Pharmacology Exam 2 Flashcards
if you have chronic BP, what is expected
Adversely effects the vascular system—most serious consequence is that the heart must work harder to pump blood to the organs and tissues.
Excessive cardiac workload can cause the heart to fail and lungs to fill with fluid (Heart failure)
if you have chronic BP, what is expected
Damage to the blood vessels
o Damage to the blood vessels supplying blood and oxygen to the brain can result in transient ischemic attacks, and CVA or stroke.
if you have chronic BP, what is expected
Damage to the arteries
o Damages arteries in the kidneys which leads to a progressive loss of renal function
if you have chronic BP, what is expected
Eyes ?
o Vessels in the retina can rupture or become occluded, resulting in visual impairment and even blindness
hydrochlorothiaizide (Microzide) Prototype*: action : 4 actions !
o Bring blood pressure down by 10-20 mmHg
o Approved to treat ascites, edema, heart failure, HTN, nephrotic syndrome.
o Decrease the reabsoprtion of Na+, when sodium moves across tubule, water flows with it
Decreases blood volume and blood pressure falls.
hydrochlorothiazide: Prototype : Interactions : Drug-Drug (What it causes)
o May reduce the effectiveness of anticoagulants, sulfonylureas, and antidiabetic drugs including insulin
o Cholestyramine and colestipol decrease the absorption of hydrochlorothiazide and reduces effectiveness
o Hydrochlorothiazide increases the risk for renal toxicity from NSAIDS
o Corticosteroids and amphotericin B increase potassium loss when given with this drug
o Hypokalemia caused by hydrochlorothiazide may increase digoxin toxicity.
o Hydrochlorothiazide decreases excretion of lithium and can lead to lithium toxicity.
Nursing Process : implementation
Patients receiving Diuretic Therapy
o Ensuring therapeutic effects:
Continue frequent assessments as above for therapeutic effects : blood pressure and pulse are we within normal limits or within parameters set by HCP.
Daily weights should remain at or close to baseline (teach patient to weigh themselves daily)
Encourage lifestyle changes. Provide dietician consultation as needed
Teach patient how to monitor BP/pulse. Ensure proper use & functioning of home equipment
Nursing process : interventions (patient understanding drug therapy and self administration
Diuretic therapy
o Discuss the rationale for the drug therapy, desired therapeutic effects, most common adverse effects, parameters when to call HCP.
o Instruct patient and/or family in proper self-administration of drug. (early in day to prevent disruption of sleep from nocturia.
Calcium channel blockers (Nifedipine (Adalat, Procardia)
Action & What it is used for
o Drug from hypertension and angina pectoris
o Concurrent use with beta blocker can increase risk of CHF.
o May increase serum levels of digoxin, leading to bradycardia and digoxin toxicity.
o Blocks calcium channels in myocardial and vascular smooth muscle
Results in less oxygen utilization by heart, an increase in cardiac output, and fall in BP.
o Do not administer immediate-release formulations of nifedipine if impeding MI is suspected, or within 2 weeks following confirmed MI.
(Nifedipine) interactions : particulary herbal/food , absorption &toxicity with foods
o Grapefruit juice may enhance the absorption of nifedipine.
o Melatonin may increase blood pressure and heart rate.
Beta Blockers : What it does and
What BP finding should you NOT give this drug
o Decreased HR and contractility
o Reduce cardiac output and lowers systemic blood pressure
process : assessments (ACE inhibitors) First thing to do put pillows underneath patients (if they have cough)? Raising head, 80 degree
o Baseline assessment prior to administration (Patients receiving ACE inhibitors)
Understand the reason the drug has been prescribed in order to assess for therapeutic effects
Obtain complete health history including cardiovascular (MI, heart failure), diabetes, renal disease, and possibility of pregnancy. Obtain drug history including allergies, current prescriptions and OTC drugs, herbal preparations, and alcohol use. Be alert of possible drug interactions
Evaluate appropriate laboratory findings, electrolytes, especially potassium level, liver function studies, and lipid profiles.
Obtain baseline weight, vital signs, (especially BP and pulse), breath sounds, and cardiac monitoring (e.g. ECG, cardiac output) if appropriate. Assess for the location and character/amount of edema if present
implementation : patient family teaching : 2nd to last block
o Instruct patient if cough becomes troublesome when in supine position, sleep with the head elevated on additional pillows
Vasodilators : Prototype drug: Hydralazine (Apresoline)
Adverse effects & what it is
o Direct- Acting Vasodilator
o Headache, reflex tachycardia, hypotension, flushing, nausea and diarrhea.
alpha-1 adrenergic blocker (doxazosin) (Cardura) Action, how does it work : arteries and veins ?
o Selective for blocking alpha-1 receptors in vascular smooth muscle, it has few side effects
o Dilates arteries and veins
o Capable of causing rapid, profound fall in BP
o Sometimes used for BPH because is it known to relax smooth muscle around the prostate gland
•Etiology of heart failure
most common : hypertension o Most common: hypertension o Coronary artery disease o Mitral stenosis o MI o Diabetes Mellitus
cardiac vital signs & : Drug-Drug interaction : Digoxin with dieuretics)
o Digoxin : Concurrent use with diuretics can cause hypokalemia and increase the risk of dysrhythmias
o Cardiac vital signs: take apical pulse for 1 full minute, noting rate, rhythm, and quality before administration.
o Usually if HR is lower than 60 bpm, hold the dose.
: digoxin (visual changes, halos ) need to know digoxin toxicity, what level you shouldn’t administer digoxin (HR : 60)
o Continue to monitor vital signs. Take apical pulse for 1 full minute before giving drug. Hold the drug and notify HCP if heart rate is 60 or above 100. Monitor ECG during digitalization period for dysrhythmias and bradycardia.
If digoxin level is above 2.0 could mean toxicity
Minimizing adverse effect (Patients receiving Digoxin therapy)
o Continue to monitor periodic electrolyte levels, especially potassium, renal function labs, drug levels, ECG. (Hypokalemia increases risk of dysrythmias. Serum digoxin levels should remain less than 1.8 mg/dL
o Weight the patient daily, report weight gain of 2 lbs or more in 24 hour period
o Daily weight is an accurate measure of fluid status.
Lisinopril (What to monitor and what levels increase
o Lisinopril (Prinivil, Zestril)
o Need to monitor BP, before and during therapy
o May cause increase of BUN, serum bilirubin, serum alkaline phosphate, AST, and ALT
Treatment of Heart Failure with phosphodiesterase inhibitors and other inotropic drugs
o Reserved for patient who have not responded to ACE inhibitors
o needs to be monitored because these drugs cause arrhythmias, are used for arrhythmias but there is a potential cause of arrhythmias from this drug
Milrinone (primacor)
Adverse effects
Ventricular dysrhythmias, headache, N+V
what is cardiac output, preload, afterload, effects of each on cardiac output, correlation of pre load and afterload on cardiac output
o Cardiac output : amount of blood pumped by each ventricular per minute
o Preload : degree to which the myocardial fibers are stretched just prior to contraction
o Afterload : degree of pressure in the aorta that must be overcome for blood to be ejected from the LEFT ventricle
Angina Pectoris
o Acute chest pain caused by insufficient oxygen to a portion of the myocardium.
relationship between angina pectoris and management of angina (what is the goal? : Reduce chest pain, nitrates are drug of choice)
o Goal : reduce intensity and frequency of chest pain
o Nitrates are drug of choice.
Nursing process : Patient& Family education : Last paragraph, how to use nitrates
&advice to give for patients with CHF
o CHF, advice to give patient upon discharge : Go to hospital if condition gets worse : #1 : Weight gain 2lbs per day/ 5 per week, SOB, Pain, Crackles, difficulty breathing, fatigue, dizziness
o Take nitroglycerin tablet under the tongue for angina/ chest pain. Remain seated or lay down to avoid dizziness or falls
o If chest pain continues, repeat one NTG tablet, under tongue in 5 minutes
o If chest pain continues, repeat one NTG tablet, under tongue in 5 minutes
o If chest pain continues, even if reduced, do not take further NTG, unless specifically directed by HCP. Call EMS system, 911, for assistance. DO NOT DRIVE self to emergency room
Beta Blockers
What we need to know about stopping it
o Before you stop it, call doctor and explain why
o Impotence in males
o Rebound hypertension and tachycardia may occur if stopped abruptly
Calcium channel blockers : adverse effects : most common complaint from people taking calcium channel blockers
o headache because vasodilation, increases contractility, so it dilates your brain which causes headache
o Other side effects: flushing, dizziness, peripheral edema, nausea and diarrhea
o Can CCB exacerbate CHF ? Monitoring for SOB, dizziness , difficulty breathing, etc (symptoms in CHF)
Thrombolytics : purpose
o Dissolves clots obstructing the coronary arteries, thus restoring circulation to the myocardium
o Quick restoration of cardiac circulation
o Reduces mortality caused by acute MI
o After the clot is successfully dissolved, anticoagulant therapy is initiated to prevent the formation of additional clots.
Myocardial Infarction : What it causes
o Primary cause is advanced coronary artery disease
o Plaque buildup can severely narrow one or more branches of the coronary arteries.
o Pieces of unstable plaque can break off and lodge in small vessel serving a portion of the myocardium.
o Decreased blood flow
o Deprived oxygen supply, the affected area of myocardium becomes ischemic.
(Prototype) Reteplase (Retavase)
Class , Administration & use
Thrombolytic
o Administered by IV bolus
o Dissolves blood clots
Values : most specific ? CK, CK-MB, troponin
o CK : normal range (22-198 units/L ) elevates 3-8 h after MI
o CK-MB (specific to heart muscle)
o Troponin 3.1 mcg/L : regulates myocardial contractile process
Antiplatlets : Plavix, Aspirin
Uses
o Aspirin given as soon as MI is suspected
o Plavix : approved for the prevention of thrombotic stroke and MI
Etiology of dysrhythmias
Signs and Symptoms
o HTN, cardiac valve disease, such as mitral stenosis, CAD, medications such as digoxin, low potassium levels in the blood, MI, stroke, diabetes mellitus, CHF
o S/s: dizziness, weakness, chest pain, fatigue, palpitations, SOB, fainting
difference between cardioversion and defibrillation
Why is it used instead of medication in some cases
o Cardioversion : synchronized
o Defibrillation : unsynchronized
o These non pharmacologic therapy are used because medications can potentially cause serious adverse effects
Beta blockers: Prototype o Propanolol (Inderal,others) : adverse effects, what it can mask, use cautiously in
o Common : fatigue, hypotension, bradycardia
o Diminished libido, impotence
o Can mask the symptoms of hyperglycemia
o Use cautiously in patients with reduced renal output, because the drug may accumulate to toxic levels in the blood and cause dysrhythmias
potassium channel blockers : actions &uses, drug-drug interactions( digoxin), lab values o Amiodarone (Cordarone)
o Treats resistant ventricular tachycardia
o Drug of choice for atrial dysrhythmias in patient with HF
o Blocking potassium channels, some of this drug’s actions on the heart relate to its blockade of sodium ion channels
o Drug-Drug : increases serum digoxin levels by as much as 70%
o May increase values for the following tests: nuclear antibody, ALT, AST, and serum alkaline phosphate, T-4
calcium channel blocker : Verapamil : herbal interactions, actions , how does it work o Verapamil (Calan)
o Herbal interaction : grapefruit juice may increase verapamil levels. Hawthorn may have additive hypotensive effects
o Action : acts by inhibiting the flow of calcium ions both in to myocardial cells and vascular smooth muscle.
In the heart, this action slows conduction velocity and stabilizes dysrhythmias.
In the vessels, calcium channel blockade lowers BP, reducing cardiac workload.
o Also dilates the coronary arteries, an action that is important when the drug is used to treat angina.
Sodium channel blocker :
o IA: procainamide
o IB: lidocaine
o IA: procainamide
Delays repolarization, slows conduction velocity, increase duration of the action potential (Indicated for A-Fib, premature atrial contractions, PVCs, ventricular tachycardia)
o IB: lidocaine
Accelerates repolarization, slows conduction velocity, decreases duration of action potential (Indicated for severe ventricular dysrhythmias)
o A-Fib, V-Fib
Very rapid uncoordinated beats, complete disorganization of rhythm resulting in lack of adequate cardiac contraction, requires immediate treatment
o A-flutter
Rapid, regular heart beats, may range between 200-300 bpm, atrial may require treatment but is not usually fatal, ventricular flutter requires immediate treatment (saw tooth)
Repolarization &depolarization (which ions are involved) which are getting in and which are getting out
o Repolarization :potassium channel gates open, potassium is getting out of cell
o Depolarization : sodium and calcium channel gates open, sodium rushes into cell, calcium also enters cell
Which organ is involved with coagulation factors : clotting factors
o If cirrhosis, cancer of liver : bleeding is a problem because clotting factor is not there
o Organ involved with coagulation factors : liver
interactions : NSAIDS, SSRI, DIEURETICS, INTERACTION WITH VITAMIN K , foods o Warfarin (Coumadin)
o Avoid vegetables that are high in Vitamin K: tomatoes , dark leafy vegetables, bananas, fish
o Interactions : increased warfarin effects with alcohol, NSAIDs, diuretics, SSRIs
o Vitamin K reverses anticoagulant effects
Low molecular heparin (Lovenox) Action, what it does more specific to ? what lab value is checked Antidote Where to administer
o Inhibition is more specific to factor X
o Sub-cut : stomach , 2 inches away from umbilicus
o Usually, CBC (platelets) checked, since PT or aPTT not affected
o Antidote: Protamine
o If you see hypotension, and don’t see bleeding, it could be internal bleeding
what kind of patient you cannot give heparin to?
increase in which lab values ?
Pregnancy
o Should not be given to patients with active internal bleeding, bleeding disorders, severe hypertension, recent trauma.
o heparin induced thrombocytopenia
o May increase : aPTT , AST, ALT
o if you have pregnant woman : does not cross placental barrier
Thrombolytics
o what kind of patients you don’t give to
stroke, bleeding, recent surgery,
o The therapeutic effects of thrombolytic is greater when they are administered as soon as possible after clot formation occurs, preferably within 4 hours.
