1
Q
Indication:
Angiotensin-converting enzyme inhibitors
(ACE inhibitors)
A
- Antihypertensive
- to decrease blood pressure
- to prevent myocardial infarction and cerebral vascular accident
2
Q
Generic names:
ACE inhibitors
A
benazepril, enalapril, lisinopril, ramipril
3
Q
Mechanism of action:
ACE inhibitors
A
- prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor
- blood vessels enlarge and blood pressure decreases
4
Q
Most common side effects:
ACE inhibitors
A
- hypotension and dizziness
- hyperkalemia
- dry cough
- taste changes
5
Q
Nursing considerations:
ACE inhibitors: hypotension and dizziness
A
- take blood pressure and hold if BP < 100/60
- use caution when getting up due to orthostatic hypotension
6
Q
Nursing considerations:
ACE inhibitors: hyperkalemia
A
- check potassium and hold if increased - normal potassium is 3.5 - 5
- use caution with kidney failure clients - clients retain potassium
- avoid salt substitutes - contains potassium
- use caution with potassium-sparing diuretics - spironolactone: retains potassium
7
Q
Nursing considerations:
ACE inhibitors: dry cough
A
May need to prescribe different med if cough is intolerable to client.
8
Q
Nursing considerations:
ACE inhibitors: taste changes
A
Advise client that the changes to diet may need to occur such as eating smaller meals or drinking lemon juice between meals.
These changes can make eating foods more tolerable.
9
Q
Most common adverse reaction:
ACE inhibitors
(Immediate complication)
A
angioedema (swelling of face and neck)
10
Q
Nursing considerations:
ACE inhibitors: angioedema
(Immediate complication)
A
- assess airway
- assess for swelling and difficulty breathing
Hold med and notify HCP.
11
Q
Indication:
Angiotensin receptor blockers
A
- Antihypertensive
- to decrease blood pressure
- to reduce risk of stroke and myocardial infarction
12
Q
Generic names:
Angiotensin receptor blockers
A
irbesartan, losartan, olmesartan, valsartan
13
Q
Mechanism of action:
Angiotensin receptor blockers
A
- blocks angiotensin II, a potent vasoconstrictor
- blood vessels enlarge and blood pressure decreases
14
Q
Most common side effects:
Angiotensin receptor blockers
A
hypotension and dizziness
15
Q
Nursing considerations:
Angiotensin receptor blockers: hypotension and dizziness
A
- take blood pressure and hold if BP < 100/60
- use caution when getting up due to orthostatic hypotension
16
Q
Nursing considerations:
Angiotensin receptor blockers: hyperkalemia
A
- check potassium and hold if increased - normal potassium is 3.5 - 5
- use caution with kidney failure clients - clients retain potassium
- avoid salt substitutes - contains potassium
- use caution with potassium-sparing diuretics - spironolactone: retains potassium
17
Q
Most common adverse reaction:
Angiotensin receptor blockers
(Immediate complication)
A
angioedema (swelling of face and neck)
18
Q
Nursing considerations:
Angiotensin receptor blockers: angioedema
(Immediate complication)
A
- assess airway
- swelling or difficulty breathing
Hold med and notify HCP.
19
Q
Indication:
Antiarrhythmic: adenosine
(Immediate complication)
A
- to treat supraventricular tachycardia (SVT)
- will chemically cardiovert to normal sinus rhythm when given IV push
20
Q
Indication:
Antiarrhythmic: amiodarone
(Immediate complication)
A
To treat or prevent life-threatening ventricular fibrillation or ventricular tachycardia.
21
Q
Indication:
Antiarrhythmic: lidocaine
(Immediate complication)
A
- to treat or prevent life-threatening ventricular fibrillation or ventricular tachycardia
- given when amiodarone is not available
22
Q
Indication:
Antiarrhythmic: atropine
(Immediate complication)
A
- will increase the heart rate when given IV push
- to treat heart blocks and symptomatic bradycardia
23
Q
Indication:
Anticoagulants
A
To treat and prevent blood clots for clients with:
- arrhythmias such as atrial fibrillation
- valve replacement
- myocardial infarction
- deep vein thrombosis
- pulmonary embolism
24
Q
Generic names:
Anticoagulants
A
- apixaban, dabigatran, rivaroxaban
- enoxaparin
- heparin
- warfarin
25
# Most common adverse reaction:
Anticoagulants
| (Immediate complication)
Bleeding
26
# Nursing considerations:
Anticoagulants
* assess for bleeding
* hold if platelets \<150,000 or active bleeding
* hold if significant decrease in hemoglobin and hematocrit
* avoid herbs since many cause bleeding
27
# Indication:
Anticoagulant: **enoxaparin**
* a low molecular weight heparin given subcutaneously
* **to prevent blood clots**, especially post-op clients
28
# Indication:
Anticoagulant: **heparin**
1. **heparin IV**
* to treat an active blood clot
* bridge therapy for PO anticoagulants
2. **heparin subcutaneous** - to prevent blood clots
29
# Nursing considerations:
Anticoagulant: **heparin**
1. **If giving IV:** hold if aPTT or PTT is \> therapeutic
2. **don't store with insulin bottles** - both are given by units and bottles look the same
30
Therapeutic **aPTT** for Intravenous **heparin**:
45 to 100
## Footnote
* **the control value is 30 - 40:** (control value can vary)
* **therapeutic is 1.5 to 2.5** times the control value
How to calculate: therapeutic is 1.5(30) to 2.5(40) = **45 to 100.** Decrease infusion rate if therapeutic level is \>100
31
**Antidote** to heparin:
protamine sulfate
32
# Indication:
Anticoagulant: **warfarin**
**To prevent blood clots** for those with arrhythmias or valve replacement.
33
# Nursing considerations:
Anticoagulant: **warfarin**
1. **assess for bleeding** - hold if actively bleeding
2. **check PT and INR** - hold if PT or INR is \> therapeutic level
3. **don't increase or decrease amount of green leafy vegetables consumed** - they contain vitamin K, which is the antidote
34
Therapeutic **INR** for **warfarin**:
* **2-3** for clients with atrial fibrillation
* **3-4** for clients with a prosthetic valve
35
Therapeutic **PT** for **warfarin**:
16.5 to 25
## Footnote
* **the control value is 11 - 12.5**: (control value can vary)
* **therapeutic is** **1.5 to 2 times** the control value
How to calculate: therapeutic is 1.5(11) to 2(12.5) = **16.5 to 25.** Hold if the therapeutic level is \>25.
36
**Antidote** to warfarin:
phytonadione (vitamin K)
37
# Indication:
Antiplatelets
To prevent **blood clots**.
38
# Generic names:
Antiplatelets
* aspirin (or called acetylsalicylic acid)
* clopido**_grel_**, prasu**_grel_**
39
# Most common adverse reaction:
Antiplatelets
| (Immediate complication)
Bleeding
40
# Nursing considerations:
Antiplatelets
**Assess for bleeding**
* hold if platelets \<150,000 or active bleeding
* hold if significant decrease in hemoglobin and hematocrit
* avoid herbs since many cause bleeding
41
# Indication:
Antiplatelet: **aspirin**
Can also be given as an **analgesic** to prevent pain and inflammation.
42
# Most common side effects and nursing considerations:
Antiplatelet: **aspirin**
1. **assess for ringing in ears** - ototoxic
2. **don't give to children \< 18 years old** - can cause Reye's syndrome
43
# Indication:
Beta blockers
* Antihypertensive
* to decrease blood pressure and heart rate
* to prevent myocardial infarction
44
# Generic names:
Beta blockers
ateno**_lol_**, carvedi**_lol_**, metopro**_lol_**, nebivo**_lol_**, proprano**_lol_**
45
# Mechanism of action:
Beta blockers
* blocks beta receptors
* decreases cardiac output and cardiac oxygen consumption
* heart beats more slowly and with less force
46
# Most common side effects:
Beta blockers
* bradycardia and hypotension
* erectile dysfunction
47
# Nursing considerations:
Beta blockers: **bradycardia** and **hypotension**
Check heart rate and blood pressure.
## Footnote
hold if HR \<60 or BP \<100/60
48
# Nursing considerations:
Beta blockers: **erectile dysfunction**
Teach client that taking medications that lower blood pressure and erectile dysfunction drugs together **can cause severe hypotension**.
49
# Nursing considerations:
Beta blockers: **asthma/COPD** and **diabetics**
1. **use caution with asthma or COPD** - can cause bronchoconstriction
2. **use caution with diabetics** - can mask signs of hypoglycemia
50
# Indication:
Calcium channel blockers
* Antihypertensive
* to decrease blood pressure and heart rate
* to treat angina
51
# Generic names:
Calcium channel blockers
* amlo**_dipine_**, nife**_dipine_**
* diltiazem and verapamil
52
# Mechanism of action:
Calcium channel blockers
* prevents movement of calcium in cardiac cells
* this dilates the arteries of the heart, which decreases blood pressure and myocardial oxygen demand
53
# Most common side effects:
Calcium channel blockers
* hypotension and dizziness
* bradycardia
* edema
54
# Nursing considerations:
Calcium channel blockers: **hypotension** and **dizziness**
1. **check BP** - hold if BP \<100/60
2. falls precautions
55
# Nursing considerations:
Calcium channel blockers: **bradycardia**
Check heart rate and hold if **\< 60**.
56
# Nursing considerations:
Calcium channel blockers: **edema**
Assess for **peripheral** and **pulmonary edema**.
## Footnote
hold med and notify HCP
57
# Nursing considerations:
Calcium channel blockers: **food-med interaction**
Drinking grapefruit juice and taking medication together will **decrease** blood pressure.
58
# Indication:
digoxin
To **decrease heart rate** with heart failure or atrial fibrillation.
59
# Most common adverse reactions:
digoxin
* bradycardia
* nausea/vomiting
* vision changes
60
# Nursing considerations:
digoxin: **bradycardia**
**Check heart rate** - hold if:
* \<60 for adult
* \<70 for child
* \<90 in an infant
61
# Nursing considerations:
digoxin: **toxicity**
* **monitor for symptoms of toxicity:** nausea/vomiting, vision changes, and bradycardia
* **check potassium level:** can get toxicity if potassium is low
62
**therapeutic level** of digoxin:
1 - 2
## Footnote
2 or greater is considered toxicity.
63
**Antidote** to digoxin:
digoxin immune fab
64
# Indication:
Nitrates
* Antianginal
* Vasodilator
* to treat chest pain and decrease blood pressure
65
# Generic names:
Nitrates
* isosorbide di**_nitrate_**, isosorbide mono**_nitrate_**
* **_nitro_**glycerin
66
# Mechanism of action:
Nitrates
**Relaxes vascular smooth muscle** causing vasodilation and decreased blood pressure.
67
# Most common side effects:
Nitrates
* headache
* hypotension
68
# Nursing considerations:
Nitrates: **headache** and **hypotension**
* **headache** - lower the head of the bed to decrease pain
* **hypotension**
* don't give if BP \<100/60
* don't give if taking erectile dysfunction drugs - can cause severe hypotension
69
# Nursing considerations:
nitroglycerin sublingual
* give 1 sublingual tablet **every 5 minutes** for chest pain
* give up to **3 doses**
* call ambulance or notify HCP if not relieved by **2 doses**
70
# Indication:
Thrombolytics
* "clot busters"
* to break up blood clots
71
# Generic names:
Thrombolytics
altepl**_ase_**, streptokin**_ase_**, tenectepl**_ase_**
72
# Most common side effects and nursing considerations:
Thrombolytics
Assess for **active bleeding** or **recent stroke**.
## Footnote
hold med if actively bleeding
73
# Indication:
Vasopressor: **dopamine**
| (Immediate complication)
To treat **shock**.
74
# Nursing considerations:
Vasopressor: **dopamine**
1. **assess blood pressure and heart rate while giving** - give fluids before giving med to increase blood pressure
2. **may cause arrhythmias** - keep client on continuous ECG monitoring
75
# Indication:
Vasopressor: **epinephrine**
| (Immediate complication)
To treat anaphylaxis, shock, severe asthma attack, treat life-threatening arrhythmias.
## Footnote
asystole, ventricular tachycardia, ventricular fibrillation
76
# Nursing considerations:
Vasopressor: **epinephrine IM shot**
Teach client to self-administer **in outer thigh as an IM shot** for those at risk of anaphylaxis.
77
# Nursing considerations:
Diuretics
1. **Assess kidney function due to diuresis** - BUN, creatinine, urine output
2. **Assess lung sounds** - fluid can back up into lungs and there should be decreased crackles and clear lung sounds after giving
3. **Assess for edema** - edema should decrease after giving
78
# Indication:
Loop diuretics
To treat **edema** and **hypertension**.
79
# Generic names:
Loop diuretics
* also called "potassium-wasting diuretics" because **potassium and urine** is excreted
* furosem**_ide_**, bumetan**_ide_**, torsem**_ide_**
80
# Indication:
Thiazide diuretics
To treat **edema** and **hypertension**.
81
# Generic names:
Thiazide diuretics
* also called "potassium-wasting diuretics" because potassium and urine is excreted
* hydrochloro**_thia_**zide, chlor**_thal_**idone
82
# Most common side effects:
Loop diuretics and Thiazide diuretics
hypokalemia
83
# Nursing considerations:
Loop diuretics and Thiazide diuretics: **hypokalemia**
1. **Check potassium level** - can cause decreases in potassium
2. **Assess for muscle cramps or dysrhythmias** - can be caused by low potassium
3. **Give potassium supplements if potassium is low**
* can be given PO (by mouth) if not severe
* given IVPB if severe hypokalemia
84
# Indication:
Potassium-sparing diuretic
To treat **hypertension** and **edema by diuresis**.
85
# Generic names:
Potassium-sparing diuretic
Spironolactone
86
What are **signs/symptoms** of bleeding?
* bright red blood from anywhere
* hematuria
* melena/tarry stools
* bruising
* bleeding gums
* large drops in hemoglobin and hematocrit
* low platelet count of <50,000
* epistaxis
* hematemesis
* petechiae/purpura
## Footnote
These symptoms could indicate that the client has taken too much anticoagulant or antiplatelet medication.
87
What are interventions for **bleeding precautions**?
* no straining (give stool softeners)
* no nail clippers or straight-edge razors
* no meds that increase the risk of bleeding
* apply pressure for at least 5 minutes to any bleeding site
* limit invasive procedures
* prevent falls
* assess for signs of bleeding
* avoid herbs that start with the letter "G"
* floss and brush teeth gently
88
Which medications **increase** the risk of bleeding?
* Antiplatelets
* Anticoagulants
* NSAIDs
* Thrombolytics
* Chemotherapy
* Herbs that start with the letter "G" (garlic, ginger)
NCLEX-RN (4) Pharmacology
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