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ATI Pharmacology Review
Terms in this set (168)
These drugs affect both the blood pressure and the rhythm of the heart. Monitor patient blood pressure.
Orthostatic hypotension is a common side effect
2) Alpha 1 Blockers
3) Calcium Channel blockers
4) ACE Inhibitors
5) ARB Inhibitors
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What additional effects of betablockers should the nurse monitor?
The nurse should monitor for broncho constriction and bronchospasms due to beta-2 adrenergic blocking mechanisms.
In what population should betablockers be used cautiously in?
Betablockers should be used cautiously in patients who suffer from asthma.
Beta blockers can mask tachycardia in patients suffering from
and hypoglycemic symptoms seen in diabetic patients.
What affects do betablockers cause?
Therapeutic effects include decreasing blood pressure and heart rate.
Alpha 1 blocker
What affects do alpha 1 blockers cause?
They cause systemic vasodilation by directly acting on smooth muscle of arteries.
What adverse effects can alpha 1 blockers cause?
Hypotension, dizziness, sedation.
In what form are alpha 1 blockers usually administered?
Alpha 1 blockers are generally administered as a patch and are changed once a week.
Calcium Channel Blockers
How do calcium channel blockers work?
They block the influx of calcium into myocardium resulting in a decrease in contractility. It helps keep vasculature relaxed and decreases SA and AV node conduction.
What is a common adverse effect caused by verapamil (Calan)?
A common adverse effect is
What should the nurse monitor in a patient receiving calcium channel blockers?
The nurse should monitor for edema and hypotension.
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How do ACE-Is work?
They block angiotensin converting enzymes in the renin-angiotensin loop resulting in decreased blood pressure which decreases workload on the heart.
What are adverse effects of ACE Inhibitors?
Adverse effects include hypotension,
What should the nurse monitor for in patients receiving ACE Inhibitors?
The nurse should monitor the patient's renal function.
A hypersensitivity reaction of the dermis, mucosa, and submucosa tissues resulting in life threatening airway obstruction.
Epinephrine is treatment of choice.
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How do ARB Inhibitors work?
These work by blocking angiotensin II receptors in the angiotensin loop.
What should the nurse monitor in a patient receiving ARB Inhibitors?
The nurse should monitor
and renal function.
What adverse effect may occur from ARB Inhibitors?
Angioedema can occur.
These are used for both antihypertensive effects and to control edema.
What should the nurse monitor in a patient receiving diuretics?
The nurse should monitor electrolytes, dehydration, orthostatic hypotension,
digoxin and lithium toxicity
In what type of patient should diuretics be used cautiously?
Diuretics should be used with caution in patients with renal impairment.
What should the nurse monitor in patients receiving loop diuretics?
The nurse should monitor for signs of hypotension,
ototoxicity, and potassium depletion.
What allergy should the nurse check for in a patient receiving loop diuretics?
The nurse should ask the patient if they are allergic to sulfa based medications.
What are potassium-sparing diuretics used for?
They are used to treat edema.
What should the nurse monitor for in patients receiving potassium-sparing diuretics?
The nurse should monitor for signs of hyperkalemia.
What are osmotic diuretics used for?
These are used to treat patients with increased intracranial pressure and acute renal failure.
What route are osmotic diuretics given in?
Osmotic diuretics are given IV with a filter.
What should the nurse monitor for in patients receiving osmotic diuretics?
The nurse should monitor the patients IV site and for
Potassium (K-Dur) is a supplement given with loop diuretics to prevent hypokalemia.
Sodium polystyrene sulfonate (Kayexalate) is given to treat hyperkalemia.
Calcium channel blockers and beta blockers are also used to treat dysrhythmias.
Digoxin (Lanoxin) is used to treat chronic heart failure, a-fib, and paroxysmal atrial tachycardia.
What is the digoxin therapeutic level?
Therapeutic level of digoxin is
0.5 - 2 ng/mL
What are the signs and symptoms of digoxin toxicity?
Signs of toxicity include abdominal pain, anorexia, nausea, vomiting, visual disturbances, and bradycardia.
What must the nurse do before administering digoxin?
The nurse must take the patient's apical heart rate.
When would a nurse hold administering digoxin?
If the patient's apical HR is below 60 or above 100.
What should the nurse monitor in a patient receiving digoxin?
The nurse should monitor the patient's potassium level. A decrease in potassium precipitates digoxin toxicity.
What is given if the patient is suffering from digoxin toxicity?
The patient receives digoxin immune fab (Digibind) to bind to reduce circulating digoxin.
What are nitrates used for?
They are used to decrease angina pain.
What route can nitroglycerin be given?
Nitro can be given in tablets, patches, paste, or IV.
When would a patient take nitroglycerin?
A patient experiencing angina, MI (given IV), or suffering from chronic heart failure.
How do nitrates work?
Nitrates lower blood pressure which improves blood flow to the myocardium.
When a patient is having an angina episode, what is the protocol for taking sublingual nitroglycerin?
The patient should take one tab under the tongue every 5 minutes up to three times.
If no relief is acquired, they should immediately call 911 and get transported to the ER.
What should the nurse monitor in patients receiving nitrates?
The nurse should monitor for hypotension, headache, and rebound tachycardia due to vasodilation.
What teaching should the nurse include in patients taking cardiac medications?
Education should include having the patients changing position slowly, reporting facial swelling, dyspnea, dizziness, signs of digoxin toxicity, weight loss or gain, and change in mental status.
A headache or tingling under the tongue confirms that nitroglycerin in is working.
Where should nitroglycerin be stored?
Nitroglycerin should be stored in a dark container and replaced every 6 months.
These are used to prevent clot formation.
What are the indications for heparin?
Indications for anticoagulants include pulmonary embolisms, MIs, CVAs, and DVTs.
What is the usual adult dosage for heparin?
The usual heparin dose for adults is 5,000 units SQ every 8 to 12 hours.
The usual IV concentration is 25,000 units in 250mL.
What are therapeutic blood levels for heparin?
Therapeutic levels are generally
1.5 - 2.5
times normal control level
aPTT (1.5 - 2.5)
What are the adverse effects of heparin?
Adverse effects include bleeding, anemia, and thrombocytopenia.
What should the nurse monitor in patients receiving heparin?
The nurse should monitor the patients aPTT or PTT and hematocrit.
What is the antidote of heparin?
The antidote of heparin is
What is enoxaparin (Lovenox)?
Enoxaparin is a low molecular weight heparin. It is similar to heparin but has a
What are the indications for warfarin?
Indications include venous thrombus, pulmonary embolism, MI, A-fib, and prosthetic valve replacement.
What are the therapeutic levels of warfarin?
Therapeutic blood levels change depending on treatment.
DVT: INR 1.5-2.0
A-Fib: INR 2.0-3.0
Valve: INR 2.5-3.5
What are the adverse effects of warfarin?
Adverse effects of warfarin are excessive bleeding.
What should the nurse monitor in patients receiving warfarin?
The nurse should monitor protime (PT) and INR.
What is the antidote to warfarin?
The antidote for warfarin is
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These medications lower cholesterol levels.
What food should patients receiving hyperlipidemics avoid?
Patients should avoid eating or drinking food or drinks with grapefruit as it can decrease metabolism.
What should the nurse monitor in patients receiving hyperlipidemics?
The nurse should monitor for muscle pain (myalgia) and
They should also check LFTs before and during therapy.
Breakdown of muscle tissue that leads to release of muscle fiber into the blood.
Causes muscle pain and dark red or cola colored urine. If untreated it can lead to kidney failure and death.
Cholesterol Absorption Inhibitors
What should the nurse monitor for in patients receiving ezetimibe?
The nurse should monitor for angioedema.
Cholesterol Combination Drugs
Vytorin: ezetimibe + simvastatin
What should the nurse monitor for in a patient receiving vytorin?
The nurse should monitor liver function studies.
What patients should be receiving insulin?
Patients with type 1 or type 2 diabetes mellitus that are unresponsive to oral hypoglycemic and diet modifications.
Rapid Acting Insulin
When should a patient take lispro?
The patient should take lispro 15 minutes prior to eating.
How long does it take for humulin R to peak?
It takes about 2 to 4 hours for humulin R to peak.
How long does it take for humulin N to peak?
It takes about 6 to 12 hours for humulin N to peak.
Long Acting Insulin
How often is glargine given?
Glargine is given once a day. This insulin lasts for 24 hours.
What are the signs and symptoms of hypoglycemia?
Signs of hypoglycemia include cool, clammy, confused, weakness, palpitations, and hunger.
What are the signs and symptoms of hyperglycemia?
Signs of hyperglycemia include dry, flushed skin, polyuria, and polydipsia.
What should the nurse monitor and teach the patient about?
The nurse should monitor and teach the patient about blood glucose monitoring.
What is the antidote to hypoglycemia?
The patient should take a CHO tab under the tongue or eat something sugary.
The patient can also receive dextrose 50% IV or glucagon IM.
What are the adverse effects of oral hypoglycemics?
Common GI adverse effects include diarrhea and bloating.
Other effects include liver dysfunction, photosensitivity, hypoglycemia, and aplastic anemia.
What allergies should the nurse assess for prior to administering oral hypoglycemic?
The nurse should ask if the patient has any allergies to sulfonamides.
What should the nurse monitor when administering oral hypoglycemic?
The nurse should monitor CBC and Hg A1C.
What does Hg A1C measure?
It reflects control of blood sugar over the previous three to five weeks.
What is levothyroxine (Synthroid) used for?
It is used to improve symptoms of hypothyroidism.
How long must patients receive levothyroxine?
Patients must take levothyroxine
What should the nurse and patient monitor for when receiving levothyroxine?
They should monitor for symptoms of hyperthyroidism, insomnia, irritability, nervousness, tachycardia, and cardiovascular collapse.
TSH level should be monitored periodically.
At what time should levothyroxine be taken?
Levothyroxine should be taken before breakfast.
When are glucocorticoids used?
They are used for various disorders. Glucocorticoids produce anti-inflammatory and immunosuppressive effects.
What are the adverse effects of glucocorticoids?
Adverse effects affect nearly every organ system.
Glucocorticoids can cause hyperglycemia, poor wound healing, decreased immune function, increased risk of infection, osteoporosis, emotional labiality, and sodium and water retention.
Can glucocorticoids be stopped abruptly?
No, glucocorticoid treatment needs to be tapered off prior to discontinuing.
Albuterol (beta 2 agonist adrenergic)
What should the nurse teach the patient after taking inhaled glucocorticoids?
The nurse should teach the patient to
rinse their mouth after each use
to reduce risk for candidiasis. In addition, they should dry the chamber after each use.
What should the nurse monitor in a patient receiving Proventil?
The nurse should monitor for increased heart rate and tremors.
How does ipratropium work as a respiratory agent?
Ipratropium relaxes bronchial smooth muscle. It is slower acting than albuterol and does not produce tachycardia.
What is diphenhydramine used for?
It is used to treat anaphylaxis, seasonal allergies, and allergic skin rashes.
It is also used as a mild sleep sedative and for motion sickness.
What should the nurse monitor for in a patient taking diphenhydramine?
The nurse should monitor for drowsiness, anorexia, and dry mouth.
It may cause paradoxical excitation in children and falls in the elderly from lingering central nervous system effects
Cough and Cold Preparations
A type of medication used to relieve coughing.
A type of medication used to help remove mucous from airways.
Reduces nasal congestion and swelling.
Isonicotinic acid (Isoniazid)
What are the adverse effects of isonicotinic acid (Isoniazid)?
Adverse effects include pyridoxine deficiency. Patients should be prescribed vitamin B6 to avoid this.
What adverse effects does ethambutol have?
Adverse effects cause decreases in color vision.
What adverse effects does rifampin cause?
It causes body fluids such as urine, sweat, and saliva to be red/orange colored.
What should the nurse monitor for in a patient receiving antituberculosis agents?
The nurse should monitor for signs of gout and hepatitis.
Check LFTs and uric acid levels.
How long are antituberculosis medications used for?
These medications are used in combination for 12 to 18 months.
Penicillin V (Pen-Vee-K)
What are general adverse effects of antibiotics?
Antibiotic use can result in bacterial overgrowth resulting in yeast infections or GI disturbances.
What can occur when antibiotics are administered too rapidly?
Rapid administration of antibiotics can increase risk of hypotension.
What adverse effects do gentamycin and vancomycin have?
They are nephrotoxic and ototoxic.
The nurse should monitor for ringing of the ears.
What adverse effects can metronidazole have?
Adverse effects include seizures. The patient should avoid alcohol.
What adverse effects does tetracycline have?
Patients should avoid sun exposure due to increased photosensitivity.
Divalproex (Depakote): Bipolar disorder
Gabapentin (Neurontin): neuropathic pain treatment
Diazepam (Valium): status epilepticus
What should the nurse monitor in patients taking antiseizure medications?
The nurse should monitor for confusion, drowsiness, and ataxia.
The nurse should monitor carbamazepine and phenytoin levels and CBC for toxicity or aplastic anemia and agranulocytosis.
What are the therapeutic levels of carbamazepine?
Therapeutic levels are between 6-12mcg/ml.
What are the therapeutic levels of phenytoin?
Therapeutic levels are between 10-20mcg/ml.
What adverse effects can phenytoin cause?
Phenytoin can cause gingival hyperplasia.
Toxicity symptoms include nystagumus, ataxia, confusion, nausea, dizziness, and Stevens-Johnson syndrome.
If phenytoin is given IV, what should the nurse watch for?
The nurse should monitor for dysrhythmias.
When should phenytoin be given if given PO?
Phenytoin should be given before or after tube feedings.
What side effects can occur from sleeping agents?
Daytime drowsiness, dizziness.
Use cautiously in older adults.
What should the nurse teach to patients taking sleeping agents?
The nurse should teach alternative sleep aids such as keeping the room dark and quiet. Avoiding alcohol/caffeine/nicotine, and don't exercise before bedtime.
Benztropine mesylate (Cogentin)
When is carbidopa/levodopa (Sinemet) given?
It needs to be given
for the best effects.
What should the nurse monitor in patients receiving Sinemet?
The nurse should monitor for constipation, drymouth, dizziness, drowsiness, confusion, and insomnia.
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What should the nurse monitor for in patients receiving antimigraine medications?
The nurse should monitor for dizziness, vertigo, paresthesias, myalgias, and chest tightness. MI can occur with Imitrex
Narcotic Analgesics (Opioids)
What should the nurse monitor for in patients receiving opioid analgesics?
The nurse should monitor for hypotension, respiratory depression, nausea, vomiting, and constipation.
What is the antidote to opioid overdose?
Non-Narcotic Analgesics (NSAIDS)
Ibuprofen (Advil; Motrin)
What should the nurse monitor in a patient receiving NSAIDS?
The nurse should monitor for GI irritation, GI bleeding, and renal failure.
What should the nurse monitor for in a patient receiving acetaminophen?
The nurse should monitor for signs of hepatotoxicity such as sweating, anorexia, nausea, vomiting, diarrhea, and abdominal pain.
What is the antidote for acetaminophen overdose?
The antidote is acetylcysteine (Mucomyst)
How much acetaminophen can be given in 24 hours?
Do not administer more than 4g of acetaminophen per 24 hours.
What is the general antidote for oral non-narcotic analgesics?
What should the nurse monitor for in a patient receiving antipsychotic medications?
The nurse should monitor for seizures, extrapyramidal symptoms, and neuroleptic malignant syndrome.
Tremors and rigid movements. Cogwheeling etc.
The body is restless. Restless movements.
Neuroleptic Malignant Syndrome
Fever, tremors, elevated blood pressure, tachycardia. If untreated it is potentially fatal.
What is the antidote for dystonia?
What should the nurse monitor for in a patient receiving olanzapine?
The nurse should monitor for orthostatic hypotension.
Bipolar Disorder Medications
What should the nurse monitor in a patient receiving lithium?
The nurse should monitor lithium levels. Therapeutic range is
0.5 - 1.5 mEq/L
The nurse should monitor intake/output.
Monitor sodium levels. If sodium levels rise, it increases risk for toxicity.
Monitor for seizures and arrhythmias.
What are the signs of lithium toxicity?
Signs and symptoms include vomiting, diarrhea, drowsiness, decreased coordination, and
Selective Serotonin Reuptake Inhibitors (SSRIs)
What are SSRIs used to treat?
What should the nurse monitor in patients taking SSRIs?
The nurse should monitor for insomnia, drowsiness, constipation, nausea, sweating, tremors, headache, and sexual dysfunction.
What are MAOIs used to treat?
What should the nurse monitor for in patients receiving MAOIs?
The nurse should monitor for seizures and
MAOIs interact with many foods and drugs. Client is placed on
tyramine resctricted diet
What foods must a patient receiving MAOIs avoid?
These patients must avoid foods that contain tyramine.
Patients cannot eat cheeses, processed meats, wine, yogurt, beer, chocolate.
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