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)
2
Q
What is angioedema?
A
sudden deep swelling or welts under the skin, particularly around the eyes and lips
3
Q
What medication can cause angioedema?
A
ACE inhibitors (captopril)
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)
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)
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
7
Q
What are indications for digoxin?
A
afib
second line tx for heart failure
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
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
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
11
Q
What ist he normal potassium level?
A
3.5-5.0
12
Q
What do antiplatelets do?
A
inhibit platelet aggregation
prevents clot
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
14
Q
What does ezetimibe do?
A
inhibits reabsorption of
cholesterol secreted in
bile and absorption of cholesterol
from food.
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
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
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
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
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
20
Q
T or F, antiplatelets must be witheld 5-7 days before a surgical procedure?
A
True
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
22
Q
What is the antidote for heparin?
A
protamine sulfate
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
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
25
What are complications of thiazide diuretics?
* Dehydration and
Hyponatremia
* Hypokalemia and
hypochloremia
* Hyperglycemia
* Hypercalcemia
* Hyperuricemia, Increased
26
What are nursing implications of thiazide diuretics?
| what labs do we check, actions do we take etc.?
* 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
27
What do we teach pts on thiazide diuretics?
* 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
28
How do we administer thiazide diuretics?
| When?
* Give at the same time each day
Effective if:
↓BP
↓Edema
↑urine output &↓urine output in diabetes
insipidus
Preserved bone integrity in postmenopausal
women
29
What is an example of a thiazide diuretic?
hydrochlorothiazide
30
What are side effects of furosemide?
* Hypokalemia
* Hypotension
* Tinnitus/ototoxicity
* Dehydration
31
Does enoxaparin require an aPTT monitoring?
No
32
Where does furosemide work?
Work in the ascending loop of
Henle
33
What labs do we monitor for furosemide?
* 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
34
How long until furosemide works?
oral: 30-60 min
IV: 2-5min
35
Can you give heparin and warfarin together?
yes
36
What are therapeutic levels for digoxin?
0.8-2ml
37
What is the antidote for digoxin?
activated charcoal
38
What does digoxin toxicity look like?
fatigue, weakness,
vision change, GI effects
39
What are indications of epinepherine?
anaphylactic shock
Treatment of AV block, heart failure,
shock, and cardiac arrest
asthma
40
How do we administer dopamine?
Used w IV Pump bc of plasma 1/2 life Dosage titrated based on BP response
41
What is the antidote for alteplase?
aminocaproic acid
42
What are indications for thrombolytics?
acute MI
alteplase: PE, acute ischemic stroke
restore central IV patency
43
What are advers effects of thrombolytics?
bleeding
ventricular arrhythmias
44
What do thrombolytics do?
lysis of blood clots
45
How do you administer thrombolytics (altepase)
* 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
46
What are side effects of ronalizine?
* 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
What are steps for taking SB NTG tablets?
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
What is the action of organic nitrates?
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
What are indications of organic nitrates?
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
What are nursing implications of organic nitrates?
* 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
What are teaching points for organic nitrates?
* Use ASA or acetaminophen for HA
52
What are other meds under the organic nitrate category?
* Isosorbide dinitrate (sublingual)
* Isosorbide mononitrate (oral)
53
How do you administer organic nitrates?
* 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
What are s/s of fluid volume overload?
Cough, shortness of breath, crackles, hypertension, tachycardia,
distended neck veins
55
How do we administer blood for clients at risk for overload?
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
What are indications for antidiuretics?
HF
HTN
edema
57
What is the first dose phenomenon?
rthostatic hypotension with palpitations, dizziness, and perhaps syncope 1 to 3 hours after the
first dose of a drug or an increased dose
58
What is hypertensive crisis?
higher than 180/ 120
59
What is the medication we use for hypertensive crisis?
Nitroprusside (centrally
-acting vasodilator)
60
What is the antidote for nitroprusside?
sodium thiosulfate
61
What do we teach patient's on verapamil?
* 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
How do we administer propranolol?
* 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
What are adverse effects of adrenergic agonists like prazosin?
* First dose phenomenon –
* orthostatic hypotension,
* palpitations,
* dizziness, and
syncope first time given
* Na+ & fluid retention
64
What are nursing implications for adrenergic agonists like prazosin?
* Start with low dose
* First dose at night
* Monitor BP for 2-6 hr p 1st
dose
65
What are indications for ranolazine?
Chronic stable angina in combination
with amlodipine, a beta-adrenergic
blocker, or an organic nitrate
66
What are complications of ranolazine?
QT prolongation-Can ↑risk for torsades de
pointes
* HTN
67
What important info do we teach pts about ranolazine?
* Ranolazine is Not for treatment of an
Acute Anginal Attack
68
What ethnicity responds to which antihypertensives better?
African Americans respond to calcium channel blockers best
69
What are indications for beta blockers?
* Atrial fibrillation
* Atrial flutter
* Paroxysmal SVT
* Hypertension
* Angina
* PVCs
* Severe recurrent ventricular tachycardia
* Exercise-induced tachydysrhythmias
* Paroxysmal atrial tachycardia
tachycardia
HTN
70
What are complications of beta blockers?
* 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
How do we administer beta blockers?
* Oral for HTN
* Oral and IV for Acute MI
* Admin IV no faster than 1mg/min
72
What do we teach pts on beta blockers?
change positions slowly
taper med slowly 1 to 2 weeks
73
How do we administer amiodarone?
* If IV: Use of central venous
catheter is indicated
74
What are contraindications for amiodarone?
* 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
What do we teach pts on amiodarone?
* Observe for dyspnea, cough, and chest
pain
* Report visual disturbances.
* Advise clients to avoid sun lamps, and
wear sunscreen and protective clothing
76
What does lidocaine do?
* Decrease electrical
conduction
* Decrease automaticity
* Increase rate of repolarization
77
What are indications for lidocaine?
* Short-term use only for
ventricular dysrhythmias
* Acute dysrhythmias post MI
78
What are complications?
* CNS Effects-Drowsiness,
altered mental status,
paresthesia, seizures
* Respiratory Arrest
* Monitor VS and ECG.
* Ensure resuscitation equipment at the
bedside
79
How long do we use lidocaine for?
* Usually used for no more than 24 hr
80
What are nursing implications for lidocaine?
Monitor client for CNS depression (sedation,
irritability, seizures).
81
What meds do we use to treat angina?
aspirin
ranolazine
nitrates
beta blockers
statins
calcium channel blockers
82
What is the antidote for warfarin?
fresh frozen plasma
83
What dietary precautions do we take with warfarin?
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
What fluid is usually administered with blood products?
normal saline
85
What are indications for a calcium channel blocker? (like veramapil or nifedipine)
* Atrial fibrillation and flutter
* SVT
* Hypertension
* Angina pectoris
86
What do calcium channel blockers do? (like veramapil or nifedipine)
Decrease force of contraction
Decrease HR
Slow rate of conduction through SA & AV
nodes
87
How do we administer calcium channel blockers? (veramapil or nifedipine)
* PO: with or without food (long
acting)
* IV push or IV drip
88
What are adverse effevts of calcium channel blockers? (like veramapil or nifedipine)
* Peripheral edema
* Constipation
* ↓ Cardiac Function
* Bradycardia
* Hypotension
* AV block
* Acute Toxicity
89
What do we teach pts of calcium channel blockers? (like veramapil or nifedipine)
* 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
What does procainamide do?
Slow impulse conductions in the atria,
ventricles
91
What are indications of procainamide?
* Supraventricular
tachycardia Ventricular
tachycardia
* Atrial flutter
* Atrial fibrillation
92
What are complications of procainamide?
* Systemic Lupus
Syndrome
* Neutropenia,
thrombocytopenia,
agranulocytosis
* Cardiotoxicity
* Hypotension
93
What are administration considerations for procainamide?
* Monitor HR & rhythm, notify HCP of
any new dysrhythmia
Monitor BP-antihypertensives add
additional hypotensive effect
94
What are nursing considerations for procainamide?
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
What do we use loop diuretics to treat?
Pulmonary edema, Heart failure, HTN
96
What is the action of loop diuretics?
act on the ascending loop of Henle- Urine output is increased, and potassium is
excreted
97
What are adverse drug reactions to loop diuretics?
hypokalemia, hyponatremia, fluids, and electrolyte
imbalances. Orthostatic HTN, ototoxicity. Hyperglycemia in Diabetics and increased uric
acid levels
98
What nursing actions do we take for loop diuretics?
monitor for electrolyte imbalances, monitor BP closely, uric acid level,
hearing loss, and ringing in ears
99
How do we administer loop diuretics?
oral or IV form. Give oral with food. Administered IV slowly to prevent
ototoxicity; give the last dose well before bedtime
100
What do we educate clients on loop diuretics about?
the patient to recognize the symptoms of Hypokalemia. Increase K+ or a K+
supplement may be added
101
What do ACE inhibitors do?
reduce peripheral vascular resistance without increasing:
CO
cardiac rate
cardiac contractility
102
What are side effects of ACE inhibiitors?
dizziness
ortho hypotension
GI distress
cough
headache
103
What medication is less effective in african americans?
ACE inhibitors
104
What are ACE inhibitors used for?
HTN
105
What labs do we check for ACE inhibitors?
CMP
BMP
potassium levels
106
What are ARBS used for?
HTN
107
How long does it take ARBS to take effect?
3-6 weeks
108
What do we use calcium channel blockers for?
HTN
Angina
109
What are beta 1 blockers?
selective, they only work on the heart
metoprolol
atenolol
110
What are beta 2 blockers?
nonselective heart and lungs
propanolol
labetelol
111
In clients with CAD, what happens if they suddenly stop beta blockers?
risk for CHF, MI, angina
112
How do we administer enoxaparin?
don't expel bubble
fully insert needle, expel all contents
in abdomen, 2inc from umbilical
don't rub
rotate sites
113
What do we teach patients on calcium channel blockers?
* Lifestyle; check BP pulse
* Avoid Grapefruit/Grapefruit juice
* Good dental hygiene: can discolor teeth
