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Pharmacology I > Unit 2- study guides > Flashcards

Unit 2- study guides Flashcards

1
Q

most likely electrolyte imbalances associated with use of furosemide (Lasix)

A 
•hyponatremia
•hypochloremia
•hypokalemia
*due to excessive secretion 
*often leads to dehydration
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2
Q

why can hyperglycemia occur with use of furosemide (Lasic)

A

•due to inhibition of insulin release
•uncommon complication of furosemide use
*SMBG crucial in diabetics

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3
Q

What is your primary concern for a patient taking digoxin and HCTZ

A

•thiazides promote K+/Na+ loss, so there is a potential for increased dig toxicity

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4
Q

What are the signs/symptoms of electrolyte imbalance in clients taking HCTZ

A

•dehydration s/s: thirst, oliguria, wt loss, etc
•thrombotic/embolism s/s: headache, calf pain
•ototoxicity
•dysrhythmias
•hypotension s/s
*can be avoided w/ alternate-day dosing

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5
Q

difference b/t furosemide and thiazide diuretics

A

•thiazide used for HTN, edema, and diabetes insipidus
•loop used for CHF or severe edema
•loop severe fluid loss, even when urine flow is scant
•thiazide cease to fxn when urine flow scant
•loop work faster
•thiazide can be combined w/ ototoxic drugs w/o risk of hearing loss (loop cannot)
*both have adverse effects on K+ sparing

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6
Q

How does spironolactone achieve its diuretic effect

A
  • competitively inhibit the action of aldosterone on the principal cells and therefore decrease the expression of the exchanger
  • less Na reabsorption leads to diuresis
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7
Q

spironolactone (aldactone) AEs

A 
•hyperkalemia (no Na/K exchange)
•endocrine effects (b/c steroid derivative)
-gynecomastia
-menstrual irregularity 
-deep voice
-impotence (helpless)
-hirsutism (abnormal hair growth)
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8
Q

drugs that are contraindicated for patients taking spironolactone (Aldactone)

A
  • K+ supplements
  • other K+ sparing agents
  • ACEIs
  • ARBs
  • DRIs
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9
Q

drugs that are commonly combined in patients taking spironolactone (Aldactone)

A
  • thiazide and loop diuretics

* spironolactone counteracts K+ wasting effects of the more powerful diuretic

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10
Q

Why is mannitol (Osmetrol) used in the treatment of increased intracranial/intraocular (glaucoma) pressure

A

•raises serum osmolality and drawing fluid back into vascular/extravascular space

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11
Q

Mannirol is contraindicated in what patient?

A

•pt w/ heart dz b/c may precipitate CHF and pulmonary edema

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12
Q

What would you tell a client who has a new prescription for Lasix or HCTZ? What information do THEY need

A
  • monitor/keep log of BP and weight
  • report signs of hypokalemia or hypovolemia (dizzy, wt loss, GI distress, weakness, etc)
  • consume foods high in K+
  • SMBG in diabetics
  • observe for hypomagnesmia (weak, twitch, tremor)
  • adequate fld intake
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13
Q

What is the most common complaint from patients taking ACE inhibitors?

A

•cough
•angioedema
-edema of tongue, glottis, and pharynx

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14
Q

Why are patients at risk for hyperkalemia while taking an ACE inhibitor

A
  • secondary to inhibition of angiotensin II production is aldosterone release
  • hypoaldosterone state causes K+ retention by kidney b/c nothing to act on Na/K exchanger
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15
Q

What is the difference between ACE inhibitors and Angiotensin II receptor blockers?

A
  • ACE inhibitors prevent the formation of angiotensin II from angiotensin I
  • ARBs antagonize angiotensin II at activation sites
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16
Q

How does the drug verapamil decrease blood pressure?

A

•blocks Ca channels in heart AND blood vessels

  • causes peripheral dilation (reduces arteriole pressure)
  • increases coronary perfusion
  • reduces HR at SA node
  • reduces AV node conduction
  • decreases FOC
17
Q

the most common side effect of verapamil

A

•constipation
•minimized by increasing dietary fluids and fiber
*result of Ca channel blockade in smooth muscle of intestine

18
Q

What is a common side effect of most anti-hypertensive medications?

A
  • hypotension
  • sedation
  • sexual dysfunction
19
Q

What pharmacological effects does digoxin have on the heart

A
  • increase contractile force of heart, which increases cardiac output (positive ionotropic)
  • also alters electrical activity of heart, decreasing rate (negative chronotropic)
20
Q

digoxin and Na,K-ATPase

A

•inhibits
•results in K+ being lost from heart cells
•results in an increase in Na+ in heart cells
•increased intracellular Na+ is then exchanged for extracellular Ca2+, which enhances myocardial ctx
*more force generated w/o increased O2 consumption

21
Q

digoxin and slowing HR

A

•slows rate of SA depolarization
•stimulates vagus nerve
*allows more filling of heart and improves cardiac output

22
Q

What laboratory value must be checked during digoxin therapy

A
  • potassium

* pt at risk for hypokalemia, which leads to dysrhythmias

23
Q

Describe at least three clinical manifestations of digoxin toxicity

A
  • fatigue
  • weakness
  • vision changes
  • GI effect
24
Q

What drugs are contraindicated during digoxin therapy

A
  • thiazide/loop diuretics -> hypokalemia
  • ACEI/ARBs -> dec. dig effects
  • sympathomimentics -> inc. contractile force
  • quinidine-> toxicity
  • verapamil -> dec. dig effects; toxicity
25
Q

what effect does quinidine have on digoxin

A
  • displaces dig from tissue binding sites

* reduces renal excretion of dig

26
Q

What information should be shared with a patient starting digoxin therapy

A
  • skip missed doses
  • take as prescribed
  • take HR before dose (notify MD < 60)
  • don’t take OTC meds
  • report s/s hypokalemia (muscle weakness)
  • observe for dig toxicity
27
Q

A client is taking quinidine for a suproventricular tachycardia. What signs/symptoms
indicate that cinchonism has developed

A
  • tinnitus (ringing in ears)
  • headache
  • nausea
  • vertigo
  • disturbed vision
28
Q

what are the adverse effects of lidocaine

A 
•adverse CNS effects in high doses
-drowsiness
-confusion
-paresthesias
•toxic doses
-convulsions
-respiratory arrest
*must have equipment for resuscitation and diazepam or phenytoin readily available
29
Q

The patient taking amiodarone should be monitored closely for?

A 
•toxicity
•the drug has a long half life, so toxicity is a risk even after drug cessation
•toxicities are manifested in the...
-lungs: cough, dyspnea, chest pain
-heart: bradycardia, AV block
-thyroid: hypo or hyperthyroidism
-liver: increased liver NZs, anorexia, N/V, malaise, fatigue, itching, jaundice, dark urine
-eyes: changes is visual acuity and peripheral vision
-skin: photosensitivity reactions
•other adverse effects involve the CNS
-ataxia
-dizziness
-tremor
-mood alteration
-hallucination
30
Q

A patient develops rhabdomyolysis secondary to atorvastatin (Lipitor) therapy. What does this
mean?

A
  • muscle disintegration, breakdown or dissolution
  • Statins can injure muscle tissue, but the benefits of lowering LDL cholesterol outweigh the small risks of myopathy associated with their use
31
Q

Clinical manifestations of rhabdomyolysis

A
  • muscle aches
  • muscle tenderness
  • muscle weakness
  • myositis (inflammation)
32
Q

What is a second very serious ADR to statin drug therapy? How is it diagnosed?

A

•hepatotoxicity
•indicated by…
-elevated transaminase levels (> 40 U/L)
•should have liver function tests (LFTs) prior to tx and every 6-12 months

33
Q

What time of the day is BEST for taking statin drugs?

A
  • evening with evening meal or at bedtime

* best in PM b/c endogenous cholesterol synthesis increases at night, so statins will have the greatest effect in the PM

34
Q

How does ezetimibe (Zetia) lower cholesterol?

A
  • acts on cells of the brush border of the small intestine to inhibit dietary cholesterol absorption
  • inhibits reabsorption of cholesterol secreted into bile
  • produces small intestine increase in HDL cholesterol
35
Q

What should you tell a patient taking niacin to help reduce a common side effect/patient complaint with this drug?

A
  • a common side effect is intense flushing/itching of the skin on the face neck and ears
  • the reaction will diminish in several weeks
  • reaction can be attenuated by taking 325 mg of aspirin 30 minutes before each dose
  • can also reduce side effect of flushing by taking extended-release niacin (Niaspan), rather than immediate release (Niacor)
36
Q

What is the most common complaint for patients taking bile-sequestrants for hyperlipidemia?

A
  • constipation
  • minimized by increasing dietary fiber and fluid intake
  • a mild laxative can be used if severe

Pharmacology I (9 decks)

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