Exam 2 Pharm Maps Flashcards
1
Q
Anticoagulants (Heparin) drug names (2)
A
Unfractionated heparin (Heparin)
Low Molecular Weight Heparin (LMWH) - enoxaparin (Lovenox)
2
Q
Reason for taking Heparin
________ to prevent clot formation in pt. with the following conditions (5)
A
Prophylactically
1. MI (heart attack)
2. Atrial fibrillation
3. CVA
4. Post Stent
5. Implanted Devices
3
Q
Action of heparin
Inhibits __ formation. Specifically, lla (thrombin)
Lovenox works more on ____
A
Clot
Factor Xa
4
Q
Heparin contraindications (3)
A
Recent surgeries
GI bleed
PUD
5
Q
Adverse reaction to heparin (3)
A
Heparin-induced thrombocytopenia (HIT)
Excessive bleeding
Bruising
6
Q
Why is IV anticoagulant Heparin more dangerous?
A
Because bleeding can occur quickly
7
Q
Assess ___ before & after administering Heparin
A
Bleeding
8
Q
Assess low ___ (heparin)
A
Hemoglobin (anemia)
9
Q
Assess ___ levels before administering each dose of heparin
A
PTT
10
Q
___ levels bt. ___ & _____ is considered therapeutic (heparin)
A
PTT
bt. 46-70
11
Q
Check med list for other ___ heparin
A
Anti-coagulants
12
Q
HOLD lovenox if ___ are less than
A
platelets are less than 50 thousand
13
Q
Report any ___ or ___ to the physician (Pt. education, heparin)
A
Unusual bleeding or bruising
14
Q
(Pt. education) Pt. on heparin should wear a
A
Medical alert bracelet
15
Q
(Pt. education) Rotate ___ with heparin
A
Injection sites
16
Q
Avoid ___ with Heparin
A
Medication that causes bleeding (ex. NSAIDS)
17
Q
(Pt. education) Heparin medication may ___
A
Burn or bruise
18
Q
What is a unique aspect to heparin administration?
A
Keep the air bubble in the syringe
19
Q
Antidote for heparin
A
Protamine Sulfate 1mg/100 units of heparin used
20
Q
What site is heparin anticoagulants administered on a pt.
A
Love handles (only)
21
Q
Signs of bleeding to watch for with heparin
A
Bleeding gums, blood in foley, IV site, any wounds, etc
22
Q
Anticoagulant Vitamin K factor drug names (1)
A
Warfarin (Coumadin)
23
Q
Reason for taking warfarin
A
Long term management of an MI, Afib, or any implantable devices
24
Q
Action of warfarin
A
Inhibits production of vitamin K dependent clotting factors
25
Warfarin contraindications (4)
Recent surgeries
GI bleeds
PUD
Many drug interactions
26
Warfarin adverse reactions (3)
Bleeding
Purple Toe Syndrome
Warfarin Toxicity
27
Assess ____ before and after administering warfarin
Bleeding
28
Monitor ____ levels with warfarin (values)
PT/INR
1.0 normal
2 - 3.5 for therapeutic
29
Be ready to administer ___ if bleeding occurs with warfarin
Vitamin K 10 mg
30
For l____ t___ bleeding, administer (warfarin)
Life-threatening
Kcentra
31
(Pt. education, warfarin) Avoid ___
Alcohol
32
(Pt. education, warfarin) Report any ___ or ___ to physician
Unusual bleeding or bruising
33
Pt. who are on warfarin should wear a
Medical alert bracelet
34
(Pt. education, warfarin) Do not change intake amount of
Green leafy vegetables you eat
35
(Pt. education, warfarin) Avoid all ___
Herbal medication
36
What do you do if the warfarin level is toxic?
Stop medication, notify MD and prepare to administer vitamin K. Watch for bleeding
37
What are examples of foods to avoid with warfarin?
Green leafy vegetables
Spinach, Kale, Cabbage, Lettuce, but also Tomatoes
38
What 2 cardiac medications can decrease the effectiveness of warfarin?
Amiodarone & Diltiazem
39
What drug is often used with warfarin until warfarin reaches a therapeutic level?
Heparin IV
D/c after warfarin reaches therapeutic level
40
After receiving Vit. K, how long are pt.s resistant to warfarin?
Up to 7 days
41
The liver will begin to make more clotting factors once warfarin is stopped, but it can take up to ___ reach homeostasis. What is given to speed to process along?
3 or 4 days
Vit. K is given
42
Anticoagulants Factor Xa drug names (3)
Rivaroxaban (Xarelto)
Fondaparinux (Arixtra)
Apixaban (Eliquis)
43
Reasons for taking Factor Xa
Prevent CVA in patients with afib, post-op ortho surgeries, or Hx of DVT, PE - to help avoid a recurrence
44
Action of Factor Xa
Inhibits factor Xa production
45
Factor Xa contraindications (4)
Recent surgeries
GI bleeds
PUD
Avoid NSAIDS
46
Factor Xa adverse reactions (3)
Peripheral edema
Bleeding & bruising
Dizziness
47
Assess ___ before & after administering Factor Xa
Bleeding
48
What labs should be monitor with Factor Xa
- renal function (BUN & Create)
- Liver enzymes (ALT & AST)
49
(Pt. education, Factor Xa) Pt. should take ___ and be sure not to ___ or ___
Whole
Do not crush or split
50
(Pt. education, Factor Xa) If _ & __ occur, what should the pt. do?
Nausea & vomiting
Call MD immediately
51
(Pt. education, Factor Xa) Stop if ___ or ___
Unusual bleeding or bruising
52
(Pt. education, Factor Xa) Notify physician for ___
Black tarry stools
53
Why should you take caution with an epidural with Factor Xa? How long should you wait to start the medication?
Can cause a spinal hematoma once epidural is pulled
Start medication about 6 hours later
54
Antiplatelet drug names (2)
Aspirin (ASA)
Clopidogrel (Plavix)
55
Reason for taking antiplatelet
Post CVA, MI, & stent placements
56
Action of antiplatlets
Make platelets slicky so they don't adhere to BV wall
57
Antiplatelet contraindications (4)
Many drugs
Amiodarone
PPI
CCB
NSAIDS
58
Antiplatelet Adverse reactions (5)
Bleeding
- Gums
- Nosebleeds
- Puncture sites
- Surgical sites
- Hematuria
59
What is hematuria?
Blood in urine
60
Monitor for ____ or ____ with Antiplatelets
Bleeding or bruising
61
(Antiplatelets nursing implications) Medication list for ___
Other NSAIDS, anticoagulants
62
Monitor ___ & ____ (Antiplatelet)
Platelets & hemoglobin (very little effect on these labs but if they are already low, could be an issue)
63
Take Antiplatelet at ____
The same time every day
64
Report any ___ or ___ to your physician (pt. education Antiplatelet)
Unusual bleeding or bruising
65
Do not crush ___ aspirin
Enteric-coated
66
Take aspirin with ___ or ___
6-8 ounces of water or with food
67
Caution with ____, ____, and ____ (Antiplatelet)
Ginko, ginger, & st. john's wart
68
Why should you not skip an Antiplatelet dose?
Becomes less effective
69
What if pt. (who is on Antiplatelet) is taking aspirin for arthritis?
Make sure MD is aware/ Can increase risk of bleeding
70
Antihyperlipidemic bile acid sequestrants drug name
Cholestyramine (Questran)
71
Reason for taking antihyperlipidemic bile acid sequestrants
Hyperlipidemia (elevated lipids)
72
Action of antihyperlipidemic bile acid sequestrants
Prevents reabsorption of bile acids from the small intestines (we excrete bile acid in stool and the body will use more cholesterol to make bile acids- lower cholesterol in the blood)
73
Antihyperlipidemic bile acid sequestrants contraindications (2)
PKU (phenylketonuria)
Bowel obstruction
74
What is phenylketonuria?
Genetic disorder where you can't break down amino acids leading to brain damage
75
Antihyperlipidemic bile acid sequestrants adverse reactions (5)
Constipation
Headaches
Loss of appetite
Heartburn
Vitamin deficiencies
76
Caution with ____, ____, & ____ (antihyperlipidemic bile acid sequestrants)
Digoxin, warfarin, diuretics (effects absorption)
77
Drink plenty of fluids to _____ (pt. education antihyperlipidemic bile acid sequestrants)
Avoid constipation
78
Eat ____ foods to avoid constipation (pt. education antihyperlipidemic bile acid sequestrants)
High-fiber
79
What should powder antihyperlipidemic bile acid sequestrants be mixed with
Water or juice
80
Antihyperlipidemic bile acid sequestrants can be used along with ____
Statins
81
Take antihyperlipidemic bile acid sequestrants ___ after or ___ before a meal to avoid interference with absorption
1 hour after or 4-6 hours before
82
Some literature suggests antihyperlipidemic bile acid sequestrants raise ___ so monitor ___ & ___
Liver enzymes
Monitor ALT & AST
83
Long-term antihyperlipidemic bile acid sequestrants use may affect vitamin __, __, & __ absorption
Vit. A, D, K
Talk to MD about supplements
84
Antihyperlipidemic HMG-CoA inhibitors drug names (3)
Simvastatin (Zocor)
Atorvastatin (Lipitor)
Rosuvastatin (Crestor)
85
Reason for taking antihyperlipidemic HMG-CoA inhibitors
Hyperlipidemia
86
Action of antihyperlipidemic HMG-CoA inhibitors
Inhibits the HMG-CoA enzymes which help make cholesterol
(These drugs help lower total cholesterol, LDL, and triglyceride levels. Some effects on raising HDL
87
Antihyperlipidemic HMG-CoA inhibitors contraindications (3)
Grapefruit
Some cardiac drugs (Amio, Cardizem, & Verapamil)
Some antibiotics/antifungals
88
Antihyperlipidemic HMG-CoA inhibitors adverse reactions (4)
GI upset
Rashes
Muscle pain
Liver problems
89
What should be monitor with Antihyperlipidemic HMG-CoA inhibitors (9)
Total cholesterol
HDL & LDL
AST, ALT, & CPK
Vitamins A, D, & K
90
Report ___ with Antihyperlipidemic HMG-CoA inhibitors
Unusual muscle soreness
91
Check ___ regularly (Antihyperlipidemic HMG-CoA inhibitors pt. education)
Liver enzymes
92
Take Antihyperlipidemic HMG-CoA inhibitors with ___ or ___
Meals or 8 ounces of water
93
Antihyperlipidemic HMG-CoA inhibitors may interact with ___ & ___
Contraceptives & antibiotics
94
Report changes in ____ (Antihyperlipidemic HMG-CoA inhibitors pt. education)
Urine color
95
Take Antihyperlipidemic HMG-CoA inhibitors ___ before or ___ after a meal to avoid absorption issues.
1 hour before or 4 hours after
96
Patients on Antihyperlipidemic HMG-CoA inhibitors need to have a ____ & ___ plan
Diet & exercise plan
97
Assess ____ & ___ before & after administering (all cardiac medications)
Blood pressure & pulse
98
Assess for ____ before ambulating (all cardiac medications)
Orthostatic hypotension
99
Pt. may feel ___ with all BP medications
Fatigue
100
All cardiac medications can cause ___ or___
Low BP or low HR
101
Start ___ after discontinuing an epidural (all cardiac medications)
6 hours
102
Teach pt. how to ___ and when to call the MD. (all cardiac medications)
Obtain vitals
103
Change ____ & ___ (all cardiac medications)
Positions slowly & lifestyle (changes)
104
Avoid ____ , ___, & ____ (all cardiac medications)
Alcohol, hot baths, & hot tubs
105
If you miss a dose _____ (all cardiac medications)
Call your primary care doctor
106
Keep a journal with your ___ (all cardiac medications)
BP checks
107
May cause ___ (all cardiac medications)
Impotence
108
Take at night as it may cause ____(all cardiac medications)
Drowsiness
109
Alpha-1 blockers drug names (4)
doxazosin (Cardura)
prazosin (Minipres)
terazosin (Hytrin)
tamsulosin (Flowmax) (used in BPH)
110
Reason for taking alpha-1 blockers
Hypertension
111
Action of alpha-1 blockers
Dilates arterial & venous blood vessels by blocking alpha -1 receptors
112
Alpha -1 blockers contraindications (2)
Caution with other CNS depressants
Caution with MOAI's, kidney, or renal failure
113
Alpha -1 blockers adverse reactions (5)
First dose effect
Dizziness
Tachycardia
Headache
Nasal congestion
114
Monitor fo CNS depression with alpha -1 blockers because it blocks ___ and ___
Epinephrine & Norepinephrine
115
Alpha -1 blockers may take ___ before you see results
1 to 2 weeks
116
Alpha -1 blockers capsule is excreated in ___
Stool (teach pt)
117
Why does the MD need to be notified if a pt. on alpha -1 blockers is having cataract surgery?
Iris may not stay dilated
118
_____ causes smooth muscle relaxation in the bladder
Flomax
119
Ace inhibitor (most common & safest) drug names (2)
captopril (Capton)
enalapril (Vasotec)
120
Reason for taking Ace inhibitor
Hypertension
- especially in pt. with heart failure and DM
121
Action of ace inhibitors
Prevents the conversion of angiotensin I into angiotensin II in the lungs
122
If angiotensin II causes vasoconstriction & releases aldosterone, when we prevent that conversion, what happens?
Vasodilation & stops aldosterone = kidneys release NA & H2O = volume loss= decreases BP
123
Ace inhibitors adverse reactions (3)
Dry hacking cough
Angioedema
Hyperkalemia
124
When should the patient notify their doctor? (Ace inhibitors)
When you notice a chronic dry cough
125
What labs would you check for this medication? And why? (Ace inhibitors)
Serum potassium (heart uses less potassium = K+ stays in serum) and BUN, Creat
126
Take ace inhibitors __ before meals
1 hour
127
What foods need to be avoided and why? (Ace inhibitors)
Tomatoes, bananas, spinach, etc. (high in potassium), because Ace inhibitors decrease potassium usage
128
Why can ace inhibitors cause a change in taste?
NA release
129
How do ace inhibitors protect the kidneys?
Decreases GFR & Decreases proteinuria (elevated protein levels in kidney = blockages)
130
Angiotensinrenin blockers drug names (2)
Valsartan (Diovan)
Irbesartan (Avapro)
131
Reason for taking angiotensinrenin blockers
Hypertension (especially pt. who experience a cough with Ace inhibitors)
132
Action of angiotensinrenin blockers
Binds with angiotensin II receptors in smooth muscle and blocks vasoconstriction and aldosterone release (BV remains open and NA & H20 is lost)
Similar to ACE except skips the step in the lungs and instead works in the blood vessels, essentially preventing the cough
133
Angiotensinrenin blockers contraindications (2)
Pregnancy/breastfeeding
Renal/hepatic failure
134
Angiotensinrenin blockers adverse reactions (3)
Dry mouth
Dizzy
Hypoglycemia (role it plays in kidney)
135
Angiotensinrenin blockers caution if taking with ___ (role it plays in kidneys)
Digoxin
136
Which labs are important to monitor with angiotensinrenin blockers?
BUN, Create, AST/ALT, & Serum glucose
137
Beta blocker drug names (3)
metoprolol (Lopressor)
atenolol (Tenormin)
propranolol (Inderal)
138
Reason for taking beta-blockers (3)
Hypertension
Heart Failure
Angina r/t (MI)
139
Action of beta-blockers
Blocks beta receptors which decrease effects of epinephrine & norepinephrine
140
What do beta receptors do?
Increase HR, Increase Bp so if blocked = decrease HR & BP
141
Beta-blockers contraindications (3)
Heart blocks
Sick sinus syndrome (SA node not effective = HR slow followed by pauses and increase HR)
Bradycardia syndrome
142
Beta-blockers adverse reactions (3)
Rebound hypertension
Fatigue
Cold hands & feet
143
What do you check before administering beta-blockers?
Bp & apical pulse
144
Patient HR is 45 bpm, what should you do if anything (beta-blockers)?
Hold & notify MD for orders.
Rule <60 hold
145
Pt. should take beta-blockers at __
The same time everyday
146
Diabetics on beta blockers need to __, Why?
Monitor glucose
interferes with insulin production = lower BS
147
Calcium channel blockers drug name
Amlodipine (Norvasc)
148
Reason for taking amlodipine (3)
Hypertension
Heart Failure
Angina r/t (MI)
149
Action of amlodipine
Blocks calcium from entering cells causing blood vessels to relax
150
amlodipine adverse reactions (3)
Gingival hyperplasia (swollen gums)
Warm, flush skin
Prolonged Headaches
151
What lab would you monitor for amlodipine?
Serum calcium
152
When should pt. on amlodipine notify their MD?
If gums become swollen
153
Take amlodipine ___
As directed
154
Nitrates drug name
Nitroglycerin (NTG)
155
Reason for taking nitroglycerin
Acute angina
156
Action of nitroglycerin
Dilates blood vessels by relaxing smooth muscles
157
Nitroglycerin contraindications (4)
Anemia
Closed-angle glaucoma
Severe head injury
Use of erectile dysfunction medication (sildenafil) Viagra
158
Nitroglycerin adverse reactions (4)
Hypotension
Severe headache
Tachycardia
Skin irritation from topical
159
How is SL nitroglycerin administered?
Under the tongue, BP after 5 min, gives another, etc.
160
What do I educate my pt. when starting nitroglycerin?
Keep in cool, dark space, Keep a fresh supply on hand (no > 3 months old), Stop and sit immediately, One tablet under tongue, Then call EMS, Do not drive to hospital, Causes severe headache, Will feel tingling under tongue when fresh
161
What class of medication do I want to caution my male patients about taking with nitroglycerin?
Erectile Dysfunction, (sildenafil -fil)
162
Alpha 2 agonist drug name
clonidine (Catapres)
163
Reason for taking clonidine (2)
Hypertension & Opioid withdrawal
164
Action of clonidine
Stimulates alpha 2 receptors in the brain, which inhibits the release of epinephrine and norepinephrine.
*without epi = BV dilate*
165
Clonidine contraindications (3)
Acute HF
MAOI's (decreases effect of clonidine)
Severe liver disease
166
Clonidine adverse reactions (5)
Orthostatic hypotension
Fatigue
Dizziness
Rebound hypertension
Dry mouth
167
What causes rebound hypertension with clonidine?
If you stop taking this medication abruptly
168
Why is clonidine cautioned in the elderly?
Increase risk of orthostatic hypotension
169
What can pt. on clonidine do for dry mouth?
Frequent sips of water or sugarless gum
170
Cardiac glycoside drug names
Lanoxin (Digoxin)
171
Reason for taking Digoxin
Treats ventricular rhythms like atrial fibrillation
172
Action of Digoxin
Inhibits the sodium and potassium pump. This slows the impulse from the SA node to the AV node.
Also increases force of contraction.
173
Digoxin contraindications (2)
Low potassium levels & renal problems
174
Digoxin adverse reactions (3)
Vision changes
Dizziness
Headache
175
Give IV Digoxin over ___
5 minutes
176
What labs do you need to monitor with Digoxin?
Digoxin level (0.5 to 2 nanograms/mL), serum potassium (low, call MD first)
177
What is the concern if the potassium level is low? (Digoxin)
Increases risk of Dig toxicity
178
Pt. on Digoxin has confusion, seeing spots & halos, and a potassium level >5. What do you suspect is happening?
Dig toxicity
179
What are you going to prepare to administer for pt. with Dig toxicity?
Digoxin immune fab (Digifab)
180
Assess ___ before administering Digoxin? Hold for __
The apical pulse for a full minute.
Hold for HR <60
