Exam 4 Flashcards
Name some nonpharmalogoical actions to help treat heart failure
- ) Limit salt intake to 2g or one teaspoon daily
- ) Avoid alcohol or one drink a day
- )Stop Smoking
- )Obesity (Decrease fat and caloric intake)
- ) Mild exercise
What two laboratory tests may confirm CHF
ANH or ANP
What does an elevated BNP level determine?
An elevated BNP level may indicate heart failure
What would be the number value of the BNP with heart failure?
high 400pg/ml
What are indications for low molecular weight heparins? What are some specific drugs?
- ) is given to prevent blood clots
2. ) examples: anapernin, doltaperin, tenzaperin
List the advantages of using LMWH vs Heparin
- ) Theraputic response at a lower dose
- ) More stable responses, safer option
- ) Do NOT need frequent lab testing
What is INR? What is the normal range and what is the range for warfarin therapy.
International normalized ration, Normal range (1.3-2) Warafrin Therapy (2-3.5)
What is the antidote for warfarin?
Vitamin K takes from 24-48 hours
When would clopidogrel be prescribed and what might be paired with it?
clopidogrel is a anti platelet used after MI or stroke to prevent second event
When should aspirin and clopidogrel therapy be stopped before surgery.
7 days
What is the purpose of a thrombolytic agent?
To promote the conversion of plasominogen to plasmin which destroys the fibrin in the blood clot. Used during acute myocardial infarction or heart attack
What causes increased bleeding with clopidogrel?
NSAIDS, SSRIs and other anticoagulants
What causes interferes with the metbaolism of clopidogrel?
Phenytoin, NSAIDs, Calcium channel blockers (A Very Nice Drug) and morphine
What causes decreased effects with clopidogrel?
Grapefruit juice
What do thrombolytic drugs end in?
-ase
What is the MOA of thiazide?
Acts directly on the arterioles causing vasodilation and promotes sodium chloride and water excretion
What are uses for thiazides?
- ) Edema (heart failure and cirhosis)
2. )
What do Urinary Antiseptics/Antinfectives/Antibiotics do?
Action occurs in the renal tubule and bladder
Name Examples of Urinary Antiseptics
- ) Nitrofurantoin
- ) Methenamine
- ) TMP-SMZ
- ) Flouroquinolones
What is Nitrofurantoin used for?
To treat UTI’s
What is the MOA of nitrofurantoin?
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.
What type of organisms does nitofurantoin target?
Both gram negative and gram positive organims.
What are side effects of Nitrofuratoin occur that should indicate immediate discontinuation
sudden onset of dyspnea, chest pain, cough, fever, and chills
What are patients should be cautious or avoid nitrofuratoin all together
- ) contradicted: Renal impairment
- ) Caution with: diabetes milletus, electrolyte imbalance, Vit B deficiency. increased risk of developing peripheral neuropathy
- )Hemolytic anemia
- ) contradiction in pregnant women at term (38-42 weeks)
Side effects of nitofuratoin
- ) Rust/brown urine
- )rash
- ) pruitus
- )nausea and vommiting
Adverse reactions of nitofuratoin
- ) Super infection (stomatitis/ anogenital discharge or itching)
- )Hemolytic anemia and agranulocytosis
What are life threatening reactions of nitofuratoin?
Hepatoxicity, Steven-Johnson’s Syndrome, patients should be monitiored regularylu for liver injury. If hepatitis occures the drug should be discontinued immediately.
Drug-Drug interactions with nitrofuratoin
- )Decrease effect with probenecid (Antigout drug)
2. )Antacids decrease nitrofurantoin absorption
Nursing interventions of Nitofuratoin
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)
What is methenamine?
Medication used for chronic UTIs/cystitis
What is a drug-drug interaction/ caution with methanmine?
not to be taken with sulfonamides causes crystalluria
What is important client teaching about methernamine?
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
What is TMP-SMZ used for ?
Acute and chronic UTIs
What are side effects/ adverse reactions with TMP-SMZ?
- ) Headache, dizziness, rash
- )Photosensitivity, GI distress, and crystalluria
- ) C-diff
- ) Hyperkalemia
-xacin
flouroquinoles
What can Fluroquinolones do?
Cause Renal dysfunction if pt has renal dysfunction is present the dosage should decreases
What client teach should be done for fluroquinolones?
Avoid excessive exposure to sunlight- photosensitivity
What are side effects of flourquinolones?
visual disturbances, headache, dizziness
What pts are a caution for flourquinolones?
May exacerbate muscle weakness in Myasthenia gravis
What are important drug-drug interactions with Antiseptic/Antiinfectives
- )Antacids decrease nitofuramtoin absorption
- )Sodium bicarbonate inhibits the action of methanamine
- )Methanamine taken with sulfonamides increases the risk of cystalluria
- )Warn patients to NOT operate heavy machinery or driving a car while on the drug if drowisiness is present
what is phenozopyridine?
A urinary analgesic
What is the MOA for phenozopyridine?
Rellieves UTI symptoms (relieve pain, burning sensations, and frequency and urgency of urination)
What is an important side effect of phenozopyridine?
May change urine to orange red color, may stain clothing
What are side effects/ adverse effects of phenozopyridine?
GI upset, nephro- and hepatoxicity
What is bethanechol?
a bladder stimulant
Bethanechol
- ) used to stimulate micturition
- )Increases bladder tone by increasing the tone of the detrusor urinal muscle
- ) Contraindication: peptic ulcer
What is tolterdone tartrate used for?
control an overactive bladder and decrease urge and urinary incontience
Oxybutynin
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
What are side effects/ adverse effects of tolterdone tartrate?
- ) Headache, dizziness, confusion
2. ) Dry mouth diahrrea, constipation, abdominal pain
What are contradictions of Tolterdone tartrate?
Narrow-angle glaucoma and hepatic impairment
What shouldn’t a pt with a UTI do?
- )Drink Alcoholic beverages- restrain immune function and stimulates bacterial growth and heightens inflammation of the urethra and bladder
- ) Drink caffeine- dehydrates the body
- ) Eat Fried foods, chilli, and other spicy foods- irritates bladder and frequent or urgent to urinate
What should a pt with a UTI do?
Drink cranberry juice
drink bottled or spring eater, decaffinated ot acid free coffee and tea
What are the types of diuretics?
- ) thiazide
- ) Loop
3) .Osmotic (ICP & IOP) - ) Carbonic Anhydrase Inhibitors (IOP)
What is the difference between Loop and Thiazide diuretics
Loop
- ) Potient immediate diuresis (Furosemide)
- ) Watch for loss of electrolyetes (HyPOcalcemia)
- )Can be used with kidney impairment
Thiaziade
- ) Maintence overall period of time
- ) short acting,Intermediate and long acting
- Can NOT be used with kidney impairment
What diuretics do in general?
Act directly on arterioles causing vasodiation and promotes sodium chloride and water excretion
What are diuretics used for
Edema
Hypertension
Used primary for clients with normal renal function
What do thizades do?
Elevate levels of uric acid glucose
What pts should you be cautious with when giving thiazides?
Diabetics can cause a hyperglycemic effect
What other medications are thiazides used with?
used with ACE inhbibitors, beta blockers, and angiotensis II blockers, and alpha blockers
When should thiazides be given?
in the morning to avoid nocturia and to avoid sleep interuption
What are side effects of thiazides?
HyPOnatremia, HyPOkalemia, HyPOmagnesemia, HypERgylcemia, HypERuricemia, HypERcalcemia, HypERlipidemia
Drug on drug interactions with thiazides
- Thiazide+ Digoxion- Thiazides cause hypercalcemia and hyPOkalemia resulting in enhanced digoxin levels. Potassium supplements frequently prescribed and levels monitored
- ) Thiazide+Lithium- Thiazide reduces lithium clearance, blurred vision, tinnitus, tremors, muscular irritability.
Thiazide and herbal supplements
- ) aloe and Licorce- Decrease serum potassium level and hypokalemia- dysrythmia, and abdominal distention, leg cramps, weakness
- ) Hawthorn- Potentiate hypotension
- )Gingko- Increases BP when takes together
Nursing interventions for thiazides
- ) Monitor vital signs and serum electrolytes
- )Monitor urine output
- ) Signs and symptoms of hypokalmeia (weakness, cramp, and cardiac dysrhythmias)
- ) Check weight or when specified
- ) photosentivity- use sunscreen
- )Instruct client to eat foods rich in potassium or potassium supplement ordered. (Banannas, rasins, potato skin, canataloupe, tomato, spinach, broccoli.
Loop Diuretics MAO
acts on the ascending loop of Henle, highly potent results in high depletion of water and electrolytes such as sodium, calcium, potassium, and magnesium
Examples of Loop Diuretics
Bumetanide, furosemide, ethacrynic acid
What are Loop Diuretics used for
- ) Edema associated with renal function
- ) Pulmonary Edema
- ) CHF
Side effects of Loop Diuretics
- )Fluid and electrolyte imbalance
- )Hypokalemia, Hyponatremia, hypocalcemia hypomagenesia, hypocholoremia
- ) HyPERgylcemia
- ) Orthostatic hypertension
- )Tinnitus
Drug-Drug Interactions With Loop Diuretics
- ) Digoxin- increased potential for digitalis toxicity
- )Corticosteriods- Potentiate potassium loss
- ) Aminoglyoscides- increase chances of deafness
- Warafrin- highly protein bound, displacement of ofverfunction which causes easy bleeding and brusising
Loop Diuretics- Nursing Intervention
- ) Urinary output and weight
- ) Monitor vital signs -Orthostatic hypotension
- ) Adminster furosemide slowly, if rapidly given hearing loss may occur.
- ) Do not drink alcohol
- ) . Monitor K+ serum levels in pts taking digoxin
- ) Observe for signs of hypokalemia- muscle weakness, adbominal distention, leg cramps, or cardiac dysrythmias
What are osmotic diuretics used for?
- ) Reduces ICP and IOP Glaucoma
2. ) Prevent/ treat kidney failure
Side effects of Osmotic diuretics
- ) Fluid and electrolyte imbalance
- )CNS symptoms: headache, vertigo, N&V, and mental confusion
- ) Tachycardia (Rapid fluid loss) , Pulmonary edema
- .) Mannitol crystalizarion due to low tempin vial, warm vial to disscolve crystals
What is the MAO for Carbonic Anhydrase Inhibitors?
Block carbonic anhydrase enzyme needed to maintain body’s acid base balance. Inhibition causes increases of sodium, potassium and bicarbonate excretion
Name an . example of a Carbonic Anhydrase Inhibitor
Acetazolamide
Name examples of Potassium Sparing
spironolactone, triamterene, and amiloride
Uses for Potassium sparing
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
Nursing interventions for potassium sparing
1.)Serum K+ monitored if greated than 5.0 then drug should be discontinued
What is special about spironolactone?
aldostorone antagonist so inhibits sodium potassium pump,Effect may take 48 hours
Drug-Drug interactions with potassium sparing
- ) potassium supplements
2. )ACE inhibitors,ARBs,Salicylates, and NSAIDs- additive effect for hypokalemia
Patient education Potassium sparing
- ) Avoid potassium rich foods and salt substitution
- )Report signs of excessive dehydration
- )Report irregular heartbeat
- )Orthostatic hypotension
- ) Administer in AM to avoid nocturia
Symptoms of Heart failure
- ) SOB
- ) swelling of legs and feet
- ) chronic lack of energy
- )Difficult sleeping at night due to breathing problems
- )Swollen or tender abdomen with loss of appetite
- )Cough with frothy sputum
- )increased urination at night
- )Confusion/ impaired memory
Nonpharmological Measures to treat heart failure
- ) limit salt intake to 2g daily or 1 teaspoon
- )Avoid alcohol or one drink a dAY
- )No smoking
- )Obesity
- )Mild excercise
What is a inotropic action?
improves contractility- improves stroke volume and cardiac output
Chronotropic action
Slows heart rate-allows more filing to improve Stroke volume and cardiac output
Dromotropic action
Decreases cardiac conductivity-slows rate and reduces abnormal electrical activity. allows more efficent filling and beating of the heart.
Example of a cardiac Gylcoside
Digoxin
Cardiac Gylcoside MAO
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.
Digoxin MAO
increase contractility effectiveness> improves cardiac output to improve tissue profusion. Decreases heart rate and decreases work of the heart
Pharmokinetics of digoxin
Long 1/2 30 to 40 hours
Narrow therapeutic index 0.5-2
To achieve theraputic dose patients are given a loading dose.
S&S of Digitalis toxicity
- ) GI upset
- ) bradycardia <60
- ) cardiac dysrthymias
- ) headaches
- ) malasie
- ) confusion and delirum
- ) Carditoxicity
What is the antidote to digitalis toxicity
digoxin immune fab
Drug-Drug interactions- Digoxin
- )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.
- ) Antacids- decrease the absorption of digoxin- doses should be staggered.
Digoxin and herbal supplements
Gingseng- falsely elevates digoxin levels
St. Johns wort - decreases abosrption
ALoe and Licroice- promotes potassium lose resulting in digitalis effecr.
-rone
phophodiestertase Inhibitors
Use for Phophodiesterase Inhibitors
Treats acute HF, used short term
MAO phodisterease Inhibitors
inhibit the enzyme phosphodisterases- inamrinone lacteate and milrinone lactate. increase cardiach outpout and promote vasodilation.
How long should phophodistererase Inhibitors be given for?
Administered via IV no longer 48 to 72 hours - Can result in cardiac Dsrythmias
ACE inhibitors
Less sodium and water retention, vasodilation, prevents remodeling, reduce after load and preload
ARBs
Same as ACE
Diuretics
Reduces Preload
Beta Blocker
Decreases oxygen demand
Vasodilators
Reduces preload, after load dilates arteries
stable angina
relied with rest also known as classic and excertional angina
Variant/Vaspoastic
Occurs at rest
If agina does not relief within 30-60 mins after a nitroglycerin what should you do?
Call 911
Nitrates
Vasodilation, improve circulation through coronary arteries increase supply, decrease workload demand
Beta Blockers
Slow HR decreasing oxygen demand - aren’t effective w/ variant.
Calcium Channel blockers
Reduces contractility and workload, decreasing oxygen demand, Goof for variant angina and decreases contractility.
MAO Nitrates
Generalized vascular and coronary vasodilation, Dilate systemic vessels, reduce cardiac work, oxygen consumption (decreases oxygen demand) Relieve intense pain during agina attacks.
Side effects Nitrates
headaches, weakness, dizziness
Adverse reactions of Nitrates
Hypotension, reflex tachycardia
Bidil
Nitrate+vasodilation hydrazaline= heart failure
Patient Education Nitrates
Medical evaluation necessary if 1 dose/ pain does not subside and worsen in 5 minutes do not relieve acute agina
African do not react well to ______
Beta Blockers
Beta blocker MAO
Decrease the effects of the sympathetic nervous system by blocking the action of catecholamines (epinepherine, and NE) Decrease heart rate and blood pressure pathophysiology.
What are antiaginal drugs used for?
classic stable angina
Side effect of Beta Blockers
Hypotension, Bronchospasm, Impotence- over period of time stops
Caution of Beta Blockers
Do not stop abruptly , may cause MI and dysrhythmia
-olol
Beta blockers
A Very Nice Drugs
Amotropline Verapmil, Nifedipine, Diltazem
- pine
Calcium channel blockers
MAO of Calcium Channel Blockers
- )Calcium activates myocardial contraction- increasing workload of the heart and need for more oxygen
- )Decrease cardiac muscle contractility, Vasodilates (decreasing peripheral resistance)
Side effects Calcium Channel Blockers
- ) Fatigue
- )Headache
- )Flushing
- )Dizziness
- ) Bradycardia
- ) Hypotension
- ) Peripheral edema
- ) may cause changes in kidney and liver functions
Antidysrhythmias
Control rhythmn by correcting . compensating for altered rhythmn, attempt to restore cardiac function
Four classes of Antidysrhtmias
- ) Sodium (fast) channel blockers) IA (quinidine) IB (Lidocaine) IC
- )Beta-Adrengenic Blockers
- ) Drugs Prolonged repolarization
- ) Calcium channel Blockers
Quinidie Side effects
Nausea vomiting , diarrhea, confusion, hypotension, neurologic or pyschiatric
Lidocaine Side Effects
Bradycardia, hypotension, seizure, blurred vision
-sin
Alpha- adrenegeric blockers
-statin
cholestrol lowering drug
Dash Diet
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
hydrochlorirthiazide
thiazides
-sartan
Angiotensin II blockers
Anticoagulants
Prevent clots from forming do not dissolve clots, only maintains blood flow.
Heparin MOA
Bind with antithrombin III
inhibits action thrombin
inhibit conversion of fibrinogen to fibrin
inhibit clot formation
Heparin Side Effects
Heparin can decrease platelet count: thrombocytpenia
Monitor PTT or aPTT
LMWH
Lower risk of bleeding
Frequent lab monitoring is not required
Inactivates Xa factor
DO NOT TAKE WITH ASPRIN
Antidote for LMWH
Protamine Sulfate (PMS)
Warfarin
Is an antagonist to Vitamin K(green leafy vegetables)
Watch patients for bloody stools, guns, hematuria, petechiae, ecymosis.
Does not require constant monitoring
Warfarin drug interation
Increase effect with of asprin, NSAIDs,allopurinol, sulfosmides, thyroids, diruetics, methylodopa
Decreases effect barbiuates, cortcosteriods and estrogen (oral contracptive and laxative)
Antidote Warfarin
Vitamin K
Aspirin
MAO- inhibits cox I and Cox II
Used for TIA
-ase
Thrombolytics
MAO thrombolytics
Binds to fibrin promoting conversions of plasminogen to plasmin. Plasmin digests in a clot and degrades fibrinogen, prothrombin, and other clotting factors disgintergrateding clot.
Drug-Drug Interactions
Increased bleeding avoid adminstering for discomfort/ pain
Thrombolytics
The thrombus or blood clot disintergrates if adminsteres within 3-4 hrs or within 30 minutes arriving to the hospital after an AMI
Antidote: Thrombolytics
Plasminogen Inactivator- Aminocarproic acid
Inhibits bleeding .
