343 exam 2 meds Flashcards
1
Q
What does digitalis (digoxin) do?
A
- increases myocardial contractility -> more forceful contractions of the heart
- decreases HR and improves cardiac output
- increases coronary artery blood flow
- increases urine production
- helps with edema, exertional and paroxysmal nocturnal dyspnea, cough, and cyanosis
- decreases preload and increases stroke volume
2
Q
what are side effects/adverse effects of digoxin?
A
- bradycardia
- dysrhythmias
- anorexia**
- N/V**
- diarrhea**
- headache
- dizziness
- blurred or yellow/green vision**
- halos around lights**
- confusion
- weakness
3
Q
what are signs of digitalis/digoxin toxicity?
A
- anorexia
- N/V
- diarrhea
- blurred vision
- yellow/green vision
- halos around lights
4
Q
what is the antidote for digitalis toxicity?
A
digoxin immune fab
5
Q
what are some contraindications for digoxin?
A
- HR below 60
- signs of digitalis toxicity
- digoxin level >2 ng/mL (toxicity)
6
Q
what patient education will the nurse provide to a patient taking digoxin?
A
teach the patient how to check pulse daily (before taking digoxin) and report side effects
7
Q
what will the nurse monitor for in a patient taking digoxin?
A
- peripheral/pulmonary edema
- HR
- serum digoxin level
- serum K+ level (for hypokalemia)
8
Q
what does milrinone lactate do?
A
- promotes stronger heart beat
- increases stroke volume and cardiac output
- vasodilation
- used as a “last resort” medication
9
Q
administer IV milrinone lactate no longer than __ to __ hours to avoid severe cardiac dysrhythmias
A
48 to 72 hours
10
Q
what are some adverse effects of milrinone lactate?
A
- dysrhythmias
- hypotension
- angina
- hypokalemia
- tremors
- thrombocytopenia (decreased platelets)
11
Q
what do nitrates do?
A
- promote vasodilation
- decrease preload and afterload
12
Q
what are some side effects/adverse effects of nitrates?
A
- headache
- hypotension**
- flushing
- dizziness
- weakness
-syncope
13
Q
what patient education does the nurse provide to a patient taking a nitrate (such as nitroglycerin)?
A
- do not abruptly discontinue (if taking continuously)
- if using transdermal patch, allow a nitrate-free period at bedtime
- burning sensation with nitroglycerin indicates the drug is still potent
- never chew or swallow sublingual nitroglycerin
- lie down if nitroglycerin is needed**
- can take up to 3 tablets 5 minutes apart. call 911 if second tablet is taken
- teach pt proper application of nitrate topical ointments/transdermal forms (site rotation, removal of old medication, etc.)
- teach pt how to check their own pulse
14
Q
what patient education will the nurse provide to a patient taking anti-dysrhythmics (such as beta-adrenergic blockers)?
A
- tell pt to report side effects/adverse reactions
- advise pt to avoid alcohol, caffeine, and tobacco
15
Q
what do diuretic drugs generally do?
A
- accelerate rate of urine formation
- removes sodium and water
- used to treat HTN, HF, edema, and renal failure
16
Q
if a patient loses 2.2 lbs, how much fluid has the patient lost?
A
1 L
17
Q
what is a contraindication for diuretics?
A
- gout or renal stones (it can increase uric acid levels)
- renal failure
18
Q
what should the nurse monitor in a patient taking diuretics?
A
- daily weights
- fluid/electrolyte balance (especially hyponatremia)
- urine output
- check peripheral extremities for edema
19
Q
what do thiazide and thiazide-like diuretics do?
A
- promote sodium, chloride, and water excretion
- first-line treatment for HTN
- treats peripheral edema
- acts on distal convoluted renal tubule
20
Q
what are some side effects/adverse reactions of thiazide and thiazide-like diuretics?
A
- sodium and K+ LOSS**
- elevated calcium, lipids, uric acid**
- dizziness, headache, hypotension, urticaria
- GI distress, constipation, hyperglycemia**
21
Q
what patient education will the nurse provide to a patient taking a thiazide diuretic?
A
- suggest that the patient take the drug early in the morning to avoid sleep disturbance from nocturia
- instruct patient to slowly change positions from lying to standing
22
Q
what is the most important electrolyte for the nurse to monitor in a patient taking a loop diuretic or thiazide diuretic?
A
potassium (for hypokalemia)
23
Q
what does a loop diuretic do?
A
- excrete sodium, water, potassium, calcium, magnesium
- acts on the ascending loop of Henle
24
Q
what are some side effects/adverse reactions of loop diuretics?
A
- hypokalemia**
- elevated glucose and uric acid
- dehydration
- photosensitivity
- tinnitus**
- blurred vision
- rash
- can be neurotoxic and nephrotoxic
25
how can loop diuretics put a patient at increased risk for digoxin toxicity?
if the patient has hypokalemia, it can increase the effects of digoxin, leading to toxicity
26
what will the nurse monitor in a patient taking a loop diuretic?
- check electrolytes/fluid balance
- check potassium****
- fluid intake (to prevent dehydration)
- monitor for dysrhythmias in people taking digoxin
- fall precautions if appropriate
27
what patient teaching will the nurse provide to a patient taking a loop diuretic?
- instruct patient to slowly change positions from lying to standing
- encourage addition of high potassium foods or potassium supplements
- suggest that the patient take the drug early in the morning to avoid sleep disturbance from nocturia
28
what do osmotic diuretics do?
- increase sodium reabsorption in the proximal tubule and the loop of henle
- excrete sodium, chloride, potassium, water
- used to excrete toxic substances
- decreases ICP and IOP
- causes rapid diuresis
29
what are some side effects/adverse reactions to osmotic diuretics?
- blurred vision
- fluid and electrolyte imbalances**
- GI distress
- acidosis
- pulmonary edema
- tachycardia
30
what are some contraindications for osmotic diuretics?
- heart disease
- HF
- renal failure
31
what do carbonic anhydrase inhibitors do?
- excrete sodium, potassium, and bicarbonate
- block action of enzyme carbonic anhydrase
- decrease IOP in patients with open-angle glaucoma
32
what are some side effects of carbonic anhydrase inhibitors?
- confusion
- orthostatic hypotension
- GI distress
- metabolic acidosis
- fluid/electrolyte imbalance
- crystalluria
- renal calculi
- hemolytic anemia
33
what do potassium-sparing diuretics (aldosterone inhibiting diuretics) do?
- promote sodium/water excretion and potassium retention
- blocks action of aldosterone at the receptor
- used for edema from HR, cirrhosis of liver
34
what are some side effects/adverse reactions to potassium-sparing diuretics?
- photosensitivity
- dizziness
- headache
- weakness
- GI distress
- paresthesia
- hyperkalemia
- hyperuricemia
- muscle cramps
35
what should the nurse monitor in a patient taking potassium-sparing diuretics?
- urinary output
- vital signs
- hyperkalemia
36
what patient education will the nurse provide to a patient taking potassium-sparing diuretics?
- take in the morning to avoid nocturia
- advise patients with high serum potassium levels to avoid foods high in potassium
37
what do beta-adrenergic blockers generally do?
- decrease HR and BP
- decrease force of contraction
- decrease rate of AV conduction
38
what do beta blockers usually end in?
-olol
39
what is the difference between nonselective and cardioselective beta blockers?
nonselective: inhibits beta1 and beta2 receptors (affects the heart and lungs)
cardioselective: inhibits beta1 receptors (affects only the heart)
40
what are the side effects of beta blockers?
- hypotension
- bradycardia
- dizziness
- insomnia
- nightmares
- fatigue
- depression
- ED**
- bronchospasm**
- wheezing **
- abnormal blood glucose**
41
which patients should nurses be careful with when administering nonselective beta blockers?
- diabetics
- respiratory related issue patients (asthma, COPD, etc)
42
what should the nurse monitor for before administering a beta blocker?
pulse
signs of CHF or hypotension
43
what patient education can the nurse provide to a patient taking a beta blocker?
- teach patient to take their pulse
- fatigue will improve with time
- discuss bradycardia
- possible sexual dysfunction
- need to regularly monitor lipid levels
- educate patients to not stop taking suddenly**
44
what do centrally acting alpha2 agonists do?
- stimulate alpha2 receptors
- decrease cardiac output
- decrease epinephrine, norepinephrine, and renin release
- increases vagus activity
45
what is a contraindication for centrally acting alpha2 agonists?
impaired liver function
46
what are some side effects of centrally acting alpha2 agonists?
- significant dizziness
- drowsiness
- dry mouth
- headache
- peripheral edema
- bradycardia
47
what patient teaching will the nurse provide to a patient taking a centrally acting alpha2 agonist?
- do not abruptly stop taking the drug. rebound hypertension may result
48
what do alpha-adrenergic blockers do?
- block the alpha-adrenergic receptors
- result in vasodilation and decreased blood pressure
- relaxes smooth muscle of the prostate and bladder neck- good choice for males with BPH
49
what are some side effects of alpha-adrenergic blockers?
- orthostatic hypotension**
- first dose syncope and hypotension
- tachycardia
- headache
- drowsiness
- dizziness
- nausea
- nasal congestion
- edema**
- weight gain**
50
what are some nursing considerations for a patient taking an alpha adrenergic blocker?
- make sure first dose is taken at night (hypotension)
- assist with position change
- monitor VS until stable
- discuss how to treat dry mouth and nausea
- advise patient to take medication at night due to orthostatic hypotension
51
what do alpha1 and beta1 adrenergic blockers do?
- block alpha1 and beta1 receptors to decrease BP and HR
52
what are some side effects of alpha1 and beta1 adrenergic blockers?
- hypotension
- bradycardia
- paresthesia
- depression
- nasal congestion
- nausea
- ED
53
what will the nurse monitor for in a patient taking beta-adrenergic blockers?
- vital signs
- lab results (especially BUN, serum creatinine, AST, and LDH)
54
what patient education will the nurse provide to a patient taking a beta-adrenergic blocker?
- do not abruptly stop taking beta blockers, as it can cause rebound hypertension
- advice patients to avoid over-the-counter drugs without first checking with a HCP (because some drugs, such as sudafed, will reverse effects of the beta blocker)
55
what will the nurse monitor for in a patient who takes an alpha-adrenergic blocker?
- vital signs
- check daily weight
- check for fluid retention in extremities/edema
56
what patient education will the nurse provide to a patient taking alpha-adrenergic blockers?
- teach patient to monitor daily weights
- inform patients that orthostatic hypotension may occur
- advise patients to comply with the drug regimen
57
what do direct-acting arteriolar vasodilators do?
relax smooth muscles of blood vessels, causing vasodilation (long-term treatment)
58
what are some side effects of direct-acting arteriolar vasodilators?
- hypotension
- reflex tachycardia
- palpitations
- headaches
- dizziness
- edema
- angina
- paresthesia
59
what do angiotensin-converting enzyme (ACE) inhibitors do?
- relax veins and arteries to decrease blood pressure
- prevents Na and H2O resorption and increases renal perfusion
- causes diuresis
- prevents conversion of angiotensin I to angiotensin II
60
what are some side effects of ACE inhibitors?
- first dose hypotension***
- hyperkalemia*** (K+ retention)
- angioedema***
- nonproductive cough
- N/V
- tachycardia
- hypotension
61
what do ACE inhibitors usually end in?
-pril
62
what patient education will the nurse provide to a patient taking ACE inhibitors?
- take first dose at night (due to hypotension)
- take on empty stomach to increase absorption
63
what are some contraindications for ACE inhibitors?
- pregnancy
- potassium-sparing diuretics
- salt substitutes that contain potassium
- caution with renal insufficiency
- patients with renal damage
64
what do ARBs (angiotensin II receptor blockers) usually end in?
-sartan
65
what do ARBs (angiotensin II receptor blockers) do?
- prevent release of aldosterone
- allow angiotensin I to be converted to angiotensin II, but block angiotensin II from angiotensin I receptors
66
what are some side effects of ARBs (Angiotensin II receptor blockers)?
- first dose hypotension ***
- orthostatic hypotension***
- hyperkalemia***
- dizziness
- fatigue
- edema
- hyperglycemia
67
what is the difference between ACE inhibitors' side effects and ARBs' side effects?
ACE inhibitors: nonproductive, dry cough; angioedema
ARB: has no cough, angioedema is rare
68
what do calcium channel blockers (CCBs) do?
- block calcium channels in vascular smooth muscle cells promoting vasodilation
- decreased peripheral vascular resistance, BP, cardiac workload, and myocardial oxygen demand
69
what are some side effects/adverse reactions to calcium channel blockers?
- peripheral edema**
- constipation**
- bradycardia**
- weakness, fatigue
- blurred vision
- hypotension
- nausea
70
what are some nursing considerations when caring for a patient who takes calcium channel blockers?
- increase fluids and fiber (for constipation)
- daily weights (for edema)
- caution when using with beta blockers or digoxin
- change positions slowly
- avoid grapefruit juice
71
what patient education will the nurse provide to a patient who takes calcium channel blockers?
- teach patient to check pulse
- if pt's HR is below 60, do not take CCB
- daily weights at home (for edema)
- lots of fluids and fiber (for constipation)
72
what is the antidote for heparin?
protamine sulfate
73
which test monitors heparin?
aPTTs (activated partial thromboplastin times)
74
what are some nursing considerations when caring for a patient who takes heparin?
- do not aspirate SCT injections or massage injection site
- do not give SCT dose within 2 in. of umbilicus, abdominal incisions, or open wounds, scars,, drainage tubes, stomas
- do not give aspirin concurrently
- monitor aPTT before administering
- examine pt's nose, mouth, skin, urine for bleeding
- frequent lab monitoring is not required
- no NSAIDS- tylenol only
75
what is heparin used for?
- preventing DVT and acute PE after surgery
- lower risk of bleeding
76
what is the antidote for warfarin?
vitamin K
77
what does warfarin do?
anticoagulant that inhibits synthesis of vitamin K ("clotting" vitamin)
78
what are some nursing considerations when caring for a patient who takes warfarin?
- monitor PT-INR regularly
- no NSAIDS - tylenol only
- highly protein bound - be careful with drug interactions
- examine pt's nose, mouth, skin, urine for bleeding
79
what patient education would you provide to a patient who is taking warfarin or heparin?
- use a soft toothbrush to prevent bleeding gums, use electric razors
- avoid eating large amounts of green, leafy vegetables (vitamin K) or be consistent with intake
- inform dentist when taking an anticoagulant
80
what are selective factor Xa inhibitors?
anticoagulants that put patients at less risk for bleeding and works for patients with financial constraints (since this does not require blood work)
81
what do antiplatelets do?
- causes peripheral vasodilation
- inhibits platelet aggregation
82
what does aspirin do?
- antiplatelet that inhibits an enzyme needed by platelets
- used to prevent MI and thromboembolism, prevention and treatment of stroke
83
what do thrombolytics do?
- treat PE, DVT, thromboembolism, thrombolytic stroke by dissolving blood clot
- degrades the clotting factors
84
what are some side effects/adverse reactions of thrombolytics?
- anaphylaxis
- dysrhythmias
- hemorrhage
85
what should the nurse monitor for when caring for a patient who takes thrombolytics?
- monitor vital signs
- observe for signs and symptoms of active bleeding
- observe for signs of allergic reaction to thrombolytics
- avoid administering aspirin or NSAIDs for pain
- avoid venipuncture/arterial sticks
- monitor for decreased LOC
86
what do bile-acid sequestrants do?
reduce LDL cholesterol levels by binding with bile acids in the intestine (soaks up cholesterol like a sponge)
87
what are some side effects of bile-acid sequestrants
- constipation**
- flatulence**
- steatorrhea**
- anorexia
- N/V
- GI bleeding/distention
- folate deficiency
88
what do fibrates do?
reduce triglycerides and VLDL
89
what are some side effects of fibrates?
- dizziness
- headache
- N/V
- diarrhea
- cholethiasis
- elevated hepatic enzymes
90
what type of drug is contraindicated when taking fibrates?
anticoagulants
91
what does niacin do?
it is a B vitamin that helps reduce VLDL and LDL
92
what are some side effects of niacin?
- dizziness
- headache
- hypotension
- edema
- GI distress
- flushing***
- liver damage
- hyperglycemia
- hyperuricemia
93
how can you prevent flushing when taking niacin?
take aspirin 30 minutes before taking niacin
94
what do statins (HMG CoA reductase inhibitors) do?
they decrease LDLs and increase HDLs, first-line treatment for elevated cholesterol
95
what are some side effects of statins?
- headache
- fatigue
- GI distress
- rhabdomyolysis ***
- muscle cramps ***
- hyperglycemia
96
what are some interactions with statins that put the patient at increased risk of rhabdomyolysis?
- macrolide antibiotics (erythromycin)
- CCB
- amiodarone
- oral antifungal medications
- grapefruit juice
- digoxin (increases digoxin levels)
97
what will the nurse monitor for when caring for a patient who takes anti-hyperlipidemics?
- monitor the patient's blood lipid levels**
- wait 3 months to recheck blood lipid level if too high
- monitor lab values for liver function**
- observe for signs and symptoms of GI upset
98
what patient education will the nurse provide to a patient who is taking anti-hyperlipidemics?
- it may take several weeks before blood lipid levels decline
- instruct patient to have annual eye examinations and report changes in visual acuity
- take anti-hyperlipidemic with biggest meal of the day
99
what medications help improve peripheral blood flow?
- ACE inhibitor
- alpha blocker
- CCB
- statins
100
what are some side effects of antiplatelets?
- dizziness
- headache
- peripheral edema
- GI distress
- abnormal stools
- tachycardia
- palpitations
- dysrhythmias
- orthostatic hypotension
101
what do hemorrheologics do?
- decrease blood viscosity, inhibits platelet aggregation
- improves perfusion
102
what are some side effects of hemorrheologics?
- N/V
- confusion
- edema
- cholestasis
103
what does excessive dosing of hemorrheologics look like?
- blurred vision
- hypotension
- tachycardia
104
what will the nurse do when caring for a patient who takes an adrenergic agonist?
- monitor vital signs
- report tachycardia, palpitations, tremors, dizziness, hypertension, increased BP, and dysrhythmias
- monitor IV site for infiltration
105
what do adrenergic antagonists do?
they block effects of adrenergic neurotransmitter by blocking the alpha and beta receptor sites
106
what are some of the effects of alpha1 adrenergic antagonists?
- vasodilation
- orthostatic hypotension***
- dizziness
- pupil constriction
- suppresses ejaculation
- reduces contraction of smooth muscles in bladder neck and prostate
107
what are some of the effects of beta-adrenergic antagonists?
- decrease BP and HR
- bronchoconstriction**
108
why do nurses use beta2 adrenergic antagonists with caution in patients with COPD or asthma?
it can cause bronchoconstriction
109
what will the nurse monitor for when caring for a patient who takes a direct-acting cholinergic agonsit?
- monitor BP and HR
- have patient rise slowly from lying to standing to avoid orthostatic hypotension
- auscultate breath sounds for crackles
- monitor pt for cholinergic crisis (overdose)
110
what are some signs of cholinergic crisis (overdose)?
- muscular weakness
- increased salivation
111
what do anticholinergics/cholinergic antagonists do?
- small doses: decrease HR
- large doses: increase HR
- bronchodilation
- relax smooth muscle tome
- decrease motility and peristalsis
- decrease secretions in lungs and GI
- decreased salivation
112
what are some side effects of reversible cholinesterase inhibitors?
- bradycardia
- hypotension
- hypersalivation
- sweating
- anorexia
- N/V
- abdominal pain
- diarrhea
113
what are some contraindications for direct-acting cholinergic agonists (such as bethanechol)?
- bradycardia
- hypotension
- peptic ulcer
- parkinsonism
- hyperthyroidism
- urinary tract obstruction
114
what are some of the effects of cholinergic agonists?
- decrease HR and BP (vasodilation)
- increased peristalsis and relax sphincter muscles
- stimulate urination
- bronchial constriction
- constrict pupils
115
what do direct-acting cholinergic agonists do?
- increase gastric emptying -> treats nausea and GERD
- decrease BP and HR
116
what do reversible cholinesterase inhibitors do?
- promote pupil constriction in glaucoma
- increase muscle strength in myasthenia gravis
117
what does atropine do?
- increase HR
- decrease GI motility, peristalsis, salivary and gastric secretions
118
what are some side effects of atropine?
- dry mouth**
- dehydration
- tachycardia
- blurred vision
- photophobia
- urinary retention
- constipation
119
what patient education will the nurse provide to a patient taking anticholinergics (such as atropine)?
- avoid hot environments (because they can't sweat as well)
- wear sunglasses in bright light
120
what do antiparkinson-anticholinergic drugs do?
decrease involuntary movement, tremors, and muscle rigidity caused by parkinsonism
121
what are some side effects of antiparkinson-anticholinergic drugs?
- dry mouth/skin
- headache
- blurred vision
- photophobia
- tachycardia
- ocular hypertension
- urinary retention
- constipation
122
what type of anticholinergic treats motion sickness?
antihistamines
123
what are some side effects of anticholinergics for motion sickness?
- dry mouth
- drowsiness
- visual disturbances
- tachycardia
- hypotension
- flushing
- urinary retention
- constipation
