Final Exam (5/7) Flashcards
Know patient teaching for doxazosin (Cardura)
○ This drug works really well, sometimes too well
○ Avoid interactions (alcohol, benzos, opioids, etc.) or it can cause additive CNS depression
○ Monitor HR & BP before taking
○ Take medication at night
Review interactions for losartan (Cozaar)
○ k supplements: Heighten the chance that they will develop hyperkalemia
○ NSAIDS: Reduces effects
○ Lithium: Leads to lithium toxicity
○ Therapeutic level increases when given with losartan
○ Rifampin: Can reduce effectiveness
○ Black box warning for pregnant or lactating (birth defects)
Identify assessments to perform prior to administering antihypertensive drugs
○ Thorough health history
○ Baseline VS
○ Serum pottasium, chloride, magnesium, and calcium levels
○ CBC and platelet count
○ Renal function
○ Hepatic function
○ Be cautious with use of antihypertensives in older adult patients and those with chronic illnesses
■ It can further compromise their physical condition due to uncontrolled or untreated hypertension or the AE’s of antihypertensives
Know AE’s of clonidine (Catapres)
○ Hypotension, do not discontinue abruptly (rebound hypertension)
Review patient teaching for ALL antihypertensives
○ Patient checks BP and pulse rate- don’t take if less than 60 BPM
○ Educate on parameters
○ Educate to change positions slowly
○ Report to doctor if they keep getting dizzy
○ If a dose is missed, contact prescriber and do not double up on doses
○ Aware that this may be lifelong
○ Do not stop taking abruptly
Know teaching that is specific to metoprolol (Lopressor)
○ Beta blocker
○ Monitor BP and Check apical pulse for 1 min before taking med
○ Parameters:
○ Pulse less than 60, do not take, call provider
○ Systolic BP (top) below 100, do not take, call provider
○ Monitor blood glucose in diabetic patients (beta blockers can hide symptoms of hypoglycemia)
○ Contraindicated in asthma
Review interactions for captopril (Capoten)
○ NSAID (Reduce effects) ○ Other hypertensives ○ Diuretics (both lead to hypotension) ○ Lithium (Lithium toxicity) ○ Potassium supplements (Hyperkalemia)
Review interactions for beta blockers and nitrates
○ BP drops significantly (hypotension)
Know therapeutic outcomes for patients taking antianginals
○ Reduced number of episodes of chest pain
○ Reduced severity of chest pain
○ Decreased BP
○ Don’t need to take it as much
Review interventions for a client taking a beta blocker to treat angina
○ Check BP and apical pulse
○ Long-term treatment
○ Would want to see decreased angina over time
Identify patient teaching for transdermal nitroglycerin
○ Don’t touch it!!
○ Wear gloves, it can cause hypotension in the person who is applying it
○ Monitor baseline orthostatic BP and pulse
○ Monitor HR
○ Severe headache occurs when taking drug; improves over time
Review AE’s for lidocaine (Xylocaine)
○ Can cause dysrhythmias ○ Dizziness, confusion, drowsiness, restlessness ○ Paresthesia ○ Seizures ○ Muscle twitching ○ Respiratory arrest ○ Hypotension ○ Bradycardia/tachycardia ○ Burning at IV sight
Know which AE’s are common for ALL antidysrhythmics
○ Dysrhythmias ○ Dizziness ○ Hypotension ○ Bradycardia/tachycardia ○ BP changes (hypotension) ○ Hypersensitivity reactions ○ N/V/D ○ Dizziness ○ Headache ○ Blurred vision ○ Prolongation of the QT interval
Identify AE’s for amiodarone (Cordarone)
○ Pulmonary toxicity
○ Pulmonary fibrosis- Course crackles in the lungs and Difficulty breathing
○ Blue/gray skin color
GI, visual, cardiac, CNS
Know which dysrhythmias verapamil (Calan) is used to treat
○ Paroxysmal supraventricular tachycardia- converts this to normal sinus rhythm (PSVT)
○ Slows rate of atrial fibrillation
Review AE’s of nitroglycerin
○ HA (Severe at first)
○ Orthostatic hypotension
○ Tachycardia
○ Tolerance develops quickly
Know AE’s of adenosine (Adenocard)
○ Short half life – causes brief period of asystole
Know AE’s of quinidine (Quinidex)
○ Ventricular dysrhythmias (Toxicity) ○ Arterial embolism ○ Cinchonism (tinnitus, visual disturbances, HA, N/V) ○ GI ○ Hypotension
Know interactions for spironolactone (Aldactone)
○ ACE inhibitors: Holds on to potassium as well, do not give together
○ Lithium levels can increase
○ NSAID: Both work in the kidneys, kidney damage
Review AE’s for furosemide (Lasix)
○ Hypokalemia ○ Muscle cramping /pain ○ Restlessness ○ Photosensitivity ○ HA
Know patient teaching for older adults taking diuretics
○ Change positions slowly (affect BP more)
○ Teach patients not to take diuretics at night to avoid excessive urination while trying to sleep
Review labs to monitor for patients taking diuretics
○ Potassium level ○ Sodium ○ Magnesium ○ Kidney- BUN, creatinine ○ Fluid and electrolytes ○ Renal and hepatic function
Identify risk factors for digoxin (Lanoxin) toxicity
○ Hypokalemia ○ Hypomagnesemia ○ Older adult (65 or older) ○ Low potassium/magnesium levels may increase potential for digoxin toxicity ■ Watch electrolyte labs
Know the therapeutic drug level of digoxin (Lanoxin)
○ 0.5-2.0 ng/mL
Review interventions for administration of milrinone (Primacor) IV
○ Do not stop abruptly- may experience sudden and severe symptoms of heart failure
○ Closely monitor vitals, I&O, evidence of hypokalemia, heart and breath sounds
○ Use dedicated IV line
○ Short term management of acute heart failure
give loading dose over 10 minutes
Review labs to monitor for the patient taking warfarin (Coumadin)
○ PT: normal levels: 11-13 seconds
■ Therapeutic level: 1.5 times the normal value or 18 seconds
○ o INR: Normal levels: 1.1 or below
■ Therapeutic levels: 2.0-3.0 with average of 2.5
■ Those with recurring clots 2.5-3.5 with an average of 3.0
Know the correct administration technique for enoxaparin (Lovenox)
○ Administer subQ in prefilled syringe
○ Don’t expel the air bubble from the syringe
○ One-time use syringe
○ Monitor for excessive bleeding and bruising
Review AE’s of alteplase (Activase)
○ Thins blood ○ Decreased platelet aggregation ○ Bleeding ○ GI bleeding ○ Internal bleeding (tachycardia, hypotension) ○ Bleeding around IV ○ Bleeding gums
