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108 Cards in this Set

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  • Back
Calcium-channel blockers
• interaction of digoxin and verapamil
-may increase digoxin toxicity
• differences between verapamil and nifedipine
-verapamil- blocks calcium channels in the heart
-nifedipine- blocks calcium channels in vascular smooth muscle- not heart
• effects of verapamil
-Angina Pectoris, Essential Hypertension, Cardiac dysrhythmias.
• drug-drug interactions with beta blockers and nifedipine
-Increase HR and decrease BP
• contraindications of administration of calcium-channel blockers
-May shorten the life in women
Vasodialators
• hydrozalene may mimic effects of what certain disease?... in regards to pain
-systemic lupus erythematosus-like syndrome
• how might you counteract adverse effects of vasodilators?
-Beta blockers- prevent reflex tachycardia
-Diuretics- prevent sodium and water retention
-take with antihypertensive agents
-don’t take with calcium channel blocker
• what would be a priority to monitor of administering nitro to HTN patients?... not VS (look in textbook)
sionide build up
HTN drugs
• Renal insufficiency and HTN- which drug would you question an order for?
-ACE inhibitor
• alpha2 agonist most likely side effect
-drowsiness and dry mouth
• Uncomplicated HTN pt- what would be the DOC?
-diuretics thiazide
• what drug-drug combination would be best in a patient with HTN and renal insufficiency?
-ACE inhibitors, ARB’s angiotension II receptor blockers
• what other health problem would increase risk of CV problems in a patient with central HTN?
-hypokalemic drugs, digoxin, hypotensive drugs
• major side effects of thiazide-diuretic therapy
-hypokalemia
• what drug would you not administer with an ACE inhibitor?
-diuretic drugs,
Heart failure drugs
• s/sx of digoxin toxicity
-Dysrhythmias ( do not give if apical pulse is less than 60)
• what would you monitor in a patient with ACE inhibitors and heart failure?
- Monitor for hyperkalemia, hypertension, cough, angioedema
• contraindicated drugs in pt with ACE inhibitor?
NSAIDs
• beta blockers- what are they used and not used for?
- Improving LV injection fraction. Increases exercise tolerance, slow progression of heart failure, reduce need for hospitalization
• which drug given with digoxin might increase likelihood of toxicity?
- guanidine
• digoxin IV- what MUST you do and monitor for?... what is it given for?
- monitor for cardiac dysrythmias
• what is considered a high digoxin level? What would you do for this?
- Norm 0.5 – 0.8 mg/ml to lower dig toxic levels digibind
Lipid-lowering agents- CHD
• statin-therapy? When should pt start to see results?
-increases HDL levels, lowers LDL levels; 2 weeks, max results 4-6 weeks
• how should a pt take a statin drug?
-orally- 30-90% absorption rate, not much systemic effect
-take at night
• drug-drug interaction between coumadin and Gemfibrozil
-Gemfibrozil increases the effects of warfarin- excess bleeding
• Niacin- what would you tell pt to look for?
-Flushing because of vasodilation for the first few weeks- take aspirin or XL
• drug-drug interactions between statin drugs and Gemfibrozil?
-increased risk for statin induced neuropathy
• instructions for Cholestramine
-increase fiber and fluid intake; may use laxative
• client education for person taking lipid-lowering drug
-treatment lifelong; don’t stop taking suddenly
• overall benefits of statin-therapy
-increases HDL, lowers LDL; slows CAD
Angina Pectoris drugs
• How they work?
- Used to treat chest pain (to reduce intensity and freq of angina attacks)
• side effects of nitroglycerin?
- Headache(vasodilator), hypotension, reflex tachycardia
• objective in drug therapy in stable angina?
- Decrease pain exertional angina (activity), primarily by decreasing cardiac oxygen demand(decreases preload and cardiac demand)
• client education in administration of sublingual nitro?
- PLACE TABLET UNDER TOUNGE AND LET DISSLOVE IF SWALLOWED NOT EFFECTIVE
• DOC in acute angina attack?
-Nitroglycerin
• administration of transdermal patch- why to get and when to come off
- Leave in place for 12-14 hrs and leave OFF for 10-12 hrs.
• MOA in calcium channel blocker?
- blocks channels in VSM primarily in arterioles( arteriole dilatation and reduction of peripheral resistance which equals afterload relaxes coronary vasospasms, blocks channels in heart to decrease HR, AV conduction, and contractility
• administration of PO nitro vs. sublingual?
- PO is sustained release that is slowly absorbed across GI wall for long term prophylaxis only, sublingual is fast acting(1-3 min) to terminating an ongoing attack and short term prophylaxis when exertion is expected.
• tolerance to nitro in which route?
- Will develop with trans dermal patch if used continuously. Recommended that 10-12 hr interval are used between patches
• which problem might men be taking nitro drugs for?
- Do not give to men using Viagra (can cause life-threatening hypotension)
• goal of therapy for angina pectoris drugs?
- Reduce the intensity and frequency of anginal attacks by increase cardiac oxygen supply or decrease oxygen demand
Anti-coagulants and Anti-platelets
• what lab tests do you monitor for heparin and coumadin
-PTT; PT with INR
• what is an abnormal value?
-lower than 60, greater than 80
-PT lower than 1.3, higher than 1.5
-INR lower than 2, greater than 4.5
• antagonist for coumadin and heparin
-protamine sulfate
• how do anti-platelets work? Ex.aspirin
-heparin suppresses clotting by helping antithrombin in activating clotting factors
-coumadin suppresses clotting by acting as an antagonist
• drug-drug interactions with aspirin and other drugs? Decrease or increase bleeding? Client education?
-increase bleeding;
• pt asymptomatic for bleeding… monitor labs
-nothing; just monitor labs
• class of drugs in treating pt with thrombus
-thrombolytic drug
• Ticlad indicated for?
-prevention of ischemic strokes
• streptokinase vs. Alteplase
-strep- induces hypotension; cheaper
-alteplase- very expensive; half life of minutes, very fast acting
• time frame for administering thrombolytic agents (not hemmorrahagic strokes)
-6 hours within clot formation
• class of drugs used to prevent thrombus (prophylactic)
-DVT; anti-coagulants
• plavix vs. aspirin- why is one used over the other
-plavix prevents ADP stimulated aggravation
-aspirin inhibits cyclooxygenase
Sedative-Hypnotic drugs
• barbiturates vs. benzodiazepines
-Benzodiazepines- treat anxiety and insomnia- manage seizure disorders, Muscle spasm, panic disorder, withdrawal from alcohol
-Barbiturates- increases risk for physical dependence
• why benzodiazepines different from each other
- Anxiety, insomnia, seizure disorders, muscle spasms, alcohol withdraw, panic disorders, and induction of anesthesia.
• why are benzodiazepines preferred in the elderly
-not likely to accumulate
• which benzodiazepines are used to treat muscle spasm
-Diazepam
• barbiturates are non-selective in CNS depression… which is exception?
-Phenobarbital
• which patients are barbiturates counterindicated in?
-respiratory depressed patients, elderly, ohther CNS depressants
• which drug leaves bitter taste in the mouth?
-Lunesta
• drug that can be given at 2am without 7am hangover- won’t leave you drowsy
-Sonata
• drugs that put you to sleep vs. drugs that keep you asleep- know examples
-Sonata- for those who need help falling asleep, but can stay asleep
-Ambien- daytime drowsiness
-put you to sleep- Ambient, Sonata, Lunesta
-keeps you asleep- Dalmane, Razerem, Desyrel
• s/sx of barbiturate toxicity
-pinpoint pupils, respiratory depression, coma- hypotension and hypothermia
Diabetic drugs
• newly diagnosed pt, what short-term complications might occur?
- Hyperglycemia, Hypoglycemia, and ketoacidosis
• short-term vs. long-term diabetes?
- Short term is with type 1 (see above), and Long term is both type 1 and type 2 takes years to develop, usually secondary to disruption of blood flow including macrovascular and microvascular damage.
• which insulin will be cloudy and which will be clear?
Short/rapid acting =clear, and long-acting= cloudy
• which drug might mask symptoms of hypoglycemia?
- Beta blockers
• what drug-drug interaction with sulfanuria?
- blood glucose levels to intensify hypoglycemia
• which pt is Glitazones contraindicated in
heart failure patients- Glitazones cause fluid retention
• tx of ketoacidosis
-restoration of insulin levels, replacement of water and sodium, normalization of potassium and glucose levels
• how do you get type 2 DM
- insulin in produced but target tissue exhibit insulin resistance (caused by reduced binding of receptors, reduced of receptive numbers, and reduced receptive responsiveness).
Diuretics
• which type do you see greatest urine production in?
-Furosemide (Lasix); high ceiling loop diuretics
• long term effects of lasix or Furosemide- serious complications?
-hyponatremia, hypchloremia, dehydration, hypokalemia, hyptension, ototoxicity
• if giving lithium and lasix- how does one effect the other regarding dosage
-excretion of lithium is reduced with low sodium levels- accumulation of lithium in the body- monitor lithium levels and reduce if toxic
• which class of drugs would you not give with spironolactone
-ACE inhibitors, anything that raised potassium levels
• which drug would be potassium-sparing
-spironolactone (Aldactone)
• drug-drug interaction with lasix
-digoxin- cause dysryhthmias because of potassium loss
-Lithium
-ototoxic drugs
-potassium sparing diuretics- spironolactone
• therapeutic effects with mannitol
-begins 30-60 min, lasts 6-8 hours
-promotes osmotic force in nephron
What type of solution would you use for fluid replacement?
-isotonic
Peptic ulcers
• side effect with bismuth
-black stool and black tongue
• H. Pylori- what would you avoid with flagyl in treating h. pylori
-administer with tetracycline and bismuth for ulcers- do not use alcohol or while pregnant
• how does Omeprazole work
-inhibition of gastric acid in parietal cells of the stomach
• how does sucralfate work?
-converted to sticky substance in stomach and adheres to ulcer
• what type of pt would you not give antacids to
-hypertensive or heart failure patients- high sodium content in antacids
• factors contributing to peptic ulcer disease
-smoking, NSAIDs, stress and anxiety, diet
Opioids
• how quickly do IV opioid drugs take effect
 immediately
• side effects of opioid drugs- what drug would make those worse?
-analgesia, sedation, euphoria, respiratory depression, cough suppression, Bowel motility suppression
• oral vs. IV opioid dose- client education?
-oral- slower onset - ER capsules last up to 24 hours, others last 4-5 hours
-IV- rapid onset, last 4-5 hours
• antagonist for opioids
-Naloxone (Narcan)- competitive atagonist at receptors- reverses respiratory depression, coma, analgesia
• whish opioid is more potent?
-Fentanyl- dosed in mcg; 100x more potent than morphine
• drug-drug interactions with aspirin and other drugs? Decrease or increase bleeding? Client education?
-increase bleeding;
• pt asymptomatic for bleeding… monitor labs
-nothing; just monitor labs
• class of drugs in treating pt with thrombus
-thrombolytic drug
• Ticlad indicated for?
-prevention of ischemic strokes
• streptokinase vs. Alteplase
-strep- induces hypotension; cheaper
-alteplase- very expensive; half life of minutes, very fast acting
• time frame for administering thrombolytic agents (not hemmorrahagic strokes)
-6 hours within clot formation
• class of drugs used to prevent thrombus (prophylactic)
-DVT; anti-coagulants
• plavix vs. aspirin- why is one used over the other
-plavix prevents ADP stimulated aggravation
-aspirin inhibits cyclooxygenase
Sedative-Hypnotic drugs
• barbiturates vs. benzodiazepines
-Benzodiazepines- treat anxiety and insomnia- manage seizure disorders, Muscle spasm, panic disorder, withdrawal from alcohol
-Barbiturates- increases risk for physical dependence
• why benzodiazepines different from each other
- Anxiety, insomnia, seizure disorders, muscle spasms, alcohol withdraw, panic disorders, and induction of anesthesia.
• why are benzodiazepines preferred in the elderly
-not likely to accumulate
• which benzodiazepines are used to treat muscle spasm
-Diazepam
• barbiturates are non-selective in CNS depression… which is exception?
-Phenobarbital
• which patients are barbiturates counterindicated in?
-respiratory depressed patients, elderly, ohther CNS depressants
• which drug leaves bitter taste in the mouth?
-Lunesta
• which opioid is available transdermally?
-Fentanyl
• how to instruct to stop opioids
-tapering dosage
• other use for codeine?
-cough suppressant