Pharm Quiz 2

Front 1

Lipitor (Atorvastatin)

Back 1

• HMG-CoA reductase inhibitor (Statin)
• Inhibits cholesterol synthesis
• Side Effects:
o GI upset, HA, nausea, sleep disturbances
o Liver enzyme elevation (must check periodically)
o Myositis (muscle pain)
o Rhabdomyolysis (Rare- ↑ risk with amiodarone)
• Nursing Considerations:
o Monitor liver enzymes (Rhabdomyolysis)
o Take in the evening
Works best at night because liver’s cholesterol production is ↑ at night & might avoid GI upset.
o Report muscle pain
o Monitor PT (can ↑ the effect of Coumadin)
o Photosensitivity
Use sunscreen; avoid grapefruit

Front 2

Lopid (Gemfibrozil)

Back 2

• Fibric acid derivative
• Raises HDL
• Lowers Triglycerides
o Also used to reduce triglycerides to prevent pancreatitis)
• Less effect on LDL
• Side Effects:
o GI Upset (Dyspepsia, abd pain, V/D
o Rash, myalgia, drowsiness, dizziness, blurred vision, biliary disorders
• Nursing Considerations:
o Do not mix with Statins; can cause Rhabdomyolysis!!!
o If used with certain Statins can cause severe myositis
o Take with food to avoid GI distress

Front 3

Ezetimibe (Zetia)

Back 3

• Cholesterol Absorption Inhibitor
• Inhibits absorption of cholesterol by the small intestine
• Side Effects (more common):
o Fatigue, abd pain, HA
• Side Effects (rare):
o Myopathy, Rhabdomyolysis, Myoglobinuria, Kidney damage, Allergic RX, Liver toxicity, Inflammation of GB, Pancreatitis
• Nursing Considerations:
o Contact MD if develop muscle pain, weakness, or brown urine

Front 4

Aspirin (ASA) (Acetylsalicylic Acid)

Back 4

• (Analgesic, anti-inflammatory, antipyretic, anticoagulant, anti-rheumatic)
• Action: Decreases platelet aggregation; Decreases mortality by 71% in acute phase MI
• Used for Prophylaxis MI, angina (+ purposes)
• Common Side Effects:
o GI, Allergy, Bleeding
• Nursing Considerations:
o Do not crush enteric product
o Give with food or milk
o May chew ASA for ACS

Front 5

Nitroglycerin

Back 5

• Nitrate
• VASODILATOR
• Used for Angina and Hypertension
• Action: Relax smooth muscle of coronary & peripheral blood vessels causing an increase in their diameter.
• Angina: vasodilates coronary artery ↓ Pain.
o Preload ↓: by ↑ venous dilation
o Afterload ↓: by ↓ peripheral vascular resistance; workload on heart is ↓ (↓ demand); Myocardial perfusion is improved by ↑ blood flow through collateral coronary vessels (↑supply)
• Side Effects:
o Flushing, HA (Okay, give Tylenol), Dizziness, Hypotension, Tachycardia
• Contraindicated:
o Severe anemia, Cerebral hemorrhage, Head trauma, Glaucoma, Hyperthyroidism
o Can cause vascular collapse if pt took Viagra within 24 hrs.
• Nursing Considerations:
o Monitor BP closely, Postural hypotension (change positions slowly, esp. after taking SL NTG)
o Give Tylenol for HA
o Angina TX: Assess chest pain & BP (S>90; 1st pill S>100) before each SL tab. 3 SL tabs in 5-min intervals; if pain is not relieved after 15 mins contact MD, go to ER.
o Tablets are inactivated by: light, heat, cold, air, & moisture. Store at room temp, in tight-fitting amber glass container.

Front 6

Isosorbide mononitrate & Isosorbide dinitrate

Back 6

• Nitrate
• VASODILATOR
• LONG ACTING
• Used for Angina and Hypertension
• Relax smooth muscle of coronary & peripheral blood vessels causing an increase in their diameter.
• Angina: vasodilates coronary artery ↓ Pain.
o Preload ↓: by ↑ venous dilation
o Afterload ↓: by ↓ peripheral vascular resistance; workload on heart is ↓ (↓ demand); Myocardial perfusion is improved by ↑ blood flow through collateral coronary vessels (↑supply)
• Side Effects:
o Flushing, HA (Okay, give Tylenol), Dizziness, Hypotension, Tachycardia
• Contraindicated:
o Severe anemia, Cerebral hemorrhage, Head trauma, Glaucoma, Hyperthyroidism
o Can cause vascular collapse if pt took Viagra within 24 hrs.
• Nursing Considerations:
o Monitor BP closely, Postural hypotension (change positions slowly, esp. after taking SL NTG)
o Give Tylenol for HA
o Angina TX: Assess chest pain & BP (S>90; 1st pill S>100) before each SL tab. 3 SL tabs in 5-min intervals; if pain is not relieved after 15 mins contact MD, go to ER.
o Tablets are inactivated by: light, heat, cold, air, & moisture. Store at room temp, in tight-fitting amber glass container.

Front 7

Morphine Sulfate

Back 7

• Narcotic Analgesic
• Relieves severe pain & anxiety associated with Acute MI
o Peripheral vasodilation reduces venous return, thereby ↓ myocardial workload
• Used for Acute MI, Pulmonary edema, Pain
• Side Effects:
o Resp. depression, Hypotension, N/V, Constipation
• Nursing Considerations:
o IV: Monitor closely for Hypotension & Resp depression
o Acute Care Setting: Give until pt is pain free or to relieve pulmonary congestion

Front 8

Metoprolol (Lopressor)

Back 8

• Beta-adrenergic blocking agent (B1 Blocker)
• Blocks sympathetic stimulation of beta receptors.
o 1. ↓ automaticity of SA node
o 2. ↓ velocity of conduction thru AV node
o 3. ↓ myocardial contractility
• ↓ myocardial workload & O2 demand by ↓ contractility, ↓ HR & ↓ BP
• Inhibits adverse long-term effects of sympathetic stimulation such as vascular & ventricular remodeling and endothelial dysfunction
• Used for: Hypertension, Angina, Arrhythmias, Prevention of MI, Heart failure, Ventricular & Supraventricular Dysrhythmias
• Side Effects (may cause):
o Bradycardia, Fatigue, Depression
• Side Effects (Can Cause):
o Erectile dysfunction
• Contraindicated:
o Heart block > 1st degree without pacemaker
o Asthma
• Nursing Considerations:
o Use with caution in pts with Asthma
o May mask signs of Hypoglycemia & Hyperthyroidism
o Warn pt not to d/c suddenly as it could exacerbate angina or precipitate MI
o Use Glucagon to reverse effects of overdose
o Used to tx dysrhythmias caused by excessive sympathetic stimulation of the heart – SVT’s & ventricular dysrhythmias
o Given IV or PO

Front 9

Diltiazem (Cardizem)

Back 9

• Calcium channel blocker
• Actions:
o Inhibits Ca influx across the slow channels of the myocardial and vascular smooth muscle cell
o ↓ HR; Slows AV conduction and prolongs repolarization
o Inhibits coronary spasm
• Uses:
o Angina
o Tachydysrhythmia such as rapid A-fib
• Common Side Effects:
o Bradycardia, peripheral edema, hypotension
• Nursing Considerations:
o Monitor BP at start of therapy & during dosage adjustments
o Smaller doses for elderly or frail pts
o May be given as an IV infusion for rapid atrial fibrillation. This titrated to effect, and require frequent BP and continuous cardiac monitoring. It may also be given PO.

Front 10

Amlodipine (Norvasc)

Back 10

• Calcium channel blocker
• Actions:
o Inhibits Ca influx across the slow channels of the myocardial and vascular smooth muscle cell
o Dilates peripheral arteries & arterioles, and coronary arteries
o Causes Vasodilation, increased myocardial oxygen supply & decreased peripheral resistance
o Inhibits coronary spasm
• Uses:
o Angina
o Mild to moderate hypertension
• Common Side Effects:
o Bradycardia, peripheral edema, hypotension
• Nursing Considerations:
o Monitor BP at start of therapy & during dosage adjustments
o Smaller doses for elderly or frail pts
o Used for management of hypertension, angina, and vasospastic angina

Front 11

Captopril (Capoten) & Lisinopril (Zestril)

Back 11

• Angiotensin-converting enzyme (ACE) blocker
• Action:
o Prevent conversion of Angiotensin I to Angiotensin II (Angiotensin II is a potent Vasoconstrictor, so the effect for Ace Inhibitors is VASODILATION; this reduces Afterload without a reflex increase in HR).
o Reduce adrenocortical secretion of aldosterone (↓ Aldosterone)
o Reduce Na and H2O retention & extracellular fluid volume
o Preserve renal function in diabetic Pts
o Decrease vascular & ventricular remodeling
• Uses:
o Hypertension, Heart failure, Post MI
o Acute MI = (1) ↓BP (2) ↓ Preload & Afterload (3) Cardio-protective (↓ remodeling)
• Common Side Effects
o Hyperkalemia, Dizziness, Hypotension, Orthostatic hypotension
o Cough – Should switch to ARB
o Angioedema – Should stop using immediately
• Nursing Considerations:
o Start slowly, 24 hours after MI with gradual dose increase
o Monitor BP, electrolytes, BUN & Creatinine
o Contraindicated with pregnancy

Front 12

Valsartan (Diovan)

Back 12

• Angiotensin II Receptor antagonist
• Action:
o Block Angiotensin II receptor sites in many tissues, leading to VASODILATION and Decreased Aldosterone secretion.
o Also, help preserve renal function in diabetic patients
• Used for:
o Hypertension
o For patients who develop a cough on ACE Inhibitors
• Common Side Effects:
o Hyperkalemia, Dizziness, Muscle cramps, Angioedema
• Nursing Considerations:
o Usually given once a day, but some pts BID treatments
o Contraindicated with pregnancy

Front 13

Lidocaine

Back 13

• Antidysrhythmic medication
• Sodium Channel Blocker
• Action:
o Blocks sodium channels; Slows conduction
o Reduces automaticity in ventricles
o Accelerates repolarization
o Raises fibrillation threshold
• Used for:
o Ventricular Dysrhythmias ONLY
o V-tach; V-fibrillation not responding to defibrillation
o Significant Ventricular ectopy in ischemic setting
• Common Side Effects:
o Signs of toxicity, Drowsiness, Disorientation, Decreased hearing, Paresthesia, Muscle twitching, Respiratory arrest
• Nursing Considerations:
o Given IV as a bolus followed by an infusion
o Reduce dose in elderly
o Rapidly metabolized so easy to control levels
o GIVEN IV ONLY
o Beware of CNS toxic effects esp in elderly, monitor levels

Front 14

Amiodarone

Back 14

• Antidysrhythmic medication
• Potassium Channel Blocker
• FIRST LINE FOR serious ventricular dysrhythmias – ACLS protocols
• Action:
o Suppresses ventricular and atrial ectopy
o Delays repolarization
o Reduces automaticity in SA node
o Reduces conduction velocity in AV node
o Reduces contractility
o Affects Na, K, & Ca channels as well as alpha & beta adrenergic blocking properties
• Used for:
o V-tach, V-fib as well as SVT
• Common Side Effects:
o Widening QRS, Prolonged PR & QT intervals
o Dilates coronary arteries & peripheral blood vessels
o Hypotension
o May have negative inotropic effects
o Long half-life (14-50 Days)
o Hyper- or Hypo Thyroidism
o Skin pigmentation
• Serious Side Effects:
o (1) Pulmonary = Pulmonary fibrosis
o (2) Optic Neuropathy = Corneal micro-deposits
o (3) Increased Dysrhythmias
• Nursing Considerations:
o Given IV as a bolus followed by as infusion
o Also given PO as a Maintenance Dose; May be given orally
o Monitor QT Interval

Front 15

Adenosine

Back 15

• Antidysrhythmic medication
• Action:
o Slows conduction through AV node
o Interrupts AV-nodal reentry pathways
o Vasodilator
• Used for:
o Converts SVT to SR
o Cardiac imaging
• Common Side Effects:
o Sinus bradycardia, Ventricular ectopy, Chest pain, Flushing
• Nursing Considerations:
o Given as Rapid bolus (1-3 seconds followed by flush)
o Short half-life
o Given as SLOW infusion for Myoview procedure

Front 16

Atropine

Back 16

• Antidysrhythmic medication
• Action:
o Blocks effects of Acetylcholine on vagus nerve
• Used for:
o Symptomatic bradycardia, Asystole, Heart block
• Common Side Effects:
o Tachycardia, Chest pain
• Nursing Considerations:
o Given IVP

Front 17

Digoxin

Back 17

• Antidysrhythmic medication
• Action:
o Increases force of myocardial contraction
o Prolongs refractory period of the AV node
o Decreases conduction through the SA and AV node So Increases cardiac output (+ inotropic effect) and slows HR (- chronotropic effect)
• Used for:
o Heart failure
o Tachy-dysrhythmias
• Common Side Effects:
o Increased PR interval, bradycardia
o DIGITALIS TOXICITY:
CV: Bradycardia
GI: Nausea & Vomiting, Diarrhea
NEURO: HA, Double, blurred, or colored vision, Restlessness
• Nursing Considerations:
o Factors predisposing to Dig Toxicity:
Hypokalemia, Severe liver & kidney disease – (detoxified in liver, secreted in kidney), Myocardial disease, Elderly
o Monitor AP for 1 full minute prior to admin.; withhold dose & notify MD if HR < 60
o Monitor continuously during IV admin.
o Therapeutic Range: 0.5 – 2 ng/ml

Front 18

Heparin

Back 18

• Anticoagulant
• Action:
o Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III.
• Used for:
o Unstable angina, MI, DVT, PE
• Common Side Effects:
o Bleeding, Hematoma hypochromic anemia, Thrombocytopenia, Cardiac toxicity, Infection at site, Hematoma
• Nursing Considerations:
o Monitor PTT for IV Heparin – be able to calculate units per hour for heparin reverse with PROTAMINE

Front 19

Coumadin

Back 19

• Anticoagulant
• Action:
o Depresses hepatic synthesis of vitamin K dependent coagulation factors
Onset: 12-25 hrs
Peak: 1.5-3 days
Duration: 3-5 days
o Metabolized in liver
• Used for:
o Valve replacement, PE, DVT, MI, Atrial dysrhythmias
• Common Side Effects:
o Bleeding
o Agranulocytosis
• Nursing Considerations:
o Monitor PT/INR
o Give in evening after labs are back and dose can be calculated
o Reverse with vitamin K and/or fresh frozen plasma

Front 20

Integrilin (Eptifibatide)

Back 20

• Glycoprotein IIB/IIIA Inhibitor
• Antiplatelet
• Action:
o Blocks GpIIb-IIIa receptor, a surface receptor involved in the final common pathway of platelet aggregation
o Prevents platelet aggregation
• Used for:
o Acute coronary syndrome
o Non-Q wave MI
o Unstable angina
o Coronary stenting
• Common Side Effects:
o Bleeding
• Nursing Considerations:
o Monitor for bleeding
o Know how to calculate rate (Given as an infusion)
o Know indications and contraindications

Front 21

Clopidogrel (Plavix)

Back 21

• Anti-platelet
• Action:
o Inhibits platelet aggregation by irreversibly inhibiting the binding of ADP to platelet receptors
• Used for:
o Atherosclerotic Events: CVA, ACS, Post-stents, Life-time for drug-eluding stents
• Common Side Effects:
o Bleeding, Hypersensitivity (Allergic) reactions
• Nursing Considerations:
o Monitor for Thrombotic thrombocytic purpura
o Monitor bleeding time
o Monitor CBC
o Asses for S&S of CVA, MI

Front 22

Alteplase (Activase, tissue plasminogen activator: t-PA)

Back 22

• Fibrolytic Agent (Dissolves clot)
• Action:
o Convert inactive plasminogen to active plasminogen
o Plasminogen is the enzyme responsible for degradation of fibrin clots
• Used for:
o Lyse intracoronary clot to restore blood flow, salvage ischemic myocardium, limit infarct size, & save LV function
• Common Side Effects:
o Hemorrhagic stroke or bleeding from other sites
o Allergic reaction
o Nursing Considerations:
o Important to recognize S&S of MI asap to initiate treatment
Selection criteria: <65-70yrs; <6 hrs since onset
o Contraindications: CVA, Recent surgery or trauma, HT, coagulopathy

Front 23

Furosemide (Lasix)

Back 23

• Loop Diuretic
• Action:
o Inhibits Na & Cl reabsorption in the ascending loop of Henle, increasing renal excretion of Na, Cl, & H2O.
o Increases excretion of Potassium
• Used for:
o Hypertension, Peripheral & pulmonary edema, Heart failure
• Common Side Effects:
o Hypokalemia
o Rapid parenteral admin may cause hearing loss & Tinnitus
• Nursing Considerations:
o Admin in morning if possible
o May be given IV (slowly) or PO
o Monitor serum Potassium – may need potassium replacement
o Monitor Creatinine

Front 24

Spironolactone (Aldactone)

Back 24

• Aldosterone Antagonist (K-sparing Diuretic)
• Action:
o Interferes with RAAS activation
o Increases urine Na & H2O excretion, sparing Potassium
o Decreases vascular & ventricular remodeling
• Used for:
o Heart failure
o Can be used with ACE Inhibitor and Loop diuretic
• Common Side Effects:
o Hyperkalemia, Hypotension, HA, Drowsiness, Gynecomastia
• Nursing Considerations:
o I&O, Monitor for volume depletion
o Monitor electrolytes, esp Potassium
o Monitor BP
o Avoid foods high in Potassium

Front 25

Dopamine

Back 25

• Inotropic medication
• Chemical precursor of norepinephrine
• Naturally occurring catecholamine
• Alpha 1, beta 1, and dopaminergic recetor stimulation
• Actions are related to dose:
o 1 – 5 mcg/kg/min “Renal dose”
Increases Urinary Output
o 5 – 10 mcg/kg/min
Increases BP & causes diuresis
o 10 mcg/kg/min
Increases BP
Decreases blood flow to kidneys, extremities & skin (watch for skin breakdown)
• Used for:
o Cardiogenic shock
o Trauma
o Endotoxic sepsis
o Post-op renal failure
o CHF
o Dopamine and Nitroprusside are frequently used together – Nipride counteracts the adrenergic constrictive effects of Dopamine
• Common Side Effects:
o Tachyarrhythmias
o Ectopy
o Hyper or Hypotension
• Nursing Considerations:
o Vesicant – should be given in a central line
Can cause necrosis
Regitine to counteract
o Don’t use in hypovolemic state
o Monitor HR, BP, PCWP, CO, Urine output
o D/C slowly; Wean

Front 26

Dobutamine

Back 26

• Inotropic medication
• Synthetic catecholamine
• Direct acting inotropic agent with predominant beta 1 stimulator activity, and mild beta 2
• Action:
o Increase cardiac output by improving/increasing myocardial contractility, minimal increase in HR & BP, and decreased peripheral vascular resistance
• Used for:
o Short-term inotropic support in cardiac decompensation resulting from depressed contractility (organic heart disease or post-op cardiac surgery)
o Left ventricular failure, and cardiogenic shock
o May be used to treat chronic CHF on a short-term basis in hospital (Dobutamine holiday) or at home
o Effective dose range: 2.5 – 20 mcg/kg/min
o Usual dose range on D5W: 2.5 – 5 mcg/kg/min
o Standard concentration: 500 mg in 250 cc D5W
• Common Side Effects:
o Ventricular irritability
o Tachycardia
o May increase myocardial ischemia in Pt. having MI
o May cause precipitous hypotension
• Contraindicated:
o Hypovolemia
o IHSS (Idiopathic Hypertrophic Subaortic Stenosis)
o Hypersensitivity to sulfites
o Shock without adequate fluid replacement
• Nursing Considerations:
o Monitor HR/Rhythm continuously
o Monitor BP when titrating up or down
o Usually start at 0.5 to 1.0 mcs/kg/min and titrate up at 2-10 minute intervals (monitoring BP and MP) until desired rate or effect is reached
o Be prepared to show me your calculations for mcs/kg/min
o Strict I&O, Daily weights, Monitor electrolytes

Front 27

Nitroglycerin

Back 27

• Nitrate, VASODILATOR, anti-anginal
• Action:
o Relaxes vascular smooth muscle; more effective on venous system
Decreases preload
Decreases ventricular volume
Increases perfusion
o Peripheral vasodilation (mild arterial dilation)
Decreases afterload
Decreases ventricular work load
Decreases myocardial O2 demand
o Dilate coronary arteries, improving O2 supply to heart
• Used For:
o Angina
o MI
o CHF
o Hypertension
• Common Side Effects:
o Hypotension
o Bradycardia or reflex tachycardia
o HA
• Nursing Considerations:
o Glass bottle only
o Special administration set – readily absorbed into plastic
o No other med added to nitro
o Monitor CP, BP, PCWP, Heart rate & rhythm, CO & Urinary Output