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57 Cards in this Set

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Digoxin AKA
(Representative Names)
Digitek, Lanoxicaps, Lanoxin
Digoxin Contraindications/Precautions
ventricular tachycardia, ventricular fibrillation, heart block, sick sinus syndrome, IHSS, acute MI, renal insufficiency and electrolyte abnormalities (decreased K+, decreased Mg++, increased Ca++).
Digoxin
Adverse effects
CNS: Headache, weakness, drowsiness, visual disturbances
CV: Arrhythmias
GI: GI upset, anorexia
Digoxin
Pharmacokinetics
Route Onset Peak Duration
Oral 30–120 min 2–6 hr 6–8 d
IV 5–30 min 1–5 hr 4–5 d
Digoxin
Dosages
Lanoxicaps capsules—0.05, 0.1, 0.2 mg; tablets—0.125, 0.25, mg, elixir—0.05 mg/mL; injection—0.25 mg/mL; pediatric injection—0.1 mg/mL
Digoxin
Indications
CHF
Atrial fibrillation
Atrial flutter
Paroxysmal atrial tachycardia
Digoxin
Classicifications
ANTIARRHUTHMIC, INOTROPIC
Digoxin
Therapeutic actions
Increases intracellular calcium and allows more calcium to enter the myocardial cell during depolarization via a sodium–potassium pump mechanism; this increases force of contraction (positive inotropic effect), increases renal perfusion (seen as diuretic effect in patients with CHF), decreases heart rate (negative chronotropic effect), and decreases AV node conduction velocity.
Furosemide
Trade Name
LASIX
Furosemide
Therapeutic Class
Classification
LOOP Diuretic
Furosemide
Mechanism I
Potently inhibits reabsorption of sodium and chloride
Action at ascending loop of Henle in glomerulus
Furosemide
Mechanism II
Direct Venodilation in Pulmonary edema
Reduces venous return (preload)
Reduces central venous pressure
Synergistic effect with morphine and Nitroglycerin
Furosemide
Mechanism III
Reduces Intravascular Volume
Reduces cardiac output
Beware hypotension in Myocardial Infarction
Furosemide
Adverse Effects
Risk of central volume depletion (dehydration)
Hypotension
Electrolyte abnormalities
Metabolic Alkalosis
Hypokalemia
Hypomagnesemia
Hypocalcemia
Hyponatremia
Hyperosmolality
Renal dysfunction
Minimize dosage when starting an ACE Inhibitor
Furosemide
SIDE EFFECTS
· muscle cramps or weakness;
· an irregular heartbeat;
· abdominal pain or diarrhea;
· low blood pressure (weakness, dizziness, fatigue); or
· decreased hearing.
Atropine Classification ?
Antiarrhythmic
Cholinergic Muscarinic Antagonists
Atropine
Contraindications
narrow-angle glaucoma; tachycardia; thyrotoxicosis; obstructive disease of the GI tract; obstructive uropathy
Atropine
Mechanism Of Action
Cholinergic Muscarinic Antagonists
Atropine
Indications
(Conditions Treated)
Cardiovascular Diseases, Fever, Heart Diseases, Impotence, Intraoperative Complications, Poisoning, Seizures
Atropine
Adverse Effects/ Side Effects
Drowssiness, Blurred vision, Dry eyes, TACHYCATDIA, PALPITATIONS, constipation, Urinary retension,
Atropine

Indications
*aystole, PEA with bradycardia <60

*unstable bradycardia

*OPP poisoning
Atropine

Action
*Competes with acetylcholine for receptor sites blocking the PNS response at the SA & AV nodes
*increses heart rate by increaseing electrical conduction through heart
*Inhibits secretions by decreasing PNS effect on Bronchial, salivary, sweat and GI glands

*onset= 1 to 2 minutes IV
*Duration= 2-6 hours
Why do we only repeat Atropine once in peds?
The pediatric dose is 0.02mg/kg and the max total given is 0.04mg/kg (twice the initial dose)
Atropine Sulfate
(side effects)
Dilated pupils, drowsiness, chest pain, hypotension, palpitations, tachycardia, dry mouth, flushed hot dry skin
Atropine Sulfate
(Use)
-bradycardias or high degree heart blocks which are heodynamically unstable
-Asystole
-Pulseless elec. act. <60BPM
-Organophosphate poisoning
Atropine Sulfate
(contra indicated)
Absolute: Hypersensitivity
Relative: Glaucoma;Suspected or evolving AMI
Note: There are no con. ind. in the settings of op, asystole, PEA
Atropine Sulfate
(Peds cardiac)
0.02 mg/kg IV or IO. Repeat q 3-5 min to a max dose of 0.04 mg/kg

Min Single Dose: 0.1mg
Max Single Dose: 1mg
T/F Concerning the heart,
Atropine causes positive chronotropic and positive dromotropic effects
TRUE
Mechanism of
Atropine sulfate
act by blocking acetylcholine receptors mainly muscarinics. Crosses the BBB to become CNS stimulant.
Nursing implication (dosage)for
Atropine sulfate
oral 0.3 to 1.2 mg q 4-6 hours.
parenteral 0.4 to 0.6 mg q 4-6 hours.
Atropine Toxicity
Dry, Hot, Red, Blind, Mad
Atropine - Side Effects
(10)
anticholinergic effects
allergic reactions
dizziness
dysrhythmias
flushed hot dry skin
headache
palpitations
paradoxical bradycardia when pushed too slow or dose < 0.5 mg
tachycardia
prochlorperazine
Trade Names (AKA)
COMPAZINE, ULTRAZINE, STEMETIL
Trade name for prochlorperazine?
Darbazine(R)
prochlorperazine
CLASSIFICATION
Antiemetics
Neuroleptic agents
What are Chlorpromazine and prochlorperazine used for?
1.relief of post-op nausea,
2. vomiting from radiation,
drugs with low emetogenic activity (opiates/cytotoxic agents)
3. 3rd line agent from cancer tx--"rescue therapy"
prochlorperazine side effects? (MAJOR)
uncontrollable movements of the tongue, face, lips, arms, or legs;
· muscle spasms of the face or neck;
· severe restlessness or tremor;
· severe drowsiness or fainting; or
· a rash.
prochlorperazine side effects? (MINOR)
decreased sweating;
· dry mouth and stuffy nose;
· constipation;
· blurred vision;
· mild restlessness, weakness, or tremor;
· difficult urination or dark urine;
· decreased sex drive;
· dizziness; or
· increased appetite.
prochlorperazine
contraindications I
children under 2 yr or 9 kg (20 lb)
pediatric surgery
Tardive dyskinesia
hypotensive reaction
prochlorperazine
contraindications II
or renal dysfunction, epilepsy, Parkinson's disease, hypothyroidism, phaeochromocytoma, myasthenia gravis, prostate hypertrophy, narrow angle glaucoma
Promethazine
Trade Name - Phenergan
Preanesthetic Med
Antipsychotic that is sedative, anticholinergic, antihistamine, antienetic, and enhances analgesia.
Promethazine
Phenergan
Nausea and vomiting, motion sickness, to enhance the effects of analgesics, and to induce sedation
Promethazine (phenergan) is often used for post-op vomiting. However, it has two potential side effects?
1) Can increase awareness of pain if given with narcotics.

2) Can cause hypotension.
Promethazine
Trade name-phenergan
Uses-nausea, vomiting, motion sickness.
Side effects-EPS, psychosis, hallucinations, blood problems
Promethazine
AKA
Phenergan, Anegan, Antinanu, Pentazine, Phenazine, Phenc-50
Promethazine
INteractions !!!!
CNS Depressants, Epinephrine, Anticholinergics, Atropine, Opiod analgesics,
Promethazine
Precautions
POTENTIAL FOR FATAL RESPIRATORY DEPRESSION
Trade name for hydroxyzine HCL?
Ataratx (R)
When administering hydroxyzine (Vistaril), you need to assess the client for anticholinergic effects, which include:
a. dry mouth and urinary retention
2nd generation antihistamine

hydroxyzine
Atarax, Vistaril
What's the trade name for hydroxyzine?
Vistaril
hydroxyzine
anxiolytic
anti-histamine w/ antiemetic activity
great for drug addicts and for sedation before dental work or surgery
hydroxyzine pamoate
(Vistaril)
Antianxiety
Antihistamines
hydroxyzine
atarax/vistaril
sedative, antiemetic, antihistamine, antispasmotic, anticholinergic
initial effect within 15-30min, peak effect at 2hrs
DRUG INTERACTIONS: Hydroxyzine
alcohol, anti-anxiety drugs, narcotic class of pain medications
Hydroxyzine
Classification:
Antihistimine, sedative-hypnotic
Hydroxyzine
Indications
Anxiety, Sedation, AntiEmetic, AntiPuritic,