Module IV Meds

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Match the anticoagulant to the correct reversal agent.

Reversal agents:
Vitamin K
Andexanet alpha
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Terms in this set (44)

...Anaphylactic shock is a life threatening allergic reaction characterized by angioedema, bronchoconstriction, edema, and urticaria (hives). Corticosteroids (methylprednisolone), antihistamines (diphenhydramine/Benadryl), albuterol, and epinephrine are all used in the treatment of anaphylactic shock. Atropine would not be indicated in this condition.

...Pernicious anemia is due to a vitamin B12 deficiency and would be treated with cyanocobalamin (Vitamin B12). Ferrous sulfate is a form of oral iron replacement used to treat iron deficiency anemia. Filgrastim (Neupogen) is used to stimulate the bone marrow to produce white blood cells. Epoetin alpha (Epogen, Procrit) is used to stimulate the bone marrow to produce red blood cells.
An isotonic IVF also known as normal saline

..Normal saline is an isotonic, 0.9% sodium chloride IVF. Ringer's lactate solution, or lactated Ringer's solution, is a type of isotonic, crystalloid fluid further classified as a balanced or buffered solution used for fluid replacement. The contents of Ringer's lactate include sodium, chloride, potassium, calcium, and lactate in the form of sodium lactate. Ringer's is especially useful for aggressive fluid replacement needed for severe burns, severe blood loss, and sepsis. Normal saline is the most widely used IVF, generally effective for management and treatment of dehydration (e.g., hypovolemia, shock), metabolic alkalosis in the presence of fluid loss, and mild sodium depletion.
Dapagliflozin was initially FDA approved for non-insulin dependent diabetes (NIDDM) but was found to have cardiovascular benefits in patients with NIDDM and then obtained FDA approval for heart failure. Lisinopril is an angiotensin converting enzyme inhibitor (ACEI), digoxin is a cardiac glycoside, and furosemide is a loop diuretic.
Why is epinephrine effective in the treatment of shock and asystole?

Epinephrine is a beta 1 agonist like dobutamine.
Epinephrine stimulates the parasympathetic nervous system, increasing heart rate and blood pressure.
Epinephrine stimulates the sympathetic nervous system, increasing heart rate and blood pressure.
Epinephrine is a beta 2 agonist like albuterol

..Norepinephrine is the primary neurotransmitter of the sympathetic nervous system. Antagonism of this neurotransmitter will lower heart rate and blood pressure by blocking the effects of norepinephrine. Acetylcholine is the primary neurotransmitter of the parasympathetic nervous system and the peripheral nervous system. Dopamine is a central neurotransmitter responsible for mood, pleasure and is the primary neurotransmitter of the reward center in the brain. GABA is an inhibitory neurotransmitter in the CNS.
Sodium restriction
Phosphorous restriction
Phosphorous restriction

...Fluids, sodium, potassium, and phosphorous are usually restricted for patients on dialysis. Calcium is not restricted and is in fact usually supplemented in dialysis patients. Carbohydrates do not require adjustment for renal disease. Protein may need to be restricted in chronic renal disease although with progression to dialysis, protein needs may increase somewhat.
How are antiplatelet medications different from anticoagulant medications?

All antiplatelet medications require a prescription. The same is not true for anticoagulant medications.

Antiplatelet medications are primarily used to prevent thrombosis in arteries. Other anticoagulants are for venous thrombosis.

Antiplatelet medications are all available in pill form, some anticoagulants need to be administered intravenously or by subcutaneous injection.

There are no affordable antiplatelet medications currently available. The same is not true for anticoagulant medications.
Antiplatelet medications are primarily used to prevent thrombosis in arteries. Other anticoagulants are for venous thrombosis.

...Antiplatelet medications such as aspirin are both very affordable and available without a prescription. These drugs are used to prevent thrombosis in arteries (aspirin, clopidogrel). Glycoprotein IIB/IIA receptor antagonists are antiplatelet medications that are available only in IV formulation. Anticoagulant medications include warfarin which is very affordable, and heparin and enoxaparin which are both available for injection only. Anticoagulants are used for venous thromboembolism. All anticoagulants require a prescription.
Which of the following is necessary for absorption of vitamin B12? Intrinsic factor Erythropoietin Vitamin DIntrinsic factor ...Intrinsic factor is produced in the terminal ileum of the small intestine and is necessary for vitamin B12 absorption. Vitamins C and D are not required for B12 absorption and erythropoietin is a hormone produced by the kidneys that promotes bone marrow production of red blood cells. Erythropoietin does not directly affect vitamin B12 absorption.Which of the following medications is classified as a low molecular weight heparin? Enoxaparin Warfarin Heparin ApixabanEnoxaparin ...Enoxaparin (Lovenox) is classified as a low molecular weight heparin. Heparin and warfarin are each in their own class and apixaban (Eliquis) is a factor Xa inhibitor.Which of the following medications should the nurse anticipate administering to a patient hospitalized for an acute MI? Select all that apply. Diuretic Nitrate Cardiac glycoside Metoprolol AspirinMetoprolol Nitrate Metoprolol Aspirin ...A beta blocker (metoprolol), aspirin, and a nitrate (nitroglycerin or isosorbide) will very likely be ordered for a patient who has had an MI who is either waiting for a stent or bypass surgery or is not a candidate for either procedure. Diuretics (furosemide) and a cardiac glycoside (digoxin) are generally used for congestive heart failure.What class of medication does streptokinase belong in? Thrombolytic Antiplatelet Heparin Factor Xa inhibitorThrombolytic ..Streptokinase is a thrombolytic medication which is given to dissolve an existing clot. This drug needs to be given within four hours of clot formation and is given intravenously only in hospital settings due to the potential for severe internal bleeding. Heparin, warfarin, and rivaroxaban (Xarelto) do not dissolve clots as part of their mechanism of action.Which of the following is an important objective measure of the effectiveness of diuretic therapy? Patient's fluid intake Patient weight Patient temperature Patient's most recent lab resultsPatient weight ...Diuretic medications are usually prescribed for hypervolemic states (CHF) and/or hypertension. Successful diuretic therapy is evaluated by monitoring patient weight and blood pressure. Patients with fluid overload should lose weight with diuretic therapy and blood pressure should also decrease. Monitoring lab results are important to determine renal function and electrolyte levels, however, these objective measures do not inform whether or not the medication has been effective. Patient temperature is not pertinent to diuretic therapy. Measuring fluid intake is important but again, this value does not inform the success of diuretic therapy.Based upon the following lab values, which of the following patients may require a dose adjustment of their prescribed medication? A male patient with a serum creatinine of 1.0 mg/dl A male patient with a serum creatinine of 1.3 mg/dl A female patient with a serum creatinine of 1.3 mg/dl A female patient with a serum creatinine of 1.0 mg/dlA female patient with a serum creatinine of 1.3 mg/dl ... Serum creatinine represents renal function. Normal serum creatinine values are as follows: men 0.8-1.4 mg/dl; women 0.6-1.2 mg/dl An elevated serum creatinine may be an indication of renal compromise. Medication dosages, especially doses of potentially nephrotoxic medications, need to be decreased if patients have elevated serum creatinine levels. Normal ranges for creatinine vary based upon gender due to differences in muscle mass between males and females.Which of the following medications would the nurse expect to administer to a patient with noninsulin dependent diabetes (NIDDM) and an elevated low density lipoprotein (LDL)? Atorvastatin Niacin Cholestyramine GemfibrozilAtorvastatin ..HMG-CoA Reductase Inhibitors, commonly referred to as statins, are the drugs of choice to lower LDL and are the standard of care for patients with diabetes. Drugs in this class include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin, rosuvastatin (Crestor), simvastatin (Zocor), and pitavastatin (Livalo). Gemfibrozil is a fibric acid drug which is most useful for lowering elevated triglycerides. Other drugs in this class include fenofibrate (Tricor) and fenofibric acid (Trilipex). Cholestyramine (Questran) is a bile acid sequestrant. These drugs will lower LDL but they are not as effective as statins and their GI side effects limit their usefulness. Other drugs in this class include colesevelam (Welchol) and colestipol (Colestid). Niacin (Niaspan) is vitamin B3 (nicotinic acid). This drug is most effective in lowering elevated triglycerides by decreasing VLDL levels. This is a prescription product and should not be substituted with over the counter B vitamin supplements.Which of the following medications is not classified as an anticoagulants? Heparin Rivaroxaban Warfarin ClopidogrelClopidogrel Clopidogrel, like aspirin, even though it does increase bleeding times, is classified as an antiplatelet drug, not an anticoagulant. Heparin, warfarin (Coumadin), and rivaroxaban (Xarelto) are all classified as anticoagulants. Heparin and warfarin are their own class each; rivaroxaban is a Factor Xa inhibitor.Match the medication to the correct drug class. Hydralazine Carvedilol Losartan Lisinopril Amlodipine vs Angiotensin receptor blocker B. Beta blocker C. Direct vasodilator D. Calcium channel blocker E. Angiotensin converting enzyme inhibitorHydralazine= Direct vasodilator Carvedilol=Beta blocker Lisinopril= Angiotensin converting enzyme inhibitor Amlodipine=Calcium channel blockerWhich of the following medications for heart failure is classified as a cardiac glycoside? Digoxin Sacubitril Lisinopril SildenafilDigoxin ...Digoxin is the only medication categorized as a cardiac glycoside. Sildenafil is a phosphodiesterase IV inhibitor (PD4-I). Sacubitril is a neprilysin inhibitor and lisinopril is an angiotensin converting enzyme inhibitor (ACEI).Which of the following should the nurse expect to inform a patient who is about to begin oral iron replacement therapy? Select all that apply. "Iron tablets should be taken with a full glass of water to promote adequate renal function." "Taking iron with a food high in vitamin C will improve your body's ability to absorb the iron." "It is best to take iron at bedtime on an empty stomach." "Iron therapy can be very constipating. Increasing dietary fiber and/or taking a stool softener are helpful in preventing constipation." "Taking iron with meals will help decrease any nausea or vomiting."Iron therapy can be very constipating. Increasing dietary fiber and/or taking a stool softener are helpful in preventing constipation." "Taking iron with a food high in vitamin C will improve your body's ability to absorb the iron." "Taking iron with meals will help decrease any nausea or vomiting." ...Iron tablets should be taken with food to prevent GI upset which is common when iron is taken on an empty stomach. Vitamin C containing foods will aid in the absorption of iron from the GI tract. Iron can be very constipating and patients should be educated to watch for this and manage it as needed. Taking any medication with a full glass of water helps promote renal function but is not pertinent to oral iron therapy.What is the role of intravenous fluids (IVF) in the treatment of shock? To preserve renal function To increase hemoglobin and hematocrit To preserve neurological function To restore intravascular volumeTo restore intravascular volume ...Intravenous fluids (IVF) treat intravascular hypovolemia due to severe blood loss, significant burns, or severe dehydration. While correction of volume deficits will certainly aid in supporting other bodily functions, such as the renal and nervous systems, that is not the main purpose of IVF replacement. IVF replacement can lead to dilutional decreases in hemoglobin and hematocrit. Only a blood transfusion will increase hemoglobin and hematocrit.Match the drug with its FDA approved indication. Omega-3-acid ethyl esters (Lovaza) Rosuvastatin (Crestor) Ezetimibe (Zetia) Alirocumab (Praluent) vs Lowers elevated LDL B. Familial hyperlipidemia with high LDL C. Add on therapy for elevated LDL D. Lowers elevated triglyceridesOmega-3-acid ethyl esters(Lovaza)= Lowers elevated triglycerides Rosuvastatin (Crestor)= Lowers elevated LDL Ezetimibe (Zetia)= Add on therapy for elevated LDL Alirocumab (Praluent)=Familial hyperlipidemia with high LDLWhich of the following best represents the mechanism of action of diuretic medications? Diuretics block the reabsorption of water and sodium through the gastric mucosa. Diuretics block the reabsorption of water and sodium in the kidney. Diuretics block the reabsorption of water and sodium in the large intestine. Diuretics block the reabsorption of water and sodium in the dermis and epidermisDiuretics block the reabsorption of water and sodium in the kidney. ...All diuretic medications act within the kidneys. Diuretics are classified by which area of the kidney they effect: osmotic diuretics-proximal convoluted tubule; carbonic anhydrase inhibitors-proximal convoluted tubule; loop diuretics-ascending nephron loop (Loop of Henle); thiazide diuretics-proximal distal convoluted tubule; potassium sparing diuretics-distal convoluted tubule. In general, diuretics will block the reabsorption of water ad NaCl (salt).Why is it important for nurses to educate patients on medication for hyperlipidemia to report symptoms of muscle soreness and/or weakness? Because of the risk of bone marrow depression Because of the risk of unpleasant side effects Because of the risk of hepatic toxicity Because of the risk of rhabdomyolysisBecause of the risk of rhabdomyolysis ...Rhabdomyolysis is a consequence of excessive muscle breakdown which leads to renal impairment and failure. Many different kinds of medications can cause rhabdomyolysis, but cholesterol lowering medications such as statins, fibric acid drugs, and ezetimibe are known to be associated with this particular adverse event. Symptoms of rhabdomyolysis include muscle soreness and weakness which is why we need patients to report these symptoms. While these are uncomfortable symptoms, comfort is not the most significant reason why patients should report muscle soreness and weakness. When these symptoms occur, the first primary strategy is for the patient to try another statin medication.Which of the following classes of medications for dyslipidemia are considered the safest? Bile acid sequestrants Fibric acid drugs HMG-CoA Reductase Inhibitors NiacinBile acid sequestrants ...Bile Acid Sequestrants will bind to bile acids increasing excretion of cholesterol through the bowel. These were the first drugs commercially available for dyslipidemia and these are the safest drugs for dyslipidemia; bile acid sequestrants have minimal systemic effects. Fibric acid drugs, niacin, and statins (HMG-CoA Reductase Inhibitors) all have the potential for serious liver toxicities (statins and fibric acid drugs) or cardiac dysrhythmias.Which of the following side effects are common with iron replacement therapy? Black stool Red bloody stool Green stool Clay colored stoolBlack Stool ...A common side effect of oral iron therapy is black stools. Iron therapy does not cause red, bloody stools. Clay colored stools are associated with liver disease and green stools represent bile in the stool.Which of the following side effects is commonly associated with ACE Inhibitors? Cough Peripheral edema Fatigue GI upsetCough ...A dry, nagging cough is a frequent adverse event associated with ACEIs. When this occurs, the medication is changed to another class of blood pressure medication. Other common side effects of ACEIs include dizziness, orthostatic hypotension, rash, and headache. Serious adverse events associated with ACEIs include angioedema, acute renal failure, and hyperkalemia. This class of blood pressure medication is also teratogenic and cannot be used during pregnancy.Which of the following are FDA indications for the use of a diuretic medication? Select all that apply. Pancreatitis Hypertension Cirrhosis Coronary Artery Disease Congestive Heart FailureCongestive Heart Failure Hypertension CirrhosisWhich of the following classes of medications results in vasodilation of coronary arteries? Calcium channel blockers Beta adrenergic blockers Nitrates AspirinNitrates ...Nitrates specifically dilate coronary arteries which will relieve ischemia during anginal episodes. Beta blockers do not vasodilate as part of their mechanism of action. The same is true for aspirin. Calcium channel blockers do have the ability to cause vasodilation but their vasodilation primarily occurs in peripheral blood vessels, not the coronary arteries.Which of the following medical problems could worsen if a patient with that problem is started on a diuretic medication? Renal failure Nephrolithiasis Coronary artery disease Pancreatic cancerNephrolithiasis ...A patient with a history of nephrolithiasis, or kidney stones, is susceptible to kidney stone formation if dehydrated. Diuretic therapy can precipitate a kidney stone if fluid intake does not compensate for the diuresis. Coronary artery disease could benefit if a patient has coexisting heart failure or hypertension. A patient with pancreatic cancer is not likely to experience a worsening of their condition because of a diuretic medication. Patients with renal failure on dialysis are frequently treated with diuretics to treat hypervolemia, hypertension, and promote renal function.Which of the following drugs are considered nephrotoxic? Select all that apply. Ibuprofen Prednisone Amphotericin B Acetaminophen GentamycinIbuprofen Amphotericin B Gentamycin ...Some drugs are referred to as nephrotoxic. These are drugs which can cause significant renal damage even at therapeutic doses. These drugs include NSAIDs (ibuprofen), some antiviral drugs, some antibiotics (gentamycin) (aminoglycosides), systemic antifungal drugs (amphotericin B), ACEI, some chemotherapies, some immunosuppressants, and contrast dye.Which of the following anti-arrhythmic drugs are available only for intravenous administration? Diltiazem Amiodarone Sotalol LidocaineLidocaine ...Lidocaine is given intravenously for the treatment of dysrhythmia. Beta blockers (sotalol), calcium channel blockers (diltiazem), and amiodarone (potassium channel blocker) are all oral arrhythmia drugs.Which of the following medications for dyslipidemia would be contraindicated in a patient with a history of anaphylaxis with seafood or shellfish? Lovastatin fenofibrate (Tricor) Cholestyramine (Questran) Omega-3-acid ethyl esters (Lovaza)Omega-3-acid ethyl esters (Lovaza) ...Omega-3-acid ethyl esters are found in fish oil. With any risk of severe allergy to seafood, this medication should not be used. None of the other medications for hyperlipidemia are contraindicated in patients with a seafood or shellfish allergy.Which of the following lab values would the nurse expect to monitor in a patient on statin therapy? AST/ALT Serum creatinine Serum potassium Hemoglobin and hematocritAST/ALT ...Statin medications are highly liver metabolized, therefore monitoring liver enzymes such as AST and ALT is the priority. Statins have minimal impact on the kidneys (serum creatinine) and no effect on serum potassium or red blood cells (hemoglobin and hematocrit). If levels of AST and ALT continually increase while a patient is on statin therapy, this needs to be investigated and the dose of the statin may need to be decreased or the drug may need to be stopped entirely.Which of the following classes of medications for dysrhythmia does not have a Black Box warning? Calcium channel blockers Sotalol Potassium channel blockers FlecainideCalcium channel blockers ...Calcium channel blockers used to treat dysrhythmia (verapamil, diltiazem) have no Black Box warnings. Sotalol, flecainide, and amiodarone (potassium channel blocker) all have Black Box warnings.Which of the following classes of diuretic medications is most commonly prescribed for the treatment of hypertension? Carbonic anhydrase inhibitor diuretics Thiazide diuretics Loop diuretics Osmotic diureticsThiazide diuretics ...Thiazide diuretics (hydrochlorothiazide, chlorthalidone) are commonly used as monotherapy or with ACEI or ARB medications for hypertension. Osmotic diuretics (mannitol) are used for cerebral edema and increased intracranial pressure. Loop diuretics (furosemide, torsemide) are used in the treatment of congestive heart failure and edema. Carbonic anhydrase inhibitors (acetazolamide) are used to treat glaucoma and altitude sickness among other indications.What is the typical clinical indication for a patient who is prescribed filgrastim? Anemia of chronic disease Pernicious anemia Sickle cell anemia Low white blood cells related to chemotherapyLow white blood cells related to chemotherapy ..Filgrastim (Neupogen) is used for patients with chemotherapy induced neutropenia (low white blood cells), chronic neutropenia (HIV), and patients undergoing bone marrow transplants. Anemia of chronic disease is often treated with epoetin alfa (Epogen, Procrit). Sickle cell anemia historically had no curative treatment but emerging gene therapy may be an option in the future. Pernicious anemia is due to vitamin B12 deficiency and is treated with vitamin B12 replacement.The nurse should be prepared to administer vitamin K in which of the following clinical scenarios? PT/INR of 5.0 PT/INR of 2.0 PT/INR of 3.0 PT/INR of 4.0PT/INR of 5.0 ...A PT/INR of 2.0-3.0 is therapeutic in a patient with a history of deep vein thrombosis (DVT) or in a patient that requires stroke prevention. A PT/INR of 2.5-3.5 is therapeutic in patients with a mechanical heart valve. A PT/INR of 4.0 would not necessarily require reversal with vitamin K. The patient would likely be instructed to hold their warfarin for 2-3 days and recheck their PT/INR. A PT/INR of 5.0 or more may necessitate vitamin K administration. The higher the PT/INR, the more likely vitamin K will be required.Which of the following potential serious adverse events do all anti-arrhythmia drugs share? Proarrhythmic effects Dizziness and headache Electrolyte disturbances Nausea and vomitingProarrhythmic effects ...All medications for dysrhythmia have the potential to cause an arrhythmia. These drugs do not usually cause GI upset or electrolyte disturbances. Headache and dizziness can occur but in general, these symptoms are not considered serious adverse events.Which of the following are common side effects associated with diuretic medications? Hypokalemia and hyponatremia Hypokalemia and hypernatremia Hyperkalemia and hypernatremia Hyperkalemia and hyponatremiaHypokalemia and hyponatremia ...All diuretic medications are associated with hypokalemia (low serum potassium) and/or hyponatremia (low serum sodium). If severe enough, these electrolyte disturbances can lead to vascular collapse and cardiac arrest.Which of the following is a severe adverse event associated with both antiplatelet and anticoagulant medications? Upset stomach Stevens-Johnson syndrome Severe bleeding Minor bleedingSevere Bleeding ...Severe adverse events associated with both antiplatelet medications and anticoagulant medications include severe bleeding, and gastrointestinal bleeding. Minor bleeding and upset stomach (N&V) are common side effects for both antiplatelet and anticoagulant medications. These would not be considered serious events. Stevens-Johnson syndrome is a severe adverse event but is not associated with antiplatelet or anticoagulant medications.In which of the following patients would use of propranolol be contraindicated? A patient with a history of asthma. A patient with a history of coronary artery disease. A patient with a history of breast cancer A patient with a history of anxietyA patient with a history of asthma. ...Propranolol is a nonselective beta adrenergic blocker. Bronchospasm is a potential adverse effect which is why propranolol is contraindicated in patients with a history of asthma. Propranolol can be used situationally for anxiety/stage fright and beta adrenergic blocker medications are part of the standard of care for patients who have known coronary artery disease, have had a heart attack (MI), or have had bypass surgery. There is no contraindication to use of this medication in patients with a diagnosis of cancer. Beta blockers must not be stopped abruptly and a dose may need to be held if the patient has a heart rate less than 60 beats/minute.Which of the following classes of antihypertensive medications are most similar to ACEIs? Calcium Channel Blockers Angiotensin II Receptor Blockers Alpha Adrenergic Antagonists Beta Adrenergic AntagonistsAngiotensin II Receptor Blockers ...ACEIs and ARBs (angiotensin II receptor blockers) have very similar side effect profiles and potential for serious adverse events. ARBs are not commonly associated with cough like ACEIs are which is one of the distinguishing features between the two classes.