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NCLEX RN chapter 57 & 59 Cardiovascular and Renal medications
Terms in this set (110)
Anticoagulants prevent the extension and formation of clots by inhibiting _____ in the clotting cascade and decreasing blood coagulability.
Heparin sodium prevents thrombin from converting _____ to _____.
fibrinogen to fibrin
Blood levels: the normal activated partial thromboplastin time (aPTT) is ___ to ____ seconds in most laboratories but may be as high as ____ seconds.
What is the antidote to heparin?
Warfarin suppresses coagulation by acting as an antagonist of ____ _____ by inhibiting four dependent clotting factors (X, IX, VII, and II).
The normal PT is ___ to ____ seconds.
9.6 to 11.8
The normal INR is ____ to ___.
1.3 to 2.0
What is the antidote for warfarin?
phytonadione (vitamin K)
Thrombolytic medications: activate ______. This generates _____ (the enzyme that dissolves clots).
Side effects of thrombolytic medications: ____, _____, and _____ reactions(can happen with any drug).
What is the antidote of thrombolytic medications?
aminocaproic acid (amicar)
_______ is the primary concern for a client taking an anticoagulant, thrombolytic, or antiplatelet medication.
Antiplatelet medications inhibit the ______ of platelets in the clotting process, thereby prolonging the bleeding time. Side effects include _______ bleeding, bruising, hematuria, _____ stools.
What is our cardiac glycoside?
Cardiac glycosides inhibit the _____ ____ ____, thus increasing intracellular _____, which causes the heart muscle fibers to contract more efficiently. Side effects include anorexia, nausea, vomiting, _____, ____ disturbances.
Early signs of digoxin toxicity present as _____ manifestations (name 3). Then the _______ _____ abnormalities and visual disturbances appear
GI (anorexia, nausea, vomiting)
What do you have to do before administering digoxin?
listen to apical pusel for 1 full minute
Digoxin: if the apical pulse rate is lower than ____ beats/min, the medication should be withheld and the HCP notified.
Antihypertensive medications: thiazide diuretics: increase ____ and _____ excretion by inhibiting sodium reabsorption in the distal tubule of the kidney.
Side effects of thiazide diuretics include hyper____, hyper_____, hyper_____. Hypo____, and hypo_____.
Loop diuretics inhibit ____ and _____ reabsorption from the loop of Henle and the distal tubule. Side effects include hypo____, hypo_____, hypo____, and hypo______.
Potassium-retaining diuretics act on the distal tubule to promote ____ and ____ excretion and _____ retention.
The primary concern with administering potassium-retaining diuretics is _________.
What are three side effects of potassium-retaining diuretics that are also signs of hyperkalemia?
nausea, vomiting, diarrhea
Peripherally acting alpha-adrenergic blockers: these medications decrease sympathetic _______ by reducing the effects of norepinephrine at peripheral nerve endings, resulting in _______ and decreased ____.
Centrally Acting sympatholytics (Adrenergic blockers): stimulate alpha receptors in the CNS to inhibit _____, thus reducing ____ _____.
Because Centrally Acting sympatholytics (Adrenergic blockers) cause BP to go down, what is the patient at risk for that could potentially cause them to get hurt?
What will happen if a patient abruptly discontinues Centrally Acting sympatholytics (Adrenergic blockers)?
they will have rebound hypertension
ACE and ARBs: ACE inhibitors prevent peripheral vasoconstriction by blocking conversion of angiotensinI to angiotensin II. ARBs prevent peripheral vasoconstriction and secretion of _______ and block the binding of AII to type I AII receptors.
What is a famous side effect of ACE inhibitors? How often does this usually last for?
persistent dry cough
it usually lasts a few weeks- if it lasts longer, make sure to see the doctor
A persistent _____ _____ is a common complaint for those taking ACE inhibitors. The client is instructed to contact the HCP if this side effect occurs and persists.
What is our antianginal medication? What do they produce in coronary vessels?
What are two side effects of nitrates?
headache, orthostatic hypotension
sublingual Nitrates: offer what before giving because dryness may inhibit medication absorption?
Antianginal medications: What is a translingual medication?
Antianginal medications: For translingual medications, the client is instructed to direct the spray against the oral ______.
Antianginal medications: sustained-released medications: the client is instructed to _____ and not chew or ____ the medication.
Antianginal medications: transdermal patch: the client is instructed to apply the patch to a ____ area, using a new patch and different ____ each day.
Instruct the client using nitroglycerin tablets to check the _____ ____ on the medication bottle because expiration may occur within __ months of obtaining the medication. The tablets will not relieve the chest pain if they have expired.
Beta blockers decrease the ____ of the heart and decrease ____ demands.
What do you need to check before administering a beta blocker?
BP (needs to be within a specific range according to the doctor's orders)
Calcium channel blockers decrease cardiac _____ (____ _____ effect by relaxing smooth muscle) and the workload of the heart, thus decreasing the need for oxygen.
Side effects of calcium channel blockers: bradycardia, hypotension, reflex _____ as a result of hypotension.
Peripheral vasodilators: alpha blockers usually end in what?
How will a person feel who is on peripheral vasodilators? what will their HR be like? What side effect are they at risk for that could cause them to get injured?
Vasodilators cause _____ _______. The client is instructed about safety measures when taking these medications, such as the need to rise from a lying to a sitting or standing position slowly.
Antilipemic medications: reduce what three serum levels?
cholesterol, triglycerides, or low-density lipoprotein
Name three side effects of antilipemic medications?
GI disturbances: heartburn, nausea
Cholestyramine comes in a gritty powder that must be mixed thoroughly in ____ or ____ before administration.
HMG-CoA reductase inhibitors are antilipemic medications that all end in what?
The client who is taking an antilipemic medication is instructed to report any unexplained _____ pain to the HCP immediately.
Gemfibrozil and Statins should not be administered with what?
anticoagulants, or each other
pg. 716 Qs: 538, 540, 542, 544
UTI antiseptics inhibit the growth of _____ in the ureter.
Methenamine is used to treat _____ UTIs, but not recommended for _____ infections.
Methenamine requires acidic urine with a pH of ___ or lower.
Should you encourage a patient on methenamine to increase fluid intake?
no, increasing fluid intake reduces antibacterial effects by diluting the medication and raising urine pH.
Patients in methenamine: alkalizing fluids such as ____ and ____ juices should be avoided however, cranberry juice is allowed.
Methenamine should not be combined with _____ (drug class) because of the risk of crystallurea and urinary tract injury.
Clients taking Methenamine should avoid _____ agents, including over-the-counter antacids containing sodium bicarbonate or sodium carbonate.
Nitrofurantoin (UTI antiseptic): pulmonary reactions include ____, chest pain, chills, fever, cough, and alveolar infiltrates. These resolve in ___ to ___ days following cessation of treatment.
Nitrofurantoin may impart a harmless _____ color to the urine. It is contraindicated in clients with _____ impairment.
Fluorquinolones are antibiotics that all end in what?
Fluoroquinolones should be used with caution in clients with ____, ___ or ____ nervous system disorders.
Fluoroquinolones: the client is advised to report _______, light-headedness, visual disturbances, increased light sensitivity, and feelings of _____, because these signs could indicate CNS toxicity.
Fluoroquinolones: avoid ______ light and _____ exposure, using protective clothing and sunscreen.
Fluoroquinolones are administered with __________, and the client is taught that it is necessary to maintain a urine output of at least _____ to ______ mL daily to minimize the development of crystalluria.
a full glass of water
1200 to 1500
Sulfamethadiazine and thrimethoprim are both what kind of antibiotics?
Sulfonamides: adults should maintain a daily urine output of ______mL by consuming ___ to ____ glasses of water each day to minimize the risk of renal damage from the medication.
8 to 10
TMP-SMZ (sulfonamide combination of trimethoprim-sulfamethoxazole) is used cautiously with clients experiencing impaired _____ function, ____ vitamin/mineral deficiency, severe allergy, or bronchial asthma.
An IV dose of TMP-SMZ is administered over ____ to ____ minutes and is not ____ with other medications.
60 to 90
Sulfonamides should be withheld if a _____ is noted. The client is informed to contact the HCP if this appears.
A urinary tract analgesic is contraindicated in clients with _____ or ____ impairment or disease.
Anticholinergics-antispasmodics are used for _______bladder. Side effects include anorexia, _____, ____, and ____ mouth.
What kind of drug is oxybutynin?
Oxybutynin is not administered to clients with known hypersensitivity, _____ or genitourinary obstruction, glaucoma, severe colitis, or _____ _____.
Bethanechol is what kind of drug? It is used to increase bladder _____ and function and to treat nonobstructive urinary retention and neurogenic bladder.
How should bethanechol be administered to avoid nausea and vomiting?
on an empty stomach, 1 hour before meals or 2 hours after
A cholinergic such as bethanechol is not given to a client who has a urinary _____ or obstruction.
What kind of drug is Cyclosporine?
used to prevent organ rejection
Cyclosporine inhibits calcineurin and acts on ____ lymphocytes to suppress the production of interleukin-2, interferon-y, and other _____.
The most common adverse effects of cyclosporine are _____toxicity, infection, _____(BP), tremor, and hirsutism.
Cyclosporine: the client should be instructed to monitor for early signs of _____ and report these signs immediately.
Cyclosporine is available in pill form. If the client is unable to swallow the pill, the client is instructed to dispense the oral liquid medication into a glass container by using a specially calibrated _____, mix well, and drink immediately; rinse the glass container with diluent and ____ it to ensure ingestion of the complete dose; dry the outside of the pipette and return it to its cover for storage.
Cyclosporine: to promote palatability, the client is instructed to mix the liquid medication with what?
What kind of drug is Sirolimus?
medication for preventing renal transplant rejection
Sirolimus increases the risk of _____, increases the risk of ____ injury, increases the risk of lymphocele (a complication of renal transplant surgery), and raises _____ and triglyceride levels.
What kind of medication is tacrolimus?
medication for preventing organ rejection.
Adverse effects of tacrolimus are similar to those of ________ and include _____toxicity, ____, _____ (BP), tremor, hirsutism.
Prednisone (also used to prevent organ rejection) can cause hyper________ and hypo______. Make sure to monitor these levels.
Azathioprine (also used to prevent organ rejection) can cause ______penia and ________penia from ____ ______ supression.
What kind of drug is mycophenolate mofetil?
prevents organ transplant rejection
Adverse effects of mycophenolate mofetil include ____, ______, (GI stuff), severe ______penia, and sepsis.
What kind of medication is antithymocyte globulin, equine?
used to prevent organ transplant rejection
Before the first infusion of antithymocyte globulin, equine, the client should undergo intradermal skin testing to determine _________.
Hematopoietic growth factors are used to treat anemia of ____ ____ disease, chemotherapy-induced anemia, anemia caoused by AZT, and anemia in clients requiring surgery.
What is the major side effect of hematopoietic growth factors?
Hematopoietic growth factors: Leukopoietic growth factors: can cause _____ pain, leukocytosis, and elevation of plasma _____ ____, lactate dehydrogenase, and alkaline phosphatase levels. Long-term therapy has caused ______megaly.
Hematopoietic growth factors: Thrombopoietic growth factor: adverse effects include fluid _____, cardiac _____, conjunctival infection, visual blurring, and papilledema.
pg. 759 Qs: 562, 563, 566, 568
The aPTT for patients on Heparin should be between what two numbers?
60-90 seconds (if it is higher than 90, lower the dose, if it is less than 60, increase the dose)
Enoxaparin- should you get rid of the air bubble from the prefilled syringe? What is the antidote?
How long should a nitrate transdermal patch be on?
for 12-14 hours- (12 on, 12 off)
Class I antidysrhythmics are sodium channel blockers, class II are beta blockers, class III are potassium channel blockers, and class IV are calcium channel blockers. What are two side effects of class I antidysrhythmics?
What are two side effects of class II antidysrhythmics? (beta blockers)
What are two side effects of class III antidysrhythmics? (potassium channel blockers)
IV? (calcium channel blockers)
hypotension, bradycardia, edema
dopamine increases _____ and ______ _______ through positive inotropic action and increases renal blood flow.
Tolterodine is an anticholinergic used for overactive bladder. It should be used cautiously in patients with what eye condition?
Antispasmodic medications used to treat overactive bladder should not be used by clients diagnosed with open-angle glaucoma. These medications will block the______ of intraocular fluid and raise the intraocular ________. This may cause permanent damage to the optic ______.
What beverage should not be consumed with cyclosporine? Why?
increases risk of toxicity
People who have had organ transplants must take their immunosuppressant medications when? Why?
at the same time each day
to ensure that the immune system is sufficiently suppressed to prevent organ rejection
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