Pharm Ch 16, 17, 18, 19

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nurseheather
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Pharm Ch 16, 17, 18, 19
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2010-09-08 21:35:16
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Bronchiodilators & Other Resp. Agents; Cardiac Stimulants & Depressants; Agents That Dilate Blood Vessels; Agents Affecting Blood Clotting
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  1. What does COPD stand for?
    Chronic obstructive pulmonary disease
  2. Never increase oxygen input for a patient without an order, because...
    it may cause hypoxia to stimulate the breathing, which will stop!!! Requires a physician's order.
  3. Within the mast cells are beta2 receptors. When they are stimulated by certain sympathomimetic agents...
    there is an increase in heart rate, uterus relaxation, vasoconstriction, and bronchodilation.
  4. Beta1 is the...?
    Heart
  5. Beta2 are the...?
    Lungs
  6. Patients on sympathomimetics should not use MAO inhibitors, because?
    MAOIs do not ever combine with other drugs, in order to avoid catastrophic toxicity
  7. What are the four smooth muscles that are connected in the body?
    Heart, lungs, blood vessels, and uterus
  8. What are two common Xanthine Bronchodilators?
    Aminophylline and Theophylline
  9. This chemical class of agents include caffeine, theophylline, and their derivatives (e.g. coffee and tea)?
    Xanthine Bronchodilators
  10. Xanthines have been found to produce?
    Diuresis (increased urine)
  11. With Xanthine Bronchodilators, it is important to monitor this every four hours?
    Patient's heart rate and rhythmn
  12. Xanthines have been found to stimulate the?
    CNS (Central Nervous System)... thus, patient should be monitored for insomnia (disturbs REM sleep), hyperexcitability, and the potential for seizure activity
  13. What is dyspnea?
    Shortness of breath
  14. When administering neuroleptic or antipsychotic agents, every 30 days the patient must be monitored for?
    • Abnormal
    • Involuntary
    • Movement
    • Screening
  15. These agents have become one of the most popular and effective agents in combating manifestations of Asthma?
    Leukotriene Receptor Antagonists
  16. What contributes to airway edema, smooth muscle constriction, and altered cellular activity?
    Leukotrienes
  17. Antagonists to leukotrines...
    decrease bronchial edema and inflammation
  18. What are the side effects of leukotriene receptor antagonists?
    Occasional headaches, drowsiness, fatigue, and gastrointestinal disturbances
  19. What is important to know about 5-lipoxygenase inhibitors?
    They inhibit the formation of leukotrienes
  20. Anticholinergics: Upon inhalation, anticholinergic drugs such as "atropine" and "Atrovent", antagonize the action of what?
    Acetycholine, thus resulting in bronchodilation
  21. What is the antagonist drug for magnesium?
    Calcium gluconate
  22. What do mucolytics do?
    They reduce the thickness and the stickiness of pulmonary secretions, so that removal by cough is facilitated & pulmonary ventilation improved
  23. A common mucolytic agent?
    acetylcysteine (Mucomyst)
  24. Mucolytics are usually administered how?
    By nebulization
  25. Considering that acetylcysteine is capable of reacting with copper and rubber, what should be taken in precaution?
    Nebulization equipment should be plastic, glass, aluminum, or stainless steel parts
  26. Mucolytics should not be used with patients who...?
    Have a cough associated with asthma, emphysema, or smoking; contraindicated for the treatment of coughs with excess secretions
  27. What is status asthmaticus?
    Severe, continuous asthma attack that may result in exhaustion
  28. Corticosteriods are also used in the treatment of bronchial asthma, and are administered how?
    Systemically or in an aerosol form; they are rarely ever used long term
  29. The CNS breaks down into what two systems?
    Peripherial and somatic
  30. The autonomic system contains what?
    The sympathetic and parasympathetic system
  31. Drugs that stimulate norepinephrine are?
    Adrenergic
  32. Cholinergics are drugs that stimulate?
    Acetycholine
  33. The sympathetic nervous system does what?
    • Accelerates heart rate
    • Dilates bronchioles
    • Vasoconstriction (BP goes up)
    • Uterus muscles relax
  34. The parasympathetic nervous system does what?
    Brings everything back to normal, i.e. "homeostasis"
  35. What are the signs of respiratory distress?
    Pallor, cyanosis, labored breathing
  36. Sinus rhythms are generated by?
    The SA node
  37. The nodal rhythms are generated by?
    AV node
  38. The right side of the heart produces what if blocked?
    Full body edema
  39. The left side of the heart, if blocked, will have what affect on the body?
    Pulmonary failure
  40. The heart rate is primarily controlled by what?
    ANS
  41. What is the inotropic effect on cardiac action?
    Affects the force/power of myocardial contraction
  42. What is the chronotropic effect of cardiac action?
    Rate of heart
  43. What is the dromotropic effect of cardiac action?
    The conductivity of the heart
  44. What is the most common cardiac glycosides?
    Digoxin
  45. Cardiac glycosides are primarily used for the treatment of what?
    Heart failure
  46. Heart failure is often characterized by what?
    • Cardiac distention
    • Cardiac "hypertrophy"
    • Sodium and water retention
  47. What is cardiac hypertrophy?
    The muscle of the heart gets thicker, the chambers get smaller, resulting in congestive heart failure
  48. What is the herbal supplement similar to cardiac glycosides?
    Purple foxglove
  49. What kind of dosing is used for cardiac glycosides when trying to rapidly bring serum levels up to a desirable therapeutic level?
    A loading, or "digitalizing" dose
  50. What is important to remember about Digoxin?
    • Taking with meals may decrease gastric irritation
    • Check apical pulse (do not administer less than 60 beats/min)
    • Report any irregular rhythm
    • Observe for symptoms of toxicity
  51. What is the therapeutic blood level of Digoxin?
    0.5 - 2 mg/mL
  52. What are symptoms of toxicity from Digoxin?
    Headaches, visual disturbances, nausea, vomiting, anorexia, or disorientation
  53. What kind of therapeutic index do cardiac glycosides have?
    A low therapeutic level; i.e. the therapeutic dose is very close to the toxic dose, requiring close patient monitoring
  54. Cardiac glycoside toxicity effects include:
    • Gastrointestinal distress (nausea, vomiting, anorexia, diarrhea)
    • Neurological effects (restlessness, irritability, headache, weakness, lethargy, drowsiness, and confusion)
    • Cardiac effects (development of a cardiac dysrhythmia)
  55. Assess a patient's apical pulse for one minute before administering?
    Antiarrhythmic/Antidysrhythmic Agents
  56. What is a dysrhythmia?
    Rhythm disturbance
  57. Although principally heart rhythm is controlled by the heart's pacemaker, the SA node...
    spontaneous electrical discharge or "automaticity" may occur under certain conditions
  58. Phenytoin (Dilantin) is used as...
    An anticonvulsion and antiarrhythmic drug; should only be administered IV for arrhythmias
  59. Beta-Adrenergic Blocking Agents treat?
    Hypertension, and blocks sympathetic (adrenergic) stimulation, producing a reduction in heart rate, reduces the contractility, and slows electrical conduction in the heart
  60. There is only how long of a window after a stroke occurs?
    Eight hours!
  61. What is the primary calcium channel blocker?
    Verapamil HCl
  62. Calcium channel antagonists reduce?
    Influx of calcium into the cell, resulting in relaxation of cascular smooth muscle and lowered blood pressure
  63. Adenosine leaves the body how fast?
    In five seconds! It has a short half-life.
  64. Adenosine is one of the most effective cardioversion drugs for use in terminating?
    PSVT (paroxysmal supraventricular tachycarida)
  65. Adrenergic (sympathomimetic) drugs are agents that mimic the action of what?
    Norepinephrine
  66. Glycogenolysis is what?
    The breakdown of what is stored in the liver into glucose, raising the blood level)
  67. Coronary vasoconstriction lead to?
    Ischemic (lack of blood flow) leading to hypoxia (inadequate tissue oxygentation), leading to pain
  68. Substernal pain or sense of constriction often radiating in neck or arms; produced by insufficient blood supply to the myocardium to mmet its oxygen demands at the time of pain?
    Angina pectoris
  69. What is often used in the symptomatic relief of angina?
    Nitroglycerin
  70. It is a sublingual tablet, dilates coronary arteries, does not mix with other drugs, may have an occurence of a headache associated with it, and must remain by the patient's bedside by law?
    Nitroglycerin
  71. A supply of nitroglycerin must be replenished how often?
    Every 3 months
  72. If relief of angina by Nitroglycerin is not observed after five minutes with the use of one tablet, what do you do next?
    A second tablet may be taken, wait five minutes; if pain persists, take a third tablet, wait five minutes... After third tablet, if angina still remains, contact health care provider or 911 immediately!
  73. Vasodilation from Nitroglycerin may cause what sort of effects?
    Burning and stinging, which is normal
  74. Nitroglycerin is only administered when?
    As soon as the onset of pain is felt, not before
  75. Nitroglycerin is contraindicated in patients with?
    Head trauma, cerebral hemorrhage, hypertension, or glaucoma
  76. Anorexia means?
    Loss of appetite
  77. Syncope means?
    Fainting
  78. Beta-adrenergic blocking agents may treat?
    Angina pectoris
  79. Amyl nitrate is administered by what route?
    Inhalation (e.g. fainting)
  80. Acute myocardial infarctions (AMIs) occur when?
    An area of the heart muscle dies as a result of insufficient oxygen
  81. The goal of care for the patient with an AMI?
    To limit damage to the myocardium to preserve enough myocardial function to sustain life by preventing and treating cardiogenic shock
  82. Cardiogenic means?
    Heart malfunction
  83. The four smooth muscles need calcium to contract; thus these agents cause?
    Blood vessels to dilate, and BP goes down
  84. Three major ways to treat blood pressure?
    • Beta blockers
    • Angiotensin-converting enzyme (ACE)
    • Calcium channel blockers
  85. Beta blockers what?
    Reduce the heart's oxygen demand by decreasing heart rate
  86. Angiotensin-converting enzyme (ACE) what?
    ACE inhibitors help reduce the risk for death or development of congestive heart failure following a AMI
  87. Diuretics are used when?
    For simple blood pressure issues, such as sodium retention
  88. Peripheral vasodilators may act by affecting?
    The sympathetic nervous system or by a direct action on the vascular smooth music
  89. Minoxidil, when administered orally, is used for?
    Blood pressure
  90. Minoxidil, when applied topically on the head, is used for?
    Regrowing hair (Rogaine)
  91. Kidneys produce?
    Renin
  92. What is peripheral circulation?
    Heart and major blood vessels
  93. These agents inhibit the action or formation of one or more clotting factors; none, however, are capable of exerting a fibrinolytic effect on existing clots...?
    Anticoagulants
  94. An agent found in mast cells located throughout the body; a potent inhibitor of the clotting process?
    Heparin
  95. Heparin potentiates the inhibitory activity of?
    antithrombin III on coagulation factors
  96. This is a physical finding, you must find the underlying cause?
    Anemia
  97. Heparin indirectly interferes with?
    The conversion of prothrombin to thrombin; which prevents conversion of fibrinogen to fibrin; thus inhibiting clot formation
  98. Heparin can only be administered how?
    Subcutaneously, Intraveneously, and continuous IV infusion
  99. What is a hematoma?
    Mass of blood outside of a blood vessel, ususally following a hemorrhage
  100. Heparin must be used with caution with diseases where there is an increased risk of?
    Hemorrhage (such as hypertension, hemophilia, petic ulcer, ulcerative colitis, dissecting aneurysm, and threatened abortion) as well as those patients undergoing major surgery or using other drugs that may induce bleeding
  101. What is hemophilia?
    Bleeding disorders where it takes blood a long time to clot
  102. What is dissecting aneurysm?
    Localized dilation of an artery (an aneurysm) in which the wall of the artery rips (dissects) longitudinally
  103. What is an ulcerative colitis?
    Type of inflammatory bowel disease (IBD) that affects the colon and rectum
  104. Overdosage of heparin can be treated with what antagonist?
    (slow infusion of 1%) protamine sulfate
  105. What is a low molecular weight heparin anticoagulant drug related to heparin that is only used SC?
    Enoxaparin
  106. These agents inhibit blood clotting by interfering with the synthesis of vitamin K-dependent clotting factors in the liver?
    Oral Anticoagulants
  107. What happens if the body is deficient in Vitamin K?
    Depression of blood clotting mechanisms in the body is observed
  108. What is the antagonist drug for cumadin?
    Vitamin K
  109. What food produce Vitamin K?
    Deep, dark green leafy vegetables
  110. What tests are performed for Heparin?
    PT/PTT
  111. What tests are performed for sodium warfarin?
    PT/INR
  112. What forms a clot?
    Platelets in the blood sticking together
  113. What agents are used to inhibit the aggregation (or sticking together) of platelets?
    Antiplatelet agents
  114. Antiplatelet agents are primarily used for what?
    Patients who have experienced CVAs or myocardial infarctions
  115. What are common antiplatelet drugs?
    Aspirin, dipyridamole, and sulfinpyrazone
  116. What agents act to convert the substance known as plaminogen to the enzyme fibrinolysin, which dissolves fibrin clots, as well as other plasma proteins?
    Thrombolytic agents
  117. What are the two thrombolytic enzymes currently available?
    urokinase and streptokinase
  118. What is another term for a Cerebrovascular Accident (CVA)?
    Stroke
  119. What agent is one that improves blood flow by decreasing blood viscosity?
    Hemorheologic agents
  120. These agents are useful in the treatment of an occlusion of the arteries of the limbs?
    Hemorheologic agents
  121. These agents stop the flow of blood in excessive bleeding (e.g. in surgery)?
    Hemostatic agents
  122. What does "eccyhmotic" mean?
    Bruising
  123. After administering a heparin dose, what should you NOT do?
    Massage or rub the site
  124. What are indications of internal bleeding while a patient is on anticoagulants?
    Headache, tarry stools, and changes in neurological status
  125. When a patient is taking anticoagulants, what should they avoid?
    Aspirin and aspirin-containing products, situations that could lead to trauma, drastic changes in diet, laxatives, and mineral oil
  126. For a patient taking anticoagulants, what would be a smart thing for them to carry or wear?
    A MedicAlert tag
  127. Nitroglycerin may have what effect on heparin?
    Decrease heparin's effect
  128. A thrombosis is fixed, while an embolus is?
    Free floating in the circulatory system

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