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NCLEX Material > Pharmacology > Flashcards

Pharmacology Flashcards

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1
Q

Cardiovascular Medications (all act to lower BP- cover slide)

A
  1. Angiotensin Converting Enzymes (ACE) Inhibitors
    - pril (lisinopril)
  2. Angiotensin II Receptor Blockers (ARBs)
    - sartan (losartan)
  3. Beta-adrenergic blockers
    - lol (carvedilol)
  4. Alpha-1 adrenergic blockers
    - osin (doxazosin)
  5. Centrally-acting alpha adrenergics
    - clonidine or methyldopa
  6. Calcium channel blockers
    - pine (amlodipine)
  7. Direct-acting vasodilators
    - hydralazine or minoxidil
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2
Q

Angiotensin Converting Enzyme (ACE) Inhibitors

A

Mechanism of action:

  • Blocks the conversion of angiotensin I to angiotensin II (prevents vasoconstriction)
  • Blocks release of aldosterone (prevents reabsorption of Na and H2O)
  • Increases diuresis
  • Decreases systemic vascular resistance (decreases after load)
  • Decreases venous pressure

Assessment:

  • hyperkalemia
  • dry cough (stop the med and switch to an ARB)
  • angioedema
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3
Q

Angiotensin II Receptor Blockers (ARBs)

A

Mechanism of action:
-Blocks angiotensin II from binding to angiotensin II receptors
-Blocks release of aldosterone (preventing reabsorption of Na and H20)
-Increase diuresis
-Decreasing systemic vascular resistance (decreasing after load)
Decreasing venous pressure

Assessment:

  • Hyperkalemia
  • Angioedema
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4
Q

Beta Blockers

A

Mechanism of action:

  • Blocks the beta-adrenergic receptors of the sympathetic nervous system (beta 1, minimal effect of beta 2)
  • Decrease HR
  • Beta selective=only beta 1, Beta-nonselective= beta 1 & beta 2, Alpha blocking

Assessment:

  • BP (drop in HR-drop in CO-drop in BP)
  • Bradycardia
  • Lung sounds (bronchoconstriction)
  • Blood sugar (hyperglycemia masking)
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5
Q

Calcium Channel Blockers

A

Mechanism of action:

  • Blocks calcium from getting into the cells-vasodilation of arteries and peripheral arterioles, but not veins
  • Decrease heart contractility (negative inotropic effect)
  • Decrease HR (negative chronotropic effect)
  • Decreases conduction velocity within the heart

Assessment:

  • BP (hypotension more common with nifedipine, less common with diltiazem)
  • Bradycardia (especially with use of verapamil)
  • Peripheral edema (with nicardipine, nifedipine, verapamil)
  • Periodic liver and kidney function tests
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6
Q

Most common adverse effect of all cardiovascular medications

A

Orthostatic hypotension.

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7
Q

Can ACE Inhibitors and ARBs be given together?

A

NO!

They act via the same route.

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8
Q

Herbal Interactions with Antihypertensives

A
  1. Ma Huang (Ephedra)
  2. Goldenseal
  3. Black Cohosh

*both decrease effectiveness

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9
Q

Nursing Considerations with Cardiovascular Meds

A
  1. Check BP before and after administering
  2. Teach clients to sit on the edge of the bed before getting up in the morning and to change positions slowly
  3. Reinforce a low-sodium diet and regular exercise
  4. Assess for herbal supplement use and teach clients which supplements to avoid
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10
Q

Thiazide Diuretics

A

Examples:

  1. Hydrochlorothiazide
  2. Chlorothiazide

Action:
Inhibits reabsorption of sodium and chloride in the distal convoluted tubules.

Adverse effects:
-Hypokalemia, hyperglycemia, blurred vision, dry mouth, hypotension

Nursing Considerations:

  • Avoid giving at bedtime
  • Monitor I/O, electrolytes, weight, BUN, creatinine & glucose
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11
Q

Potassium Sparing Diuretics

A

Example: Spironolactone

Action:
Inhibits action of aldosterone in distal tubule, which interferes with the sodium reabsorption.

Adverse Effects:
-Hyperkalemia, hyponatremia, hepatic damage, tinnitus

Nursing Considerations:

  • give with meals
  • use with other diuretics
  • monitor I/O
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12
Q

Loop Diuretics

A

Examples:

  1. Furosemide
  2. Bumetanide
  3. Torsemide
  4. Ethacrynic acid

Action:
Inhibits sodium, potassium, chloride, magnesium, and calcium reabsorption in the loop of Henle

Adverse effects:
Hypokalemia, hyperglycemia, hypotension, GI upset, weakness

Nursing Considerations:

  • Avoid giving at bedtime
  • Monitor I/O, BP, pulse, electrolytes, weight, glucose
  • IV: give slow over 2 minutes, diuresis occurs within 10 minutes
  • PO: diuresis occurs within 30 minutes
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13
Q

Osmotic Diuretics

A

Example: Mannitol

Action:
Increases osmotic pressure of the glomerular filtrate, thereby inhibiting tubular reabsorption of water

Adverse effects:
Circulatory overload, tachycardia, pulmonary congestion, dyspnea, headache, seizures

Nursing Considerations:
Monitor I/O, VS, electrolytes, neurological status

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14
Q

Chlorthalidone

A

Action: unclear diuretic

Adverse effects: aplastic anemia, hypokalemia, hyperglycemia, dizziness, orthostatic hypotension

Nursing Considerations: avoid taking at bedtime, take with food, long-lasting (2-3 days), monitor I/O, BP, electrolytes, weight, glucose

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15
Q

Antibiotic: Cephalosporins

A

Examples: cefazolin, cephalexin, ceftriaxone, cefaclor, cefepime, cefdinir, ceftaroline

Adverse Reactions: 
CNS toxicity (seizures, headache), C. diff, n/v, pancytopenia, nephrotoxicity, rash, urticaria, anaphylaxis (rare)

Drug Interactions: may increase Metformin level (monitor bg frequently), may cause nephrotoxicity if concurrently taking an aminoglycoside

Contraindications: hypersensitivity to any cephalosporin or penicillin

Precautions: pregnancy, lactation, renal/hepatic impairment

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16
Q

Antibiotic: Penicillins

A

Examples: Penicillin G, Penicillin V Potassium, Amoxicillin, Amoxicillin-clavulanate

Adverse Reactions:
Rash, anaphylaxis, CNS toxicity (come, seizures…), nephrotoxicity, C. diff, bone marrow depression

Drug Interactions: Aspirin increases penicillin concentrations, penicillins decrease effect of oral contraceptives

Contraindications: hypersensitivity to penicillins

Precautions: hypersensitivity to cephalosporins, lactation, severe renal disease

17
Q

Antibiotic: Fluoroquinolones

A

Examples: ciprofloxacin, levofloxacin, moxifloxacin

Adverse Reactions:
CNS effects (dizziness, headache, hallucinations, seizures), bone marrow depression, ventricular arrhythmias, sudden cardiac death, strongly associated with C. diff

Black Box Warnings:

  1. rupture of the Achilles tendon
  2. may exacerbate weakness in clients with Myasthenia gravis

Drug Interactions:
Medications that cause QT prolongation or bradycardia. Ciprofloxacin interacts with metformin (causing hyper- or hypoglycemia). Levofloxacin potentiates effects of warfarin

Contraindications:
hypersensitivity to fluoroquinolones, previous arrhythmias, uncorrected hypokalemia or hypomagnesemia

18
Q

Antibiotic: Macrolides

A

Examples: azithromycin, clarithromycin, erythromycin

Adverse Reactions:
GI disturbances (abdominal pain, nausea, colitis), QT-interval prolongation, arrhythmias, tinnitus, hearing loss, cholestatic jaundice, hepatotoxicity, angioedema

Drug Interactions:

  1. Erythromycin and clarithromycin: Warfarin (elevation of PT/INR)
  2. Lovastatin and simvastatin: rhabdomyolysis
  3. tacrolimus, cyclosporine, ergot alkaloids: elevated serum levels of these meds

Contraindications: hypersensitivity to macrolides

Precautions: fatal colitis can occur during treatment

19
Q

Antibiotic: Tetracyclines

A

Examples: doxycycline, minocycline, tetracycline

Adverse Reactions:
GI disturbances (colitis, n/v), C. diff, candidiasis, photosensitivity, bone and dental effects in children, hepatotoxicity

Drug Interactions: decrease effect of oral contraceptives and potentiate effect of oral anticoagulants

Precautions: renal or hepatic impairment

20
Q

Antibiotic: Sulfonamides

A

Examples: sulfamethoxazole/trimethoprim, sulfadiazine, sulfadiazine

Adverse Reactions:
hypersensitivity reactions (rash, Steven-Johnson syndrome, angioedema), crystalluria, oliguria, anuria, hematologic reactions (agranulocytosis, thrombocytopenia, hemolytic anemia), kernicterus in neonates, photosensitivity, neurological effects (headaches, hallucinations, insomnia, seizures)
Drug Interactions:
Potentiates sulfonylureas (causing hypoglycemia), phenytoin (increases adverse effects), and anticoagulants

Contraindications:
do not use sulfamethoxazole/trimethoprim when near due date or breastfeeding, clients < 2 months

Precautions: renal or hepatic impairment, bronchial asthma

21
Q

Antibiotic: Aminoglycosides

A

Examples: amikacin, gentamicin, streptomycin, neomycin, tobramycin

**REQUIRE PEAK & TROUGH LEVELS DUE TO HIGH RISK OF TOXICITY

Adverse Reactions: frequent or high does or prolonged duration, especially in the elderly or those with renal impairment

  • signs of vestibular damage (vertigo, ataxia)
  • paresthesias, peripheral neuropathy

Black Box Warnings:

  1. nephrotoxicity (often reversible)
  2. vestibular and auditory toxicity (often irreversible)

Drug Interactions: vancomycin, cycosporine, amphotericin B, contrast agents (renal toxicity), loop diuretics (ototoxicity), worsening weakness in disorders affecting neuromuscular transmission

Contraindications: pregnancy, avoid use of other ototoxic, neurotoxic, or nephrotoxic drugs

Precautions: toxicity may develop even with conventional doses

22
Q

GI: Proton Pump Inhibitors

A

Examples: Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole

Action: bind to enzyme in presence of gastric pH to prevent transport of hydrogen ion into stomach

Adverse Effects: headache, abdominal pain, constipation, d/n

Client Education: take medication at least 1 hour before meals

23
Q

GI: H2 Blockers

A

Examples: Cimetidine, Famotidine

Action: inhibit gastric secretion and decrease total pepsin output

Adverse Effects: dysrhythmias, diarrhea, confusion, dizziness, headache

Client Education: avoid antacids within 1 hour of medication

24
Q

Anticoagulants (examples)

A
  1. Vitamin K Antagonists
    - Warfarin
  2. Heparin
    - Standard Unfractionated Heparin
  3. Low-Molecular-Weight Heparins (LMWH)
    - Enoxaparin
  4. Direct Thrombin Inhibitors (DTI)
    - Bivalirudin & Dabigatran
  5. Direct Factor Xa Inhibitors
    - Apixaban, Edoxaban & Rivaroxaban
  6. Thrombolytics
    - Alteplase (tPA “clot buster”)
25
Q

What population are Warfarin and Low-Molecular-Weight Heparin typically prescribed to?

A

Clients who have. previously experienced a venous thromboembolism or DVT.

26
Q

Antiplatelets (examples)

A
  • Aspirin, Dipyridamole, Aspirin-Dipyridamole
  • CYP2Y12 Inhibitors: Clopidogrel, Prasugrel, Ticagrelor
  • GP IIb/IIIa Inhibitors: Eptifibatide, Tirofiban
27
Q

Antiplatelets Action

A

Prevent platelets from clumping together by making them more slippery, which helps prevent clots from forming and smaller clots from growing larger.

28
Q

What is low-dose aspirin typically prescribed for?

A

Prevention of clots in low-risk clients.

29
Q

Higher dose aspirin & clopidogrel can be used as combination therapy for…

A

acute, immediate post cardiovascular event phase to prevent a subsequent cardiovascular event within the first 30 days to 3-12 months after an event

30
Q

What is Prasugrel prescribed for?

A

the first 12 months after placement of a stent to prevent clot formation at the site of the stent

31
Q

Nursing Considerations for Anticoagulants & Antiplatelets

A
  • monitor clients for signs of epistaxis, gum bleeding, occult bleeding: tarry stools, anemia, fatigue
  • INR is the recommended method for monitoring warfarin (INR goal= 2-3)
  • aPTT is recommended for monitoring Heparin (aPTT normal is 25-35 seconds- on Heparin it is 1.5-2.5x the normal)
32
Q

What food/herbal supplements to avoid while taking anticoagulants/antiplatelets

A

Ginkgo, ginger, garlic, ginseng, bilberry, cat’s claw, chamomile, curcumin, Dong Quai, green tea, feverfew, licorice, St. John’s Wort

33
Q

Bleeding risk may be increased if Clopidogrel is taken with…

A

NSAIDs, Omeprazole, antineoplastics, and/or SSRIs

34
Q

An acute hemolytic reaction occurs when what happens?

What signs and symptoms will a client present with during a hemolytic reaction to a transfusion?

A

ABO-incompatible blood is infused.

S/s: fever, dyspnea, facial flushing, severe low back pain, hypotension, tachycardia, DIC, Shock
hematuria, kidney pain, cyanosis

35
Q

An allergic reaction to a blood transfusion occurs when what happens?

What signs and symptoms will a client present with?

A

Occurs due to hypersensitivity to antibodies in the donor’s blood.

Mild symptoms: urticaria, itching, flushing
Severe symptoms: anaphylaxis, dyspnea, hypoxia, hypotension

36
Q

Safe steps for administration of blood products

A
  1. Check for history of transfusions and if any reactions have occurred
  2. Obtain IV access or assess patency of current IV access
  3. Obtain blood from blood bank
  4. Cross-check blood with another nurse
    - Health care provider’s prescription
    - Client’s identity using at least two identifiers
    - Blood component tag name and number
    - Blood type and Rh
37
Q

Flow Rate Formula

A

total volume of solution (mL) / time (min) = X

X x drop factor (gtt/mL) = ANSWER

NCLEX Material (6 decks)

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