Exam 3 Misc. Flashcards
1
Q
Main point when treating patients with cardiac drugs
A
adequate cardiac output
2
Q
Priority nursing diagnosis for cardiac drugs
A
ineffective tissue perfusion
3
Q
Afterload
A
pressure the heart has to work against to get the blood out
- the higher the pressure, the less blood the L ventricle will get out
- causes decreased CO
4
Q
Preload
A
amount of blood that gets to the right atrium from the superior vena cava
- increased preload= increased CO
- decreased preload= decreased CO
5
Q
chronotropy
A
- “chrono” means time
- drugs effecting heart rate
- positive chronotropy means we make it faster
- negative chronotropy means we slow it down
6
Q
Inotropy
A
- How forcefully it contracts
- Decrease in force is a decrease in CO
7
Q
Dromotropy
A
- Speed of conduction
- increase in conduction speed= increase in HR and vice versa
8
Q
What is the risk of an increased afterload?
A
Clots will form because too much blood is sitting
9
Q
Drug that everyone is on in hospitals because of immobility
A
heparin
10
Q
Heparin antidote
A
protamine sulfate
11
Q
Normal PT values
A
10-14 sec
12
Q
Normal PTT values
A
20-45 sec., Max 112 sec
13
Q
Difference between heparin and enoxaparin
A
- Heparin is used to treat the problem, enoxaparine is used to prevent it
- enoxaparine is safer
14
Q
Antidote to warfarin
A
Vitamin K
15
Q
Blood tests for heparin and enoxaparin
A
PT and PTT
16
Q
Blood tests for warfarin
A
INR
17
Q
Problems with warfarin
A
dangerous drug, lots of toxicity and treatment failure
18
Q
What should people take instead of ferrous sulfate and why?
A
ferrous gluconate, its much easier on the stomach
19
Q
Patient teaching for ferrous sulfate/ iron
A
Take for 6 months- this is hot much time it takes for the body to store enough iron to meed daily requirements on its own
20
Q
Vitamin B12 is used for…
A
Pernicious anemia
21
Q
Sickle Cell anemia is common in which group
A
African Americans
22
Q
Antianemic drug to treat Sickle Cell anemia
A
hydroxyurea - antineoplastic that increases fetal RBCs
23
Q
Vasopressers
A
Nitroprusside and Hydralazine
-increase BP
24
Q
First choice antihypertensives
A
ACE Inhibitors
25
Expected side effect with ACE inhibitors
-cough
| ACE enzymes are also in the lungs so if we inhibit them, we get a cough
26
What do you do if ACE inhibitors cause cough?
put them on an ARB
27
How does high cholesterol affect afterload?
increases it
| -too many lipids make thick blood and increase afterload or stick to vessels making diameter thinner
28
high cholesterol
>200
29
Side effect of statins
Rhabdomyolysis- muscle tissue breaks up and all the contents of muscle cells spill out into systemic system
- lethal
- myoglobin would be present in systemic system
30
Normal triglycerides
150
31
Normal digoxin level
between 0.8 and 2
32
Digoxin's effect on the tropys
negative chronotropy, positive inotropy, negative dromotropy
33
s/s of dig toxicity
vision problems, confusion, vomiting, diarrhea
34
digoxin antidote
Dig Immune Fab- binds to digoxin and doesn't allow it to do its job
35
anti-arrhythmics and tropys
all anti-arrythmics decrease all three: negative chrono-, ino- and dromotropy
36
Side effects of nitrates
raging headaches
37
leading cause of death in the western world
CAD
38
Functions of good lipids
need lipids for steroids, hormones, helps us use vitamin D, involved in absorption of fat soluble vitamins
39
Desired cholesterol values
Total Chol
40
What do we give when people can't tolerate statins
bile acid sequestrants because they bypass the liver and metabolize in the stomach
41
Problem with bile acid sequestrants
- causes decreased fat-soluble vitamin absorption
| - GI distress
42
Can you control cholesterol with diet?
Kind of, but our bodies still make it, so its also genetic
43
When should statins be given?
at night- that's when our bodies make cholesterol
44
s/s of Rhabdo
- bloody urine, muscle pain, weakness, kidney failure
| - labs: urinalysis, BUN, creatinine, I&O, liver enzymes
45
Cholesterol absorption inhibitors
- decreases absorption in the brush border
- used with statins when statins aren't working
- works in the intestines so its good for people with liver probs
46
Fibrates
-triglyceride and lipoprotein destruction
47
side effect of fibrates
pancreatitis- severe abdominal pain and vomiting
48
Can you eat perfectly healthy and still have hyperlipidemia?
Yes
49
most common reason for use of warfarin
AFib (lots of blood in the atrium bc its not strong enough to push out)
50
anti-hemophilic agents
replace the missing factor (blood products- take someone's blood and just keep the factor)
51
hemophillia
genetically inherited lack of one of the factors in the coagulation cascade
52
Hemophillia A is lacking which factor?
8
53
Hemophillia B is lacking which factor?
9
54
How do we prevent reactions to blood products?
premedicate with benedryl and tylenol
55
Hemostatic agents
- Amicar
| - Stops bleeding
56
Side effect of Amicar
clotting
57
First intervention for bleeding
apply pressure
58
How do we check for anemia
Look at CBC for:
hemoglobin: 12-18
hematocrit: 28-54
RBCs: 4-6
59
How do we check for megaloblastic anemia
MCV- mean corpuscular volume
60
Problem with microcytic RBCs
can't carry much O2 so we have a problem with oxygenation
61
Problem with macrocytic RBCs
too big and don't know how to do their job
62
Side effect of erythropoiesis stimulating agents
bone pain and risk of cancer development
63
Side effects of iron therapy
GI effects and skin/teeth stains
64
Iron antidote
- give something that will bind to it like milk and eggs
| - Desperol
65
End organ damage can be caused by
hypertension
| -can happen in kidneys, heart, eyes (retina) and there is no pain
66
In emergency if CO is low...
- give a med or O2 bc not enough is getting to the brain
- put them in Trendelenburg position
- Give fluids
67
In emergency if CO is too high...
- decrease fluids
- teach compliance
- teach lifestyle change
- put on fall risk
- avoid anything that stresses the heart or changes BP
68
What does H2 do?
makes acid in the stomach
69
H2 blockers suffix
-dine
70
Contraindications for H2 receptor antagonists
- long term needs
| - metabolized by CYP450 so drugs and food can increase or decrease effects
71
Side effect of long-term use of ulcer meds
alkalosis
72
Contraindications of antacids/ aluminum salts
- any condition that can be axacerbated by electrolyte imbalance
- GI obstruction (Mg is a laxative- they could get megacolon and it could burst)
- anything with "salt" in the name will interact with other drugs and have absorption problems with other foods
73
Adverse effects of antacids
- rebound acidity
- alkalosis
- hypercalcemia
- constipation or diarrhea
- hypophosphatemia
74
How to know if your patient is hypercalcemic
muscle twitching and spasms
75
Adverse effects of proton pump inhibitors
- c. dif infection
- increased bone loss
- long term use could lead to increased risk of gastric carcinoma
76
probelm with PPIs
they are worse than H2s and antacids because they take down the acid to almost nothing
77
adverse effects of GI protectant agents
- constipation, diarrhea, nausea, indigestion, gastric discomfort, dry mouth
- not systemic so its very safe
78
patient teaching for GI protectant agents
give on an empty stomach bc if it binds with food it wont find the ulcer
79
Adverse effects of prostaglandins
GU effects- miscarriages, excessive bleeding, spotting, cramping, hypermenorrhea, dysmenorrhea, and other menstrual disorders
80
Major assessment before giving prostaglandins
pregnancy test
81
adverse effects of saliva enzymes
complications from abnormal electrolytes- increased Mg, Na, or K (K would be the most concerning)
82
adverse effects of pancreatic enzymes
GI irritation, nausea, abdominal cramps, diarrhea
83
Nursing consideration for pancreatic enzymes
give with meals bc they need it to digest the meal
84
adverse effects of laxatives
- GI: diarrhea, abdominal cramping, nausea
- CNS: dizziness, headache, weakness
- CV: sweating, palpitations, flushing, fainting
- Cathardic dependency
- Uterine contractions
85
adverse effects of GI stimulants
- nausea, vomiting, diarrhea
- intestinal spasms, cramps, decreased BP and HR, weakness, fatigue
- extrapyramidal effects (from blocking dopamine)
- Tortacholis- when you twist head and something hurts but this case is constant
- Akathsisia- need to be in motion (restless leg syndrome)
- parkinsons symptoms
- (nasty drug with awful side effects)
86
adverse effects of antidiarrheals
constipation, abdominal distension, abdominal discomfort, nausea, dry mouth, toxic megacolon
87
contraindications of antidirrheals
obstruction and poisoning
88
adverse effects of antiemetics: phenothiazines
- drowsiness
- red/brown urine
- sun sensitivity
89
adverse effects of serotonin 5-HT3 receptor blockers
headache, drowsiness, myalgia, urinary retention, constipation
-great drug, not many side effects
90
nursing considerations for thiazide diuretics
-they are sulfa based- don't give to people with sulfa allergies
-tell them not to stop drinking fluids... even if they stop they will bet rebound fluid bc their body thinks it needs to make more and it will stimulate ADH
(pt could be dehydrated but aldosterone will compensate and they will still pee)
91
adverse effects of thiazide diuretics
- hypokalemia
- decreased Ca+ excretion
- altered blood glucose
- causes you to have to pee all the time
* *Not a good drug for a diabetic
92
Contraindications for thiazide drugs
- sulfa or thiazide allergy
- fluid and electrolyte imbalance
- don't take with lithium (too much salt), NSAIDs, ACE inhibitors
- Don't take with Digoxin- potassium is falling
93
contraindications of loop diuretics
- elecrolyte depletion (hold if Na+ and K+ are low)
| - Anuria
94
adverse effects of loop diuretics
- effects related to electrolyte imbalance
- hypokalemia
- alkalosis*
- hypocalcemia
- hearing loss (usually reversible, discontinue drug)
95
antidote to furosemide toxicity
Give water, K+, and Na+
96
contraindications of carbonic anhydrase inhibitors
- angle closure glaucoma (the pressure cannot drain)
- metabolic acidosis
- hypokalemia
- parasthesias (numbness and tingling and pain) of extremeits, confusion, drowsiness
97
drug interactions of carbonic anhydrase inhibitors
- salycilates (aspirin)- decreases excretion and drug will become toxic
- Lithium
- Sulfonamides (could cause SJS or TENS)
98
contraindications of potassium sparing drugs
hyperkalemia, renal disease, anuria
99
adverse effects of potassium sparing drugs
hyperkalemia
100
Drug interactions with potassium sparing drugs
Aspirin causes aldactone not to be as effective
101
contraindications of osmotic diuretics
- renal disease and anuria
- pulmonary congestion
- intracranial bleeding
- dehydration
- CHF
102
adverse effects of osmotic diuretics
- effects related to sudden drop in fluid levels (s/s of shock)
- nausea, vomiting, hypotension, light-headedness, confusion, headache
103
What to include in assessment of patient taking diuretics
edema, weight, strict I&O, BUN and creatinine (bc contraindicated if kidneys aren't working well
104
When do we want/ not want patients to eat potassium rich foods
- want them to eat with loop and thiazide
| - don't want them to eat with potassium sparing
105
Foods high in K+
leafy greens, bananas, pickles, peaches
106
s/s of UTI gone to the kidneys
chills, fever, flank pain, tenderness (associated with pyelonephritis, which leads to shock)
107
contraindications to urinary tract anti-infectives
-allergies!! more intense reactions with antibiotics
108
most common infection for female UTI
e. Coli
109
most common infection for male UTI
gonorrhea or chlamydia
110
contraindications of urinary tract antispasmotics
glaucoma, myasthenia gravis, GI obstruction, acute hemorrhave
111
adverse effects of urinary tract antispasmotics
related to blocking parasympathetic system
112
adverse effects of urinary tract analgesias
reddish-orange coloring of the urine
113
contraindications of bladder protectants
conditions that involve risk of bleeding
114
adverse effects of bladder protectants
bleeding that may progress to hemorrhage
115
adverse effects of alpha adrenergic blockers for BPH
- postural dizziness
- lethargy
- tachycardia
- hypotension
- sexual dysfunction
116
adverse effects of testosterone blockers
decreased libido
| impotence
