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NU 308 Pharmacology > Exam 4 Blueprint Guide > Flashcards

Exam 4 Blueprint Guide Flashcards

1
Q

What does procainamide interact with?

A

antihypertensives ad additional hypotensive effect
don’t use with beta blockers (increases effects)

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2
Q

What is angioedema?

A

sudden deep swelling or welts under the skin, particularly around the eyes and lips

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3
Q

What medication can cause angioedema?

A

ACE inhibitors (captopril)

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4
Q

What are side effects of ACE inhibitors?

A
  • Hyperkalemia
  • Angioedema
  • Dry, Non-productive Cough
    (treated w/ anti-tussive)
  • Dizziness/ortho-hypotension
  • Metallic taste in the mouth
  • Rash
  • Headache
  • Neutropenia ( decrease WBC)
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5
Q

What are side effects of amiodarone?

A

Blue-gray skin
pulmonary toxicity
visual disturbances
phlebitis with IV admin
sinus brafy
AV block
photosensitivty (wear sunscreen)

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6
Q

What do we do before administrating digoxin?

A

check Ap and rhythm for 1 full minute
Monitor digoxin level 0.8-2ng/mL

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7
Q

What are indications for digoxin?

A

afib
second line tx for heart failure

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8
Q

How do we administer statins?

A
  • oral route
  • give lovastatin with supper
  • others can be taken without food in the evening
  • most cholesterol is synthesized at night
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9
Q

What are side effects of statins?

A
  • Hepatotoxicity: increase in aspartate
    transaminase (AST)
  • Myopathy: muscle aches, pain, and tenderness
  • Can progress to myositis or rhabdomyolysis
  • ↑ risk for elderly, frail, hypothyroid
  • Fibrates(gemfibrozil, fenofibrate) & ezetimibe
    ↑
    risk of myopathy & liver and kidney injury
  • Grapefruit juice suppresses CYP3A4 and can ↑
    levels of statins
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10
Q

What labs do we monitor with statins?

A
  • Obtain baseline liver function -Monitor after 12
    wks & q 6 mo.
  • May d/c if liver function tests are elevated
  • Baseline creatine kinase (CK) level & monitor
  • May d/c if if CK levels high
  • Monitor kidney function
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11
Q

What ist he normal potassium level?

A

3.5-5.0

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12
Q

What do antiplatelets do?

A

inhibit platelet aggregation
prevents clot

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13
Q

What are indications for antiplatelets?

A

prevnetion of MI
prevention of reinfarction following MI
prevention of ischemic stroke of TIA
ACS
intermittend claudication

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14
Q

What does ezetimibe do?

A

inhibits reabsorption of
cholesterol secreted in
bile and absorption of cholesterol
from food.

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15
Q

what are indications for ezetimibe?

A
  • Clients w/modified diets can use as an
    adjunct to lower LDL, total cholesterol,
    and apolipoprotein B (main protein in
    lipids)
  • Can be used alone or in combination with
    a statin
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16
Q

What are adverse effects of ezetimibe?

A
  • Hepatitis
  • Myopathy
  • increase the risk of liver
    dysfunction and myopathy w/statins
  • Concurrent use with fibrates increases
    risk of cholelithiasis and myopathy
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17
Q

What are contrainidcations for ezetimibe?

A
  • Pregnancy Risk Category C
  • Lactation warnings: Might cause adverse
    effects
  • Reproductive warnings
  • Contraindicated in clients w/moderate-to-
    severe liver disorders, especially those
    taking a statin
  • Use caution in clients who have mild liver
    disorders.
  • Ezetimibe is not recommended for
    use with fibrates
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18
Q

What do we teach pts on ezetimibe?

A
  • Observe for liver dysfunction (anorexia, vomiting, nausea, jaundice)
  • Avoid alcohol
  • Report muscle aches, pain, and tenderness
  • Obtain baseline cholesterol, HDL, LDL, triglyceride levels, liver and kidney function tests, and monitor periodically
  • Low-fat, low-cholesterol diet and regular
  • exercise
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19
Q

How do we administer ezetimibe?

A
  • Clients can take in a fixed-dose combo
    w/simvastatin
  • Take 2 hr before or 4 hr after bile
    sequestrants
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20
Q

T or F, antiplatelets must be witheld 5-7 days before a surgical procedure?

A

True

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21
Q

What are s/s of left sided HF?

A

paroxysmal nocturnal dyspnea
elevated pulmonary capillary wedge pressure
pulmonary congestion
cough
crackles
wheezes
bloody sputum
tachypnea
resltess
confused
orthopnea
tachycardia
fatigute
cyanosis
exertional dyspnea

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22
Q

What is the antidote for heparin?

A

protamine sulfate

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23
Q

What are s/s of right sided HF?

A

fatigue
peripheral venous pressure goes up
ascites
enlarged liver and spleen
JVD
anorexia
GI distress
weight gain
dependent edema

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24
Q

What are indicatiosns for thiazide diuretics?

A
  • First line for essential HTN either by
    themselves or in combo with other
    antihypertensives
  • Edema of mild/mod HF, liver & kidney
    disease
  • ↓urine prod. With diabetes insipidus
  • Promote reabsorption of Ca+ & ↓risk
    of osteoporosis postmenopause
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25
Q

What are complications of thiazide diuretics?

A
  • Dehydration and
    Hyponatremia
  • Hypokalemia and
    hypochloremia
  • Hyperglycemia
  • Hypercalcemia
  • Hyperuricemia, Increased
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26
Q

What are nursing implications of thiazide diuretics?

what labs do we check, actions do we take etc.?

A
  • Routine BMPs, K+, BP, I&O
  • Baseline data (ortho BP, wt, lytes,
    edema assessment)
  • Timing (AM, before 1400 for bid)
  • Weigh at same time ea. day
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27
Q

What do we teach pts on thiazide diuretics?

A
  • Reduce Na+ diet
  • Daily weight
  • FSBS on diabetics to monitor for ↑glucose
    level
  • Photosensitivity
  • Increase fluid intake (1500mL day)
  • No alcohol
  • Change positions slowly
  • May take K+ supplement/eat ↑K+ foods
  • BP log; slow position changes
  • Low Mg (weak, muscle twitching, tremor)
  • If taking BID, take 2nd dose no later than
    1400 to avoid nocturia
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28
Q

How do we administer thiazide diuretics?

When?

A
  • Give at the same time each day
    Effective if:
    ↓BP
    ↓Edema
    ↑urine output &↓urine output in diabetes
    insipidus
    Preserved bone integrity in postmenopausal
    women
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29
Q

What is an example of a thiazide diuretic?

A

hydrochlorothiazide

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30
Q

What are side effects of furosemide?

A
  • Hypokalemia
  • Hypotension
  • Tinnitus/ototoxicity
  • Dehydration
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31
Q

Does enoxaparin require an aPTT monitoring?

A

No

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32
Q

Where does furosemide work?

A

Work in the ascending loop of
Henle

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33
Q

What labs do we monitor for furosemide?

A
  • Routine BMPs (K+, Mg, Ca) uric acid,
    Lipids
  • Normal K+ (3.5-5mEq/L)
  • Baseline BP/orthostatic, edema
  • I/O & daily weight
  • Timing (sleep)
  • Assess manifestations of dehydration or
    thromboembolism
  • Monitor for Oliguria – stop med and notify
    HCP
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34
Q

How long until furosemide works?

A

oral: 30-60 min
IV: 2-5min

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35
Q

Can you give heparin and warfarin together?

A

yes

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36
Q

What are therapeutic levels for digoxin?

A

0.8-2ml

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37
Q

What is the antidote for digoxin?

A

activated charcoal

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38
Q

What does digoxin toxicity look like?

A

fatigue, weakness,
vision change, GI effects

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39
Q

What are indications of epinepherine?

A

anaphylactic shock
Treatment of AV block, heart failure,
shock, and cardiac arrest
asthma

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40
Q

How do we administer dopamine?

A

Used w IV Pump bc of plasma 1/2 life Dosage titrated based on BP response

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41
Q

What is the antidote for alteplase?

A

aminocaproic acid

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42
Q

What are indications for thrombolytics?

A

acute MI
alteplase: PE, acute ischemic stroke
restore central IV patency

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43
Q

What are advers effects of thrombolytics?

A

bleeding
ventricular arrhythmias

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44
Q

What do thrombolytics do?

A

lysis of blood clots

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45
Q

How do you administer thrombolytics (altepase)

A
  • For emergent cases, Give ASAP - within 3-4.5 hours of
    symptom onset (Within 3 Hours is Best!)
  • Give through peripheral IV site where compression can
    be held
  • Never Mix with any other Meds
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46
Q

What are side effects of ronalizine?

A
  • QT prolongation-
  • Can ↑risk for torsades de
    pointes
  • HTN
    Interactions
  • inhibitors of CYP3A4 can increase levels of
    ranolazine and lead to torsades de pointes
    (grapefruit juice, HIV protease inhibitors,
    macrolide antibiotics, azole antifungals, and some
    calcium channel blockers)
  • Quinidine and sotalol can further prolong QT
    interval
  • Concurrent use of digoxin and simvastatin ↑ blood
    levels of digoxin and simvastatin.
47
Q

What are steps for taking SB NTG tablets?

A

 Stop activity.
 Sit or lie down.
 Immediately put one sublingual tablet under the tongue and let it
dissolve.
 Rest for 5 min.-If pain not relieved by first tablet, call 911, then
take a second tablet.
 After another 5 min, take a third tablet if the pain is still not relieved.
 Do not take more than three sublingual tablets

48
Q

What is the action of organic nitrates?

A

NTG dilates veins
and ↓ venous return (preload), which ↓ cardiac O2
demands.
In variant (Prinzmetal’s or vasospastic) angina, NTG
prevents or reduces coronary artery spasm, thus ↑ O2
supply. (Demand is not decreased)

49
Q

What are indications of organic nitrates?

A

Sublingual Tab/Spray
* Treatment of acute angina attack
* Prophylaxis of chronic stable angina or variant
angina
Sustained-Release Cap./Transdermal/Topical
Ointment
* Long-term prophylaxis against anginal attacks

50
Q

What are nursing implications of organic nitrates?

A
  • Sublingual tab/trans spray: Use at the first sign of chest
    pain, prior to activity that may cause exertion.
  • Wear gloves when handling topical
    ointments/transdermal patches (HA, Facial flushing,
    Hypotension
51
Q

What are teaching points for organic nitrates?

A
  • Use ASA or acetaminophen for HA
52
Q

What are other meds under the organic nitrate category?

A
  • Isosorbide dinitrate (sublingual)
  • Isosorbide mononitrate (oral)
53
Q

How do you administer organic nitrates?

A
  • Transdermal patch-should not be cut, place on
    clear/hairless/back, chest, abdomen. (Remove old
    patch at night for 10-12 hr. to ↓ tolerance risk)
  • Topical ointment-spread over 2.5-3.5 in. paper, clear
    skin, cover with plastic wrap, remove old at night like
    patch. AVOID TOUCHING WITH HANDS
  • Intravenous-use IV tubing supplied and glass bottle,
    continuous IV due to short half-life, titrate up slowly
    from 5mcg/min until desired response or max of
    2mcg/min
54
Q

What are s/s of fluid volume overload?

A

Cough, shortness of breath, crackles, hypertension, tachycardia,
distended neck veins

55
Q

How do we administer blood for clients at risk for overload?

A

In older adults or clients at risk for overload, transfuse 1 unit of
PRBCs over 2 to 4 hr, avoiding any concurrent fluid infusion into
another IV site

  • Monitor vital signs every 15 min throughout transfusion. If possible,
    wait 2 hr btw units if multiple units prescribed
  • If manifestations occur, stop the transfusion, place the client in a
    sitting position with the legs down, and notify the provider
  • Administer diuretics and oxygen as appropriate
  • Monitor I&O
56
Q

What are indications for antidiuretics?

A

HF
HTN
edema

57
Q

What is the first dose phenomenon?

A

rthostatic hypotension with palpitations, dizziness, and perhaps syncope 1 to 3 hours after the
first dose of a drug or an increased dose

58
Q

What is hypertensive crisis?

A

higher than 180/ 120

59
Q

What is the medication we use for hypertensive crisis?

A

Nitroprusside (centrally
-acting vasodilator)

60
Q

What is the antidote for nitroprusside?

A

sodium thiosulfate

61
Q

What do we teach patient’s on verapamil?

A
  • check BP pulse
  • Avoid Grapefruit/Grapefruit juice
  • Good dental hygiene: can discolor teeth
  • Observe for edema in Legs, slow pulse
  • Increase fiber and fluids if not restricted for
    constipation
62
Q

How do we administer propranolol?

A
  • Oral for HTN
  • Oral and IV for Acute MI
  • Take at same time daily ac or hs
  • Do not stop med without
    consulting HCP
  • Take with food to increase
    absorption
63
Q

What are adverse effects of adrenergic agonists like prazosin?

A
  • First dose phenomenon –
  • orthostatic hypotension,
  • palpitations,
  • dizziness, and
    syncope first time given
  • Na+ & fluid retention
64
Q

What are nursing implications for adrenergic agonists like prazosin?

A
  • Start with low dose
  • First dose at night
  • Monitor BP for 2-6 hr p 1st
    dose
65
Q

What are indications for ranolazine?

A

Chronic stable angina in combination
with amlodipine, a beta-adrenergic
blocker, or an organic nitrate

66
Q

What are complications of ranolazine?

A

QT prolongation-Can ↑risk for torsades de
pointes
* HTN

67
Q

What important info do we teach pts about ranolazine?

A
  • Ranolazine is Not for treatment of an
    Acute Anginal Attack
68
Q

What ethnicity responds to which antihypertensives better?

A

African Americans respond to calcium channel blockers best

69
Q

What are indications for beta blockers?

A
  • Atrial fibrillation
  • Atrial flutter
  • Paroxysmal SVT
  • Hypertension
  • Angina
  • PVCs
  • Severe recurrent ventricular tachycardia
  • Exercise-induced tachydysrhythmias
  • Paroxysmal atrial tachycardia
    tachycardia
    HTN
70
Q

What are complications of beta blockers?

A
  • Bradycardia
  • Decreased cardiac output
  • SOB, Edema, Cough (esp. if lying flat)
  • CHD, Angina, MI if sudden withdrawal
    from a client with coronary heart disease
  • Orthostatic hypotension
  • AV block, heart failure, sinus arrest,
    fatigue, bronchospasm in clients who
    have asthma
71
Q

How do we administer beta blockers?

A
  • Oral for HTN
  • Oral and IV for Acute MI
  • Admin IV no faster than 1mg/min
72
Q

What do we teach pts on beta blockers?

A

change positions slowly
taper med slowly 1 to 2 weeks

73
Q

How do we administer amiodarone?

A
  • If IV: Use of central venous
    catheter is indicated
74
Q

What are contraindications for amiodarone?

A
  • Amiodarone crosses the placental barrier
    and can harm the fetus, can be found in
    breast milk.
  • Should be avoided during pregnancy, if
    breastfeeding, and for several months after
    the discontinuing of the medication
75
Q

What do we teach pts on amiodarone?

A
  • Observe for dyspnea, cough, and chest
    pain
  • Report visual disturbances.
  • Advise clients to avoid sun lamps, and
    wear sunscreen and protective clothing
76
Q

What does lidocaine do?

A
  • Decrease electrical
    conduction
  • Decrease automaticity
  • Increase rate of repolarization
77
Q

What are indications for lidocaine?

A
  • Short-term use only for
    ventricular dysrhythmias
  • Acute dysrhythmias post MI
78
Q

What are complications?

A
  • CNS Effects-Drowsiness,
    altered mental status,
    paresthesia, seizures
  • Respiratory Arrest
  • Monitor VS and ECG.
  • Ensure resuscitation equipment at the
    bedside
79
Q

How long do we use lidocaine for?

A
  • Usually used for no more than 24 hr
80
Q

What are nursing implications for lidocaine?

A

Monitor client for CNS depression (sedation,
irritability, seizures).

81
Q

What meds do we use to treat angina?

A

aspirin
ranolazine
nitrates
beta blockers
statins
calcium channel blockers

82
Q

What is the antidote for warfarin?

A

fresh frozen plasma

83
Q

What dietary precautions do we take with warfarin?

A

No Excessive intake of foods high in vitamin K, such as dark
green leafy vegetables, including cabbage, broccoli, and
Brussels sprouts, mayonnaise, canola, and soybean oils,
decreases effectiveness

84
Q

What fluid is usually administered with blood products?

A

normal saline

85
Q

What are indications for a calcium channel blocker? (like veramapil or nifedipine)

A
  • Atrial fibrillation and flutter
  • SVT
  • Hypertension
  • Angina pectoris
86
Q

What do calcium channel blockers do? (like veramapil or nifedipine)

A

Decrease force of contraction
Decrease HR
Slow rate of conduction through SA & AV
nodes

87
Q

How do we administer calcium channel blockers? (veramapil or nifedipine)

A
  • PO: with or without food (long
    acting)
  • IV push or IV drip
88
Q

What are adverse effevts of calcium channel blockers? (like veramapil or nifedipine)

A
  • Peripheral edema
  • Constipation
  • ↓ Cardiac Function
  • Bradycardia
  • Hypotension
  • AV block
  • Acute Toxicity
89
Q

What do we teach pts of calcium channel blockers? (like veramapil or nifedipine)

A
  • check BP pulse
  • Avoid Grapefruit/Grapefruit juice
  • Good dental hygiene: can discolor teeth
  • Observe for edema in Legs, slow pulse
  • Increase fiber and fluids if not restricted for
    constipation
90
Q

What does procainamide do?

A

Slow impulse conductions in the atria,
ventricles

91
Q

What are indications of procainamide?

A
  • Supraventricular
    tachycardia Ventricular
    tachycardia
  • Atrial flutter
  • Atrial fibrillation
92
Q

What are complications of procainamide?

A
  • Systemic Lupus
    Syndrome
  • Neutropenia,
    thrombocytopenia,
    agranulocytosis
  • Cardiotoxicity
  • Hypotension
93
Q

What are administration considerations for procainamide?

A
  • Monitor HR & rhythm, notify HCP of
    any new dysrhythmia
    Monitor BP-antihypertensives add
    additional hypotensive effect
94
Q

What are nursing considerations for procainamide?

A

Lupus
* Manifestations resolve with discontinuation
Neutropenia, thrombocytopenia, and
agranulocytosis
* Monitor wkly CBC for 12weeks, then periodically.
* Monitor for infection & bleeding. Stop medication if
there is evidence of bone marrow suppression.
* Hematologic status will usually return to baseline in
about 1 month
Cardiotoxicity
* Monitor med levels (therapeutic procainamide
level 4 to 10 mcg/mL)l

95
Q

What do we use loop diuretics to treat?

A

Pulmonary edema, Heart failure, HTN

96
Q

What is the action of loop diuretics?

A

act on the ascending loop of Henle- Urine output is increased, and potassium is
excreted

97
Q

What are adverse drug reactions to loop diuretics?

A

hypokalemia, hyponatremia, fluids, and electrolyte
imbalances. Orthostatic HTN, ototoxicity. Hyperglycemia in Diabetics and increased uric
acid levels

98
Q

What nursing actions do we take for loop diuretics?

A

monitor for electrolyte imbalances, monitor BP closely, uric acid level,
hearing loss, and ringing in ears

99
Q

How do we administer loop diuretics?

A

oral or IV form. Give oral with food. Administered IV slowly to prevent
ototoxicity; give the last dose well before bedtime

100
Q

What do we educate clients on loop diuretics about?

A

the patient to recognize the symptoms of Hypokalemia. Increase K+ or a K+
supplement may be added

101
Q

What do ACE inhibitors do?

A

reduce peripheral vascular resistance without increasing:
CO
cardiac rate
cardiac contractility

102
Q

What are side effects of ACE inhibiitors?

A

dizziness
ortho hypotension
GI distress
cough
headache

103
Q

What medication is less effective in african americans?

A

ACE inhibitors

104
Q

What are ACE inhibitors used for?

A

HTN

105
Q

What labs do we check for ACE inhibitors?

A

CMP
BMP
potassium levels

106
Q

What are ARBS used for?

A

HTN

107
Q

How long does it take ARBS to take effect?

A

3-6 weeks

108
Q

What do we use calcium channel blockers for?

A

HTN
Angina

109
Q

What are beta 1 blockers?

A

selective, they only work on the heart
metoprolol
atenolol

110
Q

What are beta 2 blockers?

A

nonselective heart and lungs
propanolol
labetelol

111
Q

In clients with CAD, what happens if they suddenly stop beta blockers?

A

risk for CHF, MI, angina

112
Q

How do we administer enoxaparin?

A

don’t expel bubble
fully insert needle, expel all contents
in abdomen, 2inc from umbilical
don’t rub
rotate sites

113
Q

What do we teach patients on calcium channel blockers?

A
  • Lifestyle; check BP pulse
  • Avoid Grapefruit/Grapefruit juice
  • Good dental hygiene: can discolor teeth

NU 308 Pharmacology (23 decks)

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