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Pharmacology > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Name some nonpharmalogoical actions to help treat heart failure

A
  1. ) Limit salt intake to 2g or one teaspoon daily
  2. ) Avoid alcohol or one drink a day
  3. )Stop Smoking
  4. )Obesity (Decrease fat and caloric intake)
  5. ) Mild exercise
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2
Q

What two laboratory tests may confirm CHF

A

ANH or ANP

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3
Q

What does an elevated BNP level determine?

A

An elevated BNP level may indicate heart failure

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4
Q

What would be the number value of the BNP with heart failure?

A

high 400pg/ml

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5
Q

What are indications for low molecular weight heparins? What are some specific drugs?

A
  1. ) is given to prevent blood clots

2. ) examples: anapernin, doltaperin, tenzaperin

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6
Q

List the advantages of using LMWH vs Heparin

A
  1. ) Theraputic response at a lower dose
  2. ) More stable responses, safer option
  3. ) Do NOT need frequent lab testing
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7
Q

What is INR? What is the normal range and what is the range for warfarin therapy.

A 
International normalized ration, 
Normal range (1.3-2) 
Warafrin Therapy (2-3.5)
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8
Q

What is the antidote for warfarin?

A

Vitamin K takes from 24-48 hours

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9
Q

When would clopidogrel be prescribed and what might be paired with it?

A

clopidogrel is a anti platelet used after MI or stroke to prevent second event

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10
Q

When should aspirin and clopidogrel therapy be stopped before surgery.

A

7 days

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11
Q

What is the purpose of a thrombolytic agent?

A

To promote the conversion of plasominogen to plasmin which destroys the fibrin in the blood clot. Used during acute myocardial infarction or heart attack

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12
Q

What causes increased bleeding with clopidogrel?

A

NSAIDS, SSRIs and other anticoagulants

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13
Q

What causes interferes with the metbaolism of clopidogrel?

A

Phenytoin, NSAIDs, Calcium channel blockers (A Very Nice Drug) and morphine

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14
Q

What causes decreased effects with clopidogrel?

A

Grapefruit juice

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15
Q

What do thrombolytic drugs end in?

A

-ase

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16
Q

What is the MOA of thiazide?

A

Acts directly on the arterioles causing vasodilation and promotes sodium chloride and water excretion

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17
Q

What are uses for thiazides?

A
  1. ) Edema (heart failure and cirhosis)

2. )

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18
Q

What do Urinary Antiseptics/Antinfectives/Antibiotics do?

A

Action occurs in the renal tubule and bladder

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19
Q

Name Examples of Urinary Antiseptics

A
  1. ) Nitrofurantoin
  2. ) Methenamine
  3. ) TMP-SMZ
  4. ) Flouroquinolones
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20
Q

What is Nitrofurantoin used for?

A

To treat UTI’s

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21
Q

What is the MOA of nitrofurantoin?

A

Is Bacteriocidal or bacteriostatic- depends on the dosage in low dosages it is bacteriostatic and in high doses becomes bactericidal. interferes with the metabolism and inhibits protein and wall synthesis.

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22
Q

What type of organisms does nitofurantoin target?

A

Both gram negative and gram positive organims.

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23
Q

What are side effects of Nitrofuratoin occur that should indicate immediate discontinuation

A

sudden onset of dyspnea, chest pain, cough, fever, and chills

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24
Q

What are patients should be cautious or avoid nitrofuratoin all together

A
  1. ) contradicted: Renal impairment
  2. ) Caution with: diabetes milletus, electrolyte imbalance, Vit B deficiency. increased risk of developing peripheral neuropathy
  3. )Hemolytic anemia
  4. ) contradiction in pregnant women at term (38-42 weeks)
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25
Q

Side effects of nitofuratoin

A
  1. ) Rust/brown urine
  2. )rash
  3. ) pruitus
  4. )nausea and vommiting
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26
Q

Adverse reactions of nitofuratoin

A
  1. ) Super infection (stomatitis/ anogenital discharge or itching)
  2. )Hemolytic anemia and agranulocytosis
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27
Q

What are life threatening reactions of nitofuratoin?

A

Hepatoxicity, Steven-Johnson’s Syndrome, patients should be monitiored regularylu for liver injury. If hepatitis occures the drug should be discontinued immediately.

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28
Q

Drug-Drug interactions with nitrofuratoin

A
  1. )Decrease effect with probenecid (Antigout drug)

2. )Antacids decrease nitrofurantoin absorption

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29
Q

Nursing interventions of Nitofuratoin

A

1.) Monitor Urine output (Pts. w/ anuria and oliguria promptly report any decrease in urine output)
2.)Advise Pt. to rinse mouth thoroughly drug can stain teeth
3.) Drug may cause drowisness
4.)Direct pts with diabetes to not use clinitest for glucose false positives may occur
5.)Increase fluid intake and take with food
(increases urination, minimizes the GI upset)

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30
Q

What is methenamine?

A

Medication used for chronic UTIs/cystitis

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31
Q

What is a drug-drug interaction/ caution with methanmine?

A

not to be taken with sulfonamides causes crystalluria

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32
Q

What is important client teaching about methernamine?

A

1.)Urine needs to acidic (<5.5pH) for bactericidal action
pt needs to consume acidic foods: Cranberry juice , Vit C and ammonium chloride
2.) Avoid Food that are alkaline such as milk increases the urine

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33
Q

What is TMP-SMZ used for ?

A

Acute and chronic UTIs

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34
Q

What are side effects/ adverse reactions with TMP-SMZ?

A
  1. ) Headache, dizziness, rash
  2. )Photosensitivity, GI distress, and crystalluria
  3. ) C-diff
  4. ) Hyperkalemia
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35
Q

-xacin

A

flouroquinoles

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36
Q

What can Fluroquinolones do?

A

Cause Renal dysfunction if pt has renal dysfunction is present the dosage should decreases

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37
Q

What client teach should be done for fluroquinolones?

A

Avoid excessive exposure to sunlight- photosensitivity

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38
Q

What are side effects of flourquinolones?

A

visual disturbances, headache, dizziness

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39
Q

What pts are a caution for flourquinolones?

A

May exacerbate muscle weakness in Myasthenia gravis

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40
Q

What are important drug-drug interactions with Antiseptic/Antiinfectives

A
  1. )Antacids decrease nitofuramtoin absorption
  2. )Sodium bicarbonate inhibits the action of methanamine
  3. )Methanamine taken with sulfonamides increases the risk of cystalluria
  4. )Warn patients to NOT operate heavy machinery or driving a car while on the drug if drowisiness is present
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41
Q

what is phenozopyridine?

A

A urinary analgesic

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42
Q

What is the MOA for phenozopyridine?

A

Rellieves UTI symptoms (relieve pain, burning sensations, and frequency and urgency of urination)

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43
Q

What is an important side effect of phenozopyridine?

A

May change urine to orange red color, may stain clothing

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44
Q

What are side effects/ adverse effects of phenozopyridine?

A

GI upset, nephro- and hepatoxicity

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45
Q

What is bethanechol?

A

a bladder stimulant

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46
Q

Bethanechol

A
  1. ) used to stimulate micturition
  2. )Increases bladder tone by increasing the tone of the detrusor urinal muscle
  3. ) Contraindication: peptic ulcer
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47
Q

What is tolterdone tartrate used for?

A

control an overactive bladder and decrease urge and urinary incontience

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48
Q

Oxybutynin

A

MAO: direct action on smooth muscles to relieve spasms

Side Effects/ Adverse Reactions: Drowsiness, dizziness, blurred vision, tachycardia, dry mouth, and GI distress, constipation

Contradictions: Glaucoma, GI or urinary obstruction

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49
Q

What are side effects/ adverse effects of tolterdone tartrate?

A
  1. ) Headache, dizziness, confusion

2. ) Dry mouth diahrrea, constipation, abdominal pain

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50
Q

What are contradictions of Tolterdone tartrate?

A

Narrow-angle glaucoma and hepatic impairment

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51
Q

What shouldn’t a pt with a UTI do?

A
  1. )Drink Alcoholic beverages- restrain immune function and stimulates bacterial growth and heightens inflammation of the urethra and bladder
  2. ) Drink caffeine- dehydrates the body
  3. ) Eat Fried foods, chilli, and other spicy foods- irritates bladder and frequent or urgent to urinate
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52
Q

What should a pt with a UTI do?

A

Drink cranberry juice

drink bottled or spring eater, decaffinated ot acid free coffee and tea

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53
Q

What are the types of diuretics?

A
  1. ) thiazide
  2. ) Loop
    3) .Osmotic (ICP & IOP)
  3. ) Carbonic Anhydrase Inhibitors (IOP)
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54
Q

What is the difference between Loop and Thiazide diuretics

A

Loop

  1. ) Potient immediate diuresis (Furosemide)
  2. ) Watch for loss of electrolyetes (HyPOcalcemia)
  3. )Can be used with kidney impairment

Thiaziade

  1. ) Maintence overall period of time
  2. ) short acting,Intermediate and long acting
  3. Can NOT be used with kidney impairment
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55
Q

What diuretics do in general?

A

Act directly on arterioles causing vasodiation and promotes sodium chloride and water excretion

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56
Q

What are diuretics used for

A

Edema
Hypertension
Used primary for clients with normal renal function

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57
Q

What do thizades do?

A

Elevate levels of uric acid glucose

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58
Q

What pts should you be cautious with when giving thiazides?

A

Diabetics can cause a hyperglycemic effect

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59
Q

What other medications are thiazides used with?

A

used with ACE inhbibitors, beta blockers, and angiotensis II blockers, and alpha blockers

60
Q

When should thiazides be given?

A

in the morning to avoid nocturia and to avoid sleep interuption

61
Q

What are side effects of thiazides?

A

HyPOnatremia, HyPOkalemia, HyPOmagnesemia, HypERgylcemia, HypERuricemia, HypERcalcemia, HypERlipidemia

62
Q

Drug on drug interactions with thiazides

A
  1. Thiazide+ Digoxion- Thiazides cause hypercalcemia and hyPOkalemia resulting in enhanced digoxin levels. Potassium supplements frequently prescribed and levels monitored
  2. ) Thiazide+Lithium- Thiazide reduces lithium clearance, blurred vision, tinnitus, tremors, muscular irritability.
63
Q

Thiazide and herbal supplements

A
  1. ) aloe and Licorce- Decrease serum potassium level and hypokalemia- dysrythmia, and abdominal distention, leg cramps, weakness
  2. ) Hawthorn- Potentiate hypotension
  3. )Gingko- Increases BP when takes together
64
Q

Nursing interventions for thiazides

A
  1. ) Monitor vital signs and serum electrolytes
  2. )Monitor urine output
  3. ) Signs and symptoms of hypokalmeia (weakness, cramp, and cardiac dysrhythmias)
  4. ) Check weight or when specified
  5. ) photosentivity- use sunscreen
  6. )Instruct client to eat foods rich in potassium or potassium supplement ordered. (Banannas, rasins, potato skin, canataloupe, tomato, spinach, broccoli.
65
Q

Loop Diuretics MAO

A

acts on the ascending loop of Henle, highly potent results in high depletion of water and electrolytes such as sodium, calcium, potassium, and magnesium

66
Q

Examples of Loop Diuretics

A

Bumetanide, furosemide, ethacrynic acid

67
Q

What are Loop Diuretics used for

A
  1. ) Edema associated with renal function
  2. ) Pulmonary Edema
  3. ) CHF
68
Q

Side effects of Loop Diuretics

A
  1. )Fluid and electrolyte imbalance
  2. )Hypokalemia, Hyponatremia, hypocalcemia hypomagenesia, hypocholoremia
  3. ) HyPERgylcemia
  4. ) Orthostatic hypertension
  5. )Tinnitus
69
Q

Drug-Drug Interactions With Loop Diuretics

A
  1. ) Digoxin- increased potential for digitalis toxicity
  2. )Corticosteriods- Potentiate potassium loss
  3. ) Aminoglyoscides- increase chances of deafness
  4. Warafrin- highly protein bound, displacement of ofverfunction which causes easy bleeding and brusising
70
Q

Loop Diuretics- Nursing Intervention

A
  1. ) Urinary output and weight
  2. ) Monitor vital signs -Orthostatic hypotension
  3. ) Adminster furosemide slowly, if rapidly given hearing loss may occur.
  4. ) Do not drink alcohol
  5. ) . Monitor K+ serum levels in pts taking digoxin
  6. ) Observe for signs of hypokalemia- muscle weakness, adbominal distention, leg cramps, or cardiac dysrythmias
71
Q

What are osmotic diuretics used for?

A
  1. ) Reduces ICP and IOP Glaucoma

2. ) Prevent/ treat kidney failure

72
Q

Side effects of Osmotic diuretics

A
  1. ) Fluid and electrolyte imbalance
  2. )CNS symptoms: headache, vertigo, N&V, and mental confusion
  3. ) Tachycardia (Rapid fluid loss) , Pulmonary edema
  4. .) Mannitol crystalizarion due to low tempin vial, warm vial to disscolve crystals
73
Q

What is the MAO for Carbonic Anhydrase Inhibitors?

A

Block carbonic anhydrase enzyme needed to maintain body’s acid base balance. Inhibition causes increases of sodium, potassium and bicarbonate excretion

74
Q

Name an . example of a Carbonic Anhydrase Inhibitor

A

Acetazolamide

75
Q

Name examples of Potassium Sparing

A

spironolactone, triamterene, and amiloride

76
Q

Uses for Potassium sparing

A

1.)Cardiac disorders- Potassium retaining effect HR regulate and decreased myocardial fibrosis
2,) can be combined with thiazides to increase diuretic and decrease hypertension effects

77
Q

Nursing interventions for potassium sparing

A

1.)Serum K+ monitored if greated than 5.0 then drug should be discontinued

78
Q

What is special about spironolactone?

A

aldostorone antagonist so inhibits sodium potassium pump,Effect may take 48 hours

79
Q

Drug-Drug interactions with potassium sparing

A
  1. ) potassium supplements

2. )ACE inhibitors,ARBs,Salicylates, and NSAIDs- additive effect for hypokalemia

80
Q

Patient education Potassium sparing

A
  1. ) Avoid potassium rich foods and salt substitution
  2. )Report signs of excessive dehydration
  3. )Report irregular heartbeat
  4. )Orthostatic hypotension
  5. ) Administer in AM to avoid nocturia
81
Q

Symptoms of Heart failure

A
  1. ) SOB
  2. ) swelling of legs and feet
  3. ) chronic lack of energy
  4. )Difficult sleeping at night due to breathing problems
  5. )Swollen or tender abdomen with loss of appetite
  6. )Cough with frothy sputum
  7. )increased urination at night
  8. )Confusion/ impaired memory
82
Q

Nonpharmological Measures to treat heart failure

A
  1. ) limit salt intake to 2g daily or 1 teaspoon
  2. )Avoid alcohol or one drink a dAY
  3. )No smoking
  4. )Obesity
  5. )Mild excercise
83
Q

What is a inotropic action?

A

improves contractility- improves stroke volume and cardiac output

84
Q

Chronotropic action

A

Slows heart rate-allows more filing to improve Stroke volume and cardiac output

85
Q

Dromotropic action

A

Decreases cardiac conductivity-slows rate and reduces abnormal electrical activity. allows more efficent filling and beating of the heart.

86
Q

Example of a cardiac Gylcoside

A

Digoxin

87
Q

Cardiac Gylcoside MAO

A

Inhibits sodium potassium pump which causes an increase in the level of sodium in myocytes which leads to a rise in the level of calcium ions. This increases the amount of calcium ions available for contraction of the heart muscle. Improves cardiac output and reduces distention of the heart.

88
Q

Digoxin MAO

A

increase contractility effectiveness> improves cardiac output to improve tissue profusion. Decreases heart rate and decreases work of the heart

89
Q

Pharmokinetics of digoxin

A

Long 1/2 30 to 40 hours
Narrow therapeutic index 0.5-2
To achieve theraputic dose patients are given a loading dose.

90
Q

S&S of Digitalis toxicity

A
  1. ) GI upset
  2. ) bradycardia <60
  3. ) cardiac dysrthymias
  4. ) headaches
  5. ) malasie
  6. ) confusion and delirum
  7. ) Carditoxicity
91
Q

What is the antidote to digitalis toxicity

A

digoxin immune fab

92
Q

Drug-Drug interactions- Digoxin

A
  1. )Diuretics: furosemide, hydrochlorothizade-potassium wasting drugs-promotes hypokalemia and increases effects of digitalis preparations. pt taking digoxin and diuretics should take potassium supplements and eat potassium rich foods.
  2. ) Antacids- decrease the absorption of digoxin- doses should be staggered.
93
Q

Digoxin and herbal supplements

A

Gingseng- falsely elevates digoxin levels
St. Johns wort - decreases abosrption
ALoe and Licroice- promotes potassium lose resulting in digitalis effecr.

94
Q

-rone

A

phophodiestertase Inhibitors

95
Q

Use for Phophodiesterase Inhibitors

A

Treats acute HF, used short term

96
Q

MAO phodisterease Inhibitors

A

inhibit the enzyme phosphodisterases- inamrinone lacteate and milrinone lactate. increase cardiach outpout and promote vasodilation.

97
Q

How long should phophodistererase Inhibitors be given for?

A

Administered via IV no longer 48 to 72 hours - Can result in cardiac Dsrythmias

98
Q

ACE inhibitors

A

Less sodium and water retention, vasodilation, prevents remodeling, reduce after load and preload

99
Q

ARBs

A

Same as ACE

100
Q

Diuretics

A

Reduces Preload

101
Q

Beta Blocker

A

Decreases oxygen demand

102
Q

Vasodilators

A

Reduces preload, after load dilates arteries

103
Q

stable angina

A

relied with rest also known as classic and excertional angina

104
Q

Variant/Vaspoastic

A

Occurs at rest

105
Q

If agina does not relief within 30-60 mins after a nitroglycerin what should you do?

A

Call 911

106
Q

Nitrates

A

Vasodilation, improve circulation through coronary arteries increase supply, decrease workload demand

107
Q

Beta Blockers

A

Slow HR decreasing oxygen demand - aren’t effective w/ variant.

108
Q

Calcium Channel blockers

A

Reduces contractility and workload, decreasing oxygen demand, Goof for variant angina and decreases contractility.

109
Q

MAO Nitrates

A

Generalized vascular and coronary vasodilation, Dilate systemic vessels, reduce cardiac work, oxygen consumption (decreases oxygen demand) Relieve intense pain during agina attacks.

110
Q

Side effects Nitrates

A

headaches, weakness, dizziness

111
Q

Adverse reactions of Nitrates

A

Hypotension, reflex tachycardia

112
Q

Bidil

A

Nitrate+vasodilation hydrazaline= heart failure

113
Q

Patient Education Nitrates

A

Medical evaluation necessary if 1 dose/ pain does not subside and worsen in 5 minutes do not relieve acute agina

114
Q

African do not react well to ______

A

Beta Blockers

115
Q

Beta blocker MAO

A

Decrease the effects of the sympathetic nervous system by blocking the action of catecholamines (epinepherine, and NE) Decrease heart rate and blood pressure pathophysiology.

116
Q

What are antiaginal drugs used for?

A

classic stable angina

117
Q

Side effect of Beta Blockers

A

Hypotension, Bronchospasm, Impotence- over period of time stops

118
Q

Caution of Beta Blockers

A

Do not stop abruptly , may cause MI and dysrhythmia

119
Q

-olol

A

Beta blockers

120
Q

A Very Nice Drugs

A

Amotropline Verapmil, Nifedipine, Diltazem

121
Q
  • pine
A

Calcium channel blockers

122
Q

MAO of Calcium Channel Blockers

A
  1. )Calcium activates myocardial contraction- increasing workload of the heart and need for more oxygen
  2. )Decrease cardiac muscle contractility, Vasodilates (decreasing peripheral resistance)
123
Q

Side effects Calcium Channel Blockers

A
  1. ) Fatigue
  2. )Headache
  3. )Flushing
  4. )Dizziness
  5. ) Bradycardia
  6. ) Hypotension
  7. ) Peripheral edema
  8. ) may cause changes in kidney and liver functions
124
Q

Antidysrhythmias

A

Control rhythmn by correcting . compensating for altered rhythmn, attempt to restore cardiac function

125
Q

Four classes of Antidysrhtmias

A
  1. ) Sodium (fast) channel blockers) IA (quinidine) IB (Lidocaine) IC
  2. )Beta-Adrengenic Blockers
  3. ) Drugs Prolonged repolarization
  4. ) Calcium channel Blockers
126
Q

Quinidie Side effects

A

Nausea vomiting , diarrhea, confusion, hypotension, neurologic or pyschiatric

127
Q

Lidocaine Side Effects

A

Bradycardia, hypotension, seizure, blurred vision

128
Q

-sin

A

Alpha- adrenegeric blockers

129
Q

-statin

A

cholestrol lowering drug

130
Q

Dash Diet

A 
Grains 6-8 ounces
Vegetables 4-5 servings 
Fruits 2-2 and half 
Milk 2-3 cups
Meat 6 oz or less
Nuts, Seeds, legumes 4-5 oz per week 
2000kcalories
131
Q

hydrochlorirthiazide

A

thiazides

132
Q

-sartan

A

Angiotensin II blockers

133
Q

Anticoagulants

A

Prevent clots from forming do not dissolve clots, only maintains blood flow.

134
Q

Heparin MOA

A

Bind with antithrombin III
inhibits action thrombin
inhibit conversion of fibrinogen to fibrin
inhibit clot formation

135
Q

Heparin Side Effects

A

Heparin can decrease platelet count: thrombocytpenia

Monitor PTT or aPTT

136
Q

LMWH

A

Lower risk of bleeding
Frequent lab monitoring is not required
Inactivates Xa factor
DO NOT TAKE WITH ASPRIN

137
Q

Antidote for LMWH

A

Protamine Sulfate (PMS)

138
Q

Warfarin

A

Is an antagonist to Vitamin K(green leafy vegetables)
Watch patients for bloody stools, guns, hematuria, petechiae, ecymosis.

Does not require constant monitoring

139
Q

Warfarin drug interation

A

Increase effect with of asprin, NSAIDs,allopurinol, sulfosmides, thyroids, diruetics, methylodopa

Decreases effect barbiuates, cortcosteriods and estrogen (oral contracptive and laxative)

140
Q

Antidote Warfarin

A

Vitamin K

141
Q

Aspirin

A

MAO- inhibits cox I and Cox II

Used for TIA

142
Q

-ase

A

Thrombolytics

143
Q

MAO thrombolytics

A

Binds to fibrin promoting conversions of plasminogen to plasmin. Plasmin digests in a clot and degrades fibrinogen, prothrombin, and other clotting factors disgintergrateding clot.

144
Q

Drug-Drug Interactions

A

Increased bleeding avoid adminstering for discomfort/ pain

145
Q

Thrombolytics

A

The thrombus or blood clot disintergrates if adminsteres within 3-4 hrs or within 30 minutes arriving to the hospital after an AMI

146
Q

Antidote: Thrombolytics

A

Plasminogen Inactivator- Aminocarproic acid

Inhibits bleeding .

Pharmacology (6 decks)

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