Exam 2 Review Flashcards
(53 cards)
1
Q
ACE inhibitors cause what common side effect?
A
non-productive cough (“ACE cough”)
2
Q
RAAS medications (ex: ACE inhibitors) are contraindicated in?
A
Pregnancy (fetal toxic)
3
Q
Clopidogrel
- class
- use
- route
- is this a first-choice drug for an active pulmonary embolism? What would be the first choice?
A
- antiplatelet
- prolongs bleeding time to prevent thrombosis, MI, ischemic strokes
- PO
- No, first choice would be an unfractionated heparin anticoagulant
4
Q
Aspirin
- class (3)
- patient teaching
A
- antiplatelet, antiinflammatory (pain), antipyretic (fever)
- warn patient that GI bleed can be seen in dark, tarry stool
5
Q
Warfarin
- class
- onset (days)
- can a patient be on warfarin and heparin at the same time?
A
- anticoagulant
- onset: 3-5 days
- patient can be on warfarin and unfractionated heparin at the same time
6
Q
Heparin
- class
- types (2): routes
A
- anticoagulant
- unfractionated and low-molecular-weight heparin (Lovenox)
7
Q
Unfractionated heparin should be given in what setting? Route? Nursing consideration?
A
- in the hospital, cannot be brought home
- IV admin
- “two-person sign off:” one draws up medication, second nurse confirms the right (1) syringe in units, (2) concentrations
8
Q
Alteplase
- class
- use (4); esp in what organs?
- nursing assessment/considerations (3)
- route
- contraindications (2)
A
- thrombolytic (clot buster)
- active clot breakdown in lungs, heart, and brain; for PICC line obstruction, PE, DVT
- head-to-toe assessment for cuts, bleeding, orifices that patient can bleed from
- stay with patient for initial 30 mins after admin (avoid bleed)
- assess if the patient had a thrombolytic in the last 2-3 weeks
- IV admin
- contraindications: severe HTN, NSAIDs/aspirin (increase risk for bleeding)
9
Q
If a patient had an ISCHEMIC stroke (blockage in the artery of the brain), how many hours after they’ve had the onset of the stroke are open to take a thrombolytic?
A
3-5 hours
10
Q
When should alteplase not be given?
A
If the patient had taken a thrombolytic in the past 5-7 days
11
Q
Main concern for alteplase? (2)
A
bleeding and hemorrhage
12
Q
Patient teaching for anticoagulants, thrombolytics, antiplatelets (2)
A
- keep surrounding clean and cover sharp edges
- fall risk: remove loose carpeting
13
Q
What s/s should the patient be educated on in patient teaching on internal bleeding with excessive anticoagulant use? (3)
A
- purpura
- bruising
- dark/tarry stool
14
Q
Antiplatelet vs Anticoagulant?
Warfarin works on how many places of cascade?
A
Antiplatelet: decreases platelet aggregation, does NOT break down clotting
Anticoagulant: works on more areas of the coagulation cascade
Warfarin = works on 5 places of cascade = high risk for bleeding
15
Q
Which diuretics work on:
- proximal convoluted tubules
- ascending loop of Henle
- distal convoluted tubes
- collecting ducts
A
- osmotics (mannitol)
- furosemide (lasix)
- HCTZ
- spironolactone
16
Q
Which diuretic produces the most diuresis? What can occurs with this drug?
A
- osmotics (mannitol)
- fluid can end up in lungs
17
Q
Which diuretic produces the second most diuresis? Describe:
- use
- s/s of acute decompensated HF
- nursing considerations (2)
A
- furosemide (lasix)
- HF to decrease fluid vol
- pink, frothy sputum
- sit patients upwards
- anticipate furosemide via IV if patient is showing signs of acute decomp HF
18
Q
Which diuretic produces less diuresis than furosemide?
- route
- cannot be given
- this drug is first choice therapy for?
- contraindication?
A
- HCTZ (hydrochlotothiazide)
- route: PO
- cannot through IV
- first choice drug for HF
- end-stage HF (overwork heart)
19
Q
Which diuretic produces the least amount of diuresis? Spares? Why would spironolactone and furosemide be ordered? What can happen if patient is on spironolactone and ACE inhibitors at the same time?
A
- spironolactone
- spares potassium
- to spare potassium but produce high levels of diuresis
- can raise potassium too high; may have to hold ACE inhibitor
20
Q
Psyllium
- class
- patient teaching
A
- bulk-forming laxative
- should be given immediately after mixing with water; can turn into pudding if it is mixed with water and not given right away
21
Q
Digoxin
- use
- positive inotrope…
- nursing consideration
- s/s of toxicity (2)
- derived from
A
- HF
- positive inotrope: increases contractility to increase HR (inotropic and chronotropic qualities)
- hold if HR is below 60 (listen to apical pulse for full min)
- s/s: visual disturbances, colored halos
- foxglove plant
22
Q
Nitroglycerin
- use
- indication of unstable angina
- routes (3)
- patient teaching (5)
A
- angina (chronic stable angina)
- pain does not subside after first dose
- sublingual, IV, patch
- PRN (as needed); take while sitting or laying down (decrease fall risk); cannot be swallowed
- 1 dose every 5 mins, max up to 3 doses; call 911 if pain continues after 3 doses
23
Q
Montelukast
- class
- route
- patient teaching (2): should not be used for? labs to assess?
- what medication should not be taken with montelukast?
A
- leukotriene antagonist / bronchodilator
- inhalant
- teaching: maintenence drug NOT for emergency asthma attack; assess liver function labs in the EVENING
- NSAIDs
24
Q
Vincristine
- brand name
- class
- route…caution?
- side effect to report
- patient teaching (4)
- what should be done to treat nausea?
A
- oncovin
- chemotherapeutic drug
- IV can be vesicant: can damage blood vessels
- peripheral neuropathy (tingling, numbness) report to HCP; numbness leads to poor dexterity (ex: unable to tie shoes)
- should not stop IV; report signs of infection to HCP; nausea and vomiting is expected (admin antiemetic 30 mins to 1 hr prior); hair loss is expected
25
Cyclophosphamide
- class
- common side effect?
- adverse effect?
- what would be anticipated to recommend to patients?
- chemotherapeutic drug
- side effect: hematuria (include in patient teaching)
- adverse: hemorrhagic cystitis (report to HCP)
- increase hydration to help with inflammation of cystitis
26
Cilostazol
- class (2)
- use, primarily for?
- when should improvement be seen?
- risk for?
- cautionary s/s
- direct-acting vasodilator and antiplatelet
- arterial and venous peripheral issues (PAD, PVD); primarily for INTERMITTENT CLAUDICATION
- 2-3 months
- risk for bleeding
- orthostatic hypotention = fall risk
27
Patient teaching for antiretroviral therapy? (4)
What was the first group of antiretrovirals?
- adhere to med regimen: take at the same time per day at the correct dose
- multiple antiretrovirals to prevent resistance
- dehydration is common in patients taking several ART drugs
- medication regimen is life long
- protease inhibitors (first group) and are the most resistant
28
Safety precaution for HIV patients? (4)
- handle bodily fluids
- wear proper PPE
- safe sex habits
- avoid needlesticks (esp from large bore IV catheters)
29
What should be done if a nurse gets a needlestick from HIV antiretroviral admin?
start antiretroviral within 72 hrs for 4 weeks
30
Expectations for patients after several months of ART therapy? (2)
- low viral load
| - high CD4 count
31
Diphenoxylate with atropine
- use
- atropine use? (2)
- drug contains?
- treats severe diarrhea
- atropine helps decrease motility and discourages opioid use
- contains small amt of opioids
32
Tiotropium
- class
- use (2)
- action
- route (what device)
- s/s
- patient teaching (3)
- anticholinergic
- asthma and COPD
- relaxes and dilates bronchioles
- oral inhalation (Handihaler device: dry powder capsule inhaler)
- s/s: anticholinergic effects
- wash with warm water and keep dry; rinse mouth with water immediately and sugarless candy to prevent dry mouth; cannot use as emergency inhaler/not first choice drug
33
What is the first line or rescue emergency inhaler? Usage multiple times per week indicates?
Albuterol; use multiple times per week indicates poorly controlled asthma
34
Solifenacin succinate
- class
- use
- side effects (3)
- which side effect is the main concern and should be reported and what s/s should patient know?
- when should it be given?
- anticholinergic
- treat overactive bladder and incontinence; keeps the bladder from contracting
- anticholinergic effects, tachycardia, tiredness
- urinary retention; s/s: freq but unable to urinate
- should be given earlier in the day (to avoid nocturia and decrease fall risk)
35
A patient is receiving solifenacin succinate. The nurse knows that this drug is used to treat which condition?
Overactive bladder
36
Efavirenz
- class
- use
- action
- patient teaching (2)
- biggest concern for patient teaching?
- contraindication + patient teaching
- reverse transcriptase
- HIV-1 viral infection
- inhibits enzymes needed for viral replication
- take on empty stomach/without food; dizziness and rashes is expected
- biggest concern: taken at the same time every day
- pregnancy: causes neural tube defects (female patients should be on contraceptive and have backup contraceptive - efavirenz decreases the effectiveness of contraceptive)
37
Diphenhydramine
- brand name?
- class
- use (3)
- side effects
- patient teaching (3)
- antihistamine
- Benadryl
- allergies (reactions/seasonal, ex: pollen); OTC sleep aid; mild allergic reaction to blood transfusion
- anticholinergic effects
- cause significant sedation; avoid alcohol and CNS depressants (increased CNS depression); causes drowsiness
38
Atorvastatin
- class
- use
- action
- route
- contraindication (3)
- nursing consideration (2) labs?
- side effects (5)
- adverse effects
- statin
- hyperlipidemia
- lowers LDL and decrease the risk for coronary artery disease
- route: PO
- contraindication: hepatic disorder, alcohol abuse, pregnancy/breastfeeding
- obtain baseline lipid panel and creatinine levels
- side: muscle cramps, rash, ABD pain, constipation, nausea
- adverse: rhabdomyolysis (muscle breakdown)
39
Patient teaching for atorvastatin? (7)
- avoid grapefruit
- avoid warfarin (inhibits warfarin metabolism and increases risk for bleeding)
- take in the evening
- taken with water/meal to help with GI effects
- 6-8 weeks to effect patient
- life-long medication
- report: darkening of urine, muscle pain/aches
40
Doxorubicin
- class
- route
- action
- use (2)
- side effects of concern... s/s? (3)
- patient teaching (2)
- antitumor drug
- route: IV with other chemotherapeutic drugs
- shrinks tumor
- "cocktail" for cancer treatment; solid tumors
- cardiotoxicity (damages the tissues of the heart)
- s/s of cardiotoxicity: palpitations, fluttering HR, SOB
- expect reddish urine; know s/s of cardiotoxicity
41
Dextromethorphan
- class
- route
- use... NOT used to?
- side effects (2)
- adverse reactions (3)
- contraindication (4)
- patient teaching
- antitussive
- oral PO
- treats unproductive coughs; decreases cough and makes it more productive to rid of secretions
- not used to suppress cough
- ataxia, restlessness
- adverse: tachycardia, seizures, psychosis
- caution: asthma, bronchitis, HF, smoking
- teach patient to take during the day to produce secretions
42
Methylphenidate
- brand name
- class
- patient teaching
- CNS stimulant
- Ritalin
- ask HCP before taking OTC and prescription drugs
43
Promethazine
- brand name
- class
- use
- cautionary s/s with IV use
- who should NOT receive medication? (2)
- phenergan
- antiemetic
- for nausea and vomiting after surgery
- can cause tissue necrosis with IV use
- patients with glaucoma, and patients who are pregnant
44
The universal adverse effect that would require patients to seek medical attention?
Anaphylaxis or hypersensitivity reaction to the drug
45
Anticholinergic effects? (5)
- blurred vision
- urinary retention
- constipation
- tachycardia
- dry mouth
46
A patient with stable COPD has prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient?
A long-acting inhaled beta2 agonist (LABA)
47
Can a long-acting beta-agonist be given alone to the patient with asthma?
No, must be given with the corticosteroid
48
A patient with COPD is prescribed tiotropium (Spiriva). After the initial dose, the patient reports only mild relief within 30 mins. What will the nurse tell the patient?
"You should see improved effects within the next week"
Tiotropium: maintenance drug, bronchodilation will occur within 8 days
49
A patient with asthma comes to a clinic for treatment of an acute exacerbation. Hx includes inhaled glucocorticoid, montelukast, and a SABA as needed. The nurse assesses the patient and notes a resp rate of 18 bpm, HR of 96 bpm, and oxygen sat of 95%. Mild expiratory wheezes are heard and equal breath sounds bilateral. What will the nurse do?
Question the patient about how much albuterol has been used.
(Long-acting beta2 agonists take longer to use)
50
Aluminum hydroxide
- class
- action
- patient teaching (2)
- most important patient teaching?
- antacid
- neutralizes acid; does NOT get rid of acid
- do not take with other PO meds; take after meals (acid at highest level)
- when to take it (after meals) and what not to take it with
51
Antidote for warfarin?
| Antidote for heparin?
Warfarin: vitamin K
Heparin: protamine sulfate
52
aPTT (partial thrombin time) is used to measure? Detects?
Heparin; detects defect in clotting factors
53
INR and PT are used to measure? PT is? INR normal vs when on anticoagulant?
Warfarin; PT: time it takes for blood to clot; normal INR = under 1; when on warfarin = 2-3x greater for longer clot time
