CHAPTER 8 DRUGS Flashcards
What is the other name for Labetalol?
Trandate
What is the classification of Lobetalol (Trandate) ?
Betablocker
What is the MOA of Lobetalol (Trandate) ?
Blocks stimulation of Beta 1 and Beta 2 adrenergic receptor sites. Also has blocking affect on alpha 1 receptor sites.
Why is Labetalol (Trandate) “antagonist”?
Antagonist because it binds to adenergic receptors and blocks stimulation of the sympathetic nervous system
What is the function of Beta 1?
Causes increase in HR
what is the function of beta 2?
Affects the smooth muscles of bronchioles
What is the indication of Lobetalol (Trandate) ?
Management of hypertension
What is the therapeutic effect of Lobetalol (Trandate) ?
Decreased blood pressure
why is Labetalol (Trandate) used in emergency situations?
Used in emergency situation because it is a potent anti-hypertensive
Labetalol (Trandate) is specific for what?
Stroke
where is Labetalol (Trandate) commonly used?
Commonly used in acute phase of stroke
Why is Labetalol (Trandate) used for stroke?
Blood pressure usually rises following a stroke
Why dose BP go up after a stroke?
Thought to be a protective response to maintain cerebral perfusion
When do we administer BP medications in ischemic stroke?
If the BP is extremely high
In order to administer thrombolytic therapy for ishemic stroke what must be the BP? Why?
- Systolic BP must be less than 185 mmHg and diastolic must be less than 110 mmHg
- Due to risk of sheering and bleeding on the arteries.
If patient is not recieving thrombolytics for ishemic stroke, what is the required BP for lobetalol?
Only requires if the patients BP is greater than 220 mmHg and diastolic greater than 120 mmHg.
For hemorrhagic Stroke, administer antihypertensive if what BP? why?
- If systolic is greater than 160 mmHg
- Because the higher the pressure the higher the risk for rebleeding
What are the precaution and Containdication of Labetalol (Trandate)? (5)
- Allergies/ hypersensitivity
- Heart Failure
- Pulmonary edema and pre-existing obstructive lung disease
- Bradycardia and heart blocks
- Use cautiously in renal and liver dysfunction
Why is Pulmonary edema and pre-existing obstructive lung disease contraindications of labetalol?
because labetalol blocks Beta 2 which causes a block on relaxation of bronchioles smooth muscles. If labetalol is given then patient will not be able to breath
Why is bradycardia and heart blocks contraindications for labetalol?
because we don’t want HR to be more slower –> person can get shock and die
What are the adverse effects of Labetalol (Trandate)? (5)
- Fatigue and weakness
- Bronchospasm
- Arrhythmias, bradycardia
- Congestive heart failure, pulmonary edema
- Orthostatic hypotension
What is the effects of blocking beta 1
- arrhythmias and bradycardia
What is the effects of blocking beta 2?
Bronchospasm
Why is congestive heart failure and pulmonary edema adverse effect of labetalol?
Because body is loosing CO due to decrease strength of the heart and lower HR
What are the nursing assessments and considerations for lobetalol (trandate)? (7)
- Administer with meals to increase absorption
- Frequent monitoring of BP and pulse
- Take apical pulse prior to administration, if less than 50 bpm, hold medication and notify physician
- Assess for orthostatic hypotension
- Monitor intake/output
- Daily weights
- Asses for signs of fluid overload (lung crackles, weight gain, edema. fatigue)
You are about to give lobetalol and you checked the patient’s apical pulse and it is less than 50bmp. What should you do?
- Hold the medication and notify physician
How do you asses for orthostatic hypotension?
- take BP lying, sitting, and standing
when giving lobetalol. How do we monitor for heart failure?
- monitor intake/output
- daily weights
what are the signs of fluid overload? (4)
- weight gain
- Lung crackles
- edema
- fatigue
Can students administer intravenous labetalol?
No
When receiving intravenous labetalol patients must lay on?
supine for 3 hours after administration
Intravenous labetalol is high allert medication therefore nurse must:
- have a second nurse to check the drug independently
- High alert medication –> can be very dangerous
what should nurse do during and after administering intravenous labetalol?
Vitals assessed q 5 - 15 minutes during and after administration for several hours
When receiving intravenous Labetalol (3)
1) High alert medication - can be very dangerous
2) Patient must lay supine for 3 hours after administration
3) Vitals assessed q 5 -15 mins during and after administration for several hours
What does it mean by high alert medication?
- Monitored
- Have to get checked by another nurse independently
- Very dangerous drug
Labetalol (Trandate) patient education (3)
- Abrupt withdrawal of labetalol can cause life threatening arrhythmia’s, hypertension, or myocardial infarction
- Direct patient to make slow position changes –> special caution when exercising, drinking alcohol, and in hot weather
- Diabetic patients should have sugar monitored more closely –> medication will mask warning signs of hypoglycemias ( such as tachycardia)
Abrupt withdrawal of labetalol can cause?
- life threatening arrhythmias
- hypertension
- myocardial infarction
Why does patient who takes labetalol have to be caution on hot weather?
worsens effect
Why do diabetic patient to takes lobetalol have to check their blood sugar more closely?
because lobetalol mask the hypoglycemia warning signs such as tachycardia
What is the other name for Acetylsalicylic Acid?
Aspirin
What is the classification of Acetylsalicylic Acid (Aspirin)? (2)
- Non- Steroidal Anti-inflammatory Drugs (NSAIDs)
- Cox Inhibitors
What is the indication of Acetylsalicylic Acid (Aspirin)? (4)
- inflammatory disorders
- Fever
- Prophylaxis for myocardial infarction and stroke
- Non opioid analgesic
What is the therapeutic of Acetylsalicylic Acid (Aspirin)? (3)
- decrease pain
- Decrease inflammation
- Decreased incidence of stroke and MI
What is cyclooxygenase?
an enzyme that converts arachidonic acid into prostaglandins and related compounds ( prostacyclin, thromboxane A2)
Where is cyclooxygenase found?
Found in all tissues
cyclooxygenase regulates? (7)
- Tissue injury
- Stomach
- Platelets
- Blood vessels
- Kidney
- Brain
- Uterus
How does cyclooxygenase regulates Tissue injury?
Catalyzes the synthesis of prostaglandin, promoting inflammation
How does cyclooxygenase regulates stomach?
protects gastric mucosa by reducing gastric acid secretion, increasing bicarbonate and protective mucous, and maintaining submucosal blood flow
How does cyclooxygenase regulates platelets?
Promotes synthesis of thromboxane A2 which stimulates platelet aggregation
How does cyclooxygenase regulates blood vessels?
Causes vasodilation
How does cyclooxygenase regulates kidneys?
Promotes vasodilation, maintains renal blood flow
How does cyclooxygenase regulates brain?
Prostaglandins that mediate fever and contribute to pain perception
How does cyclooxygenase regulates uterus?
Prostaglandins promote contractions
What are the 2 forms of Cox?
Cox 1 and Cox 2
What does Cox 1 do? (3)
- Promotes platelet aggregation by synthesizing TXA2
- Protects gastric mucous by producing gastric mucosa excretion
- Supports renal flow
What does Cox 2 do? (5)
- Mediates inflammatory and synthesize pain receptors
- Affects brain where it facilitates fever
- Pain perception
- dilates blood vessels
- improve renal flow
which one is good and bad? Cox 1 and Cox 2
Good - Cox 1
bad - Cox 2
What does Aspirin do?
Irreversible inhibition of COX 1 and Cox 2
What is the purpose of Thromboxane A2?
Stimulates activation of new platelets and increases platelet aggregation
Stroke often results from?
platelet aggregation at site of endothelial damage
What does aspirin do to prevent stroke?
Aspirin prevents platelet adhesion and aggregation by inhibiting the formation of thromboxane A2 by platelets
How long does 1 dose of aspirin last?
8 days ( life cycle of platelet)
Aspirin is recommended for? (4)
- Ischemic stroke
- TIA
- Unstable and Stable Angina
- Acute MI
How much is the recommended amount of aspirin for prevention of cardiovascular disease?
81 mg of aspirin per day
If person is at risk for GI bleeding and have a risk of cardiovascular disease should they still take aspirin?
If higher risk for CVD then aspirin is given, If GI bleed is higher risk then Aspirin is not given
When should you give aspirin for ischemic stroke?
Initiate within 48 hours of stroke onset ( helps further clotting prevention)
Precautions and Contraindications of aspirin (3)
- Allergies/ hypersensitivity/Asthma
- Bleeding disorders or thrombocytopenia
- Use cautiously in renal dysfunction, chronic alcohol abuse, history of GI bleeds or ulcer disease, liver disease
Large dose of Aspirin can cause what
- Hypoglycemias and enhance the effect if some oral diabetic medications
Combining steroids with NSAIDs can cause
high risk of ulcer formation
Adverse effects of Aspirin (6)
- Heartburn and Nausea
- GI bleeds
- Gastric ulceration, perforation, bleeding, haemorrhage
- Bleeding
- Renal impairment
- Salicylism
What do to do avoid heart burn and nausea while taking aspirin?
Take with food or full glass of water
Adverse effect of aspirin GI bleeding may cause
- anemia with chronic occult blood loss
What is salicylism?
Syndrome resulting from high levels of aspirin
what to take to avoid Gastic ulceration, perforation, bleeding, Hemorrhage while taking aspirin?
Prophylaxis with a proton pump inhibitor and histamine 2 receptors is recommended
adverse effect of aspirin is bleeding, what do you do before surgeries?
Discontinue 1-2 weeks prior to surgical procedures
How does renal impairment develop while taking aspirin?
Causes sodium and water retention = renal failure
Aspirin can cause renal impairment. what do you do if renal failure happens?
- acute, reversible impairment in renal function
- Discontinue if renal failure signs starts happening ( weight gain, increase CR and urea
signs of salicylism
4
- tinnitus
- sweating
- dizziness
- headache
what do to when you see signs of salicylism in patients?
With hold aspirin
what do we have to do after aspirin is given to patient? (head)
Keep head elevated 15 - 30 minutes after drug is given
GI effects such as ulcers and GI bleeding results from?
increase secretions of acid and decrease production of protective mucus and bicarb and lower submucosal blood flow.
Conditions that causes risk for serious ulcers while taking aspirin?(4)
1) Advance age
2) History of peptic ulcer
3) Smoking
4) Alcohol - intensifies effect of aspirin
What are the risk factors for renal failure while taking aspirin? (3)
- Advance age
- Pre existing renal issue
- Hypovolemia ( low fluid volume)
What are the signs of aspirin renal failure? (3)
1) Weight gain
2) increase CR
3) increase Urea
What are the nursing considerations and assessments (5) Aspirin
- Monitor for signs and symptoms of bleeding
- After procedures and injections apply pressure to the site to prevent bleeding and monitor the site carefully
- Take aspirin with food or glass of water
- Discontinue at-least one week prior to surgery
- Monitor renal function –> weight patient, urea and creatinine levels, urine output
what are the signs and symptoms of bleeding (11)
- hypotension
- tachycardia
- dizziness
- weakness
- pallor
- bruising
- bleeding gums
- epistaxis
- hematuria
- melena
- labs (CBC)
What is the other name for Tissue plasminogen Activator?
Alteplace
what is the classification of TPA
Thrombolytic
what is the MOA of TPA
- Binds to fibrin in a blood clot and activates plasminogen forming plasmin (fibrinolytic enzyme) which breaks down and dissolves the clot
- Natural in our body that dissolves clots
what is the Indication of TPA (4)
- acute MI
- Ischemic Stroke
- Pulmonary embolus
- Also used to prevent clots in central lines to dissolve clotting
what is the Therapeutic effect of TPA
- Breaks down clot and restore blood flow through the vessels
What is the route of TPA?
Intravenous
What is the half life of TPA
Short half life - 5 mins
TPA is only used for what kind of stroke? what do to use to confirm it?
- Ischemic stroke
- Must be confirmed with CT scan
When to administer TPA
Must be administered within 4.5 hours of symptom onset
Why is TPA administered for stroke?
Administered to re establish blood flow through a blocked artery
What is the risk for TPA?
Increases risk of intracranial hemorrhage because it will clot bust everything
what are ABSULUTE contraindications for TPA? Never give TPA To.. (4)
- Previous intracranial bleeding
- Known intracranial lesions/ tumours
- Active internal bleeding ( with exception of menses)
- Suspected aortic dissection ( massive bleeding)
Relative contraindications for TPA?
Risky but can maybe give.. (6)
- Severe uncontrolled hypertension > 180/110 mmHg
- Current anticoagulant use
- Traumatic/ Prolonged CPR/Surgery <3 weeks ago
- Recent internal bleeding ( within 2 - 4 weeks )
- Pregnancy
- Active peptic ulcer
Adverse effects of TPA
Bleeding
There are two main reasons for bleeding
1) Plasmin destroys preexisting clots and can promote bleeding at sites that have recently healed
2) Degradation of clotting factors which disrupts the ability for the body to coagulate when trauma or injury does occur
what are the most common sites of bleeding (3)
- recent wounds
- Sites of needle puncture
- Site of invasive procedures/surgery
Nursing considerations and assessments for TPA (8)
- Patients are screened carefully before administration - ischemic stroke must be confirmed on CT scan
- Must be administered 3 -4.5 hours of symptoms onset - “door needle” <60 minutes
- Patient history taken to determine contraindications
- Frequent monitoring of vital signs and EKG monitoring
- Glasgow Coma Scale and neurochecks - high risk for intracranial bleeding
- Monitor for bleeding - Major Risk
- Hold all anticoagulants and antiplatelets for 24 hours
- To reduce risk of bleeding –> avoid subcut and IM injections, minimize invasive procedures, do not administer with anticoagulants, do not administer with antiplatelets, minimize how much patient is moving.
To reduce risk of bleeding (5)
- avoid subcut and IM injections
- minimize invasive procedures
- do not administer with anticoagulants
- do not administer with antiplatelets
- minimize how much patient is moving.
what kind of heparin is used in stroke
unfractionated
What is the classification of Heparin?
Anticoagulant
What is the MOA of Heparin?
- Enhance activity of antithrombin which is a protein that inactivates clotting factors ( thrombin and factor Xa). Without these two clotting factors, there is reduced production of fibrin and clotting is suppressed.
- No effect on clots that is already made. Just prevents clot formations
What is the indication of Heparin? (5)
- Pulmonary embolism
- Deep vein thrombosis
- Dialysis and open-heart surgery
- Post-operative, spinal cord injury, stroke DVT prophylaxis –> to be initiated within 48 - 72 hours of ischemic stroke
- Acute myocardial infarction
What is the therapeutic effect of Heparin?
Prevention of new clots
Why do we give heparin after operations?
We give heparin so that clots are prevented on the foreign objects
Adverse effects of heparin (3) how and who they develop
- Bleeding/ hemorrhage –> develops in about 10% of patients
- Epidural hematoma –> can develop in patients with epidural/spinal anaesthesia
- Heparin induced thrombicytopenia (HIT) –> immune mediated disorder causing reduced platelet counts and increase in thrombotic events. Antibodies develop against heparin - platelet complexes
What to do to prevent Epidural hematoma
- Stop heparin several hours before taking out the epidural to reduce bleeding
What happens During HIT?
- Sudden clotting in small arteries
- Platelets become hyperactive and forms mini clots which affects microvascular
What organs are affected with HIT?
Hands, fingers, feet, kidneys (microvascular)
Signs of positive HIT
- blueish fingers, toes, etc
- lost circulation to their feet and kidneys
- platelets count drops by 50%
What is the antidote of heparin
Protamine Sulfate - positive ion binds to negative ions of heparin. Neutralizes heparin which last for 2 hours.
Nursing Considerations and assesment for heparin (5)
- Monitor vital signs
- Labs –> Monitor aPTT ( activated partial thromboplastin time), should be checked every 4-6 hours when on heparin infusion, monitor platelets and Hgb
- Monitor for signs and symptoms of bleeding –> melina, pallor, bleeding, gums, epistaxis, hematuria
- Monitor hands and feet for colour, warmth, circulation, movement –> signs of clot from heparin induced thrombocytopenia.
- Monitor for HIT –> CWCS
Atorvastatin other name
Lipitor
Atorvastatin Therapeutic effect
- Lower LDL cholesterol
- Elevated HDL cholesterol
- Reduce Triglycerides
Atorvastatin classifications
- HMG-CoA reductase inhibitor
- “Statins”
Atorvastatin MOA
- Lowers the rate of cholesterol production
- HMG-CoA reductase synthesizes –> statins block the enzyme which decreases cholesterol production
- liver increases LDL receptors and hepatocytes remove LDL from blood
Atorvastatin indication (3)
- Hypercholesterolemia
- Risk reduction for stroke, myocardial infarction, and angina
- Diabetes
Additional facts of atorvastatin (3)
- well tolerated overall, minimal s/e
- TETRANOGENIC
- should not have grapefruit juice
Atorvastatin nursing considerations (3)
- check serum lipid levels and triglycerides
- Should assess liver function (LFTs)
- Administer in evening ( works best at night because cholesterol synthesis works at night)
how long do you have to take Atorvastatin ?
Lifetime medication
Doses effect of atorvastatin
small- 25% decrease cholesterol
high dose - 60% decrease on cholesterol
What are the signs of aspirin renal failure? (3)
1) Weight gain
2) increase CR
3) increase Urea
