Pharm Week 8

Question 1

There is no cure for Heart Failure (True of False)

Answer 1

True

Question 2

Diseases that cause or accelerate HF

Answer 2

mitral stenosis, myocardial infarction (MI), chronic hypertension (HTN), coronary artery disease (CAD), diabetes mellitus

Question 3

What causes cough and shortness of breath in HF

Answer 3

Blood backs up into the lungs

Question 4

Cause of left sided HF

Answer 4

excess blood accumulates in the left ventricle, causing it to thicken and enlarge (hypertrophy) in order to compensate for the increased workload

Question 5

Cause of right sided HF

Answer 5

excess blood backs up into veins, resulting in peripheral edema and engorgement of organs, such as the liver

Question 6

What should a nurse monitor in HF and diuretic therapy

Answer 6

electrolyte levels, weakness, hypotension, confusion, vital signs, intake and output, blood glucose , blood-urea nitrogen (BUN)

Question 7

What is the max amount of sodium a heart failure pt should intake

Answer 7

4000mg daily

Question 8

ACE inhibitors

Answer 8

lisinopril, captopril, zestril

Question 9

ACE inhibitor side effects

Answer 9

cough, headache, dizziness, orthostatic hypotension, first-dose phenomenon, hyperkalemia; Serious adverse effect-angioedema*

Question 10

contra-indications of ACE inhibitors

Answer 10

hyperkalemia

Question 11

Labs to monitor while on ACE inhibitors

Answer 11

BUN, creatinine, K+

Question 12

Mechanism of action in ACE inhibitors

Answer 12

inhibits conversion of angiotensin I to angiotensin II and decreases aldosterone secretion; BP is decreased and CO is increased

Question 13

What blocks the action of ACE inhibitors

Answer 13

NSAIDS

Question 14

Cardiac glycosides

Answer 14

digoxin and lanoxin

Question 15

MOA of cardiac glycosides

Answer 15

increases contractility of heart and slows conduction which improves cardiac output

Question 16

Adverse effects of cardiac glycosides (digoxin and lanoxin)

Answer 16

n/v dysrythmia, visual disturbances(halos,yellow-green tinge, blurring)
Serious adverse effect: dysrhythmias especially in the presence of hypokalemia**

Question 17

Metoprolol side effects

Answer 17

bradycardia, orthostatic hypotension, abnormal sexual function, drowsiness, fatigue

Question 18

Contra-indications of metoprolol

Answer 18

asthma, COPD

Question 19

which drug enhances effects of hypoglycemics

Answer 19

metoprolol

Question 20

Electrical conduction pathway

Answer 20

sinoatrial (SA) node, across both atria>atrioventricular (AV) node> atrioventricular bundle (bundle of His)>to the right and left bundle branches>Purkinje fibers

Question 21

What is the most common type of dysrthymia

Answer 21

Atrial fibrillation

Question 22

Types of Dysrhythmias

Answer 22

Premature atrial contraction (PAC)
Premature ventricular contractions (PVC)
Ventricular tachycardia(VT)
Atrial flutter (AF)
Atrial fibrillation (A Fib)
Sinus bradycardia (SB)
Heart block (1st, 2nd, 3rd degree)

Question 23

When does generation of the action potential

Answer 23

begins when sodium-ion channels open and sodium ions rush in

Question 24

Depolarization (contraction)

Answer 24

calcium-ion channels open and calcium ions enter the cell, stimulating cardiac-muscle cells, SA and AV cells depolarize in response to calcium-ion influx

Question 25

Repolarization (resting)

Answer 25

return to a polarized state, sodium pump removes sodium from the cell, potassium-ion channel

Question 26

Nonpharmacological therapies for dysrhythmias

Answer 26

Cardioversion and defibrillation-(ventricular tachycardia, ventricular fibrillation)electrical shock that stops all electrical impulses in the heart and allows the sinoatrial node to regain control Catheter ablation- identifies and destroys aberrant cardiac cells that cause dysrhythmias Cardiac pacemaker-paces the heart at a set rate Implantable cardioverter defibrillators (ICDs)-combination of pacemaker and defibrillator

Question 27

Sodium-ion-channel blockers (Class IA)

Answer 27

procainamide, quinidine

Question 28

Side effects of sodium channel blockers (procainamide, quinidine)

Answer 28

hypotension, headache, cardiotoxicity

Question 29

Labs to monitor on Sodium channel blockers

Answer 29

CBC-neutropenia, TPC

Question 30

Beta-adrenergic blockers (Class II)

Answer 30

propranolol, esmolol

Question 31

Primary use of propanolol, esmolol

Answer 31

treatment of tachycardia, hypertension, angina, migraines, prevention of MI

Question 32

Adverse effects of propanolol and esmolol

Answer 32

bradycardia, hypotension, fatigue, diminished libido; masks hypoglycaemia for those taking insulin

Question 33

Contra-indication of beta blockers

Answer 33

asthma

Question 34

When to hold beta blockers

Answer 34

Pulse < 60

Question 35

Mechanism of action of potassium channel blockers

Answer 35

decreases contractility & dilates blood vessels

Question 36

Potassium channel blockers

Answer 36

amiodarone

Question 37

Side effects of amiodarone

Answer 37

blurred vision, rashes, photosensitivity, n/v, fatigue, dizziness, hypotension BBW* pumonary toxicity

Question 38

Calcium channel blockers (Class IV)

Answer 38

verapamil, diltiazem

Question 39

Side effects of calcium channel blockers

Answer 39

bradycardia, orthostatic hypotension, heart failure, flushed skin, constipation, edema

Question 40

Drug interactions of calcium channel blockers

Answer 40

increased effects of digoxin toxicity; no statins- increases muscle pain

Question 41

mechanism of action of calcium channel blockers

Answer 41

slows conduction velocity, lowers blood pressure, reduces cardiac workload

Question 42

how long does it take normal clotting to occur

Answer 42

6 minutes

Question 43

deficiency of platelets < 100,000

Answer 43

Thrombocytopenia

Question 44

bleeding disorders caused by genetic deficiencies in specific clotting factors

Answer 44

Hemophilias

Question 45

inhibit specific clotting factors, thereby inhibiting the aggregation of these cells, preventing Clots from forming or growing larger

Answer 45

Anticoagulants

Question 46

Parental anticoagulant

Answer 46

Heparin

Question 47

MOA of heparin

Answer 47

Inhibits thrombin activity,prevents enlargement or formation of clots (does not dissolve clots)

Question 48

Side effects of heparin

Answer 48

abnormal bleeding and heparin-induced thrombocytopenia (HIT), results in the opposite effect of excessive bleeding

Question 49

Heparin BBW

Answer 49

do not administer to patients with an epidural or will cause hematoma

Question 50

Heparin OD

Answer 50

protamine sulfate- reverses in 5 minutes

Question 51

Oral anticoagulant

Answer 51

Warfarin (Coumadin)

Question 52

MOA of Warfarin

Answer 52

inhibits the action of vitamin K

Question 53

Primary use of warfarin

Answer 53

prevent stroke, MI, DVT, and pulmonary embolism

Question 54

side effect of warfarin

Answer 54

abnormal bleeding

Question 55

Nursing for warfarin

Answer 55

monitor PT/ INR; Avoid vitamin K supplements and protein supplement drinks, and limit intake of garlic

Question 56

Warfarin OD

Answer 56

Vitamin K- reverses in 6 hrs

Question 57

Antiplatelet, ADP-receptor blockers

Answer 57

clopidrogrel (Plavix)

Question 58

MOA of clopidrogel

Answer 58

inhibiting ADP from binding to its receptor

Question 59

primary use of clopidrogel

Answer 59

prevent thromboembolic events in patients with a recent history of MI, CVA, or peripheral artery disease

Question 60

side effects of clopidrogel

Answer 60

abnormal bleeding, flulike syndrome, headache, dizziness, bruising, and rash or pruritus, tcp

Question 61

Thrombolytic

Answer 61

altepase (Activase)

Question 62

MOA of altepase

Answer 62

dissolves the clot

Question 63

side effect of altepase

Answer 63

abnormal bleeding

Question 64

contra indications of altepase

Answer 64

hemorrhage, CVA, recent trauma or surgery, aneurysm

Question 65

Nursing for altepase

Answer 65

check vs q 15 minutes, bedrest, hold pressure x 30 minutes, no IM/SQ injections