Exam 2 Flashcards
What type of drug is memantine?
An NMDA receptor blocker
What is the first and only drug in the NMDA drug class?
memantine
What is memantine used for?
moderate to severe Alzheimer’s disease
How does memantine work in the body?
It blocks NMDA receptors, which reduces high levels of glutamate that cause neuronal damage in Alzheimer’s
What are adverse effects on memantine?
CNS effects: dizziness, headache, increased confusion; constipation
What are some nursing considerations for NMDA drugs (memantine)?
Assist with ambulation (client can be dizzy), increase fluids and fiber, monitor adverse effects and include caregiver in instructions
When are cholinesterase inhibitors indicated?
For mild to moderate Alzheimer’s disease
T/F Cholinesterase inhibitors are effective in 1 of 12 patients.
True
How long do cholinesterase inhibitors delay or slow progression of AD?
A few months
How do cholinesterase inhibitors work?
They prevent the breakdown of ACh by cholinesterase and increase ACh levels in the brain
What are patients taking cholinesterase inhibitors at risk for?
Falls and safety issues
Cholinesterase drugs need to be tapered when discontinued. T/F
True
What are some cholinergic effects that may be shown in cholinesterase inhibitors?
They affect the GI system mostly; can cause N/V/D, increased salivation, involuntary defecation; Cardiovascular: bradycardia, hypotension, syncope
What drugs are contraindicated in cholinesterase inhibitors?
NSAIDS (cause GI bleed and ulcers) and anticholinergic drugs (reduce drug responses)
What drug is the prototype for cholinesterase inhibitors?
donepezil
What are nursing considerations for cholinesterase inhibitors (donepezil)?
Administer with food to decrease GI effects, assist with ambulation, monitor HR, weight loss, GI bleeding, CNS effects
T/F antipsychotics cause an increased risk of mortality in dementia.
True
What is the most prevalent neurologic disorder?
Epilepsy
What major risk is associated with seizure disorders?
Family planning risks (risk of abnormalities)
T/F Seizure meds need to be continued during pregnancy because of greater risk of seizures.
True
T/F Pregnant women and elderly have a higher frequency of seizures.
True
generalized onset seizures begin in ____ area of the brain and rapidly spread throughout ____ hemispheres of the brain
one, both
Tonic-clonic seizures may have an ____ and last ___ minutes.
aura, 1-2
T/F Absence seizures are more common in children starting at 3 years old, and go away in adolescence.
True
Absence seizures can be characterized by ‘staring into “space”. T/F
True
What is an atonic seizure?
A drop attack, lasting a few seconds.
What is the biggest concern for atonic seizures (drop attacks)?
Falls and injuries
What are myoclonic seizures?
Seizures involving the neck, shoulders and arms with 2 types of seizures.
What can status epilepticus (medical emergency) lead to?
hypoglycemia, acidosis, hypothermia, hypoxia, brain damage, death
What period of time must withdrawing antiepileptic drugs be done over?
6-12 weeks
What are problems associated with withdrawing antiepileptic drugs?
Physical dependence and risk for reoccurrence of seizures
What needs to be kept in consideration to antiepilectic drugs?
Family planning since this is a category D drug.
Which cultural groups metabolize antiseizure drugs differently and what needs to be done to achieve the same therapeutic effects as those of other cultural groups?
Arab Americans and Asian Americans; they may require lower doses and frequent dose adjustment
What drug type is for absence seizures?
Succinimides
What are the prototypes for barbiturates?
phenobarbital and primidone
How are barbiturates helpful as AED’s?
They reduce tonic-clonic, muscular and emotional responses to stimulation
What are disadvantages of barbiturates (phenobarbital and primidone)?
Low safety margin, profound CNS depression, respiratory depression, bradycardia, syncope and hypotension, and a high potential for drug abuse
What is the MOA of benzodiazepines?
Increases GABA
What do benzodiazepines end in?
-pam
What is the benzodiazepine prototype?
Diazepam
What should never be done and why regarding benzodiazepines?
Discontinuing abruptly can cause status epilepticus
What is the #1 treatment for status epilepticus?
benzodiazepines
What can benzodiazepines also be used for, besides seizures?
alcohol withdrawal
What is the only antidote for benzodiazepine toxicity?
flumazenil
What should be avoided with benzodiazepines (diazepam)?
Other CNS depressants/alcohol and grapefruit juice
What adverse effect is the most common with diazepam (benzos)?
CNS depression
What is the most serious adverse effect with diazepam?
Cardiovascular collapse; assess for bradycardia, tachycardia, hypotension and edema
What are hydantoins?
Antiepileptic drugs
What is the prototype for hydantoins?
Phenytoin
What is the use for phenytoin?
tonic-clonic and partial seizures
What do all hydantoins end in?
-toin
What is the most common adverse effect of phenytoin?
CNS effects–mild drowsiness and CNS depression
What are serious adverse effects of phenytoin?
Gingival hyperplasia, bone marrow suppression, and skin rash
What is gingival hyperplasia?
The swelling and overgrowth of gums
What is the black box warning for phenytoin?
If given too fast, it can cause hypotension and arrhythmias
How fast should phenytoin be given?
50mg/minute is the IV rate
What are signs of phenytoin toxicity?
nystagmus, ataxia, sedation, blurred/double vision
T/F IV phenytoin is incompatible with dextrose solutions.
True
T/F phenytoin decreases effects to oral contraceptives, warfarin and glucocorticoids.
True
What are some nursing considerations for hydantoins (phenytoin)?
Do not drive/perform hazardous activities if experiencing CNS effects, obtain regular dental checkups and brush teeth with a soft bristled toothbrush, do not abruptly stop medication
What is the only drug type used for absence seizures?
Succinimides
What is the prototype for succinimides?
ethosuximide
How long does it take ethosuximide to reach optimal effects?
4-7 days
ethosuximide, a succinimide, is ineffective at treating simple or complex partial and tonic clonic seizures. T/F
True
T/F ethosuximide cannot cause fatal pancytopenia and bone marrow suppression.
False
What drug can be used for all seizure types, migraines and mania?
valproic acid
What are serious adverse effects in valproic acid?
liver toxicity and neural tube defects
What is the serum drug level for valproic acid?
50-100 mcg/ml
What medication is used for valproic acid overdose?
naloxone
What are some nursing considerations for valproic acid?
Fall precautions and enteric coated tabs to minimize GI distress
What are goals of treatment for status epilepticus?
maintaining ventilation, correcting hypoglycemia and termination the seizure as well as initiating or continuing long term suppression drugs
What are two drugs that are used in status epilepticus?
lorazepam or diazepam
What drug is used alone or in combination for treating partial seizures?
carbamazepine
What drug can be used for neuropathy and partial seizures?
gabapentin
What drug should be taken into consideration with Asian ancestry and why?
carbamazepine, Asian ancestry has a high risk of Steven-Johnson syndrome
What are dermatologic adverse effects of carbamazepine?
rash, photosensitivity, alopecia, toxic epidermal necrosis and Stevens-Johnson syndrome
What is the black box warning for carbamazepine?
It can cause cytosis and aplastic anemia
What is something unique about carbamazepine?
It can decrease effectiveness of contraceptives and give false negatives on pregnancy tests
What are nursing considerations for carbamazepine?
Give at bedtime if possible (CNS effects), give with meals to reduce GI symptoms, use sunscreen, fall precautions
What pregnancy category is gabapentin?
C
What are adverse effects of gabapentin?
increased frequency of viral infections, weight gain and gastric upset
What two drugs should be avoided with gabapentin?
Morphine and hydrocodone
What are muscle spasms?
cramps or charlie horses
What is muscle spasticity?
a neurological condition where certain muscle groups remain in a continuous state of contraction
T/F Patients experiencing muscle spasticity are able to voluntarily relax their limbs.
False
What drug class is the 1st line for mild to moderate pain d/t muscle overexertion?
NSAIDS
How do centrally acting skeletal muscle relaxants work in the body?
They relieve actions in the CNS and do not work on the muscles themselves
What is the prototype for centrally acting muscle relaxants?
cyclobenzaprine
What is the MOA of cyclobenzaprine?
Enhances the inhibitory effects of GABA on receptors in the spinal cord
What are patients at risk for when coming off of cyclobenzaprine (a centrally acting muscle relaxant?)
physical dependence; abstinence syndrome, anxiety, restlessness, hallucinations and seizures
What age group should be cautioned with use of cyclobenzaprine?
65 and older; they are more likely to experience CNS effects
What are drugs used for spasticity?
baclofen, diazepam and dantrolene
T/F Baclofen has no direct effect on skeletal muscle, so it doesn’t decrease muscle strength.
True
How long of a period should baclofen be withdrawn over?
1-2 weeks d/t physical dependence
T/F PO Baclofen should be taken with food/milk.
True
What will nursing education of baclofen focus on?
Safety
What is the only benzo approved for spasticity?
diazepam
How does diazepam work in the body?
It acts in the CNS and mimics the actions of GABA
Which drug used for spasticity is direct acting on muscles and decreases muscle strength?
Dantrolene
T/F Dantrolene is also the treatment of malignant hyperthermia.
True
T/F Women taking estrogen and dantrolene are at a higher risk of hepatic toxicity.
True
What is the black box warning for dantrolene?
hepatotoxic death
higher virulence causes _____
more harm to the patient
What is pathogenicity?
The ability of an organism to cause disease
What is virulence?
A quantitative measure of an organism’s pathogenicity
What are exotoxins?
Proteins released by bacteria to surrounding tissues that can inactivate or kill host cells
What are endotoxins?
Harmful non-protein chemicals that are part of the outer layer of a normal cell and are released after a bacteria dies, causing inflammation, fever and chills.
T/F antibiotics may make a person feel worse before they feel better.
True
Describe gram positive bacteria.
Thick cell wall, retain violet color in stains
Describe gram negative bacteria.
Thin cell wall, lose violet color in stains
Which gram is harder to penetrate?
gram negative, because it has three layers.
Bactericidal drugs _____
kill bacteria
Bacteriostatic drugs ____
kill bacteria indirectly by slowing bacterial growth and allow natural defenses to eliminate the microorganism
Inhibition of bacterial cell wall synthesis works by ______
causing the cell wall to swell and burst
T/F in acquired resistance to antimicrobial drugs, the microbes become resistant, not the person.
True
Which antibiotics promote resistance?
Broad spectrum
How does antibiotic use promote resistance?
Antibiotics kill all of an infection besides one resistant organism, which rapidly divides
What is the most common site of HAIS (Healthcare Associated Infections)?
Catheters
What is important regarding cultures and antibiotics?
You must obtain the culture first and then start antibiotics.
What are indicators for success of antimicrobial therapy?
Fever reduction, resolution of s/s
What is a severe form of hypersensitivity reaction to abx?
Anaphylaxis
When do we see superinfections appear?
With broad spectrum abx use or long term abx
How can you prevent superinfections?
lactobacillus (probiotic) or yogurt
What are examples of superinfections?
C-diff, fungal infections in skin or oral mucous membranes
What are the drug classes that affect cell walls?
Penicillins, Cephalosporins, Carbapenems, Vancomycin
What is the MOA of penicillins (prototype PCN G (natural) and Ampicillin (broad spectrum)?
weaken and destroy cell wall, bactericidal
What is an enzyme that makes penicillin inactive?
penicillinase or anything ending in -ase
What penicillins can work against penicillinase?
Penicillinase-resistant PCNs
T/F allergies to penicillin may also happen in cephalosporins.
True
T/F you cannot outgrow a penicillin allergy.
False
T/F penicillin is effective against gram positive, gram negative and pseudimonas.
True
PCN G (a natural penicillin) is ____ spectrum and includes most gram __ bacteria.
narrow, positive
Ampicillin is a ___ spectrum and includes gram __ and some dram ___ bacteria.
broad, positive, negative
What is the prototype for cephalosporins?
Cefazolin
What is the prefix for all cephalosporins?
Cef- or Ceph-
When is Cefazolin (a cephalosporin) used?
As a broad spectrum, against gram - infections and for those who are allergic to PCN or PCN resistant
What happens when cefazolin is taken with alcohol?
A disulfiram like reaction (violent vomiting)
Which generation of cephalosporins is only effective against gram +?
1st generation
What is the prototype for carbapenems?
Imipenem
When is imipenem used?
for more serious infections
What class is imipenem in?
Carbapenem
What drugs antagonize carbapenems (Imipenem)?
PCN, cephalosporins and aztreonam
T/F you should take carbapenems (Imipenem) at the same time as PCN, cephalosporins and aztreonam.
False; should be at different times d/t cross sensitivity.
What is the suffix for carbapenems?
-penem
What is the most effective drug against MRSA and c diff?
Vancomycin
T/F If a systemic infection is present, vancomycin has to be given via IV.
True
T/F vancomycin has a low safety margin and peak and trough needs to be monitored.
True
What are some serious adverse effects of vancomycin?
Renal failure, ototoxicity, red man syndrome
What are signs of ototoxicity?
tinnitus, high tone hearing loss and deafness
What are signs of red man syndrome?
hypotension, tachycardia, rash and flushing of the face and trunk
How can a person get red man syndrome?
From a rapid Vanco IV infusion
How can red man syndrome be prevented?
By infusing vanco over 60 mins or more.
What are the three drug classes that affect bacterial protein synthesis?
Tetracyclines, macrolides and aminoglycosides
When are tetracyclines used?
When an infection is resistant to first line abx
What is the prototype for tetracyclines?
tetracycline
How does tetracycline work in the body?
It inhibits protein synthesis
How can GI irritation be treated with tetracycline?
It can be reduced if taken with food; food must be nondairy
How soon must tetracycline be given before ingesting dairy?
1-2 hours
What are some adverse effects of tetracycline?
photosensitivity (severe sunburn type reaction) and teeth discoloration
Why should tetracycline be avoided for kids under 8 or pregnant/lactating women?
They are at higher risk for teeth discoloration and it can slow down growth rates in fetuses and children
Why should patients taking tetracycline have their hepatic or renal function monitored?
It forms insoluble content in the body
What is the prototype for macrolides?
Erythromycin
What type of abx is erythromycin?
broad spectrum, most effective against gram + bacteria
What is the first line drug for Legionnaires’ disease, whooping cough and diphtheria?
Erythromycin
T/F erythromycin can increase effects of warfarin.
True
T/F erythromycin is safe but in rare cases can kill you.
True
What are important adverse effects of erythromycin?
ventricular dysrhythmias, cardiotoxicity and ototoxicity
What is the prototype for aminoglycosides?
Gentamycin
When would gentamycin be given?
As a second line abx, where there are no less toxic alternatives
T/F gentamycin is a narrow spectrum abx and works against gram - bacteria.
True
Which serious adverse effects are present in gentamycin?
ototoxicity and nephrotoxicity
What should a nurse educate a patient on when taking gentamycin?
signs of hearing loss, tinnitus and vertigo
What are things that should be monitored when taking gentamycin and why?
I/O’s, BUN & Creatinine; if irregularities are not caught early on, this medication can cause irreversible kidney damage
What is the prototype for fluoroquinolones?
ciprofloxacin (2nd generation)
What type of inhibitor is ciprofloxacin (a fluoroquinolone)?
bacterial DNA replication inhibitor
Which medication can cause tendonitis as an adverse effect?
ciprofloxacin
What are some adverse effects for ciprofloxacin?
tendon toxicity (Achilles tendon rupture), photosensitivity, cardiotoxicity, fatal dysrhythmias and prolonged QT intervals
Who is at risk for tendon toxicity for ciprofloxacin?
children, older adults and those taking glucocorticoids
What are contraindications for ciprofloxacin?
tendon pain, those under 18; also monitor patients with impaired renal function or CNS disorders
T/F antacids or mineral supplements speed up absorption when taking ciprofloxacin.
False; they delay absorption
What is the time period for taking antacids or mineral supplements when taking ciprofloxacin (fluoroquinolones)?
2 hours after or 6 hours before taking fluoroquinolones
What is the suffix for fluoroquinolones?
-floxacin
What medication is used for protozoal infections, peptic ulcer disease and infections caused by obligate anaerobic bacteria?
Metronidazole
What is the black box warning for metronidazole?
it can cause cancer
What are adverse effects of metronidazole?
It can cause violent vomiting with alcohol and causes harmless darkening of urine
What are sulfonamides used for?
Broad spectrum abx (gram + and gram -), UTI prophylaxis and tx
sulfonamides inhibit synthesis of folic acid T/F
True
What are some adverse effects of sulfonamides?
Kernicterus (a fatal type of jaundice), crystalluria and renal damage
How can crystalluria be prevented in sulfonamides?
by encouraging fluids
How much fluid intake and output should be encouraged to prevent the development of crystals when taking sulfonamides?
3 liters of fluid a day with 1500 mL of urine output in 24 hours
What are contraindications for sulfonamides?
pregnancy, nursing, children under the age of 2, folate deficiency anemia and severe renal impairment, hyperkalemia
Oral anticoagulants ______ ______ when taken with sulfonamides
increase bleeding
Potassium supplements and potassium sparing diuretics can _____ effectiveness when taken with sulfonamides.
Increase
What are the prototypes for sulfonamides?
TMP-SMZ
TMP-SMZ are used in ________ and when given ____ they ___ more bacteria.
combination, together, kill
TMP-SMZ carries the risk of kernicterus, which is ___
a fatal type of jaundice
What pregnancy category is TMP-SMZ?
Category D
Why are mycobacterial infections difficult to treat?
They have a thick layer and are often resistant
mycobacterial infections are ____ growing and require _____ treatment
slow, prolonged
What are the 3 species (diseases) of mycobacteria?
tuberculosis, leprosy, and mycobacterium avum which is secondary to HIV and AIDS
Primary tuberculosis is obtained through _______
inhaling particles from someone with TB
postprimary TB is special because ______
dormant bacteria reactivates upon weakened immune system
What is DOT therapy?
where each dose of TB needs to be taken in front of an observer
T/F TB is always treated with 4 or more drugs.
False; 2 or more.
What is the drug regimen for active or latent TB?
3-4 drugs for 6-12 months
What is the drug regimen for multi-drug resistant TB?
Up to 7 drugs for up to 2 years
What is the drug regimen for prophylactic treatment of TB?
2 drugs for 2 months
What is the first line of drugs for tx for active TB?
RIPE (rifampin, isoniazid, pyraziniamide, ethambutol)
What is the prototype for anti-tubercular drugs?
isoniazid
What is special about the adverse effect of rifampin?
orange body fluids
T/F Rifampin decreases effectiveness of oral contraceptives.
True
what are some adverse effects of isoniazid (anti-tb drug)?
Visual defects, CNS effects such as dizziness, seizures and psychosis, peripheral neuropathies and hepatotoxicity/hepatitis
How can peripheral neuropathies be treated when taking isoniazid (anti-tb drug)?
Vitamin B6
How can hepatotoxicity/hepatitis be treated when taking isoniazid (anti-tb drug)?
Pyroxidine
What are the viral infections that an be treated with antivirals?
influenza, herpes simplex virus, herpes zoster (shingles), RSV and HIV
How do antiviral medications work?
They shorten the course of the virus by inhibiting DNA or RNA replication
What is the most important molecule reabsorbed in the tubules?
Water
Aldosterone stimulates _______ reabsorption in the distal nephron which promotes _______ excretion
sodium, potassium
Antidiuretic hormone (ADH) increases _____ reabsorption by making the collecting ducts more ______ to water
water, permeable
What are some dietary restrictions a person with renal failure may have?
potassium, phosphate and sodium
T/F Loop diuretics prevent reabsorption of sodium in the renal tubules.
False; they promote reabsorption of sodium in the Loop of Henle.
Which drug group of diuretics act by blocking sodium in the distal tubule?
Thiazides
Which diuretic drug group have minimal effect of potassium ion excretion?
Potassium-sparing
What type of diuretics are the most effective, and what is their suffix?
Loop diuretics, -mide or -nide
T/F Loop diuretics (furosemide) are able to increase urine output even when blood flow to kidneys is diminished.
True
What are some serious adverse effects when taking furosemide (loop diuretics)?
Dehydration, low bp and syncope, electrolyte imbalances, hypokalemia, hyperuricemia (can cause exacerbations of gout); tachycardia, dysrhythmias, n/v, ototoxicity (permanent)
What is the black box warning referring to regarding furosemide (loop diuretics)?
diuresis, water and electrolyte depletion
What are contraindications for furosemide?
Hypersensitivity, anuria, severe fluid or electrolyte depletion
What is a nursing consideration for furosemide?
Check vitals before giving a loop diuretic
What is one of the main differences between thiazide and loop diuretics?
You cannot use thiazide if you do not have enough renal function, but you can with loop diuretics.
What is the most commonly prescribed class of diuretics?
Thiazide-like diuretics
What is the prototype for thiazide like diuretics?
hydrochlorothiazide
Which diuretics do not cause ototoxicity?
thiazide and thiazide like diuretics (hydrochlorothiazide)
What are patients taking thiazide and thiazide like diuretics (hydrochlorothiazide) at risk for?
Falls, fluid and electrolyte imbalances, hypotension and orthostatic hypotension
What causes dysrhythmias in hydrochlorothiazide or thiazide like diuretics?
hypokalemia
What medication can have toxic effects if taken with thiazide and thiazide like diuretics?
Digoxin
What is an advantage of potassium sparing diuretics?
They retain potassium not waste it
What is the prototype for potassium sparing diuretics?
Spironolactone
What patient population is potassium sparing diuretics useful for?
Those who are at high risk for hypokalemia
What is an individual taking spironolactone (a potassium sparing diuretic) at risk for?
Hyperkalemia d/t retaining potassium; gynecomastia (man boobs), impotence, diminished libido in men; menstrual irregularities, hirsutism (excessive hair growth), breast tenderness, decreased fertility
Can the adverse effects for taking spironolactone be reversed?
Yes, when the medication is stopped.
what is the black box warning for spironolactone?
It produces tumors in lab animals
What should be avoided when taking spironolactone?
Potassium supplements, ACE inhibitors, ARBs (can cause severe hyperkalemia) and foods high in potassium
What class does spironolactone belong to?
potassium sparing diuretics
What is stroke volume?
the amount of blood pumped out of ventricles with each heartbeat
What are the 3 elements that control blood pressure?
Heart rate, stroke volume, and total peripheral resistance
What is primary hypertension?
HTN with no underlying cause
What is secondary hypertension?
HTN with an identifiable cause
What is important to educate on regarding HTN?
routine screenings and risks if noncompliant with meds
What are repercussions of uncontrolled HTN?
Damage to vessels, heart, brain, kidneys, eyes
What does CCB stand for?
Calcium Channel Blockers
What is important regarding ACE inhibitors or ARBs?
They can only be on one or the other.
What is important to remember in black patients regarding HTN tx?
Thiazides or CCBs are given before ACE or ARBs
T/F African Americans are most responsive to single drug therapy for HTN.
True
What is the goal of medication for HTN?
To decrease morbidity and mortality
What medications are the 1st line of treatment for mild to moderate HTN?
Thiazide diuretics
Renin releases when blood pressure is ______ to ______ blood pressure
lower, increase
Renin forms angiotensin I from angiotensinogen, which then converts to ________
angiotensin II.
Angiotensin II ______ blood pressure.
raises
ACE inhibitors ____ blood pressure from _____
blocks, increasing
ARBs stands for ____
Angiotensin receptor blockers
Aldosterone antagonists ________
prevent aldosterone induced blood pressure increase
Direct renin inhibitors ______
inhibit renin so angiotensin I and its cascade does not occur
What is the 1st line treatment for HTN?
ACE inhibitors–they reduce HTN related morbidity and mortality
How do ACE inhibitors work?
They block the conversion of angiotensin I to angiotensin II.
What is the suffix for ACE inhibitors?
-pril
T/F ACE inhibitors are used with thiazide diuretics because effects are enhanced.
True
What is the prototype for ACE inhibitors?
Lisinopril
What are the most prominent adverse effects with lisinopril (an ACE inhibitor)?
Persistent dry cough, angioedema.
What is the black box warning for lisinopril?
A risk for major congenital defects if taken during pregnancy
Which medication class should not be taken with lisinopril due to decreasing antihypertensive activity and worsening renal disease?
NSAIDS
What is the prototype for ARBS?
Losartan
What is the suffix for ARBS?
-sartan
What is the difference between losartan (ARBS) and lisinopril (ACE Inhibitor)?
They do not cause a cough and have a lower risk of angioedema
T/F ARBS (losartan) have the lowest incidence of serious adverse effects of any of the antihypertensive classes.
True
What forms are calcium channel blockers (CCBS) available in?
sustained or extended release
What is the function of calcium channel blockers?
They decrease BP, cardiac workload and myocardial oxygen demand
What is the suffix for calcium channel blockers?
-pine
What is the prototype for calcium channel blockers?
Amlodipine
What two medications are CCBs but not used for HTN?
Verapamil, diltiazem
Regarding administration of CCBs, what is the biggest concern as an adverse effect?
Hypotension when taken with alcohol (will be on exam!)
What are adverse effects of CCBs (amlodipine)?
hypotension, bradycardia, peripheral edema, heart block, flushing and skin rash
What are alpha 1 antagonists used for?
BPH and hypertension
T/F Caution must be used in nonspecific beta blockers w/ those who have COPD and asthma.
True
What are Beta II agonists used for?
asthma and preterm labor
What is the 2nd line of drugs for HTN?
Adrenergic antagonists
What do adrenergic antagonists do?
They prevent symptoms of the fight or flight response
What are adrenergic antagonists used for?
To treat HTN, angina pectoris, dysrhythmias and MI prophylaxis
What is the suffix for Alpha 1-adrenergic antagonists?
-sin (think -sin and BPH)
What is the prototype for Alpha 1-adrenergic antagonists?
Prazosin
What is Prazosin used for?
HTN, BPH and Raynaud’s disease
How does Prazosin (an alpha 1-adrenergic antagonist) help BPH?
it relaxes the bladder and prostate
What is the first dose phenomenon with prazosin and other alpha 1 adrenergic antagonists?
pronounced orthostatic hypotension
What are adverse effects caused by in prazosin (alpha 1 adrenergic antagonists)?
the increased parasympathetic activity
Why is hypotension a risk in prazosin?
because of vasodilation
What is the treatment for reflex tachycardia in alpha 1-adrenergic antagonists?
Beta blockers
What are some adverse effects with alpha 1 adrenergic antagonists (prazosin)?
nasal congestion, decreased libido, erectile dysfunction or ability to ejaculate
What is the most important nursing consideration with beta blockers?
HOLD medication if systolic BP is less than 100 or HR is less than 60
What is the suffix for beta blockers?
-olol
What is the nonselective prototype for beta blockers?
propranolol
What is the selective (cardioselective) prototype for beta blockers?
metoprolol
Why should a beta blocker be withdrawn gradually over several weeks?
abrupt withdrawal can cause rebound cardiac excitation
What type of beta blockers are safe for those with COPD and asthma to take?
cardioselective
How do you treat a beta blocker overdose?
with an anticholinergic (atropine) or beta adrenergic agonist (isoproterenol)
Which drugs that are nonselective alpha 1 and beta adrenergic antagonists block alpha 1?
carvedilol and labetalol
What is the prototype for direct acting vasodilators?
hydralazine
When is hydralazine indicated?
When severe HTN has not responded to other therapy
What are adverse effects of direct acting vasodilators?
hypotension, reflex tachycardia, sodium and water retention, and a lupus like syndrome
When should hydralazine be discontinued gradually?
If there is an appearance of a lupus like syndrome: rash, hives, weakness, fatigue.
How can reflex tachycardia be prevented?
By administration of a beta blocker
How is a hypertensive emergency defined?
diastolic pressure is >120 mmHg with evidence of target organ system damage
what causes a hypertensive emergency (HTN-E)?
untreated or poorly controlled essential HTN
What are common symptoms of a hypertensive emergency (HTN-E)?
chest pain, dyspnea, headache
What is the goal of management of hypertensive emergencies (HTN-E)?
To lower BP quickly but not too fast; lower BP progressively by 20-25% over 30-60 minutes and gradually reduce it further over 12-48 hrs until BP is in a normal range
What is the 1st line drug for aggressive, life threatening HTN?
Nitroprusside Sodium
Nitroprusside Sodium is limited to __ hours because ____
72, toxic thiocyanate and cyanide
What is an adverse effect of nitroprusside sodium?
Thiocyanate toxicity
What are s/s of thiocyanate toxicity?
hypotension, lethargy, blurred vision, metabolic acidosis, faint heart sounds, LOC
T/F Nitroprusside sodium must be diluted prior to infusion.
True; if not diluted, it can cause irreversible ischemic injury and death d/t significant drops in BP.
serum thiocyanate levels must be monitored and discontinued if it exceeds __ mg/dL
12
What are other adverse effects of nitroprusside sodium?
inadequate cerebral circulation and kidney impairment.
