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NUR 210 Pharm > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Sympathetic Nervous System (SNS)- fight or flight

A
  • Responsible fight, flight, and fright functions
  • Speeds everything up except the GI tract
  • Epinephrine/Norepinephrine gets released by neurons of SNS and activates adrenergic receptors (alpha and beta receptors), Alpha 1&2, and Beta 1&2.
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2
Q

Alpha Receptors

A
  • Alpha 1- constricts smooth muscles, especially vessels.
  • Alpha 2- inhibitory
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3
Q

Beta Receptors

A

1 heart, 2 lungs

  • Beta 1- on the heart, increased heart rate, increases contractility (squeeze of the heart), increases blood pressure.
  • Beta 2- present throughout the airway–>relax smooth muscle–>bronchodilation.
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4
Q

Non-selective adrenergic agonist: Epinephrine
MOA:

A

Activates Alpha 1, Beta 1&2

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5
Q

Non-selective adrenergic agonist: Epinephrine
Uses:

A

o Asthmatic and allergic emergencies
o Cardiogenic shock
o Cardiac arrest
o Has a rapid onset, short duration of action.

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6
Q

Non-selective adrenergic agonist: Epinephrine
SEs/ADRs:

A

o Nervousness
o Restlessness
o Tremors
o Headache
o Angia (chest pain)
o Arrhythmias
o Hypertension
o Tachycardia
o Hyperglycemia
o GI upset

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7
Q

Non-selective adrenergic agonist: Epinephrine
Nursing Action:

A

o Monitor vital signs.
o CM (cardiac monitor)
o Monitor blood glucose closely.

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8
Q

Epi-pen autoinjector

A

“Blue to sky, orange to thigh”

o Remove the blue cap.
o Inject the orange end into the lateral thigh.
o Hold at a 90-degree angle. Insert until you hear a click. HOLD for 10 secs, remove, then gently massage the area.
o Call 911. Effects are brief. The second dose may be given in 10 mins if the patient is not better before help arrives.

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9
Q

Adrenergic Blockers: Beta-blockers
Action:

A

o Blocking Beta 1–> dec heart rate, dec blood pressure
o Blocking Beta 2–> bronchoconstriction ——-ADR
o Non-selective BBs (beta blockers) (N-Z) ex/propranolol. Block Beta 1&2
o Selective BB (A-M) ex/atenolol. Preferentially target Beta minimizes ADRs of non-selective.

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10
Q

Adrenergic Blockers: Beta-blockers
Uses:

A

o Antihypertensive
o Cardioprotective benefits post MI (heart attack)
o Heart failure (not acute)
o Arrhythmias

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11
Q

Adrenergic Blockers: Beta-blockers
SEs:

A

o Drowsy
o Dizzy
o Decreases sex drive.
o Orthostatic hypotension

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12
Q

Adrenergic Blockers: Beta-blockers
ADRs:

A

o Bronchoconstriction
o Hypoglycemia
o Bradycardia

  • Selective beta-blockers may be used with caution in patients with asthma/COPD.
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13
Q

Adrenergic Blockers: Beta-blockers
Contraindications:

A

o Bradycardia
o Heart block (arrhythmia where heart rate is very slow)
o Cardiogenic shock
o Acute heart failure – pt must be stable before initiating beta blockers (no hypotension). Once stable, begin very low-dose BB (beta-blocker).
o Asthma
o COPD
o Sick sinus syndrome (pts heart rate is tachy then brady, tachy then brady, etc.)

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14
Q

Adrenergic Blockers: Beta-blockers
Nursing Interventions:

A

o Check baseline vital signs- report heart rate less than 60.
o Check history- diabetic, asthma, or COPD.
o Counsel pt to change positions slowly.

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15
Q

Parasympathetic Nervous System (PNS)- rest and digest

A
  • Responsible for “rest and digest” functions
  • Acetylcholine (ACH) is released by neurons of PNS and activates muscarinic/nicotinic receptors (cholinergic receptors).
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16
Q

Muscarinic Receptors: M1

A

Found in exocrine- salivation and gastric acid secretions.

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17
Q

Muscarinic Receptors: M2

A

Found in the heart- slow heart rate.

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18
Q

Muscarinic Receptors: M3

A

Found in smooth muscle- bronchoconstriction, bladder contraction, GI contractility, produce vasodilation, pupil constriction, also found in pancreas–>insulin release.

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19
Q

Effects of cholinergic stimulation (when they are activated)

A
  • Hypotension, decreased heart rate
  • Inc secretions (saliva, GI, sweat)
  • Inc GI motility- diarrhea, nausea, abdominal pain
  • Increased detrusor tone–> Micturition (peeing), incontinence
  • Pupillary constriction
  • Bronchospasm
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20
Q

Effects of cholinergic blockade (anti)

A
  • Inc heart rate
  • Dec secretions (dry mouth, eyes)
  • Dec GI motility (constipation)
  • Dec detrusor muscle tone (urinary retention)
  • Pupillary dilation/ciliary muscle–> Blurred vision.
  • Bronchodilation
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21
Q

Cholinergic agonists

A

“bind to and activate cholinergic receptors.”

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22
Q

Cholinergic agonists: Bethanechol
Action:

A

o Stimulates receptors on the smooth muscle of the bladder and GI tract.

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23
Q

Cholinergic agonists: Bethanechol
Uses:

A

o Urinary retention
o MUST rule out urinary/intestinal tract obstruction.

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24
Q

Cholinergic agonists: Bethanechol
SEs/ADRs:

A

o Blurred vision
o Inc secretions
o Orthostatic hypotension
o Bronchoconstriction
o Hypotension
o Bradycardia

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25
Q

Cholinergic agonists: Bethanechol
Interactions:

A

o Other drugs that dec heart rate and blood pressure
o Atropine (reversal agent)- block PNS activity

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26
Q

Cholinergic agonists: Bethanechol
Contraindications:

A

o Bradycardia
o Hypotension
o COPD/asthma
o Peptic ulcer disease
o Parkinson’s disease
o Intestinal/urinary obstruction

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27
Q

Cholinergic agonists: Bethanechol
Nursing Actions:

A

o Check vital signs.
o Be familiar with the medications/medical history of the patient.
o Give 1 hour before, 2 hours after meals to avoid nausea and vomiting.
o Teach pt to change positions slowly.
o Monitor input and output.

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28
Q

Cholinergic agonists: Pilocarpine
Action:

A

o Directly stimulates cholinergic receptors in eye–> miosis (constrict pupil). This allows aqueous humor to exit.

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29
Q

Cholinergic agonists: Pilocarpine
Use, Administration:

A
  1. Use:
    o Eye drops to treat glaucoma.
  2. Administration: pg 86
    o Eye drops – punctal occlusion (a mechanical treatment that blocks the tear drainage system in order to aid in the preservation of natural tears on the ocular surface).
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30
Q

Cholinergic agonists: Pilocarpine
Nursing Actions:

A

o Teach proper administration of eye drops and punctual occusion technique.
o Causes difficulty in dark adaptation- advise pts to use caution while night driving or performing tasks in poor lighting.

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31
Q

Anticholinergic: Atropine
Action:

A

Opposes actions of PNS (Parasympathetic Nervous System)

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32
Q

Anticholinergic: Atropine
Uses:

A

o Eyes: mydriatic agent (dilates pupils)
o CV (cardiovascular): inc heart rate (used for symptomatic sinus bradycardia)
o Pulmonary: anti-secretory (used to dry up secretions, pre-op)
o GI: antispasmodic (dec GI motility, relieves cramps and diarrhea)
o Urinary tract: for incontinence (replaced by other drugs)
o Antidote: for cholinergic toxicity

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33
Q

Anticholinergic: Benztropine
Action:

A

o Inhibits cholinergic activity.
o Inhibits reuptake of dopamine
o Explanation: dopamine depletion–>inc ACH release–>activation of muscarinic receptors–>overstimulation of neurons by ACH–>tremors/rigidity

Overall effect: Benztropine blocks effects of ACH–>dec tremors, dec rigidity, dec drooling.

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34
Q

Anticholinergic: Benztropine
Uses:

A

o Dec tremors
o Dec rigidity
o Dec drooling

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35
Q

Urinary Anticholinergic: Tolterodine
Action:

A

Inhibits muscarinic receptors in bladder and urinary tract which helps retain bladder volume

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36
Q

Urinary Anticholinergic: Tolterodine
Use:

A

o Urge incontinence (dec frequency of urination/OAB (overactive bladder))

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37
Q

General Anticholinergics
Common SEs:

A
  • Constipation
  • Dry mouth/eyes
  • Tachycardia
  • Blurred vision
  • Urinary retention
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38
Q

General Anticholinergics
ADRs:

A
  • Confusion/hallucinations
  • inc fall risk in the elderly.
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39
Q

General Anticholinergics
Contraindications:

A
  • DO NOT GIVE to pts with a history of glaucoma.
  • GI motility issues
  • May worsen MG (myasthenia gravis)
  • Tachycardia
  • BPH (Benign prostatic hyperplasia-enlarged prostate that is not cancerous)
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40
Q

General Anticholinergics
Interactions:

A
  • Other drugs with anticholinergic effects ex. TCAs, antihistamines, cyclobenzaprine (muscle relaxer), grapefruit juice
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41
Q

General Anticholinergics
Nursing Considerations:

A
  • Asses for contraindications: glaucoma, Gi/bladder obstruction, MG (myasthenia gravis)
  • Assess neurological status.
  • Monitor vital signs.
  • Assess abdomen, monitor bowel sounds.
  • Monitor urine output.
  • Oral care
  • Safety – inc risk for falls in elderly.
  • Inc FFF (fluid, fiber, fitness)
  • Wear sunglasses in bright light due to pupil dilation
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42
Q

Parkinson’s Disease

A

Neurological disorder that results in progressive loss of coordination and movement.

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43
Q

Parkinson’s Disease
Etiology/Pathophysiology:

A
  • Loss of dopaminergic neurons in the brain.
  • Dec dopamine–>inc ACH (acetylcholine) levels–>abnormal signaling between neurons.
  • Imbalance–> signs and symptoms such as impaired mobility, resting tremor, bradykinesia, rigidity, and postural instability.
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44
Q

Parkinson’s Disease
Drug treatment goals:

A
  • Replace dopamine.
  • Mimic dopamine’s action
  • Antagonize excitatory effects of cholinergic neurons.
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45
Q

Anti-Parkinson’s Drug: Carbidopa/Levodopa

A

Dopamine replacement

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46
Q

Anti-Parkinson’s Drug: Carbidopa/Levodopa
Action:

A

Levodopa is a dopamine precursor. Dopamine itself cannot get across the blood-brain barrier. Levodopa can, with a little bit of help from carbidopa. Carbidopa prevents peripheral breakdown of levodopa so it can reach the brain.

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47
Q

Anti-Parkinson’s Drug: Carbidopa/Levodopa
Benefits of Carbidopa/Levodopa:

A

Less rigidity/hypokinesia

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48
Q

Anti-Parkinson’s Drug: Carbidopa/Levodopa
ADRs:

A

Due to inc dopamine activity in the brain

o Behavioral effects: confusion, sleep disturbances, vivid dreams, anxiety, schizophrenia-type symptoms
o Dyskinesia (involuntary movement)
o Peripheral effects: postural hypotension
o Mydriasis (dilation of the pupil)–>precipitate an attack of glaucoma.
o Alteration of smell and taste
o Altered labs: inc BUN and LFTs
o Brownish discoloration of body fluids

“Wearing-off effect”-as the disease advances, more neurons are lost, and the dose of the drug (carbidopa/levodopa) “wears off” before the next one is due.

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49
Q

Anti-Parkinson’s Drug: Carbidopa/Levodopa
Interactions, Contraindications:

A
  1. Interactions: MAOIs
  2. Contraindications:
    o Psychosis
    o Glaucoma
    o Melanoma
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50
Q

Anti-Parkinson’s Drug: Carbidopa/Levodopa
Administration:

A

o With or without food
o inc protein, food may dec absorption

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51
Q

Anti-Parkinson’s Drug: Carbidopa/Levodopa
Nursing Actions:

A

o Monitor vital signs: may cause orthostatic hypotension.
o Drug is taken with food, take with low protein.
o Do not abruptly discontinue (may–>NMS (neuroleptic malignant syndrome)

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52
Q

Anti-Parkinson’s Drug:
Tolcapone

A

COMT- inhibitor, used in combination with carbidopa/levodopa.

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53
Q

Anti-Parkinson’s Drug:
Tolcapone
Action:

A

Inhibits COMT so that additional loss of levodopa is prevented and more enters the brain.

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54
Q

Anti-Parkinson’s Drug:
Tolcapone
Benefits:

A

o Prolongs the time dopamine is available to the brain.
o Lower doses of carbidopa/levodopa
o Dec wearing off effect.

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55
Q

Anti-Parkinson’s Drug:
Tolcapone
ADRs:

A

serious liver toxicity (entacapone preferred)

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56
Q

Alzheimer’s Dementia

A

Most common form, diagnosis of exclusion. Pt slowly loses orientation to time, place, then person.

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57
Q

Alzheimer’s Dementia
Etiology/Pathophysiology:

A
  • Cortical atrophy- brain “shrinks.”
  • Abnormal proteins in the brain called “plaques and tangles” accumulate in the brain and
    destroy neurons–>dec ACH (acetylcholine)–>loss of memory and learning.
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58
Q

Alzheimer’s Dementia
Management:

A

o Palliative, aimed at reducing symptoms.
o Drugs improve symptoms but have no effect on the cause of disease.
o Approximate time between diagnosis of death is 8 yrs.

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59
Q

Alzheimer’s Dementia
Drug treatment:

A

Rivastigmine- acetylcholinesterase inhibitor

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60
Q

Alzheimer’s Dementia:
Rivastigmine
Action:

A

Inhibits enzymes from breaking down ACH (acetylcholine)–>inc levels/duration of action of ACH

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61
Q

Alzheimer’s Dementia:
Rivastigmine
SEs:

A

o Nausea and vomiting
o Diarrhea
o Insomnia

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62
Q

Alzheimer’s Dementia:
Rivastigmine
ADRs:

A

o Bradycardia
o Hypotension
o Syncope (a loss of consciousness for a short period of time)
o Lack of appetite
o Weight loss

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63
Q

Alzheimer’s Dementia:
Rivastigmine
Contraindications:

A

o Cardiac conduction abnormality
o Liver/renal disease

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64
Q

Alzheimer’s Dementia:
Rivastigmine
Administration:

A

o Transdermal patch or capsule BID
o Take with food.

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65
Q

Alzheimer’s Dementia:
Rivastigmine
Interactions:

A

o NSAIDs
o Other drugs that cause bradycardia/hypotension
o TCAs

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66
Q

Alzheimer’s Dementia:
Rivastigmine
Patient Teaching:

A

DON’T SMOKE – smoking inc clearance of drug–>dec amount of drug in the body.

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67
Q

Myasthenia Gravis

A

A disorder at the neuromuscular junction. It affects the nerve’s ability to communicate with muscles.

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68
Q

Myasthenia Gravis
Etiology/Patho:

A

Caused by antibodies that block ACH (acetylcholine) at receptors–>absence of muscle contraction–>weakness.

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69
Q

Myasthenia Gravis
Signs & Symptoms:

A

Systemic muscle weakness

o Primarily facial muscle weakness–>difficulty with eye-opening, talking, chewing.
o Also, proximal limb muscles
o Sever cases: may affect respiratory muscles- EMERGENCY!

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70
Q

Myasthenia Gravis
Drug treatment:

A

Pyridostigmine: acetylcholinesterase inhibitor

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71
Q

Myasthenia Gravis:
Pyridostigmine
Benefits:

A
  • inc ACH (acetylcholine)levels in the synapse
  • inc levels of ACH “outcompete” the antibodies.
  • Improves muscle weakness (inc muscle strength).
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72
Q

Myasthenia Gravis:
Pyridostigmine
Caution:

A

o Hyperthyroidism
o Renal impairment

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73
Q

Myasthenia Gravis:
Pyridostigmine
Contraindications:

A

Intestinal/urinary obstruction

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74
Q

Myasthenia Gravis:
Pyridostigmine
SEs/ADRs:

A

Due to cholinergic overstimulation

o Glands: sweating, salivation, lacrimation (tearing)
o GI/GU: diarrhea, abdominal cramps, urination
o Effects on the heart: bradycardia
o Respiratory: bronchospasms (bronchoconstriction)
o M/S (Musculoskeletal): over-excitation
o Eye: miosis (pupil constriction)

75
Q

Myasthenia Gravis:
Pyridostigmine
Interactions:

A

Atropine and other anticholinergics

76
Q

Myasthenia Gravis:
Pyridostigmine
Nursing Interventions:

A

o Monitor vital signs.
o Monitor for SEs/ADRs and report.
o Administer before meals on an empty stomach.

77
Q

Muscle Spasms:
Cyclobenzaprine

A

skeletal muscle relaxant. Pharmacologically and structurally similar to TCAs.

78
Q

Muscle Spasms:
Cyclobenzaprine
Action:

A

Acts within CNS at the brainstem–> dec motor neuron activity–>dec muscle spasms

79
Q

Muscle Spasms:
Cyclobenzaprine
Use:

A

Dec muscle spasms

80
Q

Muscle Spasms:
Cyclobenzaprine
Administration:

A

o oral, usually dose is 5mg TID with food.
o MEANT TO BE TAKEN SHORT TERM, MAX LENGTH OF ADMINISTRATION IS 2-3 WEEKS
o SHOULD NOT BE STOPPED ABRUPTLY may–> rebound muscle spasms.
o Tapered down over a 1-week period.

81
Q

Muscle Spasms:
Cyclobenzaprine
SEs:

A

o Dizziness
o Drowsiness
o Confusion
o Blurred vision
o Headache
o Dry mouth
o Constipation
o Nausea
o Altered taste.

82
Q

Muscle Spasms:
Cyclobenzaprine
ADRs:

A

Can activate the cardiovascular system (CV)–> inc risk of arrhythmias, MI (heart attack), stroke.

83
Q

Muscle Spasms:
Cyclobenzaprine
Contraindications:

A

o Patient’s recovering from MI (heart attack)
o Glaucoma
o AVOID in elderly (BEERS list)
o Hepatic impairment

84
Q

Muscle Spasms:
Cyclobenzaprine
Interactions:

A

o Antidepressants (structurally similar to TCAs), inc serotonin levels–>serotonin syndrome
o Alcohol
o Other CNS depressants

85
Q

Muscle Spasms:
Cyclobenzaprine
Nursing Actions:

A

o Monitor vital signs.
o Monitor for CNS effects.
o Safety- maintain a safe environment.
o Don’t stop abruptly.
o Avoid alcohol and other CNS depressants.
o Don’t drive.
o Inform the doctor if pregnant or nursing.

86
Q

Heart failure

A

The heart is “too pooped to pump” insult or injury to heart causes heart muscle to weaken, no longer pumps effectively.

87
Q

Cardiac Drug:
Digoxin

A

Cardiac glycoside

88
Q

Cardiac Drug:
Digoxin
Action:

A

o Pos inotrope: inc contractility (inc heart rate)
o Neg chronotrope: dec heart rate

89
Q

Cardiac Drug:
Digoxin
Uses:

A

o CHF (congestive heart failure)
o Arterial arrhythmias

90
Q

Cardiac Drug:
Digoxin
SEs:

A

o Dizziness
o Weakness
o Headache

91
Q

Cardiac Drug:
Digoxin
ADRs:

A

o Digoxin toxicity (rare) - may be triggered by hypokalemia, dec K–>inc digoxin.
o Severe symptoms: bradyarrhythmia
o Antidote: Digibind
o Signs & Symptoms:
* Hypersalivation
* Nausea and vomiting
* Diarrhea
* Fatigue
* Loss of appetite
* “yellow” visual disturbances (Blurred or yellow vision)

92
Q

Cardiac Drug:
Digoxin
Monitoring:

A

o Digoxin levels: 0.5-2.0 ng (nanograms)/ml.
o Potassium levels

93
Q

Cardiac Drug:
Digoxin
Interactions:

A

o Other drugs that dec heart rate
o Antacids (dec digoxin levels)
o PPI (proton pump inhibitor)- inc digoxin levels

94
Q

Cardiac Drug:
Digoxin
Contraindications:

A

o Renal failure (dose adjustment)
o Hypokalemia
o Hypo/hyperthyroidism
o Bradycardia

95
Q

Cardiac Drug:
Digoxin
Nursing Actions:

A

o Check apical pulse for a full minute.
o Hold and contact doctor if less than 60.
o Check potassium and digoxin levels before giving.

96
Q

Angina

A

Chest pain due to decreased blood flow to the heart (ischemia).

97
Q

Stable angina

A

Chest pain with exertion, relieved with rest.

98
Q

Unstable angina

A

Chest pain with exertion, NOT relieved with rest.

99
Q

Printzmetal’s angina (vasospastic)

A

Chest pain due to vasospasms, occurs in cycles. It may occur at rest.

100
Q

Anti-anginal drugs: Nitroglycerin

A

Main medication therapy for angina.

101
Q

Anti-anginal drugs: Nitroglycerin
Action:

A

Cause vasodilation–>inc blood flow to heart

102
Q

Anti-anginal drugs: Nitroglycerin
Use:

A

Acute anginal attack

103
Q

Anti-anginal drugs: Nitroglycerin
Forms:

A

o SL (sublingual)- most common
o Spray
o IV
o Topical
o TD (transdermal) patch
o Isosorbide (pill form)

104
Q

Anti-anginal drugs: Nitroglycerin
SEs, ADRs:

A

Due to vasodilation

o Headache- oral acetaminophen may provide some relief.
o Flushing
o Orthostatic hypotension
o Syncope (fainting)
o Reflex tachycardia

105
Q

Anti-anginal drugs: Nitroglycerin
Contraindications:

A

o Allergy
o Hypotension
o Anemia
o Inc intracranial pressure (ICP)

106
Q

Anti-anginal drugs: Nitroglycerin
Interactions:

A

PDES inhibitors (sildenafil)–>dramatic hypotension

107
Q

Anti-anginal drugs: Nitroglycerin
Patient instructions:

A

o Keep SL (sublingual) nitro in original glass container, store away from heat and light.
o Cap is screw-on, not child proof to facilitate emergency use.
o Sit or lie down when taking, may cause syncope (fainting) due to dilation.
o 3 doses five minutes apart can be taken.
-Nitro pill………Nitro,5 min—if pain is not relived in 5 minutes call 911……. Nitro,5min
-DO NOT EXCEED 3 DOSES IN 15 MINS

108
Q

Anti-anginal drugs: Beta-Blockers
Action:

A

Block Beta 1–>dec heart rate and blood pressure
Block Beta 2–>bronchospasm

o A-M: preferentially block Beta 1, but still antagonize Beta 2 a little. Use caution in patients with asthma/COPD.
o N-Z: non-selective-antagonize both Beta 1&2, contraindicated in patients with asthma/COPD.

109
Q

Anti-anginal drugs: Beta-Blockers
Uses:

A

o Hypertension
o Congestive heart failure- not acute
o Stable angina (dec MO2 demand —> dec angina)
o Cardioprotective post MI (heart attack)
o Tachyarrhythmias

110
Q

Anti-anginal drugs: Beta-Blockers
SEs:

A

o Dizziness
o Depression
o Fatigue
o Sexual dysfunction

111
Q

Anti-anginal drugs: Beta-Blockers
ADRs:

A

o Bronchospasm
o Bradycardia
o Hypotension

112
Q

Anti-anginal drugs: Beta-Blockers
Caution:

A

DO NOT abruptly discontinue.
-Can lead to anginal symptoms, rebound hypertension or tachycardia/palpations, anxiety.

113
Q

Anti-anginal drugs: Calcium channel blocker (CCB): Diltiazem
Action:

A

Prevents calcium from entering into cells of blood vessels–>relaxation of vessel walls.

114
Q

Anti-anginal drugs: Calcium channel blocker (CCB): Diltiazem
Uses:

A

o Hypertension
o Angina (vasospastic)
o Tachyarrhythmias

115
Q

Anti-anginal drugs: Calcium channel blocker (CCB): Diltiazem
ADRs:

A

Syncope (fainting)

116
Q

Anti-anginal drugs: Calcium channel blocker (CCB): Diltiazem
Contraindications:

A

Congestive heart failure

117
Q

Antidysrhythmic drugs: Beta-Blockers: Acebutolol

A
  • Prevent action of catecholamines (epinephrine & norepinephrine) on heart
  • Dec sinus node activity–>dec heart rate
118
Q

Antidysrhythmic drugs: Potassium(K+) channel blocker: Amiodarone

A

Also blocks sodium (Na+) channels, calcium channels, and some alpha and beta receptors.

119
Q

Antidysrhythmic drugs: Potassium(K+) channel blocker: Amiodarone
Effect:

A
  • Dec cardiac muscle cell excitability,
  • Prevents abnormal heart rhythms.
120
Q

Antidysrhythmic drugs: Potassium(K+) channel blocker: Amiodarone
Uses:

A
  • Atrial and life-threatening ventricular dysrhythmias—
  • Ventricular fibrillation,
  • Unstable ventricular tachycardia
121
Q

Antidysrhythmic drugs: Potassium(K+) channel blocker: Amiodarone
ADRs:

A
  • Pulmonary toxicity
  • Blue-gray skin discoloration
  • Neuropathy
  • Hepatotoxicity
  • Thyroid disfunction
  • Hypotension
  • Bradycardia
122
Q

Antidysrhythmic drugs: Calcium channel blockers (CCBs): Diltiazem

A

Slows conduction through SA & AV nodes–>dec heart rate.

123
Q

Antidysrhythmic drugs: Calcium channel blockers (CCBs): Diltiazem
Use:

A

Most commonly used in arterial arrhythmias

124
Q

Nursing Action for antidysrhythmic drugs: Acebutolol, Amiodarone, Diltiazem

A

o Monitor vital signs: hypotension, bradycardia.
o Monitor EKG: pt should be on cardiac monitor.
o Teach pt to take medication as ordered: DO NOT stop abruptly (BB)
o Teach pt to change positions slowly.
o Teach pt to avoid alcohol, tobacco, and caffeine.

125
Q

Thrombus

A

Blood clot which may form in arteries/veins.

  • Due to stasis, platelet aggregation or hypercoagulability
  • Thrombus suppression: anti-platelets (ex/aspirin), anticoagulants (ex/heparin)
  • Thrombolytics: “clot-busters”- dissolve blood clots
126
Q

Anti-platelets: Aspirin
Action:

A

Inhibits platelet aggregation by inhibiting COX-1

127
Q

Anti-platelets: Aspirin
Use:

A

Prevent MI (heart attack)/stroke.

128
Q

Anti-platelets: Aspirin
Precautions:

A

Irreversibly inhibits platelets for 7 days. Stop 1 week before surgery/procedures.

129
Q

Anti-platelets: Aspirin
Contraindications:

A

o GI bleed (peptic ulcer disease)
o Esophageal varices
o Intracranial bleed

130
Q

Anti-platelets: Clopidogrel
Action:

A

Also inhibits platelet aggregation and clot formation

131
Q

Anti-platelets: Clopidogrel
Uses:

A

Prevent repeat MI (heart attack)/stroke.

132
Q

Anti-platelets: Clopidogrel
Interactions:

A

o Other drugs that cause bleeding
o Herbs/supplements: (4 Gs)
* Ginger
* Garlic
* Gingko
* Green tea
* Feverfew (inc bleeding)

133
Q

Anticoagulants: Warfarin

A

Disrupts coagulation cascade.

134
Q

Anticoagulants: Warfarin
Action:

A

Vit K antagonist, disrupts synthesis of clotting factors 2 (prothrombin),7,9, and 10.

135
Q

Anticoagulants: Warfarin
Uses:

A

Prophylaxis and treatment of thromboembolic disorders (PE-pulmonary embolism, embolic stroke)

136
Q

Anticoagulants: Warfarin
Monitor:

A

Monitor INR (International Normalization Ratio) at regular intervals, maintain at level of 2-3. To find number move the decimal place of the prothrombin level to the left ex 20 —>2, 25—>2.5

137
Q

Anticoagulants: Warfarin
ADR:

A

Bleeding

138
Q

Anticoagulants: Warfarin
Interactions:

A

o Other drugs that cause bleeding

Inc effects of warfarin
* Other drugs that cause bleeding
* Antibiotics
* Amiodarone
* Cranberry juice
* Vit E (is a blood thinner)

Dec effects of warfarin
* Ginseng
* Ginko
* Ginger
* Kava-Kava (used for anxiety)
* Green tea
* Foods high in Vit K (consistency)

139
Q

Anticoagulants: Warfarin
Antidote:

A

o Vit K -slow reversal process
o FFP (fresh frozen plasma)- quicker reversal

140
Q

Anticoagulants: Heparin
Action:

A

Inactivates thrombin, which converts fibrinogen–>fibrin

141
Q

Anticoagulants: Heparin
Uses:

A

Prophylaxis and treatment of thromboembolic disorders:
* VTE (venous thromboembolism)-
* PE (pulmonary embolism) & DVT (deep vein thrombosis)
* afib (Atrial fibrillation)
* AMI (acute heart attack)
* Mechanical valves

142
Q

Anticoagulants: Heparin
Monitor:

A

o PTT/APTT at regular intervals while on IV Heparin gtt (Keep 50-70)
o NOT needed for SQ Heparin

143
Q

Anticoagulants: Heparin
ADRs:

A

o Bleeding
o Thrombocytopenia

144
Q

Anticoagulants: Heparin
Interactions:

A

Other drugs that cause bleeding

145
Q

Anticoagulants: Heparin
Contraindications:

A

Thrombocytopenia (platelet count less than 100,000 or if drops by more than 50% from baseline)

146
Q

Anticoagulants: Heparin
Antidote:

A

Protamine sulfate

147
Q

Anticoagulants: Enoxaparin

A

Made from heparin, lower risk of bleeding, more stable response at lower doses

148
Q

Anticoagulants: Enoxaparin
Action:

A

Similar to heparin
-Inactivates thrombin, which converts fibrinogen–>fibrin

149
Q

Anticoagulants: Enoxaparin
Advantages:

A

o Effects are more predictable.
o Fewer shots (1-2x daily)

150
Q

Anticoagulants: Enoxaparin
Uses:

A

o Prevent VTE (venous thromboembolism)-: 40mg daily subcut. -in love handles
o Treatment (MI (heart attack), DVT (deep vein thrombosis), PE (pulmonary embolism)): 1 mg/kg SQ BID

151
Q

Anticoagulants: Enoxaparin
Monitor:

A

none

152
Q

Anticoagulants: Enoxaparin
ADRs:

A

o Bleeding
o Thrombocytopenia

153
Q

Anticoagulants: Enoxaparin
Contraindications:

A

Thrombocytopenia reduced renal function.

154
Q

Anticoagulants: Enoxaparin
Antidote:

A

Protamine

155
Q

Anticoagulants: Thrombolytics: Alteplase
Action:

A

Activates protein called plasminogen which then converts to plasmin. Plasmin breaks up fibrin and dissolves clots.

156
Q

Anticoagulants: Thrombolytics: Alteplase
Use:

A

o Ischemic stroke
o MI (heart attack)
o Massive PE (pulmonary embolism)

157
Q

Anticoagulants: Thrombolytics: Alteplase
Administration:

A

Weight based IV infusion.

158
Q

Anticoagulants: Thrombolytics: Alteplase
ADR:

A

Bleeding

159
Q

Anticoagulants: Thrombolytics: Alteplase
Contraindications:

A

o Active internal bleeding
o Recent surgery
o Head trauma
o Severe uncontrolled hypertension -higher than 185/10

160
Q

Anticoagulants: Thrombolytics: Alteplase
Monitor:

A

o Perform regular neurological assessments.
o Asses for bleeding
o Check for signs and symptoms of intracranial hemorrhage (ICH)
o Discontinue infusion if:
* Severe headache -might indicate
bleeding.
* Severe hypertension
* Nausea and vomiting
* Worsening neurological status

161
Q

Anticoagulants: Thrombolytics: Alteplase
Interactions:

A

Anticoagulants –inc risk of bleeding

162
Q

Anticoagulants: Thrombolytics: Alteplase
Reversal agent:

A

Cryoprecipitate or aminocaproic acid

163
Q

Nursing Actions: Anticoagulants

A

o Baseline vital signs/labs: CBC, PT, PTT
o Medical history: any contraindications?
o For thrombolytics- inclusion/exclusion criteria
o Monitor for bleeding/bruising.
o Electric razors
o Soft bristle toothbrush
o Consistent intake of Vit K for Warfarin

164
Q

Patient teaching: Anticoagulants

A

o Tell ALL health care providers you are taking this drug.
o Use care to prevent injury.
o Consistent intake of Vit K for Warfarin
o Wear a medical ID bracelet.
o Do not smoke- inc drug metabolism.

165
Q

Hyperlipidemia

A

Abnormally high levels of fat particles in the blood, known as lipids.

  • Why is this a problem? They can adhere to the walls of arteries and reduce blood flow.
    o lead to risk of MI (heart attack), stroke, PAD (peripheral arterial disease)
  • 85% is produced by the liver, the rest from food.
166
Q

Four major results of lipid panel:

A
  • Total cholesterol: under 200
  • LDL (bad cholesterol-deposits in arteries): depends on risk factors.
  • HDL (want it to be high): greater than 45 in men and less than 55 in women. Picks up LDL, carries it away to the liver.
  • Triglycerides: more than 150
167
Q

HMG COA reductase inhibitor: Atorvastatin

A

They are associated with inc survival in pts with CAD (coronary artery disease).

168
Q

HMG COA reductase inhibitor: Atorvastatin
Action:

A

dec biosynthesis of cholesterol.
o Liver cell (HMGCOA)—-HMGCOA—->mevalonic acid (cholesterol precursor)
o By inhibiting this enzyme, statins dec concentration of cholesterol

169
Q

HMG COA reductase inhibitor: Atorvastatin
Use:

A

o Dec LDL (bad cholesterol)
o Inc HDL

170
Q

HMG COA reductase inhibitor: Atorvastatin
SEs:

A

o GI upset
o Dizziness
o Rash
o Pruritus (itching)

171
Q

HMG COA reductase inhibitor: Atorvastatin
ADRs:

A

o Inc LFTs
o Inc risk of liver toxicity
o Muscle pain
o Rhabdomyolysis
- triad- muscle pain, weakness, dark urine

172
Q

HMG COA reductase inhibitor: Atorvastatin
Contraindications:

A

o Liver disease
o Pregnancy

173
Q

HMG COA reductase inhibitor: Atorvastatin
Nursing actions/teaching:

A

o Take at night.
o Monitor LFTs
o Avoid alcohol.
o Avoid grapefruit juice (can inc statin levels)
o Annual eye exams
o REPORT:
- Muscle pain
- Weakness
- Tenderness
- Dark urine
- Dec appetite
- Stomach pain
- Yellowing of skin/eyes

174
Q

PAD (peripheral arterial disease)

A

Most common form of PVD (peripheral vascular disease)

Atherosclerosis of lower extremities- arteries become hardened due to plaque buildup.

175
Q

PAD (peripheral arterial disease)
Signs and Symptoms:

A
  • Ischemia/pain in lower extremities
  • Numbness
  • Non-healing ulcers
  • Dec/absent peripheral pulses
  • Cool/pale legs/feet
  • Less hair growth on the affected limb
  • Dependent rubor
176
Q

PAD (peripheral arterial disease)
Hallmark Stage:

A

Stage 2 PAD (peripheral arterial disease)- intermittent claudication- “exercise-induced reversible ischemia.” Pain occurs with exercise and is relieved with rest, due to not enough oxygen in the lower extremities. Most commonly felt in the calf.

177
Q

Drug treatment: PAD-
Cilostazol

A
  • Anti-platelet
  • Vasodilator
178
Q

Drug treatment: PAD-
Cilostazol
Use:

A

Treatment of intermittent claudication due to PVD (PAD)

179
Q

Drug treatment: PAD-
Cilostazol
SEs:

A

o Headache
o Diarrhea
o Palpitations

180
Q

Drug treatment: PAD-
Cilostazol
ADRs:

A

o Arrhythmias
o Inc heart rate
o Hypotension
o Thrombocytopenia
o Leukopenia

181
Q

Drug treatment: PAD-
Cilostazol
Contraindications:

A

o Heart failure
o Arrhythmias
o Bleeding disorders

182
Q

Drug treatment: PAD-
Cilostazol
Interactions:

A

o Grapefruit juice
o Other drugs that cause bleeding

183
Q

Drug treatment: PAD-
Cilostazol
Nursing actions/teaching:

A

o Perform peripheral vascular assessment.
o Monitor vital signs.
o Desired response may take up to 3 months.
o Do not smoke.
o Change positions slowly
o Take with food but not grapefruit.

NUR 210 Pharm (4 decks)

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