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Pharmacology > Exam Two Blueprint > Flashcards

Exam Two Blueprint Flashcards

1
Q

What are the purposes of diuretics?

A

Lower blood pressure and decrease edema

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2
Q

How do diuretics work

A

block sodium and chloride and prevent water from being absorbed

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3
Q

How to recognize thiazides?

A

end in az(ide) + metolazone, chlorthalidone

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4
Q

Can thiazides be used for immediate diuresis?

A

no because they are slow acting

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5
Q

Indications of thiazides?

A

edema and heart failure

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6
Q
A
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7
Q

Contraindications of thiazides

A

Renal failure, pregnancy, allergy to sulfonamides (sulfa), anuria (kidneys not producing urine)

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8
Q

lab interactions of thiazides

A

hypokalemia, hypomagnesemia, hyponatremia, hypercalcemia, hyperglycemia, hyperlipidemia, hyperuricemia (elevated urea levels)

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9
Q

Drug interactions of thiazides

A

digoxin and antihypertensive drugs

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10
Q

Are thiazides potassium wasting or potassium sparing?

A

potassium wasting ; result in hypokalemia

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11
Q

Nursing interventions of thiazides?

A

monitor S/S of hypokalemia (twitches, cramps, arrhythmias), monitor VS, monitor calcium level, monitor blood sugar, monitor urine output, obtain order for potassium supplement, monitor weight, recognize fall risk due to orthostatic hypotension

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12
Q

urine output should be?

A

30 ml/hr

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13
Q

2.2 lbs is how many liters of fluid?

A

1

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14
Q

Patient teaching for thiazides

A

change positions slowly (due to hypotension), take in AM (reduce getting up at night and falling), monitor blood glucose, eat potassium rich foods, take with food, take daily weights at same time with same clothes, use sunblock and avoid sun

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15
Q

How to evaluate effectiveness of thiazides

A

blood pressure, edema, dyspnea, and crackles all decrease

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16
Q

What are the loop diuretics we discussed?

A

furosemide, ethacrynic acid, torsemide, bumetanide

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17
Q

Indications of loop diuretics?

A

CHF, edema, HTN, acute renal failure (ARF), acute pulmonary edema/ fluid overload

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18
Q

Why is furosemide, a loop diuretic, called fast and furious?

A

it works the quickest and has strongest effect

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19
Q

Contraindications of loop diuretics?

A

sulfonamide (sulfa) allergy (except for ethacrynic acid) , anuria, hypokalemia

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20
Q

Adverse effects of loop diuretics and nursing interventions

A

hypokalemia (obtain EKG and recommend potassium rich foods+ potassium supplement)
hypotension (take in morning to prevent getting up at night, monitor VS, change positions slowly and dangle legs, keep BP log)
phototoxicity (wear sunscreen and avoid sun)
dehydration (encourage fluid intake ,monitor urine output, take daily weights)
Tinnitus/ Ototoxicity (push loop diuretics into IV slowly)

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21
Q

Evaluating effectiveness of loop diuretics

A

BP, edema, dyspnea, and crackles all lessen

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22
Q

Examples of potassium rich foods

A

bananas, potatoes, dried fruit, tomatoes, nuts, apricots, citrus fruits

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23
Q

What are the potassium sparing diuretics?

A

spironolactone, amiloride, triamterene, eplerenone

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24
Q

Potassium sparing diuretics cause retention of_____ and excretion of _____

A

potassium ; sodium

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25
Q

Side/adverse effects of potassium sparing diuretics?

A

hyperkalemia, dizziness, headache, cramping, tumorigenic, risk of gastric bleeding, androgen effects (control sexual/ puberty functions) , and gynecomastia (overdevelopment of breast tissue in boys)

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26
Q

Nursing Interventions/ patient teaching for potassium sparing diuretics

A

monitor for hyperkalemia (nausea, diarrhea, abdominal cramps) , avoid potassium rich foods, avoid potassium salt substitutes, know the have long half-life and only given once a day

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27
Q

When are the latest time we can take diuretics?

A

2pm

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28
Q

What is the osmotic diuretic

A

mannitol

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29
Q

Side and adverse effects of mannitol?

A

edema, fluid and electrolyte imbalances, heart failure (with edema), hypotension, tachycardia, nausea and vomitting

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30
Q

Nursing interventions for mannitol

A

Monitor S/S of heart failure (SOB, retaining fluid, pitting edema, activity intolerance), monitor VS, monitor EKG, I&O, RFT (renal function tests), electrolytes, In-line filter (used for IV administration)

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31
Q

We should avoid potassium-sparing diuretics with what kind of medication?

A

ACE Inhibitors

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32
Q

How to recognize beta blockers

A

end in -olol

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33
Q

Intended effects/ side effects of beta blockers

A

Intended: Lower blood pressure and HR ; nonselective can cause bronchoconstriction and hypoglycemia
Side effects: orthostatic hypotension, masked signs of hypoglycemia, insomnia, nightmares, erectile dysfunction, depression

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34
Q

Patient teaching for beta blockers:

A

monitor blood glucose levels, change positions slowly, dangle legs, do not stop abruptly, report signs of depression, lower sodium intake, report signs of sexual dysfunction

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35
Q

Cultural differences of beta blockers

A

Blacks: not used as initial treatment
Asian Americans: more sensitive to beta blockers so lower doses

36
Q

What are the side effects of clonidine (Central acting Alpha 2 agonist)

A

hypotension, bradycardia (do not give with betas blockers), anticholinergic effects, peripheral edema (caused by sodium retention)

37
Q

How to recognize ace inhibitors

A

end with -pril (lisinopril)

38
Q

Black box warnings of ACE inhibitors

A

pregnancy, angioedema

39
Q

Adverse and side effects of ACE inhibitors

A

Adverse: hyperkalemia, angioedema
Side Effects: dry cough, hypotension, reflex tachycardia, bone marrow suppression

40
Q

Patient teaching for ACE Inhibitors/ ARBS

A

taper dose (avoid rebound hypertension), avoid K+ foods and potassium supplement, monitor BP, report pregnancy immediately

41
Q

How to recognize ARBS (angiotensin II receptor Blockers)

A

end in sartan

42
Q

How do ARBS differ from ACE inhibitors in terms of side effects?

A

no cough, less risks of angioedema and hyperkalemia (pregnancy contraindication remains)

43
Q

ARBS are less effective in what population of people?

A

African americans

44
Q

How to recognize calcium channel blockers?

A

end with -dipine , -mil, -dil except for diltiazem

45
Q

Indications of calcium channel blockers

A

anti-arrhythmic, pulmonary disorders, hypertension, angina

46
Q

intended effects of calcium channel blockers?

A

Lower blood pressure, decrease chest pain (angina) / decrease coronary spasms

47
Q

Side effects of calcium channel blockers

A

peripheral edema, hypotension, bradycardia, CHF and Stevens-Johnson Syndrome

48
Q

Patient teaching while on calcium channel blockers

A

taper dose (rebound tachycardia/hypertenion) , report CP/SOB, know drug interactions

49
Q

Drug interactions of calcium channel blockers

A

avoid statins, grapefruit juice (increase level of CCB)

st.johns wart (decreases level of CCB)

50
Q

What is the therapeutic range of digoxin? (cardiac glycoside)

A

0.5-2.0 ng/ML

51
Q

What should we monitor to ensure our patient doesn’t go into toxicity while on digoxin

A

serum peak and trough levels because therapeutic window is narrow

52
Q

What are the nursing interventions for abnormal digoxin levels?

A

listen to apical pulse one full minute, monitor S/S of heart failure, monitor digoxin and potassium levels (EKG may be needed)

53
Q

What is the antidote for digoxin?

A

digoxin immune fab (given by (IV and must have continuous cardiac monitoring)

54
Q

Signs and symptoms of digoxin toxicity?

A

anorexia is first symptom, bradycardia, nausea/V/D, visual changes, diplopia (blurry vision) , dysrhythmias, fatigue, drowsiness

55
Q

We can say digoxin has been effective when we evaluate what?

A

decreased HR, crackles, SOB, edema, coughing, increased breathing

(improved symptoms of heart failure)

56
Q

Side effects of nitroglycerin (antianginal)

A

headaches and hypotension (two biggest), dizziness, weakness/syncope, flushing, peripheral edema, tolerance

57
Q

Adverse effects of nitroglycerin

A

orthostatic hypotension, reflex tachycardia, palpitations, dyspnea

58
Q

Nursing interventions of nitroglycerin

A

monitor VS, have patient sit or lie down, change positions slowly, sip of water before SL administration, acetaminophen for headache, do not put ointment or patch near defibrillator

59
Q

Patient teaching for nitroglycerin

A

avoid alcohol, do not abruptly stop, avoid ED drugs (Pde5 inhibitors), keep SL in original bottle and away from light, topical should be taken off at bedtime

60
Q

What is the nitrate free period?

A

when we remove nitroglycerin patches/ cream at night to prevent tolerance

61
Q

How do we instruct patient to take nitroglycerin for acute chest pain

A

take 1 SL tablet every 5 minute for a total of 3 tablets

62
Q

How to recognize HMG CoA Reductase Inhibitors?

A

end in -statin

63
Q

Adverse effects of HMG CoA reductase inhibitors (Statins)

A

myalgia, myopathy, rhabdomyolysis (indicated with brown/tea colored urine), hepatotoxicity, cataracts, GI effects

64
Q

Patient teaching for HMG CoA Reductase Inhibitors (statins)

A

avoid alcohol and grapefruit juice, report pregnancy and pregnancy, get yearly eye exam, take with food, do not stop abruptly, take medicine at night

65
Q

What lab values can we use for HMG-CoA reductase inhibitors to evaluate effectiveness?

A

Total cholesterol <100 , LDL <130, HDL >90

66
Q

Side effects of nicotinic acid (Niacin or Vitamin B3)

A

peripheral vasodilation (hypotension, dizziness, flushing of face, ears, chest, neck) , GI effects

67
Q

Patient teaching for Nicotinic Acid

A

take with food, take 3 25 mg aspirin to reduce flushing

68
Q

Patient teaching for cholestyramine (bile acid sequestrant)

A

mix powder drug completely with water or juice, increase fiber and fluids, take laxatives if needed, take a supplement for fat-soluble vitamins, take other medications 4 hrs before this one

69
Q

What are the anti platelet drugs

A

NSAIDS (includes aspirin/ASA/acetylsalicylic acid), P2Y12 receptor blockers

70
Q

What are the P2y12 receptor blockers

A

ticlopidine, clopidogrel, prasugrel, ticagrelor

71
Q

What is the purpose of anti platelets

A

prevent aggregation of platelets, prevents clots in the arteries (prevents MI or stroke)

72
Q

Adverse effects of anti-platelets

A

hemorrhagic stroke, increased bleeding, tennitus and hearing loss, thrombocytopenia

73
Q

What are the labs for heparin?

A

aPTT : therapeutic at 60-80 seconds (at risk of bleeding at 70 seconds; greater than 80 hold medicine and contact provider)
PTT: therapeutic between 100-140 (at 100 seconds @ risk of bleeding; greater than 140 hold medicine and contact provider)

74
Q

What should we remember when administering heparin?

A

SQ: 2 in from umbilicus, rotate sites, pinch up skin, DO NOT RUB IN, apply pressure after, do not aspirate, 25-26 gauge 1/2-5/8 in needle, do not expel air bubble in enoxaparin (profiled syringe)

IV: aPTT should be verified before administration/ rate change. Verify dose calculation with second nurse before administration. Monitor every 4-6 hours. Delivered via pump and not gravity, has its own line.

75
Q

What is the antidote for heparin?

A

protamine sulfate

76
Q

What are the indications for warfarin?

A

DVT, prevent thrombus formation with a-fib or prosthetic heart valves,. prevent MI, PE and TIA

77
Q

What is the antidote for warfarin?

A

vitamin K

78
Q

What are the labs for warfarin?

A

INR: 2-3 is therapeutic (3-4.5 if they have mechanical heart valve)
PT: 18-24 seconds

79
Q

Signs and symptoms of bleeding

A

petechiae, hematoma, bleeding gums, tarry stool, pink urine, coffee ground emesis, increased bruising

80
Q

Patient teaching for warfarin

A

notify dentist, soft bristled toothbrush, wear medic alert bracelet, no smoking (slows down warfarin metabolism), eat vitamin k in consistent amounts

81
Q

Important consideration of pharmacokinetics and warfarin?

A

it is highly protein bound; check other drugs because we may need to lower dose to prevent toxicity

82
Q

Contraindications of warfarin

A

pregnancy

83
Q

What are the adverse effects of erythropoietin?

A

HTN (contraindication) , risk for thrombotic events, DVT, stroke (monitor for headaches and body aches)

84
Q

What does epoetin alfa do?

A

increase production of red blood cells

85
Q

What are the side effects of filgrastim (used for neutrophil production)

A

bone pain (can give acetaminophen), leukocytosis, splenomegaly and risk of splenic rupture

86
Q

What are the indications of oprelvekin?

A

treat thrombocytopenia (increase production of platelets), decrease need for platelet transfusion

87
Q

How do we evaluate effectiveness of oprelvekin?

A

platelet level greater or equal to 50,000

Pharmacology (12 decks)

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