Exam4 Flashcards
1
Q
Maturation of ovarian follicle
A
Gonadotropin
2
Q
Potential result of ovulation stimulation by
Menotoropin or clomiphene
A
Twins
3
Q
Methylergonovine reduces this post partim
A
Hemorrhage
4
Q
Treats preeclampsia.
A
Magnesium
5
Q
Induction of labor
A
Oxytocin
6
Q
Needed in order to give oxytocin
A
Infusion pump
7
Q
Cheap imposter for cervical ripening
A
Misoprostol
8
Q
Reverses magnesium toxicity
A
Calcium gluconate
9
Q
Adrenergic agonist that stops hyperstimulation of uterus
A
Terbutaline
10
Q
Thickens cervical mucus
A
Clomiphene
11
Q
Severe hypertension
A
Preeclampsia
12
Q
Gel for cervical ripening
A
Dinoprostone
13
Q
Sex the night b4 injection & the next 2-3 days
A
Menotropin
14
Q
Menotropin is a combo drug of____& LH
A
FSH
15
Q
Terbutaline decreases these
A
Contractions
16
Q
% of water in body
A
60
⬆️ in infants
⬇️ in elderly
17
Q
Colloids
A
Plasma volume expanders like:
-albumin
- globulin
-fibrinogen
Tx: hypovolemic shock
-burns
-hemorrhage
- surgery
Side effects:
-dilution effect alters coagulation
18
Q
If protein falls below ______ fluid shifts from blood to tissue
A
5.3 g/dL
19
Q
Albumin
A
Natural protein made in liver
Pull fluid back into blood vessel
Human donation
5% albumin= most common
25%albumin = emergent, blood loss, 3.5x the amount in 15-30 min
⬆️ BP
⬆️ HR
20
Q
Dextran
A
Synthetic polysaccharide
Longer acting within minutes
Double plasma volume
Put pt on tele
21
Q
Blood products
A
Expensive
Human donor
22
Q
Cryoprecipitate
A
Blood product
Acute bleeding
23
Q
FFP
A
Fresh frozen plasma
Blood product
⬆️ clotting factors
24
Q
PRBC
A
Packed red blood cells
Blood product
⬆️ oxygen carrying capacity
25
Whole blood
Blood product
⬆️ oxygen carrying capacity
Emergent🚨
>25% blood loss
Higher risk for reaction
26
Blood transfusion
> or = 19 gauge needle
Hang within 30 min
Appropriate tubing
Normal saline piggy back
Infuse over a max 4 hrs
Stay in room for first 15 minutes
27
Blood transfusion vitals
B4
Every 15 min after
Then hrly
At completion
1 hr after completion
28
Hemolytic reaction
Clue: think infection/kidney
- headache
- chills
- shaking
-fever
- vomiting
- red urine
-flank pain
- shock
- renal failure
-death in 7-12 days
29
TX for Hemolytic reaction
- Diuresis/diuretics
-rapid IV fluids
30
Allergic reaction happens because…
foreign plasma protein
-shown as urticaria
Anti-IgA mediated response
- shown as anaphylaxis
31
Tx for allergic reaction
Benadryl
Tylenol
32
Suspected transfusion reaction, what do you do?
1. Stop blood
2. Stay in room
3. Notify Dr
4. Normal saline
5. Oxygen
6. Set of vitals
What can another nurse do?
33
Define heart failure
Inability to eject blood due to:
Chamber dilation
⬆️ intracardiac pressure
Ejection fraction <65%
34
Symptoms of heart failure
Dyspnea
Fatigue
Fluid retention
Pulmonary edema
⬇️ urine out put
35
Inotropin
Force of muscular contractions🫀
Goal is to ⬆️
36
Chronotropic
Rate of heartbeat
Positive drug =⬆️ HR
Negative drug =⬇️ HR
37
Dromotropic
Conduction of electrical impulse
38
Digoxin
0.5 - 2
Cannot stop cardiac remodeling
39
Digoxin. Toxicity
Nastagmous
Walking problems
Infusion dysthythmias
Death
40
Goals per the American ❤️ Association and American college of cardiology
⬇️ effects of renin-angiotension- aldosterone system
⬇️ effects of sympathetic nervous system
41
What does "ace" in ace inhibitors stand for
Angiotension
Converting
Enzyme
42
Ace inhibitors
Stops ACE to prevent angiotensin II
⬇️ BP
43
Angiotensin II is a...
Vasoconstrictor that causes aldosterone to release
44
Aldosterone Causes..,.
Na and H2O retention = ⬆️ blood volume
⬆️ blood volume = ⬆️ BP
45
Only Ace to be given IV
Enalapril
46
What do "pro drugs" need
Good liver function
47
The 5 prodrugs
Enalapril
Quinapril
Benazepril
Remipril
Fusinopril
48
Not prodrug that has a short half life , may need frequent doses
Captopril
49
Not prodrugs
Captopril
Lisinopril
50
Ace inhibitors adverse effects
Hyperkalemia
Headache
Dry, non productive cough
Bradykinin release
51
What is Bradykinin release
Relaxation of smooth muscle &
Angioedema I swelling of neck throat, mouth)
Causes wet cough or stridor
52
Ace contraindications
Pregnancy
Breast feeding
53
What are ARBs?
Angiotensin II receptor blockers
Blocks vasoconstriction & release of aldosterone
Goal: ⬇️ BP
54
ARB'S end in...
-sartan
55
ARB'S adverse effects
Hyperkalemia
Headache
Bradykinin release
Gingival hyperplasia
*no dry cough*
56
ARB'S contraindications
Pregnancy
Breast feeding
57
What does ARNi'S stand for?
Angiotensin receptor- neprilysin inhibitors
58
ARNi'S adverse effects
Hyperkalemia
Angioedema
Hypotension
Poor renal function
⬆️ serum creatinine
59
Valsartan/sacubitril
Popular
⬇️ cardiovascular death/ heart failure by 20%
Class I recommended management for pt with heart failure and ⬇️ejection fraction
Contraindication
Pregnancy
Breast feeding
60
Beta blockers
Cardio protective quality
Blocks epinephrine & norepinephrine in heart=does not ⬆️ HR
Slows conduction of SA node =⬇️ HR
Allows for ventricles to fill
61
Beta blocker end in...
-LOL
62
Most common beta blocker & treats 🫀 failure
Metoprolol
63
Slows progression of HF & ⬇️ rate of readmission in HF
Carvedilol
64
. Phosphodiesterase inhibitors
Stops enzyme phosphodiesterase
Vasodilation
➕inotropic response
➕chromotropic response
65
Milrinone
Phosphodiesterase inhibitor
Can't use long term
Demonstrates poor outcome
IV, use pump
66
Milrinone adverse effects
Hypotension
Hypokalemia
Ventricular dysrhythmia
Aggravation of existing angina
Thrombocytopenia
Elevated LFT'S
67
First approved drug for a specific ethnic group
Hydralazine/isosorbide dinitrate
Hydralazine=Hypertensive drug
isosorbide dinitrate= antianginal drug
68
Nesiritide
Synthetic BNP
Vasodilating effects
⬆️ urine output
Without⬆️ HR
Used in ICU
Treat severe HF
Worsens renal function
⬆️ mortality
69
Adrenergic agonists
Stimulate SNS
Fight or flight
Mimics effects of:
Norepinephrine
Epinephrine
Dopamine
70
Receptor that are vasoconstrictors of blood vessels
Alpha 1&2
71
Receptor for cardiac stimulation
Beta 1
72
Receptor for broncodilation
Beta 2
73
Epinephrine
Non selective catecholamine
Primary drug for ACLS
IV
1 or 0.1 my/ mL
Adverse effects :
Tremors
Insomnia
Tachycardia
Hypertension
74
Epinephrine Low dose
Beta 1
⬆️ contractility
➕ inotrope
⬆️ HR
➕ chromotrope
75
Epinephrine high dose
Alpha, Beta 1 & Beta 2
Vasoconstriction lead to hypertension
IV drip
⬇️ kidney perfusion
76
Norepinephrine
Non selective catecholamine
Tx: hypotension and shock
Continuous IV infusion
Converts to dopamine
Adverse effect:
Headache
Hypertension
77
Norepinephrine beta 1
⬆️ contractility
➕inotrope
⬆️ HR
➕chromotrope
* less calcium in🫀 cells=⬇️ risk for MI*
78
Norepinephrine alpha receptors
Vasoconstriction
⬇️ renal blood flow
Last resort bc of kidney issues
79
Dopamine
Selective catecholamine
Drug of choice for shock
Not hard on kidneys
Given continuous infusion
80
Dopamine low dosage
Stimulates dopaminergic receptors
⬆️ blood flow to heart, kidneys, brain.
81
Dopamine high dose
Stimulates beta 1 -⬆️ contractility
Stimulates alpha adrenergic.- ⬆️ BP by vast o construction of peripheral blood vessels
Affects kidneys negatively
82
Dobutamine
Selective catecholamine
Tx: heart failure
Stimulates beta 1
⬆️ contractility=⬆️ stroke volume
Continuous IV
83
Fenoldopam
Peripheral dopamine agonist
Beta 1
TX: short term for hypertension
⬇️ BP by arteriolar vasodilation
⬆️ renal blood flow
84
Midodrine
Prodrug converted into desglymidodrine
Tx: symptomatic orthostatic hypotension
Stimulates alpha 1
Causes peripheral vasoconstriction by constricting arterioles & veins
Adverse effects
Supine hypertension
Insomnia
85
Midodrine nursing implications
Asses orthostatic BP
Take 2-3 X daily
AM dose in bed W lots of water
Final dose: min. 4 hrs b4 sleep not after 6pm bc supine hypertension
86
Mirabegron
Tx: overactive bladder by⬆️ bladder capacity
Stimulates beta 3
Relaxes detrusor muscle and urothelium
Adverse effects:
Hypertension
UTI
Nurse implications
sustain released so Do not chew!
stretch out peeing 4-5 hrs to empty completely
87
Phenylephrine
Tx: short term⬆️ BP for shock
Controls SVT
Stimulates alpha
IV, topical, ophthalmic nasal
88
Phantolamine
Adrenergic infiltration
Leads to vasodilation
TX: dental anesthetic reversal and erectile dysfunction tx /diagnosis
Inject into penis intracavernosal
89
Define dysrhythmia
Any deviation from normal heart rhythm
90
Antidysrhythmic drug
TX and prevent disturbances in cardiac rhythm
91
P wave
Depolarization of atria
Multiple P waves consecutively = conduction block
92
QRS complex
Depolarization of ventricles
Wide QRS = lethal v-tach
Skinny QRS =SVT
93
T wave
Depolarization of the ventricles
94
ST segment
MI dysfunction
95
Long Q T
Can't repolarize= 🫀 stops
96
Quinidine
Class 1A: sodium channel blockers
Po, IV, IM
TX: atrial and ventricular duysrhythmias
Adverse effects
Cinchonism
Tinnitus
Blurry vision
Headache
Nausea
97
Procaïnamide
Class 1A sodium channel blockers
Po, IV, IM
TX: atrial and ventricular dysthythmias
Adverse effects
Blood dyscrasias
Lupus erythematosus-like syndrome
Butterfly rash
Autoimmune
98
Lidocaine
Class 1B sodium channel blocker
IV
TX: ventricular dysrhythmias
Adverse effects:
CNS symptoms
Confusion
Drowsiness
99
Mexiletine
Class 1B sodium channel blocker
PO (oral of lido)
TX: ventricular dysthythmia
No adverse effect
100
Propafenone
Class 1C sodium channel blocker
PO
TX & prevention: Life threatening ventricular dysrhythmias
101
Flecaïnide
Class 1C sodium channel blocker
Po
Tx: life-threatening ventricular dysrhythmias
* lowest dose possible*
Adverse effect:
Proarrhythmic effects= ⬆️incidence of cardiac arrest
102
Class 2 beta blockers & TX SVT
Propranolol
Acebutolol
Sotalol
Esmolol
103
Amiodarone
Tx: life threatening dysrhythmias only
sustained ventricular tachycardic
Class 3 potassium channel blocker
IV
Compassion care
Long half life= 2-3 Months
Adverse effects
Pulmonary toxicity
Cardio toxicity
Corneal microdeposits(adults longer than
6m)
Skin photo sensitivity (cover up)
104
Do not take amiodarone with____
Digoxin
⬆️ levels by 50%
105
Class 4 calcium channel blockers that treat a-fib and SVT
Verapamil
Diltiazem
106
Last resort antidyschythmic drug
Adenosine
Tx: SVT if verapamil isn’t working
10second half life
Push IV FAST
Adverse effect:
Asystole for seconds
