Lecture 15 Nursing 100 Flashcards

Question

Ca Channel Blockers adverse reactions

Answer 1

``` cardiovascular common & serious low BP, slow P, sinus block worsening CHF, dizziness, flush, weak GI- N/V/D, muscle fatigue, cramps Worsening of angina Photosensitivity, Pruitus Nasal congestion, Mood changes ```

Answer 2

Caution in pt w/ low BP, CHF, sick sinus Caution in pt w/ renal or hepatic impairment Hold dose & call MD if P , < 90 mm Hg

Answer 3

BP > 140/90 on 3 separate readings Silent killer- no symptoms causes damage to vital organs heart, brain, kidney, eyes Primary- unknown cause Secondary- specific disease process (hyperthyroidism)

Answer 4

Normal Less than 80 diastolic and 120 systolic Prehypertensive 80-89 diastolic and/or 120-139 systolic Hypertension: __ /90-99 no symptoms (or 140-159SBP) Tx = low Na, reduce Wt., Dc smoking ________ />100 few symptoms (or > 160) Tx diuretics & anti HTN _______ />115 symptomatic damage kidney, eyes Tx 3rd & 4th step anti-HTN agent HTN crisis & Malignant HTN ____/ 130-170 medical Emergency

Answer 5

low Na, low fat | 130-170 diastolic!

Answer 6

angiotensin antagonsts Ca channel blockers sympatholytics

Answer 7

add direct vasodilators

Answer 8

add direct sympatholytic

Answer 9

Catapress (clonidine)-inhibits sympathetic transmitter outflow Aldomet (Methyldopa)- displaces norepinephrine Inhibit stimulation of sympathetic nervous system Decreases BP by peripheral vasodilatation Decreased Cardiac Output

Answer 10

Step 2 agent to control HTN Used in mild HTN Combined with Step 3 or 4 agents in severe HTN

Answer 11

With many drugs in this class (antiHTN) Beta Blockers- cause Hi BP (paradoxical response) Haldol (increases disorientation w/ Aldomet) Norepinephrine & catecholamines- prolong presser response)

Answer 12

Clonidine- anticholinergic effects, drowsy dry mouth, constipation, orhostatic hypotension, rebound HTN if Dc abruptly Methyldopa - sedation, dec. alertness, depression dry mouth, dark urine, sexual dysfunction, anemia

Answer 13

Teach pt about side effects Take at night to dec. drowsiness Check BP before, hold if SBP <110 & call MD Check CBC with long term therapy Use caution if pt has coronary insufficiency, recent MI, CVA, RF Mouth care, cool drinks, gum Do not stop abruptly (rebound BP, inc P, salivation)

Answer 14

Direct vasodilatation- Apresoline (hydralazine) Acts directly on arteries &/ or veins to relax peripheral smooth muscle Reduces BP and decreases peripheral vascular resistance Used as Step 3 Drug given w/ Diuretic or Beta Blocker Tx Malignant HTN w/ renal insufficiency or CHF or HTN crisis (IM or IV)

Answer 15

Additive Effect with other Anti HTN Additive effect with Nitrates Ca Channel Blocker Beta Blockers

Answer 16

``` Cardiovascular Effects: palpations, angina tachycardia, orthostatic hypotension GI effects- N/V, anorexia Lupus syndrome- joint pain, fever, rash Sodium and Fluid retention ```

Answer 17

Do not use in pt w/ Lupus, angina, recent MI Use cautiously in pt w/ liver dysfunction Take with meals to help absorption Teach pt to check for edema, signs of Lupus Test for Lupus w/ LE prep test regularly Warn pt to rise slowly I & O, Daily Wt.

Answer 18

cardiazem (diltiazem) Amlodipine (Norvasc) Vasodilates by preventing binding of Ca to its receptors prevents contraction of smooth muscles around vessels dilates vessels to reduce BP Used as Step 2 or 3 agent for moderate - severe HTN Drug interaction- Rx that affect hepatic microsomal system Beta Blockers-severe bradycardia

Answer 19

``` Most serious = Low BP and Slow P flushing, HA, edema sleepy, tremors, insomnia Nausea, rashes Increased liver enzymes ```

Answer 20

Not in pt w/ 2nd or 3rd degree Heart Block or impaired renal function Caution in pt w/ impaired hepatic function Assess for orthostatic hypotension, edema Teach to take own BP Inform may not feel well with Rx Do not stop abruptly, call MD for side effects

Answer 21

ACE angiotensin converting enzyme inhibitors Capoten (captopril) Vasotec (enalapril) Interrupts renin-angiotension-aldosterone system Inhibits enzyme action that converts Angiotension I to II Also prevents Na and Fluid retention

Answer 22

``` Pt who fails to respond to other anti-HTN Step 4 (capoten) Step 1&2 (vasotec) Mild - Moderate HTN Renal insufficiency ```

Answer 23

Enhanced effect with diuretics Other anti-HTN Especially Beta Blockers

Answer 24

``` Wide range from mild to severe cough Proteinuria, skin rash Low BP, tachycardia Loss of taste sensation GI distress Renal failure, neutropenia (capoten) ```

Answer 25

Assess for Hx of decreased renal function, low WBC More effective w/ diuretic Use w/ caution in pt w/ Lupus, renal disease, Hi K elderly, recent MI, cardiovascular disease Question pt re. before & during Tx & orthostatic changes Monitor WBC, proteinuria, liver & kidney function,

Answer 26

Selectively antagonizes Angiotension 2 receptor sites so they can not cause vasoconstriction Losartan (Cozaar) Valsartan (Diovan) Side effects- dizziness, fatigue Nursing care- Check BP, renal function Usually does not cause cough like ACE inhibitors

Answer 27

Venous status = clots (DVT) Damage to vein thrombin adheres to area = thrombus Part of clot breaks off = embolus Body has natural heparin to dissolve clot

Answer 28

Heparin - prevents clot from enlarging Lovenox- (enoxaparin) Low Molecular Weight Heparin Inactivates thrombin, inhibits coagulation Decreases platelet adhesiveness Given SQ for prevention of clots IV bolus & continuous drip for Tx of clot

Answer 29

``` Prevention or treatment of thromboembolisms r/t Cardiac or Vascular surgery, Acute MI Atrial Fibrillation Prostate or Orthopedic surgery Prolonged bedrest ```

Answer 30

Oral anticoagulants = synergistic effect (blood thinner) Antiplatelet Rx (ASA) = additive effect Oral contraceptives = antagonistic effect Antihistamines, nicotine phenothiazines, PCN Very acidic - Do not mix in IV with other Rx, ONLY NS

Answer 31

``` Bleeding- urine, stool, GI tract, brain thrombocytopenia hair loss osteoporosis (spontaneous Fx) Antidote is Protamine Sulfate ```

Answer 32

APTT or PTT (activated or partial thromoplastin time) Therapeutic range 1 1/2 to 2 1/2 times control Call MD if PTT > 3 x control platelet count (lowered) Hct & Hgb drops (indicates bleeding)

Answer 33

Do not use if actively bleeding, bleeding disorder ETOH ism, GI ulcer, spinal or eye surgery, pregnant Use w/ caution in hepatic or renal disease, elderly Assess for bleeding- gums, nose, urine, stool, emesis, wounds Avoid IM injections, use soft toothbrush, no ASA, no rectal temps SQ injections - use TB syringe, 1/2”, 27g Administer in abdomen > 2” from umbilicus, do not aspirate or rubUse infusion pump for IV Protect pt from injury (pad rails) Prescribed in units (not milligrams) Teach pt home care- sx of bleeding, need for testing Do not use straight edge razor

Answer 34

``` 99% protein bound Onset 24-72 hr Duration 2-5 days Indirectly interferes w/blood clotting by depressing hepatic synthesis of Vit K Vitamin K antagonist Prevents clot formation Limits growth of existing clot ```

Answer 35

``` Often in conjunction with Heparin (quicker acting) Long term anticoagulation DVT or prophylactic Heart valve replacement Chronic Atrial Fibrillation decreases synthesis of vit. K in liver ```

Answer 36

Many drugs can interact and cause Serious side effects Especially highly protein bound drugs: dilantin, Lasix, barbiturates ASA, Heparin, NSAIDs = additive effect (thinner blood) Foods high in Vitamin K will increase clotting ETOH will increase bleeding

Answer 37

``` Bleeding complications Range form minor to severe Treatment of reaction range from: DC Coumadin, po, IM, IV Vit K to transfusion of plasma or blood Rare- anorexia, itching, hair loss ```

Answer 38

PT - Protime (Prothrombin) or INR (international normalizing ratio) Therapeutic range 1.2 to 1.5 times control of PT or INR values 2-3 times control Call MD if > 2 times control on PT or INR value > 4 times control

Answer 39

Do not use if active or past GI bleed, thrombocytopenia, Malignant HTN recent neuro or eye surgery, ETOHism, kidney or liver disease, pregnant, lactating Vitamin K is antidote (aquamephyton) Assess for sx bleeding Assess for sx of clot formation- Homan’s sign Assess for sx PE= SOB, CP, dec. O2, Inc. RR Dose individual according to PT Teach pt to keep log of dose and lab results Do not use OTC Rx & other Rx that interact Avoid ETOH and High Vitamin K foods Report sx bleeding Wear ID band Avoid activities that could cause bleeding