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221 Cards in this Set
- Front
- Back
Antidote for versed (midasolam) =
how do you give IV? |
on case study
-flumazenil (Romazicon) stop the blood, flush with NS, give the med in the port closest to the insertion site. Remember SAS(H) – flush with saline, administer, saline, and start the blood again |
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Antidote for heparin =
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protamine sulfate
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Normal Saline 0.9% sodium chloride
-what kind of solution is this? |
isotonic solution
-action: crystalloid and will keep fluid in the intravascular space increasing intravascular volume |
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Normal Saline 0.9% sodium chloride
-why is this often used? -what is the purpose of giving this? |
-it can also be infused with any blood product
-increases plasma volume |
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Lopressor (metoprolol) SE (2)
what do you look at on the EKG before adminstering this? |
-bradycardia
-hypotension -EKG for heart block (lopressor will sow down the HR.. if the person has a block, you don’t want to slow the HR down anymore) |
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NTG (nitroglycerin)
-side effects (4) |
-headache
-N/V -diaphoresis -hypotension |
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Lanoxin (Digoxin) :
-does it have a position or negative inotropic action? -what does it do to heart rate and conduction? |
-positive inotropic action (contraction)
-decrease the conduction through the AV node slowing the HR (chronotropic action) |
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Lanoxin (Digoxin) :
-what does it do to cardiac output? what does it do to preload? |
-CO increases because of increase stroke volume from improved contractility
-decreases preload |
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Digitalsis toxicity
-dysrhythmias such as: -what electrolyte does it affect? |
-bradycardia is most common
-hypokalemia (dig and K compete for the same binding sites) |
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Digitalsis toxicity
-what does it do to one's visual acuity? |
-visual disturbances (yellow haze)
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Digitalsis toxicity
-digoxin is absorbed where? -where is it excreted? -what do you teach a patient based off of knowing where it is absorbed? |
-the GI tract
-renal excretion do not take at the same time as antacids or laxatives |
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Diuretics
-increase or decrease preload? |
decreases preload
(preload is the stretching of the muscle fibers in the ventricles as they fill with blood) |
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is Heparin an anticoagulant or an antiplatelet?
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Anticoagulants:
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is Coumadin (Warfarin) an anticoagulant or an antiplatelet?
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Anticoagulants:
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Anticoagulants (Heparin and Warfarin) are used when (3)
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thrombi,
pulmonary embolism, prophylaxis |
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Anticoagulants (Heparin and Warfarin)
-contraindicated: |
-GI bleed
-recent trauma or surgery -aneurysms -NSAIDS -thrombocytopenia --renal, liver, pancreas disease -alcoholism -pregnancy "gran trap" is a way to remember |
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Heparin
-what does it do to a clot? |
-delays clotting time,
-does not resolve clot, |
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Heparin
-what is the mechanism of action? it blocks...... |
-blocks conversion of prothrombin to thrombin and finbrinogen to fibrin
-inhibits synthesis of thrombin to prevent development of fibrin clot |
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Heparin
-what is the dosage based off of? -what is the dosage also determined by? -what is normal? -what is therapeutic? |
-dosage is weight based
-dosage determined by monitoring activated partial thromboplastin time (aPTT) -normal: 25-35 seconds -therapeutic is 1.5-2.5 x the nromal (50-70 seconds) |
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-aPTT (activated partial thromboplastin time)
-what is it? -what is normal? -what is therapeutic? |
evaluates clotting factors.
-normal is 25-35 seconds -therapeutic is 1.5-2.5 X the normal (50-70 seconds) |
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-PT (prothrombin time)
what is it? what is normal? |
time required to form a fibrin clot.
Normal is 10-14 seconds |
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-INR:
what is it? |
PT value divided by the standard.
-Example: how long it takes a person on antiplatelets (blood thinners) to clot vs a normal person. -measures the effects of oral anticoagulants |
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-INR:
-what is normal? what a person is anticoagulated/therapeutic, what should their #s be? -if a pt has a valve replacement, what should their numbers be? |
-normal: 0.75-1.25
-when anticoagulated/therpeutic: 2-3 -valve replacement 2.5-3.5 (different for a pig valve, this is only mechanical valve) |
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-Lovenox or “parin” is an example of what class of medication?
|
Low molecular weight heparins
|
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-PT (pro time)
what is it? what is normal? |
time required to form a fibrin clot.
Normal is 10-14 seconds |
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-aPTT (activated partial thromboplastin time)
-what is it used for? -what is normal? -what is therapeutic? |
evaluates clotting factors and used to determine dosage in Heparin
-normal is 25-35 seconds -therapeutic is 1.5-2.5 X the normal (50-70) |
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-INR:
what is it? |
PT value divided by the standard.
-Example: how long it takes a person on antiplatelets (blood thinners) to clot vs a normal person. |
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Low molecular weight heparins such as Lovenox or “parin” are used most often for what?
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preventing and treating DVTs
|
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-Lovenox or “parin” do not require PTT or aPTT monitoring (true or false)
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true
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Low molecular weight heparins such as Lovenox or “parin”
-when giving this, where on the body is it administered? -angle of insertion of needle? -what do you make sure you don't do after giving the injection? |
-administering either IV or subq (give in fatty tissue – abdomen or thigh), insert needle at right angle to skin, do not rub site (bruising can result)
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Pt education of Heparin: avoid
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NSAIDS, trauma, use soft bristle toothbrush, report signs of bleeding: gums, nose, urine, stool, emesis, bruising
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SE of Herparin and LMW Herparins:
-5 |
alopecia,
flushing, bleeding, osteoporosis, rashes |
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Caution when using heparin and LMW heparins:
-if given SC, what do you make sure you do not do? -what about the elderly? |
do not stretch skin or rub injection site,
use smaller doses in the elderly |
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Coumadin (Warfarin)
-action? inhibits synthesis of... |
-inhibits synthesis of clotting factors (II, VII, IX, and X) by blocking formation of prothrombin from vitamin K (which is necessary for the synthesis of clotting factors) = disrupts coagulation cascade
|
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Coumadin (Warfarin)
-dosage: what is the starting dosage for coumadin? |
start with 10-15 mg/day
|
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Caution when using heparin and LMW heparins:
-if given SC, what do you make sure you do not do? -what about the elderly? |
do not stretch skin or rub injection site,
use smaller doses in the elderly |
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Coumadin (Warfarin)
-how many days does it take for this drug to reach therapeutic levels? -then what does the dosage go to for maintance? |
- takes 2-3 days to achieve therapeutic levels, then 2.5-7.5 mg/day as maintenance up to 6 months
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Coumadin (Warfarin)
-action? inhibits synthesis of... |
-inhibits synthesis of clotting factors (II, VII, IX, and X) by blocking formation of prothrombin from vitamin K (which is necessary for the synthesis of clotting factors) = disrupts coagulation cascade
|
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Coumadin (Warfarin)
-what 2 levels are you monitoring to determine the dosage?? |
monitor PT and INR
-dosage is determined by PT time (1.5-2.5 times control or international normalized ratio (INR) 1.5-3.0) |
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Coumadin (Warfarin)
-dosage: what is the starting dosage for coumadin? |
start with 10-15 mg/day
|
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Coumadin (Warfarin)
-how many days does it take for this drug to reach therapeutic levels? -then what does the dosage go to for maintance? |
- takes 2-3 days to achieve therapeutic levels, then 2.5-7.5 mg/day as maintenance up to 6 months
|
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Caution when using heparin and LMW heparins:
-if given SC, what do you make sure you do not do? -what about the elderly? |
do not stretch skin or rub injection site,
use smaller doses in the elderly |
|
Coumadin (Warfarin)
-what 2 levels are you monitoring to determine the dosage?? |
monitor PT and INR
-dosage is determined by PT time (1.5-2.5 times control or international normalized ratio (INR) 1.5-3.0) |
|
Coumadin (Warfarin)
-action? inhibits synthesis of... |
-inhibits synthesis of clotting factors (II, VII, IX, and X) by blocking formation of prothrombin from vitamin K (which is necessary for the synthesis of clotting factors) = disrupts coagulation cascade
|
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Coumadin (Warfarin)
-dosage: what is the starting dosage for coumadin? |
start with 10-15 mg/day
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Coumadin (Warfarin)
-how many days does it take for this drug to reach therapeutic levels? -then what does the dosage go to for maintance? |
- takes 2-3 days to achieve therapeutic levels, then 2.5-7.5 mg/day as maintenance up to 6 months
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Coumadin (Warfarin)
SE: |
-weakening of bone with long term use
-red/orange urine -alopecia at injection site -bleeding tendencies -nausea and vomiting -anorexia -diarrhea and cramping |
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Coumadin (Warfarin)
-what do you teach a pt who is taking this about their diet, what should they avoid? |
-Teach pts to decrease the intake of green leady veggies
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Coumadin (Warfarin)
-what is the antidote? |
-Vitamin K is the antidote
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Platelet inhibitors (Antiplatelet)
-examples are: |
aspirin (ASA) and plavix
|
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Platelet inhibitors (Antiplatelet) –prevents
|
platelet aggregation (prevents them from sticking together)
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ASA (Aspirin) - used for 4 diseases:
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PVD,
Acute coronary syndrome prophylaxis against stroke and MI |
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-if pt is experiencing an MI at home, instruct them to do what?
|
take 4 baby aspirin and
chew (81 mg each) |
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ASA (Aspirin)
-what does it do when giving it for an MI? |
-decreases inflammatory effects of MI
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ASA (Aspirin)
-ASA inhibits platelet aggregation and ________ |
vasoconstriction
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ASA (Aspirin)
-when does this drug start working in the body? -how long does it last in the body? -what does it do to bleeding time? |
-antiplatelet effects begin with 1 hr of use and continues for 7-10 days
-prolongs bleeding time to inhibit the aggregation of platelets |
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-assess for what that may indicate ASA toxicity?
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-assess for ringing of the ears (tinnitus may occur with aspirin toxicity)
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Antiplatelets, such as aspirin prevent the clot from getting bigger, it doesn’t dissolve the clot (true or false)
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true
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Platelet inhibitors (Antiplatelet)
-if given IV, what is the dosage based off of? |
weight based
|
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Contraindications to antiplatelets?
|
-pregnancy & lactation,
-bleeding disorders, -recent surgery, -closed head injuries, -recent history of viral infection (flu or chicken pox) in children puts them at risk for Reyes syndrome |
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Teaching of antiplatelets
-should they take this with food? why? -what may they do prior to surgery? |
-give with milk , food, or full glass of water to decrease gastric irritation
-may hold drug 7-10 prior to surgery |
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-ASA toxicity: 4 SE
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tinnitus,
itching, severe HA, sweating ("tiss") |
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SE of aspirin:
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SE:
-bleeding -bruising -hematuria -tarry stools -headache -dizziness -weakness - skin rash -n/v -abdominal pain |
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ASA”
-is an antiplatelet. it also has 2 other actions. |
ASA”
-anti inflammatory – helps decrease inflammatory response and antipyretic, keeps down the fever |
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Nitrates (vasoconstrictor or vasodilator)
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vasodilator
-helps decrease pain |
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Nitroglycerin – nitrate vasodilator
-what does it do to the oxygen demand on the heart? |
(decreases oxygen demand on the heart)
|
|
Nitroglycerin – nitrate
what does it do to preload? |
-relaxes veins which decreases preload
|
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Nitroglycerin – nitrate
-what does it do to afterload? |
-relaxes arteries which reduces system vascular resistance which decreases afterload
work directly on vascular smooth muscle producing coronary and peripheral vasodilation |
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isosorbide dinitrate (Isordil)
erythrityl tetranitrate (Cardilate) are examples of? |
nitrates
nitroglycerin (NTG) |
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Nitroglycerin – nitrates
-Used (4) |
-angina pain
-acute MI -heart failure -hypertension |
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Nitroglycerin – nitrate
Contraindications: -what 2 other meds? -what 3 other conditions? |
-beta blockers
-erectile dysfunction medications (Viagra) -hypotension -hypovolemia -increased ICP |
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Nitroglycerin – nitrate
Sublingual is _____ acting. how many can you instruct them to take? |
-short acting: take up to 3 pills SL, 5 minutes apart
|
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Nitroglycerin – nitrate
-what is important to teach pt who are using the patches? |
-patches = intermittent therapy so don’t develop high tolerance. take off at night for 10-12 hrs
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Nitroglycerin – nitrate
-monitor: -instruct them to do what (2) |
-if dizzy or lightheaded after taking, sit down
-monitor HR and BP -change positions slowly SE: reflex tachycardia and orthostatic hypotension |
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Nitroglycerin – nitrate
-what can they take prophylactically? |
-prophylactic acetaminophen for headache
|
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Nitroglycerin – nitrate
-if they get a dry mouth when taking the sublingual tablets, what can you tell them to do? -what should they take these with? |
-if dry mouth, take sips prior to taking SL
-take on empty stomach with glass of water -don’t crush or chew |
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Nitroglycerin - nitrates
-what does the nurse have to know when this drug is being discontinued? -can you push this medication IV? |
-taper slowly when discontinued b/c aprubt withdrawl can cause the rebound effect of severe pain from an MI
-never push this medication IV |
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-SL nitroglycerin tablets are light sensitive. where do you teach pts to store them?
how long are they good for after opening? |
store in dark bottle with cap on tonight
(good for 6 mo after opening) |
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Side effects of nitroglycerin - nitrates?
|
-hypotension *
-syncope -dizziness -headache* -orthostatic hypotension* -dry mouth |
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Nitro paste – must always use the paper. do not rub in, tape on skin (true or false)
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true
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where should you place the nitro paste?
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close to the heart , it is absorbed locally.
make sure you do not go over bone (shoulder blade) because it wont be absorbed |
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-nitro causes what side effect that bothers people?
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head ache, so give tylenol
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-when you put on a nitro patch, what should you make sure of?
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make sure old one is off and wipe down the old area
-date time and initial patch |
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Nitro spray and sublingual tablets for pts with angina are instructed the same: take 3 doses, 5 minutes apart. true or false
|
true
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how do they tell if nitro is working?
|
gives you a tingling/burning sensation under the tongue
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“statins” are what class of drugs
|
antilipidemic or HMG-CoA Reductaste inhibitors
|
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"statins"
-what do they do? |
-decrease cholesterol or triglyceride levels
|
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Statins
-what is their action? inhibits formation of...... |
- inhibits formation of HMG-CoA reductase which is an enzyme that is required to make cholesterol in the liver
-increases removal of LDL from plasma by liver |
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crestor (rosuvastatin calcium)
SE (3) |
--statin
muscle weakness, cramps, rhabdomyolysis (rhabdomyloysis -muscle break down, they urinate red urine, it is not blood, it is muscle breakdown) |
|
crestor (rosuvastatin calcium)
-what is an example of a disease that would be contraindicated in someone taking this drug? -what test should you always monitor? |
-someone with Heb B would not continue on crestor, the crestor causes the liver
to decreases the synthesis of cholesterol so if there is liver damage, the liver can’t do its job and as a result it can cause further liver damage -always have liver tests done to make sure the crestor isn’t damaging the liver (It works in the liver) |
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niaspan (Niacin)
-what about the dosage? -what does it do in the body? -what organ does it affect? |
--statin and B vitamin
-need high doses (750 mg) for it to work. do not take it OTC. it will lower cholesterol. you need a prescription. it can ruin the liver. |
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niaspan (Niacin)
-major side effect -what intervention can you do? |
flushing = take aspirin to help that SE
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WelChol (colesevelam): bioacid sequestrant
-where does this action take place in the body? -what SE do you watch for? |
it binds with cholesterol in the intestines and prevents it from being absorbed)
- n/v is a SE that you watch for because it works in the GI tract |
|
Interventions for statins:
-monitor? -instruct them to get what kind of exam? -when time of day should they take this drug? |
Interventions:
-monitor LFT -eye exams because they can cause cataract formation -best to take drug in the evening |
|
Contraindications to statins:
2 |
-liver disease
-hepatitis |
|
SE of statins:
|
-GI
-rash -elevated liver enzymes* -lens opacities (caractacts)* -myopathy = rhabdomyolysis = leg pain* -hepatotoxicity* -muscle damage (increase in CK)* |
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Teaching when taking statins:
-tell them to report |
any muscle pain or tenderness (adverse reaction is myopathy and muscle damage)
|
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Niaspan (niacin)
-what does it do to LDL and HDL? |
- inhibits synthesis and secretion of VLDL and LDL from liver, increases HDL levels
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Niaspan (niacin)
-given to pts with high _____ |
triglycerides
|
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Niaspan (niacin)
-insturct them to take this when? -when should they take ASA to counteract the flushing? |
-take with meals
-take ASA 30 min prior to prevent flushing |
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Niaspan (niacin)
SE: |
-SE: flushing, itching, nausea, ingestion, diarrhea, hyperglycemia
|
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"pril" is what drug class?
|
ACE inhibitors
|
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ACE inhibitors (pril)
-what does it improve? |
-improves cardiac output, how?????
-helps ventricular remodeling (helps prevent stretching of the ventricles), decreasing vascular resistance & afterload |
|
ACE inhibitors (pril)
-action: what do they prevent? |
they prevent peripheral vasoconstriction by blocking conversion of angiotension I to angiotension II, decreasing vascular resistance and reducing afterload
they also help ventricular remodeling (prevent stretching) |
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ACE inhibitors (pril)
-uses: 3 |
heart failure
MI hypertension |
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ACE inhibitors (pril)
Interventions: -instruct them to take this medication when? |
-give before meals (on empty stomach) to enhance absorption
|
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ACE inhibitors (pril)
-teach them to avoid which kind of foods , supplements, and meds?? |
-avoid potassium rich foods
-potassium supplements -potassium sparing diuretics |
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ACE inhibitors (pril)
-change position slowly -what does this do to ones taste? |
-loss of taste --> anorexia
|
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ACE inhibitors (pril)
-monitor what organ function? -monitor for what else? |
-monitor renal function
-monitor for bleeding |
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ACE inhibitors (pril)
-instruct them not to use OTC ____? what should you teach them about discontinuning this med? |
don’t use OTC cold/cough preps
if you discontinue this med, rebound hypertension can occur |
|
ACE inhibitors (pril)
Contraindications: what about the use of this drug in a diabetic pt? |
-renal artery stenosis
-renal artery insufficiency -2nd and 3rd trimester pregnancy -can cause a hypoglycemic reaction in the pt with DM |
|
ACE inhibitors (pril)
SE: |
-granulocytopenia
-hemolytic anemia -proteinuria -stomatitis -loss of taste* -tongue ulcers -fever -rash -dry nagging cough* -hyperkalemia* -angioedema (fluid around eyes)* |
|
ACE inhibitors (pril)
SE: -hyperkalemia or hypokalemia? -hypertension or hypotension? |
-hyperkalemia
hypotension |
|
ACE inhibitors (pril)
SE: |
-angioedema (fluid around eyes)
-nagging, dry cough -loss of taste -hyperkalemia (avoid K+ rich foods) |
|
Diuretics
-what does it do to fluid volume? -does it control preload, afterload, or contracility? |
-decreases the amount of fluid volume (therefore decreasing edema and controlling afterload so they heart does not have to work as hard to pump the blood out)
|
|
Diuretics
-action is where in the body? -what does it do there? |
-action: nephrons of kidney increases excretion of electrolytes (Na, Cl)
|
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Diuretics
-what do they do to BP? |
-as urine sodium increases, additional water is excreted to dilute the urine. this results in a decrease of total body water and BP, and increase urine output
|
|
Loop diuretics
-action: |
-inhibit sodium and choloride reabsorption from the loop of Henle and the distal tubule
-renal excretion of sodium, water, and potassium. -initial decrease in blood volume and cardiac output |
|
what is this an example of?
-bumetanide (Bumex) |
-furosemide (Lasix)
-ethacrynic acid (edecrin) -torsemide (Demadex) Loop diuretics -what are examples |
|
-DRUG OF CHOICE FOR CHF IS?
|
-furosemide (Lasix) --Loop diuretic
|
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Diuretics
-Thiazide: action: -not effective for: -what electrolyte imbalances does this cause? 2 other side effects |
inhibit sodium reabsorption in the distal tubule, not as potent as the loop diuretics
immediate diuresis hypercalcemia hyperglycemia hyperuricemia hypokalemia hyponatremia photosensitivty --- use suncreen constipation |
|
Diuretics
-K+ sparing: action? |
inhibits aldosterone, thus causing renal excretion of sodium and water and
retention of potassium |
|
-spironolactone (Aldactone)
is an example of what? |
Diuretics
-K+ sparing: |
|
Diuretics
-uses? 3 |
-Heart failure
-Edema -HTN |
|
-________is the drug of choice for afib
|
Digoxin
|
|
Interventions for diuretics:
-instruct them to take at what time of the day? |
-give early in the day to prevent nocturia (urinating at night)
|
|
Interventions for diuretics:
-electrolytes what one in particular should you monitor? |
-monitor electrolytes (especially potassium)
-monitor S/S of hypokalemia (weakness, fatigue, muscle cramps) |
|
Interventions for diuretics:
-what else should the nurse monitor? |
-monitor I/O
-monitor weight -monitor BP -monitor for s/s of digitalis toxicity -monitor for hearing loss |
|
Interventions for diuretics:
-instruct them to eat what kind of foods? |
-give potassium rich foods (green seedless grapes, potatoes, tomatoes, OJ, bananas, hamburger, romaine lettuce, peanuts)
|
|
Contraindications for loop and thiazide diuretics
-diseases |
-renal failure
-hepatic disease -lactation/pregnancy -hypokalemia -gout -diabetes -peripheral vascular disease |
|
Contraindications for loop and thiazide diuretics
-what drugs |
-digoxin (hypokalemia can acuse dig toxicity)
-antihypertensive meds (increases hypotension) -lithium (dieresis can cause toxicity) -NSAIDs (reduces diuretic effect) |
|
Contraindications for potassium sparing diuretics
-what disease (3) |
-renal failure
-hyperkalemia -diabetes |
|
Contraindications for potassium sparing diuretics
-what drugs |
-calcium channel blockers
-ACE inhibitors (they retain K+) |
|
SE for loop and thiazide diuretics:
|
-decreased BUN and creatinine (due to dehydration)**
-hypokalemia** -hypocalcemia = muscle cramps** -hypovolemia (dehydration, polyuria, vertigo, thirst, dry mouth) -hyperglycemia -restlessness -GI disturbances -agranulocytosis -gynecomastia - photosensitivity** |
|
SE for potassium sparing diuretics:
-hypokalemia or hyperkalemia -hyponatremia or hypernatremia |
-hyperkalemia
-hyponatremia -gynecomastia -irregular menses -rash -lethargy -confusion -vertigo -headache -dry mouth |
|
SE for potassium sparing diuretics:
-hypoglycemia or hyperglycemia |
hyperglycemia
|
|
Dopamine (Intropin)
--Classification: |
catecholamine (positive inotropic)
|
|
Dopamine (Intropin)
-Action: what does it increase (3) |
increase cardiac output, BP, and SVR...how does it improve CO??
by activating beta 1 receptors |
|
Dopamine (Intropin)
-at low doses (5mcg), what does it do? (2) |
dilates renal arteries and increases urine output
|
|
Dopamine (Intropin)
moderate doses (10mcg) -what does it stimulate in the body? -what does it increase? |
stimulate beta I and increase cardiac contractility, stroke volume, and cardiac output
|
|
Dopamine (Intropin)
moderate doses (10mcg) -what does it do to the kidney? -does it cause vasoconstriction or vasodilator? |
– increases blood to kidney
vasoconstriction |
|
Dopamine (Intropin)
high doses (20mcg) -what does it stimulate in the body? -what does it do to BP? |
stimulate alpha 1, causing vasoconstriction --> increases BP
|
|
Dopamine (Intropin)
-purpose of dopamine and how it affects cardiac output |
- improve cardiac output by activating the beta 1 receptors
|
|
Dopamine (Intropin)
-Uses: (3) |
-decreased renal perfusion
-decrease CO, -shock (hypovolemic and septic) |
|
Dopamine (Intropin)
-it is a vasoconstrictor to raise BP. what do you want to make sure they hae before you give this |
make sure they have adequate fluid because if they don’t, they will have nothing to push from the constricted vessels to the core of the body
|
|
Dopamine (Intropin)
Nursing interventions: -monitor for what? -correct what first? |
-monitor for ischemia due to increased HR
-correct any pre-existing hypovolemia first |
|
Dopamine (Intropin)
-positive inotropic drug that decreases contractility (true or false) |
false, it increases contractility
|
|
Dopamine (Intropin)
Nursing interventions: -monitor for what? -what should you monitor in regards to urine output? |
-monitor for hypertension
-monitor for decreased renal output (should increase UO if effective) |
|
Dopamine (Intropin)
Nursing interventions: -monitor for signs of HF. why? |
-monitor for signs of heart failure (if dopamine is not effective, HF gets worse)
|
|
Dopamine (Intropin)
-adverse affects (4) |
-tachycardia
-dysrhythmias -angina pain -vasoconstriction |
|
Beta blockers – “olol”
are they positive or negative inotropic drugs? |
(negative inotropic drug - lessens the hearts workload by decreasing the rate and strength of heart beat)
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Beta blockers – “olol”
-what does it do to oxygen demand? -what does it do to contractility? |
-decrease oxygen demand by decreasing HR and contractility,
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Beta blockers – “olol"
-what does it prolong? |
increases coronary filling by prolonging diastole
-slows down the HR and allows for better filling. allows more efficient contraction |
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Beta blockers – “olol"
-how does it affect cardiac output? |
-decreases cardiac output by decreasing the oxygen demand, prolonging diastole, allowing for more efficient contraction
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Beta blockers – “olol"
action: block..... |
block beta adrenergic receptors located in the heart muscle and body
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Beta blockers (olol)
•Beta 1 works primarily in the heart --what happens if you block beta 1? |
o if you block Beta 1, you will get decrease HR, decrease or more efficient contraction, decrease automaticity, decrease myocardial O2 demand
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Beta blockers (olol)
•Beta 2 = works primarily in the lungs, bronchioles, and vascular bed. -what happens if you block beta 2 ? |
-if you block beta 2 you will see bronchospasms and vasoconstriction
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Beta blockers (olol)
Uses: |
-angina
-hypertension -tachyarrhythmia’s -prophylaxis for MI |
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Beta blockers (olol)
-give meds when in regards to food? -what can this cause in the elderly? |
-give medication before meals
-in elderly, can cause sensitivity to cold |
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Beta blockers (olol)
-don't miss or stop a dose -if the drug causes drowsiness, tell them to do what? |
-if drug causes drowsiness, take at night
-change positions slowly |
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Contraindications to beta blockers
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-diabetes
-conditions that cause bronchospasms (asthma, COPD) -heart failure (CHF, cardiomegaly) -sinus bradycardia -renal or hepatic impairment -after major surgery -peripheral vascular disease -1st or 2nd degree heart block |
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Contraindications to beta blockers (what other class of drug)
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MAO inhibitors
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beta blockers SE neuro:
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-lethargy, fatigue, depression
-vertigo, insomnia -headache |
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beta blockers SE in the lungs:
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-bronchospasm & bronchoconstriction
-dyspnea |
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beta blockers SE to the cardiac system?
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-bradycardia
-palpitations -orthostatic hypotension |
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beta blockers SE in the GI system:
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nausea, vomiting, diarrhea, fluid retention
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beta blockers SE in diabetic patients?
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-hypoglycemia (don’t give to DM pt. it will decrease blood flow to renal arteries. monitor for tachycardia which is a CM of hypoglycemia)
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beta blockers SE in the reproductive system
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-impotence
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PEDS: supraventricular tachycardia (SVT)
treatment: |
ice water, bending over, stand on head
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Calcium Channel Blockers
are they positive or negative inotropic drugs? |
(negative inotropic drug)
(lessens the hearts workload by decreasing the rate and strength of heart beat) |
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Calcium Channel Blockers
end in what " " |
“pine” ending, except diltiazem, (Cardizem) and verapamil (Calan, Isoptin)
-think “VND – very nice drugs” Verapamil, Nifedipine, Diltiazem |
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-Calcium helps maintain muscle tone & _______ secretion
-transmision of: -contraction of: |
, hormone secretion,
transmission of nerve impulses, contraction of skeletal and heart muscle |
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Calcium Channel Blockers
-what do they do to smooth muscle? |
they promote vasodilation of the coronary and peripheral vessels
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Calcium Channel Blockers
-how does it affect afterload? |
inhibits calcium ion movement across cell membranes causing dilation, reducing peripheral vascular resistance, and increasing output
it also slows conduction through the SA and AV node = slows HR |
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Calcium Channel Blockers
-Action: what does it do to increase cardiac output |
inhibits calcium ion movement across cell membranes causing vascular smooth muscle to relax and coronary arteries to dilate and reduce peripheral vascular resistance, thus increasing cardiac output
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Calcium Channel Blockers
-how does this slow HR? |
-slow SA and AV node conduction and slows HR
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Calcium Channel Blockers
Uses: |
-angina
-hypertension -supraventricular tachycardia -migraine headache |
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Calcium Channel Blockers
-Nursing interventions: what should you monitor (2) |
-monitor BP for hypotension
-monitor EKG for bradycardia and dysrhythmias |
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Calcium Channel Blockers
-assess for what? -check labs, specifically for what tests? |
-assess for CHF
-check labs for LFTs |
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Calcium Channel Blockers
-tell me about the weight? |
-weight pt and check for edema or weight gain
SE include fluid retention and peripheral edema |
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Calcium Channel Blockers
-teach aboout what? -avoid what? -administer when in regards to food? |
-teach about postural hypotension
-avoid grapefruit -administer before meals |
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Calcium Channel Blockers
SE: -big one is what? what can you teach about this |
-constipation (teach pt to increase fiber and fluid in diet)
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Calcium Channel Blockers
SE: |
-peripheral edema*
-fluid retention* -palpitations -tachycardia* -flushing -hypotension* -nausea -bradycardia -muscle aches, tremors, and cramps |
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Thrombolytics
-what do you have to remember when repositioning them? |
-reposition them carefully ( they bruise easily)
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Thrombolytics AKA __________drugs
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Fibrinolytic
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Thrombolytics break down fibrin threads already present in the formed blood clot / they dissolve the clot (true or false)
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true
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Thrombolytics
-action: |
-to degrade fibrin, these drugs activate plasminogen to its active form, plasmin.
-fibrin is what holds the clots together. thus, the action breaks down formed clots with less effect on clot formation |
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Thrombolytics
-dissolves thrombi in the coronary arteries and restores myocardial blood flow (true or false) |
true
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Thrombolytics
-dissolve clots through enzyme activation |
of plasmin “ase”
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ateplase (tPA tissue plasminogen activator)
reteplase (retavase) are examples of: |
thrombolytics
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Thrombolytic
Indications: |
blood clots, MI, stroke, PE, DVT
-used for treatment of acute MI within 6 hrs of start of pain |
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Thrombolytic
Interventions: prior to giving through an IV, what should you do: |
-prior to giving – start 2-3 IVs, draw all labs. 2-3 b/c if you start an IV or draw blood after giving a thrombolytic, they can have impaired bleeding)
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Thrombolytic
Interventions: -what do you do when punturing a patient? |
-Apply pressure and then pressure dressing with any punctures
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Thrombolytic
-after giving this, what do you make sure to follow up with? |
-Follow with anticoagulant (thrombolytics work anywhere from a few hours to 24 hours and follow with an anticoagulant for long term management of clot formation) blood pools and clots form
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Thrombolytic
-monitor for what in the heart? |
-Monitor for reperfusion dysrhythmias (expect inflamm process to irritate heart muscle, breakdown and increase blood flow
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Thrombolytics
-what is their activity? -is this pricey? |
- maintain in bedrest
-very expensive. do not open package until you know 100% that u will give it |
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-tPA can only be given by a trained personnel
true or false |
true
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Thrombolytics
-Contraindications: works on the whole body |
-if active internal bleeding
-history of CVA/stroke (fresh clots are broken down or dissolve) -surgery or trauma in the last 2 months -aneurysm -uncontrolled hypertension -bleeding/clotting disorder (DIC) -history of GI bleed |
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Thrombolytics
SE: -bleeding and (tachycardia or bradycardia) |
bradycardia
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Morphine
-prescribed to relieve discomfort that doesn’t respond from the use of ______________________ how does it relieve MI pain? what does it cause in the periphery? what does it do to HR and BP? |
nitroglycerin
decreases the oxygen demand on the heart peripheal vasodilation lowers HR and BP |
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Morphine
-what does it do to the oxygen demand of the heart? -what does it do to smooth muscle? |
-it relieves MI pain, decreases myocardial oxygen demand,
-relaxes smooth muscle |
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Morphine
-what does it do to catecholamines? |
reduces circulating catecholamines (chemicals release in SNS activation)
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Morphine
-adverse effects: |
respiratory depression,
hypotension, bradycardia, severe vomiting |
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Morphine
-what can happen if you give this IM? |
– it may not be absorbed as fast and the IM may increase your CK. CK rises from muscular damage.
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Digoxin (Lanoxin)
-absorbed where -excreted/metabolized by the ________ |
GI tract
kidney |
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Digoxin (Lanoxin)
-what does it do to conduction of the heart? |
-slows AV node conduction, slows ventricular response to atrial dysrhythmias
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Digoxin (Lanoxin)
-what does it do to the contraction of the heart? -what does it do to cardiac output? -what does it do to heart rate? |
increase the strength of contraction (inotropic) by slowing AV node conduction
increases CO because of increased stroke volume from improved contractility lowers HR (chrontopoic) |
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Digoxin (Lanoxin)
-cardiac output is increased because of what? |
-CO increases because of increased stroke volume from improved contractility
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Digoxin (Lanoxin)
-what does it do to conduction? |
-increase filling of ventricles, slows conduction
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Digoxin (Lanoxin)
-Uses: (3) |
afib, a-flutter, heart failure
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Digoxin (Lanoxin)
Nursing interventions: -what do you do before administering this drug |
fcheck pulse for 1 minute prior to giving (hold if less than 60 or 100 if they are under age 7)
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Digoxin (Lanoxin)
-toxicity easily occurs (optimal range is |
0.5-0.8 ng/mL)
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Digoxin (Lanoxin)
-level over ___ng/mL is toxic |
2
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Digoxin (Lanoxin)
-what electrolyte level should you check? |
-can give with K+ rich food, check potassium levels
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Digoxin (Lanoxin)
Contraindications: |
-digoxin toxicity
-WPW syndrome -ventrical dysrhythmias -hypokalemia -renal insufficiency |
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Digoxin (Lanoxin)
Drug interactions: |
-quinidine
-diuretics -beta blockers -antacids -antilipidemic -antidiarrhea meds -OTC cold preps (they stimulate the heart) |
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Digoxin (Lanoxin)
SE: |
-anorexia
-n/v -headache, fatigue, confusion, restlessness -impaired color perception |
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Digoxin (Lanoxin)
-tell me about Dig and potassium. what should you watch for? |
-hypokalemia (compete for binding sites.. S/S is muscle weakness)
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Digoxin (Lanoxin)
Toxicity of Digoxin (what happens to adults) (what happens in children) |
-dysrhythmias (bradycardia is most common)
-hypokalemia -visual disturbance -dysrhythmias -fatigue -loss of appetite -muscle weakness -confusion |
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Digoxin (Lanoxin)
-hypokalemia (Dig and K compete for the same binding sites) -what happens to vision? |
-visual disturbances (blurred vision & yellow haze)
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Digoxin (Lanoxin)
-early S/S of toxicity in kids is: |
dysrhythmias
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