Exam 4 Green Packet Flashcards by Rebecca Nims

What are the contraindications for anticoagulants, antiplatelets and thrombolytics? (6)

Excessive blood loss
Hemorrhage
Closed head injury
Hemorrhagic stroke
Prior to surgery
Pregnancy/lactation*

*Genetic conditions only

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What is the purpose of antiplatelet drugs?

To prevent thrombosis by inhibiting platelet aggregations or clumping

May decrease CVA/MI

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Clopidogrel (Plavix) is what type of medication?

Antiplatelet (~grel)

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What is the purpose of anticoagulants?

Reduce clotting by interfering with clotting factors. Fibrinogen to fibrin.

Inhibit further clot formation

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What are some uses of Heparin? (7)

DVT - thrombosis clot
PE - blood clot
MI - heart attach
heart valve devices
Thrombotic stroke
Orthopedic surgeries
Post-op

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What are the side effects/adverse reactions to heparin? (3)

Itching
Burning
Bleeding

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What is the antidote of heparing?

Protamine Sulfate IV - not a sulfonamide

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When is heparin given SQ?

Post-op
Knee/bone manipulation surgeries

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When is heparin given IV?

Acute MI
Acute stroke (CVA)

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What are you monitoring when your patient is on heparin?

PTT

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What is the therapeutic range for PTT?

60-90

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What is Enoxaparin (Lovenox)?

Low molecular weight heparin

~parin

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What is the antidote for LMWH Enoxaparin (Lovenox)?

Protamine sulfate

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What drug is typically sent home with patients in a pre-filled syringe given once per day?

Enoxaparin (Lovenox)

Leave air bubble in!
Based on body weight

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What are you monitoring when giving warfarin?

PT
INR

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What is the therapeutic range of INR for those on coumadin?

2.0-3.0

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What is the antidote for warfarin?

Vitamin K

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What are some side effects/adverse reactions of warfarin? (3)

Anorexia
N/V/D
Bleeding

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How long can it take for warfarin to become therapeutic?

3-7 days

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What teaching will you provide a patient on coumadin?

Keep intake of vitamin K consistent.

Soft toothbrush

Electric razor

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How quickly must a thrombolytic be given to be effective on current clots and prevent side effects?

3-4 hours

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How long does it take to see results of statins?

2-3 weeks

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What are the three new anticoagulant drugs that have less diet changes?

Dabigatran (Pradaxa)
Xa inhibitors - rivaroxaban (Xarelto) - Apixaban (Eliquis)

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What is the first test a patient should get if a thrombolytic is to be given?

Determine if clots are caused by aneurism

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What is the one drug that can dissolve current clots?

Thrombolytics (~plase, ~kinase)

What are some adverse reactions of thrombolytics? (3)

Anaphylaxis Hemorrhage Arrythmias

What are three nonpharmacological ways to lower cholesterol?

Diet - <=30% fats, <=300 mg cholesterol Exercise No smoking

What is the use of antilipemics?

Lower abnormal blood lipid levels (cholesterol)

What are side effects of taking niacin for high cholesterol? (5)

GI upset Flush/cramping Hyperglycemia Hyperuricemia Abnormal liver function

What medication is a powder that must be taken with fluids and mixed with water or juice?

Questran - bile acid sequestrants

What major adverse reaction are you looking out for when on statins?

Rhabdomyolysis - muscle tenderness or weakness. Attacks the kidneys, hyperhydrate, dialysis.

What are the 3 most important teachings for a patient on statins?

Do not abruptly stop! Sever hypercholestemia leading to heart attack. Monitor liver enzymes Annual eye exam (cataract formation)

What is the most prescribed antilipidemic?

Vastatins or Statins ~statin

What are side effects of statins? (4)

GI upset Headache Muscle cramps Tiredness

What is the biggest intervention for patients on peripheral vasodilators?

Safety! Low blood pressure, fall risk.

What is the blood force that stretches the LV?

Preload

What is the resistance to LV ejection of blood?

Afterload

When a patient is put on a cardiac glycoside, how does this affect their conduction, contraction HR, and SV?

Lowers conduction Lowers HR Increases SV Increases myocardial contraction

What is left sided heart failure?

LV fails to contract effectively, blood backs up in to lungs.

What is right sided heart failure?

RA fails to contract effectively, blood backs up in to the periphery.

What are some nonpharmacological ways to prevent heart failure? (5)

2gm salt intake a day Avoid alcohol Stop smoking Lose weight Mild exercise

What are the two lab tests for HF, which is more reliable?

ANP - 20-77 BNP - <100 most reliable We MUST know if the HF is cardiac or respiratory!

What are signs of digoxin toxicity? (7)

Anorexia N/V Headache Blurred vision Green/yellow halos Confusion Flu-like symptoms

What is the antidote for Digoxin?

Digibond

What are side effects of Digoxin? (3)

Bradycardia Heart blocks Ventricular dysrhythmias

What nursing interventions are appropriate for Digoxin? (3)

Check apical pulse for 1 min - if HR is less than 60 DO NOT GIVE! Assess for HF - edema, congestion, daily weights Monitor K+

What is the therapeutic range of Digoxin (Lanoxin)?

0.5-2.0 ng/ml

What are the three types of angina?

Classic (Stable) Unstable Variant (Prinzmetals)

What are the three main antianginal drugs? NBC

Nitrates - emergent Beta Blockers Calcium channel blockers

What is stable angina?

Pain from exertion/stress

What is unstable angina?

Frequently, progressive

What is variant angina?

Occurs at rest due to coronary artery spasm

What are the side effects of nitroglycerine? (7)

N/V Pounding headache Dizzines Weakness Flush Low BP Tachycardia

Nitroglycerine can increase hypotensive effects if given with what other medication?

Antihypertensives & alcohol

What is the most common way nitroglycerin is administered?

Sublingual

How often can you give SL nitroglycerin?

Up to 3 times, 5 minutes apart. If pain continues call 911

How long is nitroglycerin good for?

6 months

What medication comes in a small brown bottle stored away from light?

Nitroglycerin

Where can the nitroglycerin patches be placed? (3)

Chest Arms Thighs Avoid hair

When should you remove NTG Transdermal patches?

At night to avoid bottoming out BP

What are the two shockable ventricular arrhythmias?

V-fib (quivering) V-tach

What are the three main antiarrythmics? ABC

Amiodarone - emergent Beta blockers Calcium channel blockers

You will not give antiarrythmics if the heart rate is below...?

Phenytoin (dilantin) can help with what two diagnoses?

Dysrrythmias Seizures

What determines the potency of diuretics?

The proximity to Bowman's capsule

What are the purposes of diuretics? (5)

Lower blood pressure Decrease edema Decrease fluids due to liver/renal disease Lower Na reabsorption

What is the most common loop diuretic?

Furosemide (lasix)

What is the main osmotic diuretic?

Mannitol

What electrolytes do you lose when taking furosemide?

Na K Ca Mg

Would a patient with a sulfa allergy be able to take lasix?

No, furosemide is a sulfonamide derivative

IV push furosemide to avoid what?

Ototoxicity

What are some nursing interventions for loop diuretics and thiazides?

Monitor VS, U/O, weight Monitor for hypokalemia Monitor electrolytes Suggest take in am with food

What is the name of the most common thiazide?

Hydrochlorothiazide

What is the name of potassium sparing diuretics?

Spironolactone

What is the weakest diuretic?

Potassium sparing

Potassium sparing is the only diuretic you will watch for...?

Hyperkolemia

What is important to check before giving osmotic diuretics (mannitol)?

Check the solution to make sure there are no crystals!

What are the side effects of mannitol?

Fluid/electrolyte imbalance PE N/V Tachycardia Acidosis

What are some interventions for antihypertensives?

Check BP and HR - hold if below 100/60 Monitor for edema Do not suddenly stop Rise slowly AA use diuretics or combos

What are some nonpharmacological approaches to prevent hypertension?

Low sodium diet Exercise No smoking No alcohol Stress reduction

What do all beta blockers have in their name?

~lol

What do all calcium channel blockers have in their name?

~dipine

What do all ACE inhibitors all have in their name?

~pril

What do all Alpha adrenergic blockers have in their name?

~zosin

What do all ARBs have in their name?

~sartan

What two antihypertensives are also used for angina and arrythmias?

Beta blockers Calcium channel blockers

Native and african americans have the most succes with what two antihypertensives?

ARBs and ACE inhibitors

Which antihypertensive is good to use with patients that have asthma/COPD?

ARBs

Which antihypertensives can actually cause hypotension?

All of them

Which antihypertensive should not be mixed with grapefruit juice?

Calcium channel blockers

Which hypertensives should you not take when pregnant or with OTC drugs?

ACE inhibitors ARBs

Which antihypertensive should not be taken with potassium sparing diuretics?

ACE inhibitors

Which antihypertensive should you monitor BUN creatinine?

Beta Blockers ACE inhibitors ARBs

Exam 4 Green Packet Flashcards

(93 cards)