Pharmacology Review Flashcards
Access Devices: Peripheral IV
- Short-term therapy
- Use most distal appropriate site in non dominant arm
*Avoid:
-infected site
-vascular (dialysis) graft/fistula
-same side as mastectomy
-areas of flexion
-hand veins on older clients
*Initiation
-Apply tourniquet 4-6 inches above insertion site
-BP cuff as tourniquet, inflate to just below client’s diastolic pressure (less than 50 mmHg)
Access Devices: Central Venous Access Devices
- Long-term therapy
*“central” refers to end-point of the catheter tip –usually superior vena cava
*change dressing 2-3 times per week
*flush with normal saline or with NS followed by heparinized solution, per agency policy
*use a syringe with a barrel capacity of 10 mL or more for flushing
*use a push-pause technique for flushing
*verify placement with chest x-ray
*Types:
**Peripherally inserted central catheter (PICC)
-Use basilic, cephalic, or axillary veins of dominant arm
-Do NOT take BP or draw blood from extremity with PICC line
**Tunneled central catheter
-inserted surgically
-threaded under the skin to the subclavian vein and advanced to superior vena cava
-catheter is cuffed and can be single or double lumen
-avoid chemotherapy or parenteral nutrition
**Non-tunneled percutaneous catheters
-typically inserted through subclavian vein or internal jugular vein
-triple-lumen catheter
-use catheter for less than 6 weeks
-never use force when flushing catheter
-change IV tubing every 72-96 hours, per agency policy
Complications of IV Therapy
*Circulatory overload of IV solution
-reduce or stop IV rate
-raise HOB & determine need for oxygen and diuretics
-Assess V/S
-Notify HCP
*Infiltration or Extravasation
-Discontinue IV
-Apply warm or cold compresses to infiltrated site (depending on type of fluid)
-Apply sterile dressing
-Elevate arm
*Phlebitis
-discontinue IV
-Apply warm, moist compresses
*Local infection
-culture any drainage
-Clean skin with alcohol, remove catheter and save for culture, apply sterile dressing
*Bleeding at venipuncture site
-Assess if IV system is intact
-Apply pressure dressing over site
-If bleeding persist, discontinue and start in other extremity or proximal to previous insertion site
Cardiovascular Medications
ACE Inhibitors, ARBs, Beta-adrenergic blockers, Alpha-1 adrenergic blockers, centrally-acting alpha adrenergics, CCBs, Direct-acting vasodilators
Angiotensin converting enzyme (ACE) Inhibitors
*Suffix
-pril (lisinopril)
*MOA
-decreases stimulation of the renin-angiotensin-aldosterone system
-blocks conversion of angiotensin I to angiotensin II (prevents vasoconstriction)
-blocks release of aldosterone (prevents reabsorption of sodium and water)
-increases diuresis
-decreases systemic vascular resistance (decreases afterload)
-decreases venous pressure
*Monitor
-Potassium (hyperkalemia)
-Cough (dry, chronic)
-angioedema (swelling of lips/face)
Angiotensin II Receptor Blockers (ARBS)
*Suffix
-sartan (losartan)
*MOA
-decreases stimulation of the renin-angiotensin-aldosterone system
-blocks angiotensin II from binding to Angiotensin II receptors
-blocks release of aldosterone (prevents reabsorption of sodium and water)
-increases diuresis
-Decreases systemic vascular resistance (decreases afterload)
-decreases venous pressure
*Monitor
-Potassium (hyperkalemia)
-angioedema
Beta-adrenergic blockers
*Suffix
-lol (carvedilol)
*MOA
-blocks sympathetic nervous system in heart
-blocks the beta-adrenergic receptors of the sympathetic nervous system (beta 1, minimal effect of beta 2)
-decreases HR
-Beta Selective: Atenolol, Beta Non-Selective: Propranolol, Beta-nonselective and alpha blocking: carvedilol and labetalol
*Monitor
-BP (drop in HR –> drop in cardiac output, can drop BP
-HR (bradycardia)
-lung sounds (bronchoconstriction)
-blood sugar (masking of hypoglycemia)
Alpha-1 adrenergic blockers
*Suffix
-osin (doxazosin)
*MOA
-blocks sympathetic nervous system at level of blood vessel
Centrally-acting alpha adrenergics
*Suffix
-clonidine or methyldopa
*Blocks sympathetic nervous system in medulla
Calcium channel blockers
*Suffix
-pine (amlodipine)
*MOA
-inhibit (block) calcium ion movement to slow conduction
-blocks calcium from getting into cells –> vasodilation of cardiac arteries and peripheral arterioles, but not veins
-decreases contractility of heart (negative inotropic effect)
-Decreases HR (negative chronotropic effect)
-decreases conduction velocity within the heart (AV Node) (negative dromotropic effect)
-3 types: smooth muscle selective: nifedipine, Negative inotrope: verapamil, Both: diltiazem
*Monitor
-BP (hypotension more common with nifedipine, less common with diltiazem)
-bradycardia, especially with use of verapamil
-Peripheral edema (nicardipine, nifedipine, verapamil)
-periodic liver and kidney function tests
Direct-acting vasodilators
*Suffix
-hydralazine or minoxidil
*MOA
-directly act on blood vessels to vasodilate
Contraindications & adverse effects of Cardiovascular Medications
*Common adverse effects, contraindications, & interactions for all anti-hypertensives
-orthostatic hypotension
-medications that act via the same route should NOT be administered together (e.g. ACE inhibitors should NOT be administered with ARBs)
*Herbal Interactions
-ma huang (ephedra): decrease effectiveness of antihypertensives
-goldenseal: decrease effectiveness of antihypertensives
-black cohosh: increases risk of hypotension
Nursing Considerations: Cardiovascular Medications
- When administering ant-hypertensives:
-Check BP before and after administration
-teach clients to sit on edge of bed before getting up in morning and to change positions slowly
-reinforce a low-sodium diet and regular exercise
-assess for herbal supplement use and teach about herbal supplements to avoid
Cardiovascular Medications: Diuretics
Thiazide, Potassium Sparing, Loop, Osmotic, Other
Thiazide Diuretics
*hydrochlorothiazide, chlorothiazide
*Actions
-inhibits reabsorption of sodium and chloride in distal convoluted tubules
*Adverse effects
-hypokalemia
-hyperglycemia
-blurred vision
-dry mouth
-hypotension
*Nursing Considerations
-avoid giving at bedtime
-Monitor I/Os, electrolytes, weight, BUN, creatinine, glucose
Potassium Sparing Diuretics
*Spironolactone
*Actions
-inhibits action of aldosterone in distal tubule, which interferes with sodium reabsorption
*Adverse effects
-hyperkalemia
-hyponatremia
-hepatic damage
-tinnitus
*Nursing Considerations
-give with meals
-used with other diuretics
-Monitor I/O
Loop Diuretic
*Furosemide, Bumetanide, Torsemide, Ethacrynic acid
*Actions
-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: slow over 2 minutes, diuresis occurs within 10 minutes
-PO: diuresis within 30 minutes
Osmotic Diuretic
*Mannitol
*Actions
-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, V/S, electrolytes, neurologic status
Other Diuretics
*Chlorthalidone
*Actions
-unclear
*Adverse effects
-Aplastic anemia
-hypokalemia
-hyperglycemia
-dizziness
-orthostatic hypotension
*Nursing Considerations
-avoid giving at bedtime
-take with food
-long-lasting (2-3 days)
-Monitor I/O, BP, electrolytes, weight, glucose
Antibiotics: Nursing Considerations
*Pediatric Overuse
*indiscriminate weapons of mass destruction
*GI disturbance
*Pregnant and breastfeeding women
*Oral contraceptives
*Older adults
*Photosensitivity reactions
*Adverse effects:
-kidney damage
-GI toxicity
-liver toxicity
-neurotoxicity
-hypersensitivity rxns
-superinfections
Antibiotics: Types
Penicillins, Cephalosporins, Macrolides, Fluoroquinolones, Sulfonamides, Tetracyclines, Aminoglycosides
Antibiotics: Penicillins –Nursing Considerations
*Examples: penicillin G, penicillin V potassium, amoxicillin, amoxicillin-clavulanate
*Adverse Rxns
-Rash, anaphylaxis
-CNS toxicity (e.g. coma, seizures)
-nephrotoxicity
-C. difficile - induced diarrhea
-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
Antibiotics: Cephalosporins–Nursing Considerations
*Examples: cephazolin, cephalexin, ceftriaxone, cefaclor, cefepime, cefdinir, ceftaroline
*Adverse rxns
-CNS toxicity (seizures, headaches)
-C. difficile - induced diarrhea
-nausea, vomiting
-pancytopenia
-nephrotoxicity
-rash, urticaria
-anaphylaxis (rare)
*Drug Interactions
-Cephalexin may increase metformin level (monitor blood glucose level frequently) and cause nephrotoxicity if concurrently taking an aminoglycoside
*Contraindications
-Hypersensitivity to any cephalosporin; penicillin anaphylaxis
*Precautions
-Pregnancy, lactation, renal/hepatic impairment
Antibiotics: Fluoroquinolones –Nursing Considerations
*Examples: ciprofloxacin, levofloxacin, moxifloxacin
*Adverse rxns
-CNS effects (dizziness, headaches, seizures, hallucinations)
-Black Box Warning: rupture of Achilles tendon
-Black Box Warning: may exacerbate muscle weakness in clients with myasthenia gravis
-Bone marrow depression
-ventricular arrhythmias and sudden cardiac death
-strongly associated with C. difficile - induced diarrhea
*Drug interactions
-Meds that cause QT prolongation or bradycardia
-Ciprofloxacin interacts with metformin, causing hypo or hyperglycemia
-Levofloxacin potentiates effects of warfarin
*Contraindications
-hypersensitivity to Fluoroquinolones, previous arrhythmias, uncorrected hypokalemia or hypomagnesemia
