Med Cards

Question 1

Furosemide is also called?

Answer 1

Lasix

Question 2

Furosemide: Classification:

Answer 2

Therapeutic - diuretics. -Pharmacologic - loop diuretics

Question 3

Furosemide:

Standard Dosage:

Answer 3

PO adults- 20-80 mg/day as a single dose initially, may repeat in 6-8 hr; may
increase dose by 20-40 mg q 6-8 hr until desired response. Maintenance doses may be given once
or twice daily.

Question 4

Furosemide:

Drug Action:

Answer 4

-Inhibits reabsorption of sodium and chloride from the loop of henle and distal
renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, calcium.
Effectiveness persists in impaired renal function.

Question 5

Furosemide:

Therapeutic Uses:

Answer 5

Diuresis and subsequent mobilization of excess fluid (edema, pleural
effusions). Decreased BP

Question 6

Furosemide:
Indication:

Answer 6

Edema due to heart failure, hepatic impairment or renal disease. Hypertension.

Question 7

Furosemide:

Adverse Effects of the central nervous system and cardiovascular system?

Answer 7

CNS - blurred vision, dizziness, headache, vertigo. CV - hypotension.

Question 8

Furosemide:

Adverse Effects of the gastrointestinal and genitourinary systems?

Answer 8

GI -
anorexia, constipation, diarrhea, dry mouth, dyspepsia, increased liver enzymes, nausea,
pancreatitis, vomiting. GU - increases BUN, excessive urination, nephrocalcinosis.

Question 9

Furosemide:

Adverse Effects of EENT (ears, eyes, nose, throat) and dermis (skin):

Answer 9

EENT - hearing
loss, tinnitus. Derm - erythema multiforme, stevens-johnson syndrome, toxic epidermal necrolysis,
photosensitivity, pruritus, rash, urticari

Question 10

Furosemide:

Adverse Effects of Endo:

Answer 10

Endo - hypercholesterolemia, hyperglycemia,

hypertriglyceridemia, hyperuricemia.

Question 11

Furosemide:

Adverse Effects of Fluids and Electrolytes:

Answer 11

F & E - dehydration, hypokalemia, hypochloremia,

hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis

Question 12

Furosemide:

Adverse Effects of Muscular system and neuro (brain nerves)?

Answer 12

MS - muscle cramps.

Neuro - paresthesia. Misc - fever.

Question 13

Furosemide:

Nursing Implications:

Answer 13

Assess fluid status. Monitor daily weight, I & O ratios, amount and
location of edema, lung sounds, skin turgor & mucous membranes. Notify HCP if thirst, dry mouth,
lethargy, weakness, hypotension or oliguria occurs. Monitor BP and pulse before and during
administration. Monitor frequency of prescription refills to determine compliance in patients treated
for hypertension. (Geri): diuretic use is associated with increased falls in older adults. Assess fall
risk/prevention strategies. Assess patients receiving digoxin for anorexia, nausea, vomiting, muscle
cramps, paresthesia and confusion. Increased risk of digoxen toxicity because of potassium
depleting effect of diuretic. Can give potassium supplements/potassium sparing diuretics to prevent
hypokalemia. Asses for tinnitus or hearing loss. Audiometry is recommended for patients receiving
prolongs high IV dosage. Hearing loss is most common after rapid or high dose/rapid IV admin in
patients with decreased renal function, or those taking ototoxic drugs. Assess for allergies to
sulfonamides. Assess for skin rash frequently (discontinue at first sign of rash, dermal side effects
may develop).

Question 14

Furosemide:

Drug Interactions:

Answer 14

^risk of hypotension with antihypertensives, nitrates, or acute ingestion of
alcohol. ^ risk of hypokalemia with other diuretics, amphotericin B, stimulant laxative and
corticosteroids. Hypokalemia ^ risk of digoxin toxicity and ^ arrhythmia in patients taking drugs
that prolong the QT interval. Decreases lithium excretion, may cause lithium toxicity. ^ risk of
ototoxicity with aminoglycosides or cisplatin. ^ risk of nephrotoxicity with cisplatin. NSAIDS
decrease effect of furosemide. May ^ risk of methotrexate toxicity. Decrease effects of furosemide
when given same time as sucralfate, cholestyramine, colestipol. ^ risk of salicylate toxicity (with
use of high dose salicylate therapy). Concurrent use with cyclosporine may ^ risk of gouty arthritis.

Question 15

Furosemide:

Patient Teaching:

Answer 15

Take as directed, do not double, do not miss doses. Change positions slowly,
don’t drink alcohol, exercise in hot weather or stand for a long time due to orthostatic hypotension.
Consult HCP about high potassium diet, and about weight gain if more than 3lbs in a day. Make
sure all Rx or OTC medications are known by HCP, during therapy and before treatment or surgery.
Caution patient about wearing sunscreen or clothing in sun due to photosensitivity. Contact HCP
immediately if rash, muscle weakness, cramps, nausea, dizziness, numbness or tingling of
extremities occur. Advise diabetic patients to monitor blood sugar closely. Emphasize importance
of follow up exams. Assess fall risk/prevention strategies in older adults. Advise patients on
antihypertensive regimen to continue meds even if feeling better, and continue the use of addition
therapies for hypertension (weight loss, exercise etc.)

Question 16

What is another name for tamsulosin?

Answer 16

Flomax

Question 17

Tamsulosin:
Classification:

Answer 17

Pharmacologic - peripherally acting antiadrenergics

Question 18

Tamsulosin:

Standard Dosage:

Answer 18

PO (adults) 0.4 mg once daily after meals; maybe increase after 2-4 weeks to
0.8 mg/day.

Question 19

Tamsulosin:

Drug Action:

Answer 19

: Decreases contractions in smooth muscle of prostatic capsule by preferentially
binding to alpha 1 adrenergic receptors.

Question 20

Tamsulosin:

Therapeutic effects:

Answer 20

decreased symptoms of prostatic hyperplasia (urinary urgency, hesitancy,
nocturia)

Question 21

Tamsulosin:
Indications:

Answer 21

Management of S/S of benign prostatic hyperplasia (BPH).

Question 22

Tamsulosin:

Adverse Effects:

Answer 22

CNS- dizziness, headache. EENT- intraoperative floppy isis syndrome, rhinitis.
CV- orthostatic hypotension. GU- priapism, retrograde/diminished ejaculation.

Question 23

Tamsulosin:

Nursing Implications:

Answer 23

Assess for symptoms of BPH (urinary hesitancy, feeling of incomplete
bladder emptying, interruption of urinary stream, impairment of size and force of urinary stream,
terminal urinary dribbling, straining to start flow, dysuria, urgency). Before and during therapy.
Asses for first dose orthostatic hypotension and syncope(adjust dose in occurs)observe closely
during first dose. Monitor I&O ratios, weight and edema daily. Rectal exams prior to and
periodically throughout therapy to assess prostate size.

Question 24

Tamsulosin:

Drug Interactions:

Answer 24

Cimetidine may ^ blood levels and risk of toxicity. ^ risk of hypotension with
other peripherally acting antiadrenergics (doxazosin, prazosin, terazosin); concurrent use should be
avoided. ^ risk of hypotension with sildenafil, tadalafil, and vardenafil. Strong CYP3A4 inhibitors
and CYP2D6 inhibitors may ^ blood levels (concurrent use should be avoided).

Question 25

Tamsulosin:

Patient teaching:

Answer 25

Emphasize importance of continually taking meds even if feeling well. Take
meds at same time each day. Do not miss doses, do not double doses. May cause dizziness. Change
positions slowly to avoid OHPT. Notify HCP of all other Rx and OTC meds being taken. Do not
take any new meds without consulting HCP (allergy and cold meds). Emphasize importance of
follow up visits.

Question 26

Betaloc, Lopresor, Lopresor SR, Lopressor, and Toprol-XL are trade name for what drug?

Answer 26

Metoprolol

Question 27

Metoprolol:
Classifications:

Answer 27

Therapeutic: antianginals, antihypertensives
Pharmacologic: beta blockers

Question 28

Metoprolol:

Standard Dosage:

Answer 28

· PO: (Adults) Antihypertensive/antianginal– 25–100 mg/day as a single dose initially or 2 divided doses; may be ↑ q 7 days as needed up to 450 mg/day (immediate-release) or 400 mg/day (extended-release) (for angina, give in divided doses). Extended-release products are given once daily. MI– 25–50 mg (starting 15 min after last IV dose) q 6 hr for 48 hr, then 100 mg twice daily. Heart failure– 12.5–25 mg once daily (of extended-release), can be doubled every 2 wk up to 200 mg/day. Migraine prevention– 50–100 mg 2–4 times daily (unlabeled).
· IV: (Adults) MI– 5 mg q 2 min for 3 doses, followed by oral dosing.

Question 29

Metoprolol:

Drug Action:

Answer 29

Blocks stimulation of beta1 (myocardial)-adrenergic receptors. Does not usually affect beta2 (pulmonary, vascular, uterine)-adrenergic receptor sites.
· Crosses the blood-brain barrier, crosses the placenta; small amounts enter breast milk

Question 30

Metoprolol:

Therapeutic Effects:

Answer 30

· Decreased BP and heart rate.
· Decreased frequency of attacks of angina pectoris.
· Decreased rate of cardiovascular mortality and hospitalization in patients with heart failure.

Question 31

Metoprolol:
Indications:

Answer 31

· Hypertension.
· Angina pectoris.
· Prevention of MI and decreased mortality in patients with recent MI.
· Management of stable, symptomatic (class II or III) heart failure due to ischemic, hypertensive or cardiomyopathc origin.

Question 32

Metoprolol:

Adverse Effects:

Answer 32

·CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares
· EENT: blurred vision, stuffy nose
· Resp: bronchospasm, wheezing
· CV: bradycardia, HF, pulmonary edema, hypotension, peripheral vasoconstriction
· GI: constipation, diarrhea, drug-induced hepatitis, dry mouth, flatulence, gastric pain, heartburn, increased liver enzymes, nausea, vomiting
· GU: erectile dysfunction, decreased libido, urinary frequency
· Derm: rash
· Endo: hyperglycemia, hypoglycemia
· MS: arthralgia, back pain, joint pain
· Misc: drug-induced lupus syndrome

Question 33

Metoprolol:

Nursing Implications:

Answer 33

· BP, ECG, and pulse frequently during dose adjustment and periodically during therapy.
· Monitor frequency of prescription refills to determine compliance.
· Monitor vital signs and ECG every 5–15 min during and for several hours after parenteral administration. If heart rate <40 bpm, especially if cardiac output is also decreased, administer atropine 0.25–0.5 mg IV.
· Monitor intake and output ratios and daily weights. Assess routinely for signs and symptoms of HF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention).
·Angina: Assess frequency and characteristics of anginal attacks periodically during therapy.

Question 34

Metoprolol:
Implementations:

Answer 34

·PO: Take apical pulse before administering. If <50 bpm or if arrhythmia occurs, withhold medication and notify health care professional.
· Administer metoprolol with meals or directly after eating.
·Extended-release tablets should be swallowed whole; do not break, crush, or chew

Question 35

Metoprolol:

Drug Interactions:

Answer 35

· General anesthesia , IV phenytoin , and verapamil may cause increased myocardial depression.
· Increased risk of bradycardia when used with digoxin , verapamil , diltiazem , or clonidine .
· Increased hypotension may occur with other antihypertensives , acute ingestion of alcohol , or nitrates .
· Concurrent use with amphetamines , cocaine , ephedrine , epinephrine , norepinephrine , phenylephrine , or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia).
· Concurrent administration of thyroid administration may ↓ effectiveness.
· May alter the effectiveness of insulins or oral hypoglycemic agents (dose adjustments may be necessary).
· May decrease the effectiveness of theophylline .
· May decrease the beneficial beta1 -cardiovascular effects of dopamine or dobutamine .
· Use cautiously within 14 days of MAO inhibior therapy (may result in hypertension).

Question 36

Metoprolol:

Patient Teaching:

Answer 36

· Instruct patient to take medication as directed, at the same time each day, even if feeling well; do not skip or double up on missed doses. Take missed doses as soon as possible up to 8 hr before next dose. Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia.
· Teach patient and family how to check pulse daily and BP biweekly and to report significant changes to health care professional.
· May cause drowsiness. Caution patient to avoid driving or other activities that require alertness until response to the drug is known.
· Advise patient to change positions slowly to minimize orthostatic hypotension.
· Caution patient that this medication may increase sensitivity to cold.
· Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any Rx, OTC, or herbal products, especially cold preparations, concurrently with this medication. Patients on antihypertensive therapy should also avoid excessive amounts of coffee, tea, and cola.
· Diabetics should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. Medication does not block sweating as a sign of hypoglycemia.
· Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, light-headedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs.
· Instruct patient to inform health care professional of medication regimen before treatment or surgery.
· Advise patient to carry identification describing disease process and medication regimen at all times.
· Hypertension: Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Medication controls but does not cure hypertension