Exam 2: Final Crunch

Front 1

1) What are the IV infusion drugs? How do they have to be infused?

2) What does dobutamine do?

3) What is the therapeutic range for digitalis?

4) What kind of dressing do you use on venous ulcers?

Back 1

1) "IV inotrope"- milnirone and dobutamine.

"IV vasodilators"-ntroprusside, nitroglycerine, and nassiritide (natrecor).

--> must be infused VERY SLOWLY

2) Dobutamine: major action is to increase contractility and renal perfusion (to increase urine output). Also increases HR to percipitate ectopic beats and tachydysrhythmias.

3) 0.8-2.0

4) dry dressings.

Front 2

1) What are the s/s of dig toxicity?

2) What does Dig do?

3) What does milnirone do?

4) What conditions put patients at risk for dig toxicity? What drug won't u want to give as a result?

Back 2

1) Dig toxicity slow or very rapid vent rhythm (ex. PVC-"skipped heart beat=most common dysrhythmia), n/v, atrial tachycardia, loss of appetite, abdominal distention, blurred vision, anorexia and mental changes.

2) positive inotropic (increases contractility), negative chronotropic (slows HR/ vent contraction).

3) milnirone: "promotes vasodilation" decreasing preload and afterload and reducing cardiac workload. increases force of contraction. administered to severe HF and heart transplant pt.s/e: hypotension and increased ventricular dysrhythmia. (used for ST use of severe hf not controlled by dig, diuretics, and dilators). cardiac inotropic agent.

4) hypokalemia. Do not give lasix. hypokalemia ENHANCES dig toxicity (even when therapeutic levels aren't high)

Front 3

Reduces preload, afterload or both?

1) milnirone.

2) nesiritide (natrecor)

3) ace inhibitors.

Back 3

1) decreases preload and afterload (reducing cardiac workload)

2) reduces preload and afterload. (BNP drug)

3) decreases preload and afterload

Front 4

1) What does nesiritide do?

2) How does ace inhibititors interact with potassium? What does it mean in terms of distributing with other drugs?

3) what do betablockers do?

4) What does losartan potassium do?

5) What is spirnolactone?

Back 4

1) "vasodilates and diuresis"

2) it increases potassium levels (remember, its decreasing aldosterone secretion thereby demoting Na. NA and K are reversible). do not give w/ spirinolactone.

3) reverses SNS effect.

4) Blocks AG2. vasodilates

5) K sparing drug. aldosterone antagonist. decreases edema in pts w/ HF.

Front 5

1) Ace inhibitors.

2) When do you give the first loading dose for aceinhibitiors (esp. captopril, and monopril). Why?

3) What safety issue do you keep in mind when giving anti-hypertensive meds (ACE, ARB Beta)?

4) what are s/s of hepatotoxicity? what are nursing impl?

Back 5

1) vasodilation and diuresis.

2) night time. The first loading dose causes orthostatic hypotension. It's better to get them to bed instead. always have pts use call bell.

3) orthostatic hypotension.

4) hepatitis (jaunndice, abd pain, n/v, anorexia). increased liver enzymes. alcohol breaks down liver function.

Front 6

1) s/s of pneumonia

2) What drug is used in DIC? Why?

3) what is heparin induced thrombocytopenia?

4) What do you do when HIT occurs?

Back 6

1) fever, chills, pleuritic chest pain (aggravated by deep breathing and coughing), headache, myalgias, rash, pharegitis. Also: tachypnea, SOB, use of accessory muscles. 2) Heparin used in DIC. To prevent blood from clotting long enough so that clotting factors could be replenished in bloodstream. (DIC: total body inflammation causes clotting factors to be used which causes hemmhorage). 3) heparin use decrease platlet counts. 4) discontinue heparin and use DTIs such as "agatroban". also DTI "lepirudin". "bivalrudin" (DTI) also used as replacement 4 heparin in pts w/ or at risk for HIT.

Front 7

1) What is digoxin excreted by? what implications does this have?

2) What is levofloxacin?

3) What does nesiritide do?

3) Sartans: how do they help HF?

Back 7

1) Excreted by kidneys. impaired renal function=r/o dig toxicity

2) used to treat multi resistant TB drugs.

3) reduces preload and afterload via diuresis (increases sodium secretion and supressing RAAS). decreases secretion of endothelein and norepinephrine and relaxes smooth muscle.

4) reduce BP