Medications Flashcards
what is heparin used for
anticoagulant; prevent blood clots in VTE/PE, A.fib, stroke, surgery; emergency
how is heparin used
IV or subQ injection
side effects of heparin
bleeding
bruising
HIT
osteoporosis (long term, high dose)
hair loss
rashes
injection site necrosis
how does heparin work
enhances antithrombin III
therapeutic range of heparin
1.5 - 2.5x normal range(30-40sec) -> 60-80secs aPTT test
what to monitor when using Heparin
decreased Hgb & Hct
decreased platelets
what not to take with Heparin
aspirin, NSAIDs, OTC
Digoxin, antihistamines
contraindications for Heparin
hx of HIT, hypersensitivity to pork (works for pregnant women)
antidote for heparin
protamine sulfate
what is coumadin also known as
Warfarin
what is coumadin used for
anticoagulant; treat PE,MI,A.fib, venous thrombosis, heart valve replacement
how does coumadin work
vitamin K antagonist
how is coumadin used
oral tablets
what to monitor for coumadin use
international normalized ratios (INR): clotting time 2-3
decreased INR increase dose
prothrombin time
contraindictions for coumadin
active bleeding, surgery, renal/liver failure, pregnant
nursing education for coumadin
no alcohol, no excessive green leafy veg, avoid NSAIDs aspirin OTC
adverse effects of coumadin
bleeding, bruising, nausea, bloating, ab.cramping
antidote for coumadin
vit K and fresh frozen plasma
what is Lovenox also known as
enoxaparin
how does enoxaparin work
binds with antithrombin III
how is lovenox given
subQ or IV then subQ injections
adverse reactions with lovenox
A.fib, anemia, PE, embolism,
what does lovenox treat
DVT, PE, acute MI, unstable angina
contraindications for lovenox
active major bleeding, hypersensitivity to benzyl alcohol & heparin & pork products, pregancy, prosthetic heart valves, epidural/spinal anesthesia
interactions with lovenox
NSAIDs, oral anticoagulants, aspirin, garlic, ginger
what is ACE inhibitor used for
antihypertensives; hypertension, heart failure, post MI
how does ACE inhibitor work
inhibits the RAAS (renin angiotensin aldosterone system)
adverse reactions with ACE inhibitors
persistent dry cough (normal), dizziness, hyperkalemia, angioedema (life threatening), kidney&liver issues
interactions with ACE inhibitors
K+ sparing diuretics such as spironolactone
what to look out for when using ACE inhibitors
Ekg with tall peaked t-waves
BUN (5-20) & creatine (0.6-1.2)
K level (3.5 -5)
echocardiograms, MRI of heart
nursing education for ACE inhibitors
avoid salt and K rich foods, rebound hypertension when suddenly stop meds
how are ACE inhibitors taken
oral tabs; end with “pril”
antidote for ACE inhibitors
IV fluids for hypotension, oral activated charcoal
what does aldosterone do to the body
increase blood volume, vasoconstriction
keep Na & water
excrete K
so antihypertensives blocking aldosterone would excrete Na & water and keep more K
what are beta blockers used for
antihypertensive; disrhythmias, tachycardia, glaucoma, hypertension, stable angina and compensated heart failure
adverse effects of beta blockers
bradycardia, edema, heart failure, JVD, ED
severe drowsiness, dyspnea
contraindications with beta blockers
unstable heart failure
asthma, COPD, diabetes
what test is done to make sure a pt can continue to take beta blockers
ekg: look for tall t waves indicating secondary or tertiary heart block
how do beta blockers work
NE&E can’t bind to beta receptors and no SNS response (adrenaline)
how does beta blockers affect ionotropic effect
negative, decrease
compare beta1, 2, 3 blockers
1: heart, kidneys RAAS system
2” lungs, GI, vascular smooth muscle, skeletal muscle, eye
3: fatty/adipose tissue
selective beta 1 blocker target
cardiac nodal tissue to decrease HR
cardiac myocytes to decrease contraction strength
selective beta 2 blocker target
intraocular pressure decrease
bronchoconstriction, hypo/hyperglycemia, peripheral vasoconstriction
adverse effects for beta blockers
fatigue, dizziness, cold extremities
bradycardia, hypotension, heart block, mental status change, ED
what to monitor for pt taking beta blockers
Ekg for tall T-waves for secondary or tertiary heart block
bradycardia
client education for taking beta blockers
will mask tachycardia in pts having hypoglycemia
orthostatic hypotension
what are calcium channel blockers used for
antihypertensives; hypertension, angina, dysrhythmias, A.fib
how do calcium channel blockers work
vasodilation causes decreased SVR and afterload
affects vascular smooth muscle, cardiac myocytes, cardiac nodal tissue
interactions with calcium channel blockers
grapefruit
digoxin
contraindications with calcium channel blockers
heart failure
side effects of taking calcium channel blockers
constipation, dizziness, ankle swelling
what to monitor for calcium channel blockers
Ekg
bradycardia, hypotension, dw
purpose of cardiac glycoside - Digoxin
digitalis glycoside - inhibits Na/K pump to decrease conduction rate and increase refractory period of AV node; antiarrhythmic, heart failure, A.fib
increase contractions, decrease heart rate, slows rate of conduction
therapeutic range for digoxin
0.5-2 ng/mL; above is toxic
contraindications with digoxin
renal/liver function issues
adverse effects of digoxin
N&V, anorexia, vision changes
arrhythmias, heart block, electrolyte imbalances
toxicity first signs are GI issues
interactions with digoxin
loop diuretics such as Lasix
beta blockers, calcium channel blockers
dronedarone: sudden death
high fiber foods decrease absorption
bradycardia
what to monitor for digoxin
bradycardia can’t give meds
hypokalemia
hypomagnesemia
hypercalcemia
how are digoxin administered
IV, oral tab/soln
how does thiazide diuretics for
inhibit Na/Cl cotransporter (NCC); stops reabsorption of Na&water; hypertension, heart failure, renal calculi
adverse reactions of thiazide diuretics
dehydration, electrolyte imbalances, hypotension
hyponatremia, hypokalemia, hyperglycemia,
hyperuremia -> gout
contraindications with thiazide diuretics
compromised glomerular filtration rate <30mL/hr
interactions with thiazide diuretics
digoxin
lithium
NSAIDs (aspirin, ibuprofen)
client education for thiazide diuretics
K supplements and K rich foods
how do loop diuretics work
inhibits NKCC2 cotransporter; heart failure, liver impairment, PE, hypertension, hypercalciemia
adverse effects with loop diuretics
dehydration, electrolyte imbalances, hypokalemia, ear damage, gout
contraindications with loop diuretics
anuria (can’t produce urine)
severe electrolyte imbalances
pregnant & breastfeeding
interactions with loop diuretics
digoxin toxicity
client education for loop diuretics
healthy foods with vitamin K
don’t take at night
DW, change positions slowly
how are loop diuretics taken
oral tab
IV
how do potassium sparing diuretics work
inhibit Na&K exchange via Na channels; hypertension, edema, hypokalemia
adverse effects with potassium sparing diuretics
hyperkalemia
dehydration
gynecomastia, menstrual irregularities
sexual dysfunction
contraindications with potassium sparing diuretics
renal failure
interactions with K sparing diuretics
ace inhibitor, NSAIDs, Lithium
what to monitor when taking K sparing diuretics
BUN, Creatine
EKG
client education for potassium sparing diuretics
no high K foods
potassium rich foods
potatoes/pork
oranges
tomatoes
avocados
strawberries
spinach
fish
mushrooms
melons (cantaloupe)
strength of all the diuretics
loop diuretic > thiazide diuretic > K-sparing diuretic
