Exam 2 Prototypes Flashcards
(124 cards)
1
Q
diphenhydramine (Benadryl) Pharmacological Class
A
H-1 receptor blocker
2
Q
diphenhydramine (Benadryl) Indications
A
Allergies motion sickness insomnia pruritus Parkinson's Disease
3
Q
diphenhydramine (Benadryl) MOA
A
H-1 receptor antagonist
4
Q
diphenhydramine (Benadryl) Contraindications
A
elderly more likely to experience delirium, dizziness, inc HR. Children more likely to have paradoxical excitation
5
Q
diphenhydramine (Benadryl) Adverse Effects
A
drowsiness (develop tolerance to this), dry mouth, inc. HR (anticholinergic effects
6
Q
diphenhydramine (Benadryl) Other Considerations
A
avoid concurrent use w/ other CNS depressants (opioids, alcohol, etc.)
7
Q
fluticasone(Flonase) pharmacological class
A
corticosteroids
8
Q
fluticasone(Flonase) Indications
A
allergic rhinitis, asthma(can be given as an inhaler)
9
Q
fluticasone(Flonase) MOA
A
decreases inflammation in nasal mucosa
10
Q
fluticasone(Flonase) adverse effects
A
burning sensation when spraying, epistaxis (nose bleed)
11
Q
oxymetazoline (Afrin) Pharmacological class
A
sympathomimetic
12
Q
oxymetazoline (Afrin) Indications
A
allergic rhinitis, nosebleeds
13
Q
oxymetazoline (Afrin) MOA
A
alpha 1-adrenergic agonist (causes vasoconstriction of blood vessels in nasal mucosa and drying of mucous membranes)
14
Q
oxymetazoline (Afrin) adverse effects
A
rebound congestion, dry/stinging nasal mucosa
15
Q
atropine adverse effects
A
Dry mouth, constipation, urinary retention, tachycardia, blurred vision
16
Q
atropine pharmacological class
A
anticholinergic
17
Q
atropine indications
A
GI hypermotility, suppress secretions during surgery, symptomatic bradycardia, pupil dilation for exam, antidote for poisoning with nerve gas or organophosphates (insecticides)
18
Q
atropine contraindications
A
Clients with glaucoma
19
Q
atropine MOA
A
Blocks cholinergic (muscarinic) receptors, causing increased heart rate, decreased GI motility, mydriasis, bronchodilation, and decreased secretion from glands (salivation)
20
Q
spironolactone pharmacological class
A
Aldosterone antagonist
21
Q
spironolactone indications
A
Heart failure , edema with liver failure, HTN, hyperaldosteronism
22
Q
spironolactone MOA
A
Inhibits aldosterone, increasing the secretion of water and sodium while decreasing the excretion of potassium
23
Q
spironolactone adverse effects
A
Hyperkalemia, hyponatremia, diarrhea, gynecomastia
24
Q
spironolactone nursing implications
A
Monitor urine output, BP, potassium levels; educate clients to avoid foods high in potassium or salt substitutes high in potassium
25
spironolactone therapeutic class
Antihypertensive, drug for edema
26
furosemide therapeutic class
Drug for heart failure, hypertension
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furosemide pharmacological class
Loop diuretic
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furosemide indications
Heart failure, renal failure, hepatic cirrhosis, pulmonary edema, edema, HTN
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furosemide MOA
Inhibits reabsorption of sodium and chloride in the ascending loop of Henle. Results in increased excretion of sodium, potassium, chloride, calcium, magnesium, and water
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furosemide adverse effects
Dehydration, hypotension (low BP), electrolyte depletion (especially K+ and Mg), renal impairment, ototoxicity (higher doses, rapid IV administration)
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furosemide nursing implications
Monitor urine output, BP, creatinine, K+, Mg (may require electrolyte replacement)
Avoid taking at bedtime
Educate patients on importance of monitoring lab work and BP
Rise slowly when getting up (orthostasis)
Older adults at risk for falls
Related to sulfonamides; watch for cross-sensitivity
Avoid using with other nephrotoxic or ototoxic drugs
If taking digoxin, monitor for toxicity if hypokalemic (low potassium level)
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hydrochlorothiazide therapeutic class
Antihypertensive, Drug for edema
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hydrochlorothiazide pharmacological class
Thiazide diuretic
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hydrochlorothiazide indications
Mild to moderate HTN
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hydrochlorothiazide MOA
Affects sodium reabsorption at the distal renal tubule, causing increased excretion of sodium and chloride
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hydrochlorothiazide adverse effects
Electrolyte imbalances (dec. K+, Na, Mg), hypotension, vertigo, renal impairment, hyperglycemia in diabetic patients
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hydrochlorothiazide nursing implications
Monitor BP, urine output, electrolytes, renal function, administer in morning. Less effective than loop diuretics
38
lisinopril therapeutic class
drug for HTN, heart failure, MI prevention
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lisinopril pharmacologic class
ACE inhibitor
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lisinopril indications
HTN, heart failure, acute MI
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lisinopril MOA
prevents conversion of angiotensin 1 to angiotensin 2, decreases vasoconstriction and aldosterone secretion
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lisinopril adverse effects
orthostatic hypotension, dizziness, headache, persistent dry cough, renal impairment, hyperkalemia, angioedema
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lisinopril nursing considerations
discontinue if pregnant (teratogen), patient education (signs of hypotension, angioedema, avoid high sodium and high potassium foods, first dose phenomenon) monitor potassium and renal function (creatinine)
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diltiazem therapeutic class
antihypertensive, abtianginal, antiarrhythmic
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diltiazem pharmacologic class
calcium channel blocker
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diltiazem indications
HTN, angina, tachyarrhythmias
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diltiazem MOA
blocks transport of calcium into myocardial and vascular smooth muscle cells
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diltiazem contraindications
heart block, shock
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diltiazem adverse effects
hypotension, bradycardia, heart failure symptoms, headache, fatigue, n/v, arrhythmias
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diltiazem nursing considerations
monitor BP, HR, ECG, can be given PO or IV, do not crush extended release tablet, patient education
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beta blockers indications
HTN, heart failure, arrhythmias, MI, many non-cardiovascular uses as well
52
beta blockers MOA
block beta receptor site, resulting in decreased HR and myocardial contractility, which in turn decreases BP and myocardial oxygen demand
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beta blockers adverse effects
bradycardia, hypotension, dizziness, fatigue/lethargy, decreased sexual ability, depression, worsening heart failure symptoms, bronchoconstriction
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beta blockers nursing implications
monitor HR and BP, don't stop medication abruptly, may mask symptoms of hypoglycemia, have patient report dizziness, lightheadedness, avoid in patients with asthma
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beta blockers black box warning
clients with CAD, don't stop abruptly
56
alpha 1 adrenergic blocker indications
HTN, benign prostate hypertrophy
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alpha 1 adrenergic blocker MOA
block the a1 adrenergic receptor, resulting in vasodilation and relaxation of smooth muscles in the prostate
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alpha 1 adrenergic blocker adverse effects
orthostatic hypotension, dizziness/drowsiness, headache, fatigue, syncope, first does phenomenon
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alpha 1 adrenergic blocker nursing implications
take at night to avoid dizziness/drowsiness, rise slowly when getting up
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alpha 2 adrenergic agonists indications
HTN
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alpha 2 adrenergic agonists MOA
stimulating a2 adrenergic receptors results in decreased sympathetic response from the CNS, causing vasodilation and decreased BP
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alpha 2 adrenergic agonists adverse effects
CNS depression, dizziness/ drowsiness, orthostatic hypotension
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alpha 2 adrenergic agonists nursing implications
do not stop abruptly, rotate patch site weekly
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vasodilators indications
hypertensive crisis (> 180/120), during or post-cardiac surgery
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vasodilators MOA
relaxation of venous and arterial smooth muscle, leading to vasodilation and decreased peripheral resistance
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vasodilators adverse effects
flushing, headache, n/v, cyanide and thiocyanate toicity
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vasodilators nursing implications
administered as IV, rapid onset and short half life (2 min), monitor BP, HR, monitor for cyanide/thiocyanate toxicity, transition to oral therapy ASAP
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therapeutic class of digoxin
drug for heart failure
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pharmacologic class of digoxin
cardiac glycoside
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indications of digoxin
heart failure, atrial fibrillation, atrial flutter
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MOA of digoxin
increases intracellular calcium leading to positive inotropic effect, decreases conduction through SA and AV nodes leading to a negative chronotrophic effect and increased diastolic filling time
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adverse effects of digoxin
bradycardia, arrhythmias, fatigue, N/V, blurred/yellow vision (Sign of toxicity), increased risk of toxicity when hypokalemic
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nursing considerations of digoxin
loading dose followed by daily maintenance dose (IV or PO), monitor drug levels (narrow therapeutic range), check apical pulse for one minute before administering
74
carvedilol therapeutic class
antihypertensive, drug for heart failure
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carvedilol pharm. class
beta-blocker
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carvedilol MOA
Blocks stimulation of beta1, beta2, and alpha1 adrenergic receptors, leading to decreased heart rate and BP
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carvedilol indications
HTN, heart failure, MI
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carvedilol ADRs
Dizziness, fatigue, depression, bradycardia, weakness, erectile dysfunction, heart failure, bronchospasm/wheezing, diarrhea, hyperglycemia
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carvedilol other consider.
Nursing consid: Monitor BP, HR, weight, signs of worsening heart failure, glucose levels, use with caution in patients with asthma, client eduation (do not stop medication abruptly, monitor BP and HR, change position slowly)
80
hydralazine pharm. class
vasodilator
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hydralazine therapeutic class
antihypertensive
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hydralazine MOA
Arteriolar vasodilation leading to decreased BP and afterload
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hydralazine indications
HTN, heart failure unresponsive to other therapies (off-label)
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hydralazine ADRs
Headache, N/V, reflex tachycardia, lupus-like symptoms (with higher doses, rare)
85
hydralazine nursing considerations
monitor BP, educate patient to notify provider if lupus-like symptoms develop, take 3-4 times daily, can lead to compliance issues
86
milrinone therapeutic class
inotrope
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milrinone pharmacologic class
phosphodiesterase inhibitor
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milrinone indications
acute, decomposed HF (short term therapy)
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milrinone MOA
blocking of phosphodiesterase enzyme leads to increased cardiac contractility (positive inotropic effect) and vasodilation (decreased preload and after load). this leads to increased cardiac output
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milrinone ADRs
hypotension, arrhythmias (10% risk) angina
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milrinone nursing implications
administered as continuous IV infusion, short half life, monitor BP, cardiac output/index, ECG
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digoxin therapeutic class
drug for HF
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digoxin pharm. class
Cardiac glycoside
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digoxin indications
Heart failure, atrial fibrillation, atrial flutter
95
digoxin MOA
Increases intracellular calcium leading to positive inotropic effect. Decreases conduction through SA and AV nodes, leading to a negative chronotropic effect and increased diastolic filling time
96
digoxin ADRs
Bradycardia, arrhythmias, fatigue, N/V, blurred/yellow vision (sign of toxicity); increased risk of toxicity when hypokalemic
97
digoxin other consider.
Nursing consid: Loading dose, followed by daily maintenance dose (IV or PO), monitor drug levels (narrow therapeutic range), check apical pulse for one minute before administering (generally hold for HR <60), antidote is digoxin immune fab (Digibind)
98
hydralazine other consider.
nursing consid:Monitor BP, educate patient to notify provider if lupus-like symptoms develop, take 3-4 times daily; can lead to compliance issues
99
milrinone therapeutic class
inotrope
100
milrinone pharm. class
phosphodiesterase inhibitor
101
milrinone indications
Acute, decompensated heart failure (short term therapy)
102
milrinone MOA
Blocking of phosphodiesterase enzyme leads to increased cardiac contractility (positive inotropic effect) and vasodilation (decreased preload and afterload). This leads to increased cardiac output
103
milrinone ADRs
Hypotension, arrhythmias (10% risk), angina (chest pain)
104
milrinone other consider.
Nursing Imp: Administered as continuous IV infusion; short half-life; monitor BP, cardiac output/index, ECG
105
oxymetazoline (Afrin) contraindications
those with HTN, thyroid disorders, diabetes and heart disease should consult with provider
106
oxymetazoline (Afrin) nursing implications
instruct clients not to use for more than 3 days.
107
heparin therapeutic class
anticoagulant
108
heparin pharmacologic class
Indirect thrombin inhibitor
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heparin indications
Prevent formation of clots; often used prophylactically
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heparin MOA
The binding of heparin to antithrombin III blocks clotting through the inactivation of Factor X and inhibition of prothrombin’s conversion to thrombin (thrombin inhibitor)
111
heparin adverse effects
Bleeding, heparin induced thrombocytopenia (HIT)
*Heparin Induced Thrombocytopenia leads to a prothrombic stated (increased risk of clotting) and the development of thrombocytopenia (a low platelet count)
112
heparin other consider.
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Administered SQ (for prophylaxis) or IV
Monitor for bleeding
Monitor platelets (for HIT)
Monitor PTT (Partial Thromboplastin Time
Goal 1.5-2.5 x normal value
May also monitor anti-Factor Xa levels
Protamine sulfate is antidote
Half life is ~1 hour (for IV)
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113
warfarin therapeutic class
anticoagulant
114
warfarin pharm. class?
vitamin K antagonist
115
warfarin indications
Prevent formation of clots; can be used prophylactically
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warfarin MOA
Blocks the generation of vitamin K, thereby inhibiting synthesis of vitamin K dependent clotting factors
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warfarin ADRs
Bleeding, skin necrosis (rare)
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warfarin other consider.
Given orally at same time each day
Takes several days to reach maximum effect (overlaps with heparin therapy)
Monitor PT/INR (Prothrombin Time/Internationalized Ratio)
goal is typically INR of 2-3
INR must be measured regularly on outpatient basis as well
Educate clients about bleeding precautions
Contraindicated in pregnancy
Multiple drug-drug and drug-diet interactions (consistency is key)
119
amiodarone therap. class?
antidysrhythmic
120
amiodarone pharm. class?
potassium channel blocker
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amiodarone indications
Treatment of life threatening ventricular dysrhythmias, treatment of atrial dysrhythmias (off-label)
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amiodarone MOA
Prolongs action potential and refractory period, slowing the heart rate. Decreases peripheral vascular resistance through vasodilation
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amiodarone ADRs
Worsening of dysrhythmias, pulmonary toxicity, bradycardia, hypotension, N/V, dizziness, fatigue, blue discoloration of skin, increased liver enzymes, effect on thyroid function, photosensitivity, tremors, blurry vision
124
amiodarone other consider.
Interactions Multiple drug interactions- increases drug levels of digoxin, warfarin, and carvedilol (just to name a few)
Nursing Considerations Requires loading dose, ECG monitoring if giving IV, monitor HR and BP, assess for signs of pulmonary toxicity (thorough respiratory assessment), monitor liver and thyroid function, avoid grapefruit juice, can be given PO or IV, prolonged half-life (several weeks), pregnancy category D
