Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
143 Cards in this Set
- Front
- Back
|
Adverse Effects of local anesthetics
|
CNS
Cardiovascular Allergic reaction Labor and delivery |
|
|
Lidocaine
|
Most widely used local anesthetic
Topical and injectable applications Effects extended if given with epinephrine Also used for cardiac dysrhythmias |
|
|
High potential for abuse and no approved medical use in the US
|
Schedule I
|
|
|
all have approved applications. Assignment to a schedule is based on abuse potential and potential for causing physical or psychologic dependence, with Schedule II having highest potential for abuse and dependence.
|
Schedules II – V
|
|
|
A general term defined as any drug, natural or synthetic, that has actions similar to those of morphine
|
Opioid
|
|
|
More specific-Applies only to compounds present in opium (morphine, codeine)
|
Opiate
|
|
|
Pure Opioid Agonists
|
Activate Mu receptors
Analgesia, euphoria, sedation, resp depression, physical dependence, constipation, etc Divided in two groups--strong (morphine) and moderate to strong |
|
|
Agonist-Antagonist Opioids
|
Action at Mu and Kappa receptors
Analgesic effect except if given with another pure agonist |
|
|
Pure Opioid Antagonists
|
Antagonists at Mu and Kappa receptors
No analgesic effect Used to reverse overdoses of opioid agonists |
|
|
Seedpot of the poppy plant
|
Morphine
|
|
|
Indication: Relief of moderate to severe pain
|
Morphine
|
|
|
Receptors involved
Pain relief Drowsiness Mental clouding Anxiety reduction Sense of well-being |
Morphine
|
|
|
Which assessment would best determine the effectiveness of Sumatriptan?
|
Termination of the migraine headache
|
|
|
What is a serious drawback to the use of ergotamine?
|
The risk of physical dependence with routine use
|
|
|
What is the DOC for to abort a severe migraine h/ache?
|
Sumatriptan
|
|
|
What are some adverse effects of Cafergot (ergotamine)?
|
Numbness & tingling in fingers and toes
Weakness in legs Myalgias Angina-like pain Tachycardia or bradycardia Nausea & vomiting |
|
|
What medication is preferred for the prevention of migraine headache?
|
Beta Blockers (propranolol)
|
|
|
Why is ergotamine coupled with caffeine?
|
Caffeine enhances vasoconstriction and ergotamine absorption
|
|
|
What drugs should be avoided within 24 hours of the use of sumatriptan (Imitrex)?
|
Other triptans, and ergot derivatives
|
|
|
In which pts should sumatriptan (Imitrex) be avoided?
|
Pts with a hx of ischemic heart disease, myocardial infarction (MI), uncontrolled hypertension, or other heart disease due to the risk of coronary vasospasm.
|
|
|
Briefly explain how tricyclic antidepressants (TCAs) reduce symptoms of depression.
|
Block reuptake of monoamines (serotonin)
↑ concentration of serotonin Support theory that depression is an imbalance of neurotransmitters Exactly why unknown |
|
|
Side effects of the TCAs limit their use. What are some of these major SE?
|
Orthostatic hypotension
Sedation: block histamines Cardiac toxicity: slows conduction at Bundle of His SZ: lowers sx threshold Anticholinergic SE: Dry as a bone, etc… |
|
|
Which diagnostic tests require that a TCA be stopped for 48 hours?
|
Tests requiring a “dye”
Contrast media lowers sz threshold, thus the combination ↑ risk for seizures Phenothiazines (Thorazine) and demerol should also be stopped Cautious use in pts with history of seizures |
|
|
What important instructions should you give pts receiving TCAs?
|
Change position slowly (orthostatic)
Initial response may take 1-4 weeks Maximum response may take a month Take at HS If drowsy in AM, take med early in evening |
|
|
What drugs do you teach the pt to avoid while on TCAs?
|
MAOIs (↑ norepi, thus ↑ risk of HTN)
Direct acting sympathomimetic drugs (epi, norepi) Indirect sympathomimetic (ephedrine) Anticholinergics (additive effect) CNS depressants (additive effect) |
|
|
A pt is admitted with a TCA overdose. What does the nurse plan to do?
|
Gastric lavage, followed by charcoal
Physostigmine (cholinesterase inhibition to ↑ Ach, to counteract anticholinergic effects Propranolol, lidocaine, or phenytoin may be given to treat cardiac effects |
|
|
Why can’t TCAs be given IV?
|
Take weeks to work
|
|
|
How many TCA tablets is it safe to give at one time?
|
A week’s supply, to try to prevent suicide attempt
|
|
|
Which antidepressant has also proven effective in smoking cessation?
|
Wellbutrin (bupropion)
|
|
|
A pt on an SSRI is admitted with serotonin syndrome. What symptoms does the nurse anticipate the pt will demonstrate?
|
Occurs 2-72 hrs post initiation of therapy
Mental status changes: altered LOC, agitation, confusion, hallucinations, anxiety, poor concentration Uncoordination, twitching, excessive sweating, fever |
|
|
A patient with depression is prescribed fluoxetine (Prozac). Which of the following statements made by the patient indicates an understanding of the medication teaching?
A. “Disorientation and hallucinations are common adverse effects.” B. “I may experience sexual fantasies while taking this medication.” C. “It may take 3 to 4 weeks before my mood is elevated.” D. “I can stop this medication when I feel less depressed.” |
C
|
|
|
A patient with schizophrenia is prescribed chlorpromazine
(Thorazine) oral concentrate. Which of the following discharge instructions should the nurse complete? A. Sexual arousal may be enhanced with this medication. B. Avoid direct skin contact with the medication. C. The medication may cause excessive salivation. D. Do not limit salt intake while taking the medication. |
B
|
|
|
Which assessment best determines tardive dyskinesia in a patient taking antipsychotic agents?
A. Pacing and squirming with an uncontrollable need for motion B. Mask-like face with drooling, tremors, rigidity, and shuffling gait C. Twisting, writhing, worm-like movements of the tongue and face D. Sudden high fever, sweating, and fluctuations in blood pressure |
C
|
|
|
Second- generation antipsychotic (SGA)drugs are commonly preferred over first generation antipsychotics (FGA) primarily because they:
A. Are perceived as being more effective. B. cost less. C. do not affect thinking. D. only cause minor adverse effects. |
A
|
|
|
Who are considered high risk patients for lithium therapy?
|
Pregnant women (esp 1st trimester)
Pts with renal & CV disease; dehydration, sodium depletion and those concurrently taking diuretics. |
|
|
What can the nurse advise pts to decrease gastric upset when taking lithium?
|
Take drug with meals or milk.
|
|
|
How should slow-release tabs be taken?
|
Swallow intact, without crushing or chewing.
|
|
|
How can the nurse promote adherence with lithium therapy?
|
Educate pts and families about nature of BPD.
Educate about importance of taking lithium as directed. Encourage family to oversee lithium use. Have family urge pt to visit HCP or psych clinic if a pattern of nonadherence develops. |
|
|
How can the nurse minimize the adverse effects of lithium?
|
Teach pts about signs of toxicity.
Instruct pts to withhold med and notify HCP if signs of toxicity develop. |
|
|
What will the nurse teach the pt about causes of lithium accumulation?
|
Kidney function should be monitored yearly.
Maintain a normal sodium intake. Diarrhea can cause significant sodium loss. Use diuretics with caution. |
|
|
What can the nurse tell the pt to do to counteract the polyuria that occurs with lithium treatment?
|
Instruct pts to drink 8 to 12 glasses of fluid daily to maintain hydration.
|
|
|
A patient with bipolar disorder is taking lithium. Which of the
following signs and symptoms exhibited by the patient would indicate lithium toxicity? A. Anuria, increased appetite, and abdominal distention B. Nonproductive cough, increased deep tendon reflexes, and hypertension C. Polydipsia, slurred speech, and fine hand tremors D. Constipation, asterixis, and generalized edema |
C
|
|
|
A patient with bipolar disorder is taking lithium. Which statement made by the patient indicates a need for further teaching?
A. “I should take the medication with milk to decrease stomach upset.” B. “I will notify my doctor if I feel hyperactive.” C. “I should drink at least 8 to 10 glasses of water every day.” D. “I will restrict my sodium intake while taking this medication.” |
A
|
|
|
A patient states that the dose of oxycodone he currently receives
does not provide the same pain relief. The nurse charts that the patient has developed: A. physical dependence. B. tolerance. C. withdrawal syndrome. D. an addiction. |
B
|
|
|
A patient is in treatment for drug addiction. What goal should the
nurse discuss with the patient? A. Reduce the use of the drug. B. Completely abstain from use of the drug. C. Seek treatment for relapses. D. Use a less addictive drug. |
B
|
|
|
A female patient is planning to become pregnant. The nurse should
advise the patient to: A. reduce alcohol intake to one glass of wine per day during pregnancy. B. abstain from alcohol intake while pregnant and breast-feeding. C. take a folic acid vitamin if alcohol intake is planned during pregnancy. D. consume low-alcohol-content beverages during pregnancy. |
B
|
|
|
Which person will live the longest based on alcohol intake?
A. A person who drinks 10 or more drinks per day B. A person who drinks on holidays and social occasions C. A person who drinks in moderation and exercises regularly D. A person who is a nondrinker |
C
|
|
|
A patient with a cocaine addiction is admitted to a mental health
facility for treatment. The nurse will plan for: A. medicating with delta-9-tetrahydrocannabinol (THC) to reduce withdrawal symptoms. B. administration of naloxone (Narcan) to precipitate immediate withdrawal. C. psychosocial therapy as the best treatment for this addiction. D. maintenance therapy with methadone. |
C
|
|
|
A patient with heart disease smokes 1 to 1½ packs of cigarettes
per day. The nurse should teach the patient that a decrease in nicotine intake will result in: A. reduction of blood pressure. B. weight loss. C. increased heart rate. D. increased cardiac workload. |
A
|
|
|
An uncomfortable state with psychologic and physical components
Characterized by fear, apprehension, dread, and uneasiness Among the most common psychiatric illnesses |
Anxiety
|
|
|
In order to avoid serious reactions to IV injections of benzos, what procedures should you follow?
|
Inject slowly
Avoid arterial injection and extravasation Use direct access; close to vein as possible Dilute according to manufacturer Have resuscitation equipment available (hypotension, respiratory and cardiac arrest potential) |
|
|
What are some indications for Benzos?
|
Anxiety
Insomnia Seizures Muscle spasms Panic Disorder Alcohol withdrawal Pre-op End of life sedation N and V |
|
|
According to the Controlled Substance Act, which schedule do the benzos fall under?
|
Schedule IV
Barbiturates: Schedule II or III |
|
|
When are benzodiazepines contraindicated?
|
During pregnancy (Category D or X)
For pts with sleep apnea Use with caution in pts with suicidal tendencies Use with caution in pts with a hx of substance abuse (sedative-hypnotic abuse) The elderly |
|
|
In which patients should benzos be used with caution?
|
Those with pulmonary dz (COPD)
Alcoholics Pts taking other CNS depressants Those with liver problems Pts with porphyria (< metabolism of porphyrin – a nitrogen containing compound); can cause neuro sxs, skin lesions, hemolytic anemia |
|
|
What would you teach a patient who will be receiving benzos?
|
Tell pts about possible CNS depression
Avoid hazardous activities (driving or use of hazardous equipment) if daytime sedation is significant. Warn pts about complex sleep-related behaviors. Must notify HCP. Warn pts about possible paradoxical reactions: rage, excitement, heightened anxiety. (Notify HCP), Avoid pregnancy (fetal injury esp 1st trimester) Avoid P450 drugs (warfarin, phenytoin, OCPs) |
|
|
When a pt has been taking a benzo for several weeks, what is the best way to discontinue the drug?
|
To < withdrawal sxs:
Taper over weeks to months Use long half-life benzos to taper Assess for return of anxiety |
|
|
Why is BuSpar a safer drug than Xanax or barbiturates?
|
Does not enhance alcohol, barbiturates, or other general CNS depressants
Devoid of hypnotic, muscle relaxant and anticonvulsant effects Used for anxiety only (use first; short term – less than 1 year) Little abuse potential Well tolerated |
|
|
A patient is prescribed eszopiclone (Lunesta) for treatment of insomnia. The nurse should teach the patient that the most common adverse effect is:
A. respiratory depression. B. bitter aftertaste. C. anterograde amnesia. D. tolerance. |
B
|
|
|
A 24-year-old female patient is prescribed triazolam (Halcion) for
short-term management of insomnia at home. Which statement made by the patient indicates an understanding of teaching related to this medication? A. “The medication will not alter my breathing.” B. “I can safely drink one or two glasses of wine before bedtime.” C. “My chance of addiction to this medication is high.” D. “I do not need to take precautions while taking this medication during pregnancy.” |
C
|
|
|
Intravascular → interstitial movement due to:
|
1. Increased capillary permeability due to tissue injury (burn, trauma, allergic reactions, or inflammatory reactions.
2. Increased capillary hydrostatic pressure due to increased blood volume (fluid overload or Na+ & H2O retention) or obstruction of venous blood flow (CHF, pulmonary edema, renal failure). 3. Decreased plasma oncotic pressure due to decreased synthesis of plasma protein (liver disease, malnutrition) or increased loss of plasma proteins (burn injuries, nephrotic syndrome.) |
|
|
Where in the nephron does Lasix work?
|
Ascending Loop
|
|
|
What 2 electrolytes must be monitored before, during and after Lasix administration?
|
Potassium
Magnesium |
|
|
When giving Lasix IVP, how many mg/minute can you give?
|
Dose dependent:
Up to 60 mg, can give 20 mg/minute 80 mg or more: 4 mg/minute |
|
|
Why can’t a higher dose of Lasix be given at 20 mg/minute?
|
Ototoxicity
Which can be reversed (to a degree) |
|
|
What patient conditions would contraindicate the use of Lasix?
|
Anuria
Electrolyte depletion (K+ and Magnesium, especially) |
|
|
What are some drug classifications that might contraindicate the concurrent use of Lasix?
|
Use of other ototoxic drugs
Nephrotoxic drugs NSAIDS (blunt Lasix effect by inhibiting prostaglandins Antipsychotic drugs (Lithium decreases sodium and thus increases lithium effects) |
|
|
Administer Accurately-Diuretics
|
Give in early morning
Keep bedpan/urinal in reach Give IV dose over 1-2 minutes Give IV furosemide continuous IV infusions at a rate of 4 mg/min or less |
|
|
Observe for therapeutic effects-Diuretics
|
Decrease or absence of edema
Increased urine output Decreased blood pressure Weigh patient daily (look for a drop in weight) Observe/record characteristics of urine Assess for improvement in lung sounds in CHF |
|
|
Observe for adverse effects-Diuretics
|
Hypokalemia/Hyperkalemia
Check other electrolytes: Na, Cl, Mg, etc. Monitor blood sugars Assess for dehydration: dry mucous membranes/poor skin turgor |
|
|
Observe for drug interactions-Diuretics
|
Drugs that increase effects of diuretics (Aminoglycoside antibiotics, antihypertensives, corticosteroids)
Drugs that decrease effects of diuretics (NSAIDS, OC, Vasopressors) |
|
|
A patient is prescribed spironolactone (Aldactone) for treatment
of hypertension. Which foods should the patient be taught to avoid? A. Baked fish B. Low-fat milk C. Salt substitutes D. Green beans |
C
|
|
|
A patient with heart failure is prescribed furosemide (Lasix). The
nurse should instruct the patient to consume: A. oranges, spinach, and potatoes. B. baked fish, chicken, and cauliflower. C. tomato juice, skim milk, and cottage cheese. D. oatmeal, cabbage, and bran flakes. |
A
|
|
|
A patient has the following arterial blood gases: pH 7.49, PaCO2 42.5 mm Hg, HCO3 28.2 mEq/L. What treatment would the nurse plan to administer to correct this imbalance?
A. Sodium bicarbonate infusion B. Infusion of sodium chloride with potassium chloride C. Rebreathe expired air through a paper bag D. Hypertonic solution of 3% sodium chloride |
B
|
|
|
A patient has a serum potassium level of 3.1 mEq/L. The nurse plans to administer:
A. sustained-release potassium tablets (K-Dur). B. foods that are deficient in potassium. C. furosemide (Lasix). D. sodium polystyrene sulfonate (Kayexalate). |
A
|
|
|
What is the usual mg/kg dose of IVP lidocaine?
|
1 mg/kg
|
|
|
What is the usual staring lidocaine IV drip rate?
|
1-4 mg/minute
|
|
|
A nurse administers quinidine to a patient with atrial fibrillation. The nurse will observe the electrocardiogram (ECG) tracing for:
A. prolongation of the QT interval. B. prolongation of the PR interval. C. narrowing of the QRS complex. D. tall, peaked T waves. |
A
|
|
|
The nurse is preparing to administer adenosine (Adenocard) to a patient in paroxysmal supraventricular tachycardia. The nurse will:
A. inject the medication into the peripheral intravenous (IV) line. B. infuse the first dose by diluting the medication in 100 mL of saline. C. administer a small test dose to determine hypersensitivity. D. give the medication through the central line catheter. |
D
|
|
|
How should IVP Digoxin be given?
|
Over 5 minutes due the increased risk of toxicity/arrhythmias
|
|
|
EKG changes with Digoxin toxicity:
|
_______ T wave amplitude
Decreased _______ PR interval (SA to AV nodes) Prolonged _______ QT interval Shortened |
|
|
A dig level is ordered for a patient started on dig yesterday. What is the most optimal time for a dig level to be drawn?
|
Dig levels should be drawn at least 4-5 half-lives (6-7 days) and at least 6-12 hours after the first dose. Draw just before the next scheduled dose.
Half-life is 1.5 days. |
|
|
It is 6 days since your patient was started on dig and HCTZ for heart failure. It is time for these AM drugs to be given. You notice that his pulse is irregular (new finding).
What do you do? |
Hold dig and HCTZ
Obtain an ECG (? Heart block) Call MD Consider getting a K+ level Hold dig is HR is less than 60 bpm, as dig can cause bradycardia. |
|
|
A patient is to receive prescribed doses of digoxin (Lanoxin) and furosemide (Lasix). Before these drugs are administered the nurse should check the:
A. serum sodium level. B. respiratory rate and depth. C. serum potassium level. D. blood pressure. |
C
|
|
|
A nurse is teaching a patient about the symptoms associated with digoxin toxicity. The nurse will teach the patient to report:
A. cough, arthralgia, and rigidity. B. dizziness, ataxia, and diarrhea. C. tachycardia, dyspnea, and edema. D. muscle weakness, nausea, and fatigue. |
D
|
|
|
How do the direct vasodilators reduce blood pressure?
Hydralazine Minoxidil Hyperstat (Diazoxide) Nitroprusside (Nipride) |
Relax vascular smooth muscle (periphery)
Thus, reducing Afterload Preload May increase sodium and water retention (< BP; > aldosterone; >Na and H20 retention) |
|
|
Beta blockers should be used with caution in the presence of what major disease?
|
Diabetes Mellitus
DM Type 1: can mask the symptoms of hypoglycemia DM Type 2: increases blood sugar. |
|
|
What blood lab must be drawn before and after initiation of an ACEI?
Why? |
BUN & Creatinine
In the presence of renal artery stenosis, the kidneys release large amounts of renin to maintain GFP (glomerular filtration pressure). If this renin release is blocked by an ACEI, the GFP will fall, leading to acute renal failure. |
|
|
In what group of patients are the ACEIs contraindicated?
|
Pregnancy
|
|
|
What are some major side effects of ACEIs?
|
Has 1st dose hypotensive effect
Angioedema: stop drug immediately with signs of angioedema (swelling face, lips, tongue & dyspnea) (precursor to anaphylaxis) Dry hacking cough (d/t release of bradykinin) |
|
|
What is their site of action?
|
They block angiotensin 2 receptors on the blood vessels.
|
|
|
What is the advantage of giving Procardia sustained release (SR) vs the immediate release preparation?
|
Indirect effects of baroreceptor reflex can result in ↑ HR and ↑ force of contraction with immediate release form
This is minimized with SR form |
|
|
What conditions would contraindicate the use of CCBs?
|
Acute Heart Failure
Cardiogenic shock Beta Blockers and Digoxin may counteract the effect of CCBs (in theory). |
|
|
A patient is prescribed a medication that lowers the arterial blood
pressure. The nurse will observe for tachycardia because: A. the renin-angiotensin-aldosterone system is activated. B. atrial natriuretic peptide is produced. C. the baroreceptor reflex is triggered. D. contractility and preload are decreased. |
C
|
|
|
A patient is prescribed a medication that causes venous dilation.
The nurse should teach the patient about: A. peripheral vascular disease. B. postural hypotension. C. renal diuresis. D. retention of water. |
B
|
|
|
Which patient would the nurse be most concerned about
developing hyperkalemia? A. A patient who is prescribed enalapril (Vasotec). B. A patient who is prescribed losartan (Cozaar). C. A patient who is prescribed an angiotensin II receptor blocker. D. A patient who has type II diabetes mellitus with hypertension. |
A
|
|
|
A patient who is taking spironolactone (Aldactone) is newly
prescribed losartan (Cozaar). The nurse should: A. assess for signs of hyperkalemia. B. observe for a hypertensive crisis. C. administer the medications as scheduled. D. evaluate for first-dose hypotension. |
C
|
|
|
A patient is to receive a scheduled dose of diltiazem (Cardizem).
The nurse should hold the medication and contact the prescriber if: A. blood pressure is at or above 190/88 mm Hg. B. cardiac rhythm is in atrial fibrillation. C. the patient is complaining of chest pain. D. the patient is in second-degree heart block. |
D
|
|
|
A patient is prescribed nifedipine (Procardia XL). Which
statement made by the patient indicates an understanding of medication teaching? A. “I will stop taking my beta blocker.” B. “I must swallow the pill whole.” C. “The medication will cause constipation.” D. “This medication will treat my heart rhythm problems.” |
B
|
|
|
A patient is prescribed hydralazine (Apresoline). Which of the
following is most important to include in medication teaching? A. Precautions for postural hypotension. B. A beta blocker will be added to prevent tachycardia. C. High dosages will be initiated then tapered. D. Common adverse effects include hypertrichosis. |
B
|
|
|
Which of the following patients would most likely be started on
sodium nitroprusside (Nitropress)? A. A patient with a recent diagnosis of essential hypertension B. A patient with heart failure managed in an outpatient setting C. A patient with a hypotensive episode following a myocardial infarction D. A patient with a hypertensive crisis in the intensive care unit |
D
|
|
|
Which of the following patients would be a candidate for both
lifestyle changes and drug therapy with an antihypertensive medication? A. A 47-year-old patient with blood pressure of 110/78 mm Hg and with type 2 diabetes mellitus B. A 76-year-old patient with blood pressure of 128/88 mm Hg and a history of dyslipidemia C. A 52-year-old patient with blood pressure of 136/89 mm Hg who smokes 1 pack of cigarettes per day D. A 32-year-old patient with blood pressure of 142/94 mm Hg who is overweight and sedentary |
D
|
|
|
Deliver triglycerides from liver to adipose tissue and muscle
|
Very-low-density lipoproteins (VLDLs) - (very bad)
|
|
|
Cholesterol primary core lipid
Greatest contributor to coronary heart disease (CHD) Accounts for 60-70% of cholesterol |
Low-density lipoproteins (LDLs) – (bad)
|
|
|
Carries cholesterol from peripheral tissue back to liver (aids in cholesterol removal)
|
High-density lipoproteins (HDLs) – (good)
|
|
|
How do we get cholesterol?
|
From:
Food (exogenous) Liver (endogenous) |
|
|
What is the primary treatment for hypercholesterolemia
|
Diet and exercise
|
|
|
Which drugs are the most effective in lowering LDL cholesterol?
|
HMG CoA Reductase Inhibitors
IE: “Statins” |
|
|
How do the HMG CoA Reductase Inhibitors (the “statins” work?
|
Blocking reductase results in less cholesterol synthesis by liver
This causes the body to synthesize more LDL receptors (up-regulation) Resulting in more receptors for the fewer cholesterol molecules |
|
|
When a patient is started on one of the statins, what lab tests should be performed periodically?
|
Liver function tests (AST, ALT)
CPK (released from heart muscle) Rhabdomyolysis is measured by CPK levels Rhabdo: breakdown of muscle: muscle pain, general malaise, potentially life threatening Potential adverse effect |
|
|
What would you teach a patient being discharged on Lipitor?
|
A statin
↑ removal of cholesterol from blood Takes 2 weeks to work 4-6 weeks for max effect Better to take at noc Take with or without food Lifelong RX |
|
|
How do these lower cholesterol?
|
Resins form an insoluble complex with bile acids in intestine
Accelerates bile acid excretion This creates a demand for more cholesterol to make bile acid |
|
|
Can bile acid-binding resins be used in pregnant women?
|
No: Category X
|
|
|
What are the major side effects of bile acid-binding resins?
|
GI: bloating, indigestion, nausea
|
|
|
Which drugs when given with bile acid-binding resins form insoluble complexes and thus should not be given together?
|
Thiazide diuretics
Digoxin Warfarin Okay to give 1 hr before or 4 hrs after the resin drugs |
|
|
Which is the DOC for lowering VLDLs?
|
Nicotinic acid (Niacin)
SE: intense skin flushing often limits its use Extended release formulations = less SE Take aspirin before taking Niacin to reduce SE |
|
|
Which cholesterol lowering drugs should not be given together and why?
|
Lopid (gemfibrozil) and the “statins”
Because can cause statin induced myopathy Also, displaces warfarin from plasma albumin → ↑ anticoag effects |
|
|
The patient is prescribed lovastatin (Mevacor). The nurse will teach the patient to take the medication:
A. at any meal. B. with the evening meal. C. one hour before breakfast. D. two hours after a meal. |
B
|
|
|
The nurse will teach a patient who is prescribed niacin (Niacor) to prevent flushing of the face by:
A. drinking a full glass of water after taking the medication. B. taking 325 mg of aspirin 30 minutes before each dose. C. ingesting a meal before taking the medication. D. increasing dietary fiber. |
B
|
|
|
Clinical trials suggest that HMG-CoA reductase inhibitors (statins) benefit patients with atherosclerosis by:
A. Increasing serum LDL. B. Promoting the production of thrombin. C. Reducing serum HDL. D. Stabilizing endothelial plaque. |
D
|
|
|
What are the major side effects of nitrates?
|
HYPOTENSION
Reflex tachycardia (autonomic nervous system response) Headache |
|
|
Since tolerance to nitrates can occur, what is the best way to administer the transdermal formulation?
|
Remove patch at night for 8 – 12 hours.
In hospital, put on at 10 am, take off at 10 pm At home, can keep off for 6 hours and leave on at night |
|
|
What do you teach a pt as to proper use of NTG tablets?
|
Do not swallow (Use SL)
Place under tongue (tingling sensation should be felt) Store in dark bottle Good for 3-6 months after opening. Works in 1-3 minutes Max dose: 1 tab q 5 minutes X 3 tabs (series of 3) If no relief, call 911! |
|
|
What do you teach a pt as to proper use of NTG ointment?
|
Squeeze ordered ribbon length on paper (Print side down)
Fold together, spread around Remove old patch, wash area of skin off Apply patch to non-hairy area and rotate sites Cover with plastic wrap Avoid touching or rubbing Remove at night or during day for 6 hours |
|
|
A patient was admitted to the ED with persistent anginal pain after having taken 3 NTG tablets. His pain is relieved with 2 NTG tablets in the ED. What may account for this?
|
Old bottle of tablets.
(This can also be try for albuterol inhaler for asthma). |
|
|
Your pt has been receiving IV sodium nitroprusside. The MD has prescribed an NTG patch and ordered the IV NTG to be weaned. How will you do this?
|
Patch takes 30-60 minutes to work
Wait 30 minutes to begin downward titration of IV NTG Monitor BP and chest pain |
|
|
Since your patient is going home on a NTG patch, should you advise him to buy NYG SL tablets?
|
Yes
When patch if off at night or during the day, he may have chest pain |
|
|
What toxic poison can accumulate in patients receiving IV sodium nitroprusside?
|
Cyanide poisoning from prolonged use.
|
|
|
A patient with angina pectoris is prescribed sublingual nitroglycerin. Which of the statements made by the patient indicates understanding of the medication teaching?
A. “I may experience a headache as a side effect.” B. “The chest pain should be relieved within 20 minutes.” C. “I should swallow the tablet.” D. “I should take this medication in the morning before breakfast.” |
A
|
|
|
A patient is prescribed a nitroglycerin transdermal patch. The nurse will teach the patient to:
A. apply the patch to the chest over the heart. B. change the patch each week. C. remove the patch at night. D. use the patch to prevent exercise-induced chest pain. |
C
|
|
|
The goal of drug therapy for chronic stable angina is to:
A. Constrict coronary arteries to increase blood pressure stress. B. Decrease myocardial need for oxygen during stress. C. Increase myocardial blood flow during systole. D. Prevent coronary artery spasms. |
B
|
|
|
A patient asks the nurse why nitroglycerin can be administered in so many ways. The basis of the nurse’s response is that nitroglycerin:
A. Does not undergo first-pass effect in the liver. B. Has few adverse effects, so varying doses can be administered via different routes. C. Is an inactive compound, so it does not matter by which route it is administered. D. Is lipid soluble, so it is readily absorbed via different routes. |
D
|
|
|
It is important for the nurse to teach a patient who has been prescribed nitroglycerin (NItroQuick) on an as needed basis to:
A. Discard unused tablets after 12 months. B. Store the tablets in a locked medicine cabinet in the bathroom. C. Take a few tablets from the bottle and keep them in a plastic bottle in your purse or pocket for emergency use. D. Write the date that the tablets are opened on the outside of the bottle. |
D
|
|
|
A patient is receiving an intravenous infusion of heparin to treat a pulmonary embolism. What laboratory value will the nurse monitor to evaluate the treatment with this medication?
A. Activated partial thromboplastin time (aPTT) B. Prothrombin time (PT) C. Platelets D. Hemoglobin and hematocrit |
A
|
|
|
Which of the following patients may need an increased dose of warfarin (Coumadin) to have the same anticoagulant effect?
A. A patient taking acetaminophen (Tylenol) for back pain B. A patient taking cimetidine (Tagamet) to prevent gastric ulcers C. A patient taking oral contraceptives to prevent pregnancy D. A patient taking prednisone (Deltasone) for rheumatoid arthritis |
C
|
|
|
A patient who has been receiving heparin tells the nurse that she thinks she could be pregnant. The nurse should:
A. Administer the heparin as ordered and notify the prescriber of the possible pregnancy status. B. Withhold the heparin. C. Withhold the heparin until pregnancy status can be confirmed. D. Withhold the heparin and consult the prescriber regarding administration of the antidote protamine sulfate. |
A
|
|
|
The nurse would consult the prescriber if which of the following drugs was prescribed, but there was no order for monitoring of aPTT?
A. Fragmin B. Heparin C. Innohep D. Lovenox |
B
|
|
|
The nurse should teach patients who are prescribed warfarin (Coumadin) to eat consistent amounts of which of the following foods? (Select all that apply.)
A. Cabbage B. Citrus foods C. Dairy foods D. Green leafy vegetables E. Liver |
A,C,D
|
|
|
A patient is admitted to the emergency room with suspected ST-elevation myocardial infarction. The nurse will instruct the patient to take aspirin:
A. after being admitted to the intensive care unit. B. with a full glass of water. C. by swallowing the enteric-coated tablet. D. by chewing the 325-mg tablet. |
D
|
|
|
A patient has indications of an ST-elevation myocardial
infarction. Which five medications would the nurse consider routine therapy for this patient? A. Beta blocker, angiotensin II receptor blocker (ARB), oxygen, clopidogrel, and heparin B. Aspirin, angiotensin-converting enzyme (ACE) inhibitor, diuretic, warfarin, and morphine C. Aspirin, beta blocker, oxygen, morphine, and nitroglycerin D. Heparin, oxygen, nitroprusside, ACE inhibitor, and morphine |
C
|
|
|
A protocol in the emergency department (ED) is to administer 4 chewable 81-mg aspirin tablets (total 325 mg) to patients with suspected myocardial infarction. A student nurse asks the nurse why 4 chewable aspirin tablets are administered instead of 2 regular aspirin tablets (650mg). Which of the following is the most accurate explanation for this protocol for the first does of aspirin?
A. Aspirin is an acid, and acids are more readily absorbed in the acid environment of the stomach. B. Chewable forms of aspirin are absorbed through the buccal mucosa bypassing hepatic first pass. C. Chewing breaks the tablet into smaller particles, which are more readily absorbed in the intestines. D. Exceeding 325-mg doses can offset the vasodilation and antiplatelet effects of lower doses. |
B
|
|
|
A patient who is undergoing an acute ST-elevation myocardial infarction (STEMI) is prescribed Metoprolol 50 mg by mouth every 6 hours. Which of the following assessment findings would be a reason to withhold the medication and immediately contact the prescriber?
A. Altered taste B. Insomnia C. Rhinorrhea C. Wheezing |
D
|
|
|
The ED triage nurse answers the call of a patient who has a history of angina pectoris and chronic obstructive pulmonary disease (COPD) who reports chest pain that has not been relieved by three doses of nitroglycerin. The patient had been told by his physician that he should take chewable aspirin should this occur but he does not have any aspirin. The nurse should instruct this individual to:
A. Call 911. B. Call his physician for directions. C. Take ibuprofen and seek medical care. D. Turn on his home oxygen and rest. |
A
|
