Exam 3 Misc. Flashcards
Main point when treating patients with cardiac drugs
adequate cardiac output
Priority nursing diagnosis for cardiac drugs
ineffective tissue perfusion
Afterload
pressure the heart has to work against to get the blood out
- the higher the pressure, the less blood the L ventricle will get out
- causes decreased CO
Preload
amount of blood that gets to the right atrium from the superior vena cava
- increased preload= increased CO
- decreased preload= decreased CO
chronotropy
- “chrono” means time
- drugs effecting heart rate
- positive chronotropy means we make it faster
- negative chronotropy means we slow it down
Inotropy
- How forcefully it contracts
- Decrease in force is a decrease in CO
Dromotropy
- Speed of conduction
- increase in conduction speed= increase in HR and vice versa
What is the risk of an increased afterload?
Clots will form because too much blood is sitting
Drug that everyone is on in hospitals because of immobility
heparin
Heparin antidote
protamine sulfate
Normal PT values
10-14 sec
Normal PTT values
20-45 sec., Max 112 sec
Difference between heparin and enoxaparin
- Heparin is used to treat the problem, enoxaparine is used to prevent it
- enoxaparine is safer
Antidote to warfarin
Vitamin K
Blood tests for heparin and enoxaparin
PT and PTT
Blood tests for warfarin
INR
Problems with warfarin
dangerous drug, lots of toxicity and treatment failure
What should people take instead of ferrous sulfate and why?
ferrous gluconate, its much easier on the stomach
Patient teaching for ferrous sulfate/ iron
Take for 6 months- this is hot much time it takes for the body to store enough iron to meed daily requirements on its own
Vitamin B12 is used for…
Pernicious anemia
Sickle Cell anemia is common in which group
African Americans
Antianemic drug to treat Sickle Cell anemia
hydroxyurea - antineoplastic that increases fetal RBCs
Vasopressers
Nitroprusside and Hydralazine
-increase BP
First choice antihypertensives
ACE Inhibitors
Expected side effect with ACE inhibitors
-cough
ACE enzymes are also in the lungs so if we inhibit them, we get a cough
What do you do if ACE inhibitors cause cough?
put them on an ARB
How does high cholesterol affect afterload?
increases it
-too many lipids make thick blood and increase afterload or stick to vessels making diameter thinner
high cholesterol
> 200
Side effect of statins
Rhabdomyolysis- muscle tissue breaks up and all the contents of muscle cells spill out into systemic system
- lethal
- myoglobin would be present in systemic system
Normal triglycerides
150
Normal digoxin level
between 0.8 and 2
Digoxin’s effect on the tropys
negative chronotropy, positive inotropy, negative dromotropy
s/s of dig toxicity
vision problems, confusion, vomiting, diarrhea
digoxin antidote
Dig Immune Fab- binds to digoxin and doesn’t allow it to do its job
anti-arrhythmics and tropys
all anti-arrythmics decrease all three: negative chrono-, ino- and dromotropy
Side effects of nitrates
raging headaches
leading cause of death in the western world
CAD
Functions of good lipids
need lipids for steroids, hormones, helps us use vitamin D, involved in absorption of fat soluble vitamins
Desired cholesterol values
Total Chol
What do we give when people can’t tolerate statins
bile acid sequestrants because they bypass the liver and metabolize in the stomach
Problem with bile acid sequestrants
- causes decreased fat-soluble vitamin absorption
- GI distress
Can you control cholesterol with diet?
Kind of, but our bodies still make it, so its also genetic
When should statins be given?
at night- that’s when our bodies make cholesterol
s/s of Rhabdo
- bloody urine, muscle pain, weakness, kidney failure
- labs: urinalysis, BUN, creatinine, I&O, liver enzymes
Cholesterol absorption inhibitors
- decreases absorption in the brush border
- used with statins when statins aren’t working
- works in the intestines so its good for people with liver probs
Fibrates
-triglyceride and lipoprotein destruction
side effect of fibrates
pancreatitis- severe abdominal pain and vomiting
Can you eat perfectly healthy and still have hyperlipidemia?
Yes
most common reason for use of warfarin
AFib (lots of blood in the atrium bc its not strong enough to push out)
anti-hemophilic agents
replace the missing factor (blood products- take someone’s blood and just keep the factor)
hemophillia
genetically inherited lack of one of the factors in the coagulation cascade
Hemophillia A is lacking which factor?
8
Hemophillia B is lacking which factor?
9
How do we prevent reactions to blood products?
premedicate with benedryl and tylenol
Hemostatic agents
- Amicar
- Stops bleeding
Side effect of Amicar
clotting
First intervention for bleeding
apply pressure
How do we check for anemia
Look at CBC for:
hemoglobin: 12-18
hematocrit: 28-54
RBCs: 4-6
How do we check for megaloblastic anemia
MCV- mean corpuscular volume
Problem with microcytic RBCs
can’t carry much O2 so we have a problem with oxygenation
Problem with macrocytic RBCs
too big and don’t know how to do their job
Side effect of erythropoiesis stimulating agents
bone pain and risk of cancer development
Side effects of iron therapy
GI effects and skin/teeth stains
Iron antidote
- give something that will bind to it like milk and eggs
- Desperol
End organ damage can be caused by
hypertension
-can happen in kidneys, heart, eyes (retina) and there is no pain
In emergency if CO is low…
- give a med or O2 bc not enough is getting to the brain
- put them in Trendelenburg position
- Give fluids
In emergency if CO is too high…
- decrease fluids
- teach compliance
- teach lifestyle change
- put on fall risk
- avoid anything that stresses the heart or changes BP
What does H2 do?
makes acid in the stomach
H2 blockers suffix
-dine
Contraindications for H2 receptor antagonists
- long term needs
- metabolized by CYP450 so drugs and food can increase or decrease effects
Side effect of long-term use of ulcer meds
alkalosis
Contraindications of antacids/ aluminum salts
- any condition that can be axacerbated by electrolyte imbalance
- GI obstruction (Mg is a laxative- they could get megacolon and it could burst)
- anything with “salt” in the name will interact with other drugs and have absorption problems with other foods
Adverse effects of antacids
- rebound acidity
- alkalosis
- hypercalcemia
- constipation or diarrhea
- hypophosphatemia
How to know if your patient is hypercalcemic
muscle twitching and spasms
Adverse effects of proton pump inhibitors
- c. dif infection
- increased bone loss
- long term use could lead to increased risk of gastric carcinoma
probelm with PPIs
they are worse than H2s and antacids because they take down the acid to almost nothing
adverse effects of GI protectant agents
- constipation, diarrhea, nausea, indigestion, gastric discomfort, dry mouth
- not systemic so its very safe
patient teaching for GI protectant agents
give on an empty stomach bc if it binds with food it wont find the ulcer
Adverse effects of prostaglandins
GU effects- miscarriages, excessive bleeding, spotting, cramping, hypermenorrhea, dysmenorrhea, and other menstrual disorders
Major assessment before giving prostaglandins
pregnancy test
adverse effects of saliva enzymes
complications from abnormal electrolytes- increased Mg, Na, or K (K would be the most concerning)
adverse effects of pancreatic enzymes
GI irritation, nausea, abdominal cramps, diarrhea
Nursing consideration for pancreatic enzymes
give with meals bc they need it to digest the meal
adverse effects of laxatives
- GI: diarrhea, abdominal cramping, nausea
- CNS: dizziness, headache, weakness
- CV: sweating, palpitations, flushing, fainting
- Cathardic dependency
- Uterine contractions
adverse effects of GI stimulants
- nausea, vomiting, diarrhea
- intestinal spasms, cramps, decreased BP and HR, weakness, fatigue
- extrapyramidal effects (from blocking dopamine)
- Tortacholis- when you twist head and something hurts but this case is constant
- Akathsisia- need to be in motion (restless leg syndrome)
- parkinsons symptoms
- (nasty drug with awful side effects)
adverse effects of antidiarrheals
constipation, abdominal distension, abdominal discomfort, nausea, dry mouth, toxic megacolon
contraindications of antidirrheals
obstruction and poisoning
adverse effects of antiemetics: phenothiazines
- drowsiness
- red/brown urine
- sun sensitivity
adverse effects of serotonin 5-HT3 receptor blockers
headache, drowsiness, myalgia, urinary retention, constipation
-great drug, not many side effects
nursing considerations for thiazide diuretics
-they are sulfa based- don’t give to people with sulfa allergies
-tell them not to stop drinking fluids… even if they stop they will bet rebound fluid bc their body thinks it needs to make more and it will stimulate ADH
(pt could be dehydrated but aldosterone will compensate and they will still pee)
adverse effects of thiazide diuretics
- hypokalemia
- decreased Ca+ excretion
- altered blood glucose
- causes you to have to pee all the time
- *Not a good drug for a diabetic
Contraindications for thiazide drugs
- sulfa or thiazide allergy
- fluid and electrolyte imbalance
- don’t take with lithium (too much salt), NSAIDs, ACE inhibitors
- Don’t take with Digoxin- potassium is falling
contraindications of loop diuretics
- elecrolyte depletion (hold if Na+ and K+ are low)
- Anuria
adverse effects of loop diuretics
- effects related to electrolyte imbalance
- hypokalemia
- alkalosis*
- hypocalcemia
- hearing loss (usually reversible, discontinue drug)
antidote to furosemide toxicity
Give water, K+, and Na+
contraindications of carbonic anhydrase inhibitors
- angle closure glaucoma (the pressure cannot drain)
- metabolic acidosis
- hypokalemia
- parasthesias (numbness and tingling and pain) of extremeits, confusion, drowsiness
drug interactions of carbonic anhydrase inhibitors
- salycilates (aspirin)- decreases excretion and drug will become toxic
- Lithium
- Sulfonamides (could cause SJS or TENS)
contraindications of potassium sparing drugs
hyperkalemia, renal disease, anuria
adverse effects of potassium sparing drugs
hyperkalemia
Drug interactions with potassium sparing drugs
Aspirin causes aldactone not to be as effective
contraindications of osmotic diuretics
- renal disease and anuria
- pulmonary congestion
- intracranial bleeding
- dehydration
- CHF
adverse effects of osmotic diuretics
- effects related to sudden drop in fluid levels (s/s of shock)
- nausea, vomiting, hypotension, light-headedness, confusion, headache
What to include in assessment of patient taking diuretics
edema, weight, strict I&O, BUN and creatinine (bc contraindicated if kidneys aren’t working well
When do we want/ not want patients to eat potassium rich foods
- want them to eat with loop and thiazide
- don’t want them to eat with potassium sparing
Foods high in K+
leafy greens, bananas, pickles, peaches
s/s of UTI gone to the kidneys
chills, fever, flank pain, tenderness (associated with pyelonephritis, which leads to shock)
contraindications to urinary tract anti-infectives
-allergies!! more intense reactions with antibiotics
most common infection for female UTI
e. Coli
most common infection for male UTI
gonorrhea or chlamydia
contraindications of urinary tract antispasmotics
glaucoma, myasthenia gravis, GI obstruction, acute hemorrhave
adverse effects of urinary tract antispasmotics
related to blocking parasympathetic system
adverse effects of urinary tract analgesias
reddish-orange coloring of the urine
contraindications of bladder protectants
conditions that involve risk of bleeding
adverse effects of bladder protectants
bleeding that may progress to hemorrhage
adverse effects of alpha adrenergic blockers for BPH
- postural dizziness
- lethargy
- tachycardia
- hypotension
- sexual dysfunction
adverse effects of testosterone blockers
decreased libido
impotence
