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Pharma: Exam THREE
Terms in this set (83)
Alpha Agonist Use
-Increase heart rate and BP, vasoconstrict
-heart failure, shock, bleeding
-bronchodilate: asthma, COPD
Antihypertensives and male sx
Antihypertensives taken w/ Viagra can cause hypotension. Impotence.
Sodium nitroprusside (Niprifde) administration considerations
-sunlight=cyanide. Indicated by blue color change.
-renal pt toxicity risk increased
To decrease toxicity risk of Niprifde...
combine w sodium thiosulfate
Pt. teaching antihypertensives
-decrease sodium, fat.
-1st dose (orthostatic hypotension)
Beta Blocker suffix
-olol, -ilol, -allol
Beta Blocker Use
-CAD, heart attack, angina, dysrhythmias, heart failure.
Beta Blocker sx
-symptoms of heart failure (edema, coughing, fatigue)
ACE inhibitors suffix
ACE inhibitors Use
-vasodilation (inhibits angiotension I to II conversion)
-hypertension, heart failure
ACE inhibitors sx
-Elevated potassium (hyperkalemia)
-Sexual dysfunction (impotence)
Vasodilation (block angiotenson II from binding to receptor sites). Heart failure, antihypertension.
cough, URI, angioedema (but less than ACE)
Kidney or liver failure
What to give pt if coughing on ACE?
Common Calcium Channel Blocker Drugs
Calcium Channel Blocker Use
(prevent calcium used for contraction)
Calcium Channel Blocker Sx
Tachycardia or bradycardia
Considerations for topical Nitroglycerin administration
-Used for LONG-TERM, prophylactic mngmnt of angina pectoris
-cardioversion or AED is required, remove patch to avoid burning of the skin and damage to defibrillator
Considerations for sublingual Nitroglycerin administration
-don't give if BP below 90
-Store tabs in original container and prevent exposure to air and moisture as poss inactivation can occur
-Pt should sit or lie down when taking
Most common use of Nitroglycerin
When a patient on Nitro sublingual should call 911
If the chest pain or discomfort is not relieved in 5 minutes, after one dose, the patient of family member MUST call 911 immediately
Considerations for Lanoxin (Digitalis) administration
-Low mg or potassium levels may increase potential for digoxin toxicity so monitor electrolytes.
-Administer Digoxin immune FAB if toxicity develops
-Wide variety of significant drug interactions!
Lanoxin (Digitalis) patient teaching
-Take pulse before taking. If <60 or >100, notify HCP
-Pt and family should be familiar of signs of toxicity
Lanoxin (Digitalis) adverse effects
-Cardiovascular: bradycardia, tachycardia, hypotension
-CNS: headache, fatigue, confusion, convulsions
-Ocular: colored vision, halo vision
-GI: anorexia, N/V/D
Digitalis therapeutic range
Therapeutic: 0.5 and 2 ng/mL. Narrow range, monitor closely!
Dig toxicity sx (picmonic!)
Cardiovascular: Bradycardia, hypotension, heart block, tachycardia, dysrhythmias
CNS: headache, dizziness, confusion, halo vision
GI: N/V/D (cholinergic effects)
-Digoxin immune Fab (DigiFab) for life-threatening toxicity.
mg/dig antidote can bind with
-One vial of DigiFab binds to .5 mg digoxin.
Negative chronotropic effect
-Decrease heart rate
-Treat heart failure
Pos inotropic effect (Beta I's, Digoxin)
-Increase heart rate
-Treat heart failure
Adverse effect of milrinone (Primacor)
-Elevated Liver Enzyme Levels
Blood levels to be alert of for potential toxicity for Cardiac Glycosides
Toxicity: > 2.0 ng/ml
Classes of drugs for first-line treatment of congestive heart failure
Drugs for ventricular dysrhythmia after MI
Common side effect for Adenosine (Adenocard)
Adverse effects of Lidocaine
-CNS toxicity: twitching, convulsions, confusion
-Cardio: hypotension, bradycardia, dysrhythmias
Most common side effects of anti-dysrhythmia drugs
-Dizziness, headache, blurred vision
-Producing new dysrhythmias w/ prolonged QT can lead to torsades de pointes
Drip used most commonly to treat A-Fib
Cardizem, verapmil, digoxcin
Common use of ibutilide (Corvert)
Antidysrhythimc for atrial dysrhythimas and flutter
Side effects of Carbonic anhydrase inhibitors
-melana (blood in stool)
Common potassium-sparing diuretic
Potassium-sparing diuretics side effects
Acceptable potassium blood level
3.5 - 5
Nursing assessments diuretics
-Frequent lab tests measuring electrolytes, uric acid, blood gas
Patient teaching for diuretics
-Increase potassium-rich foods (or K supplement) except when using potassium-sparing diuretics.
-Change positions slowly
Diuretic used for increased ICP
Osmotic diuretics (Mannitol)
Prevention of medication errors
Can occur during: procuring, prescribing (most error-prone), transcribing, dispensing, administering, and monitoring medication.
Failure to create "just culture"
Adrenergic effect on NS
-ramp up sympathetic NS within the CNS
Adrenergic drug use
bronchodilation (asthma), reduce intraocular pressure, cardiac failure and shock
Adrenergic drug Sx
-bradycardia w/ reflex tachycardia, palpitations, dysrhythmias
Uses of epinephrine
-Cardiac Arrest: vasoconstriction
-Anaphylactic shock & acute asthma: bronchodilation
-Open angle glaucoma
Patient teaching and Salmeterol
-NOT for acute symptoms
-Do not use alone: Use bronchodilator first, wait 5 mins, then take 2nd drug.
-Rinse mouth thoroughly
specific receptors that adrenergic drugs work on to create bronchodilation (action)
Beta 2 Agonists act on beta 2 receptors in bronchii to increase their action, ramping up fight or flight response, causing dilation.
Considerations for Dopamine administration
-Confirm titered to correct dose
-IV can lead to tissue necrosis from excessive vasoconstriction around IV site so check skin and infusion rate often.
-W infusion, use only clear solutions and proper dilutional fluid. Infuse w/ an IV pump.
-Closely monitor cardiac system as can cause dysrhythmias
Antidote for Dobutamine extravasation and how this works
-Causes alpha-adrenergic receptor blockade and vasodilation → increased blood flow to ischemic tissue.
Use of beta blockers after MI
-MI causes catecholamines to be released which increase heart rate and contractile force → increase oxygen demand of the heart
-Beta blockers occupy beta 1 receptors so the catecholamine molecules cannot bind. So, beta blockers protect the heart from being stimulated by the catecholamines.
Contraindication for non-selective beta blockers
-Peripheral artery disease
Specific beta blocker for diastolic heart failure
Beta receptor blockers (-OLOL)
Patient teaching for beta blockers (-OLOL)
-Pt w/ diabetes, masks potential hypoglycemic episode as medication increases tachycardia unbeknownst to pt
-monitor BP often
Tamsulosin (Flomax) drug interaction
-Drugs that induce or inhibit hepatic enzymes may reduce or enhance the effects of Tamsulosin.
-other alpha blockers, calcium channel blockers, erectile dysfunction drugs.
Side effects of alpha blockers
-first dose phenomenon- severe and sudden drop in BP after 1st administration. Can cause fall or faint.
-Orthostatic hypotension- dizziness, headache
Side effects of cholinergic drugs
diarrhea, GI distress, emesis (vomiting)
Can add an M for muscle spasm or miosis (pupils constrict)
Most common use of pilocarpine (Pilocar)
Antidote for overdose of cholinergic drugs
Myasthenia gravis and cholinergic drugs (why and patient teaching)
Myasthenia gravis: muscle weakness of voluntary muscle groups
Pyridostigmine: cholinergic shown to improve muscle strength
-take 30 min before meals so drug begins to work before chewing/swallowing
Expected action of Donepezil (Aricept) and patient teaching
increases concentrations of acetylcholine in the brain by inhibiting cholinesterase.
May take 6 weeks to take effect
Only 15-30% see effect
Donepezil (Aricept) patient teaching
-take 6 weeks to take effect -helps to enhance and maintain memory and learning capabilities. -Temporary but noticeable change in pt.
-15-30% see benefits
Cevimeline (Evoxac) uses ?
-Parasympathomimetic used in treatment of GI
Common side effect of Ginko Biloba
GI upset, headache, bleeding, allergic reaction
Interaction w Ginko Biloba
aspirin, warfarin, heparin, antidepressants, antihypertensives, insulin
Use of edrophonium (Tensilon)
Diagnose myasthenia gravis. Differentiate between myasthenia gravis and cholinergic crisis.
Side effects Atropine
Block ach at cholinergic receptors which allow sympathetic NS to dominate
Antidote of Atropine overdose
Side effects anticholinergics
-tachycardia or bradycardia, blurred vision, sensitivity to light, hypersensitivity reactions
"Blind as a bat"
"Mad as a hatter" (confusion)
"Dry as a bone" (dry mouth, urinary retention)
"Red as a beet" (flushed skin)
"Hot as a desert" (hyperthermia)
Common use of tolterodine (Detrol)
-Urgency and urge incontinence caused by bladder overactivity.
Uses of anticholinergics
-Parkinson's disease: improved ability to carry out activities of daily living and fewer problems with tremors, salivation, and drooling, muscle rigidity
-decreased GI symptoms, such as hyperacidity, abdominal pain, and nausea and vomiting, with improved comfort
-decreased genitourinary hypermotility, with increased comfort and improved patterns of voiding with an increase in time between voidings
Use of Scopolamine patch
Expected effect and medical term of anticholinergic eye drops
Mydriasis: pupil dilation
-increase heart rate
-relaxes GI tract and bladder
-decrease heart rate
-dilates blood vessels
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