Exam 2 Flashcards
Hydrochlorothiazide should not be given to patients with what?
severe renal impairment; therefore, an decreased creatinine clearance
A client is taking an aminoglycoside ABX and furosemide. What symptom should the nurse teach the client to report?
ringing in the ears
A pt on dig has been Rx furosemide. VS- BP 132/84 HR irreg 87 bpm RR 23. Crackles are present. What lab is concerning?
potassium levels that are not within range
What symptoms would the nurse monitor for in a patient with suspected hypokalemia caused by diuretic use?
muscle weakness and lethargy
A nurse assesses dyspnea, bilat crackles, & pitting edema in a pt RX spironolactone. Which intervention is appropriate?
request an order for furosemide
A pt has 2+ pitting edema of BLE. The nurse hears crackles. The serum K+ level is 6. Which drug would the nurse question
spironolactone
A pt is taking furosemide 4 HTN & CHF. The dr has just added dig. What other drug does the nurse suspect will be added?
spironolactone
A pt w/ CHF has been taking dig&HCTZ. Spironolactone has just been added. What statement indicates teach’g is effective?
“I need to stop taking potassium supplements.”
What time of day would the nurse teach a client that it is best to take their diuretic medication?
morning
What time of day would the nurse teach a client that it is best to take their diuretic medication?
reduces intracranial pressure.
What electrolyte imbalances might occur in a pt taking 40 mg furosemide daily?
low serum potassium, sodium, magnesium, and calcium
What kind of drug is aspirin/NSAIDs/ASA (acetylsalicylic)?
antiplatelets
What kind of drugs are P2Y12 ADP Receptor Blockers (clopidogrel/prasugrel)?
antiplatelets
When are antiplatelet medications used?
treatment of acute MI, reinfarction prevention, ischemic strokes/TIAs, and acute coronary symptoms (they prevent clots in arteries by suppressing platelet aggregation)
What are the adverse effects of clopidogrel/prasugrel and aspirin?
bleeding and GI effects
What are the effects of aspirin/NSAIDs/ASAs?
gastric bleeding, hemorrhagic stroke, thrombocytopenia, tinnitus/hearing loss(aspirin overdose)
What is the antidote for for heparin?
protamine sulfate
What lab is prevalent for heparin? What range is considered therapeutic?
PTT (120-140 secs)
aPTT (60-80 secs)
Describe heparin subcutaneous injection administration.
Get accurate weight. Use a 1/2-5/8 in; 25-26 G needle. Give in abdomen, 2in from umbilicus. Don’t rub site
Describe heparin IV administration.
aPTT before initiating/changing rate. Accurate weight. verify with second nurse. Use pump. No IVPB, must have separate line.
What is the antidote for warfarin?
Vitamin K
What is warfarin used for?
treat DVT, prevent thrombus formation in those with A-fib or prosthetic heart valves, prevent MI/ TIA/ PE/ DVT
What labs are prevalent to warfarin?
PT (18-24 secs) and INR (2-3: <2 indicates it is not working)
What patient education should be provided by the nurse for a patient starting warfarin?
inform dentist before operations, smoking cessation (it can increase warfarin metabolism), avoid aspirin, wear medical alert bracelet, and eat consistent vitamin K foods
What pregnancy category is warfarin?
category X
What are effects of erythropoietin meds (ex. epoetin alfa)?
HTN, risk for thrombotic events, DVT, headache, and body aches
What are the indications for oprelvekin (thrombopoietic growth factors)?
thrombocytopenia (low platelet) and decreases need for platelet transfusion following chemo
How is effectiveness of oprelvekin determined?
platelet level of 50,000, so CBC should be done before and after
What are the side effects of filgrastim (leukopoietic growth factors)?
bone pain, leukocytosis, splenomegaly, and risk of splenic rupture with long-term usage
What some examples of thiazide diuretics?
HCTZ (hydrochlorothiazide), Chlorthalidone, and Metolazone
What are the contraindications for thiazide diuretics?
renal failure, pregnancy, allegry to sulfonamides, and anuria (no urine production)
What lab interactions can be expected with a patient on a thiazide diuretic?
HYPO- kalemia, magnesemia, natremia
HYPER- calcemia, glycemia, lipidemia, uricemia
What patient teaching should be provided for thiazide diuretics?
Take in the AM, monitor blood glucose (hyperglycemia), potassium-rich foods, take daily weight, sunblock, change positions slowly
What kind of medication is furosemide (potassium-wasting) ?
loop diuretics
What are reasons that loop diuretics are given?
CHF, edema, HTN, acute renal failure, acute pulmonary edema, and hypertensive crisis
What are the contraindications of loop diuretics (furosemide)?
sulfonamides/sulfa allergies and uncorrected hypokalemia
A client on lovastatin complains of muscle pain, what condition may the nurse suspect?
rhabdomyolysis
What is a very common side-effect of nicotinic acid (aka Niacin or Vitamin B3)?
flushing ( red face, neck, ears and face)
What kind of medications end in -pril?
ACE inhibitors
What kind of drugs end in -sartan?
ARBs (angiotensin II-receptor blockers)
What class is valsartan?
ARB
If the dry cough caused by lisinopril becomes too severe for the patient to handle, what type of medication may be taken into consideration for them to switch to?
ARBs (valsartan)
What should individuals on an ACE inhibitor avoid?
high K= foods (salt substitutes, bananas, prunes)
What type of antihypertensives are effective for diabetics? Why?
ACE no glucose effect and less effect on kidneys (diabetes damages kidneys)
What type of diuretic should be avoided for a patient on an ACE inhibitor? Why?
potassium sparing (spironolactone), because ACE inhibitors can cause elevated potassium (hyperkalemia)
What are the black box warnings for lisinopril?
angioedema and pregnancy
Clonidine is an antihypertensive medication that causes anticholinergic effect. Name a few.
dry mouth, constipation, sedation, drowsiness
Hypotension, bradycardia, dry mouth, constipation, sedation, drowsiness, and peripheral edema are all effects that could be caused by which antihypertensive medications?
clonidine
Diltiazem, verapamil and drugs ending in
-dipine are what class of medication, and used for what?
calcium channel blockers and antihypertensives
What are the intended effects of calcium channel blockers?
decease hypertension, vasodilation
What are the indications for calcium channel blockers (verapamil, diltiazem and
-dipine drugs?
arrythmias, angina and hypertension
What are some side effects of calcium channel blockers?
edema (peripheral), chronic heart failure, syncope, hypotension, and bradycardia
What patient teaching should be provided from individuals taking a calcium channel blocker?
avoid grapefruit juice and statins, report chest pain/SOB, taper dose, and change positions slowly
How are beta blockers recognized?
-olol
In which patients should beta blockers not be used as initial treatment or monotherapy?
African American
In which ethnic group should lower dosages of beta blockers be considered, due to their sensitivity to antihypertensives?
Asian individuals
What are the contraindications for thiazide diuretics?
renal failure, pregnancy, allergy to sulfonamides, and anuria (no urine production)
What lab interactions are expected to occur with thiazide diuretics?
HYPER (GLUC) HYPO (KMN)
hyper (glycemia, lipidemia, uricemia, and calcemia)
hypo (kalemia, magnesemia, and natremia)
What is the antidote for warfarin?
Vitamin K
What are some effects of warfarin?
bleeding, hemorrhage, and hepatitis
What class of drug is warfarin?
anticoagulant
What is the mechanism of action for anticoagulants (heparin/warfarin)?
don’t dissolve clots, but prevent new ones forming/growing
What are the indications for warfarin?
DVT, prevent thrombus formation in those
with A-fib or prosthetic heart valves, prevent MI, TIA, PE,
and DVT
What should individuals wear who are on warfarin?
medical alert bracelet
What should be avoided while taking warfarin?
aspirin and smoking
Which food type should be eaten at a consistent level for those on warfarin?
Vitamin K
In what cases should warfarin not be given?
pregnancy, active bleeding, hemorrhagic stroke and used in caution with other highly protein bound drugs
What is the antidote for heparin?
protamine sulfate
