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Pharmacology 101 > Lecture 15 Nursing 100 > Flashcards

Lecture 15 Nursing 100 Flashcards

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1
Q

Angina Pectoris

A

Chest pain

Lack of oxygen (ischemia) to heart muscle

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2
Q

3 types of angina

A

stable
unstable
vasospastic

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3
Q

Stable angina

A

coronary atherosclorisis

w/ an activity

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4
Q

Unstable angina

A

progressive

doing nothing

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5
Q

Vasospastic

A

vessels go into spasm- o2 can’t pass through prinzmetal or variant=unusual

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6
Q

Goal of Treatment- Angina

A

Decrease preload by dilating veins and decreasing blood return
reduce afterload by dilating arteries and decreasing peripheral vascular resistance

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7
Q

Preload

A

venous return to heart

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8
Q

Afterload

A

pumping against arterial system

high BP increases afterload

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9
Q

antianginal agents

A 
Decrease heart rate
Decrease preload
Decreased afterload
decrease heart’s contractility
All in effort to dec. oxygen demand or
Increase blood supply to cardiac muscle (or both)
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10
Q

Nitrates- Nitroglycerin (Nitrobid, Nitrostat)

A

SL- rapid absorption (for acute attack)
PO- 50% absorbed (prophylactic)- prevention
IV- immediate action for acute attack- when SL doesn’t work
Transdermal patch or paste- slow absorption (prophylactic)

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11
Q

Nitrates action

A 
relax vascular smooth muscle
dilates coronary arteries
reduces cardiac workload
reduces myocardial demand for oxygen
reduces or relieves chest pain
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12
Q

Nitrates therapeutic uses

A

Immediate relief of angina (acute attack)
Prevention of angina before exercise (anticipated attack)
Long Term prevention (chronic angina)

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13
Q

Nitrates drug interactions

A

Other Antianginals
Antihypertensives
Vasodilators
ETOH

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14
Q

Nitrates adverse reactions

A

Vasodilatation-HA, dizziness, flushing, syncope
Postural hypotension
Tachycardia
Topical- skin rash, dermatitis, staining clothes

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15
Q

Nitrates nursing implications

A

Do not use if angina due to enlarged heart
Do not use with ICP or head trauma
use caution w/ dehydration, diuretics, vascular depletion
First dose pt sit or lie, check P & BP a & p
take to ER after 3 pills
SL keep in air tight, light resistant bottle, replace q6 mon. (DO NOT swallow SL tab)
Topical- remove old med and clean area
May repeat SL q 5 min (up to 3 tabs) if no relief to ER
Do not abruptly DC med (vasospasms)- consult MD\

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16
Q

Beta Adrenergic Blockers (Antianginals)

A

Inderal (Propranolol)
Not for acute attacks
PO - 30 min. onset
Used for long term prevention

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17
Q

Beta Adrenergic Blockers Actions

A 
only in chronic treatment
reduce  BP
blocks beta receptor site in cardiac muscle
reduces HR
reduces force of contractions
reduces oxygen needs
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18
Q

Beta Adrenergic Blockers drug interactions

A

Additive effect with Digoxin (reduced HR )
Additive effect with Antihypertensive (low BP)
Antiarrythmias
Phenothiazines
Aminophyline- opposite effect (antagonist)
Cimetidine inhibits metabolism of Inderal

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19
Q

Beta Adrenergic Blockers Adverse reactions

A 
Related to Cardiovascular system
Low HR, low BP
Angina, syncope
CNS- dizzy, fatigue, confusion
depression, insomnia
Bronchoconstriction & spasms
Hypoglycemia- especially in diabetics
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20
Q

Beta Adrenergic Blockers implications

A 
Not in pt w/ asthma, heart block, shock
Caution in diabetes, CHF, COPD
Hold if P <90 mmHg
Teach pt to take at same time q day
Do not DC abruptly (taper off to avoid HTN, angina, dysrhythmia or MI)
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21
Q

Ca Channel Blockers

A

Used for prevention of angina (esp. if not responsive to other Rx)
SL absorbed quickly (lowers BP)
PO goes through first liver by-pass
90% protein bound

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22
Q

Ca Channel Blockers Action

A

blocks Calcium ion flow in myocardial muscles & pacemaker
decreases contractility
decreases oxygen needs
Acts at vascular smooth muscle
decreased afterload & oxygen needs by dec. HR
Increases oxygen to heart by dilating coronary arteries

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23
Q

Ca Channel Blockers therapeutic use

A

Long term prevention of angina
Not for acute attack
Especially helpful in spasm type (Prinzmetal)

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24
Q

Ca Channel Blockers drug interactions

A

Beta Adrenergic blockers = heart block, CHF
Displaces protein bound Digoxin
high protein bound drugs- increased effect of Rx
Enhanced effect of Antihypertensives (lower BP)

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25
Q

Ca Channel Blockers adverse reactions

A 
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
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26
Q

Ca Channel Blockers nursing implications

A

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

27
Q

Hypertension

A

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)

28
Q

Types of HTN

A

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

29
Q

Prehypertensive treatment

A

low Na, low fat

130-170 diastolic!

30
Q

Step 2

A

angiotensin antagonsts
Ca channel blockers
sympatholytics

31
Q

Step 3

A

add direct vasodilators

32
Q

Step 4

A

add direct sympatholytic

33
Q

Sympatholytics

A

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

34
Q

Sympatholytics Therapeutic uses

A

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

35
Q

Sympatholytics drug interactions

A

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

36
Q

Sympatholytics adverse reactions

A

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

37
Q

Sympatholytics nursing implications

A

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)

38
Q

Vasodilating Agents

A

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)

39
Q

Vasodilating Agents drug interactions

A

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

40
Q

Vasodilating Agents adverse reactions

A 
Cardiovascular Effects: palpations, angina
tachycardia, orthostatic hypotension
GI effects- N/V, anorexia
Lupus syndrome- joint pain, fever, rash
Sodium and Fluid retention
41
Q

Vasodilating Agents nursing implications

A

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.

42
Q

Vasodilating Agents Ca Channel blockers

A

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

43
Q

Vasodilating Agents Ca Channel blockers adverse reactions

A 
Most serious = Low BP and Slow P
flushing, HA, edema
sleepy, tremors, insomnia
Nausea, rashes
Increased liver enzymes
44
Q

Vasodilating Agents Ca Channel blockers nursing implications

A

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

45
Q

Angiotensin-Antagonist Agents

A

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

46
Q

Angiotensin therapeutic uses

A 
Pt who fails to respond to other anti-HTN
Step 4 (capoten)
Step 1&2 (vasotec)
Mild - Moderate HTN
Renal insufficiency
47
Q

Angiotensin drug interactions

A

Enhanced effect with diuretics
Other anti-HTN
Especially Beta Blockers

48
Q

Angiotensin adverse reactions

A 
Wide range from mild to severe
cough
Proteinuria, skin rash
Low BP, tachycardia
Loss of taste sensation
GI distress
Renal failure, neutropenia (capoten)
49
Q

Angiotensin nursing implications

A

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,

50
Q

Angiotensin 2 receptor antagonist (A2RA)

A

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

51
Q

Thrombus/Embolus

A

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

52
Q

Anticoagulant Agents- parenteral

A

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

53
Q

Parenteral

A 
Prevention or treatment of thromboembolisms r/t
Cardiac or Vascular surgery, Acute MI
Atrial Fibrillation
Prostate or Orthopedic surgery
Prolonged bedrest
54
Q

parenteral drug interactions

A

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

55
Q

parenteral adverse reactions

A 
Bleeding- urine, stool, GI tract, brain
thrombocytopenia
hair loss
osteoporosis (spontaneous Fx)
Antidote is Protamine Sulfate
56
Q

parenteral lab tests to monitor

A

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)

57
Q

parenteral nursing implications

A

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

58
Q

Oral Anticoagulants- Coumadin (Warfarin)

A 
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
59
Q

Coumadin therapeutic uses

A 
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
60
Q

Coumadin drug interactions

A

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

61
Q

Coumadin adverse reactions

A 
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
62
Q

Coumadin lab test to follow

A

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

63
Q

Coumadin nursing implications

A

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

Pharmacology 101 (15 decks)

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