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307 Cards in this Set

  • Front
  • Back
Which nervous system?

- controls involuntary responses in smooth muscle, secretory glands & visceral organs (in order to maintain homeostasis; respond to stress; repair tissues
Autonomic Nervous System (ANS)
Nervous system responsible for "Fight or Flight"/stress state (adrenergic response)
Sympathetic Nervous System (SNS)
Nervous system responsible for Rest and Digestion/Calming (cholinergic response)
Parasympathetic Nervous System (PNS)
75% of Parasympathetic nerve fibers are in which nerve?
Vagus nerve
What are the neurotransmitters for the Sympathetic Nervous System?
Catecholamines (epinephrine, norepinephrine, dopamine)
The actions below are by neurotransmitters of which nervous system?

- Dilate Bronchioles
- Increase Heart Rate (HR)
- Increase Blood Pressure
- Vasoconstriction
- Decreased GI motility
- Dilates Pupils
- Relaxes Bladder
- Decreases Urine Output
- Constricts Salivary Glands
- Glucogenolysis/Gluconeogenesis
Catecholamines of the Sympathetic Nervous System
What is the neurotransmitter for the Parasympathetic Nervous System (PNS)?
acetylcholine (aCH)
The actions below are by neurotransmitters of which nervous system?

- Constrict Bronchioles
- Decrease Heart Rate
- Vasodilation
- Increase GI motility (increase digestion)
- Constrict Pupils
- Contracts Bladder
Parasympathetic Nervous System (PNS)
SLUDGE: define acronym and which nervous system it represents
Urinary Incontinence
GI cramps

Represents the Parasympathetic nervous system's actions
What are the two cholinergic receptors?
- muscarinic (internal organs)
- nicotinic (skeletal muscle)
Which Adrenergic Receptor(SNS)?

- vasoconstricts blood vessels
Alpha1 Receptors
Which Adrenergic Receptor(SNS)?

- inhibits release of norepinephrine
Alpha2 Receptors
Which Adrenergic Receptor(SNS)?

- Increases Heart Rate
- Increases myocardial contraction
Beta1 Receptors
Which Adrenergic Receptor(SNS)?

- Bronchodilation
- Vasodilation
- Decreased GI motility
Beta2 Receptors
Which Adrenergic Receptor(SNS)?

- Vasodilation in kidneys, heart, & viscera
nerve fibers that secrete acetylcholine?
Cholinergic fibers
nerve fibers that secrete norepinephrine?
Adrenergic fibers
Which ANS drugs are used for the follwing?

- prevent uterine contractions in preterm labor
- local anesthetics
- mydriasis
- decongestion
- allergic reactions
- bronchodilation
- stimulation of the heart
- increasing blood pressure
Adrenergic drugs
What are some common contraindications for Adrenergic drug use? (try to name at least 5)
- Dysrhythmias
- Hyperthyroidism
- Cerebrovascular disease
- Narrow-angle Glaucoma (increases intraocular pressure)
- Hypersensitivity
- During second stage of labor (may slow progression)
- Caution with anxiety, insomnia, CNS disorders
What route is NOT used with Epinephrine, why?
PO, no bioavailability after GI enzymes destroy it
What important nursing implication concerning epinephrine involves pregnancy?
crosses the placenta
Which receptors does epinephrine stimulate?
- A1
- B1
- B2
Which receptors does pseudoephedrine (Sudafed) stimulate?
- A1
- B1
- B2
Unlike Epinephrine, Sudafed commonly administered via what route?
What is pseudoephedrine (Sudafed) indicated for?
- bronchodilation
- nasal decongestion
Which receptors does isoproterenol (Isuprel) stimulate?
- B1
- B2
What is isoproterenol (Isuprel) indicated for?
- cardiac stimulant
- bronchodilator
What receptors does phenylephrine (Neosynephrine) stimulate?
- A1 (very powerful)
What is phenylephrine (Neosynephrine) indicated for?
- increase BP with pts in shock/hypotension
- locally as nasal decongestant
What are main signs of Anaphylaxis?
- laryngeal swelling
- vasodilation
- decreased blood pressure
- bronchoconstriction
What is the protocol concentration and volume for Epinephrine administration

0.3-0.5 mL SQ
What is the administration route of choice for anaphylactic shock?
IV or SC
What are some common toxic effects of adrenergics?
- HA
- confusion
- seizures
Which drug class:

- inhibits release of norepinephrine
- results in decreased blood pressure
- decreased urinary retention
Alpha2 agonists (blockers)
clonidine (Catapres) is what type of antiadrenergic drug?
Alpha2 blocker
Which drugs:

- result in vasodilation of smooth muscles
- decreased BP
Selective Alpha-adrenergic blocking agents (Alpha1)
ex: terazosin (Hytrin)
Which drugs:

- relax muscles in prostate and bladder
- decreases urinary retention
Selective Alpha-adrenergic blocking agents (Alpha1)
ex: tamsulosin (Flomax)
Which drugs:

- result in:
- vasodilation
- cardiac stimulation
- hypotension
- tachycardia
Nonselective Alpha-adrenergic blocking agents
Which drugs are used to control BP during removal of pheochromocytoma?
Nonselective Alpha-adrenergic blocking agents
Which drugs are used as local injection for prevention of sloughing after extravasation?
Nonselective Alpha-adrenergic blocking agents
phentolamine (Regitine) is an example of what drug group?
Nonselective Alpha-adrenergic blocking agents (used as local injection for prevention of sloughing after extravasation)
Which drugs:

- decrease HR
- decrease cardiac contractility
- decrease renin activity
Cardioselective beta blockers (Beta1)
Which drugs:

- Decrease O2 demand of the heart for MI pts
B1 blockers
metoprolol (Lopressor) is an example of which drug group?
Cardioselective B1 blockers
Which threshold sign requires withholding of B1 blockers?
If HR < 60
When is caution required for B1 blocker administration?
- diabetic pts (may cause hypoglycemia)
- HF pts
When are B1 blockers contraindicated?
- bradycardia
- heartblock
Which drugs:

- Block B1 & B2
Nonselective beta blockers
Which drugs are indicated for:

- angina
- migraine headaches
- stage fright
Nonselective beta blockers
When is caution required for Nonselective beta blocker administration?
- Asthma
propanolol (Inderal) is an example of which drug?
Nonselective beta blocker
Which drugs stimulate the PNS (mimics acetylcholine)?
Cholinergic drugs
What is noted concerning the agonistic action of cholinergic drugs and the BBB?
they do not readily cross BBB
Which enzyme is inhibited by indirect-acting cholinergic drugs?
What is the diagnostic test for myasthenia gravis?
Tensilon test
What primary ANS effect is attributed to myasthenia gravis?
decreased acetylcholine
By inhibiting cholinesterase what results from indirect-acting cholinergic drugs?
more aCH is made available at receptor sites
What cholinergic drug is indicated for urinary retention?
bethanecol (Urecholine)
What cholinergic drug is indicated for treatment and dx of Myasthenia gravis?
neostigmine (Prostigmin)
What cholinergic drug is indicated for Alzheimer's Disease?
donazepil (Aricept)
What cholinergic drug reverses the action of some neuromuscular blocking?
tubocurarine (Curare)
What cholinergic drug is indicated for Glaucoma and intraocular surgery?
pilocarpine (Isopto Carpine)
What are some contraindications for Cholinergic drugs (try to name 5)?
- Urinary obstruction
- GI obstruction
- Asthma
- Bowel disorders
- Hyperthyroidism
- Pregnancy
What is the best antidote for Cholinergic medication?
Atropine (anticholinergic)
What are some Nursing Implications for Cholinergic drugs (try to name 5)?
- Make sure bathroom facilities are readily available
- Medical ID bracelet
- Atropine is antidote
- Monitor liver function
- Safety measures for clients being tx for Alzheimers
MOA of which drugs?

- Blocks action of aCH
- Crosses BBB
- Low doses
Anticholinergic Drugs
How do low doses of Anticholinergic drugs affect the HR?
Decrease HR
How do high doses of Anticholinergic drugs affect the HR?
Increase HR
How do Anticholinergic drugs affect pupil size?
Dilates pupil
What is mydriasis?
dilation of the pupil
What is the drug of choice for symptomatic bradycardia?
What Anticholinergic is indicated for GI: PUD, gastritis, diverticulitis?
dicyclomine (Bentyl)
What Anticholinergic is indicated for GU: urinary incontinence, neurogenic bladder?
oxybutynin (Ditropan)
What Anticholinergic is indicated for dilation of eyes for intraocular surgery?
What Anticholinergic is indicated for asthma/bronchitis (bronchodilation)?
ipratropium (Atrovert)
What Anticholinergic is indicated for Bradycardia; heart block?
What Anticholinergic is indicated for Parkinson's disease?
benztropine (Cogentin)
What Anticholinergic is indicated as preoperative to decrease salivation/secretions?
What are some contraindications for Anticholinergic drugs? (try to name 5)
- Myasthenia gravis
- Hyperthyroidism
- Glaucoma
- Tachycardia/dysrhythmias
- MI
What nursing implication applies to Anticholinergics for GI disorders?
Administer 30 minutes before meals
What nursing implication applies to Anticholinergic IM Atropine?
IM Atropine may be mixed in the same syringe with several common preop meds
What two neural compensation systems are activated in HF?
- SNS stimulation
What complication in the myocardium related to HF is fought with drug therapy?
ventricular remodeling related to hypertrophy
What is the first line of drug therapy for HF?
diuretic & ACE inhibitor (or ARB)
Which drugs used for HF increases the force of contraction of the heart?
Which common HF drug:
- positive inotropic (increase pump)
- negative chronotropic (decrease HR)
Digoxin (Cardiac Glycosides)
When is Digoxin indicated?
- management of HF
- atrial fibrillation
- atrial flutter
Does Digoxin improve survival in HF patients?
When is Digoxin contraindicated? (Name 2)
- Ventricular dysrhythmias
- Heart block
- Electrolyte imbalances
- Renal impairment
What procedure must be followed concerning Digoxin administration?
- give slowly ~5 minutes
- client should be on cardiac monitor during administration
What is the standard concerning Digoxin IV and PO doses?
IV: 0.125-0.5 mg/d (onset 10-30 min)
PO: 0.125-0.25 mg (onset 30 min - 2 hrs)
What is the therapeutic range for Digoxin?
0.5 - 2 ng/mL
Which two drugs might Digoxin interact with?
- verapamil
- nifedipine
If Digoxin is administered in too large a dose what adverse effects may occur?
- impaired renal function
- electrolyte imbalances
What are some signs and symptoms of Digoxin toxicity?
- bradycardia
- confusion
- anorexia
- N/V
What is the antidote for Digoxin?
Digoxin is widely distributed and crosses the placenta. What percentage of Digoxin is protein bound?
23% protein bound
True or False:

Digoxin is strongly metabolized in liver.
False, Digoxin undergoes minimal hepatic metabolism
Which HF drug:

- vasodilates (decreasing preload and afterload)
- increases diuresis
- suppresses RAAS
Human B-Type Natriuretic Peptide (Nesiritide)
What important nursing implication concerns the administration of Human B-Type Natriuretic Peptide (Nesiritide)?
Must be administered via SEPARATE IV line
Which B1 blocker for HF pts is also an A1 blocker causing vasodilation and decreased afterload?
What term means giving a larger bolus medication to attain a steady state faster.
What herbal supplement blocks the effects of spironolacone (aldactone) and causes Na retention and K loss?
What herbal supplement may increase effects of ACE inhibitors?
What herbal supplement may worsen Digoxin toxicity?
What most important nursing implication must be carried out before Digoxin administration?
Check APICAL pulse before administration (hold if <60 in adults, <70 in older children, <100 in young children/infants)
Over what time frame should IV Digoxin be administered?
5 minutes
Which Antidysrhythmic:

- blocks the movement of Na into the cells of the cardiac conduction system
- Not used very often
Class I Sodium Channel Blockers
The Na channel blockers below belong to which class:

- Quinidine
- procainamide (Pronestyl)
Class IA: atrial/ventricular dysrhythmias
The Na channel blockers below belong to which class:

- Lidocaine
- mexiletine (Mexitil)
- phenytoin (Dilantin)
Class 1B: ventricular dysrhythmias
The Na channel blocker below belong to which class:

- propafenone (Rhythmol)
Class 1C: ventricular dysrhythmias - may be used in supraventricular tachycardia
Which Antidysrhythmic:

- Blocks SNS
- tx of atrial dysrhythmias
Class II Beta-Adrenergic Blockers
The Antidysrhythmics below belong to which class:

- acebutolol (Sectral)
- esmolol (Brevibloc)
- propranolol (Inderal)
Class II Beta-Adrenergic Blockers
Which Antidysrhythmic:

- Tx of atrial/ventricular dysrhythmias
- Have demonstrated decrease in mortality rates (used more frequently)
Class III Potassium Channel Blockers
The Antidysrhythmics below belong to which class:

- amiodarone (Cordarone)
- bretylium (Bretylol)
- ibutilide (Covert)
- betapace (Sotalol)
Class III Potassium Channel Blockers
What administration routes are available for tx with the K channel blocker amiodarone (Cordarone)
IV or PO
Which Antidysrhythmic:

- Blocks the movement of calcium into conduction cells and contractile cells of the myocardium
- Used for atrial dysrhythmias
Class IV Calcium Channel Blockers
The Antidysrhythmics below belong to which class:

- diltiazem (Cardizem)
- verapamil (Calan)
Class IV Calcium Channel Blockers
What Antidysrhythmic:

- used to re-establish normal rhythm with rapid atrial dysrhythmias
- Has extremely short half-life (10 seconds)
- Must be given RAPID IV push (at port closest to body)
Adenosine (Adenocard)
What medication is often given for low Mg levels?
Magnesium Sulfate
What are some Specific Nursing Implications for Antidysrhythmics?
- use cautiously in elderly
- observe for adverse effects (heartblock, worsening dysrhythmias, hypotension)
Which Antianginal medication:

- Dilates veins (decreases venous return -> decreases preload)
- Dilates coronary arteries (increases oxygen/blood flow to myocardium)
- Dilates arteries (decreases BP/ decreases afterload)
Nitrates are indicated for:
- angina
- MI
True or False:

The heart recieves blood during diastole.
When are Nitrates contraindicated?
- hypotension
- hypovolemia
How must sublingual Nitrates be stored?
Sublingual Nitrates are stored in dark bottle (light inactivates)
What nursing implication applies to Nitrate IV solutions?
Must be on pump
What is the half-life of all Nitrate forms/routes?
1-5 minutes
What drugs should not be mixed with Nitrates?
- OTC decongestants
- cold meds
- diet pills
What is an expected side effect of Nitrates?
What must be monitored closely on pts taking Nitrates?
blood pressure
Which Antianginal medication:

- decreases HR
- decreases myocardial contractility -> (decreased O2 demand of the heart
- decreased BP -> (decreased O2 demand of heart)
Beta-Adrenergic Blocker Agents
Which Antianginal medication is the drug of choice for CAD?
Beta-Adrenergic Blocker Agents
The drugs below are of which Antianginal class?

- metoprolol (Lopressor)
- atenolol (Tenormin)
- propanolol (Inderal)
Beta-Adrenergic Blocker Agents
Which Antianginal class?

- Dilates vessels
- Decreases myocardial contractility
- Depresses the myocardial conduction system
Calcium Channel Blocking Agents
Which Antianginal is also used for:

- hypertension
- atrial dysrhythmias
- migraine headaches
Calcium Channel Blocking Agents
When are Calcium Channel Blocking Agents contraindicated?
- Heartblock
- symptomatic bradycardia
- hypotension
- HF
- cardiogenic shock
The drugs below belong to which Antianginal class?

- nifedipine (Procardia)
- diltiazem (Cardizem)
Calcium Channel Blocking Agents
What are 3 adjunctive therapies for Calcium Channel Blocking administration?
- aspirin
- antilipemics
- antihypertensives
What are some nursing implications for Calcium Channel Blocking Agents?
- always check BP prior to administration
- avoid OTC decongestants, cold remedies & diet pills
- ED meds are contraindicated
What drugs are typically used to manage hypotension and shock?
Which volume replacement tx:

- fluid replacement
- manage F&E imbalances (contain F&E found in the body)
- NO risk of hypersensitivity rxn
What concentration of NaCl is considered "normal saline"
0.9% NaCl
Which volume replacement tx:

- volume/plasma expanders
- increase colloidal oncotic pressure
- use with hypotension (2ndary to volume depletion); malnutrition
Below is an example of what type of volume replacement tx:

3% NaCl, 5% NaCl, 50% Dextrose
hypertonic Crystalloid IV
Below is an example of what type of volume replacement tx:

0.9% NaCl, Lactated Ringers, 5% D5W
Isotonic Crystalloid IV
Below is an example of what type of volume replacement tx:

0.45% NaCl
Hypotonic Crystalloid IV
What are the 4 different types of colloid volume replacements?
- Albumin
- Dextran
- Hetastart
- Blood components
Which colloid volume replacement:

- protein
- only given IV
- contraindicated with CHF, renal insufficiency, pregnancy category C
What are the 5 different types of blood components given?
- whole blood
- packed red blood cells
- platelets
- fresh frozen plasma
- cryoprecipitate
Which hypovolemic/shock medication:

- naturally occuring catecholamine
- MOA is dose dependent
- higher doses likely to cause tachycardia
dopamine (Intropin)
Low doses of dopamine (0.5-10 mcg/kg/min) causes:
stimulation dopamine receptors:
-> dilates renal arteries
-> improves blood flow to kidneys
(3-20 mcg/kg/min) of dopamine causes:
stimulation beta receptors
(20-50 mcg/kg/min) of dopamine causes:
stimulation of alpha and beta receptors
How is dopamine administered?
via continuous IV infusion (short half-life)
Which hypovolemic/shock medication:

- synthetically made catecholamine
- stimulates B1
- administered via continuous IV infusion
dobutamine (Dobutrex)
epinephrine (Adrenalin) stimulates _______ receptors at low doses.
B receptors
epinephrine (Adrenalin) stimulates _______ receptors at higher doses.
A receptors
What is the drug of choice for anaphylaxis (SC 1:1000) by preventing the release of histamine - reversing vasodilation/bronchoconstriction
epinephrine (Adrenalin)
What is the drug of choice for cardiac arrest (IV - 1:10,000)
epinephrine (Adrenalin)
True or False:

epinephrine (Adrenalin) may NOT be given continuous IV infusion.
False. Adrenalin CAN be administered via continuous infusion
Which hypotension/shock medication increases CO in cardiogenic shock?
milrinone (Primacor)
Which hypotension/shock medication:

- naturally occuring catecholamine
- stimulates A receptors
- stimulates B1 receptors
- used as a last resort (if dopamine & dobutamine are not effective
- administered via continuous IV infusion
norepinephrine (Levophed)
Which hypotension/shock medication:

- stimulates A receptors
- less direct cardiac effect than epinephrine
phenylephrine (Neo-Synephrine)
Nursing Implication related to hypotension/shock medications
- goal is to restore blood pressure, maintain adequate perfusion to bodily tissues
- volume replacement
- closely monitor urine output
- use caution in clients w/ hepatic impairment
- all vasoactive meds must be administered via infusion pump
What are some therapeutic effects to look for with hypotension/shock medications?
- BP
- urine output
- HR 60-100
- skin color/temp
What are some adverse effects to look for with hypotension/shock medications?
- extravasation
- bradycardia
- tachycardia
- tissue necrosis
- hypo/hypertension
What is the goal of antihypertensive meds?
BP <120/80
Which antihypertensive medications:

- blocks the enzyme that converts angiotensin I to angiotensin II
- blocks potent vasoconstrictor resulting in vasodilation
ACE Inhibitors
Which antihypertensive medications:

- decreases aldosterone secretion
-> decreases Na/H2O retention
- inhibits breakdown of bradykinin (dilate arterioles, constrict venules)
- prevents/reverses cardiac remodeling
ACE Inhibitors
The Antihypertensive drugs below belong to which class:

- ramipril (Altace)
- captopril (Capoten)
- enalapril (Vasotec)
- lisinopril (Prinivil)
ACE Inhibitors
What percentage of ACE Inhibitors are metabolized in the liver?
What annoying side effect do 10-20% of clients taking ACE Inhibitors develop?
dry cough
What method is used to prevent hypotension with clients on ACE Inhibitors?
start at low doses and take at HS
What pregnancy category are ACE Inhibitors?
Pregnancy category X
What pts taking ACE Inhibitors may develop hyperkalemia?
- DM
- renal impairment
- concurrent use with potassium sparing diuretics
Which Antihypertensive medication:

- Block angiotensin II receptors preventing angiotensin II from binding to receptor sites and inducing vasoconstriction
- well tolerated -> rare incidence of cough
- less likely to cause hyperkalemia
Angiotensin II Receptor Blockers (ARBs)
The Antihypertensive medications below belong to which class:

- losartan (Cozaar)
- valsartan (Diovan)
- Irbesartan (Avapro)
- telmisartan (Micardis)
- olmesartan (Benicar)
Angiotenisn II Receptor Blockers (ARBs)
Where is the Angiotensin converting enzyme located?
in the endothelium of the pulmonary blood vessels
Which Antiadrenergic medication:

- significant for first-dose effect
A1 blockers
Which Antiadrenergic medication:

choice for pregnant women with HTN
Alpha2 agonist:

methyldopa (Aldomet)
Which Antiadrenergic medication:

Shown to have greater effect in Asian population
Beta blockers
The Antiadrenergic medications below belong to what class:

- doxazosin (Cardura)
- prazosin (Minipress)
- terazosin (Hytrin)
Alpha1 Blockers
Which medication, for HTN, dilates peripheral arteries and decreases peripheral vascular resistance
Calcium Channel Blockers
amlodipine (Norvasc) is an example of which Antihypertensive class?
Calcium Channel Blockers
Which diuretic is the first choice for HTN?
thiazide diuretics
Research has shown that what tx should be the first line tx for HTN?
diuretic therapy
Which Antihypertensive medication:

promotes loss of Na and H2O -> decreasing in vascular volume
True or False:

Geriatric clients and African Americans have good results with diuretic therapy
Which Antihypertensive medication:

- directly relaxes smooth muscles in blood vessels
-> vasodilation, decreased peripheral vascular resistance, decreased afterload
Which Vasodilator causes arteriole relaxation?
hydralazine (Apresoline) [IV or PO]
Which Vasodilator causes arteriole and venule relaxation?
nitroprusside (Nipride) [IV only]
What nursing implication applies to nitroprusside (Nipride)?
No contact with light; very strong (measure cianide levels in long-term therapy)
Which Antihypertensive medications are usually used in combination with other drugs because they stimulate baroreceptors and SNS, initiating compensatory mechanisms
What method of Antihypertensive medication administration is used to prevent orthostatic hypotension?
give meds at HS
Which Antihypertensive meds require monitoring for electrolyte imbalances?
thiazide/loop diuretics
What herbal/dietary supplements can decrease the effectiveness of Antihypertension meds?
- Antihistamines
- cold/cough preparations
- weight loss products
What percentage of cardiac output do kidneys require?
25% of cardiac output
How many nephrons are in kidney?
1 million
In which part of the kidney does the most reabsorption occur
proximal tubule
What elements are absorbed in the proximal tubule?
- glucose, amino acids
- 80% H2O
- Na
- K
- Cl
What elements are secreted in the proximal tubule?
- creatinine
- H+
- uric acid
- NH3
What is reabsorbed in the ascending loop of Henle?
Na reabsorbed
What is reabsorbed in the descending loop of Henle?
H2O reabsorbed
Which drugs suffix:

beta blockers
Which drugs suffix:

alpha1 blockers
Which drugs suffix:

ace inhibitors
Which drugs suffix:

angiotensin receptor
The distale tubule reabsorbs what substances?
- Na
- final reabsorption of H2O
The distale tubule secretes which substances?
- K
- H+
- NH3
Diuretics act on kidney to decrease reabsorption of ____,____, and _____
- Na
- Cl
- H2O
Diuretics are indicated for what?
- edema
- HF
What effect do diuretics initially have on CO?
initially decrease CO (later returns to normal)
Which diuretic:

- decreases reabsorption of Na, H2O, Cl, HCO3 in the distale tubule
- relatively weak diuretics since most of Na is reabsorbed in proximal tubule
Thiazide diuretics
which diuretic is the first line drug for HTN
thiazide diuretics
What route are thiazide diuretics given?
PO (only diuril can be given IV)
Below are examples of which diuretic class?

- hydrocholorthiazide (Hydrodiuril)
- chlorothiazide (Diuril)
Thiazide diuretics
True or False:

Increasing doses of Thiazide diuretics improves effects
False, increased dosages does not improve effects (ceiling dose)
True or False:

Small doses of Thiazide diuretics are most effective
True, (12.5-25 mg)
Which diuretic:

- inhibits Na&Cl reabsorption in ascending loop of Henle
- Potent (produce considerable diuresis)
Loop diuretics
True or False:

Loop diuretic doses can be titrated upwards to produce increased effects
Which route/s can Loop diuretics be administered?
PO or IV
Which diuretic is indicated for when rapid elimination of fluids is required?
Loop diuretics
What are some adverse effects of Loop diuretics?
- hypovolemia
- hypotension
- hypokalemia
The examples below belong in which diuretic class?

- furosemide (Lasix)
- bumetanide (Bumex)
- torsemide (Demadex)
Loop diuretics
Which diuretic:

- decreases Na reabsorption and K excretion at the distale tubule
- inhibits aldosterone
- weak if used alone
Potassium-Sparing Diuretics
When are Potassium-Sparing Diuretics contraindicated?
contraindicated in renal insufficiecy
The examples below belong in which diuretic class?

- spironolactone (Aldactone)
- triamterene (Dyrenium)
Potassium-Sparing Diuretics
Which diuretic:

- increases osmotic pressure of glomerular filtrate
- pulls water into vascular system
- increases blood volume, decreasing reabsorption of Na & H2O
Osmotic Diuretics
Which diuretic:

- used to manage oliguria (slight/infrequent urine) and increased intracranial pressure
Osmotic Diuretics
The example below belongs in which diuretic class?

- mannitol (Osmitrol)
Osmotic Diuretics
What nursing implications apply to the administration of Osmotic diuretics?
- given IV only
- must be room temp/warm
Which diuretic:

- decreases intraocular pressure with glaucoma and intraocular surgery
- decrease production of aqueous humor
Carbonic Anhydrase Inhibitors
Which 3 routes may Carbonic Anhydrase Inhibitors be given?
- PO
- IV
- IM
The example below belongs in which diuretic class?

- acetazoamide (Diamox)
Carbonic Anhydrase Inhibitors
How must furosemide be given to achieve diuretic response in renal disease?
Large doses necessary
What implication concerns diuretics and Digoxin?
Diuretics increase dig toxicity when given with Digoxin
Which diuretics are more common which children?
furosemide & spironolactone
When are diuretics typically administered?
AM (keep bedpan, urinal, bathroom access available)
Which anticoagulant:

- Inhibits conversion of prothrombin to thrombin
- Inactivates IX, X, XI, XII
- Prevents conversion of fibrinogen to fibrin
Which anticoagulant given via IV or SC (effects in 20-30 min)?
True or False:

Heparin cross placenta
False, (drug of choice in pregnancy)
What must be monitored with Heparin administration?
PTT (partial thromboplastin time)
What is the target range for PTT during Heparin tx?
60-80 seconds
What is the normal range for PTT?
25-35 seconds
Which anticoagulant cannot be absorbed orally?
When is Heparin contraindicated? (try to name 3)
- GI bleeds
- Intracranial bleeds
- Blood dyscrasias (abnormal blood condition)
- Severe hypertension
- Recent surgery
Which anticoagulant:

- only given SC to abd area
- does not require monitoring PTT
Low-Molecular-Weight Heparins (LMWH)
What is the antidote for LMWH?
protamine sulfate (IV)
The example below belong in which anticoagulant class?

- enoxaparin (Lovenox)
Low-Molecular-Weight Heparins (LMWH)
What are some nursing implications regarding LMWH?
- Never aspirate injection
- Keep air in syringe to ensure entire dose administered
Which anticoagulant:

- prevents synthesis of II, VII, IX, X (Vit. K dependent clotting factors)
warfarin (Coumadin)
Which anticoagulant is given only PO?
warfarin (Coumadin)
How long does warfarin take to be effective?
3-5 days
What percentage of warfarin is bound to plasma proteins?
99% protein bound
What are the indication for warfarin use?
- *Long-Term* prevention/management of thromboembolic disorders (DVT, PE, Atrial fibrillation, prosthetic heart valves)
What contraindicates warfarin use?
any bleeding disorders
What is monitored during warfarin therapy?
What is the target INR during warfarin therapy?
What 2 important nursing implication apply to warfarin administration?
- Has many drug-drug interactions
- teach client high vitamin K foods should be avoided
What is the antidote for warfarin?
Vitamin K (PO, IM, SC)
What is type of Antiplatelet is Aspirin?
Thromboxane A2 Inhibitors
Which antiplatelet:

- inhibits the synthesis of prostaglandins by blocking thromboxane A2 (a prostaglandin)
What daily dose of aspirin is effective as an antiplatelet?
325 mg
How long is the lifetime of a platelet?
7-10 days
What Antiplatelet is indicated for long-term management of CAD, MI, stroke, heart valves, and TIA
Which Antiplatelet:

- prevents ADP-induced binding between platelets and fibrinogen
- inhibits platelet aggregation irreversibly
- lasts for lifetime of platelet
Adenosine Diphosphate Receptor Antagonist
The examples below belong in which antiplatelet class?

- ticlopidine (Ticlid)
- clopidogrel (Plavix)
Adenosine Diphosphate Receptor Antagonists
What Antiplatelet is indicated for TIA, and thrombotic CVA?
Adenosine Diphosphate Receptor Antagonists
What is the normal range for platelets?
150,000 - 400,000
Which agents:

- stimulate conversion of plasminogen to plasmin
- used to dissolve clots
Thrombolytic agents
When are thrombolytic agents indicated?
- acute MI
- acute ischemic stroke
- PE
What is required to differentiate between ischemic and hemorrhagic stroke?
CAT scan
What therapy always follows thrombolytic therapy?
anticoagulant therapy
When are thrombolytics contraindicated?
- recent surgery
- on anticoagulants/antiplatelets
- Hx of CVA
- bleeding
- any trauma in last 2 months
- severe HTN
What important method is used concerning IV sites with thromboytic treatment?
Requires 2 IV sites before starting
The examples below belong in which coagulation modification class?

- streptokinase (Streptase)
- urokinase (Abbokinase)
- alteplase (Activase)
Thrombolytic agents
What nursing implications apply to coagulation modifiers?
- dont shave, use soft toothbrush
- teach client to report any bleeding (nosebleed, bleeding gums, blood in stool/urine, excessive bruising, medic ID)
- most ok in renal impairment
- high caution in hepatic impairment
Which coagulation modifiers are used in children?
- Heparin & coumadin (others such as LMWH have no established indications)
What is normal cholesterol?
<200 ng/dL
What is normal HDL?
>60 mg/dL
What is normal LDL?
<100 mg/dL
What is normal Triglycerides?
<150 mg/dL
Which dyslipidemia agent:

- inhibits an enzyme required for hepatic synthesis of cholesterol
- decrease total serum cholesterol, LDL, VLDLD, & Triglycerides
HMG-CoA Reductase Inhibitors
How long do HMG-CoA Reductase Inhibitors take to reach maximum effects?
4-6 weeks
When are HMG-CoA Reductase Inhibitors indicated?
- hyperlipidemia
- reduce risk of cardiovascular events
The examples below belong in which Dyslipidemia agents?

- atorvastatin (Lipitor)
- lovastatin (Mevacor)
- pravastatin (Pravachol)
- simvastatin (Zocor)
HMG-CoA Reductase Inhibitors
When should Statin tx be stopped?
Stop if liver enzymes elevated
Which Dyslipidemia agents:

- binds bile acids in the intestines causing bile acids to be excreted in the stool
-> thereby preventing recirculation to the liver
Bile Acid Sequestrants
Which Dyslipidemia agents:

cause loss of bile acids stimulating liver to synthesize more bile acids from cholesterol
-> causing serum cholesterol to move to the liver
Bile Acid Sequestrants
What Dyslipidemia agent is used to reduce LDL in clients taking statin?
Bile Acid Sequestrants
What Dyslipidemia agent is used in conjunction with statins increases HDLs?
Bile Acid Sequestrants
What Dyslipidemia agent is may cause abd fullness, flatulence, & constipation?
Bile Acid Sequestrants
The example below belongs to which Dyslipidemia agent group?

- cholestyramine (Questran)
Bile Acid Sequestrants
What Dyslipidemia agent:

- increases the oxidation of fatty acids in the liver and muscle tissue
- decreases hepatic production of triglycerides
What Dyslipidemia agent:

- decreases VLDL and increases HDL
- very effective in reducing triglyceride levels
The examples below belong to which Dyslipidemia agent group?

- gemfibrozil (Lopid)
- fenofibrate (Tricor)
What Dyslipidemia agent:

- decreases cholesterol and triglycerides *at high doses*
- inhibits mobilization of free fatty acids from peripheral tissues
-> reducing hepatic synthesis of triglycerides and secretion of VLDL
Niacin (Nicotinic acid)
What Dyslipidemia agent produces the following adverse effects?

- skin flushing
- pruritis
- gastric irritation
Niacin (Nicotinic acid)
How can skin flushing associated with Niacin use be diminished?
decreasing dose and taking ASA 325 mg
What Dyslipidemia agent

- inhibits the absorption of cholesterol in the small intestines
- reduces total cholesterol, triglycerides
- increases HDL
Cholesterol Absorption Inhibitor
What Dyslipidemia agent may be taken with food; but should be 2 hours before or 4 hours after a bile acid sequestrant
Cholesterol Absorption Inhibitor
What Dyslipidemia agent is preferred for single dose therapy?
Which ethnic group tends to have lower cholesterol levels than other Americans?
American Indians
Which ethnic groups are less likely to be treated with cholesterol lowering meds
- African Americans
- Mexican Americans
When are Dyslipidemia agents contraindicated?
liver disease
What 3 herbal/dietary supplements are used as Dyslipidemia agents?
- Flaxseed
- Garlic (little supporting research)
- Green tea (may be CNS stimulant)