Terms in this set (475)
What patients should you give Alpha 1 agonist to?
What patients should you give Alpha 1 antagonists to?
What patients should you give Alpha 2 agonist to?
What patients should you give Alpha 2 antagonist to?
Which adrenergic receptor's actions can be drcribed by the phrase "My Vessleses Get Grooving & Contrscted"
Which adrengeric reseptor's action can be described as "On 2nd thought, dont constrict"
In what patients would Alpha 1 agonist be contraindicated?
patietns with HTN
In what patients would an Alpha 2 agonist be contraindicated?
give Apha 1 agonist
Alpha 1 agonist contraindicated
give Alpha 1 antagonist
Alpha 1 antagonist contraindicated
give Alpha 2 agonist
Alpha 2 agonist contraindicated
give Alpha 2 antagonist
Alpha 2 antagonist contraindicated
What it the action of Alpha 1 ?
contraction of uterus and GU smooth muscle
dialated pupils as a result of contrsction of radial muscle
What is the action of Alpha 2?
block Alpha 1
What is the action of Beta 1?
increased AV conduction
What patients should be given Beta 1 agonist?
patietns in shock and with low BP
Which nervous system does Beta 1 act upon?
What are the efects of RAAS?
What is the action of Beta 2?
what patients should be given Beta 2 agonist?
strength of heart pump
What effect does negative inotropic have?
decrease strength of contraction
What effect does positive inotropic have?
increase strength of contraction
Chronotropic relates to
What effect does negative chronotropic have?
What effect does positive chonotrophic have?
The parasympathetic nervous system is related to what actions?
rest and digestion
Acetylcholine is the main neurotransmitter for which nervous system?
parasympathetic nervous system
Norepinephrine is the main neurotransmitter for which nervous system?
sympathetic nervous system
Which of the following agents would be indicated for the treatment of benign prostatic hypertrophy? Select all that apply.
Your 96-year-old patient is receiving digoxin (Lanoxin) and furosemide (Lasix). In the morning the patient complains of a headache and nausea. What will you do first?
Check her laboratory values and vital signs
The client's digoxin level is 0.125. How does the nurse interpret this level?
A 66-year-old woman has a complex medical history that includes poorly-controlled type 1 diabetes, renal failure as a result of diabetic nephropathy and chronic heart failure (CHF). Her care provider has recently added spironolactone (Aldactone) to the woman's medication regimen. The nurse should consequently assess for signs and symptoms of
A patient presents to the Emergency Department (ED) with rales, wheezing, and blood-tinged sputum. The nurse suspects the patient is in congestive heart failure (CHF). What would the nurse suspect the patient is experiencing?
The client is experiencing digitalis toxicity and presents with symptomatic bradycardia. The nurse knows that which of the following medications may be administered to treat bradycardia?
Which of the following is an adverse reaction associated with cardiotonic medications?
What vasodilators are used to treat heart failure? (2 types)
A nurse suspects that a client is experiencing left-sided heart failure. Which of the following would the nurse assess? (Select all that apply.)
The client receiving propranolol (Inderal) at home for management of a ventricular dysrhythmia should monitor which of the following parameters? Why?
Blood pressure daily
Hypotension can occur with propranolol
The nurse would instruct a client receiving acebutolol about which of the following adverse effects?
In which form is Esmolol only available?
Which of the following factors would necessitate a reduction in the dosage of disopyramide?
IV lidocaine blood concentration levels should remain below
You are caring for a patient who takes an antidysrhythmic. What would be a priority nursing action before administering this drug?
Check the patient's apical and radial pulses
A patient on anti-arrhythmic drug therapy complains of nausea, vomiting, abdominal pain, diarrhea, and a ringing sensation in the ears. Which of the following drugs should the nurse consider as the cause for these adverse effects?
When caring for a patient with a cardiac dysrhythmia, the most appropriate goal for the patient is what?
Maintain cardiac output
Urinary retention during administration of disopyramide (Norpace) is caused by which of the following?
Your ED patient presents with dyspnea, tachycardia, and chest pain. He has a history of cardiomyopathy. Your assessment reveals hypotension with an apical pulse of 134 bpm. What would you conclude might be causing the symptoms?
Inadequate cardiac output
The pathway for blood flow through the heart is:
Right atria to right ventricle to pulmonary artery through lungs to pulmonary veins to left atria and then to left ventricle.
What is the treatment strategy for anginal pain?
The client is experiencing an acute onset of angina. The nurse would administer which of the following medications?
The nurse is administering sublingual nitroglycerin to a patient. Prior to administering the medication, the nurse informs the patient that immediately after administration, the patient may experience what?
Throbbing headache or dizziness
A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for which of the following? Why?
When combined, nitrates and calcium channel blockers can cause symptomatic orthostatic hypotension.
Which of the following agents would be most appropriate for a client with Prinzmetal's angina?
Anti-anginal drugs are used in the treatment of
cardiac disease for which of the following? Select all that apply.
Relieve the pain of acute anginal attacks.
Prevent angina attacks.
Treatment chronic stable angina pectoris
When describing the possible adverse effects associated with nitroglycerin, which of the following would the nurse include?
adverse effects of nitroglycerin (Nitrostat) include
hypotension, bradycardia, peripheral edema, heart block, flushing and rash
Beta-adrenergic blocking agents decrease the oxygen demands of the heart by what mechanism?
Decreasing the heart rate
Nitrates can result in which of the following adverse reactions? (Select all that apply)
For relief of acute angina and for prophylaxis before events that cause acute angina, what is the primary drug of choice?
The nurse knows that what are the goals of antianginal drug therapy? (Select all that apply.)
To relieve acute anginal pain
To improve exercise tolerance and quality of life
To prevent MI and sudden cardiac death
The use of nitrates should be avoided in clients taking which following medications?
phosphodiesterase enzyme type 5 inhibitors (erectile disfunction meds)
Which of the following would a nurse identify as a nitrate?
You are caring for a client who takes sublingual nitroglycerin. This version of the drug typically begins acting within
one to three minutes
When describing angina to a group of clients, which of the following would be most accurate?
Pain due to lack of oxygen in the heart muscle
You are caring for a client who is taking a calcium-channel blocker. What adverse effects would you caution this patient about?
Headache and dizziness
A 48-year-old black man with an extensive history of hypertension and obesity returns to your office for a 6-month check on his attempt to decrease risk factors for his CAD progression. What other risk factors are included in metabolic syndrome?
Elevated fasting glucose
Which of the following should the nurse tell the client about storage of oral nitroglycerin products? Select all that apply:
keeping tablets and capsules in their original container, never mixing oral nitroglycerin with other drugs in a container, never storing oral nitroglycerin in a plastic container, and always replace the container tightly and as soon as the drug is removed.
You are caring for a 59-year-old client who has been prescribed nitroglycerin to control angina. Which of the following adverse effects might you observe in this patient?
To relieve angina pectoris symptoms, the nurse administers nitroglycerin sublingual to the patient. Which of the following is an action of nitroglycerin?
Decreases myocardial oxygen consumption
Mr. Lang, a 52-year-old man who experienced a myocardial infarction, has a physician's order for discharge. Part of the discharge teaching includes prior administration of nitroglycerin for chest pain. Which statement by the patient indicates that he understands the teaching provided?
"I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately."
A physician has prescribed sublingual nitroglycerin and the nitroglycerin patch for your patient. When explaining the medications to your client, what advantage of the patch might you mention?
It has a longer duration of action.
A client using a nitroglycerin patch should avoid which of the following?
A patient is using propranolol for treatment of angina. The nurse understands that this drug is administered by which route?
You are an ED nurse caring for a patient who is receiving furosemide for treatment of pulmonary edema. Which of the following will you monitor to observe for adverse effects of the drug?
low potassium levels
Potassium-sparing diuretics are contraindicated in what clients? Why?
high risk of hyperkalemia.
A physician is considering ordering hydrochlorothiazide for a patient. This drug must be used cautiously, if at all, if the patient has a history of
hypersensativity to sulfonamides
A female patient reports that she has frequent muscle cramps while on hydrochlorothiazide therapy. The nurse will advise her to
eat potassium-rich foods.
Where does the countercurrent mechanism occurs?
loop of Henle
Your 91-year-old patient, who is being prepared for discharge, has been prescribed the diuretic spironolactone. While teaching your patient about the drug, what major adverse effect should you be sure to mention?
A physician has prescribed a loop diuretic for a patient with hypertension. The patient also has diabetes mellitus. What condition should the nurse monitor for in this patient after administering the prescribed drug?
Increased blood glucose levels
A nurse understands that loop diuretics are considered high ceiling diuretics because of which of the following?
They cause a greater diuresis.
A nurse is caring for a patient with acute renal failure. The physician has prescribed a diuretic therapy for the patient to promote dieresis. What intervention should the nurse perform to prevent the inconvenience caused by increased urination?
Administer the drug early in the day.
Your patient is a 36-year-old man who undergoes dialysis three times weekly while waiting for renal transplant. A diuretic has been added to his current medications to combat developing edema. Why would potassium-sparing diuretics be contraindicated?
They may cause hyperkalemia.
The students are discussing the electrolytes in the body. What should the students know has the greatest influence on potassium loss from the body?
A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?
A student asks the pharmacy instructor what the difference is between the diuretics spironolactone (Aldactone) and furosemide (Lasix). What would the instructor reply?
Potassium losses are less with spironolactone
A physician prescribes diuretic therapy to a patient with nephrotic syndrome. The patient experiences hyponatremia as an effect of the therapy. Which of the following symptoms of hyponatremia should the nurse monitor for in the patient?
tachycardia, cold and clammy skin, confusion, and hypotension
Your 91-year-old patient is being discharged on the diuretic spironolactone (Aldactone). What is the major adverse effect of this type of medication?
You are caring for a patient who is experiencing elevated intracranial pressure following neurosurgery. The physician orders an osmotic diuretic to reduce pressure. Which of the following agents would the physician select?
A clinic nurse has been assigned to follow up with a group of patients on hydrochlorothiazide therapy. Which patient will the nurse most closely monitor for hyponatremia?
patients with diabetes or advanced arteriosclerosis should be monitored closely during hydrochlorothiazide therapy, older patients (over 65 years), especially women, are more at risk for hyponatremia.
A client comes to the clinic for a 1 month follow-up appointment. They tell the nurse they have been taking chlorothiazide (Diruil) for the month it has been prescribed and now they have leg cramps and "feel tired all the time." What will the nurse consider as the cause of the patient's symptoms?
muscle weakness, fatigue, and arrhythmias
What are the symptoms of hyponatremia?
weakness, nerve disorders, weight loss, salt hunger, cramps, and digestive problems
A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms?
A physician prescribes spironolactone, a potassium-sparing diuretic, for a patient with cirrhosis. For which of the following categories of patients is the use of potassium-sparing diuretics contraindicated?
Patients with hyperkalemia
After teaching a group of students about loop diuretics, the instructor determines that the teaching has been successful when the students identify which agent as the safest for use in the home? Why?
less powerful than bumetanide and torsemide and therefore has a larger margin of safety for home use
You are caring for a patient in the Emergency Department (ED) who is in pulmonary edema. The patient is treated with furosemide (Lasix). What will you monitor?
Hyperkalemia presents with
cardiac arrhythmias and muscle weakness
Hypercalcemia is characterized by
fatigue, depression mental confusion, nausea, vomiting, and constipation
Hypocalcemia presents with
muscle spasms, facial grimacing, possible convulsions, irritability, and depression.
A nurse is caring for a patient receiving the anticoagulant drug warfarin. What pre-administration assessments should the nurse perform before administering the drug to the patient?
Assess prothrombin time (PT) and INR
A nurse is caring for a patient prescribed warfarin. Which of the following foods should the nurse inform the patient as having high vitamin K content?
Green leafy vegetables
A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the patient's
A client taking warfarin (Coumadin) tells the nurse she is having bleeding in the gums and teeth. When reviewing client history, the client states she has decided to try an herbal remedy. Which of the following is most likely the cause of increased bleeding?
The physician orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client
does not have peptic ulcer disease.
A 75-year-old client presents to the physician's office with complaints of bleeding gums and multiple bruises. When the nurse reviews his drug history, the nurse finds that he is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin?
Ms. Carter is discharged from the hospital after a myocardial infarction. The physician prescribes continuance of the drug clopidogrel at home to help prevent future myocardial infarction (MI). Five days after discharge, she contacts the physician's office with complaints of low-grade fever and painful GI distress. What important adverse effect(s) should the nurse instruct the patient to monitor for?
GI ulcers and bleeding
To effectively prevent or manage metabolic syndrome, what should the desired blood lipid profile include? Select all that apply.
High HDL cholesterol
Low LDL cholesterol
The nurse instructs a client to take the prescribed pravastatin at bedtime based on the understanding about which of the following?
the highest rates of cholesterol synthesis occur between 12 and 5 AM, and the drug should be taken when it will be most effective.
Name the 2 cholinergic receptors.
What are the 4 naes for drugs that stimulate the sympathetic nervous system?
alpha adrenergic agonist
beta adrenergic agonist
What are the three names for drugs that stimulate the parasympathetic nervous system?
What are the 4 names of drugs that block the stimulation of the SNS?
alpha adrenergic antagonist
beta adrenergic antagonist
What are the 3 names of drugs that block the stimulation of the PSNS?
What is adrenergic drugs action?
stimulate the SNS
Which adrenergic drug interacts directly with receptors on cell membrane?
What adrenergic drug interacts indirectly with receptors by stiulating norepinephrine secretion?
Which adrenergic drug acts both directly and indirectly on receptors?
What are adrenergic drugs primarily used for? (general)
What are the general indications fro adrenergic drugs? (specific)
prevent uterine contractions in preterm labor
When might the doctor order an adrenergic drug even though use in the patient is contraindicated?
if the patient's life is in danger and the need for the drug ourweighs the potential problem the drug could cause
WHat are the contraindications for andrenergic drugs?
druing second stage of labor
in what patietns should the use of andrenergic drugs be used cautiously?
What are the andrenergic drugs?
What reseptors does epinephrine stimulate?
What is epinephrine indicated fro?
What ration is epinephrine for inhalation?
What routs can epinephrine be given?
Why cant epinephrine be given oraly?
GI enzymes destroy it
Does epinephrine cross the placenta?
Does epinephrine cross the bbb?
describe epinephrine's onset of action and half life
short half life
What is the specific treatment for anaphylaxis with epinephrine?
relieves bronchospasm, laryngeal edema, and hypotension
What is the epinephrine ratio for the treatment of coariopulmonary resuscitation?
What SNS reseptors does pseudophedrine stimulate?
What is pseudophedrine used for?
how is pseudophedrine administered?
Does a patient need a perscripton for pseduophedrine?
no, it is available OTC
Is pseudoephedrine addictive?
yes, highy addictive
What SNS reseptors doea phenylephrine stimulate?
What is phenylephrine used fro?
increase BP in shock and hypotension
In use for patients suffering from shock or hypotension, how is phenylephrine administered?
For patietns with nasia congestion, is a percription nesisary for phenylephrine?
no, it is available OTC
Does henylephrine cause increased HR?
How long should the use of phenylephrine be limited to?
What weight control drug was prohibited by the FDA in 2004? Why?
linked to HTN, stroke, MI and death
When is IV administrstion of adrenergic drugs utilized?
what are the route of choice for anaphlatic shock?
IV or Sub Q
What drugs can be used for hypotension/ shock?
decreased blook supply to bodily tissuses
What are the results of shock?
impaired tissue perfusion
lactic acid accumulation
What is the goal for all shock states?
correct underlying problem
prevent organ failure
how are drugs for hypotension and shock administered?
What action does 0.5-3mcg/kg/min of dopamine cause?
stimulate dopamine receptors
dialates renal arteries improving blood flow to kidneys
What action does 2-20 mcg/kg/ min of dopamine cause?
stimulates beta receptors
consdtricts vessils to increase BP
What action does 20-50 mcg/kg/min of dopamine cause?
stimulates alpha and beta receptors
What is the difference between dopamine and dobutamine?
dopamine is a natural occurring catecholamine
dobutamine is a synthetically made catecholamine
What receptor does dobutamine stimulate?
What effect does dobutamine elicit?
increase in cardiac output by improving contractility of the heart
Why is ddobutamine preferred over dopamine?
dobutamine had less risk for tachycardia
At low doses, what receptor does epinephrine stimulate?
At high doses, what receptor does epinephrine stimulate?
What action does Milrinone have?
increase CO in cardiogenic shock
What receptors does Norepinephrine stimulate?
What receptors does Phenylephrine stimulate?
Describe the cardiac effect of Phenylephrine compared to epinephrine.
Why should urine output be monitored in patients on vasoactive medications?
decreased urine output due to constriction of vessles
In what client population should casocative bedications be used cautiously?
What does titration refer to in the use of vasoactive medications?
start at the lowest dose possible, increase slowly; decrease slowly
Which viens are preferred when administering vasoactive drugs?
What are the therapeutic effects of vasoactive drugs?
urine output 30ml/hr
MAP optimal 70
What are the adverse effects associated with vasoactive drugs?
nercrosis and extravastion- at administration site
rebound nasal congestion with decongestants
excess CNS stimulation
decreased urine output
What are the circumstances that IV administration of vasoconstrictors?
critical care seting with infusion pump
What shoud the nurse moniror in patients on vasoactive drugs?
What drugs can be used as antiadrenergic drugs?
give an example of an alpha 2 adrenergic agonist
what is the MOA of clonidine, a apha 2 adrenergic agonist?
inhibits release of norepinephrine resulting in DECREASED BLOOD PRESSURE
What disorders can clonidine, a alpha 2 adrenergic agonist, be used for?
Can clonidine, an alpha 2 adrenergic agonist cross the bbb?
yes because it is very lipid soluble
What is a major side effect of clonidine?
What may happen as a result of the dialation of vessels associated with clonide?
SNS activation due to barroreseptors activated by decrease in BP
What suffix is associated with selective alpha adrenergic blocking agents?
What action does terazosin, doxazosin and prazosin have?
block alpha 1
resulting in vasodilation and decreased BP
What action does tamsulosin have?
relax prostate and bladder which decreases urinary retention
What medication would you give a patient with Benign Prostatic Hyperplasia (BPH)?
What are the side effects of selective alpha adrenergic blocking agents?
-1st does effect: hyotension
inhibition of ejacuation
What method is utilized to minimize the 1st dose effect for selective alpha adrenergic blocking agents?
give medication at bed time
Why is the inhibition of ejactuation a seriouse side effect of selective alpha adrenergic blocking agents?
may lead to noncompliance
What is an example of nonselective alpha adrenergic blocking agents?
What does phentolamine, a nonselective alpha adrenergic blocking agent, result in?
What advers effects are associated with phentolamine?
what is the drug of choice to control BP with pheochromocytoma (tumor on adrenal medulla causing excess secretion of epinephrine and norepinephrine)?
What is the drug of choice to prevent sloughing after extravation?
What is the suffix associated with selective beta blockers (cadioselective)
What is the most common cardioselective beta blocker?
What effect does metoprolol, a cardioselective beta blocker, have?
slow AV conduction
decrease carsiac contractility
decrease renin activity
thus decreases the O2 demand of the heart
In what patients should cardioselective beta blockers be used cautiously?
diabetics- blocks symptoms(tachycardia) of hypoglycemia
What patients would metoprolol be contraindicated?
Because metoprolol decreases the O2 demand of the heart, what population might the drug be given to?
those with lung disease
Propanolol is an example of what category of drugs?
nonselective beta blockers
What is propanolol used for?
Does propanolol cross the bbb?
in what populations would propanolol be used cautiously?
diabetics- inhibits glycogenolysis
lung diseases- causes bronchoconstriction
What are the side effects of propranolol?
What may occur as a result of abruptly stopping any beta blocker?
exasperated beta activion leading to SNS activation
What are the cholinergic drugs?
What is the MOA for cholinergic drugs?
stimulates the PSNS by mimicking acetylcholine
Does cholinergic drugs cross the bbb?
How do direct-acting (agonist) cholinergic drugs act?
bind to nicotinic or muscarinic reseptors
How do indirect- acting cholinergic drugs act?
inhibit cholinesterase which makes more Ach availabke at receptor sites
Whatis bethanecol used for?
What is pilocarpine used for?
What is neostigmine used for?
diagnosis and treatment of myasthenia gravis
What is edrophonium used for?
diagnosis od myasthenia gravis
What is donazipil used for?
Cholinergic drugs is the antidote for
What contraindicates the use of cholinergic drugs?
bowl disoders/recent bowl surgery
What is atropine the antidote for?
What are some specific nursing implications for patients receiving cholinergic drugs?
monitor liver function
What is the MOA for anticholinergic drugs?
blocks the receptor sites of acetylcholine
Do anticholinergic drugs cross the bbb?
What drugs are clasified as anticholinergic drugs?
A does of less than 0.5mg of anticholinergic medication causes
A dose of 0.5-1 mg of antichoinergic medication causes
What are the effects of anticholinergic drugs?
What is the drug of choice for symptomatic bradycardia?
Why is atropine the drug of choice for symptomatic bradycardia?
effects only the HR, not the blood vessles
What is dicylomine used for?
What is oxybutynin, tolterodine, darifenacin, or solifenacin used for?
What is scopolamine or isopto-atropine used for?
dialate eyes for intraocular surgury
What is ipratropium used for?
What is atropine used for?
preoperative to decrease salivation/secretions
What is benztropine used for?
What are the adverse effects of anticholinergic drugs?
What are anticholinergic drugs counterindicated fro?
If giving dicyclomine, an anticholinergic drug, for GI disorders, when should the drug be taken?
30 min before meals
Why is atropine a good choice with the use of preop meds?
it can be mixed in the same syringe with the other drugs
What is the antidote for anticholinergic drugs?
What are crystalloids used for?
manage F&E imbalances
What is the 1st line of treatment for fluid deficit?
What is the risk for hypersensitivity with crystalloids?
What is the composition of hypertonic crystalloid solution?
3-5% NaCl, 50% dextrose
What is the composition of an isotonic crystalloid solution?
0.9% NaCl, lactated Ringers, 5% D5W
What is the composition of an hypotonic crystalloid solution?
What are examples of colloids?
What effect does colloids elicit?
increase colloidal oncotic pressure
What are colloids used for?
What is albumin composed of?
What form of administration are colloids?
What pregnancy category are colloids?
pregnancy category C
When id albumin contraindicated?
WHat are the blood componetns
packed red blood cells
fresh frozen plasma
Describe the MOA of ACE inhibitors
block constriction from Anginotension II
What suffix is associated with ACE inhibitors?
What action does ACE inhibitors have?
relaxation of blood vessels
decreased blood volume
Describe the MOA of ARBS
angiotension II receptor blocker
What are ARBS used for?
decrease O2 demand
for increased BP
What suffix is associated with ARBS?
Describe the MOA of calcium channel blockers
block Ca from moving into cells
What action does calcium channel blockers have?
dialates peripherial arteries
decrease HR-diolate myocardial arteries
slows conductivity cia AV node
In HF, what effect does the SNS stimulation have?
In HF, what effect does endothelin have?
In HF, what effect does RAAS have?
How is preload decreased in HF?
Na and fluid restriction
What complications can arise with HF?
hypertrophy of myocardium
increased venos congestion
What is the goal of care for patients with HF?
block compensatory mechanisms
limit/reverse cardiac remodeling
What is the first line or drug therapy for HF?
or beta blocker
What drugs can be used for HF?
What is the MOA for Digoxin?
inhibits KNaATPace enzyme
increase Ca movement into cell
positive inotropic-increase pump
negative chronotrioic- decrease HR
positive dromotropic-speed of conduction
What effect does administration with food have on Digoxin?
Does Digoxin cross the placenta?
What is digoxin used for?
Does Digoxin improve survival in HF patietns?
Can Digoxin be used in children?
yes but use should be managed by a pediatric cardiologist
What patients would need a decreased dose of Digoxin?
What are the adverse effects of Digoxin?
In what patients would the use of Digoxin be contraindicated?
What is the theraputic range for Digoxin?
What is the onset for Digoxin administered IV?
What is the onset for Digoxin administered oraly?
30 min -2 hrs
What is digitalization?
administering a higher dose initialy to achieve therapeutic dose faster
What can Digoxin toxicity result from?
impared renal function
What are the signs of Dig toxicity?
visual distubances (halo)
What is the treatment for Dig toxicity?
treat electrolyte disturbances
avtivated charcoal, digoxin immune fab, IV digbind
What is the QSEN for Digoxin?
always get the same brand and type
What should the nurse do before administering digoxin?
check apical pulse
When should Digxin be taken?
same time each day
How often should a patient taking Digixin be weighed?
What is an example of phosphodiesterase inhibitor?
What is the MOA for mirlrinone?
What is mirlrinone indicated for?
short-term use for HF symtoms not controlled by other meds
In what populations is mirinone used cautiously?
What are the adverse effects of milrinone?
What are the nursng implications fro milrinone?
continuous cardia monitoring
frequent vital signs
monitor platlet count/electrolytes
What is an example of hyman B-type natriuretic peptide?
What is nesiritide's MOA?
suppress RAAS-increase diuresis
What is nesiritide indicated for?
acute decompensated HF
What are the adverse effects of nesiritide?
What is unique about the IV line to give nesiritide?
dedicated IV line
not compatable with other drugs
When should nesiritide not be administered?
SBP <90 mmHg
What effect can licorice have?
What effect may Hawthorn have?
increase effects of ACE inhibitors
What effect may ginseng have?
worsen dig toxicity
What is the term for rapid atrial dysrhythmias?
What is the most common non life-threatening dysrhythmia?
What are dysrhythmias caused by?
What is the result of antidysrhythmic drugs?
slow conduction and prolong refractory perios
What are the adverse effects af antidysrhythmias?
prolonged QT interval
cardiac conduction depletion
What classes of drugs are considered antidysrythmias?
Sodium channel blockers
potassium channel blockers
calcium channel blockers
What is the MOA for calcium channel blockers?
blocks the ovement of Na into cells slowing conduction and prolonging the refractory period
What drugs are included in class IA- atrial/ ventricular dysrhythmias?
What is the advers effect of quindine?
What should be monitord in patients while on class IA- atrial/ ventricular dysrhythmias?
prolonged QT interval
What medications are included in Class 1B- ventricular dysrhythmias?
What is the MOA of lidocaine and mexiletine
decrease automaticity in the ventricals
What drug is classified as Class 1C- ventricular dysrithmias?
What may propafenone be used in?
What is the MOA for propafenone?
slows conduction and refractory period
What is the MOA of beta-adrenergic blockers?
prolongs PR interval
What type of dysrhythmias are beta blockers used to treat?
What can propranolol be used to treat
What is the most common type of antidysrhythmic medication?
potassium channel blockers
What medications are classified as potassium channel blockers?
what type of dysrhythmias can potassium channel blockers be used for?
atrial and ventricular
What is the MOA of potassium channel blockers?
slows AV conduction
delays repolarization resulting in prolonged QT interval
What is the first choice to treat atria dysrhythmias?
What BBW is associated with amiodarone?
potentially fatal pulmpnary toxicity
What are the side effects of amiodarone?
accumulation in liver, lungs, eyes, fat, and skin
drug drug interactions
What are the only two calcium channel bloackers used to treat dysrhythmias?
What is the MOA for calcium chanel blockers?
block the movement of Ca into conuction and contraction cells of the myocardium
reduces automaticity in SA node
What type of dysrhythmias are diltiazem and verapamil used to treat?
WHat are the adverse effects of calcium channel blockers?>
In what patients would the use of calcium chanel blockers be contraindicated?
What the the MOA of adenosine?
stops AV conduction
10 sec half life
What is adenosine used for?
re-establishing normal rhythm with rapid atrial dysrhythmias
Why might magnesium sulfate be given to treat dysrhythmias?
hypomagnesemia can cause life threatening dysrhythmias
In what populations should all antidysrhythmia drugs be used cautiously?
What does angina result in?
decreased blood/ O2 supply tto the heart muscle causing pain
What are the medication that can be used for angina?
calcium channel blockers
What medications are included in the category of organic nitrates?
What are the oral forms of organic nitrates?
What is the MOA of organic nitrites?
dialates arteries- decrease BP, decrease afterload
dialates veins- decrease venous return, decrease preload
dialates coonary arteries- increases O2/ blood flow to myocardium
What are the indications for the use of organic nitrites?
prevention of angina pain
What are the adverse effects of organic nitrates?
In what patients would the use of organic nitrites be contraindicated?
What medications should not be taken while on organic nitrites?
phosphodiesterase enzyme type 5 inhibitors (erectile dysfunction medications)
What formulations are available for nitroglycerin?
What is the QSEN in relation to the duration of nitrate use?
tolerance my develop with long term use so nitrate free intervals should be utilized
What vital sign must be monitored closely in patients taking nitrates?
How should th paitent be indtructed to take sublingual tabs for acute pain?
1 tab q 5 min x 3 doses
What type of storage is nesisary for nitrites?
out of direct sunlight
What medications can not be taken while on nitrates?
OTC decongestiants, cold meds, diet pills
What special implications should be used with nitroglycerin transdermal ointment?
alternate sites on chest wall/ upper arms
wipe residual ointment off before reapplying
nuseses must wear gloves
What is the drug of choice for CAD?
What is the QSEN associated with beta blockers?
do not abruptly stop a beta blocker
What are calcium channel blockers used for?
In what patients is calcium channel blockers contraindicated?
What medications are associated with calcium channel blockers for angina?
In what patients should calcium channel blockers be used cautiously due to the location of metabolism and excretion?
WHat medication is considered a metabolic modulator?
What is the unclear MOA?
prevents Ca overload and diastolic tension
What other medications may ranexa be used in combination with for angina?
Ca channel blocker
In what patients is ranexa contraindicated?
What is the adverse effect of ranexa?
What medications may be used as adjunctive therapy with angina?
What constitutes the diagnosis of HTN in a patient?
BP >140/90 repeatedly
What causes HTN?
RAAS- angiotensin II= increased afterload
aging-decreases elasticity of vesels
What is known as the "signlent killer"?
What catigories of drugs are used to treat HTN?
calcium channel blockers
While taking ACE inhibitors, what actions should be taken to prevent hypotension?
start at a low dose
HS- take at bed time
What medication is recommended to preotect against diabetic nephoprophy associated with HTN?
In what patients should ACE inhibitors not be used?
renal artery stenosis
Hyperkalemia may develop in what patietns taking ACE inhibitors?
taking K supplements
K sparing diuretics
What pregnancy category are ACE inhibitors?
pregnancy category x
What side effect occurs in 10-20% of patients taking ACE inhibitors?
What advantages do ARBs have over ACE inhibitors?
well tolerated-rare instance of coughliss likel to cause hyperkalemia
What pregnancy category are ARBs?
pregnancy category x
What drug catagorrries are considered antiadrenergics?
alpha 1 adrenergic antagonist
alpha 2 agonist
What suffix is associated with apha 1 antagonists?
What significant first dose effect is seen in patietns taking alpha 1 antagonists?
Because of the orthostatic hypotension associated with alpha 1 antagonist, when should the first dose be given?
What drugs are catoagorised as alpha 2 agonist?
What drug is recommended for pregnant woment with HTN?
What is the drug of choice for African American patients with hypertension?
calcium channel blockers
What category of drugs should be the first line of treatment for HTN?
What action does hydralazine have?
What action does nitrprusside have?
arteriole and venule relaxation
Why must nitrpusside be kept out of the light and not used for extended periods of time?
metabolizes into syanide
What population may be more susceptible to the adverse effects of HTN medication?
What must the nurse monitor for in patient taking diuretics?
What can decrease the effectiveness of anitHTN drugs?
weight loss meds
What effect can caffine have on HTN?
What drug used to treat erectile dysfunction may effect BP?
Even if patients are NPO, should they continue their cardiac meds?
What is the functional unit of the kidneys?
What are the indications for diuretics?
Initially, what happens to CO?
What suffix is associated with thiazide diuretics?
What is the MOA for thiazide diuretics?
decrease reabsorption of Na, H2O, Cl, and HCO3 in distal convoluted tubule
Why are thiazide diuretics relatively weak diaretics?
most Na isn't reabsorbed in the distal convoluted tubule
When would thiazide diuretics be ineffective?
GFR is low
What is the first line of drugs for HTN?
How is hydrochlrothizide administered?
How is chlorothiazide administered?
What are the adverse effects associated with thiazide diuretics?
In what patients would thiazide diuretics be contraindicated?
hypersensitivity to thiazides or sulfonamide agents
What doses of thiazide diuretics are most effective?
low doses- 12.5-25 mg
What drugs are considered loop diuretics?
What is the MOA for loop diuretics?
inhibit Na & Cl reabsorption in asending loop of henle
What effect will titrating the dose of loop diaretics upwards produce?
What methods of administration can loop diuretics be given?
What is the onset of action for loop diuretics given PO?
What is the onset of action for loop diuretics given IV?
What are lop diuretics indicated for?
pulmonary edema( rapid elimination of fluids)
What are the adverse effects associated with loop diuretics?
In what patients the use of loop diuretics contraindicated?
hypersensitivity to thiazides or sulfonamide agents
What drugs are considered potassium spairing diuretics?
What is the MOA for potassium sparing diuretics?
decrease Na reabsorption and K excretion in distal tubule
What are the indications for potassium sparing diuretics?
What are the adverse effects of potassium spairing diuretics?
other electrolyte imbalances
What is the BBW for potassium sparing diuretics?
has caused benign and malignant tumors to arize in rates while taking extremely high dose for extended periods of time
In what patietns is potassium sparing diuretics contraindicated?
What drugs are catergorized as osmotic diuretics?
What is the MOA for mannitol?
increase osmotic pressure of glomerular filtrate, pulling water into vascular system, increasing blood volume, decreasing reabsorption of Na and H2O
What are the indications for mannitol?
increace intracranial pressure
How must mannitol be administered?
IV with filter at room temp
In what populations would a smaller dose of diuretis be ndicated?
Why is furosemide given in large doses?
in renal disease to achieve diuretic responce
What should the nurse monitor in patients taking diuretics?
for hyperkalemia with potassium sparing diuretics
What effect can diuretics have when taken with Digoxin?
increased risk for dig toxicity
What foods are high in K?
What diuretic drugs are most commonly used in children?
How should diuretic injections be given?
slowly over 2 min
What effect can rapid IV administration of furosemide have?
What is the result of anticoagulants?
prevent clot formation
prevent clot extension
What actions does heparin exhibit?
-inhibits conversion of prothrombin to thrombin
-inactivates IX, X, XI, XII
-prevents conversion of fibrogen to bibrin
WHat is the onset of action for heparin given IV?
What is the onset of action for heparin given sup Q?
Does heparin cross the placenta?
What is the anticoagulant drug of choice in pregnancy?
What are the indications for heparin?
risk for clots (immobility, surgical;, smoking, a fib, dialis)
during procedures( dialysis)
What does the use of heparin require monortoring of?
What should the PTT be while on Heparin?
What are the advers effects of heparin?
heparin induced thrombocytopenia (HIT)
In what patients would the use of heparin be contraindicated?
Blood dyscrasias( thrombocytapiena)
What drug is considered a low molecular weight heparin (LMWH)?
How should enoxaparin be administered?
sub Q in abdominal area
Does enoxaparin require monitoring of aPTT?
What is the prophylaxis dose of enoxaparin?
30-60 mg sub Q q 12hr
What is the therapeutic dose fro enoxaparin?
At what platlet count would enoxaparin be held?
less than 1000000
What is the antidote for heparin and enoxaparin?
Promine sulfae IV
What is the MOA for warfarin?
prevents synthesis of II, VII, IX, X (vit k dependent clotting factors)
How is warfarin administered?
How long does ti take for warfarin to be effective?
Why might a patient be on heparin/enoxaparin and warfarin?
while warfarin is becoming effective
What percentage of warfarin is protein bound?
What are the indications for warfarin?
long term prevention/management of thromboembolic disorders
In what patients would warfarin be contraindicated?
What monitoring is required fro patietns taking warfarin?
What rekationship does warfarin have with othe rdrugs?
many drug-drug interactions increasing or decreasing effectivness
What food should patients on wardarin be taught to eat on regular basis?
high in vit k
green leafy veggies
What pregnancy category is warfarin?
pregnancy category x
What is the antidote for warfarin?
What action does fondaparinux have?
reduces production of thrombin
inhibits factor Xa
How is fondaparinux administered?
sub Q daily
What is fondaparinux indicated for?
What is an adverse effect of fondaparinus?
What drugs are catagorised as direct thrombin inhibitors?