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Flashcards in Exam 3 Misc. Deck (116):
1

Main point when treating patients with cardiac drugs

adequate cardiac output

2

Priority nursing diagnosis for cardiac drugs

ineffective tissue perfusion

3

Afterload

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

Preload

amount of blood that gets to the right atrium from the superior vena cava
-increased preload= increased CO
-decreased preload= decreased CO

5

chronotropy

-"chrono" means time
-drugs effecting heart rate
-positive chronotropy means we make it faster
-negative chronotropy means we slow it down

6

Inotropy

-How forcefully it contracts
-Decrease in force is a decrease in CO

7

Dromotropy

-Speed of conduction
-increase in conduction speed= increase in HR and vice versa

8

What is the risk of an increased afterload?

Clots will form because too much blood is sitting

9

Drug that everyone is on in hospitals because of immobility

heparin

10

Heparin antidote

protamine sulfate

11

Normal PT values

10-14 sec

12

Normal PTT values

20-45 sec., Max 112 sec

13

Difference between heparin and enoxaparin

-Heparin is used to treat the problem, enoxaparine is used to prevent it
-enoxaparine is safer

14

Antidote to warfarin

Vitamin K

15

Blood tests for heparin and enoxaparin

PT and PTT

16

Blood tests for warfarin

INR

17

Problems with warfarin

dangerous drug, lots of toxicity and treatment failure

18

What should people take instead of ferrous sulfate and why?

ferrous gluconate, its much easier on the stomach

19

Patient teaching for ferrous sulfate/ iron

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

Vitamin B12 is used for...

Pernicious anemia

21

Sickle Cell anemia is common in which group

African Americans

22

Antianemic drug to treat Sickle Cell anemia

hydroxyurea - antineoplastic that increases fetal RBCs

23

Vasopressers

Nitroprusside and Hydralazine
-increase BP

24

First choice antihypertensives

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