Real test 3 Flashcards
Fibric acid agents: gemfibrozil (Lopid) patient teaching and side effects
-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.
Types of lipoproteins & lab values
LDL: <100
Triglycerides: <150, preferably <100
HDL: >60, 40 average
Total: <200
intake: <300 mg/d
Statin side/adverse effects *first line Tx
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)
Calcium channel blockers MOA and side/adverse effects
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
ACE inhibitors indication, mechanism of action, common side effects, patient teaching, nursing assessment
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
ARB indication, mechanism of action, adverse/side effects
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
Know the special endings for medications. For example, what drugs end in “pril”, what drugs end in “lol”
-pril: ACE inhibitors
-lol: Beta blockers
-sartan: Angiotensin Receptor Blockers (arbs)
-pine or -amil: Calcium Channel Blockers
Diuretics (loop, thiazide, potassium sparing) mechanism or action, side/adverse effects, patient teaching
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)
hydrochlorothiazide (Microzide), drug classification, mechanism of action, adverse/side effects, patient teaching
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
Nephrotoxic drugs and strategies for managing medication administration
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
Isotonic IVF indications, colloid mechanism of actions and indication, nursing assessment & monitoring
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.
Types and definitions of crystalloid & colloid IVFs
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
Body system(s) affected by hyperkalemia and hyperkalemia drugs therapy
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.
Potassium IV administration
K rider (slow K drip) NO IV PUSH IT WILL CAUSE DYSRHYTHMIA), no more than 10 mEq.
Non-pharmacological management of hypertension, consequences of untreated hypertension, first-line of treatment
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
Beta-blocker mechanism of action, side effects, contraindications, patient teaching
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
MONA
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)
Nitroglycerin mechanism of action, adverse/side effects, and teaching
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
Angina stable vs unstable CP
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.
Myocardial Infarction (MI) – Blood clot(s) that blocks coronary arteries
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)
**The primary means to stop angina/myocardial ischemia
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
lanoxin/digitek (Digoxin) mechanism of action, therapeutic effects, nursing assessment, adverse/side effects
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.
Cardiac output and tachycardia r/t CHF, CHF patient teaching
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
Inotropic drugs mechanism of action
MOA; increase cardiac output via increased strength of contraction and slow the HR to decrease workload/stress on heart
