Pharm Test 3 #11-31

Front 1

Digoxin
-what does this drug do?


-what does inotropic mean?

Back 1

-improves Cardiac output
-blocks the enzyme that breaks down calcium so calcium can make strong contractions

increases myocardial contractility (helps ventricle squeeze better so you get more cardiac output)

Front 2

Digoxin
what medical problems is it used for? (3)

Back 2

cardiomyopathy patient

treat dysrhythmias (Afib and Aflutter)

improve cardiac output

Front 3

Digoxin

know the nursing assessment associated with the administration of this drug

what electrolytes do you monitor?
-what other levels do you check?

Back 3

check pulse before administration
-hold if less than 60 pulse count for a full minute
-monitor K, sodium, and calcium
-rental function test
-monitor digoxin levels

Front 4

Digoxin

-what are symptoms associated with toxicity? (6)

toxicity can be tied to what electrolyte level?

-how do you treat a toxic state?

what is given for symptomatic bradycardia

what is given for ventricular dysrhythmias

what is the antidote?

Back 4

anorexia may be the first sign
-see yellow halo around things
-feel like heart is skipping a beat
-vomiting
-headache
-disorientation

-toxicity can be tied to K+ level changes

-treated with oxygen, IV access, EKG, digoxin level, sodium, potassium, calcium levels.

atropine for symptomatic bradycardia,

Lidocaine for ventricular dysrhythmias


digibind- binds to digoxin so digoxin cannot connect to the receptor)

Front 5

Digoxin

precaution related to this med:
-what supplement should they take?
-what do you teach them to do at home? (2)
-what should they avoid? (2)
-what restriction should they go on?

Back 5

importance of taking med as prescribed and not to double the dose if they miss a pill,
- importance of taking K supplement,
- how to take radial pulse for a full min and mointor weight
-avoiding OTC cold preparations and antacids
-sodium restrictions

Front 6

Adenosine

Know when the drug is given

Back 6

only for termination of PSVT (HR over 160) reset heart chemically.

Front 7

Adenosine

Dosage of medication for initial treatment
-do you give fast or slow?
-location of IV site
-what is the half life?

Back 7

-6mg IVP and if that doesn't work, repeat the dose at 12 mg x2 if needed
-give fast (under a minute) iv push followed by flush of NS,
-iv site close to hrt as possible
-half life close to 10sec

Front 8

Adenosine

Cardiac response to medication
-what 3 things does it decrease?
-what does it prolong
-what does it shut off completely?
-what will happen to the pts heart?

so what do you tell the patient?

Back 8

decreases automaticiity in SA node,

greatly decrease conduction through the heart,

decrease the heart rate,

prolong PR interval,

shuts off SA node completely,

pt will flatline and then restart


explain that they will feel a pause in their chest but its ok because in 10 seconds it will be back to normal

Front 9

Cardiac Disease

what is meant by lifestyle changes

Back 9

changing unhealthy habits to improve health

Front 10

Cardiac Disease

what are some of the components of lifestyle changes (7)

Back 10

weight loss
increase physical activity
moderation of Na
reduce caffeine intake
stress management
proper diet
stop smoking (#1 thing)

Front 11

Cardiac Disease

know cardiac risk factors:

Back 11

smoking
diabetes
dyslipidemia
hypertension
family history of cardiac event
microabuminuria
obesity
inactivity

Front 12

CHF
-what drug is the cornerstone of treatment for CHF

Back 12

Lasix (ACE inhibitors)

Front 13

know signs and symptoms of CHF

Back 13

-decrease tissue perfuson (reduced exercise tolerance)
-fatigue
-shortness of breath

-cardiomegaly (increase sympathetic tone, tachycardia, increased ventricular filling, reduced systolic ejection and myocardial hypertrophy)
-peripheral edema
- hepatomegaly

-weight gain from fluid retention

Front 14

-what is the general role of lipid lowering drugs in reducing cardiac disease?

Back 14

inhibit formation of LDL

Front 15

lipid lowering drugs
-how do they work?

Back 15

enzyme in the liver that inhibits the production of cholesterol by inhibiting the enzymatic action decreasing LDL and increases HDL

Front 16

lipid lowering drugs
-what 3 tests do you have to monitor for adverse effects?

Back 16

liver function tests for hepatoxicity


CPK for muscle damage

cholesterol level to ensure drug is working

Front 17

lipid lowering drugs
-patient education

when should they take the drug?

-what should they look for regarding their body?
-can they take this with food?
-what can they not have?

pregnancy category?

Back 17

importance of follow up visits and importance of compliance
-take at night to get best effects
-dietary changes,
possible muscle aches and when to report
-take with food for GI upset
-no grapefruit juice


-pregnancy category x

Front 18

Angina
-acute situation treatment

Back 18

oxygen
nitroglycerine SL + nitro paste 1 in to chest wall
-ASA 81 mgx4 chewed
-MS 2-4mg IVP only if nitro doesn't work
-nitroglycerine infusion
-betablocker
-heparin
-ACEI

Front 19

Angina
-maintenance situation treatment

Back 19

beta blocker (decrease oxygen demands on heart)
-calcium channel blocker (dilates arterioles, relaxes coronary spasm)
-nitroglycerin (vasodilator)

Front 20

Nitroglycerin
-when and what is it used for?
-what does it NOT do?

Back 20

dilation and decreases oxygen demand on the heart,

- doesn't increase blood flow to ischemic heart tissue

Front 21

Nitroglycerin
-what is the bodies physiologic response to this med?

Back 21

-dilating veins
-decreases venous return to the heart
-decreases ventricular filling, resulting in decreased wall tension, and
-decreases oxygen demand

Front 22

Nitroglycerin
-Nitro SL
when would you give it?
how often do you take it?
what is unique about these pills?

Back 22

in acute angina experiences,

1 taken q5 minutes x 3 doses

tablets are light sensitive so store in dark bottle with cap on tonight
-good only for 6 months after opening

Front 23

Nitroglycerin
-sustained release nitro

when are the used for?
how much should they be taken? why?

Back 23

for long term use only; prophylaxis
-pt can build up tolerance so should be taken once or twice a day

Front 24

Nitroglycerin SR

pt education with medication

Back 24

don't crush or break the tablets, must be d/c slowly

Front 25

-what is isosorbide?

Back 25

SR release nitroglycerin
it is a maintenance / prevention medication


organic nitrate; many formats

Front 26

Nitroglycerin
-what precautions do you have to take when applying ointment
-if the nurse is not careful, what will happen to her?

Back 26

be careful not to get it on hands nurse will absorb med

BP will drop

Front 27

Nitroglycerin
-know how to educate pt on the use of this drug
s/s of: (2)

what is the most significant:
1)
2)

Back 27

s/s of angina
-monitor symptoms
-proper way to administer SL tablets
-proper way to apply transdermal patch
-S/S associated with orthostatic hypotension
-possibility of HA occurring
-need for follow ups


1) HYPOTENSION
2) HEAD ACHE

Front 28

Nitroglycerin

know the differenre routes of administration and the reason they are used (angina)

SL:
SR:
Transdermal:

Back 28

SL- for acute angina episodes
SR- for long term prophylaxis only
Transdermal for maintenance and history of chest pain and CAD

Front 29

Nitroglycerin

know the different routes of administration and the reason they are used (angina)

ointment:
IV:
Translingual


whats important to know when giving it IV

Back 29

ointment- acute situations only

IV - for pt who has failed to respond to other treatments / acute angina / acute MI

Translingual- for acute angina episodes, short term prophylaxis

-never push this medication because of hypotensive qualities (never push potassium either)

Front 30

Cholesterol drugs
-know what hyperlipidemia means

Back 30

high blood cholesterol and triglyceride levels

Front 31

Cholesterol drugs
-lab values

Optimal
LDL
Total cholesterol
HDL
Triglycerides

Back 31

optimal LDL less than 100 (for CAD)

total cholesterol: less than 200
HDL 40-60
Triglycerides <150

Front 32

Cholesterol drugs
-lab values

Borderline
-Total
-LDL


Elevated
Total
LDL

Back 32

Borderline: Total 170-190 LDL 130-159

Elevated: Total > 200 and LDL > 160

Front 33

Cholesterol drugs

therapeutic lifestyle changes

Back 33

first line of treatment for hyperlipidemia

Front 34

HMG-CoA reductaste inhibitors

-what do they do to cholesterol LDL and HDL

Back 34

inhibit the production of cholesterol lowering LDL and increasing HDL

Front 35

HMG-CoA reductaste inhibitors
-what are the 3 drugs in this class?

Back 35

Atorvastatin Lipitor
Simuvastatin Zocor
Pravastatin Pravachor

Front 36

HMG-CoA reductaste inhibitors

adverse reactions


how can we tell if there is muscle damage

Back 36

myopathy: muscle damage, hepatotoxicity

-increase CK (creatinine kinease)

Front 37

HMG-CoA reductaste inhibitors
-how would you educate a patient on this medication

Back 37

importance of follow up visits and lab work
-importance of compliance and what drug means for long term health, dietary changes, possible muscle aches, and when to report,
-take at bedtime and take food if GI upset

Front 38

Nicotinic Acid
-what are the expected changes to the cholesterol levels with this drug (4)

Back 38

vasodilation
reduces the production of VLDL,
lowers triglycerides
increases HDL

Front 39

Nicotinic Acid
-when is this drug typically given (3)

or it can be used as an:

Back 39

for pt with high triglycerides(150 is ok) ,
pt who has problems with other cholesterol meds,
pt who have very low HDL (we want it to be 40 or more for it to be normal),

as an adjunct to other cholesterol meds

Front 40

Nicotinic Acid
-side affects?

Back 40

itching, flushing, nausea, indigestion, diarrhea, hyperglycemia


find-hi

Front 41

Lopid:
-what family of drugs is this under?
-what is the action of this drug? (2)
drug interactions:
when is this drug used:

Back 41

-fibric acid derivative
-inhibits synthesis of VLDL, reduces triglycerides

reacts with Warfarin
given for pt with elevated triglyceride levels to lower LDL

Front 42

ASA
-what is it a primary prevention for? why?

(aspirins role in cardiac prevention?)

Back 42

use for primary prevention of MI

because of the antiplatelet aggregation

Front 43

Lidocaine
-what type of cardiac arrhythmia is this drug used to treat?
-what is the other action it does?

Back 43

only for ventricular dysrhythmias




block Na+ channels

Front 44

Lidocaine
-Dosage range for infusion and standard dose IVP
-whats the max?

Back 44

IVP: 1.0-1.5 mg/kg weight based!!!!!!

max 3 mg/kg

Front 45

MI
-review the medication treatment process for these types of patients

tPa (alteplase)
-when is this drug used and how does it work

Back 45

during a stroke, PE, or MI to dissolve clots through enzymatic activation of plasmin

Front 46

tPa (alteplase)

precautions


how is this drug administered?

Back 46

previous hemorrhagic stroke
known intracranial bleed
active internal bleeding
suspected aortic dissection
recent trauma
recent surgery
pregnancy
peptic ulcer
recent internal bleeding




only given IV by trained personal

Front 47

tPa (alteplase)
-which beta blocker is used in this situation?

Back 47

selective beta blockers atenolol or metoprolol = works on beta 1 only

Front 48

Anticoagulants and antiplatelets
-lab values

PT:

Back 48

normal 10-14 seconds

time required to form a fibrin clot PRO TIME

Front 49

Anticoagulants and antiplatelets
-lab values

aPTT

Back 49

normal 25-40
therapeutic 1.5-2.5 x the normal

*evaluates clotting factors*

Front 50

Anticoagulants and antiplatelets
-lab values

INR

Back 50

when anticoagulated 2-3
valve replacement 2.5-3.5

PT value divided by the standard

*how long it takes a person on blood thinners/antiplatelets to clot vs a normal person*

Front 51

Definitions and mechanism of action

Anticoagulant
-what does this mean?

Back 51

disrupts coagulation cascade...

HOW? (2)

drugs that reduce formation of fibrin by inhibiting synthesis of clotting factors ---WHAT CLOTTING FACTORS???

(including factor x and thrombin)

or by inhibiting the activity of clotting factors

disrupts coagulation cascade (clotting process)

Front 52

Definitions and mechanism of action

Antiplatelet

Back 52

suppresses platelet aggregation -----HOW?????????




-inhibits enzyme production for platelet development or blocks ADP receptor

Front 53

Definitions and mechanism of action

thrombolytic

Back 53

remove thrombi that have already formed by promoting conversion of plasminogen to plasmin (an enzyme that degrades the fibrin matrix of thrombi)

Front 54

Heparin

mechanism of action:

what does it cause an interruption of?

what does it prevent?

Back 54

enhances the activity of antithrombin and factor x, components
--cause interruption of generation of thrombin,
---prevents venous thrombosis

Front 55

Heparin

lab monitoring
-aPTT on heparin (therapeutic dose) expected value:

Back 55

60-80

Front 56

Heparin
-patient educations (things a nurse needs to watch for)

what to do when administrating? (3)

-what should you monitor for?
-what should they not have?

Back 56

double check dose with college
- infusions must be on a pump
-dont rub area after administration

-monitor for hypotension, leading precautions
-follow up care lab assessments

S/S associated with bleeding, fall precautions, what to do if cut themselves = PRESSURE!!

no OTC meds

Front 57

Heparin
-drug scale for determining IVP dose
1) typically a pt will receive what?
2) what is the acception?
3) after the bolus, how much do you give?

Back 57

1) a bolus of heparin that's weight based 100 units/kg

2)acceptation if have ACS DVT or CVA start at 80 units/kg,


after bolus 15 units/hr

Front 58

Heparin
-what is the reversal agent

Back 58

1% protamine sulfate

Front 59

Levonox
-know that it is a low molecule weight heparin
-mechanism of action:

Back 59

inactivates factor x and prevents conversion of fibrinogen to fibrin and prothrombin to thrombin

Front 60

Levonox

when is this used (5)

Back 60

treatment of DVT,
prevention of DVT after surgery
PE
trauma
spinal injury

Front 61

Levonox

know that this product is the only one that the patient can self administer
-pt education related to this drug

Back 61

how to self administer
-importance of follow up care and lab assessment
-s/s associated with bleeding
-use a soft toothbrush
-electric razor

Front 62

Warfarin (Coumadin)

action of this drug:
-what is this drug dependent on?

Back 62

antagonist of Vit K, interferes with the synthesis of vitamin K, dependent on clotting factors in the liver

Front 63

Warfarin (Coumadin)

lab monitoring
-INR that indicates therapeutic levels (no valve)

Back 63

2-3

Front 64

Warfarin (Coumadin)

Nursing considerations related to pt education
-what test do you monitor (2)

-what signs of symptoms do you monitor for (2)

Back 64

monitor CBC and platelet
-assess for bleeding

-monitor prior for hematuria
-monitor patient for excessive diarrhea

-interacts with numerous medications
-educate importance of follow up care and lab assessment
-S/S of bleeding
-use soft toothbrush

Front 65

Anemia's
-iron products orally: how should this be administered?

Back 65

300-600 mg in divided doses / 3 times a day

Front 66

Anemia's
-pt education: general

when should you take this during the day?

what test do you monitor them on?

what is a side effect that is an issue with this medication?

what does the liquid preparation do your teeth?

how long will it take to see the effects?

Back 66

-foods can decrease absorption so take between meals


-monitor HGM and HCT


-discuss ways to manage constipation


-caution that liquid iron preparations stain teeth
-use a straw and dilute


-takes 3-6 months to see effects

Front 67

Vitamin B 12 deficiency
-why is B12 important and what system can be effected if a deficiency is present?

Back 67

restores normal synthesis of DNA and maintains mylenation of neurons
-anemia and injury to the nervous system
-GI disturbances
-impaired production of WBC and platelets

Front 68

Vitamin B 12
-how is IM injection given
-what's the dosage

Back 68

z track method
30-100 mcq daily for 5-10 days; and then 100-200mcq once a month

Front 69

Erythropoiesis- stimulating agents

-what type of patient would receive these and why?

-what other 2 types of pt would use these

Back 69

for patient receiving chemotherapy and suppressed bone marrow because it stimulates bone marrow (increases RBC)

AIDS
chronic renal failure