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Pharm > Exam 3 Misc. > Flashcards

Exam 3 Misc. Flashcards

1
Q

Main point when treating patients with cardiac drugs

A

adequate cardiac output

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2
Q

Priority nursing diagnosis for cardiac drugs

A

ineffective tissue perfusion

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3
Q

Afterload

A

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
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4
Q

Preload

A

amount of blood that gets to the right atrium from the superior vena cava

  • increased preload= increased CO
  • decreased preload= decreased CO
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5
Q

chronotropy

A
  • “chrono” means time
  • drugs effecting heart rate
  • positive chronotropy means we make it faster
  • negative chronotropy means we slow it down
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6
Q

Inotropy

A
  • How forcefully it contracts

- Decrease in force is a decrease in CO

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7
Q

Dromotropy

A
  • Speed of conduction

- increase in conduction speed= increase in HR and vice versa

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8
Q

What is the risk of an increased afterload?

A

Clots will form because too much blood is sitting

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9
Q

Drug that everyone is on in hospitals because of immobility

A

heparin

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10
Q

Heparin antidote

A

protamine sulfate

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11
Q

Normal PT values

A

10-14 sec

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12
Q

Normal PTT values

A

20-45 sec., Max 112 sec

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13
Q

Difference between heparin and enoxaparin

A
  • Heparin is used to treat the problem, enoxaparine is used to prevent it
  • enoxaparine is safer
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14
Q

Antidote to warfarin

A

Vitamin K

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15
Q

Blood tests for heparin and enoxaparin

A

PT and PTT

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16
Q

Blood tests for warfarin

A

INR

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17
Q

Problems with warfarin

A

dangerous drug, lots of toxicity and treatment failure

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18
Q

What should people take instead of ferrous sulfate and why?

A

ferrous gluconate, its much easier on the stomach

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19
Q

Patient teaching for ferrous sulfate/ iron

A

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

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20
Q

Vitamin B12 is used for…

A

Pernicious anemia

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21
Q

Sickle Cell anemia is common in which group

A

African Americans

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22
Q

Antianemic drug to treat Sickle Cell anemia

A

hydroxyurea - antineoplastic that increases fetal RBCs

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23
Q

Vasopressers

A

Nitroprusside and Hydralazine

-increase BP

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24
Q

First choice antihypertensives

A

ACE Inhibitors

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25
Q

Expected side effect with ACE inhibitors

A

-cough

ACE enzymes are also in the lungs so if we inhibit them, we get a cough

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26
Q

What do you do if ACE inhibitors cause cough?

A

put them on an ARB

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27
Q

How does high cholesterol affect afterload?

A

increases it

-too many lipids make thick blood and increase afterload or stick to vessels making diameter thinner

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28
Q

high cholesterol

A

> 200

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29
Q

Side effect of statins

A

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
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30
Q

Normal triglycerides

A

150

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31
Q

Normal digoxin level

A

between 0.8 and 2

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32
Q

Digoxin’s effect on the tropys

A

negative chronotropy, positive inotropy, negative dromotropy

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33
Q

s/s of dig toxicity

A

vision problems, confusion, vomiting, diarrhea

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34
Q

digoxin antidote

A

Dig Immune Fab- binds to digoxin and doesn’t allow it to do its job

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35
Q

anti-arrhythmics and tropys

A

all anti-arrythmics decrease all three: negative chrono-, ino- and dromotropy

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36
Q

Side effects of nitrates

A

raging headaches

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37
Q

leading cause of death in the western world

A

CAD

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38
Q

Functions of good lipids

A

need lipids for steroids, hormones, helps us use vitamin D, involved in absorption of fat soluble vitamins

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39
Q

Desired cholesterol values

A

Total Chol

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40
Q

What do we give when people can’t tolerate statins

A

bile acid sequestrants because they bypass the liver and metabolize in the stomach

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41
Q

Problem with bile acid sequestrants

A
  • causes decreased fat-soluble vitamin absorption

- GI distress

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42
Q

Can you control cholesterol with diet?

A

Kind of, but our bodies still make it, so its also genetic

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43
Q

When should statins be given?

A

at night- that’s when our bodies make cholesterol

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44
Q

s/s of Rhabdo

A
  • bloody urine, muscle pain, weakness, kidney failure

- labs: urinalysis, BUN, creatinine, I&O, liver enzymes

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45
Q

Cholesterol absorption inhibitors

A
  • 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
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46
Q

Fibrates

A

-triglyceride and lipoprotein destruction

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47
Q

side effect of fibrates

A

pancreatitis- severe abdominal pain and vomiting

48
Q

Can you eat perfectly healthy and still have hyperlipidemia?

A

Yes

49
Q

most common reason for use of warfarin

A

AFib (lots of blood in the atrium bc its not strong enough to push out)

50
Q

anti-hemophilic agents

A

replace the missing factor (blood products- take someone’s blood and just keep the factor)

51
Q

hemophillia

A

genetically inherited lack of one of the factors in the coagulation cascade

52
Q

Hemophillia A is lacking which factor?

A

8

53
Q

Hemophillia B is lacking which factor?

A

9

54
Q

How do we prevent reactions to blood products?

A

premedicate with benedryl and tylenol

55
Q

Hemostatic agents

A
  • Amicar

- Stops bleeding

56
Q

Side effect of Amicar

A

clotting

57
Q

First intervention for bleeding

A

apply pressure

58
Q

How do we check for anemia

A

Look at CBC for:
hemoglobin: 12-18
hematocrit: 28-54
RBCs: 4-6

59
Q

How do we check for megaloblastic anemia

A

MCV- mean corpuscular volume

60
Q

Problem with microcytic RBCs

A

can’t carry much O2 so we have a problem with oxygenation

61
Q

Problem with macrocytic RBCs

A

too big and don’t know how to do their job

62
Q

Side effect of erythropoiesis stimulating agents

A

bone pain and risk of cancer development

63
Q

Side effects of iron therapy

A

GI effects and skin/teeth stains

64
Q

Iron antidote

A
  • give something that will bind to it like milk and eggs

- Desperol

65
Q

End organ damage can be caused by

A

hypertension

-can happen in kidneys, heart, eyes (retina) and there is no pain

66
Q

In emergency if CO is low…

A
  • give a med or O2 bc not enough is getting to the brain
  • put them in Trendelenburg position
  • Give fluids
67
Q

In emergency if CO is too high…

A
  • decrease fluids
  • teach compliance
  • teach lifestyle change
  • put on fall risk
  • avoid anything that stresses the heart or changes BP
68
Q

What does H2 do?

A

makes acid in the stomach

69
Q

H2 blockers suffix

A

-dine

70
Q

Contraindications for H2 receptor antagonists

A
  • long term needs

- metabolized by CYP450 so drugs and food can increase or decrease effects

71
Q

Side effect of long-term use of ulcer meds

A

alkalosis

72
Q

Contraindications of antacids/ aluminum salts

A
  • 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
73
Q

Adverse effects of antacids

A
  • rebound acidity
  • alkalosis
  • hypercalcemia
  • constipation or diarrhea
  • hypophosphatemia
74
Q

How to know if your patient is hypercalcemic

A

muscle twitching and spasms

75
Q

Adverse effects of proton pump inhibitors

A
  • c. dif infection
  • increased bone loss
  • long term use could lead to increased risk of gastric carcinoma
76
Q

probelm with PPIs

A

they are worse than H2s and antacids because they take down the acid to almost nothing

77
Q

adverse effects of GI protectant agents

A
  • constipation, diarrhea, nausea, indigestion, gastric discomfort, dry mouth
  • not systemic so its very safe
78
Q

patient teaching for GI protectant agents

A

give on an empty stomach bc if it binds with food it wont find the ulcer

79
Q

Adverse effects of prostaglandins

A

GU effects- miscarriages, excessive bleeding, spotting, cramping, hypermenorrhea, dysmenorrhea, and other menstrual disorders

80
Q

Major assessment before giving prostaglandins

A

pregnancy test

81
Q

adverse effects of saliva enzymes

A

complications from abnormal electrolytes- increased Mg, Na, or K (K would be the most concerning)

82
Q

adverse effects of pancreatic enzymes

A

GI irritation, nausea, abdominal cramps, diarrhea

83
Q

Nursing consideration for pancreatic enzymes

A

give with meals bc they need it to digest the meal

84
Q

adverse effects of laxatives

A
  • GI: diarrhea, abdominal cramping, nausea
  • CNS: dizziness, headache, weakness
  • CV: sweating, palpitations, flushing, fainting
  • Cathardic dependency
  • Uterine contractions
85
Q

adverse effects of GI stimulants

A
  • 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)
86
Q

adverse effects of antidiarrheals

A

constipation, abdominal distension, abdominal discomfort, nausea, dry mouth, toxic megacolon

87
Q

contraindications of antidirrheals

A

obstruction and poisoning

88
Q

adverse effects of antiemetics: phenothiazines

A
  • drowsiness
  • red/brown urine
  • sun sensitivity
89
Q

adverse effects of serotonin 5-HT3 receptor blockers

A

headache, drowsiness, myalgia, urinary retention, constipation
-great drug, not many side effects

90
Q

nursing considerations for thiazide diuretics

A

-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)

91
Q

adverse effects of thiazide diuretics

A
  • hypokalemia
  • decreased Ca+ excretion
  • altered blood glucose
  • causes you to have to pee all the time
  • *Not a good drug for a diabetic
92
Q

Contraindications for thiazide drugs

A
  • 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
93
Q

contraindications of loop diuretics

A
  • elecrolyte depletion (hold if Na+ and K+ are low)

- Anuria

94
Q

adverse effects of loop diuretics

A
  • effects related to electrolyte imbalance
  • hypokalemia
  • alkalosis*
  • hypocalcemia
  • hearing loss (usually reversible, discontinue drug)
95
Q

antidote to furosemide toxicity

A

Give water, K+, and Na+

96
Q

contraindications of carbonic anhydrase inhibitors

A
  • angle closure glaucoma (the pressure cannot drain)
  • metabolic acidosis
  • hypokalemia
  • parasthesias (numbness and tingling and pain) of extremeits, confusion, drowsiness
97
Q

drug interactions of carbonic anhydrase inhibitors

A
  • salycilates (aspirin)- decreases excretion and drug will become toxic
  • Lithium
  • Sulfonamides (could cause SJS or TENS)
98
Q

contraindications of potassium sparing drugs

A

hyperkalemia, renal disease, anuria

99
Q

adverse effects of potassium sparing drugs

A

hyperkalemia

100
Q

Drug interactions with potassium sparing drugs

A

Aspirin causes aldactone not to be as effective

101
Q

contraindications of osmotic diuretics

A
  • renal disease and anuria
  • pulmonary congestion
  • intracranial bleeding
  • dehydration
  • CHF
102
Q

adverse effects of osmotic diuretics

A
  • effects related to sudden drop in fluid levels (s/s of shock)
  • nausea, vomiting, hypotension, light-headedness, confusion, headache
103
Q

What to include in assessment of patient taking diuretics

A

edema, weight, strict I&O, BUN and creatinine (bc contraindicated if kidneys aren’t working well

104
Q

When do we want/ not want patients to eat potassium rich foods

A
  • want them to eat with loop and thiazide

- don’t want them to eat with potassium sparing

105
Q

Foods high in K+

A

leafy greens, bananas, pickles, peaches

106
Q

s/s of UTI gone to the kidneys

A

chills, fever, flank pain, tenderness (associated with pyelonephritis, which leads to shock)

107
Q

contraindications to urinary tract anti-infectives

A

-allergies!! more intense reactions with antibiotics

108
Q

most common infection for female UTI

A

e. Coli

109
Q

most common infection for male UTI

A

gonorrhea or chlamydia

110
Q

contraindications of urinary tract antispasmotics

A

glaucoma, myasthenia gravis, GI obstruction, acute hemorrhave

111
Q

adverse effects of urinary tract antispasmotics

A

related to blocking parasympathetic system

112
Q

adverse effects of urinary tract analgesias

A

reddish-orange coloring of the urine

113
Q

contraindications of bladder protectants

A

conditions that involve risk of bleeding

114
Q

adverse effects of bladder protectants

A

bleeding that may progress to hemorrhage

115
Q

adverse effects of alpha adrenergic blockers for BPH

A
  • postural dizziness
  • lethargy
  • tachycardia
  • hypotension
  • sexual dysfunction
116
Q

adverse effects of testosterone blockers

A

decreased libido

impotence

Pharm (20 decks)

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