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MTC Pharmacology NUR 105 Study Guide
Terms in this set (50)
What is the initial tx for mild htn?
• Initiate lifestyle modifications. If the B/P does not normalize, add diuretic or beta blocker medication. Life style modifications: 1) Cardiac fitness diet: 4 GM Sodium, Low fat, 2) Aerobic exercise: walking 60 min daily 7 days a week, 3) Achieve Ideal Body Weight, 4) Stop smoking, 5) Limit caffeine and alcohol 6) Stress (anger) management.
What are the two med for initial tx of moderate htn?
A diuretic or beta blocker, or select a different diuretic or beta blocker, or combine the meds and give both a diuretic and a beta blocker.
What med is used for severe htn?
Nipride (sodium nitroprusside) Emergency Department-IV vasodilation (Nipride) to lower the B/P to non-life threatening levels. Must have continuous B/P monitoring while receiving Nipride. The severe hypertension treatment protocol is initiated to control B/P long term.
What major side effect is caused by all meds that lower BP? What are pts taught to do to lessen this side effect?
All B/P lowering meds can cause dizziness from orthostatic (postural) hypotension. Arise slowly from lying to standing to accommodate. Avoid sudden strenuous exercise (pulse rate cannot adapt), hot baths (vasodilates), motionless and dependent legs (blood pools).
Atenolol (Tenormin) is what type adrenergic inhibitor?
Beta blocker, it blocks receptors at vessel level.
What are three side effects of beta blockers: propanolol (Inderal) & nadolol (Corgard)?
Bradycardia (teach patient to monitor pulse & report if below 60/min), Depression (suicidal tendencies, have patient report incidence), Impotence, Impaired control of glucose level in diabetics.
What type antihypertensive is verapamil (Calan)?
Calcium channel blocker, it decreases entry of calcium into smooth muscle and reduces peripheral resistance.
What type of antihypertensive is lisinopril (Zestril)?
ACE inhibitor, it blocks the enzyme that converts rennin to angiotensin. Renin is a hormone secreted by the kidney that increases B/P.
What side effect should a pt taking Corgard report if it occurs?
If the pulse rate is below 60/min, and suicidal tendencies associated with depression.
What foods are high in potassium that the pt taking a loop (high ceiling) diuretic or thiazide diuretic should eat?
Bananas, citrus juice, meat, nuts.
Administer potassium supplement (K-Lor, K-Dur, Kaon Syrup).
What two drugs are combined in Aldactozide? What are their actions?
- hydrochlorothiazide (HCTZ) and Aldactone
- Action: block Na and H20 reabsorption in the distal tubule and blocks action of aldosterone on nephron. Sodium and water are excreted in larger than normal amounts.
Describe the hair growth when taking minoxidil (Lonitin).
• Excessive hair growth. Agent in crème preparation: Rogaine used for baldness.
What happens to BP when the pt takes enalapril (Vasotec), an ACE inhibitor, and is losing fluid through vomiting?
decrease in BP is more pronounced with fluid loss. Can also occur from increased sweating elevated temperature and wound drainage
How rapidly does sodium nitroprusside (Nipride) lower BP?
Immediate decrease in B/P. Given by IV infusion. Patient must be on continuous B/P monitoring during infusion. B/P begins to lower within 5 minutes. Nipride for short term use only. Blood level of the drug is monitored because breakdown products can accumulate and cause cyanide poisoning.
How long will a pt have to take prescribed antihypertensive meds?
Meds control B/P, not cure disorder, so the patient will have to take them for a lifetime.
List four activity (ADL) precautions for anyone taking antihypertensive meds
Arise slowly from lying to standing to accommodate, Avoid sudden strenuous exercise (pulse rate cannot adapt), Hot baths (vasodilates), Motionless and Dependent legs (blood pools).
What is the action on LDL of a bile acid sequestrant?
Binds bile acids and LDL's are removed.
What is a side effect of simvastatin (Zocor)?
flatulence, leg muscle pain, myocardium damage
What is the action of Niacin?
Lowers cholesterol in blood,
Depresses the synthesis of LDL's and increases the level of HDL's.
What is a side effect of nicotinic acid (niacin)?
sensitivity, flushing, and itching
How is the effectiveness of NTG evaluated?
Absence of chest pain. Check vital signs. No erectile dysfunction medication or any med that vasodilates as B/P can drop to a deadly level. Take NTG to avoid pain that may occur with activity (stair climbing, sexual intercourse).
What is the correct procedure for taking NTG sublingually?
NTG Tablets: 1/200-1/100 grain sublingual, rest supine with head elevated, place tablet under the tongue at first sign of chest discomfort, do not swallow until completely dissolved, may repeat a total of three doses taken at 5 minute intervals, if no relief after 3rd dose, CALL EMS AND GO TO ED.
Nitroglycerin should be taken with the pt in what position? Why?
Supine with HOB elevated.
How should a nitroglycerin patch be applied?
Apply patch on dry, hairless area away from monitoring and defibrillation sites, rotate application sites.
State the steps to correctly use nitroglycerin aerosol.
1-2 sprays sublingual ( do NOT shake container, hold container upright, close mouth around mouth piece, activate spray, do not swallow for 1-2 minutes).Do not swallow for 1-2 mins
Identify three long acting nitroglycerin medications
Tablets: Peritrate, Cardilate, Isordil
How should NTG be stored? How long is it good? How can the pt tell if it is good?
Keep in a dry place, tight capped, dark glass container.
Obtain a new prescription every 5 months.
Patient will know NTG is fresh when burning sensation is felt under the tongue.
Why does the pt with angina receive a beta blocker like propranolol (Inderal)?
Decrease oxygen requirement of the myocardium (blocks receptor vessels)
How frequently can NTG tablets be taken? When should the pt go to the ED?
3 doses may be taken at 5 minute intervals, after the 3rd dose if no relief Call EMS and got to the ED.
What is the action of quinidine?
Decrease myocardial cell excitability--anti-arrhythmia
What drug is given for bradycardia following an MI, heart attack?
PRIMARY med is Atropine 0.5mg IV Atropine if heart rate is less than 50/per min
Aspirin 300mg? Dysrhythmia Agents? ?
Positive inotropic means what?
increases myocardial contraction stroke volume
How do digoxin and beta-blockers effect pulse rate?
Decreases pulse rate
Beta Blockers: Bradycardia. Digoxin: Bradycardia.
What must the adult pulse rate be to administer digoxin?
If rate is less than 60/min (adult), hold the digoxin and notify the physician. Report below 50/min and above 100/min and any irregular rhythm.
What heart arrhythmia indicates digoxin toxicity?
Bigeminy Dysrhythmia: alternating regular beat & irregular beat. If assessed or reported by EKG, notify the physician promptly.
What is the therapeutic serum digoxin level?
What is the action of a loop diuretic?
Increase excess fluid pulled from the serum into the urine filtrate. They block sodium and water reabsorption in Loop of Henle in nephron. Sometimes give after systemic circulation is improved with digoxin and an increase in blood to the kidneys occurs.
What time of day should diuretic meds be taken?
Take daily diuretic in early AM and if taken twice daily, take second dose before 6 PM to avoid interrupting sleep to urinate.
How should a pt monitor fluid loss or gain when taking furosemide (Lasix)?
Weigh at the same time daily and report 2lbs weight gain and swelling in ankles and feet.
What effect does heparin or enoxaparin (Lovenox) or warfarin (Coumadin) or dabigatran (Pradaxa) have on a blood clot?
Therapeutic anticoagulants to prevent further development on an existing thrombus and prevent embolization. Prevents clotting
What are the therapeutic levels of PT and PTT for a pt receiving an anticoagulant?
• Heparin: Therapeutic 2-2.5 X(times normal PTT in seconds) (about 75 to 85 seconds ). Normal PTT: 30-40 seconds.
• Warfarin (Coumadin): Therapeutic PT: 1.25 - 2.5 X (times normal PT in seconds) (about18-24 seconds). Normal PT: 11-12.5 seconds.
• Therapeutic INR 1.3 - 2
How will spontaneous bleeding, a side effect of anticoagulant, be seen?
Hematuria, Epistaxis nose bleed), Bleeding gums, Oozing from venipuncture sites, Black tarry stools, Coffee ground vomitus.
What is the antidote to warfarin (Coumadin)? To heparin?
Heparin: Protamine sulfate 1 mg IV for every 100 units of Heparin.
• warfarin (Coumadin): Vitamin K (Aqua-mephyton)
What bleeding precautions should a pt on anticoagulant take?
- use a soft bristle toothbrush
- avoid putting toothpicks or sharp objects in the mouth
- do not walk barefoot
- wear well fitting shoes that cover foot completely
- avoid using cutting tools and sharp objects;
-use electric razor for shaving
- avoid rough and contact sports; blunt injury can cause internal bruising and hemorrhaging
- apply dressing and pressure to any cut; if bleeding has not stopped within 10 mins promptly notify M.D.
- circle mark any bruised areas; if continuing to increase in size, promptly notify M.D.
- Check urine and bowel movements after each elimination; if pink or red urine or black or maroon BM occur, promptly notify M.D.
- if excessive nosebleed, bleeding gums, red-purple spots on skin, menstrual bleeding or bleeding hemorrhoids occurrs, promptly notify M.D.
- if pegnancy occurrs orr suspect are pregnant, promptly notify M.D. (Coumadin is in catagory X)
What med is prescribed for iron deficiency anemia?
- ferrous sulfate (Feosol)
- iron dextran injection
How should liquid iron be taken?
Give oral with food to prevent GI irritation. Liquid Iron preparations should be taken through a straw because they stain the teeth.
What effect does vitamin B12 have on RBC formation?
affects the maturation of RBC's
What med is pescribed for pernicious anemia? How is it given and how often?
• Vitamin B12 (Cyanocobalamin): given IM daily for one week, then monthly throughout lifetime.
• Vitamin B12 (Nascobal): given nasal once a week at least one hour before or after ingestion of foods or liquids.
The malnourished or alcoholic/substance abuse pt needs what med to promote RBC development
Folic acid (Folvite) 1 mg oral daily
What is the action of epoetin? How is it given and how often?
To stimulate red blood cell production. Given SubQ ,
3 times a week to patients with renal failure and after treatments of chemotherapy when myelosuppression has occurred.
What are indications of diuretic agents?
Cephalosporins are divided into five generations of drugs and the progression from the first-generation to the third-generation drugs shows an increase in sensitivity of gram-negative microorganisms and a decrease in the sensitivity of gram-positive microorganisms.
WHY ARE BETA BLOCKERS EFFECTIVE FOR ANGINA
What are COX 1 and COX 2 responsible for?
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