Test 3 (22-35) Flashcards by Kelsey Sheen

Primary Hypertension

Elevated systemic arterial pressure for which no cause can be found

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Secondary Hypertension

High blood pressure associated with renal, pulmonary, endocrine, and vascular disease

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Primary effect of diuretic

Decrease plasma and extracellular fluid volumes

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Another name for primary hypertension

Idiopathic, essential

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Drugs used in the management of hypertensive emergencies

Vasodilators

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Orthostatic hypotension

A common adverse effect of adrenergic drugs involving a sudden drop in blood pressure when a patient changes position

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Drugs used as first line drugs in treatment of both heart failure and hypertension

ACE inhibitors

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Possible adverse effects of ACE inhibitors?

Fatigue, headaches, dry cough

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Drug used to treat hypertensive emergencies

Sodium Nitroprusside (Nitropress)

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Woman in eighth month of pregnancy, has pre eclampsia. BP 210/100. What type of hypertension is this?

Secondary

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Adverse effect while on beta 1 blocker that may indicate serious problem

Edema, shortness of breath

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Purpose of antianginal drug therapy

Increase blood flow to ischemic cardiac muscle

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Common adverse effect of troglycerin (nitrostat)

Headache

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Nitroglycerin can be given through which routes

Sublingual, buccal, continuous IV drip, oral dosage forms, topical ointment

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How do we prevent tolerance of nitroglycerin (typically patches)

Remove the patch at night for 8 hours and then apply a new patch in the morning

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What is important patient teaching with beta blockers (for angina)

These drugs are for long-term prevention of angina episodes

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Potential Effect of ACE inhibitors

Hyperkalemia

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Who are most commonly taking Calcium Channel Blockers

Patients with Coronary Artery Spasms (For treatment)

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Before giving Digoxin, the patient has a radial pulse of 52 bpm. What do you do next?

Check apical pule for 60 seconds

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What increases chance of digoxin toxicity

Low potassium levels

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What should you monitor for when infusing Milrinone (Primacor)

Cardiac Status

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Signs and Symptoms of Toxicity of Digoxin

Anorexia
Visual Changes
Nausea and Vomiting
Headache
Bradycardia

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Laboratory tests that are priority with ACE inhibitors

Serum potassium leve
Creatinine level
Blood urea nitrogen (BUN)

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What medication are you typically taking with Ventricular Dysrythmias?

Lidocane (Infusion)

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Possible adverse effects of Quinidine (Quinidex)

GI upset Tinnitus Ventricular Ectopic Beats

Adverse Effect of amiodarone (Cordarone)

Pulmonary Toxicity

What medication is used to treat Recurrent Paroxysmal Supraclavicular Tachycardia (PSVT)

Verapamil (Calan)

Correct administration of adenosine (Adenocard)

Fast intravenous push

If a drug has a prodysrhythmic effect, what must be monitored

New Dysrhythmias

Potential drug interaction with quinidine (Quinidex)

amiodarone (Cordarone) digoxin (Lanoxin) erythromycin (Erythrocin)

A drug that prevents the lysis of fibrin, thereby promoting clot formation.

Antifibrinolytic

The termination of bleeding by mechanical or chemical means

Hemostasis

A substance that prevents platelet plugs from forming

Anti platelet Drug

The general term for a drug that dissolves thrombi

Thrombolytic Drug

The general term for a substance that prevents or delays coagulation of the blood

Anticoagulant

A laboratory test used to measure the effectiveness of heparin therapy

Activated partial thromboplastin time

Two tests used to monitor the effects of drug therapy with warfarin sodium

``` Prothrombin time (PT) International Normalized Ratio (INR) ```

A standardized measure of the degree of coagulation achieved by drug therapy with warfarin sodium

International Normalized Ratio

A substance that reverses the effect of heparin

Protamine sulfate

A substance that reverses the effect of warfarin sodium

Vitamin K

A pharmaceutically available tissue plasminogen activator that is created through recombinant DNA techniques

alteplase (Activase)

Anticoagulants are used for which conditions

Atrial Fibrillation Myocardial Infarction Presence of mechanical heart valve

A blood clot that dislodges and travels through the bloodstream

Embolus

Over the counter drug use with warfarin sodium (Coumadin), what to teach the patient

Aspirin products mat result in increased bleeding

Which drug is recommended to prevent platelet aggregation for stroke prevention by the American Stroke Society?

Aspirin

Which symptoms may indicate a serious problem during thrombolytic therapy

Hypotension Decreased LOC Increased pulse rate Restlessness

Which medication must a nurse remember to inject the medication without aspirating for blood return

Heparin

What drug is most often used for DVT prevention after orthopedic surgery after the patient has been discharged?

Low molecular weight heparins, such as enoxaparin (Lovenox)

Patients taking cholestyramine (Questran) may experience which adverse effects?

Belching and bloating

Dietary measures with antilipemic drugs

Taking supplements of fat-soluble vitamins Increasing fluid intake Choosing foods that are lower in cholesterol and saturated fats Increasing the intake of raw vegetables, fruit, and bran

Patient will have a cantraindication to antilipemic therapy if they had what condition

Liver Disease

Negative (favorable) risk factor for coronary artery disease

HDL cholesterol of 75 mg/dL

Good cholesterol

HDL

Bad cholesterol

LDL

What medication can minimize adverse effects of niacin if taken 30 minutes before dose (of niacin)

Ibuprofen (Advil)

Which medications may cause an interaction with the statin drug

Warfarin (Coumadin) erythromycin (Erythrocin) cyclosporine (Gengraf) gemfibrozil (Lopid)

Potent drugs that act along the ascending limb of the loop of Henle; furosemide is an example

Loop diuretics

Abbreviation for the term that describes a gauge of how well the kidneys are functioning as filters

GFR

A general term for drugs that accelerate the rate of urine formation

Diuretics

The main structural unit of the kidney

Nephron

Part of the kidney structure located between the proximal and distal convoluted tubules

Loop of Henle

Diuretics that result in the diuresis of sodium and water and the retention of potassium; sironolactone is an example

Potassium-sparing diuretics

Diuretics that act on the distal convoluted tubule, where they inhibit sodium and water resorption; hydrochlorothiazide (HCTZ) is an example

Thiazides

Abbreviation for a class of diuretics that inhibit the enzyme carbonic anhydrase; acetazolamide is an example

CAIs

Drugs that induce diuresis by increasing the osmotic pressure of the glomerular filtrate, which results in rapid diuresis; mannitol is an example

Osmotic diuretics

An abnormal intraperitoneal accumulation of fluid

Ascites

Indications for the use of diuretics

Increase urine output Treat hypertension Treat open angle glaucoma Treat edema associated with heart failure

Dietary guidelines for potassium-sparing drug such as spironolactone (Aldactone)?

Avoid excessive intake of foods high in potassium

Best time to take medication during diuretics therapy

Morning

Symptoms of hypokalemia related to diuretic use

Muscle weakness and lethargy

Reason for short treatment of CAI in heart failure

Metabolic acidosis develops in 2 to 4 days after therapy is started

Condition that may be a contraindication of spironolactone (Aldactone)

Renal Failure | Hyperkalemia

Common uses of crystalloids

Fluid replacement Promotion of urinary flow Replacement of electrolytes As maintenance fluids

High TSH

Hypothyroidism | Decreased of T3 and T4

Low TSH

Hyperthyroidism | Increase in T3 and T4

IV of normal saline (NS) at 100mL/hr, what concentration will be used

0.9%

IV administered for severe dehydration

0.9% sodium chloride

What is important to remember when giving IV potassium

Potassium must always be given in diluted form

What product will be given when a patient with a blood disorder needs tranfusion

Fresh frozen plasma

What signs should you monitor for when patient is receiving blood products

Apprehension, restlessness, fever, and chills

Functions of Adrenocorticotropic hormone (ACTH, corticotropin)

Targets adrenal glands Mediates adaptation to stressors Promotes synthesis of the following three hormones (glucocorticoids, mineralocorticoids, androgens)

Appropriate actions by nurse when patient is taking conivaptan (Vaprisol)?

Report serum levels of 149mEq/L

Mimicking drug of Adrenocorticotropic hormone (ACTH, corticotropin)

Cosyntropin

Functions of Growth hormone

``` Regulates anabolic processes related to growth and adaptation to stressors Promotes skeletal and muscle growth Increases protein synthesis Increased liver glycogenolysis Increased fat mobilization ```

Mimicking drug of growth hormone

Somatropin and somatrem

Functions of Antidiuretic hormone (ADH)

Increases water resorption in distal tubules and collection duct of nephron Concentrates urine Potent vasoconstrictor

Mimicking drugs of Antidiuretic hormone

Vasopressin and Desmopression

Function of Oxytocin

Promotes uterine contraction

Mimicking drug of oxytocin

Pitocin

Test for Diabetes

A1C

Prior assessment for Vasopressin

Blood pressure

Purpose of octreotide (Sandostatin) in patient with metastatic carcinoid tumor

Helps to control the flushing and diarrhea that you are experiencing

Nursing diagnosis most appropriate for patient taking pituitary drug

Disturbed body image

How to obtain maximum benefit from desmopressin acetate as a nasal spray

Clear the nasal passages before spraying the medication

During vasopressin therapy, what is the priority nursing action

Monitor the IV site for sign of infiltration

Closely monitor what when taking octreotide (Sandostatin) therapy

Blood glucose levels

The type of hypothyroidism that results from insufficient secretion of thyroid stimulating hormone (TSH) from the pituitary gland

Secondary

The principal thyroid hormone that influences the metabolic rate

Thyroxine

The type of hypothyroidism that is due to inability of the thyroid gland to perform a function

Primary

The most commonly prescribed synthetic thyroid hormone

Levothyroxine

Excessive secretion of thyroid hormones

Hyperthyroidism

A drug used to treat hyperthyroidism

Propylthiouracil

The type of hypothyroidism that stems from reduces secretion of thyrotropin-releasing hormone from the hypothalamus

Tertiary

Another name for TSH

Thyrotropin

Nurse responds to patient wanting to switch to a different brand of levothyroxine (Synthroid)

Check with provider before switching

How long after beginning levothyroxine (Synthroid) will it start working

Within a few weeks

What foods need to be avoided when taking antithyroid medications

Soy products and seafood

What information needs to be included in the nurse's teaching of patients taking thyroid medication

Keeping a log or journal of individual responses and a graph of pulse rate, weight, and mood would be helpful The medication needs to be taken at the same time every day Nervousness, irritability, and insomnia may be a result of a dosage that is too high

What medication order needs to be made before a radioactive isotope study is scheduled when taking levothyroxine (Levothroid)

Stop the levothyroxine 4 weeks before the test

What is the most immediate and serious adverse effect of insulin therapy

Hypoglycemia

Which type of insulin is long acting (taken at bedtime)

Glargine

Which type of insulin is used for an IV drip to control high blood glucose levels

Regular

Signs of hypoglycemia

Irritability Sweating Confusion

When would a nurse administer the drug acarbose (Precose)

With the first bite of a meal

What information would be important to provide regarding the mechanism of action of glipizide (Glucotrol)

Increases insulin production

What condition is a contraindication of the amylin mimetic drug pramalintide (Symlin)

Gastroparesis

Monitor for significant interaction if sitagliptin (Januvia) is given with...

Sulfonylureas

What are rapid acting antidiabetic drugs?

``` Insulin lispro (humalog) Insulin aspart (novolog) Glulisine (apidra) ```

What is the onset for rapid acting antidiabetic drugs?

5-15 minutes

What is the onset for short acting antidiabetic drugs?

30-60 minutes

What is the short acting antidiabetic drug?

Humulin R (regular) IV

What is the onset for intermediate acting antidiabetic drugs?

1-3 hours

What is the intermediate acting antidiabetic drug?

NPH (cloudy)

What are the long acting antidiabetic drugs?

Glarine (lantus) | Detemir (levemir)

Long acting insulin drugs are also called what kind of insulin?

Basal insulin

Why can you not suddenly stop taking prednisone (Deltasone), even when the dose gradually decreases

Sudden discontinuation of this medication may result in adrenal insufficiency

Preferred oral glucocorticoid for anti-inflammatory or immunosupressant purposes

prednisone (Deltasone)

Adverse effects of coritcosteroids

Fragile skin, Hyperglycemia, Nervousness

Drug that is used to inhibit the function of adrenal cortex in the treatment of Cushing's syndrome

aminoglutethimide (Cytadren)

Nursing diagnosis for "moon face", facial redness, and many bruises on arms

Disturbed body image

What patients will be monitored when taking corticosteroids? Why?

Heart Failure patients | b/c they may cause sodium retention

Adverse effects of aminoglutethimide

Dizziness Anorexia Lethargy

Important health history factors when administering oral contraceptives

Pregnancy Thrombophlebitic disorders Estrogen-dependent cancers

When combination oral contraceptives are given for emergency contraceptive (Plan B), what must be remembered

The are not effective if the woman is already pregnant

Purpose for dinoprostone cervical gel (Prepidil)

To improve cervical ripening near term for labor induction

Pharmacologic measures are used to stop contractions in pregnancy is okay during what time frame

Between the 20th and 37th weeks

Patient teaching that is important when taking alendronate (Fosamax)

Take with 8-oz glass of water Take first think in the morning upon arising Do not lie down for at least 30 minutes after taking

Potential adverse effects of raloxifene (Evista)

Leg cramps | Hot flashes

What is important to know about taking steroids to "beef up"

Long-term use may cause a life-threatening liver condition

When would androgens be prescribed for women

Fibrocystic breast disease Treatment of endometriosis Inoperable breast cancer

Teaching about transdermal testosterone (Testoderm); testosterone therapy

Apply patch only to the scrotum

What lab test needs to be performed before therapy with finasteride (Proscar)

Prostate specific antigen (PSA) level

What is important teaching for finasteride (Proscar) if a pregnant woman is involved

This medication should not be handled by pregnant women because it may harm the fetus

Drug that can be used for male baldness (androgenetic alopecia)

finasteride (Propecia) | Low dosages

Drug that would cause significant interaction with sildenafil (Viagra)

isosorbide dinitrate (Isordil), nitrate

Adverse effects for finasteride (Proscar)

Loss of Erection Gynecomastia Ejaculatory dysfunction

Which hypertensives are considered more effective in white patients than in African American patients

Beta blockers and ACE inhibitors

Which hypertensives are considered more effective in African American patients than in white patients

Calcium channel blockers and diuretics

Best ACE inhibitor for patient with liver dysfunction, seriously ill, and high blood pressure

Captopril; short half life (if problem arrives then they are short lived); not a prodrug

Best ACE inhibitor for patient with history of poor adherence to medication regimine

Drug with a long half life and long duration of action | Benazepril, fosinopril, lisinopril, quinapril, ramipril

What should be taught before the first dose of prazosin (Minipress)

Must be lying down and arise slowly because it will cause a sudden decrease in blood pressure because it has a first dose effect.

How would you administer a 0.2 mg/hr of a transdermal nitroglycerin patch, when there are only 0.4 mg/hr available

Call the provider and DO NOT CUT IT IN HALF

Adverse effect you might see with a beta blocker

Lethargy, depression, unusual dreams

Adverse effects of glycosides

Vomiting, headache, fatigue, dysrhythmias

Positive intropic effect

Increases myocardial contractility

Negative chronotropic effect

Decreases heart rate

Negative dromotropic effect

Slows the conduction of electrical impulses in the heart

Digioxin effects on stroke volume

Increases

Digoxin effect on venous blood pressure and vein engorgment

Decreased

Digoxin effects on coronary circulation

Increased

Digoxin effects on diuresis

Increased due to improved circulation

Drug for management of life-threatening ventricular tachycardia

Amiodarone

Amiodarone caused conditions

``` Hypothyroidism Hyperthyroidism Corneal microdeposits Pulmonary toxicity Dysrythmias ```

Lidocaine administration

Injected IM or IV

Expected therapeutic effects of verapamil (Calan)

Prevention or reduction of supraventricular rhythms

adenosine (Adenocard) use

Useful for the treatment of PSVT (paroxysmal supraventricular tachycardia) that has failed to respond to verapamil

What is the antidote for warfarin toxicity

Vitamin K (use lowest amount possible)

Use of antifibrinolytic drugs

Stop excessive oozing from surgical sites

What condition is Desmopressin used for and why

Patients with type IWillebrand's disease; it increases the levels of clotting factor VIII

What herbal products should be avoided when taking clopidogrel (Plavix)

Products that contain St. John's wort, garlic, ginger, ginseng, and ginkgo because they have anticoagulant properties

Important patient teaching about atorvastatin (Lipitor)

Dietary guidlines should still be followed for the antilipemic medication to be effective

What is an uncommon but clinically important side effect of statins

Myopathy (muscle pain)

Generic drugs that decrease cholesterol synthesis end with this suffix

"statins"

Patient (taking Lasix/furosemide for 3 months) is feeling tired, has muscle weakness, no appetite, BP is 100/50, what does this suggest and how did it happen?

Suggest hypokalemia; Furosemide causes potassium to be excreted along with sodium and water

What type of food should you maybe avoid while taking furosemide (Lasix)

Foods high in potassium, including, bananas, broccoli, oranges, apricots, dates, raisins, green beans, potatoes, tomatoes, meats, fish, wheat bread, and legumes

How does spironolactone (Aldactone) differ from furosemide

Spironolactone is a potassium sparing diuretic; it causes sodium and water to be excreted, but potassium is retained

What is the normal protein level

Around 7.4 g/dL

How will albumin work to help with chronic malnutrition causing hypopreoteinemia

The albumin will increase the colloid oncotic pressure (COP) and move fluid from outside the blood vessels to inside, thus reducing the edema

What is cosyntropin (Cortrosyn)

The diagnosis of adrenalcortical insufficiency, NOT treatment

How do you administer vasopressin

Injections, either IM or SC, two to four times a day

What are the most damaging or serious adverse effects of propylthiouracil (PTU)

Liver and bone marrow toxicity; important to asses liver function and do complete blood count during therapy

Symptoms associated with hyperglycemia

Fatigue, polydipsia

Symptoms associated with hypoglycemia

Irriratability, tremors, sweating

How do oral contraceptives effect adrenal drugs

They increase the half life

Important teaching about corticosteroids

They must not be stopped suddenly; because these drugs cause endogenous (body's own) production of the hormones to stop.

-pril

ACE inhibitor

-olol

Beta Blocker

-dipine

Calcium Channel Blocker

-mycin

Aminoglycocide