Real test 3

Question 1

Fibric acid agents: gemfibrozil (Lopid) patient teaching and side effects

Answer 1

-do not take with statins or cholchicine

T:
Take with food to decrease gi upset
monitor GI effects
preg category B

S/E
gi upset, abdominal cramps
Interaction: potentiates (makes effects stronger) anticoagulants.

Question 2

Types of lipoproteins & lab values

Answer 2

LDL: <100
Triglycerides: <150, preferably <100
HDL: >60, 40 average
Total: <200
intake: <300 mg/d

Question 3

Statin side/adverse effects *first line Tx

Answer 3

S/E: headache, GI upset, muscle weak, fatigue, joint pain, heart burn
A/E: Rhabdomyolysis, disorder of muscle breakdown releasing damaging protein into blood that hurt kidneys-sign is muscle weakness; Can be fatal by acute renal failure. Rare. Makes urine look like cola
difficulty ambulating. Risk for hepatotoxicity (hard on liver)

Question 4

Calcium channel blockers MOA and side/adverse effects

Answer 4

MOA: Blocking calcium channels has significant physiologic effects on the heart and vascular smooth muscle.
Vascular smooth muscle: Help dilate peripheral arterioles to reduce the afterload (workload of heart) to make myocardium work less (less o2 demand)
Myocardium: reduces force of myocardial contraction
Cardiac conduction: slow the speed of electrical conduction to treat dysrhythmias
Two main categories:
Dihydropyridines – Selective for vascular smooth muscle. Used for chest pain (CP) & hypertension (HTN).
nifedipine (Adalat)
Nondihydropyridines – Act on both vascular smooth muscles and the myocardium. Used for treating dysrhythmias.
verapamil (Calan)
S/E: Angioedema (peripheral swelling), orthostatic hypotension, constipation, headache

Question 5

ACE inhibitors indication, mechanism of action, common side effects, patient teaching, nursing assessment

Answer 5

lisinopril (Prinivil, Zestril)
captopril (Capoten)
enalapril (Vasotec)
I: used to treat HTN CHF
MOA: Inhibits enzyme that converts angiotensin 1—> angiotensin 2 blocking RAAS cascade
S/E: Cough r/t bradykinin buildup in lungs, Orthostatic HTN (all bp meds), rash, high potassium
PT: no use in pregnancy,suggest contraceptive, cough risk in 20-30% people to lookout for, and very bad in angioedema risk.
NC: check if pregnant, monitor bp for hypertension, monitor for edema

Question 6

ARB indication, mechanism of action, adverse/side effects

Answer 6

Angiotensin receptor blockers
losartan (Cozaar)
Tx of HTN
MOA: blocks angiotensin ii from binding to receptors in muscles and blood vessels consequently blocking potent vasoconstrictive effects of angiotensin 2
S/E: usually better tolerated, no cough. dizziness, nausea, vomit, diarrhea, ortho HTN

Question 7

Know the special endings for medications. For example, what drugs end in “pril”, what drugs end in “lol”

Answer 7

-pril: ACE inhibitors
-lol: Beta blockers
-sartan: Angiotensin Receptor Blockers (arbs)
-pine or -amil: Calcium Channel Blockers

Question 8

Diuretics (loop, thiazide, potassium sparing) mechanism or action, side/adverse effects, patient teaching

Answer 8

Loop: furosemide (Lasix) *most effective
MOA: Prevents reabsorption of Na, Ca, and K in the loop of Henle. Other option is Bumetanide which is 40 x more potent than furosemide and shorter duration
S/E: hypokalemia, ortho htn, ototoxicity- too much to fast can damage ears, hypotension, dizzy,
PE: potassium supplementation needed. Weigh daily - report a weight gain or loss of more than 1kg in a 24 hr period. Take diuretics in the morning.

Thiazide: hydrochlorothiazide HCTZ (Microzide) *most prescribed
MOA: Blocks reabsorption of Na+, Cl- and water at the distal tubules.
S/E: ortho htn, increased blood sugar. No ototoxicity unlike loop and less K loss
PE: may need K, sulfa allergy may contraindicate

Potassium sparing: spironolactone (Aldactone), metolazone
MOA: Blocks aldosterone which Block reabsorption of Na, which reduces excretion of K
S/E: increased K levels, and ortho. htn
PE: don’t take with potassium supplements (salt substitutes)

Question 9

hydrochlorothiazide (Microzide), drug classification, mechanism of action, adverse/side effects, patient teaching

Answer 9

Class: Diuretic-Thiazide: hydrochlorothiazide HCTZ (Microzide) *most prescribed
MOA: Blocks reabsorption of Na+, Cl- and water at the distal tubules.
S/E: ortho htn, increased blood sugar. No ototoxicity unlike loop and less K loss
PE: may need K, sulfa allergy may contraindicate

Question 10

Nephrotoxic drugs and strategies for managing medication administration

Answer 10

NSAIDS, due to inhibiting cox
Ace Inhibitors
Radiographic Dyes (ct or x ray)
Aminoglycosides (a type of antibiotic)
amphotericin B
Cancer drugs
Immunosuppressants

managing In renal failure:
Dose reduction because most drugs are excreted by kidneys
Discontinue nephrotoxic medications

Question 11

Isotonic IVF indications, colloid mechanism of actions and indication, nursing assessment & monitoring

Answer 11

Isotonic indications: Hydrating without causing fluid shift, ex low bp, hypovolemia, blood loss, etc.
Colloids:
MOA: Colloids are to big to pass capillary membrane (proteins, starches, other big molecules) and consequently act similar to hypertonic solutions
I: shock, burns, hemorrhage, surgery
NA: Risk for fluid overload : distended neck veins, pulmonary edema, cough, htn, tachycardia. Monitor vitals including BP and P. Risk for fluid overload-listen to lungs for crackle and monitor breathing/shortness of breath.

Question 12

Types and definitions of crystalloid & colloid IVFs

Answer 12

Crystalloids (IV solutions, contain electrolytes levels similar to plasma/extracellular fluid)
diffuse into interstitial fluid and ICF
Isotonic – Hydrates without causing fluid shift to treat low bp
Normal saline
lactated ringers
D5W
Hypertonic – Draws water away from cells and tissues, treats cellular edema.
helps with edema, not given that often due to fluid shift that can be dangerous
Ex: hypertonic saline
Hypotonic – Water moves out of plasma to tissue and cells to treat dehydration with normal bp
Hydrating effect, treat cellular dehydration, dilute concentrated serum, done slowly!
Can cause hypotension
Half NS
Colloids (proteins pull water into vessels and expands plasma volume).
serum Albumin - most common: a protein from blood given to expand volume, part of our blood used to measure protein in blood
Dextran 40 -Synthetic polysaccharide, 12 hr effects: double plasma volume only for 12 hr
Hetastarch

Question 13

Body system(s) affected by hyperkalemia and hyperkalemia drugs therapy

Answer 13

Hyperkalemia (>5 mEq/L)
Causes: potassium sparing diuretics, consuming food c high K, renal failure or insufficiency
S/S: muscle twitch , fatigue, cramp, dyspnea, dysrhythmia
TX: low K diet, some meds (kayexalate) -(can be given oral or rectal but oral is best) which causes diarrhea and pulls k out of blood. iv insulin which causes K to move into cells with glucose. Calcium gluconate which prevents heart damage. calcium and and sodium bicarbonate to correct acidosis.
Hypokalemia (<3.5mEq/L)
Causes: high doses of loop diuretics- not enough K, vomiting, diarrhea, strenuous exercise, strenuous muscular activity, body not storing K-must be given daily in this case
S/S: muscle weak, lethargy, dysrhythmias, cardiac arrest
TX: increase dietary K, K replacement PO, K rider (slow K drip) NO IV PUSH IT WILL CAUSE DYSRHYTHMIA), no more than 10 mEq.

Question 14

Potassium IV administration

Answer 14

K rider (slow K drip) NO IV PUSH IT WILL CAUSE DYSRHYTHMIA), no more than 10 mEq.

Question 15

Non-pharmacological management of hypertension, consequences of untreated hypertension, first-line of treatment

Answer 15

Not smoking
Refined carbohydrates
Exercise
Lifestyle changes should always be included
Monitor blood-lipid levels regularly
Maintain weight at optimum level
Diet with low fats AND cholesterol
>30% or 3 grams from calories (fat)
>20 mg of cholesterol and 2 grams saturated per cholesterol
Increase fiber, veggies and fruits
Reduce or eliminate tobacco use
Increased clotting
Reduces HDL
consequences: HF, MI, organ damage, decreased perfusion, etc.
First line: ARBs, calcium channel blockers, Thiazides, Second: ACE inhibitors, cardiac glycosides

Question 16

Beta-blocker mechanism of action, side effects, contraindications, patient teaching

Answer 16

MOA:Decreases heart rate and myocardial contractility reducing cardiac output, Negative inotropic effort
SE: Bradycardia, Exercise intolerance
Contradictions: Don’t give with asthma or Chronic bronchitis
Pt teaching: stand slow, possible exercise intolerance

Question 17

MONA

Answer 17

MONA: Used to treat angina and sometimes MI
morphine (decrease pain=slow heart/bp)
oxygen (increase supply)
nitroglycerine (dilate vessels) given every 3-5 min
asa (aspirin) (prevent blood clot, give 4 baby aspirin (you can chew=1 adult)

Question 18

Nitroglycerin mechanism of action, adverse/side effects, and teaching

Answer 18

MOA: Relax arterial and venous smooth muscle. reduce workload and therefore o2 demand. Pain should be relieved, if not it is likely MI causing pain not angina.
S/E: headache, hypotension
T: monitor BP and pain

Question 19

Angina stable vs unstable CP

Answer 19

Angina Pectoris – Acute chest pain caused by myocardial ischemia (lack of blood flow to heart muscle) and is characterized by severe chest pain brought on by physical activity or emotional stress
aggravated by exertion (common in winter-snow shovel, or times of bettering body-summer/new year)
steady intense pain in anterior chest, usually goes away
goes away with stress reduction relieved by Nitroglycerin (NTG)
-myocardium receives blood from coronary arteries
Stable – predictable person may be going out for exercise
Unstable –random, wakes you up at night
What else can cause chest pain?
GERD
Gallstones
ulcer
musculoskeletal injury
pulmonary embolus (blood clot in lung)
Always rule out heart when chest pain occurs.

Question 20

Myocardial Infarction (MI) – Blood clot(s) that blocks coronary arteries

Answer 20

high mortality rate
primarily caused by CAD
not relieved by NTG (because heart vessels are blocked so dilating doesn’t help)
ECG changes
marker enzymes (CK, troponin) when heart cells die these enzymes spill into bloodstream. Test by blood draw.
Plaque activates clotting cascade, platelets aggregate forming thrombus, blood flow is cut off=ischemia (cardiac cells begin to die)

Question 21

**The primary means to stop angina/myocardial ischemia

Answer 21

slow HR
dilate veins (reduce preload)
decrease SC
lower BP (reduce afterload)
Pharmacotherapy
nitrates
beta blockers
calcium channel blockers
Lifestyle
weight
diet
exercise
Surgical/Procedural Intervention
PCI (percutaneous coronary intervention): cath lab, enter heart through artery and inject dye into coronary arteries to see if blocked. Place stent if vessel is narrowed pushing clot snug against vessels. Done with thrombus in MA but more complex (need to suck out clot first then place stent)
most common, high success rate
CABG (coronary artery bypass grafting): multiple vessels narrowed, open heart surgery

Question 22

lanoxin/digitek (Digoxin) mechanism of action, therapeutic effects, nursing assessment, adverse/side effects

Answer 22

Cardiac Glycoside
MOA: increase cardiac output by increasing the force of myocardial contraction
Therapeutic: Treat heart failure by decreasing heart strain via cardiotonic effect
NA:
monitor s/s: heart rate-Hold <60, weight, med precision/schedule
fluid restriction
Early intervention-most , common hospital admit cause
no cure
S/E;
May cause dysrhythmias N/V, anorexia and visual disturbances (halo with yellow-green tinge)
Extra beats, Diarrhea in elderly, confusion, dizziness, drowsiness, restlessness, nervousness, agitation and amnesia, visual disturbances, gynaecomastia, local irritation (IM/SC inj), rapid IV admin may lead to vasoconstriction and transient hypertension.
Potentially Fatal: Cardiac arrhythmias in combination with heart block.

Question 23

Cardiac output and tachycardia r/t CHF, CHF patient teaching

Answer 23

In CHF heart beats faster to try and compensate for the inadequate output which is caused by incomplete filling and emptying.
PT:
COMPLICATIONS OF HF. Tell the patient to call for emergency assistance for acute shortness of breath or chest discomfort that is not alleviated with rest
PREVENTION. To prevent exacerbations, teach the patient and family to monitor for an increase in shortness of breath or edema. Tell the patient to restrict fluid intake to 2 to 2.5 L per day and restrict sodium intake as prescribed. Teach the patient to monitor daily weights and report weight gain of more than 4 pounds in 2 days

Question 24

Inotropic drugs mechanism of action

Answer 24

MOA; increase cardiac output via increased strength of contraction and slow the HR to decrease workload/stress on heart

Question 25

Antidysrhythmic side/adverse effects, patient teaching

Answer 25

S/E: for all: flushing headache, dizziness, chest pain, fatigue, worsening of symptoms, new dysrhythmias, palpitations
Class 1: produce or worsen dysrhythmias
2: Don’t give with pulmonary problems, may cause bradycardia, fatigue, ortho hypo
3: Worst side effect pulmonary toxicity which may be fatal, but also can cause or worsen dysrythmias, blurry vision, photosensitivity, nausea, vomiting
4: s/e: headache, angioedema, dizzy, ortho. hypo, bradycardia, heart fail, constipation

Question 26

Cardioversion rationale

Answer 26

put someone to sleep and shock the heart to shock back into rhythm. safer with less side effects because it is more easily controlled-can stop right away, body doesn’t have to metabolize a drug.

Question 27

Therapeutic indication, for anticoagulants and antiplatelet agents, s/s DVT/PE

Answer 27

I: to prevent blood clots
s/s of deep vein thrombosis:
pain, swelling and tenderness in one of your legs (usually your calf or thigh)
a heavy ache in the affected area
warm skin in the area of the clot
red skin, particularly at the back of your leg below the knee
s/s of deep pulmonary embolism:
breathlessness – which may come on gradually or suddenly
chest pain – which may become worse when you breathe in
sudden collapse

Question 28

warfarin (Coumadin), indication, lab tests, overdose treatment, patient teaching

Answer 28

I: Anticoagulant: prevent blood clots from forming or getting worse, can be used to break clots or treat recurring TIA’s or MI’s
Tests: PT/INR: a test that measures the time it takes to clot, INR is the standardization of the different tests.
*ideal INR of 2-3
Overdose: IV Vitamin K10
Vitamin K regulation: (Avoid Vit K foods or eat a consistent amount
PT:
Many factors may change your body’s response to this drug—fever, change of diet, change of environment, other medications. Your dosage may have to be changed repeatedly. Write down changes that are prescribed.
Do not start or stop taking any medication without consulting your health care provider. Other drugs can affect your anticoagulant; starting or stopping another drug can cause excessive bleeding or interfere with the desired drug effects.
Carry or wear a medical ID tag to alert emergency medical personnel that you are taking this drug.
Avoid situations in which you could be easily injured (contact sports, shaving with a straight razor).
Have periodic blood tests to check on the drug action. These tests are important.
Use contraception; do not become pregnant while taking this drug.
You may experience these side effects: Stomach bloating, cramps (transient); loss of hair, rash; orange-red discoloration to the urine (if upsetting, add vinegar to your urine and the color should disappear).
Report unusual bleeding (from brushing your teeth, excessive bleeding from injuries, excessive bruising), black or bloody stools, cloudy or dark urine, sore throat, fever, chills, severe headaches, dizziness, suspected pregnancy

Question 29

Pernicious anemia cause

Answer 29

Lack of intrinsic factor is the most common cause. gastric bypass can affect since the stomach helps make intrinsic factors. Develops over time. Folic acid insufficiency can also manifest as anemia and metabolism of vitamin b12 and folic acid are intricately linked.

Question 30

epoetin alfa (Epogen) indication, administration, patient teaching

Answer 30

I: Tx: chronic renal failure, chemo pt from bone marrow suppression
-be careful about pregnancy
-Epoetin sometimes causes seizures, especially during the first 90 days of treatment. During this time, it is best to avoid driving, using heavy machinery, or doing other activities that could cause serious injury if a seizure occurs while you are performing them
-look out for signs of blood clots

Question 31

Iron administration teaching
given z-track

Answer 31

Vitamin C helps absorption
-Teach to take with food for GI upset however, absorption is best on empty stomach
-Don’t take at the same time as calcium
-Takes up to 6 months to alleviate anemia

Question 32

Colony Stimulating Factors (CSF) - filgrastim (Neupogen) indication, mechanism of action, patient teaching

Answer 32

-I: increase WBC’s such as in cancer chemo patients, pts who are neutropenic (hiv/aids, immunosuppressed),
-MOA: increases Leukopoiesis: increases neutrophil production in bone marrow thus increasing leukocytes (WBCs), made through recombinant DNA technology.
-PT: give iv slow, sub q, watch for infection-hold if active infection/fever, educate on avoiding crowds/children

Question 33

S/S of anemia

Answer 33

S/S: fatigue, low bp, pallor

Question 34

anti-platelet drug mechanism of action

Answer 34

MOA: reduce the aggregation properties of platelets.

Question 35

alteplase (Activase) mechanism of action, therapeutic indication

Answer 35

-MOA: Thrombolytics - dissolve existing intravascular clots, destruction through fibrinolysis; converts plasminogen to plasma to dissolve clot. if done quick restores flow and prevents infarction (tissue death) *narrow margin of safety
-I: I: MI, stroke, PE, DVT

Question 36

enoxaparin (Lovenox) administration, rationale for why it is the preferred treatment for managing clots

Answer 36

short heparin molecule, similar moa, more stable, can be given sub q bid vs iv drip, can teach pts how to use and self administer at home. has air bubble which is left in and helps distribute, give in abdomen inch away from umbilicus

Question 37

Heparin side/adverse effects, nursing care, lab test

Answer 37

-S/E:
Slight fever, headache, chills, nausea, vomiting, constipation, epistaxis, bruising, slight haematuria, skin necrosis (SC inj), osteoporosis, alopecia. Hypersensitivity reactions include urticaria, conjunctivitis, rhinitis, asthma, angioedema and anaphylactic shock. Priapism.
-Potentially Fatal: Heparin-induced thrombocytopenia with or without thrombosis; bleeding.
-NC: History: Recent surgery or injury; sensitivity to heparin; hyperlipidemia; pregnancy
Physical: Peripheral perfusion, R, stool guaiac test, PTT or other tests of blood coagulation, platelet count, renal function tests
-lab test: The PT test, also known as the PT/INR test, looks at the extrinsic pathway of coagulation (meaning coagulation that occurs after blood escapes a blood vessel).
-The PTT test looks at the intrinsic pathway of coagulation (meaning coagulation that occurs within a blood vessel).
simple terms:
-Prothrombin Time (PT) Evaulates ability to clot
International Normalized Ratio (INR) Ensures that results from a –PT test are the same from one lab to another
Partial Thromboplastin Time (PTT) Determines if blood-thinning therapy is effective