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
