null Flashcards by Janel Henry

Indications: Angina.
______________________________________________

MOA: Vasodilation, ↓ preload and myocardial oxygen demand.

______________________________________________

Side Effects: Orthostatic hypotension, headache, reflex tachycardia.

______________________________________________

Interactions: Erectile dysfunction medications 🍆 (e.g., sildenafil).

______________________________________________

Patient Teaching:

Sublingual 👅: Store in cool/dark place. Take up to 3 tablets. Place 1st under tongue, wait 5 minutes. If no relief, call 911. Take 2nd, wait 5 minutes. If no relief, take 3rd.
______________________________________________

Transdermal 💪🏼: Wear gloves, remove prior dose, rotate sites, place on hairless site.

Organic nitrates
Prototype: Nitroglycerin (Nitro-Bid, others)

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Indications: Hypertension, angina, heart failure, arrhythmias, MI.
______________________________________________

MOA: ↓ BP and HR by blocking beta1 (heart) receptors.
______________________________________________

Side Effects: Bradycardia, hypotension, erectile dysfunction.
______________________________________________

☠️ Ischemic heart disease possible if stopped abruptly.
______________________________________________

Nursing Care: Monitor BP and HR. Hold per provider’s order parameters (e.g., SBP < 90, HR < 60).
______________________________________________

Patient Teaching: Change positions slowly. Do not stop medication suddenly (must taper!).

Beta-adrenergic blockers
Prototype: Atenolol (Tenormin)

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Indications: Hypercholesterolemia, prevention of Coronary Artery Disease.
______________________________________________

MOA: ↓ LDL production, ↑ HDL production.
______________________________________________

Side Effects: Hepatotoxicity, muscle pain, rhabdomyolysis.
______________________________________________

Nursing Care: Monitor liver function and CK levels.
______________________________________________

Patient Teaching: Avoid alcohol and grapefruit juice. Report muscle pain or coca cola-colored urine immediately. 💪🏾🩸 Take in evening (cholesterol is synthesized at night).

HMG-CoA reductase inhibitors (statins)
Prototype: Atorvastatin (Lipitor)

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Indications: Hypercholesterolemia.
______________________________________________
MOA: Binds bile acids in the GI tract, ↓ LDL cholesterol.
______________________________________________

Interactions: Many medications, including oral contraceptives.
______________________________________________

Side Effects: Constipation, Gl upset.
______________________________________________

Patient Teaching: ↑ Fiber and fluid intake. Take with food and a full glass of water. Interferes with absorption of fat-soluble vitamins (A, D, E, K). Take other medications 1 hour before or 4 hours after taking colesevelam or cholestyramine.

Bile acid sequestrants
Prototype: Cholestyramine (Prevalite)

Memory Trick: Cholestyramine will help reduce your cholesterol.

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Indications: Hypercholesterolemia.
______________________________________________

MOA: ↓ Triglyceride production and transport. ↑ HDL levels.
______________________________________________

Side Effects: Gl upset, gallstones, hepatotoxicity, muscle pain.
______________________________________________

Nursing Care: Monitor liver function.
______________________________________________

Patient Teaching: Take 30 minutes before breakfast and dinner.

Fibrates
Prototype: Fenofibrate (Tricor)

Memory Trick: Just like eating a lot of** fiber, fenofibr**ate will help decrease your cholesterol.

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Indications: Hypercholesterolemia.
______________________________________________

MOA: Inhibits absorption of cholesterol in the small intestine.
______________________________________________

Side Effects: Hepatotoxicity, muscle pain.
______________________________________________

Nursing Care: Monitor liver function and CK levels.

Cholesterol absorption inhibitor
Prototype: Ezetimibe (Zetia)

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Indications: Hypercholesterolemia.
______________________________________________

MOA: ↓ Lipoprotein and triglyceride synthesis.
______________________________________________

Contraindications: Use cautiously in patients with diabetes.
______________________________________________

Side Effects: Flushing of the face, Gl upset, pruritus, hepatotoxicity, hyperglycemia.
______________________________________________

Nursing Care: Monitor liver function.

Miscellaneous dyslipidemic agent
Niacin

Memory Trick: My face doesn’t look very nice because it’s flushed after taking niacin!

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Indications: Heart failure, atrial fibrillation, atrial flutter.
______________________________________________

MOA: Positive inotropic effect (↑ force and efficiency of heart contractions) and negative chronotropic effect (↓ HR).
______________________________________________

Side Effects: Arrhythmias, bradycardia, digoxin toxicity (S/S: Gl upset, fatigue, weakness, vision changes).
______________________________________________

Nursing Care: Check pulse before administration (do not administer if pulse < 60 bpm). Monitor digoxin levels during therapy (therapeutic range = 0.5 - 2 ng/mL). Treat bradycardia with atropine, toxicity with digoxin immune fab.
______________________________________________

❗️Hypokalemia increases the risk of toxicity with this drug class’ prototype.

Cardiac glycosides
Prototype: Digoxin (Lanoxin)

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Indications: Ventricular arrhythmias and supraventricular tachycardia.
______________________________________________

MOA: Sodium channel blocker.
______________________________________________

Side Effects: Hypotension, arrhythmias, thrombocytopenia, leukopenia.
______________________________________________

☠️ Lupus-like syndrome.
______________________________________________

NC: Monitor EKG, vital signs, CBC levels.
______________________________________________

❗️Therapeutic procainamide blood levels are 4 - 8 mcg/mL.

Class I: Sodium Channel Blockers
Class IA Prototype: Procainamide
Class IB Prototype: Lidocaine (Xylocaine)

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Indications: Severe arrhythmias (e.g., ventricular fibrillation, ventricular tachycardia).
______________________________________________

MOA: Potassium channel blocker.
______________________________________________

Side Effects: Hypotension, bradycardia, blue-gray skin discoloration, thyroid dysfunction.
______________________________________________

☠️ Pulmonary, hepatic, and cardiac toxicity.
______________________________________________

Patient Teaching: Do not consume grapefruit juice.

Class III Potassium Channel Blockers
Prototype: Amiodarone (Nexterone, Pacerone)

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Indications: Supraventricular tachycardia.
______________________________________________

MOA: Conduction time through the AV node.
______________________________________________

Side Effects: Facial flushing, shortness of breath, brief period of asystole 💔 after administration.
______________________________________________

NC: Monitor EKG rhythm.

Unclassified Drugs Administered for the Treatment of Dysrhythmias
Drug: Adenosine (Adenocard)

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Indications: Prevention and treatment of thromboembolic disorders (e.g., stroke, DVT, PE).
______________________________________________

MOA: Activates antithrombin, inhibiting thrombus formation. Prevents new clot formation. Does not break up existing clots.
______________________________________________

Side Effects: Bleeding, heparin-induced thrombocytopenia (HIT).
______________________________________________

☠️ Spinal/epidural hematomas (with spinal catheter).
______________________________________________

Nursing Care: Closely monitor aPTT. Therapeutic aPTT is 1.5 - 2 times baseline. Antidote is protamine sulfate!

Anticoagulant Drugs: Heparins
Prototype: Heparin

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Indications: Prevention and treatment of thromboembolic disorders (e.g., DVT, PE, AFIB with thrombus). Prevention of complications following an MI.
______________________________________________

MOA: Antagonizes vitamin K, preventing formation of several clotting factors.
______________________________________________

Side Effects: GI upset, hepatitis.
______________________________________________

☠️ Life-threatening bleeding.
______________________________________________

Nursing Care: Closely monitor PT/INR levels. Therapeutic INR is 2 - 3 (takes 5 - 7 days to get to a therapeutic level). Antidote is vitamin K!
______________________________________________

Patient Teaching: Maintain a consistent dietary intake of vitamin K.

Anticoagulant Drugs: Vitamin K antagonists
Prototype: Warfarin

Memory Trick: Warfarin is going to war on vitamin K!

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Indications: Prevention and treatment of thromboembolic disorders (dabigatran). Anticoagulation in patients with HIT (argatroban).
______________________________________________

MOA: Blocks thrombin receptors, which prevents activation of clotting factors and ↓ thrombus formation.
______________________________________________

Side Effects: Bleeding.
______________________________________________

☠️ Spinal/epidural hematoma (with spinal catheter).

Anticoagulant Drugs: Direct thrombin inhibitors
Prototype: Dabigatran etexilate

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Indications: Prevention of DVT, PE, stroke in patients with AFIB.
______________________________________________

MOA: Inhibits factor Xa, blocking the coagulation cascade.
______________________________________________

Side Effects: Bleeding, ↑ liver enzymes.
______________________________________________

☠️ Spinal/epidural hematoma (with spinal catheter).
______________________________________________

Nursing Care: Monitor liver function.

Anticoagulant Drugs: Direct factor Xa inhibitors
Drug: Rivaroxaban

Memory Trick: Rivaroxaban bans factor Xa and helps your blood flow like a river.

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Indications: Prevention of MI, stroke in patients with acute coronary syndrome or peripheral vascular disease.
______________________________________________

MOA: Inhibits platelet aggregation.
______________________________________________

Side Effects: Bleeding, Gl upset, rash.

Antiplatelet Drugs: Adenosine diphosphate receptor antagonists
Prototype: Clopidogrel

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Indications: MI, stroke, PE, occluded central IVs.
______________________________________________

MOA: Indirect destruction of fibrinogen, dissolves clots.
______________________________________________

Contraindications: History of hemorrhagic stroke, internal bleeding, recent trauma/surgery, severe hypertension.
______________________________________________

Side Effects: Bleeding.
______________________________________________

Nursing Care: For an ischemic stroke, administer within 3 hours of symptom onset. Closely monitor labs and vital signs.

Antiplatelet Drugs: Thrombolytic drugs
Prototype: Alteplase

Memory Trick: Alteplase goes to the place where there is a clot and breaks it up!

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Indications: Anemia related to chronic kidney disease, HIV, chemotherapy.
______________________________________________

MOA: Stimulates bone marrow to produce RBCs.
______________________________________________

Contraindications: Hgb level > 11 g/dL, uncontrolled hypertension.
______________________________________________

Side Effects: Hypertension (due to ↑ Hct), bone pain, ↑ risk of seizures.
______________________________________________

☠️ Thromboembolic events (e.g., MI, stroke), tumor progression/recurrence.
______________________________________________

Nursing Care: Do not agitate vial. Monitor BP, Hgb, Hct.
______________________________________________

Patient Teaching: Ensure adequate dietary iron intake.

Erythropoiesis-stimulating agents
Prototype: Epoetin alfa (Epogen, Procrit, Retacrit)

Memory Trick: Taking epoetin alfa will fix your anemia so you can be a strong alpha male.

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Indications: Neutropenia related to chemotherapy.
______________________________________________

MOA: Stimulates bone marrow to produce neutrophils.
______________________________________________

Side Effects: Bone pain, leukocytosis, splenomegaly.
______________________________________________

Nursing Care: Do not agitate vial. Monitor CBC.

Colony-stimulating factors
Prototype: Filgrastim

Memory Trick: You fill up on neutrophils with filgrastim.

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Indications: Cancers and viral infections (e.g., hepatitis).
______________________________________________

MOA: Enhances the body’s immune response to tumors/viruses. Slows cancer proliferation.
______________________________________________

Side Effects: Flu-like symptoms (e.g., fever, muscle aches, chills, lethargy), bone marrow suppression, cardiotoxicity, hepatotoxicity, dyspnea, alopecia, Gl upset.
______________________________________________

☠️ Psychiatric, autoimmune, ischemic, and infectious disorders.
______________________________________________

Nursing Care: Monitor CBC levels, cardiac and liver function throughout therapy.

Interferons
Prototype: Interferon alfa-2b (Intron A)

Memory Trick: Interferon Interferes with cancer by enhancing the body’s immune response.

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Indications: Pain, frequency, urgency associated w/ UTI.
______________________________________________

MOA: Acts as a local anesthetic on the urinary tract. Not an antibiotic, does not treat a UTI.
______________________________________________

Side Effects: Orange/red discoloration of urine and other bodily fluids (e.g., tears) during treatment.
______________________________________________

Patient Teaching: Can cause staining of soft contact lenses. Urine discoloration can stain clothes, bedding.

Drug: Phenazopyridine hydrochloride (Pyridium)
Drug Class: Urinary Antiseptics

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Before administering this drug class, assess if the patient is breastfeeding. This drug class can displace bilirubin from albumin in a fetus or infant, leading to hyperbilirubinemia and kernicterus, which can cause life-threatening toxicity.

Drug Class: Sulfonamides

Definitions:
Hyperbilirubinemia: Bilirubin accumulated in the bloodstream

Kernicterus: Bilirubin accumulated in the central nervous system

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Bundle-branch block and changes in the ST and T waves are cardiac-related adverse effects of ___________.

Nitrofurantoin

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The adverse effects below should be reported immediately because they indicate an accumulation of which drug?

Yellowing of the skin
Bruising
Sore throat
Fever

Phenazopyridine
Drug Class: Urinary Antiseptics

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The FDA has issued a **BOXED WARNING** regarding the potential risk of tissue damage with extravasation of ________. The drug should be infused into a **large vein** or **central line** if possible. * What should be done if extravasation occurs?

norepinephrine ## Footnote If extravasation occurs, the medication should be stopped, **phentolamine** should be infused, and the infusion site should be changed.

Giving a drug with ____ agonist activity causes an increased force of cardiac contraction, increased speed of electrical conduction, increased heart rate, increased blood pressure, and increased renin production.

beta1 ## Footnote Memory Trick: You have 1 heart ❤️. beta1

# Patient Teaching Guidelines for Hypotension and Shock If you have ____, monitor your ____ levels carefully because adrenergic medications may elevate them.

If you have **diabetes**, monitor your **glucose** levels carefully because adrenergic medications may elevate them.

A patient receiving norepinephrine for shock has an arterial line in place. The patient’s blood pressure has been near 90/42 mm Hg for most of the morning. The blood pressure reading on the continuous monitor suddenly shows a blood pressure of 130/80 mm Hg. What step should the nurse take?

Confirm the blood pressure with a manual reading ## Footnote Rationale: Confrming the blood pressure with a manual blood pressure reading will verify the accuracy of the blood pressure from the arterial line, which will determine the appropriate next step.

# Drug Therapy for Hypertension The FDA has issued a **BOXED WARNING** for patients with ________ who are withdrawing from oral forms of atenolol, metoprolol, nadolol, propranolol, and timolol (beta-adrenergic blockers). Abrupt withdrawal has resulted in exacerbation of angina, the incidence of ventricular dysrhythmias, and the occurrence of MIs.

The FDA has issued a **BOXED WARNING** for patients with **Coronary Artery Disease** who are withdrawing from oral forms of atenolol, metoprolol, nadolol, propranolol, and timolol. Abrupt withdrawal has resulted in exacerbation of angina, the incidence of ventricular dysrhythmias, and the occurrence of MIs.

Taking captopril and other ________ at the same time as potassium-containing salt substitutes (no salt, Morton salt substitute, and others) or large amounts of high-potassium foods (bananas, oranges, and other fruit) increases the risk of hyperkalemia.

ACE inhibitors

# Patient Teaching Guidelines for Antihypertensive Drugs Take on an empty stomach; food decreases drug absorption.

oral captopril

# Patient Teaching Guidelines for Antihypertensive Drugs If you are a sexually active female, use birth control measures when taking: ## Footnote Hint: There are two answers.

Aliskiren and (ACE) inhibitors

# Patient Teaching Guidelines for Antihypertensive Drugs When taking these drugs, immediately report hypersensitivity reactions, especially lip or eyelid swelling, throat tightness, and difficulty breathing. ## Footnote Hint: There are three answers.

Aliskiren, ACE inhibitors and ARBs

# Patient Teaching Guidelines for Antihypertensive Drugs Avoid taking ________ with a high-fat meal because this significantly decreases the amount of available drug.

Avoid taking **aliskiren** with a high-fat meal because this significantly decreases the amount of available drug.

With pra**zosin**, doxa**zosin**, or tera**zosin**, take the first dose and the first increased dose ________ to prevent dizziness and possible fainting.

**at bedtime**

# Patient Teaching Guidelines for Antihypertensive Drugs All drugs in this class can commonly cause a nonproductive cough and a tickling in the throat.

angiotensin-converting enzyme (ACE) inhibitors ## Footnote The patient should report these or any adverse effects to the healthcare provider. The cough resolves when the drug is discontinued.

# Additional Medications Used for the Treatment of Hypertension The FDA has issued a **BOXED WARNING** for this drug because the drug can exacerbate angina and precipitate pericardial effusion (which can progress to cardiac tamponade).

minoxidil

# Additional Medications Used for the Treatment of Hypertension ____________ is a potent vasodilator that decreases peripheral vascular resistance. The drug is given by continuous intravenous (IV) infusion and requires continuous blood pressure monitoring, most effectively by intra-arterial monitoring. ## Footnote It helps widen (dilate) blood vessels, which reduces the resistance the heart has to work against to pump blood. By decreasing the peripheral vascular resistance, it lowers blood pressure.

Nitroprusside

The nurse should ensure that serum **thiocyanate** levels are measured if ________ is given longer than ____ hours because it is metabolized to thiocyanate. ## Footnote STOP the infusion after 72 hours if the serum thiocyanate level is more than **12** mg/dL.

The nurse should ensure that serum thiocyanate levels are measured if **nitroprusside** is given longer than **72** hours because it is metabolized to thiocyanate.

# Drug Therapy for Coronary Artery Disease To avoid development of tolerance to ________, it is essential to observe a 10- to 12-hour nitrate-free interval.

nitroglycerin ## Footnote Rationale: Patients who take long-acting dosage forms of nitrates on a regular schedule develop tolerance to the vasodilating (antianginal) effects of the drugs. The use of a drug-free period, typically during sleep, reduces the development of this drug tolerance.

Males taking nitroglycerin or any other nitrate should not use ________________ inhibitors such as sildena**fil** (Viagra), tadala**fil** (Cialis), or vardena**fil** (Levitra) for erectile dysfunction. The combined effect can produce profound, life-threatening _________.

Males taking nitroglycerin or any other nitrate should not use **phosphodiesterase enzyme type 5 inhibitors** such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) for erectile dysfunction. The combined effect can produce profound, life-threatening **hypotension**. ## Footnote Main Point: Do not take medications for erectile dysfunction when taking nitroglycerin and other nitrate preparations.

# Identify the drug class and prototype for the patient teaching below: * Increase water and fiber to prevent constipation. * **Elevate feet** to reduce ankle swelling. * Do not stop taking this drug abruptly. May result in rebound tachycardia and hypertension. ## Footnote Drug Therapy for Coronary Artery Disease

Drug Class: Calcium Channel Blockers Prototype: Nifedipine

# Identify the drug class and prototype for the patient teaching below: * Take blood pressure **before** administration (can lower BP). * **Sit down** when taking to prevent dizziness. **Sublingual tablets:** * Dissolve under the tongue at the first sign of chest pain. * If pain persists after 5 minutes, take another tablet (up to 3 tablets). * Seek medical help if pain continues after 3 tablets. ## Footnote Drug Therapy for Coronary Artery Disease

Drug Class: Organic nitrates Prototype: Nitroglycerin

# Drugs Used for Coronary Heart Disease Do not stop abruptly – causes rebound tachycardia and hypertension.

Drug Class: Beta-Adrenergic Blockers Prototype: Atenolol

**Heart disease drugs** should be taken on a regular schedule, at ______ ______ intervals, to prevent acute attacks of angina. * What is the only exception?

Heart disease drugs should be taken on a regular schedule, at **evenly spaced** intervals, to prevent acute attacks of angina. ## Footnote Exception: **Nitroglycerin transdermal paste**, because you may be directed not to take it at night.

The nurse removes a patient’s transdermal nitroglycerin disk at bedtime as ordered to minimize nitrate tolerance. The patient awakens during the night and complains of anginal symptoms. What action should the nurse take?

Give a short-acting nitrate as ordered for immediate relief. ## Footnote Rationale: * Long-acting nitrates (like patches) can cause tolerance if used continuously. * To prevent this, the lowest effective dose and an intermittent schedule are used. * Short-acting nitrates work quickly to relieve acute chest pain.

Nonselective beta-adrenergic blockers should not be used in patients with ______ ______ because they are ineffective and may increase the tendency to induce coronary artery ________.

Nonselective beta-adrenergic blockers should not be used in patients with **variant angina** because they are ineffective and may increasing the likelihood of coronary artery **vasospasm**. ## Footnote Explanation: Coronary artery vasospasm: sudden narrowing of the coronary arteries, which reduces blood flow to the heart and increases chest pain. Example of a nonselective beta-adrenergic blockers: Propranolol

# Drug Therapy for Coronary Artery Disease Patients taking ________ should not take it with **grapefruit juice**, which affects hepatic enzymes.

ranolazine

This metabolic modulator increases the energy production of the heart to preserve cardiac function but does not relieve acute anginal attacks.

ranolazine

This drug helps to reduce the risk of death during a heart attack (myocardial infraction) and should be taken as soon as possible after symptoms start, unless contraindicated.

Aspirin

# Patient Teaching Guidelines for Dyslipidemic Drugs If you are taking a ________ and plan or become pregnant, it is important to notify your prescriber as soon as possible as the drugs can cause or increase the risk of congenital anomalies.

statin ## Footnote Example: Atorva**statin**

# Drug Therapy for Dyslipidemia Because this drug binds bile acids, it may interfere with normal fat digestion and absorption and therefore may prevent absorption of the fat-soluble vitamins A, D, E, and K; supplementation may be required.

cholestyramine

# Drug Therapy for Dyslipidemia This drug can bind with vitamin K; therefore, it is used with caution in people with any coagulopathy.

cholestyramine

# Identify the drug based on the patient teaching below: * Mix with water or other fluids before consuming. * Maintain good dental hygiene as the medication can damage teeth. * Main adverse effects are gastrointestinal, including: abdominal fullness, flatulence, diarrhea, and constipation.

cholestyramine ## Footnote Drug Therapy for Dyslipidemia

# Drug Therapy for Dyslipidemia: Statin Patient Teaching Which statin should be taken with food?

lovastatin

# Drug Therapy for Dyslipidemia: Statin Patient Teaching Which statins should be taken in the evening, with or without food? (2)

* fluvastatin * simvastatin

# Drug Therapy for Dyslipidemia: Statin Patient Teaching List the statins that can be taken with or without food and without regard to time of day. (3)

* atorvastatin * rosuvastatin * pravastatin

**Skin flushing** may occur with ________; preparations that are marketed as causing “no flush” may have no free nicotinic acid and are therefore ineffective in treating dyslipidemia.

niacin

# Drug Therapy for Dyslipidemia It is necessary to give with food to increase drug absorption.

fenofibrate and other fibrates

# Drug Therapy for Heart Failure It is important to assess the older adult with HFrEF for:

respiratory symptoms ## Footnote Example: tachypnea, **dyspnea** and orthopnea

# Drug Therapy for Heart Failure Black people are at higher risk of developing angioedema with administration of:

sacubitril/valsartan

# Drug Therapy for Heart Failure A 35-year-old female has been prescribed enalapril maleate. What should the nurse teach the patient?

Use effective contraception ## Footnote Rationale: Enalapril maleate is teratogenic and can cause congenital anomalies or fetal demise.

# Drug Therapy for Heart Failure During the administration of milrinone, if a marked decline in blood pressure or pulse rate occurs, what steps should the nurse take?

**the rate of administration should be reduced** and then the provider should be notifed.

# Identify the drug based on the patient teaching below: * Monitor blood pressure, pulse, and heart rhythm regularly. * Expect increased urination; call for assistance with toileting due to bed rest. * Report pain at the injection site. * Report numbness, tingling, shortness of breath, or chest pain. ## Footnote Drug Therapy for Heart Failure

Milrinone

# Identify the drug based on the patient teaching below: * If heart rate is **less than 50 beats**/min, skip dose and call provider. * Watch for **vision changes**, especially brightness with light changes. * Take with food for consistent effect; avoid grapefruit and grapefruit juice. * Use reliable birth control if of childbearing age and notify provider if pregnant, as this drug may harm the baby. ## Footnote Drug Therapy for Heart Failure

Ivabradine (Corlanor)

# Drug Therapy for Heart Failure Drug can be prescribed to decrease extracellular fluid related to heart failure. A potassium-rich, low-sodium diet is recommended, and the nurse should instruct the patient on symptoms of hypokalemia such as weakness, fatigue, muscle cramps, and palpitations.

Furosemide (Lasix)

The FDA has issued a BOXED WARNING for the ________ component of sacubitril/valsartan because ________ acts on the RAAS during the second and third trimesters of pregnancy, reducing fetal kidney function and increasing fetal and neonatal morbidity and death.

valsartan

null Flashcards

(67 cards)