Exam 3 Study Guide Flashcards

Question

Antiarrhythmic & Antihypertensive Drugs - Evaluation ## Footnote care plan

Answer 1

- 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?)

Answer 2

- **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

Answer 3

- **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 -

Answer 4

Alteplase (tPA)

Answer 5

- **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

Answer 6

- 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

Answer 7

- **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

Answer 8

Atrovastatin (Lipitor)

Answer 9

- **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)

Answer 10

- Ventricular fibrillation - Ventricular tachycardia - Medical emergencies > controls ventricular arrhythmia; Lidocaine

Answer 11

- **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

Answer 12

- Lidocaine - Metoprolol - Amiodarone - Diltiazem

Answer 13

- Thiazides: Hydrochlorothiazide - Loop: Furosemide - Osmotic: Mannitol - Postassium-Sparing: Spironolactone

Answer 14

- **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

Answer 15

- **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

Answer 16

- **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)

Answer 17

- **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)

Answer 18

- 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

Answer 19

- **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)**

Answer 20

- **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)**

Answer 21

- Digoxin - Metoprolol - Lisinopril - Furosemide (diuretic)

Answer 22

- **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**

Answer 23

- **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**

Answer 24

- 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

Answer 25

- **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

Answer 26

- **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

Answer 27

- 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

Answer 28

- **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

Answer 29

- **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

Answer 30

- **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

Answer 31

- Heparin - Enoxaprin (Lovenox) - Warfrin (Coumadin) - Rivaroxaban (Xarelto)

Answer 32

- **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)

Answer 33

- **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?

Answer 34

- **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

Answer 35

- Kale - Collard greens - SPinach - Brussel sprouts - Broccoli - Asparagus - Sauerkraut - Soybeans - Edamame

Answer 36

- 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)

Answer 37

- **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)

Answer 38

- **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

Answer 39

- Dyssynchronous firing of artia - Uncoordinated w/ ventricles - Acute & chronic > slow HR: Metoprolol, Diltiazem, Amiodarone

Answer 40

- **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

Answer 41

- 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**

Answer 42

- 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

Answer 43

- **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

Answer 44

- **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

Answer 45

- **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

Answer 46

- **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**

Answer 47

- **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

Answer 48

- **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 ## Footnote taken for HTN;need to assess BP prior to admin

Answer 49

- **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)

Answer 50

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

Answer 51

- 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

Answer 52

- Aspirin (ASA) - Clopidogrel (Plavix)

Answer 53

- 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

Answer 54

- **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

Answer 55

- **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

Answer 56

- 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

Answer 57

- Anticholinergics - Antihistamines - Antidopaminergics - Neurokinin Receptor Antagonists - Prokinetics - Serotonin Blockers - Tetrahydro Cannabinoids

Answer 58

**- 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

Answer 59

- **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

Answer 60

- 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

Answer 61

- **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

Answer 62

- **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)

Answer 63

- **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)

Answer 64

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

Answer 65

- 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

Answer 66

- **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

Answer 67

- **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

Answer 68

- 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

Answer 69

- 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

Answer 70

- **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

Answer 71

- 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

Answer 72

- 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

Answer 73

- **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

Answer 74

- **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_

Answer 75

- Folic Acid - Ferrous Sulfate - Cyanocobalamin (Vit B12) - Epoetin Alfa

Answer 76

- **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

Answer 77

- **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)