIT)? | A rare immune reaction to heparin that can cause low platelet levels and clot formation |
| What are petechia? | Little dots that indicate bleeding from small vessels (often seen in bruises) |
| What should nurse monitor for pt taking anticoagulants? | Signs of bleeding |
| What lab is monitored when taking heparin and warfin? | INR |
| What lab is monitored when taking warfin? | PT (prothrombin time) |
| What lab is monitored when taking heparin? | PTT (partial thrombo plastin time) |
| What do INR, PT, and PTT measure? | Time it takes for blood to clot |
| What are contraindications for anticoagulants? | Any acute bleeding or risk of bleeding |
| What pt are LMWH contraindicated for? | Patients with an indwelling epidural catheter risk of epidural hematoma |
| How is heparin given? | Continuous IV infusion |
| How long is IV heparin given? | Usually, every 6 hours or until therapeutic effects are seen |
| How much heparin is given for DVT prophylaxis? | 5000 units subcutaneously two or three times a day |
| Does heparin need to be monitored for DVT prophylaxis? | Does not need to be monitored when used for prophylaxis |
| Where should subcutaneous doses be given? | Areas of dep subcutaneous fat and sites rotated |
| Where should you not given subcutaneous doses? | Within 2 inches of the umbilicus, abdominal incisions, open wounds, scars, drainage tubes, or stomas |
| What should you not do with subcutaneous injects? | Do not aspirate or massage the injection site |
| What are the two types of heparin? | Unfractioned and low molecular weight (LMWHs) |
| When is unfractionated heparin given? | Given through IV when there is a clot present |
| When is low-molecular weight heparins given? | Given subq when a pt is at a high risk of a clot |
| What type of heparin has a more predictable anticoagulant response? | Low molecular weight heparins |
| Which type of heparin requires lab monitoring? | Unfractionated heparin |
| What is antidote for low molecular weight heparins? | Protamine sulfate |
| What is contraindication for low molecular weight heparins? | Epidural catheter |
| What is the most commonly prescribed oral anticoagulants? | Warfain |
| What needs to be carefully monitored when taking warfarin? | PT and INR |
| What is the normal INR without taking warfarin? | 1.0 |
| What a normal INR with warfarin? | 2-3.5 |
| What dietary considerations are important when taking Warfarin? | Limit amount of potassium |
| What are herbal interactions with warfarin? | Garlic, ginger, ginkgo |
| Can warfarin and heparin be given together? | Yes can be started on warfarin while still taking heparin until PT/INR levels indicate adequate anticoagulation |
| How long does warfarin take to show therapeutic effect? | Several days |
| What is the antidote of warfarin? | Vitamin K |
| What should a pt wear while taking an anticoagulant? | A medical alert bracelet |
| What are two examples of Factor Xa anticoagulant drugs? | Rivaroxaban (Xarelto) and Apixaban (eliquis) |
| What is rivaroxaban (xarelto) used for? | Stroke prevention in patients with a fib, post-op thromboprophylaxis with ortho surgeries, and treatment of DVT+PE |
| Does rivaroxaban (xarelto) require lab monitoring? | No |
| What are the adverse reactions of rivaroxaban (xarelto)? | Peripheral edema, dizziness, headache, bruising, diarrhea, hematuria, and bleeding |
| What does thrombolytic (fibrinolytic) do? | Break down existing clots |
| What are two examples of a thrombolytic (fibrinolytic)? | Alteplase and reteplase |
| What does alteplase and reteplase do? | Target fibrin in clots |
| What are the indications for thrombolytic (fibrinolytic) drugs? | Acute MI, ischemic stroke, arterial thrombolysis, DVT, occultation of shunts or catheters, and pulmonary embolus |
| What is the most widely known thrombolytics (fibrinolytic) drug? | tPA |
| What are the side effects of thrombolytic (fibrinolytic) drugs? | Increased bleeding risk and risk of reperfusion injury |
| What is a reperfusion injury? | When a clot is dissolved, blood flow is restored to the previously blocked area cause potential tissue damage due to sudden reperfusion |
| Where are thrombolytic drugs given? | In controlled settings such as ICU or ED |
Created by:
emilychaltraw