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N317: Pharmacology > Overview > Flashcards

Overview Flashcards

1
Q

Thiazide and Thiazide-Like Diuretics

  • MOA?
  • Prescribed for? (2)
  • Side effects? (2)
  • Nursing considerations? (4)
  • Teaching points? (2)
A

Work in the distal convoluted tubule to:
- Inhibit reabsorption of Na, K, Cl, and water –> more excreted in the urine
- Helps dilate small blood vessels & decrease peripheral vascular resistance –> additional mechanism to decrease BP

Prescribed for:
- HTN
- Edema

Side effects:
- Hypokalemia (low K)
- Hyponatremia (low Na)

Nursing considerations:
- Check BP
- Check electrolytes labs (Na has neuro implications; K has cardiac implications)
- Decreased libido (effects pt compliance)
- Dizziness (esp. in beginning)

Teaching points:
- Instruct pt to change positions slowly (dizziness)
- Encourage to take medication in morning or afternoon (increased urination + fall risk)

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2
Q

Loop Diuretics

  • MOA?
  • Prescribed for? (4)
  • Side effects? (4)
  • Nursing considerations? (4)
  • Drug interactions? (1)
  • Teaching points? (2)
A

Given when diuresis needs to occur quickly.

Work in the loop of Henle to:
- Inhibit reabsorption Na, K, Cl, and water –> more excreted in urine
- Helps dilate small blood vessels & lower peripheral vascular resistance –> additional mechanism to lower BP

Prescribed for:
- HTN
- Edema
- Heart failure
- Kidney failure (depending on level)

Side effects:
- Hypokalemia (K wasting)
- Hypovolemia (diuresis quickly)
- Dizziness
- Tinnitus (ear ringing)

Nursing considerations:
- Check BP
- Check electrolytes labs
- CBC (complete blood count) for Torsemide* (thrombocytopenia)
- Good respiratory assessment (is fluid being drawn off?)

Drug interactions:
- Sulfonamides d/t possibility of cross-reactions

Teaching points:
- Instruct pt to change positions slowly (dizziness)
- Encourage to take in morning or afternoon (increased urination + fall risk)

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3
Q

Potassium-sparing diuretics

  • MOA?
  • Prescribed for? (1)
  • Side effects? (3)
  • Nursing considerations? (3)
  • Medication interactions? (3)
A

Work in the collecting ducts and distal convoluted tubule to:
- Reabsorb (spare) K instead of excreting
- Exchange with Na, so more Na and water are excreted
- Competitive aldosterone receptor –> prevents Na and water reabsorption

Prescribed for:
- Protective purposes of the heart (K has cardiac implications)

Side effects:
- Hyperkalemia (potassium sparing)
- Gynecomastia (enlarged breast tissue) r/t male sex patients –> med effects testosterone hormone
- Amenorrhea (irregular/stopped menses) r/t female sex patients –> med effects testosterone hormone –> also post-menopausal bleeding

Nursing considerations:
- Check BP
- Check electrolytes labs
- Pregnancy category C –> can reduce levels of testosterone in male sex fetuses/could alter sex development

Medication interactions:
- Lithium –> can cause lithium toxicity
- Potassium supplements –> can cause potassium levels to be too high
- ACE inhibitor –> can increase chance of hyperkalemia

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4
Q

Osmotic diuretics

  • MOA?
  • Prescribed for? (2)
  • Side effects? (3)
  • Nursing considerations? (5)
A

Works in proximal convoluted tubule to:
- Remove water very quickly
- Dilate blood small blood vessels to reduce BP/decrease peripheral vascular resistance

Prescribed for: *Critical care situations
- Swelling in the brain/inter-cranial pressure
- Getting rid of toxic substances faster

Side effects:
- Convulsions
- Thrombophlebitis (blood clot blockage formation)
- Pulmonary congestion

Nursing considerations:
- Check BP
- Good cardiac assessment r/t electrical activity (K)
- Draw + monitor frequent electrolytes labs; renal labs
- Frequent neuro checks d/t swelling in the brain
- Will be given IV through a filter d/t crystallization

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5
Q

Isotonic Crystalloids (fluids)

  • MOA?
  • Nursing considerations?
A

Keeps everything steady and equal:
- fluid balance remains the same inside and outside the cell
- RBC looks “normal”

Most commonly used “maintenance fluid”

Nursing considerations:
- Know kidney function
- Know heart function
- Monitor electrolytes labs and renal labs
- Ensure ordered rate is correct (indications for heart and kidneys)
- Monitor site for infiltration (fluid leaking into tissues where IV has been place )

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6
Q

Hypotonic Crystalloids (fluids)

  • MOA?
A

Lower concentration of solutes used to:
- pull water and sodium into cells
- cells swell

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7
Q

Hypertonic Crystalloids (fluids)

  • MOA?
  • Nursing considerations?
A

High concentration of solutes used to:
- draw water and sodium out of cells
- cells shrink

Nursing considerations:
- double check rate (high alert medication!)
- administer slowly –> r/t risk of osmotic demyelination syndrome (problems in the brain stem)

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8
Q

What is a “normal” sodium level range (labs)?

A

136-145

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9
Q

Alpha 2 Receptor Agonists
- i.e., Alpha 2 Adrenergic Receptor Stimulators

  • MOA?
  • Side effects?
  • Nursing considerations?
A

MOA:
Work centrally in the brain to:
- Stimulate alpha 2 adrenergic receptors in the brain (and kidneys!)
- Decreases norepinephrine production –> reduces BP (brain)
- Decrease renin activity –> promotes vasodilation (kidney)

Side effects: Pretty significant
- Orthostatic hypotension
- Fatigue
- Dizziness

Nursing considerations:
- Check BP
- Pt can NOT stop taking suddenly (rebound hypertension)

Teaching points:
- Instruct to change positions slowly
- Instruct to not stop taking suddenly

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10
Q

Alpha 1 Receptor Blockers

  • MOA?
  • Side effects?
  • Nursing considerations?
  • Teaching points?
A

“azosin” - word root

MOA:
Work peripherally in the blood vessels to block alpha 1 adrenergic receptors from the effects of norepinephrine
- dilates arteries and veins
- reduces peripheral vascular resistance –> lowering BP

Side effects:
- Dizziness
- Orthostatic hypotension
- Bradycardia (slow HR)

Nursing considerations:
- Check BP

Teaching points:
- Change positions slowly (dizziness)
- Can’t stop taking suddenly (rebound hypertension)

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11
Q

Beta receptor blockers
- i.e., Beta Blockers

  • MOA?
  • Side effects?
  • Nursing considerations?
  • Teaching points?
  • Medication interactions?
A

“Olols” = word root

MOA:
Work peripherally by blocking ALL Beta 2 receptors (including heart, lungs, GI, Kidneys)
- Reduces HR
- Also reduce renin activity in the kidneys –> causing vasodilation

Side effects:
- Bradycardia (slow HR)
- Dizziness

Nursing considerations:
- Check BP
- Check PULSE
- Can’t stop suddenly d/t rebound hypertension

Teaching points:
- Change positions slowly
- Don’t stop suddenly

Medication interactions:
- Albuterol –> can decrease effectiveness i.e., narrowing airways and worsening breathing (d/t being non-selective)

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12
Q

Dual-Action Alpha1 and Beta Receptor Blockers

  • MOA?
  • Side effects?
  • Nursing considerations?
  • Teaching points?
A

Works in the periphery to:
- Target alpha-1 receptors –> dilate heart and blood vessels
- Block beta receptors –> lower HR

Side effects:
- Dizziness
- Bradycardia (slow HR)
- Orthostatic hypotension

Nursing considerations:
- Check BP
- Check HR
- Can’t stop taking medication suddenly

Teaching points:
- Change positions slowly (dizziness; orthostatic hypo)
- Instruct to not stop taking medication suddenly (rebound hypertension)

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13
Q

Angiotensin-Converting Enzyme (ACE) Inhibitors

  • MOA?
  • Side effects?
  • Nursing considerations?
  • Teaching points?
  • Medication interactions?
  • Contraindications
A

“prils” = word root

MOA:
Inhibits ACE (enzyme):
- Inhibits angiotensin I conversion, promoting vasodilation (heart doesn’t have pump against resistance)
- Inhibits aldosterone secretions –> inhibits reabsorption sodium and water, promoting diuresis and lowering BP (decreases work-load for heart)

Side effects:
- Dry cough
- Hyperkalemia (cardiac implications)
- Fatigue
- Dizziness

Nursing considerations:
- Monitor BP
- Monitor potassium levels
- Talk to pt about cough and possibly trying another medication

Teaching points:
- Change positions slowly
- Pay attention to cough

Medication interactions:
-Potassium supplement
- Spironolactone (potassium sparing diuretic)
- Lithium –> toxicity

*NOT to be used for pregnant people –> can be toxic to fetus

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14
Q

Angiotensin II Receptor Blockers (ARBs)

  • MOA?
  • Side effects?
  • Nursing considerations?
  • Teaching points?
  • Contraindications?
A

“sartans” - word root

MOA:
Blocks angiotensin 2 receptors (vasodilation blood vessels) and aldosterone secretion (prevents reabsorption sodium and water)
- more selective for smooth muscle (no cough)
- don’t have issues with hyperkalemia

Side effects:
- Chest pain
- Fatigue
- Weakness
- Diarrhea

Nursing considerations:
- Check BP

Teaching points:
- Change positions slowly
- Don’t stop taking suddenly

*Should NOT be given to pregnant people –> can be toxic to fetus

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15
Q

Calcium Channel Blockers

  • MOA?
  • Side effects?
  • Nursing considerations?
  • Teaching points?
A

“dipines” = word root

MOA:
Blocks the binding of calcium to receptors in the heart and blood vessels
- Prevents muscle contraction, promotes vasodilation

Results in:
- Decreased peripheral vascular resistance
- Decreased BP
- Decreased peripheral smooth muscle tone

Prescribed for:
- HTN
- Angina

Side effects:
- Hypotension (BP)
- Peripheral edema

Nursing considerations:
- Check BP
- Monitor for edema

Medication interactions:
- Grapefruit juice –> can cause higher drug levels in the blood

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16
Q

Vasodilators

  • MOA?
  • Nursing considerations?
A

MOA:
Works directly to relax smooth muscle in the blood vessels

Results in:
- Decreased peripheral vascular resistance (after-load)

Side effects: (Depending on medication example)
- Tachycardia/Bradycardia
- Headache
- Edema
- Decrease platelet aggregation
- hypotension
- Hair growth

Nursing considerations:
- Monitor BP –> through arterial line for Nitroprusside

17
Q

Loop diuretics for Heart Failure

  • MOA?
  • Preload, After-load, Contractility?
  • Side effects?
  • Nursing considerations?
  • Medication interactions?
A

Decrease BP and decrease blood volume through diuresis
- After-load
- Preload

Side effects:
- Ototoxicity
- Dehydration

Nursing considerations:
- Monitor BP
- Monitor K, Na, Cl labs
- Good respiratory assessment (is fluid being drawn off?)
- CBC (complete blood count)

Medication interactions:
- Sulfonamides

18
Q

Thiazide diuretics for Heart failure

  • MOA?
  • Preload, After-load, Contractility?
  • Side effects?
  • Nursing considerations?
A

Decrease BP and decrease blood volume through diuresis
- After-load
- Pre-load

Side effects:
- Dehydration
- Hypokalemia

Nursing considerations:
- Monitor K, Na, and Cl labs
- Monitor BP
- Monitor dizziness

19
Q

ACEs, ARBs, and Beta-blockers for heart failure

  • Preload, after-load, contractility?
A

ACEs & ARBs = after-load d/t decreasing BP

Beta-blockers = after-load and contractility d/t decreasing BP and heart rate
*Decreases HR to increase contractility

20
Q

Phosphodiesterase Inhibitors (PDIS)

  • MOA?
  • Preload, after-load, contractility?
  • Side effects?
  • Nursing considerations?
A

Inhibits phosphodiesterase:
- Increases contractility
- Decreases peripheral vascular resistance (after-load)

Side effects:
- Hypotension
- Cardiac side effects (ventricular tachycardia)

Nursing considerations:
- Monitor BP
- Monitor for cardiac side effects
- Use only short-term (can see rebound effects after certain amount of time)

21
Q

Cardiac Glycosides

  • MOA?
  • Pre-load, after-load, contractility?
  • Side effects?
  • Nursing considerations?
  • Teaching points
A

MOA:
- Inhibits Na from being pumped out of cell membranes; allows for calcium buildup and stronger contractions
- Increase heart contractility (HR)

Side effects:
- Increased risk for arrhythmias (cardiac implications)
- Bradycardia
- Dizziness
- Abnormal vision
- Headaches

Nursing considerations:
- Monitor EKG
- Monitor HR –> do not give below 60 bpm
- Narrow therapeutic range –> need to draw blood frequently

Teaching points:
- Change positions slowly
- Be aware of vision changes

Therapeutic range = 0.5-2.0 ng/mL

Digoxin antidote for toxicity = DIgoxin immune fab (Digibind)

22
Q

Direct Vasodilators

  • MOA?
  • Pre-load, after-load, contractility?
  • Side effects?
  • Nursing considerations?
A

MOA:
Dilate blood vessels (arteries and veins)
- decrease BP (after-load)

Side effects:
- Dizziness
- Headache
- Hypotension
- Reflex tachycardia (heart trying to maintain CO esp. when standing)

Nursing considerations:
- Monitor BP
- Check for orthostatic hypotension

Drug interactions:
- Viagra (erectile dysfunction drug)
- Cialis (erectile dysfunction drug)

23
Q

Nitrates and Nitrites

  • Treats?
  • Rapid-acting forms?
  • Long-acting forms?
A

Dilates blood vessels to treat stable (chronic), unstable (acute onset), and vasospastic angina

Rapid-acting forms:
- Acute anginal attack

Long-acting forms:
- Prevent anginal episodes

Contraindications:
- Known drug allergy
- Severe anemia
- Hypotension (BP) (medication dilating blood vessels)
- Use of erectile dysfunction drugs –> Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil)

Nursing considerations:
- Tolerance for patients taking around-the-clock or long-acting forms –> ensure. a nitrate-free period
- Ensure patient’s take off their previous patch before placing another one on
- Potency lost 3 months after bottle is opened (PO)

24
Q

HMG-CoA Reductase Inhibitors

  • MOA?
  • Side effects?
  • Nursing considerations?
  • Medication interactions?
  • Teaching points?
A

“statins” = word root

Inhibits HMG-CoA Reductase enzyme to:
- Inhibit cholesterol synthesis in the liver
- Reduces LDL levels (very effective), can increase HDL levels, and can reduce triglyceride levels (not main effect)

Side effects:
- GI –> take with food if possible
- Elevated liver enzymes d/t medication working in the liver
- Rhabdomyolysis (dark urine) –> sign of muscle breakdown which can lead to kidney failure

Medication interactions:
- Warfarin –> toxic levels; pt at risk for bleeding
- Azoles (anti-fungals) –> myopathy; increased risk for rhabdomyolysis –> myopathy (muscle weakness or pain); increased risk for rhabdomyolysis
- Erythromycin
- Grapefruit juice

Teaching points:
- Should be taken in the evening when most cholesterol is synthesized

25
Q

Bile Acid Sequestrates

  • MOA?
  • Side effects?
  • Nursing considerations?
A

MOA:
Work in the small intestine and bind to bile acids to inhibit cholesterol reabsorption

Side effects:
- GI: constipation, heart burn, bloating, gas, belching (can increase fluid and fiber intake)
- Binds to other medications!

Nursing considerations:
- Must be taken 1-2 hours after or 4-6 hours before other medications

26
Q

Niacin (Vitamin B3)

  • MOA?
  • Side effects?
  • Nursing considerations?
A

Works on all elements of cholesterol:
- Decreases LDLs
- Increases HDLs
- Decreases Triglycerides
- Increases lipase (enzyme that breaks down lipids)

Side effects:
- Flushing
- Pruritus (itching)
- Hepatotoxicity

Nursing considerations:
- Needs to be given in high doses alone (not with other lipid lowering medications)
- Monitor liver functioning d/t hepatotoxicity

27
Q

Fibric Acid Derivatives

  • MOA?
  • Side effects?
  • Nursing considerations?
  • Medication interactions?
A

Work to (primarily) lower triglycerides
- do NOT work on LDLs
- also work on Lipase
- Also can block synthesis of cholesterol; increase cholesterol secretion

Side effects:
- GI; Diarrhea and nausea
- Increased risk for gall stones
- Increased liver enzymes
- Pulmonary embolism (Rare)

Nursing considerations:
- Good respiratory assessment for rare side effect

Medication interactions:
- Anticoagulants –> can enhance

28
Q

Cholesterol Absorption Inhibitors

  • MOA?
  • Side effects?
  • Nursing considerations?
A

Inhibit cholesterol from being absorbed in the small intestine
- lowers LDLs and triglycerides
- increases HDLs

Side effects:
- Hepatotoxicity
- Pancreatitis
- Rhabdomyolysis (if combo med with statin)

Nursing considerations:
- Monitor liver functioning
- Monitor for dark urine
- Good extremity assessment (damaged or wasting muscles)
- Monitor amylase and lipase levels (pancreatitis side effect)

29
Q

Potassium Channel Blocker

  • MOA?
  • Side effects?
A

Blocks potassium channels - prolonging re-polarization - to return heart to normal rhythm

Side effects:
- Ocular (eye) issues
- Bradycardia
- Hypotension
- Photosensitivity
- Hypo/hyper thyroidism
- Respiratory issues (Blue man syndrome)
- Pulmonary fibrosis
- Pulmonary toxicity

N317: Pharmacology (7 decks)

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