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NUR 3180 PHARM > Exam 3 Study Guide > Flashcards

Exam 3 Study Guide Flashcards

1
Q

ACE

A

(adverse effects)
A = Angioedema
C = Cough
E = Elevated Potassium

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2
Q

Treatment of Atrial Fibrillation

A
  • Goal HR: <110bpm
    > Amiodarone
    > Metoprolol
    > Diltiazem
  • Anticoagulant
    > Warfarin
    > Rivaroxaban
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3
Q

Anticoagulant Drugs - Evaluation

therapeutic response
AEs
teaching

A
  • Therapeutic Response: absence of blood clots, restored perfusion
  • AEs: s/s bleeding (most important)
  • Teaching (was it effective?)
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4
Q

Antiemetic Agents

teaching
evaluation
lifespan

A
  • Teach
    > timing of admin
    > do not operate heavy machinery
  • Evaluation:
    > therapeutic effects: absence of nausea and/or vomiting
    > document response to intervention
    > AEs: drowsiness, dizziness, cardiovascular
  • Lifespan Older Adults:
    > polypharmacy, anticholinergic effects, CNS effects - falls
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5
Q

HTN Medication

A
  • Hydrochlorothiazide (diuretic)
  • Lisinopril
  • Losartan
  • Metoprolol
  • Diltiazem
  • Nitroprusside
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6
Q

Renal Functions

5

A
  • Maintenance of volume & composition of body fluids
    > sodium regulation
  • Blood pressure control
    > RAAS
  • Electrolyte stability (K+)
  • Regulation of RBC production (erythropoietin)
  • Regulation acid-base
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7
Q

Admin Considerations for Antihypertensive Drugs (acute care)

A
  • Take BP prior to admin! (all drugs can cause hypotension)
  • If dosed once daily, give in AM
    > do NOT split, crush, or chew ER or XL tabs
  • Do not abruptly discontinue (esp. adrenergic blocking agents)
    > risk for reflex HTN
  • IV push meds: admin over a minimum of 2 mins/tele monitor
  • PRN meds require a evaluation
    > IVP: recheck BP in 5-10mins
    > PO: recheck BP in 1hr
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8
Q

Acute Acetaminophen Overdose

A
  • Leads to acute liver failure: N/V, jaundice, malaise, confusion
  • Treat: acetylcysteine (use w/in 24hrs of toxicity)
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9
Q

Laxatives

AEs
therapeutic effect

A
  • Monitor for AE
    > loose stools (hold next dose)
    > N/V
    > abd pain
    > dehydration
    > electrolyte loss (K, Na, Mg, Cl)
  • Monitor for therapeutic effect
    > achievement of a soft BM w/in 24hrs of admin
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10
Q

Isotonic IV Fluids

function
indications
AEs
EXs

A
  • Expands vascular fluid vol w/ no shifts in compartments
  • Indications:
    > isotonic fluid vol deficient (hydration)
    > expands vol (ECF) to correct hypotension
  • AEs: fluid overload
  • EX:
    > Normal Saline (0.9% NaCl)
    > Lactated Ringers (LR)
    > 5% Dextrose in water (D5W)
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11
Q

Epoetin Alfa (Procrit)

Class
MOA
Indications
Contraindication
AEs
Nursing

A

- Class: Erythropoiesis-Stimulating Agent
- MOA: erythropoietin factor controlling rate of RBC production
- Indications: disorders of RBC formation to dcr need for blood transfusions; renal failure, antineoplastic treatments
- Contraindication: caution in CHF
- AE: fatigue, bone pain, edema, HTN (DVT, CVA, MI have occurred)
- Nursing: monitor CBC weekly (dose depends on HgB & indication), monitor BP; goal HgB >10; hold if HgB >11

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12
Q

Nurse Teaching - Nitroglycerin

A
  • No relief after 2nd dose; call 911
  • Med must be stored in a dry, dark place; keep in dark glass container
  • Refill med when it is near expiration date
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13
Q

General Cosiderations - Antidysrhythmic Drugs

AEs
d-d
contra

A
  • All have potential AEs:
    > bradycardia, heart blocks, arrhythmias, & hypotension
    (greater risk w/ IV admin: tele & BP monitor)
  • Drug-Drug: antidysrhythmic & antihypertensives
  • Contraindications: bradycardia, hypotension, heart block
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14
Q

Sodium Bicarbonate

class
MOA
indications
route
AEs
nursing

A
  • Class: Antacids
  • MOA: neutralize stomach acid by direct chemical reaction
  • Indications: relief of upset stomach r/t hyperacidity
  • Route: PO rapid onset, short duration, give PRN to treat symptoms
    > also used IV for metbolic acidosis & cardiac emerg (more severe AE profile & urgent nursing)
  • AEs:
    > gastric rebound
    > belching
    > fluid retention
    > hypokalemia
    > metabolic alkalosis (headache, confusion, irritability, nausea, weakness, tetany; if OD)
  • Nursing: give other meds 1-2hrs after oral antacids; chew tab & give w/ 8oz water; don’t take w/ milk; teach: not to take >2wks; OTC
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15
Q

Laxatives

indications
actions
assessment

A
  • Indicated for treatment/prevention of constipation
  • Actions:
    > soften stool
    > incr peristalsis
  • Assessment:
    > baseline hx & physical including allergies & meds
    > focused assessment: bowel sounds, I&Os, electrolytes
    > contraindicated in acute bowel disorders such as ileus, obstructions, ischemia, perforation
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16
Q

Mannitol

Class
MOA
Indications
Route/Dose
Contra
AEs
Nursing

A
  • Class: Osmotic Diuretics
  • MOA: incrs osmolarity of glomerular filtrate (sugar molecule); inhibits reabsorption of water & incrs urinary output; profound & rapid diuresis
  • Indications: reduce intracranial pressure of cerebral edema, acute renal failure, elecated intraocular pressure
  • Route/Dose: IV only (must use filter)
  • Contra: can worsen edema; used w/ caution in pulm edema, renal failure, CHF, stroke…exacerbated by large shifts in fluid
  • AEs: fluid & electrolyte imbalances, infusion site reactions, CHF, pulm edema, rebound cerebral edema
  • Nursing: monitor VS, electrolytes, ICP (if appropriate) closely
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17
Q

Aspirin (ASA)

Class
MOA
Indications
Dose
AE
Nursing

A
  • Class: Antiplatelet Agent/Salicylate
  • MOA: inhibit platelet aggregation (COX inhibitor)
  • Indications: prevention of MI, TIA, ischemic CVA in high-risk pops (primary or secondary prevention)
  • Dose: 81-325mg PO daily (81mg is “baby aspirin”)
  • AE: GI irritation (N/V, epigastric pain), bleeding; GI bleeding, hematuria, easy bruising, tinnitus (w/ toxicity)
  • Nursing: take as directed, take w/ food, hold 1wk prior to procedure, monitor for s/s GI bleed (dark/bloody stools)
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18
Q

Hepatic Encephalopathy

A
  • Liver cirrhosis, incrd ammonia lvls
  • Treat: lactulose
    > excretes ammonia in stool
    > loose stools are expected therapuetic effect
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19
Q

Initial Management Anticoagulant Overdose

assessment
interventions

A
  • Assessment:
    > CMs of bleeding & VS (HR/BP/O2 sat)
  • Interventions:
    > stop mediation (infusion)
    > notify provider
    > draw labs as ordered: H/H (bleeding), platelets (bleeding, HIT), clotting time (PT/INR, aPTT, anti-Xa)
    > admin fluids (NS) and/or packed RBCs as ordered
    > admin reversal agent as ordered
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20
Q

Nursing Actions - Nitroglycerin

A
  • May admin 1 dose q5mins up to 3 doses
    > if no relief after 2nd dose, assume MI & call rapid response
  • Monitor BP afer admin
  • High fall risk
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21
Q

Herbals to Avoid with Warfarin

A
  • Dcr Effect:
    > St. John’s wort
  • Incr Effect:
    > garlic
    > gingko
    > ginger root
    > chamomile
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22
Q

Diltiazem (Cardizem)

Class
MOA
Indication
Route
AEs
Nurisng

A
  • Class: Calcium-Channel Blocker
  • MOA: inhibits flow of calcium ions into myocardial cells & vascular smooth muscle; slows HR, lowers BP
  • Indication: HTN, A-fib, A-flutter, supraventricular tachycardias
  • Route: maintenance; oral, acute; IV infusion
  • AEs: hypotension, bradycardia/heart block, peripheral edema
  • Nursing: avoid grapefruite juice (incr lvls)
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23
Q

Angina Medications

A
  • Nitroglycerin (acute tx)
  • Diltiazem (chronic)
  • Metoprolol (chronic)
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24
Q

Antiarrhythmic & Antihypertensive Drugs - Asssessment

care plan

A
  • Physical assessment w/ focus CV, resp, & neuro assessments
  • Labs: electrolytes, kidney & liver func
  • Assess cardiac rhythm (if on monitor)
  • Always assess HR & BP prior to admin in acute care
    > hold parameters
  • BP parameters (general)
    > High: >180 SBP and/or >110 DBP = call MD
    > Low: <90 SBP and/or <60 DBP = hold & call MD
  • HR parametrs (general)
    > hold if HR <60bpm
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25
Q

Antiarrhythmic & Antihypertensive Drugs - Evaluation

care plan

A
  • Therapeutic response (depends on indication/MOA)
    > BP goal for most pts: SBP < 140 & DBP <90; multiple antihypertensive may be needed to achieve goal
    > HR goal for A-fib <110bpm; caution D-D interaction multiple meds tht slow HR
  • AEs: bradycardia, hypotension, drug specific
  • Teaching (was it effective?)
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26
Q

Nitroglycerin (Nitrostat)

Class
MOA
Indication
Route/Dose
Caution
AEs

A
  • Class: Antianginal Agents
  • MOA: relaxes vascular smooth muscle; dilates coronary arteries to incr blood flow
  • Indication: acute angina
  • Route/Dose: sublingual tablet q5mins up to 3 doses; onset 1-3min, duration 30-60mins
  • Caution: Sildenafil w/in last 24hrs (severe hypotension)
  • AEs: hypotension, headache
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27
Q

Oxybutynin

class
actions
indications
route/dose
contra
drug/drug
AEs
nursing

A
  • Class: Urinary Tract Antispasmodics/Anticholinergics
  • Actions: inhibits effect of acetylcholine (blocks PSNS) to relax smooth muscle of bladder (anticholinergic); dcrs bladder stimulation
  • Indications: bladder spasm, overactive bladder
  • Route/Dose: oral
  • ## Contra: GI obstruction, obstructive urinary tract problems (BPH), myasthenia gravis
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28
Q

Thrombolytic

A

Alteplase (tPA)

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29
Q

Potassium Administration - Oral

A
  • Do NOT break, crush, or chew ER caps or enteric capsules
  • With or after meals w/ full glass of water
  • Dissolve effervescent tabs in 8 oz cold water
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30
Q

Antihypertensive Drugs - Interventions

care plan

A
  • Monitor for situation which may lead to dcrd fluid vol
  • Reduce risk for falls (orthostatic hypotension)
  • Consult w/ prescriber to switch from IV to oral if indicated
  • Education:
    > lifestyle changes: weight loss, smoking cessation, dcrd alcohol/salt intake
    > med: dosing, timing, drug specific AE
    > do not abruptly d/c (pt will take scheduled)
    > how to assess pulse, BP, & s/s bradycardia or hypotension
    > need for follow-up & monitoring
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31
Q

Potassium Chloride

Class
MOA
Indication
Route
AEs
nursing

A
  • Class: Electrolyte Replacement
  • MOA: transmission of nerve impulses, cardiac contraction, renal func, intracellular ion maintenance
  • Indication: prevention & treatment of hypokalemia
  • Route: PO, IV
  • AEs: hyperkalemia: N/V/D, GI cramping, bradycardia, cardiac arrest
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32
Q

Lipid Lowering

A

Atrovastatin (Lipitor)

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33
Q

Lisinopril

Class
MOA
Route
Contra/Caution
AEs
Nurisng

A
  • Class: ACE-Inhibitor
  • MOA: blocks ACE, the enzyme responisble for converting angiotensin I to angiotensin II in lungs; dcrs resistance, prevents aldosterone secretion, prevents breakdown of bradykinin (potent vasoconstrictor)
  • Route: oral
  • Contra/Caution: ACE-inhibitors, ARB’s, K+ sparing diuretics, NSAIDs (kidneys)
  • AEs: common; persistent dry cough (bradykinin), orthostatic hypotension, hyperkalemia (block aldosterone) rare; angioedema
  • Nursing: monitor K+, renal func, change positions slowly (esp 1st dose)
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34
Q

Tachycardias

A
  • Ventricular fibrillation
  • Ventricular tachycardia
  • Medical emergencies
    > controls ventricular arrhythmia; Lidocaine
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35
Q

Drugs Affecting Blood Coagulation

assessment
diagnosis
outcomes

A
  • Assessment
    > physical assessment w/ focus on cardiovascular & S/S bleeding
    > labs: aPPT, PT/INR, H/H, platelets
    > drug-drug: more than 1 anticoag/antiplatelet (ie; ASA, warfarin), herbal supplements, antibiotic therapy
  • Diagnosis
    > risk for injury
    > ineffective tissue perfusion
  • Outcomes
    > therapeutic effect w/ limited AEs (ir; absence of DVT, PE, stroke)
    > pt undertsanding of drug therapy, AEs, safety
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36
Q

Dysrhythmia Medications

A
  • Lidocaine
  • Metoprolol
  • Amiodarone
  • Diltiazem
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37
Q

Diuretics: Site of Action

A
  • Thiazides: Hydrochlorothiazide
  • Loop: Furosemide
  • Osmotic: Mannitol
  • Postassium-Sparing: Spironolactone
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38
Q

Polyethylene Gylcol (MiraLAX)

class
MOA
indications
AE
nursing

A
  • Class: Bulk Stimulants: Hyperosmotic Laxative
  • MOA: incr water absorp into colon & GI tract (water follows polyethylene gycol; which stays in colon & GI tract)
  • Indications: constipation, evacuate bowel for diagnostic procedures (high dose)
  • AE:
    > loose stools (hold next dose)
    > N/V
    > abd pain
    > dehydration
    > electrolyte loss (K, Na, Mg, Cl)
  • Nursing: mix w/ 4-8oz of water; acute care fall risk
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39
Q

Cyanocobalamin (Vitamin B12)

Class
MOA
Indications
Dosage/Routes
AE
Nursing
Teach

A
  • Class: Agents for Megaloblastic Anemias
  • MOA: replaces vit B12; required for HgB formation
  • Indications: B12 deficiency anemia, pernicious anemia
  • Dosage/Route: monthly SQ/IM (pernicious anemia)
  • AE: rare
  • Nursing: monitor labs for therapeutic response (HgB, B12)
  • Teach: pt sudden discontinuation can cause anemia to return & irreversible nerve damage/depression; pernicious anemia will need injections for lifetime
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40
Q

Furosemide (Lasix)

Class
MOA
Indications
Route/Dose
Contraindications
AEs
Nursing

A
  • Class: Loop Diuretics
  • MOA: inhibits reabsorption of Cl of the Na/K/Cl symporter in loops of Henle which causes a greater degree of diuresis than other diuretics
  • Indications: conditions of fluid overload; hyperkalemia
  • Route/Dose: oral; IVP (slow IV push 20mg/min); IV infusion 10-40mg/hr
  • Contraindications: ototoxic drugs (gentamicin, vancomycin, high dose aspirin); caution sulfa allergy
  • AEs: electrolyte imbalance: hypokalemia, hyponatremia, hypotension, dehydration, CNS effects: paresthesia, ototoxicity (IVP slowly to prevent ?)
  • Nursing: potassium supplements; fall precautions (IV fall risk)
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41
Q

General Nursing Considerations - Anticoagulants/Thrombolytics

AE
contra
d-d

A
  • All anticoagulants have AE of bleeding (non-fatal & fatal)
    > non fatal: hematuria, epistaxis, bruising
    > fatal: hemorrhagic stroke, internal bleeding, GI bleeding (older adult higher risk)
  • Implement fall precautions (avoid injury & falls)
  • Implement bleeding precautions
  • Contraindications:
    > pregnancy (except heparin/enoxaparin), bleeding disorders, hx of bleed, thrombocytopenia
  • Drug-Drug:
    > antiplatelet agents, NSAIDs, herbals (most incr bleeding)
42
Q

Colloids

function
EXs

A
  • Molecules too large to easily cross capillary membrane
    > stay in intravascular space & rapidily expand plasma vol
  • Draw water from intracellular fluid & interstitial spaces into plasma
    > incr osmotic pressure
  • EXs:
    > 5% Albumin (trauma; blood loss, ascites; cirrhosis of liver)
    > Dextran 40 in NS
    > Dextran 40 in D5W
43
Q

Heparin

Class
MOA
Route/Dose
Indications
Contraindications
AEs
Nurisng
Reversal Agent

A
  • Class: Indirect Thrombin Inhibitor (Anticoagulant)
  • MOA: disrupts clotting cascase; prolongs bleeding time
  • Dose/Route: 5000units SQ q8 (prevention) or IV drip (protocol)
  • Indications: prevent or treat DVT (SQ), treat PE (IV)
  • Contraindications: pork allergy, pork abstention religion (Judaism, Muslim)
  • AEs: bleeding, heaprin-induced thrombocytopenia (HIT), bruising at injection site
  • Nursing: rotate/monitor injection sites for SQ (do not admin IM), monitor platelet count, monitor aPTT (therapeutic 45-70 sec), anti-Xa
  • Reversal agent: protamine sulfate (heparin short half-life, stop infusion)
44
Q

Hypotonic IV Fluids

function
indications
AEs
EX

A
  • Water moves OUT of vascular space to cells (ICF)
  • Indications:
    > hypernatremia
    > cellular dehydration
  • AEs:
    > depletion of intravascular compartment
    > consequential hypotension
    > too much expansion of intracellular compartment (peripheral edema)
  • EX: 0.45% NaCl (1/2 NS)
45
Q

Heart Failure Medication

A
  • Digoxin
  • Metoprolol
  • Lisinopril
  • Furosemide (diuretic)
46
Q

Rivaroxaban (Xarelto)

Class
MOA
Route/Dose
Indications
AE
Nursing
Reversal Agent

A
  • Class: Factor Xa Inhibitor (Anticoagulant)
  • MOA: disrupt clotting cascade; prolongs bleeding time
  • Route/Dose: 10mg PO daily (prevention), 15mg PO BID (treatment)
  • Indications: chronic AFib; prevent DVT & PE
  • AE: bleeding
  • Nursing: no blood monitoring required
  • Reversal Agent: Andexxa
47
Q

Warfarin (Coumadin)

Class
MOA
Route/Dose
Indications
AEs
D-D
Nursing

A
  • Vitamin K Antagonist (Anticoagulant)
  • MOA: interfere w/ hepatic synthesis of vitamin K-dependent clotting factors, prolongs bleeding time
  • Route/Dose: 2-10mg/day PO based on INR level
  • Indications: Chronic AFib, artifical heart valves, prevent/treat DVT, PE
  • AEs: bleeding, GI effects (N/V)
  • Drug-Drug: antibiotics (monitor INR during therapy), amiodarone, herbals
  • Nursing: monitor PT/INR (therapeutic INR 2.0-3.0), first oral anticoagulant drug on market
  • Reversal Agent: vitamin K
48
Q

Antidiarrheals

teach

A
  • Take meds exactly as prescribed
  • notify PCP if symps persist after 2 days and/or S/S of dehydration
  • do not use for infectious diarrhea
  • keep hydrated by drinking at least 3L water/day
49
Q

Ondansetron (Zofran)

class
MOA
indications
caution
AEs
nursing

A
  • Class: Serotonin Blockers
  • MOA: blocks serotonin peripherally, centrally, & small intestine; blocks chemoreceptor trigger zone (CTZ)
  • Indications: N/V
  • Caution: cardiac dysrhythmias, CNS depression
  • AEs: drowsiness, dizzines, headache, diarrhea, prolonged QTc/dysrhythmias (dose dependent(
  • Nursing: see general nursing, tele monitoring typically NOT required
50
Q

Lactulose

class
MOA
indications
route
AEs
nursing

A
  • Class: Hyperosmotic Laxative
  • MOA: pulls fluid out of venous system & into lumen of small intestine, inhibits diffusion of ammonia back to blood, excreting more ammonia in stool
  • Indications: hepatic encephalopathy, constipation
  • Route: oral or enema
  • AEs: N/V/D, electrolyte loss
  • Nursing: titrate as directed (# of loose stools) or scheduled dose, monitor ammonia lvls, I&Os, electrolytes, mental status, skin rectal area, use caution w/ additional laxatives, bad taste, assess compliance in cirrhosis
51
Q

0.9% Sodium Chloride (Normal Saline)

A
  • Isotonic fluid
    > osmotice pressure inside & outside of blood cell are equal
  • No net fluid movement
  • Administer too much = expansion of intravascular space
    > incrs BP
  • Used as a maintenance fluid or in dehydration w/out electrolyte abnormalities
52
Q

Losartan (Cozaar)

Class
MOA
Route
Contra/Caution
AE

A
  • Class: Angiotensin-Receptor Blocker (ARB)
  • MOA: blocks binding of angiotensin II to specific receptors in blood vessels and adrenal gland; used as alternate to ACE-inhibs
  • Route: oral
  • Contra/Cautions: same as ACE-I
  • AE: hypotension
53
Q

Digoxin Toxicity

manis
reversal agent
toxic and…

A
  • Manifestations:
    > bradycardia
    > headache
    > dizziness
    > confusion
    > N/V
    > visual disturbances
  • Reversal Agent
    > digoxin immune fab (creates antigen-antibody immune complexes w/ drug; inactivates)
  • Use reversal if toxicity AND
    > hyperkalemia
    > life-threatening dysrhythmia
    > life-threatening lvls
54
Q

Loperamide (Imodium)

class
MOA
indications
AEs
nursing

A
  • Class: Antidiarrheals
  • MOA: slow motility of GI tract through direct action on lining of GI tract
  • Indication: non-infectious dirrhea
  • AEs: constipations, abd discomfort, nausea
  • Nursing: admin drug after each loose stool, don’t exceed recommended daily max dose
55
Q

Anticoagulant Drugs

A
  • Heparin
  • Enoxaprin (Lovenox)
  • Warfrin (Coumadin)
  • Rivaroxaban (Xarelto)
56
Q

Bisacodyl (Dulcolax)

class
MOA
indications
route
AEs
nursing

A
  • Class: Bowel Chemical Stimulant
  • MOA: chemical irritant tht directly stimulates GI tract motility
  • Indications: constipation, evacuate bowel for diagnostic procedures
  • Route: PO or suppository
  • AE:
    > loose stools (hold next dose)
    > N/V
    > abd pain
    > dehydration
    > electrolyte loss (K, Na, Mg, Cl)
  • Nursing: admin PO w/ water (interactions: milk, juice, antacids)
57
Q

Drugs Affecting Blood Coagulation

intervention
evaluation

A
  • Interventions
    > bleeding precautions
    > reduce risk for falls
    > hold for procedures
    > educate pt: S/S bleeding; lab monitoring & diet if indicated
  • Evaluation
    > therapeutic response: absence of blood clots, restored perfusion
    > AEs: S/S bleeding most important!
    > teaching: was it effective?
58
Q

Spironolactone

Class
MOA
Indications
Route/Dose
Drug-Drug
AEs
Nursing

A
  • Potassium-Sparing Diuretic
  • MOA: aldosterone antagonist; blocks action of aldosterone in the distal tubule; loss of Na & retention of K
  • Indications: conditions of fluid overload (CHF & liver disease)
  • Route/Dose: oral
  • D-D: ACE-I, potassium supplement
  • AEs: hyperkalemia (weakness, cardiac dysrhythmias, N/V/D), GI effects, photosensitivity, hypotension, dehydration
  • Nursing: monitor for high K+, Teach: avoid high K+ foods, use sunscreen
59
Q

Food High in Vitamin K

A
  • Kale
  • Collard greens
  • SPinach
  • Brussel sprouts
  • Broccoli
  • Asparagus
  • Sauerkraut
  • Soybeans
  • Edamame
60
Q

Antiarrhythmic Drugs - Interventions

care plan

A
  • Monitor cardiac rhythm w/ admin of IV antiarrhythmic agent
    > ensure emergency life support equipment readily available
  • Reduce risk for falls (bradycardia = risk for syncope)
  • Consult prescriber to switch from IV to oral if indicated
  • Education:
    > med: dosing, timing, drug specific AE
    > do not abruptly d/c med (pt will take scheduled)
    > how to assess pulse, BP, and s/s bradycardia & hypotension
    > need for follow-up & monitoring: periodically assess cardiac rhythm w/ oral agents (yearly)
61
Q

Sodium Polystyrene Sulfonate (Kayexalate)

Class
MOA
indication
route
contra/warning
AEs
nursing

A
  • Class: Potassium Exchange Resin
  • MOA: incrs potassium excretion in intestines (exchange for sodium)
  • Indication: hyperkalemia
  • Route: oral or enema
  • Contra: abnormal bowel func; constipation
    > warning: GI bleeding, ischemic colitis, bowel perforation
  • AEs: hypernatremia, hypokalemia, N/V
  • Nursing: monitor electrolytes (potassium)
62
Q

Metoprolol (Toprol)

Class
MOA
Indications
Route
D-D
Contra/Cautions
AEs
Nursing

A
  • Class: Beta Adrenergic Blocker
  • MOA: block beta1 & beta2 receptors of the SNS; slows HR & lowers BP
  • Indications: HTN, HF, s/p MI, A-fib/flutter
  • Route: maintenance; oral, acute HTn or dysrhythmias; IV push
  • D-D: beta-agonist inhaler (albuterol, salmeterol, etc.)
  • Contra/Cautions: bradycardia, hypotension, masks signs of hypoglycemia
  • AEs: bradycardia, hypotension, bronchospasm, pulmonary edema, weakness, fatigue, dcrd exercise intolerance, alterations in BG
  • Nursing: monitor hypogylcemia closely in DM; immediate & extended release (XL, XR) prescribed
63
Q

Atrial Fibrillation

A
  • Dyssynchronous firing of artia
  • Uncoordinated w/ ventricles
  • Acute & chronic
    > slow HR: Metoprolol, Diltiazem, Amiodarone
64
Q

Nitroprusside

Class
MOA
Route
Caution
AE

A
  • Direct Vasodilator
  • MOA: act directly on vascular smooth muscle (vensou and arterial) to cause relaxation/vasodilation
  • Route: Maintenance: oral or transdermal; Acute HTN crisis: IV push
  • Caution: PVD, heart failure
  • AE: significant hypotension
65
Q

Laxatives

interventions
teaching

A
  • Interventions
    > HOLD if loose stools
    > encourage 3L water/daily, high fiber diet, incr activity
    > for multiple PRN softener/laxative orders: docusate first; safe
  • Teach
    > do not take laxative if experiencing N/V, abd pain (bowel obstruct?)
    > contact provider if experiencing severe abd pain, muscle weakness, cramps, and/or dizziness
    > long term use of laxatives results in dcrd bowel tone & may lead to dependency; use for no more than 7 days
66
Q

Furosemide Teachings

A
  • Take in AM
  • Weight daily on same scale in same clothes @ same time
  • Symptoms of hypotension or hypokalemia (call PCP)
  • Importance of prescribed potassium supplements
  • Maintain fluid intake to prevent fluid rebound or dehydration
  • aggravating factors of fluid loss: diarrhea, vomiting, excessive heat, sweating
  • S/S of fluid deficit
67
Q

Nurisng - GI Secretion Drugs

assessment
administration
education

A
  • Assessment Focus:
    > baseline hx & phsyical including allergies & meds
    > focus: GI & abdominal assessment r/t disorder & AE
  • Follow administration protocol
  • Educate:
    > non-pharm interventions for disorder
    > proper admin
    > shortest duration to reduce risk of AE
68
Q

Docusate (Colace)

class
MOA
route
AEs
nursing

A
  • Class: Lubricant / Stool Softener
  • MOA: promotes electrolyte & water absorp into colon, promotes incorporation of water into stool (results in stool softening)
  • Route: PO or suppository
  • AEs: well-tolerated, low risk for dehyration & electrolyte loss
  • Nursing: 1st line pharmacologic therpay for prevention of constipation
69
Q

Omeprazole (Prilosec)

class
MOA
indications(4)
caution
AEs
Nursing

A
  • Class: Proton Pump Inhibitors (PPI)
  • MOA: blocks secretion hydrochloric acid in stomach; ALL gastric acid secretion is temporarily blocked
  • Indications:
    > GERD
    > GI ulcers
    > H. pylori
    > prevention ulcers in acute care
  • Caution: long term use risk: atrophic gastritis (malabsorp of vit B12=pernicious anemia), osteoporosis related fracture (dcr Ca2 absorp); associated w/ C-diff
  • AEs:
    > headache
    > dizziness
    > upper resp infection
    > pneumonia
  • Nursing: admin on an empty stomach (30-60 min b4 meal); teach shortest duration, report S/S severe diarrhea; OTC
70
Q

Enoxaparin (Lovenox)

Class
MOA
Indications
Route
Contraindications
AEs
Nursing
Reversal Agent

A
  • Class: Low Molecular Weight Heparin (Anticoagulant)
  • MOA: disrupts clotting cascade; prolongs bleeding time
  • Indications: prevention or treatment of DVT
  • Route: 1mg/kg q12hrs SQ
  • Contraindications: pork allergy, pork abstention religion (Judiasm, Muslim)
  • AEs: bleeding, bruising at injection site
  • Nursing: admin deep SQ; do not aspirate or massage site, do not remove air bubble from prefilled syringe, rotate/monitor injection site, monitoring of clotting time not necessary (anti-Xa assay)
  • Reversal Agent: protamine sulfate
71
Q

Nursing Considerations - Antiplatelet Agents

assessment
interventions

A
  • Assessment:
    > indication for med = prevention of blood clots
    > CMs of bleeding
  • Interventions:
    > bleeding precautions: soft bristle toothbrush, electric razor, avoid injury
    > fall precautions in acute care (avoid injury & falls)
    > hold prior to procedure/surgery
    > educate pt on medication
72
Q

Hydrochlorothiazide (HCTZ)

Class
MOA
Indications
Route/Dose
Contra
AEs
Nursing

A
  • Class: Thiazide Diuretics
  • MOA: inhibits reabsorption of Cl of the Na/K/Cl symporter in distal tubule kidneys; all 3 remain in tubule for excretion (water follows Na)
  • Indications: 1st line treatment for HTN; adjunct for HR & cirrhosis
  • Route/Dose: oral
  • Contraindication: allergy to sulfa drugs
  • AEs: electrolyte loss: K, Na, Cl (usually mild); hypotension, dehydration, photosensitivity
  • Nursing: monitor BP, K, & Na for fluid overload see furosemide, use sunscreen

taken for HTN;need to assess BP prior to admin

73
Q

Sucralfate (Carafate)

class
MOA
indications(2)
AEs(2)
nursing

A
  • Class: Gastrointestinal Protectant
  • MOA: binds to base of ulcers & erosions forming protective barrier from pepsin
  • Indications:
    > GI ulcer
    > chronic renal failure w/ hyperphosphatemia
  • AEs: constipation, dry mouth
  • Nursing: admin med on empty stomach, 1hr b4 or 2hrs after meals & HS, admin other mids at least 2hrs b4 (impairs absorp)
74
Q

Angina

stable vs unstable

A
  • Stable:
    > chest pain w/ exertion
    > incrd O2 demand of heart
    > relieved w/ rest & nitroglycerin
  • Unstable:
    > chest pain at rest
    > unrelieved w/ nitroglycerin
    > possible MI
75
Q

Potassium Chloride - Nursing Considerations

A
  • Utilize electrolyte replacement protocol
    > oral admin preferred
    > follow dosing & lab draw times
  • Throughout admin monitor for:
    > cardiac abnormalities (tele not required)
    > vein phlebitis (if IV)
  • Teach Pt:
    > incr intake of high K+ foods
    > do NOT break, crush, or chew ER caps or enteric capsules
    > report burning sensation at IV site
76
Q

Antiplatelet Drugs

A
  • Aspirin (ASA)
  • Clopidogrel (Plavix)
77
Q

Potassium Administration - IV Infusion

A
  • Central line preferred
    > caustic to veins
  • Admin rate (nfusion):
    > 10 mEq/hr ; slower through IVPush if needed, tele not required
  • Monitor IV site (phlebitis)
  • Do NOT admin SQ or IM
78
Q

Nursing - Diuretics

teaching
evaluation

A
  • Teaching: exception for spironolactone; avoid high potassium foods & teach S/S of hyperkalemia
  • Evaluation
    > lab values: Na & K
    > S/S of hypotension, dehydration, hypo-/hyperkalemia
    > HCTZ: BP in normal range
    > Furosemide & Spironolactone
79
Q

Hypertonic IV Fluids

function
indications
AEs
EXs

A
  • Expands plasma vol by drawing water AWAY from cells & tissues
  • Indications:
    > hyponatremia
    > cerebral edema
  • AEs:
    > excessive expansion of intravascular compartment (plasma)
    > fluid overload
    > HTN
  • EXs:
    > 3% Normal Saline (3% NS)
    > 10% Dextrose in water (D10W) (any dextrose >10% is hypertonic)
    > D5W in 0.9% NaCl
    > D5W in 0.45% NaCl
80
Q

Antidiarrheals

indication
contra
assessments

A
  • Indicated for non-infectious diarrhea
  • Contraindications:
    > diarrhea caused by poisoning or infectious agents
    > acute abd disorders including GI obstructions
  • Assess:
    > baseline hx & physical including allergies & meds
    > I&Os & elimination patterns, electrolytes, hydration, bowel sounds, & abdomen
    > therapeutic effect: dcr # of BMs
    > AEs
81
Q

Classifications Used to Treat N/V

A
  • Anticholinergics
  • Antihistamines
  • Antidopaminergics
  • Neurokinin Receptor Antagonists
  • Prokinetics
  • Serotonin Blockers
  • Tetrahydro Cannabinoids
82
Q

Atorvastatin (Lipitor)

Class
MOA
Admin
Cautions
AEs
Nursing

A

- Class: HGM-CoA Reductase Inhibitors
- MOA: Blocks HGM-CoA reductase from completing synthesis of cholesterol in liver
- Admin: at HS (highest rates cholesterol synthesis)
- Caution: renal impairment, liver disease, heavy alcohol use, pregnancy cat X
- AE: GI effects (cramping, diarrhea, constipation), liver damage, myalgias
> toxic: rhabdomyolysis w/ AKI
- Nursing: monitor liver & kidney func (toxicity), report myalgias, no grapefruit juice (incrs lvls=toxicity), lifestyle mods

83
Q

Alteplase (Activase; tPA)

Class
MOA
Indications
AE
Contraindications

A
  • Class: Thrombolytic Agent
  • MOA: local fibrinolysis (acute clot lysis)
  • Indications: Systemic: ischemic (embolic) stroke, PE, coronary thrombosis (MI), Local: central venous catheter occlusion
  • AE: bleeding
  • Contraindications: many
84
Q

Diuretics

A
  • Hydrochlorothiazide (HCTZ)
  • Furosemide
  • Spironolactone
  • Mannitol
  • ALL work in renal tubules to excrete more water in 2 ways:
    > inhibiting reabsorptin of sodium (leaving Na in renal tubule for excretion…water follows sodium)
    > incring osmolarity of urine which pulls water into urine
85
Q

Lidocaine

Class
MOA
Indication
Routes
Onset,Peak,Duration
AEs
Nursing

A
  • Class: Sodium Channel Blocker
  • MOA: dcrs depolarization, dcring automaticity of the ventricular cells; incrs ventricular fibrillation threshold
  • Indications: treatment of life-threatening ventricular arrhythmias during MI or cardiac surgery
  • Routes: IV (topical lidocaine low risk systemic)
  • Onset: IV-immediate, Peak: IV-immediate, Duration: IV-20min
  • AEs: cardiac arrest, resp depression/arrest, anaphylaxis
  • Nursing: have resuscitation equpiment available
86
Q

Nursing - Diuretics

assessment
diagnosis / expected outcomes
interventions

A
  • Assessment:
    > r/t condition, s/s fluid overload focusing on cardiac & resp
    > VS: BP prior to admin
    > electrolytes: Na & K
    > kidney func: BUN, creatinine, GFR
  • Diagnosis / Expected Outcomes: fluid vol excess / dcrd fluid vol
  • Interventions
    > maintain adequate fluid intake (2-3L unless otherwise prescribed)
    > admin potassium supps if prescribed (furosemide/HCTZ)
87
Q

Amiodaron

Class
MOA
Indications
Dose
D-D
AEs
BB
Nursing

A
  • Class: Potassium Channel Blocker
  • MOA: blocks potassium channels, delays repolarization; slows HR
  • Indications: v-tachy & v-fib; atrial fib or flutter
  • Dose: maintenance: oral; acute: IV push/infusion (tele floors/ICU/ACLS)
  • Drug-Drug: many! incr Digoxin lvls (up to 50-70%); dcr metabolism of Warafin requiring lower doses (50% incr in INR); dcr doses of either drug by 50%
  • AEs: corneal microdeposits (photophobia, visual halos, dry eyes), fatigue, dizziness, photosensitivity, thyroid dysfunction
  • Black Box: hepatotoxicity, pulmonary toxicity, pro arrhythmias (new/existing)
  • Nursing: no grapefruit juice, use sunscreen, tele monitoring (IV)
88
Q

Anticoagulant Drugs - Interventions

A
  • Bleeding precautions
  • Reduce risk for falls
  • Hold for procedures
  • Education: s/s bleeding, lab monitoring, & diet if indicated
89
Q

Fluid & Electrolytes - Nursing Implications

A
  • Hx & Physical
  • Monitor: fluid vol (overload or dehyration), HR, BP, heart, lungs
  • Fluid I&Os
    > should be balanced; urine 30mL/hr
  • Daily weights (gain & loss)
    > best way to determine fluid status
    > edema not apparent until 5-10lbs excess fluid
    > rapid gain or loss of 1kg (2.2lbs) = 1L of fluid
  • Laboratory studies as appropriate to administration
90
Q

Clopidogral (Plavix)

Class
MOA
Indications
AEs
Nursing

A
  • Class: Antiplatelet Agent
  • MOA: inhibit platelet aggregation (alters signaling)
  • Indications: prevent blood clot w/ hx of MI, ischemic stroke, or PAD; prevent blood clot w/ cardiac stent or graft
  • AE: bleeding, bruising
  • Nursing: hold 5 days prior to procedure
91
Q

Folic Acid

Class
MOA
Indications
AE

A
  • Class: Agents for Megaloblastic Anemias
  • MOA: required for erythropoiesis
  • Indications: folic acid deficiency anemia (rare in US), alcoholism, pregnancy prevention of neural tube defects
  • AE: urine turns bright yellow
92
Q

Coronary Artery Disease (CAD)

A
  • Atherosclerosis (plaque build up in arteries) narrows coronary arteries
    > stable & unstable plaques = plaque rupture
  • Leads to dcrd blood flow; dcrs oxygen to cardiac tissue
  • Leads to myocardial infarction causing tissue death
93
Q

Antiemetic Routes

A
  • Oral
  • Oral disintegrating tablet
  • Transdermal patch
  • Suppository
  • Intramuscular
  • Intravenous
  • Consider pt situation
    > oral preferred, but if vomiting, select alternate route (contact PCP)
    > suppository often used in hospice care
94
Q

Digoxin (Lanoxin)

Class
MOA
Indications
Routes
D-D
Caution
AEs
Nursing

A
  • Class: Cardiac Glycoside
  • MOA: incrs force of contraction, incring cardiac output & renal perfusin; slows HR (goal: slower but more powerful heart)
  • Indications: HF
  • Routes: PO, IV (push over at least 5 mins w/ tele monitor)
  • Drug-Drug: many! Amiodarone & other antidysrhythmic drugs
  • AEs: GI effects, visual disturbances (green/yellow halo), bradycardias
  • Nursing: take apical pulse 1 full min prior to admin, hold if HR <60, notify provider; use same brand consistently - varied bioavailability; narrow therapeutic index, toxicity rare but serious, monitor blood lvls q3months
95
Q

Antiemetic Agents

assessment
implementation

A
  • Assessment:
    > focus: GI, I&Os, neuro/LOC
    > document emesis output amnt, color, & frequency
    > vomiting: S/S dehydration, electrolye loss
    > drug-drug: CNS depressants
  • Implementation:
    > give prn med as appropriate (Ondansetron 1st choice)
    > consider appropriate route, use least invasive
    > verify route; wrong route can be dangerous
    > preventative therapy: admin 30-60 mins prior to drug or procedure
    > fall precautions (high fall risk) in acute care
96
Q

Fluid Rebound

A
  • Occur w/ pts on diuretics tht do not take in adequate water
    > dcr fluid intake to dcr trips to bathroom
  • Results in concentrated plasma of smaller vol
  • Dcrd vol is sensed by nephrons, which activate RAAS cycle
  • Concentrated blood is sensed by osmotic center in brain, ADH is released to hold water & dilute blood
  • Result in “rebound” edema as fluid is retained
97
Q

Nursing - Diuretics

AEs
Contra
long term use
drug-drug

A
  • AEs: hypotension, dehydration, electrolyte disturbances, fluid rebound
  • Contra: hypotension, dehydration
  • Long Term Use:
    > incrd serum uric acid (dcrd excretion - gout)
    > incrd blood glucose lvls (change K+ keeps glucose out of cells)
    > dcrd kidney func
  • Drug-Drug Interactions: lithium. NSAIDs, antidiabetic drugs
98
Q

Ferrous Sulfate

Class
MOA
Indications
D-D/F
AE
Nursing

A
  • Class: Agents for Iron Deficiency Anemia
  • MOA: replace iron; required for HgB formation
  • Indications: iron deficiency, iron-deficiency anemia
  • D-D/F: antacids & diary reduce absorption
  • AE: GI upset, dark tarry stools, constipation
  • Nursing: monitor labs (HgB, iron), take W/OUT food for best absorption, take w/ vit C to incr absorption, do not take w/in 1hr of bedtime (GERD), do not crush or empty capsules, reassess HgB after 3mths
  • Keep out of reach of children; fatal if OD
99
Q

Treating Anemias

A
  • Folic Acid
  • Ferrous Sulfate
  • Cyanocobalamin (Vit B12)
  • Epoetin Alfa
100
Q

Cimetidine (Tagamet)

class
MOA
indications (5)
AEs
Nursing

A
  • Class: Histamine 2 (H2) Antagonists
  • MOA: blocks histamine-2 receptor sites to reduce gastric acid secretion & pepsin production
  • Indications:
    > GI ulcers
    > GERD
    > hypersecretory conditions
    > heartburn
    > acid indigestion
  • AEs:
    > headache
    > dizziness
    > severe: cardiac arrhythmias
  • Nursing: smoking diminishes effectiveness of med, extended duration (>6mnths) risk for vit B12 malabsorption; OTC
101
Q

Warfarin Special Considerations

A
  • Dosing
    > daily; usually in evening or HS
    > if INR is greater than 3.0 HOLD & call prescribing provider
    > expect an order for vit K if INR is greater than 4.0 (PO or SQ)
  • Lab Draws
    > dose change = next lab in 3 days
    > long term monitoring = weekly or monthly
  • Diet
    > teach pt to maintain consistent intake (avoid) vit K-containing foods (high intake may dcr warfarin effect)

NUR 3180 PHARM (6 decks)

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