Exam 3 Flashcards
What type of angina occurs during rest?
Variant (prinzmetal, vasospastic) angina
What is heart failure?
Its when the heart muscle weakens and enlarges, it loses its ability to pump blood through the heart and into the systemic circulation.
What are commonly used Statin’s?
atorvastatin calcium, fluvastatin sodium, lovastatin, pravastatin sodium, rosuvastatin calcium, simvastatin, pitavastatin
Loop diuretic drug
Furosemide (lasix)
What labs need to be monitored with calcium channel blockers?
Liver enzymes
Define badykinesia
slow movement
What type of diuretic is spironolactone?
potassium sparing diuretic. Does not deplete potassium!!
What is the most prevalent type of URI?
the common cold
Digoxin nursing interventions
check apical pulse rate before administering
check for peripheral & pulmonary edema
monitor digoxin levels & potassium
What labs do you monitor for heparin?
PTT
Explain the mechanisms of action of medication used to treat Parkinson’s disease.
DOPAMINE AGONISTS
stimulate dopamine receptors
Define antifungal drugs
agents that are used to treat fungal infections
What is Hypercapnia?
Increased carbon dioxide in the blood
What is COPD?
a restrictive pulmonary disease that is caused by airway obstruction with increased airway resistance of air flow to the lung tissue
What do Beta blocker drug names end in?
“LOL”
little old lady needs a beta blocker!
Define central nervous system
system that involves the brain and spinal cord that regulates body functions.
Metered-dose inhaler: Do you shake the inhaler before administering dose?
YES
What are statins used to treat?
High cholesterol
What type of angina occurs frequently with progressive severity unrelated to activity; unpredictable regarding stress/ exertion and intensity?
Unstable (preinfarction) angina
Define ADHD
thought to be caused by a dysregulation of the transmitters serotonin, epinephrine, and dopamine.
What lab values are monitored with hyperlipidemia?
Homocysteine, hsCRPs, LDL, HDL and triglycerides
Define nystagmus
constant, involuntary, cyclical movement of the eyeball.
Short acting nitrate drug name?
Nitroglycerin
What are signs and symptoms of hypokolemia?
Muscle weakness, leg cramps, cardiac dysrhythmias.
Define gingival hyperplasia
overgrowth of the gum tissues or reddened gums that bleed easily.
How long does it take to wean off of Beta blockers?
1-2 weeks
What can anticholinergic drugs help prevent in LRI?
bronchospasm
Which generation of antihistamines are not sedative?
second generation
Cardiac Glycoside Drug
Digoxin
What are expectorants?
agents that loosen bronchial secretions so they can be eliminated by coughing
True/False: Antiparkinsonism drugs can cause dark urine and perspiration to be dark as well.
TRUE!
PTT Cation
60-70
Define seizure threshold
level at which seizure may be induced
Digoxin + quinidine or fecainide or verapamil =
increased digoxin serum level
Thiazide side effects include:
dizziness, vertigo, weakness, nausea, vomiting, diarrhea, abdominal pain, hyperglycemia, constipation, rash, photo sensitivity, blurred vision
What is sudafed used for?
congestion!!
Thiazide adverse reactions include:
severe dehydration, hypotension, gout, severe potassium depletion, aplstic anemia, hemolytic anemia, thrombocytopenia, agranulocytosis, renal failure
Define restrictive lung disease
a decrease in total lung capacity as a result of fluid accumulation or loss of elasticity of the lung
Define convulsion
involuntary paroxysmal muscular contractions
pitavastatin brand name is
Livalo
Anti parkinsonism side effects
Anorexia, nausea, vomiting, dysphagia, fatigue, dizziness, headache, dry mouth, bitter taste, twitching, blurred vision, insomnia, dark urine
Explain the effects of stimulants on the central nervous system related to the increased release of specific neurotransmitters.
causes euphoria and alertness
What are antianginal drugs used for?
To treat angina pectoris
Define opportunistic infections
infections that occur in the immunocompromised or debilitated population
What labs should be monitored with ARBs?
potassium
Montelukast (singular) – Lower respiratory disorders
ADVERSE REACTIONS
Angioedema, bleeding, vasculitis, seizures, edema, anaphylaxis, suicidal ideation, stevens-johnson syndrome
ARB adverse reactions include:
Orthostatic hypotension, hypoglycemia, hyperkalemia, renal dysfunction
What is diazapam used for?
Seizures!
Determine nursing care for patients receiving prescribed medication that stimulates the central nervous system.
Monitoring weight, height and growth (for children).
Observe for withdrawal symptoms
Monitor for side effects
Loop diuretic adverse reactions?
severe dehydration, marked hypotension, hyperglycemia, gout, hearing loss, renal failure, thrombocytopenia, agranulocytosis
Define cluster headaches
Headaches that occur 1 to 3 times a day in a period lasting from about 2 weeks to 3 months.
Labs to monitor with ACE inhibitors
Potassium
Tiotropium (spiriva) – Lower respiratory disorders
ADVERSE REACTIONS
Anaphylaxis, dehydration, hyperglycemia, cardiac dysrhythmias, cardiac arrest, paradoxical bronchocontriction
True/ False: Tolerance to nitroglycerin can occur.
TRUE!
How long should you hold your breath for after administering a dose from a Metered-dose inhaler? Whats next?
Just a few seconds and exhale slowly through pursed lips.
Is benedryl an antihistamine?
YES!
Why diuretics are used to treat hypertension?
Because they promote sodium and water loss by blocking sodium and chloride reabsorption.
What is bronchospasm?
the result when the lung tissue is exposed to extrinsic or intrinsic factors that stimulate a bronchoconstrictive response.
What vital signs should be closely monitored with antianginals?
Blood pressure
What is the difference between cardio-selective and non cardio-selective beta blockers?
Cardio selective beta bockers act mainly on beta1 receptors & brochoconstriction is less likely to occur.
Adverse reactions of Nitroglycerin
Hypotension, reflex tachycardia, paradoxical bradycardia.
Define myathenia gravis
a chronic autoimmune neuromuscular disease that affects approximately 14 in 100000 persons.
How long do you wait if you need to administer a second dose from Metered-dose inhaler?
2 minutes
Define antitubercular drugs
agents that are used to treat tuberculosis
What are the dietary restrictions for a patient who is on Loop diuretics?
Patient needs to avoid licorice because it may increase potassium loss!
What labs do we monitor on patients taking thiazides
calcium, glucose, potassium, magnesium, sodium
What is the mode of action of nitrates?
Nitrates cause generalized vascular and coronary vasodilation which increases blood flow through the coronary arteries to the myocardial cells.
What are calcium channel blockers used for?
Treatment of stable and variant angina pectoris, certain dysrhythmias and hypertension
What is amiodarone used for?
Life threatening dysrhythmias
Explain the mechanisms of action of medication used to treat Parkinson’s disease
COMT INHIBITORS
inhibits the catechol O-methyltransferase enzyme that inactivates dopamine
Loop diuretic mode of action
inhibits sodium and water reabsorption from loop of Henle and distal renal tubules; can also excrete potassium, magnesium and calcium
What is alberatrol?
A beta blocker used to treat lower respiratory infections
Define muscle relaxants
relieve muscular spasms and pain associated with traumatic injuries and spasticity from chronic debilitating disorders
Side effects of Nitroglycerin
Nausea, vomiting, headache, blurred vision, dizziness, syncope, weakness, diaphoresis, flushing, confusion, pallor, rash, dry mouth, palpitations, tolerance
Define multiple sclerosis
an autoimmune disorder that attacks the myelin sheath of nerve fibers in the brain and spinal cord, causing lesions that are called plaques.
ACE inhibitors MAIN mode of action
Dilate venules and arterioles which improves renal blood flow and decreases blood fluid volume.
What are the five categories of diuretics that are effective in removing water and sodium?
Thiazides, Loop, Osmotic, Carbonic anyhydrase inhibitor, and Potassium sparing.
fluvastatin sodium brand name is
Lescol
Digibind onset is
30 minutes
Digoxin side effects
anorexia, nausea, vomiting, diarrhea, abdominal pain, headache, blurred vision, diplopia, photophobia, drowsiness, dizziness, fatigue, confusion
What is emphysema
a progressive lung disease caused by cigarette smoking or atmospheric contaminants.
What are the four classes of antidysrhythmic drugs?
Class I: Sodium channel blockers
Class II: Beta Blockers
Class III: Drugs that prolong repolarization
Class IV: Calcium channel blockers
True/ False: Patients can ingest alcohol while taking nitroglycerin.
FALSE!
Phenytoin therapeutic levels
10-20 mcg/mL
What are some dietary restrictions for a patient of ACE inhibitors
Avoid high potassium foods
Anticonvulsants half life
7-42 hours average is 24 hours
What are some dietary restrictions for the patient on ACE inhibitor’s?
Low sodium diet
What is the difference between beta blockers and anticholinergics used for lower respiratory infections?
Beta blockers open brochiole tubes while anticholinergics dry up!
What class of antidysrhthmic drug is amiodarone?
Class III
When giving Digoxin via IV what other equipment is important to have at patient bedside?
Cardiac monitor
What can ARB adverse reactions mask?
Hyperkolemia
Phenytoin side effects
headache diplopia confusion dizziness sluggish decreased coordination ataxia slurred speech rash anorexia nausea vomiting hypotension pink/red/brown discoloration of urine
Define fasciculations
involuntary muscle twitching
What is angina pectoris?
a condition of acute cardiac pain caused by inadequate blood flow to the myocardium due to either plaque occlusions within or spasms of the coronary arteries.
Digoxin + loop diuretics or thiazide diuretics =
increase risk of digoxin toxicity
What are side effects of statins?
Headache, rash/pruitus, constipation, diarrhea
Define HIV
virus causing an infection characterized by profound immuno-suppression
Montelukast (singular) – Lower respiratory disorders
SIDE EFFECTS
fever, headache, drowsiness, dizziness, fatigue, restlessness, insomnia, confusion, depression, nasal congestion, cough, core throat, dental pain, influenza, dyspepsia, nausea, vomiting, abdominal pain, weight loss, rash
atorvastatin calcium brand name is
Lipitor
Explain the mechanisms of action of medication used to treat Parkinson’s disease.
ANTICHOLINERGICS
block cholineergic receptors
Tiotropium (spiriva) – Lower respiratory disorders
SIDE EFFECTS
insomnia, dizziness, depression, headache, nausea, vomiting, abdominal pain, constipation, urinary retention, hyperglycemia, muscle cramping in extremities, peripheral edema, blurred vision, oral ulceration
What lab values should be monitored when on Antiplatelet therapy?
Platelets
Nursing process for Anticonvulsants
Assessment
Health history with current drugs and herbs being used
Check urinary output (needs to be >1500ML)
Determine lab values for BUN and creatinine and liver enzymes
Antihistamine mode of action?
compete with histamine receptor sites which prevent a histamine response
Side effects of calcium channel blockers?
Headache, hypotension, dizziness, and flushing of the skin
Define rhinorrhea
watery nasal discharge
What does peripheral refer to?
the extremities
Nursing process for Anticonvulsants
Patient teaching
No driving or performing other hazardous activities
Avoid alcohol
Advise not to abruptly stop but to rather gradually stop under medical supervision
Nursing process for Anticonvulsants
Interventions
monitor serum drug levels to determine therapeutic range (10-20 mcg/mL)
monitor CBC for early detection of blood dyscrasias
use precautions (environmental protection from sharp objects) for all patients at risk for seizures
watch nutritional intake
females need to use backup contraceptives
True/False: Metered-dose inhaler.
Breathe out through nose. Open mouth wide and hold inhaler 1-2 inches from mouth.
FALSE. Breath out through mouth**
What are peripheral vasodilators used for?
poor circulation, decrease edema
Define anticonvulsants
drugs that stabilize nerve cell membranes and suppress the abnormal electric impulses in the cerebral cortex.
Anti parkinsonism dietary restrictions
Administer with low protein foods – high protein foods can interfere with drug transport to CNS
What type of diet should patients taking thiazides be on?
High potassium
True/ False: For Amiodarone, the initial dose is usually greater and then it decreases over time.
TRUE!
What are some non-pharmacological measure to help the patient with heart failure
Limit salt intake to 2 g/day Decrease alcohol to one drink a day or completely avoid it No smoking Obese patients should diet Mild exercise
Digibind (digoxin antidote) mode of action is
binding with digoxin to form complex molecules which prohibits digoxin from attaching to cellular side of action
Define cholinergic crisis
an acute exacerbation of symptoms
If symptoms do not clear up after 3-5 days while on sudafed, what should you do?
call the doctor.
What medication is use for dysrhythmia?
Antidysrhythmias–
Beta1 blocker: cardioselective beta-adrenergic antagonis
Acebutotol HCl
What is Diltiazem (cardizem) used for?
to increase blood pressure
Furosemide (lasix)
ADVERSE REACTIONS
severe dehydration, marked hypotension, hyperglycemia, gout, hearing loss, renal failure, thrombocytopenia
What do anginal attacks usually lead to?
MI (heart attack)
Define analeptics
CNS stimulants that mostly affect the brain stem and spinal cord and sometimes the cerebral cortex
Define narcolepsy
falling asleep during normal waking activities such as driving a car or talking with someone.
Which generation of antihistamines are very sedative?
first generation
Adverse reaction of calcium channel blockers?
Reflex tachycardia & peripheral edema
How long do you wait to administer a steroid after administering a bronchdilater?
five minutes
Define miosis
abnormal pupil constriction
True/ False: Patient should take thiazides on an empty stomach.
FALSE!
How fast is Digoxin administered through IV?
give dose over 5 minute time span
What labs should be monitored for patients on Anticoagulant therapy?
PT, PTT, INR, Platelets
Can prednisone be immediately stopped?
No, it needs to be tapered and weaned off.
pravastatin sodium brand name is
Pravachol
Define seizure
abnormal electric discharges from the cerebral neurons
Can mannitol be given to patients who have heart failure or heart disease?
NO
If a patients heart rate is greater than 100, can you give alberatrol?
NO!
What is hypoxia?
Lack of oxygen to body tissues
Define migraine headaches
headaches that cause severe throbbing pain. Often preceded by an aura (visuals, smells, tingling, vertigo, warning)
Digoxin cation
0.8-2
What are some first generation drugs used to treat URI?
Benedryl
True/ False: All diuretics are potassium wasters.
FALSE!
What is Protamine Sulfate used for?
Antidote for heparin
Digoxin + antacids or colestipol =
decrease in digoxin absorption
Anti parkinsonism adverse reactions
involuntary movements, palpitations, orthostatic hypotension, urinary rentention, priapism, psychosis, severe depression with suicidal ideation, hallucinations, agranulocytosis, hemolytic anemia, thrombocytopenia, cardiac dysrhythmias, neuroleptic malignant syndrome
True/False: It is okay for patients to immediately discontinue antiparkinsonism drugs.
False; abruptly discontinuing these medications can lease to rebound parkinsonism
Signs & Symptoms of Digoxin Toxicity
Anorexia, diarrhea, nausea and vomiting, bradycardia, premature ventricular contractions, cardiac dysrhythmias, headache, malaise, blurred vision, visual illusions, confusion, and delirium.
Define dopamine agonists
agent that stimulates dopamine receptors
Long acting nitrate drug name?
Isosorbide dinitrate
What type of medication is commonly used to treat hyperlipidemia?
Statins
True/false: Metered-dose inhaler.
The medication canister is inserted into plastic mouthpiece
TRUE!
What are ACE inhibitors used for?
Heart failure
Explain the mechanisms of action of medication used to treat Parkinson’s disease.
MAO-B INHIBITORS
inhibits the monoamine oxidase b enzyme that interferes with dopamine
When are ARB’s used?
When a patient doe not respond to or tolerate an ACE inhibitor.
selegiline food restrictions
Avoid foods high in tyramine – aged cheese, yogurt, chocolate, bananas, red wine, cream, raisins
Hydantoins mode of action
reduces motor cortex activity by alerting ion transport
What type of angina occurs with predictable stress or exertion
Classic (stable) angina
What are the three types of Antianginal drugs?
Nitrates
Beta Blockers
Calcium channel blockers
True/ False: A patient does not need to check their pulse rate before administering digoxin.
FALSE!
What are 3 vitamins that lower homocysteine?
Vit b6, Vit b12, folic acid
What do ARB drugs usually end in?
“sartans”
What position do you place a patient in if hypotension results from SL nitroglycerin?
Supine position with legs elevated
Anticonvulsants drug name
Phenytoin (dilantin)
Anticonvulsants excretion
Small amounts in urine, moderate amounts in bile and feces
What is a sign of peripheral edema and poor circulation?
a cap refill greater than 3 seconds
Digoxin adverse reactions
Bradycardia, visual disturbances
What is pseudoparkinsonism?
an adverse reaction that occurs with antipsychotic drugs
What are adverse reactions of statins?
Rhabdomyolusis, myalgia, photosensitivity, hyperglycemia, elevated liver, enzymes.
Anticonvulsants adverse reactions
leukopenia hepatitis depression gingival hyperplasia nystagmus hirsutism osteoporosis aplastic anemia thrombocytopenia agranulocytosis stevens-johnsons syndrome hypotension ventricular fibrillation encephalopathy suicidal ideation
True/ False: It is important to advise the patient to avoid adverse drug interactions with digoxin by not taking OTC drugs without first consulting health care provider
TRUE!
What do beta blocker drugs usually end in
“lol”
What type of diuretic is hydrochlorothiazide?
Thiazide diuretic
What is the antidote for Coumadin?
Vitamin K
What are side effects of loop diuretics?
Nausea, diarrhea, electrolyte imbalances, vertigo, abdominal cramping, constipation, rash, headache, weakness, ECG changes, blurred vision, photo sensitivity, muscle cramping
Define dystonic movement
involuntary abnormal movement
True/False: Continuing to monitor pulse rate while on digoxin is part of the nursing process.
TRUE!
Furosemide (lasix)
SIDE EFFECTS
Nausea, diarrhea, electrolyte imbalances, vertigo, abdominal cramping, constipation, rash, headache, weakness, ECG changes, blurred vision, photosensitivity, muscle cramping
Which ACE inhibitors spares potassium?
Spironolactone
What are signs and symptoms of heart failure?
fatigue, shortness of breath, edema, decrease in physical activity
Define acute rhinitis
acute inflammation of the mucous membranes of the nose
What labs do you monitor for coumadin?
INR
Difference between digoxin & digitoxin
digoxin half life is 36 hours while digitoxin half life is 4-9 days,
What is thrombocytopenia?
low platelet count
Define Parkinsonism
a chronic neurologic disorder that affects the extrapyramidal motor tract
Digoxin therapeutic use
Treat heart failure, atrial fibrillation
Anticonvulsants excretion
Small amounts in urine, moderate amounts in bile and feces
What is important to teach patients about regarding transderm nitro patch?
Apply once a day, usually in the morning. Rotate skin sites and avoid hairy areas.
Furosemide (lasix) labs to monitor
potassium & urinary intake & output
ACE inhibitors other mode of action
Decrease the release of aldosterone which reduces sodium and fluid retention
What vital sign should be checked after administering peripheral vasodilators?
Assess pain level!!
lovastatin brand name is
Mevacor
What do ace inhibitor drugs usually end in?
“prils”
What does a vasodilator do?
opens up the veins!
rosuvastatin calcium brand name is
Crestor
What is a cardiac dysrhythmia?
any deviation from the normal rate or pattern of the heartbeat.
Digoxin mode of action
Inhibits sodium-potassium ATPase, promoting increased force of cardiac contraction, cardiac output, and tissue perfusion; decreases ventricular rate.
What are some second generation antihistamine drugs?
clariton, allegra, zyrtec
What type of diet does a patient need to be on while taking digoxin?
high potassium diet (fresh and dried fruits, fruit juices, and vegetables, including potatoes)
What are the three types of seizures?
Grand mal, petit mal, psychomotor
What is amicor used for?
Help stop bleeding
True/False: African Americans have more than twice the rate of heart failure as whites.
TRUE!
Labs to monitor with Digoxin?
Potassium, magnesium, calcium, digoxin toxicity
Define EEG (electroencephalogram)
a machine that records abnormal electric discharges of the cerebral cortex
Define anorexiants
appetite suppressants
True/false: Do a test spray before administering the metered dose of a new inhaler or when the inhaler has not been used recently.
TRUE!
Name the three types of angina
Classic (stable)
Unstable (preinfarction)
Variant (prinzmetal, vasospastic)
Define anoxia
absence of oxygen
What is dyskinesia
Impaired voluntary movement
What can albertrol help prevent?
Acute asthma
What is status epilepticus seizures?
rapid succession of epileptic seizures
What is Alzheimer’s disease
a chronic, progressive, neuro degenerative condition with marked cognitive dysfunction.
simvastatin brand name is
Zocor
INR Cation
2-3
How do we know if antidysrhythmics have been effective?
Comparing heart rate to baseline heart rate and assessing patient’s response to drug
Define amphetamines
Stimulate the release of neurotransmitters (norepinephrine and dopamine) from the brain and symphathetic nervous system
Which type of antianginal drugs are non effective against variant (prinzmetal, vasospastic) anginas?
Beta Blockers
What are some nursing interventions for patients on thiazides?
Observe for hypokolemia
Monitor patients weight daily
Watch urine output to determine fluid loss or retention.
Define idiopathic
of unknown cause
Define AIDS
immune disorder characterized by opportunistic diseases.
Are anticholinergic drugs used for acute asthma?
NO!
Define tolerance
a condition in which larger and larger doses of a drug are needed to reproduce the initial response.
Antidote for digoxin
Ovine, digibind
Explain the mechanisms of action of medication used to treat Parkinson’s disease.
DOPAMINE REPLACEMENTS
stimulate dopamine receptors
Why does an African American need to be given a diuretic with ACE inhibitors?
to prevent coughing and angidema (swelling of the face)
Digibind duration of action is
3-4 days
Common side effects of ACE inhibitors
constant, irritated cough, nausea, vomiting, diarrhea, headache, dizziness, fatigue, insomnia, hyperkalemia and tachycardia.
What are the therapeutic uses for calcium channel blockers?
Relax peripheral arterioles Decrease cardiac oxygen demand Decrease cardiac contractility Decrease afterload Decrease peripheral resistance Reduce the work load for the heart
When do we use osmotic diuretics?
to prevent kidney failure
to decrease intracranial pressure (ICP)
to decrease intraocular pressure (glaucoma)