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N201 > Perfusion Pharmacology > Flashcards

Perfusion Pharmacology Flashcards

Know Generic and Brand names of meds, Mechanism of Action, class and everything else :)

1
Q

Name the statins: Generic (brand)

A

Atorvastatin (Lipitor), Fluvastatin (Lescol), Lovastatin (Mevacor), Pravastatin (Pravachol), Simvastatin (zocor)

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2
Q

Name the MA of statins

A

These drugs inhibit 3-hydroxy-3-methylglutaryl coenzyme (HMG-CoA), a reductase, which results in less cholesterol biosynthesis

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3
Q

Name the Nursing considerations for Statins.

A
  • Asses triglycerides, total cholesterol, LDLs, HDLs
  • Avoid in pregnant or nursing pts
  • monitor liver function tests
  • Avoid use in pts with liver disease of consume a lot of alcohol
  • teach to avoid alcohol
  • Asses for muscle pain, weakness or tenderness
  • increases bleeding with Coumadin admin
  • give 1 hour before bile sequestering drugs (cholestyramine)
  • priority labs:lipids, platelets, liver function (is it ordered?)
  • fall & bleeding risk
  • is ultimately a cholesterol lowering agent
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4
Q

what is prophylaxis for CAD?

A

Cholesterol lowering agents: Statins, bile sequestering drugs & Fibric Acid derivitives

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5
Q

name the bile sequestering drug

A

cholestyramine

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6
Q

Name the MA for the bile sequestering drug, cholestyramine

A

lowers LDL

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7
Q

Name what the bile sequestering drug, cholestyramine treats.

A

Treatment of type 2 hyperlipioproteinemia, when diet has failed

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8
Q

Nursing considerations for bile sequestering drug, cholestyramine.

A
  • not absorbed in GI, will excrete in stool hours after admin
  • Diet change is always tried before the use of this drug
  • short term side effects: fecal impaction or vomiting
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9
Q

Name the Fibric acid derivatives.

A

fenofibrate & gemifibrozil

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10
Q

Name the MA of fibric acid derivatives (fenofibrate & gemifibrozil)

A

reduces cholesterol early and mobilizes it from the tissues while increasing secretion. it increases HDLs and dissolves additional cholesterol and decreases triglycerides

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11
Q

Nursing considerations for the fibric acid derivatives (fenofibrate & gemifibrozil)

A
  • absorbs in GI but excreted in urine
  • watch with anticoagulation use for it increases bleeding risk
  • monitor labs
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12
Q

when should a cholesterol med usually be taken?

A

At night, ideally at dinner time

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13
Q

Name an anti cholesterol lowering agent, absorption inhibitor

A

ezetimibe

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14
Q

Name the nursing considerations for anti cholesterol lowering agent, absorption inhibitor

A
  • metabolized in small intestines
  • can be administered alone & with dietary changes to treat hypercholesteremia. it lowers cholesterol and increases HDL
  • used when other therapy is ineffective
  • when mixed with other cholesterol meds it decreases its effect
  • side effects are fatigue, abdominal pain, diarrhea and cough
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15
Q

Name the thiazide like diuretic.

A

hydrochlorothiazide

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16
Q

Nursing considerations for thiazide like diuretics (hydrochlorothiazide)

A
  • treats HTN with edema
  • absorbed in GI tract, can cross placenta barrier and excreted in urine.
  • monitor labs for low: Na (< 135), Ca (<9), CL ( <95), bicarb (<22), K( <3.5) glucose
  • contraindicated in people allergic to sulfonamide drugs
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17
Q

Name the loop diuretics: Generic (brand)

A

furosemide (lasix) & Bumetanide (Bumex)

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18
Q

nursing considerations for Loop diuretics (furosemide).

A
  • treats edema associated with HF, HTN, liver disease or nephrotic syndrome
  • metabolized in liver excreted in urine
  • most potent diuretic
  • risk of ototoxicity
  • monitor glucose
  • increase risk of lithium toxicity
  • given IV push initially than PO for maintanance
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19
Q

Name the potassium sparing diuretic

A

spironolactone (Aldactone)

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20
Q

Nursing considerations for the potassium sparing diuretic (spironolactone i.e. Aldactone)

A
  • treatment of edema, diuretic induced hypokalemia, cirrhosis, HF and HTN
  • weaker in anti hypertensives and diuretics
  • only po and absorbed in GI tract
  • monitor for K levels (k> than 5.3 can cause dysrhythmias)
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21
Q

Name the antihypertensives:

class: Generic (brand)

A

Diuretics: Furosemide (lasix), Hydrochlorothiazide (Micozide), Bumetanide (Bumex), Triamterene (Dyrenium), Spironalactone (aldactone), metolazone (Mykrox)
ACE inhibitors: Benazepril (Lotensin), Captopril (Capoten), Lisinopril (Prinivil)
Angiotensin II receptor blockers: Losartan (cozzar), valsartan (diovan)

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22
Q

Antihypertensives MA for the 3 classes

A

diuretics: reduce fluid volume in the vessels
Ace inhibitors and Angiotensin II receptor blockers: Angiotensin II (a major vasoconstrictor) is blocked by both ACE inhibitors and angiotensin inhibitors and promotes the excretion of aldosterone.

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23
Q

Nursing considerations for antihypertensives for the 3 classes.

A

Diuretics:
-monitor serum and electrolyte levels
-obtain pt weight daily
-teach pt compliance with medication
-asses hydration often
-monitor breath sounds for FVE
ACEs and ARBs:
-follow trends
-first does can cause severe hypotension
-first dose is best administered at bed time
-with IV monitor LOC and BP carefully
-educate on the dry cough for Ace inhibitor if intolerable
-Asses for angioedema
-monitor for neutropenia or agranulocytosis

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24
Q

Name the ACE inhibitors: Generic (Brand)

A

Benazepril (lotensin), captopril (capoten), Enalapril (vasotec), fosinopril (Monopril), Lisinopril (prinvil or zestril), ramipril (Altace), perindopril (aceon)

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25
Q

What is the nurses priority action of angioedema as a result of the ACE inhibitor, and the clients airway is totally blocked?

A

Call a condition

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26
Q

Do ACE inhibitors directly or indirectly effect BP?

A

Indirectly because they are interfering with RAAS in the kidneys.

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27
Q

Ace inhibitor nursing interventions.

A
  • monitor vitals
  • first dose may cause severe hypotension, so closely monitor BP
  • first dose best administered at bed time
  • monitor bp closely especially in IV infusion for LOC can change quickly
  • encourage patient to report dry cough
  • angioedema
  • monitor blood count for neutropenia & agranulocytes
  • avoid use with NSAIDs for it can impair absorption and alter renal function
  • side effects: tickle in throat, cough, proteinuria & headache
  • admin 1 hr before meals
28
Q

name the ARBs: generic (brand)

A

Losartan (cozzar), valsartan (diovan)

29
Q

nursing considerations for ARBs

A
  • used in its with HF and with DM for these protect the renal system
  • Used for its who do not tolerate ACEs
  • side effects are less prominent in ARBs than ACEs: headache, fatigue, cough or sickly throat, angioedema, hyperkalemia ( >5.4)
  • Monitor K, BUN (>21), cr (>1.2) it can cause elevations
  • can cause sexual dysfunction especially in men
30
Q

what hormone regulates BP, and where?

A

aldosterone through the Na K pump

31
Q

Name the direct vasodilation drugs: generic (brand)

A

hydralazine (apresoline), Minoxidal (loniten), Nitroprusside (Nipride)

32
Q

MA for direct vasodilators

A

cause dilation of blood vessels, by blocking sympathetic nervous system. it relaxes the smooth muscle and reduces peripheral resistance.

33
Q

Nursing considerations for direct vasodilators.

A
  • can cause reflex tachycardia (which is decreased bp but HR increases)
  • may produce angina with its with CAD
  • monitor for NA and H2O retention
  • IV nitroprusside is commonly used in HTN emergency, but must be monitored to not drop BP to quickly.
  • rash can occur
  • minoxidal is a PO med
  • hydralazine is IV or PO
34
Q

Name the calcium channel blockers: Generic (Brand)

A

Amlodipine (Novasc), Diltiazem (Cardizem), Felodipine (Plendil), isradipine (dynacirc), nicardipine (Cardene), Nifedipine (Procardia), Nisoldipine (Sular), Verapamil (Isoptin)

35
Q

Name the MA of calcium channel blockers.

A

These drugs inhibit flow of calcium across the cell membrane of vascular tissues and cardiac cells. They relax arterial smooth muscle and lower peripheral resistance by vasodilation.

36
Q

nursing considerations for calcium channel blockers.

A
  • watch for impaired cardiac function and worsening heart failure
  • prior to admin asses BP, apical pulse, and liver and renal function
  • is used for HTN of A fib
  • Do not admin verapamil or diltiazem to its with hypotension, or sinus or AV blocks
  • Admin with caution with its taking digoxin or a beta blocker
  • Monitor vitals report bradycardia, AV block, or HF to PCP
  • can cause constipation
  • encourage pt to report SOB, weight gain or extremity swelling to PCP
  • can be used alone
  • decreases HR and BP so monitor these closely
37
Q

Name the Alpha adrenergic Blockers: generic (brand)

A

doxasosin(cardura), prazosin (minipress), Terazosin( Hytrin), Eragotime

38
Q

Name the MA of Alph adrenergic blockers.

A

These drugs block alpha receptors in vascular smooth muscle. The decrease vasomotor tone and vasoconstriction. These drugs also reduce the serum levels of HDLs and LDLs.

39
Q

What are the two most common alpha adrenergic blockers?

A

Prazosin (Minipress) & Terazosin (hytrin)

40
Q

What are the nursing considerations for alpha adrenergic blockers?

A
  • orthostatic hypotension can be severe
  • hypertension can occur with these
  • they are used to treat htn and PVD
  • possible side effects are bradycardia, tachycardia, edema, difficulty breathing, arrhythmias and angina
41
Q

name the Beta adrenergic blockers: Generic (brand)

A

Acebutolol (spectral), Atenolol( Tenormin), Metoprolol (Lopressor), Nadolol (cougars), propranolol (Inderal), Carveidol (Corgard), Labetalol (Trandate)

42
Q

name the MA of beta adrenergic blockers.

A

These drugs reduce BP by preventing beta receptor stimulation in the heart resulting in decreased heart rate and cardiac output. These interfere with the renin released by the kidneys, decreasing the effect of angiotensin aldosterone system.

43
Q

Name the nursing considerations for Beta adrenergic blockers.

A
  • monitor for bronchospasm, fatigue, sleep disturbances, nightmares, bradycardia, heart block, worsening hf, GI disturbances, impotence and increased triglyceride levels
  • These drugs are contraindicated for asthma and chronic lung disease, bradycardia and heart block
  • asses BP and apical pulse prior to administration
  • report abnormal vital signs to pharm
  • encourage patient to change positions slowly
  • notify MD is SOB occurs, cough or extremity swelling occurs
  • do not discontinue without discussing with the MD
  • This med decreases BP, workload of heart and decreases O2 needed in the heart.
44
Q

Name the cardiac glycosides: generic (brand)

A

Digoxin (Cardoxin), Lanoxin

45
Q

Name the MA of cardiac glycosides.

A

These drugs cause the heart to contract more forcefully and more slowly, to increase CO. (positive inotropic effect)

46
Q

Name the nursing considerations for Cardiac glycosides.

A
  • it is indicated for low EF, and for HF which can move fluid.
  • can be given IV or orally, IV is for 3 initial doses and then 1 time a day.
  • monitor for digoxin toxicity (>2.0) signs include nausea, anorexia, visual disturbances, drowsiness and fatigue
  • contraindicated for its with partial heart block or renal insufficiency
  • monitor serum potassium (3.5-5.3)
  • administer caution to older adult post MI with incomplete Heart block
  • follow labs to maintain therapeutic levels
47
Q

what are the most common Beta adrenergic blockers?

A

metoprolol (lopresser) and carvedilol (corguard)

48
Q

Name the phosphodiesterase inhibitors (PDEs): generic (brand)

A

Viagra, Milrinone (primacor)

49
Q

Name the MA of PDEs

A

These drugs block the enzyme phosphodiesterase in cardiac and smooth muscle, increasing the amount of calcium available to myocardial contractions. which results in positive inotropic action and vasodilation.

50
Q

name the nursing considerations for PDEs.

A
  • DO NOT use with Nitrates
  • is a PO medication is viagra only
  • may cause hypotension and arrhythmias
  • asses serum K levels (3.5-5.3)
  • when administering Milirinone ( Primacor) IV monitor for ventricular dysrhythmias
  • used for HF and pulmonary edema
51
Q

Name the nitrates: generic (brand)

A

Nitroglycerin (Nirostat) & isosorbide dinatrate (Dilatrate)

52
Q

Name the MA of nitrates.

A

These drugs are potent vasodilators that dilate both arterial and venous smooth muscle. Dilation of veins reduces preload.

53
Q

Name the nursing considerations for Nitrates.

A
  • do not use with PDEs
  • drug of choice for the treatment of angina
  • can be administered PO, SL, patches and IV drip
  • if BP is below 80/50 get NS to increase the fluid volume and increase BP
  • monitor frequently for hypotension
  • to prevent falls have patient lie down while having chest pain to take this medication
  • teach client to take this med a certain amount of times before it becomes necessary to call 911.
  • contraindicated in patients with cardiac tamponade, pericarditis, or patients with head & neck injury, shock or increased ICP (intracranial pressure)
  • teach patient to avoid alcohol for this can cause severe hypotension and cardiovascular collapse
54
Q

name the thrombolytics or Fibrinolytics: generic (brand)

A

reteplase (retavase), altepase (activase), Streptokinase (streptase) & urokinase

55
Q

Name the mA of thrombolytics/ fibronolytics.

A

These drugs are administered to dissolve clot s resulting in MI or stroke with quick restoration of perfusion.

56
Q

Name the nursing considerations for Thrombolytics and fibronolytics.

A
  • need to be administered within 6 hours of onset of symptoms
  • high risk bleed after administration
  • when giving for a stroke you must get a CT and ensure it is not a head bleed. however if it is a clot you should administer within 3 hours
  • do not administer in patients who recently have fallen, been involved in an MVA or have experienced any form of trauma
  • closely monitor cardiac rhythm for the rapid reperfusion can cause VT.
57
Q

Name the antiplatlet medication.

A

aspirin

58
Q

Name the MA of antiplatlet medication.

A

Inhibits the clot formation by blocking the synthesis of prostaglandins and decreased aggregation.

59
Q

Name the nursing considerations for antiplatlet medication.

A

-used to prevent MI, ASHD, and stroke.
–peaks within 1-2 hours after oral intake
is excreted int he urine an dis minimally absorbed
-side effects often include stomach pain, heartburn and bleeding
-may be used with other anticoagulants such a clopidergral (plavix)

60
Q

Name the perfusion analgesic.

A

morphine

61
Q

Name the nursing considerations for morphine.

A
  • used for active chest pain by decreasing preload, vasodilation and comfort during episodes of SOB
  • can be give IVP
  • monitor respirations and hypotension
62
Q

Name the anti- arrhythmics: generic

A

Amiodarone, cordarone, lidocaine

63
Q

Name the nursing consideration of the Anti arrhythmics.

A
  • fall into a variety of Classes
  • treats the excitability of the heart muscle due to ischemia or dysfunctional of the electrical system
  • nurse assessment should focus on rhythm changes, vital signs, and pt tolerance
  • if on multiple meds need to monitor even closer
64
Q

Name the anticoagulants: generic (brand) & route

A

Heparin IV and Sub Q, Lovenox sub Q & warafarin (Coumadin) oral, Elliquis (apixaban), pradexa (dabigatran) and xarelto (rivaroxaban)

65
Q

Name the Mechanism of action for heparin.

A

Activation of antithrombin III by inhibiting the formation of thrombin and fibrin.

66
Q

name the nursing considerations for Heparin.

A

-reversal agent is protein sulfate and FFP
-may be given IV or Sub Q
Used for DVT, PE, MI, arterial clotting, arrhythmias, prevention of cardiovascular issues. prophlatictally used for prevention or extension of present clots or development of new clots
-monitor aPTT and anti-XA with IV Heparin (if sub Q does not need monitored) if the labs are elevated it indicate blood is too thin and may call for reversal agent (FFP must be thawed for 20 mins prior to use) and perhaps stop IV.

67
Q

Name the nursing considerations for Warfarin.

A

-used for thromboembolism, DVT, A fib, Artificial valve surgery, and arterial clotting
-metabolized in the liver, binds to the plasma albumin and is excreted in the urine. is absorbed rather quickly, and effects only last about 48 hours.
-Monitor PT and INR
INR should be 2-3x normal range
INR < 2 is too thick
INR > 3.5 is too thin
INR goal is between 2-3.5
-may be used with other antiplatlet meds
-the newer meds such as Eliquis (apixaban), Pradaxa (dabigatran) & xarelto (rivaroxaban) do not need blood work monitored
-high bleeding risk

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