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Exam 2 Flashcards

1
Q

What is a Thiazide?

A

Type of diuretic

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2
Q

How do you recognize a thiazide?

A

Ends in thiazide-except for Chlorithalidone, Metolazone, and Indapamide

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3
Q

what are the contraindications of a Thiazide?

A

renal failure, pregnancy, allergy to sulfonamides, and anuria

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4
Q

What are the lab interactions for thiazide?

A

Hypokalemia, hypomagnesemia, hyponatremia, hypercalcemia, hyperglycemia, hyperlipidemia, hyperuricemia

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5
Q

Nursing interventions/pt teaching for thiazides?

A

S/S hypokalemia and EKG needed, monitor BP, calcium level, blood sugar, potassium supplements needed, output monitor, and daily weight

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6
Q

what are loop diuretics?

A

Potassium wasting diuretic that have a rapid onset of action and are potent

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7
Q

Pt teaching for thiazides?

A

Eat potassium rich foods (fresh fruits and veggies), change positions slowly, take it in the morning (increase urination= safety risk at night), daily weight needed at same time of day in same amount of clothes, wear sunblock (photoxicity), and take with food (decrease GI upset)

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8
Q

What route are loop diuretics given?

A

IV, PO, and IM

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9
Q

What are loop diuretics used for?

A

CHF, edema, HTN, acute renal failure, acute pulmonary edema, rapid mobilization of edema needed, and hypertensive crisis

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10
Q

How do you recognize loop diuretics?

A

End in -emide, -anide; except for ethacrynic acid

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11
Q

Contraindications for loop diuretics

A

Sulfamide or sulfa drug allergies, hypokalemia or anuria (except for enthacrynic acid)

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12
Q

Adverse effects for loop diuretics?

A

Hypokalemia, hypotension, photoxic, dehydration, tinnitus/ototoxicity (only if IV pushed too fast)

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13
Q

What are the nursing interventions for loop diuretics?

A

Ask for sulfa/Sulfamide allergies
Assess for S/S of hypokalemia
Monitor BG
Potassium supplements
Monitor output and daily weight

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14
Q

Pt teaching for loop diuretics

A

Move positions slowly (orthostatic hypotension)
Eat potassium rich foods
Take it in the AM
S/S hypokalemia, hypocalcemia, and hypomagnesemia
Take with food
Avoid foods high in sodium
Take daily weight
wear sunscreen
If using loop diuretics for HTN- BP log

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15
Q

How do you evaluate for effectiveness for a patient on loop diuretics?

A

If BP tx= decreased BP
If fluid overload tx= decreased edema, crackles, and dyspnea

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16
Q

What is the most common thiazide?

A

HCTZ or Hydrochlorothiazide

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17
Q

What is the strongest loop diuretic?

A

Furosemide (fast and furious)

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18
Q

What are the potassium sparing drugs we talked about?

A

Spironolactone, amiloride, triamterene, eplerenone

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19
Q

Spironolactone- how does it work?

A

Save the potassium and get rid of the water by blocking aldosterone= getting rid of sodium and water

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20
Q

What should you remember for potassium sparing diuretics?

A

Reacts with other drugs that increase potassium levels (supplements, ACE inhibitors) thiazide and loop diuretics rxn bc K+ intention different

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21
Q

Contraindications for potassium sparing diuretics?

A

Hyperkalemia, kidney failure, and 1st trimester pregnancy

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22
Q

What are the side/adverse effects of potassium sparing diuretics?

A

Hyperkalemia, dizziness, androgen effects, gynecomastia, diarrhea, increased risk of gastric bleeding, tumor prone, headache, and abd cramping

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23
Q

Nursing interventions for Potassium sparing diuretics?

A

Hyperkalemia monitor, N/V/D, paresthesia (safety), tachycardia, oliguria, abd cramps, watch potassium levels, avoid salt substitutes and k+ rich supp, avoid fruit juices

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24
Q

What should be remembered about diuretics?

A

Check BP before giving, dehydration risk bc inc output, output should be 30 mL/hr, take in AM (no later than 2pm- urinate frequently=safety risk at night),daily weights needed

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25
What is mannitol?
An osmotic diuretic that treats acute renal failure, increased ICP or ocular pressure. It also protects kidneys from susplatin, a chemo tx
26
What are the side/adverse effects for mannitol?
Edema, fluid and electrolyte imbalance, heart failure, N/V, headache, hypotension, tachycardia, pulmonary edema, renal failure
27
When should a nurse question administering mannitol to a pt?
If they have cardiac disease or failure
28
Nursing interventions for drugs like mannitol?
S/S HF, monitor VS, EKG, I&O, RFTs, electrolytes monitor, in-line filter for IV administration
29
What are the S/S of HF?
Peripheral edema, JVD, crackles, dysrhythmias, dyspnea
30
What kinds of drugs are antihypertensives?
ACE inhibitors and ARBs
31
How do you recognize ARBs (angiotensin II receptor blockers)
End in -sartan (i.e. valsartan)
32
How do you recognize ACE inhibitors(Angiotensin converting enzyme inhibitors)
They end in -pril (i.e. lisinopril)
33
What are the side effects/adverse effects of ACE inhibitors and ARBs?
ACE= angioedema, cough(dry and irritating), elevated potassium ARBs=angioedema, elevated potassium , less risks, no cough
34
What is the black box warning for ACE inhibitors?
Pregnancy and angioedema
35
What is contraindicated pt population wise for ARBs?
Contraindicated in pregnancy
36
Pt teaching for ACE inhibitors/ ARBs?
If cough= tolerable, continue meds; if not tolerable= notify provider and TAPER off drugs (ACE)—> ARBs have no cough effect. BP method and range Avoid K+ high foods If pregnant, notify provider
37
What are calcium channel blockers used for?
Block calcium channels in cardiac smooth muscle= vasodilation and increased bloodflow
38
How do you recognize calcium channel blockers?
End in -di, -pine, -mil, -dial (except dilitiazem)
39
What are the side/adverse effects of calcium channel blockers?
Edema (hands, feet, ankles), hypotension, bradycardia, reflex tachycardia, CHF, flushing, palpitations
40
Nursing interventions for calcium channel blockers?
Monitor calcium levels (statins and grape fruit juice increase calcium blockers), monitor VS, EKG, I&O, daily weight, labs, edema and flushing?
41
Pt teaching for calcium channel blockers
Taper dose, report CP or SOB to provider, statins and grape fruit juice increase calcium blockers effect)
42
How do you recognize beta blockers?
-olol
43
What are the intended effects of selective beta blockers?
Decrease myocardial contractility- bradycardia and hypotension
44
What are the intended effects of Nonselective beta blockers?
Decrease myocontractility, decrease blood sugar, and bronchoconstriction
45
Pt teaching for beta blockers
Do not abruptly stop taking Move slowly-dizziness (hypotension) decrease sodium in diet Report S/S depression Sexual dysfunction=effect of med How to take BP Monitor BG
46
What are the cultural differences in Asians, Caucasians, and African Americans with beta blockers?
Asians are hypersensitive to beta blockers, lower doses African americans are not initially treated /monotherapy with beta blockers but diuretics like thiazides(decreased Renin HTN) Caucasian’s have increased renin HTN
47
What is clonidine?
Central acting alpha agonist transdermal patch (replace every 7 days, rotate sites), contraindicated in pregnancy and liver dysfunction
48
What does clonidine do?
Stimulate alpha 2 receptors, decrease epi/norepi release=vasodilation and decrease CO
49
Side effects of Clonidine?
Hypotension, bradycardia, anticholinergic effects, peripheral edema
50
What type of drug is Digoxin?
A cardiac glycoside
51
What is Digoxin used for?
To decrease the cardiac workload and increase the contractility= increased CO
52
What is the therapeutic level of digoxin?
0.5-2 ng/mL
53
What are the interventions for abnormal levels of Digoxin?
Antidote if too high= dixogin immune fab (IV and continuous cardiac monitoring), monitor for S/S of HF, monitor Digoxin serum levels, monitor potassium level and get EKG if abnormal and need supplement; apical pulse before administering- if <60, hold
54
What are the S/S of Digoxin toxicity?
CNS effects(green yellow halos, diplopia, dysrhythmias, headache, fatigue, drowsiness) cardiac effects(bradycardia), and GI effects(N/V/D, anorexia-first symptom)
55
What are you looking for when you evaluate a pt on Digoxin?
Did the HR or dysrhythmias, crackles, SOB, coughing, edema and S/S of HF decrease? Is their breathing better?
56
What is Nitroglycerin?
An antianginal medication that decreases cardiac oxygen demand and vasodilates (preload= lower)
57
What routes can Nitroglycerin be given?
IV(monitor VS frequently and titration based on reason), ER cap, topical, transdermal
58
What are side effects of Nitroglycerin?
headache, hypotension(biggest) Others: dizziness, weakness, syncope, flushing, peripheral edema, tolerance
59
What are adverse effects of Nitroglycerin?
Orthostatic hypotension, reflex tachycardia, palpitations, dyspnea——> concern is SAFETY
60
nursing interventions for nitroglycerin
BP monitor, have pt sit or lie down when taking it, sip of water before SL, acetaminophen for headache, avoid defibrillator/cardioverter(patch/topical=burns), evaluate for CP
61
Pt teaching for nitroglycerin?
Take SL route if acute CP occurs- take 1 SL tab every 5 min for total of 3 tabs, avoid alcohol, avoid ED drugs, do not abruptly stop meds, keep SL in original bottle (photophobic), topical take off at bedtime to avoid tolerance and give break for 7-12 hrs one time a day
62
How would a pt use nitroglycerin tabs for acute chest pain?
1 tab. If after 5 minutes, pain doesnt go away- call 911 and take another tab. Wait five minutes. If still hurting, take a third tab. Total tablets allowed to take is 3 over 15 minutes (5 in between). ER!
63
What is a HMG CoA reductase Inhibitor?
AKA statin. Tx for hypercholesterolemia, lowers cholesterol
64
How do you recognize statins or HMG-CoA reductase inhibitors?
-statin
65
Adverse effects for HMG-CoA Reductase Inhibitors?
HMGCRI- hepatotoxicity, myopathies, Gi effects, Cataract risk increase, Rhabdomyolysis
66
Side effects of Statins?
Gi issues, diplopia, myopathy
67
What are the signs of rhabdomyolysis?
Tea/ brown colored urine, myalgia, myopathy, and increased creatinine kinase
68
What are the contraindications for HMG-CoA Reductase Inhibitors?
Liver disease, breastfeeding, and pregnancy
69
what is a nurse evaluating for with a pt on Statins?
is total cholesterol <200? LDL= <130? HDL=>35?
70
What should a pt avoid when on HMG-CoA Reductase Inhibitors?
Alcohol, grapefruit juice(increases drug conc)
71
What should a pt report when on Statins?
Pregnancy, muscle pain
72
What can a pt do to reduce GI upset when taking a statin?
Take it with food
73
When should a pt take a statin?
At night before bed
74
What is Nicotinic acid?
Vitamin B3
75
What is another word for Nicotinic acid?
Niacin
76
When would a pt need Niacin?
If triglyceride>500
77
what are the side effects of Nicotinic acid?
Peripheral vasodilation(flushing face, ears, neck, chest, dizziness, syncope, hypotension-with higher doses), GI effects(take with food)
78
What is the dosing for Niacin?
1,500-3,000mg qid or tid ; ER 1,000-2,000mg before bed
79
What can be used to decrease flushing as a side effect of Nicotinic acid?
Aspirin, 325 mg
80
what is cholestyramine?
A bile acid-binding resin that lowers the amount of lipids in the blood. They bind to stomach bile to force the body to use available cholesterol to compensate for excreted bile (excreted through feces without being absorbed or metabolized)
81
What should a nurse teach a pt about cholestyramine?
it comse in a powder that is mixed with water or juice, se=abd fullness, flatulence, consitpation, diarrhea; increase fiber fluids and exercise, laxatives can be used, mix well. All other meds 4 hours before
82
Antiplatelet drug action
Prevent clots in the arteries by preventing platelet aggregation
83
What two drugs are antiplatelets?
Clopidogrel and aspirin
84
What are the adverse effects of Aspirin or Clopidogrel?
Bleeding and GI effects Possible hemorrhagic stroke, gastric bleeding (ulcer), thrombocytopenia, tinnitus, hearing loss Melena, black tarry stool, bruising, petichiae
85
What signs would a nurse notice if a patient overdosed on aspirin?
Tinnitus or hearing loss
86
Antiplatelets have an adverse effect of possible CVA- what kind and what are signs of a CVA?
Hemorrhagic, facial drooping, one sided weakness, slurred speech
87
What type of drug is Heparin?
Anticoagulant
88
Anticoagulant drugs _______ clot ________ or _______ a clot __________ ______________.
Prevent clot formation or prevent a clot from getting bigger.
89
What labs need to be monitored for Heparin?
aPTT(60-80 sec) and PTT(120-140 sec) and platelet count (greater or equal to 100,000…. 100,000-400,000)
90
What is the antidote for Heparin?
Protamine sulfate, 1:1.5/100 Units of IV Heparin
91
How is Heparin administered?
IV (with pump, aPTT verified prior to initiating any rate change= q4-6h; rate based on weight, verify with second nurse)or SC in abdomen 2 inches from umbilicus, rotate sites with a 25-26G 1/2-5/8 inch needle
92
T/F the nurse must rub the injection site to get Heparin to infuse in the tissues after administering in a SC injection?
False
93
What must be remembered about Heparin when given via IV?
Must have a dedicated line, verify aPTT prior to infusion or every 4-6 hours, monitor platelet count and vital signs as well
94
What is Warfarin?
Vitamin K inhibitor Used to treat DVT, prevent thrombus formation in those with A-fib or prosthetic heart valves, prevent MI, TIA, PE; anticoagulant
95
What labs are important for warfarin?
PT(18-24 sec) and INR(2-3)
96
Indications for Warfarin?
Treat and prevent DVT, prevent thrombus formation in A-Fib, prosthetic heart valve, MI, TIA, PE patients
97
Antidote for warfarin?
Vitamin K
98
What are the S/S of bleeding when on warfarin?
Melena, bruising, CVA, petichiae, pink tinged urine(hematuria)
99
Warfarin side/adverse effects?
Bleeding(hemorrhage), hepatitis, toxicity, overdose
100
Pt teaching for warfarin?
Wear a medic alert, consume vitamin K foods regularly / consistently, avoid smoking, avoid prolonged sitting or cross legs, soft toothbrush, electric razor, pregnancy category X
101
Pharmacokinetics of warfarin?
Highly protein bound, inhibits synthesis of clotting factors, slow onset, prolonged duration, eliminated hepatically, PT INR monitoring
102
Contraindications for warfarin?
Elective surgeries(stop 7 days prior), pregnancy, GI bleeds, CVA (if hemorrhagic), any disorder that increases the risk of bleeding
103
Erythropoietin
Stimulates the production of RBCs- e poetic Alfa (injection-prefilled)and Darapoetin alfa(long-acting)
104
Adverse effects of erythropoietin
HTN, DVT, headache/body ache , risk for thrombotic events
105
Oprelvekin
Increases production of platelets; used commonly for chemo patients
106
Indications for oprelvekin
Severe thrombocytopenia
107
How do you evaluate effectiveness for oprelvekin
If platelet count increases and is above 50,000
108
Filgrastim
Increases production of neutrophils and decreases infection risks for neutropenia patients
109
Side effects of filgrastim?
Bone pain, leukocytosis, spleen omegaly, risk of splenic rupture (long term use)

Pharmacology (12 decks)

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