pharm 2 cardiac/renal/anticoagulants

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mthompson17
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223785
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pharm 2 cardiac/renal/anticoagulants
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2013-06-16 19:27:14
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pharmacology nursing
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pharmacology nursing - vickers
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  1. What is the main drug used for CHF?
    ACE inhibitors
  2. 3 types of drugs given for CHF?
    • ACE inhibitors
    • diuretics
    • cardiac glycosides
  3. What is the use of cardiac glycosides?
    increase heart contractility
  4. What type of cardiac drugs are contraindicated in CHF but are sometimes given?

    When should they not be give to CHF pt?
    beta blockers

    should not be given during CHF exacerbation
  5. What type of drug is lanoxin/Digoxin?
    cardiac glycoside
  6. 2 pharm uses for digoxin?
    • 1. manage s/s of CHF
    • 2. treat atrial fibrillation and flutter
  7. Ionotropic drugs?
    affect contractility of the heart

    positive - increases and neg decreases
  8. Dromotropic drugs?
    effect on conduction of current in the heart

    positive increases and neg decreases
  9. Chronotropic drugs?
    change HR

    positive increases and neg decreases
  10. 3 actions of digoxin?
    • 1. positive ionotropic effect
    • 2. negative dromotropic effect
    • 3. negative chronotropic effect
  11. 2 net effects of the action of digoxin?
    increases CO and controls atrial rhythm
  12. AE of digoxin are ____ related and are signs of _______.
    dose

    toxicity
  13. What is the most frequent cause of digoxin toxicity?
    hypokalemia
  14. Most common AE of ACE inhibitor?

    How is it TX?
    chronic cough - "ACE cough"

    must stop med
  15. 3 S/S of digoxin toxicity?
    • 1. GI disturbances
    • 2. cardiotoxicity
    • 3. CNS toxicity
  16. Important consideration when giving digoxin IV push?
    if pushed too quickly can decrease HR and cause death
  17. What should always be done prior to giving a dose of digoxin?
    take apical pulse for 1 minute
  18. What things need to be monitored with mannitol/Osmitrol?
    • 1. breath sounds r/t excess fluid initially
    • 2. BP
    • 3. electrolytes
  19. Which diuretic requires filtered tubing?
    mannitol/Osmitrol
  20. What should the nurse teach pt to do prior to taking a dose of digoxin?
    take their RADIAL pulse
  21. Why can EPI not be given if a person OD's on beta blockers?
    beta receptors are blocked to EPI
  22. Antidote for OD of digoxin?

    How does it work and how long does it take?
    digibind

    binds to digoxin and takes days to work
  23. Hold digoxin if the apical pulse is < _____ BPM in adults and ____ BPM in children.
    60

    90
  24. Most important thing to monitor in a pt on digoxin?
    potassium level r/t K and digoxin use same receptors
  25. What antihypertensive drug prevents reflex tachycardia?
    labetalol/Normodyne
  26. Relationship of K and digoxin?
    K and digoxin use the same receptors

    giving digoxin with decreased K levels will cause digoxin toxicity b/c more will bind to receptors

    giving digoxin when K levels are increased will decrease effects of digoxin
  27. Normal K level?
    3.5-5
  28. When should drug levels of digoxin be checked?
    after starting, dose changes, if toxicity is supected
  29. Therapeutic range of digoxin?
    0.5-2.0
  30. 6 things to teach pt taking digoxin?
    • 1. never stop abruptly
    • 2. take pulse before each dose
    • 3. weigh yourself daily & call MD with weight gain of 5 or more pounds in 24 h
    • 4. wear medic alert bracelet
    • 5. see MD q 6 months
    • 6. seek help immediately for SOB
  31. S/S of toxicity that should be reported to MD by digoxin pt?
    • 1. irregular pulse
    • 2. rapid weight gain
    • 3. loss of appetite
    • 4. NV
    • 5. blurred or yellow vision
    • 6. unusual tiredness
    • 7. swelling in ankles, legs, or fingers
  32. What type of drug is carvedilol/Coreg?
    beta blocker
  33. Important consideration with carvedilol/Coreg?
    drops BP drastically
  34. What is carvedilol/Coreg used for?
    adjunct in treating mild to moderate CHF
  35. Actions of carvedilol/Coreg?
    • 1. decreases force of contraction & CO
    • 2. increases vasodilation and decreases peripheral resistance
  36. Important consideration for CHF pt taking carvedilol/Coreg?
    may exacerbate CHF s/s at first
  37. How is carvedilol/Coreg given initially?
    start with small dose and gradually increase
  38. Why may carvedilol/Coreg require a diuretic to take with it?
    decreased force of contraction and decreased CO can exacerbate CHF - need fluid gone
  39. Most important thing to monitor with carvedilol/Coreg?
    BP
  40. What 2 drugs are considered short term Tx for CHF in pt who are not responding to other drug therapy?

    What are their actions?
    iamrinone/Inocor & milrinone/Primaccor

    both increase contractility and vasodilate
  41. Suffix for beta blockers?
    lol
  42. What cardiac drug is metabolized into cyanide?
    nitroprusside/Nipride
  43. What assessment should be monitored when CHF pt is taking beta blocker?
    lung sounds - if get crackles = going into failure
  44. What diuretic may be used to decrease intracranial pressure?
    mannitol/Osmitrol
  45. Teaching for a pt on beta blockers?
    teach s/s of CHF
  46. How may digoxin affect K+ levels?
    can cause hypokalemia
  47. If a pt is having NV should you hold digoxin dose?
    yes, can be a sign of digoxin toxicity
  48. Yellow halo with digoxin is a sign of ____ toxicity.
    CNS
  49. HR of a person exp. digoxin toxicity?
    very low
  50. What may be done to stabilize HR with digoxin toxicity?
    temporary pacemaker
  51. If BP systolic is < ____ will hold BP meds.
    90
  52. Risk with a pt who is taking diuretic and digoxin?
    some diuretics decrease K+ and digoxin decreases K
  53. What antihypertensive drug is broken down if exposed to light?
    nitroprusside/Nipride
  54. What is digitizing a pt?

    Important consideration?
    when pt HR really high will give IV dig to decrease HR in seperate doses then go to po

    Watch for toxicity r/t higher doses
  55. What receptors are involved in regulating BP?
    adrenergic alpha and beta receptors
  56. Stimulation of alpha I receptor causes ______.
    vasoconstriction
  57. Formula for calculating BP?
    CO X PR = BP

    PR - peripheral resistance
  58. Drug therapy to reduce hypertension is designed to reduce either _____, _____ _____, or both.
    CO

    peripheral resistance
  59. Hypertension is a sustained BP > _____.
    140/90
  60. What drug is used for hypertensive crisis?

    How must it always be admin?
    nitroprusside/Nipride

    PUMP
  61. Hypertensive crisis = BP of _____ or more.
    210/120
  62. 2 Tx for hypertension?
    lifestyle changes:  low Na, weigh loss, exercise, DASH & TLC diets

    drug therapy is started with q pt who has been diagnosed as having hypertension
  63. How is BP med dosed?
    start low and titrate up
  64. First line drugs for hypertension?

    2 others?
    • 1. diuretics
    • 2. beta blockers
    • 3. Ca channel blockers

    • 1. ACE inhibitors
    • 2. ARB - angiotensin II receptor blockers
  65. How do diuretics lower BP?
    decrease peripheral resitance by decreasing BF volume thru increasing Na & water excretion

    increase effecacy of other antihypertensives
  66. Action of ACE inhibitors?
    block conversion of angiotensin I to angiotensin II = vasodilation

    prevents Na & water retention, decreases peripheral vascular resistance, and lowers BP
  67. What type of drug is captopril/Capoten
    ACE inhibitor
  68. 4 significant AE of ACE inhibitors?
    • 1. chronic cough
    • 2. first dose hypotension
    • 3. angioedema
    • 4. hyperkalemia
  69. Where does angioedema occur in catopril/Capoten ACE inhibitor?
    laryngeal, throat, tongue, face
  70. When can angioedema occur with catopril/Capoten/ACE inhibitors?
    can occur with first dose
  71. Why does K need to be monitored with ACE inhibitors?

    When is pt especially at risk for K imbalance?
    ACE inhibitors can cause hyperkalemia

    esp at risk if the pt is taking K sparing diuretic also
  72. What occurs when a beta II receptor is stimulated?
    bronchial and peripheral dilation & decreased BP
  73. losartan/Cozaar is what type of drug?
    ARB
  74. What should be assessed prior to giving a diuretic?
    electrolyte levels esp K
  75. Action of losartan/Cozaar/ARBS?
    prevents antiotensin II from binding to receptors in many tissues & blocks its vasoconstricting & aldosterone secreting effects

    = vasodilation and excretion of Na & water
  76. 2 uses for ARB drug/losartan/Cozaar?
    CHF & increased BP
  77. Most important thing to monitor with losartan/Cozaar/ARB meds?
    BP!!
  78. When are ARB drugs/losartan/Cozaar usually prescribed?
    when pt can't take ACE inhibitor due to AE like ACE cough
  79. Do ARB meds/losartan/Cozaar cause chronic cough like ACE inhibitors?
    no, but they cause upper resp infections
  80. Action of selective aldosterone blockers?
    block aldosterone receptors
  81. EX of a selective aldosterone blocking drug?
    eplerenone/Inspra
  82. Action of eplerenone/Inspra (aldosterone blocker)?
    blocks aldosterone = decreased BP
  83. Eplerenone/Inspra (selective aldosterone blocker) can cause the 2 electrolyte imbalances ____ & ______ which can result in ______.
    • hyperkalemia
    • hyponatremia
    • arrhythmias
  84. Why is eplerenone/Inspra (selective aldosterone blocker) considered a K sparing diuretic?
    because it blocks the effect of aldosterone water and Na are excreted but K is not
  85. What type of drug is labetalol/Normodyne?
    alpha/beta blocking agent
  86. When should BP be checked when giving labetalol/Normodyne?
    before and after giving
  87. What are the alpha and beta blocking effects of labetalol/Normodyne?
    alpha blocking causes peripheral vasodilation that reduces BP

    beta blocking prevents reflex tachycardia
  88. How should cardiac drugs always be administered?
    slowly
  89. What is reflex tachycardia?
    if drug causes significant vasodilation the heart will get decreased BF and will speed up HR in response

    HR can get very high 170-180
  90. What type of drug is clonidine/Catapres?
    alpha-2 agonist
  91. Important consideration with clonidine/Catapres?
    it is a very potent antihypertensive

    monitor BP!!!
  92. The diuretic _____ causes nocturia.
    HCTZ
  93. Action and results of clonidine/Catapres (alpha 2 agonist)
    inhibits SNS response and reduces sympathetic outflow from the CNS

    decreased HR, BP, vasoconstriction, and renal vascular resistance
  94. 2 most important considerations when admin lasix?
    • 1. check K level - very K wasting
    • 2. DO NOT EVER PUSH - give slowly by PUMP
  95. Use for clonidine/Catapres (alpha 2 agonist) other than antihypertensive?
    controls w/d symptoms from abused substances because of sympatholytic effects
  96. 2 AE of clonidine/Catapres (alpha 2 agonist)?
    • 1. dry mouth
    • 2. drowsiness
  97. Pt teaching when taking clonidine/Catapres?
    need to make sure how it affects them before driving etc
  98. What type of drug is hydralazine/Apresoline?
    direct acting vasodilator
  99. Action of hydralazine?
    decreases peripheral resistance and arterial BP
  100. 3 uses for hydralazine?
    • 1. adjunct with other antihypertensives
    • 2. with beta blockers or clonidine to prevent reflex tachycardia from the peripheral vasodilation
    • 3. with diuretics to offset fluid retention from increased production of angiotensin II
  101. 2 things important to monitor with hydralazine?
    BP & HR
  102. ANY drug that decreases BP can cause _____ ______ including diuretics.  This puts pt at risk for falls.

    Pt teaching?
    orthostatic hypotension

    teach to dangle, etc
  103. If ortho BP drops by ____ or more = positive for orthostatic hypotension.
    20
  104. What/where is nitroprusside/Nipride given?
    given for hypertensive crisis

    must be in unit setting with monitoring
  105. What is the most important assessment when in the beginning of nitroprusside/Nipride therapy?
    BP
  106. Action of nitroprusside/Nipride?
    directly relaxes vascular sm mus, dilates veins more than arteries = decreased preload & afterload & lowers BP dramatically
  107. Which diuretic is K - sparing?
    triamteren/Dyrenium
  108. How is nitroprusside/Nipride administered?
    admin via IV pump

    MUST BE ON PUMP
  109. 3 important considerations with nitroprusside/Nipride?
    • 1. monitor BP constantly
    • 2. can cause cyanide poisoning
    • 3. protect the drug from light
  110. How does nitroprusside/Nipride cause cyanide poisoning?
    metabolism of nitroprusside produces cyanide as a metabolite

    need to check levels after 24 h of therapy
  111. What should the nurse do if a pt taking nitropursside/Nipride becomes nauseated?
    check the BP - it may be too low

    if it is decrease the med
  112. What type of drugs are used for shock?
    vasopressors
  113. EX of a vasopressor drug?
    dopamine/Inotropin
  114. What is dopamine?
    catecholamine that is a precursor to NE
  115. Effect of dopamine on the heart?
    increases contractility
  116. When/where is dopamine given?
    give IV only in acute care setting
  117. How may diuretics causes othrostatic hypotension?
    dehydration can cause orthostatic hypotension
  118. What is imperative in a pt receiving dopamine?
    continuous monitoring of pt cardiovascular status
  119. Most common adverse effects of dopamine?
    CV system effects
  120. 3 dopamine actions?
    • 1. dopaminergic action with doses of .5-3 mcg/kg/min = renal vasodilation
    • 2. beta adrenergic with doses 2 -10 mcg/kg/min = cardiac stimulation
    • 3. alpha adrenergic with doses 10-20mcg/kg/min = increased peripheral vascular resistance
  121. What is normal MAP?
    60
  122. What can occur with extreme vasoconstriction caused by dopamine or levafed?
    ischemia and amputation
  123. What diuretic drug can exacerbate gout?

    Why?
    HCTZ - b/c it increases uric acid levels
  124. What drug may be used if dopamine doesn't work?
    levafed = more potent vasoconstrictor than dopamine

    levafed = leave em dead
  125. What is the biggest concern for diuretics?
    electrolytes esp. K wasting or sparing
  126. What can be an adverse effect of diuretics and other meds that lower BP?
    orthostatic hypotension
  127. 6 uses for diuretics?
    • 1. hypertension
    • 2. CHF
    • 3. cirrhosis
    • 4. renal disease
    • 5. increased intracranial pressure
    • 6. increased intraocular pressure
  128. Action of diuretics?
    decrease reabsorption of Na and water in renal tubule

    increases urine output
  129. Major AE of diuretics?
    electrolyte imbalance
  130. What may be given along with a diuretic to decrease AE?
    K supplement
  131. What is an AE of diuretics that affects when the pt should take the med?
    can cause excessive urination
  132. What teaching needs to be done for a pt taking HCTZ?

    Why?
    K+ rich foods

    mildly K-wasting so may not require supplements
  133. HCTZ drug type and action?
    thiazide diuretic - weak diuretic

    increases excretion of Na, Cl, K, and water
  134. What condition is contraindicated with HCTZ (thiazide diuretic)?

    Why?
    preexisting renal disease, because it may reduce GFR
  135. Do all pt taking diuretics have high BP?
    no
  136. What effect do ACE inhibitors have on K level?

    How is this helpful if take ACE and HCTZ/thiazide diuretic together?
    ACE increases K

    HCTZ decreases K = if take together will balance out
  137. If a pt has HTN need to teach them s/s of ____.
    stroke
  138. Most common AE of HCTZ?
    • 1. orthostatic hypotension
    • 2. dizzy, lightheaded, and vertigo
    • 3. anorexia, NV
    • 4. polyuria & nocturia
    • 5. electrolyte changes
    • 6. hyperglycemia
    • 7. increased uric acid levels
  139. What teaching needs to be done for a pt who is starting HCTZ besides K foods?
    how to prevent orthostatic hypotension
  140. What are the 4 most important AE with HCTZ a thiazide diuretic?
    nocturia, hypokalemia, hyperglycemia, and increased uric acid levels
  141. What electrolyte imbalances may be caused by HCTZ, a thiazide diuretic?
    hypokalemia, hyponatremia, hypochloremia, and hypercalcemia
  142. 7 things nurse should monitor with a pt taking HCTZ, a thiazide diuretic?
    • 1. BP
    • 2. pulse
    • 3. weight
    • 4. I&O
    • 5. electrolyte levels, esp K
    • 6. glucose levels
    • 7. uric acid levels
  143. Drug that is a loop diuretic?
    furosemide/Lasix
  144. 3 routes of lasix admin?
    PO, IV, IM
  145. Where does lasix work at in the body?

    What is its action?
    loop of henle- promotes excretion of Na, Cl, K, and water

    strong diuretic effect
  146. Uses for lasix?  (5)
    • 1. edema from CHF
    • 2. pulm edema
    • 3. hepatic disease
    • 4. renal disease
    • 5. sometimes for HTN esp if renal disease exists
  147. AE of lasix?
    similar to thiazide drugs, but has greater loss of K+
  148. What supplement is usually given with lasix therapy?
    K+ supplements b/c it is very K wasting
  149. Teaching for a pt taking lasix?
    encourage diet high in K or give supplements prn
  150. Can K tablets be crushed for admin?
    no, there is an elixir if needed
  151. Rate of admin of IV K?
    IV by PUMP no more than 10meq/h
  152. EX of a K sparing diuretic?
    triamterene/Dyrenium
  153. Why may triamterene/Dyrenium be given along with another diuretic?
    to decrease the other diuretic's K wasting effect
  154. Action of triamterene/Dyrenium?
    promotes Na and water excretion & reabsorption of K
  155. Triamterene/Dyrenium has a ______ diuretic effect compared to other diuretics but has a _____ effect when used with other diuretics.
    weak

    synergistic
  156. What is the major electrolyte imbalance that may occur with use of triamterene/Dyrenium?
    hyperkalemia
  157. What are the increased risks ass. with older ppl taking diuretics and other BP meds?
    more at risk for falls, hypotension, and K probs
  158. What toxicity may be caused by lasix and other loop diuretics?
    ototoxicity - will have hearing issues

    stop med if this occurs
  159. What type of drug is mannitol/Osmitrol?
    osmotic diuretic
  160. Action of mannitol/Osmitrol?
    draws water into the vascular space through osmosis -> will be filtered in the kidney but not reabsorbed = diuresis
  161. What diuretic may not be given to a person with CHF?  Why?
    mannitol/Osmitrol b/c it draws fluid into the vascular space - too much volume in the BF will overwhelm the heart
  162. 3 uses for mannitol/Osmitrol an osmotic diuretic?
    • 1. acute renal failure
    • 2. increased intracranial pressure
    • 3. increased intraocular pressure
  163. AE of mannitol/Osmitrol?
    • 1. electrolyte imbalances
    • 2. may initially cause fluid overload
    • 3. crystallizes easily
  164. 2 nursing interventions for crystallization of mannitol/Osmitrol?
    • 1. use filtered tubing
    • 2. warm drug in water before admin to dissolve crystals
  165. What type of drug is acetazolamine/Diamox?
    carbonic anhydrase inhibitor diuretic
  166. Action of acetazolamine/Diamox, a carbonic anhydrase inhibitor diuretic?
    inhibits hydrogen ion secretion in the tubule & increases loss of Na, K, bicarb, and water

    also prevents formation of aqueous humor and decreases intraocular pressure
  167. Primary use for acetazolamine/Diamox?
    chronic, open angle glaucoma

    may also be used in CHF
  168. What type of drug is tolterodine/Detrol?
    cholinergic muscarinic antagonist that blocks receptors in the bladder to decrease ability of bladder to contract
  169. Use for tolterodine/Detrol? (3)
    • overactive bladder
    • manage urinary frequency
    • urgency and urge incontinence
  170. 3 AE of tolterodine/Detrol?
    • 1. dry mouth
    • 2. HA
    • 3. urinary retention
  171. If a pt is taking a diuretic like lasix and not in good enough health to get up what nursing intervention should be done?
    ask MD for a catheter order

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