Pharmacology Mod Iv

Front 1

The most common form of digitalis is ______.

Back 1

digoxin

Front 2

What is the drug class, and rationale for use in HF for the prototype drug spironolactone (Aldactone)?

Back 2

Drug Class: Aldosterone antagonist/potassium-sparing diuretic
Rationale for Use in HF: Reduces preload/afterload Therapeutic Effects: Weak diuretic and antihypertensive response when compared with other diuretics. Conservation of potassium.

Hint 2

Therapeutic: diuretics
Pharmacologic: potassium-sparing diuretics
Adverse Reactions/Side Effects: F and E: hyperkalemia

Front 3

What is the drug class, therapeutic effects, and rationale for use in HF for the prototype drug captopril (Capoten)?

Back 3

Drug Class: Angiotensin-converting enzyme inhibitor
Rationale for Use in HF: Reduces preload/afterload
Therapeutic Effects: Lowering of BP in HTN patients. Improved symptoms in patients with CHF (selected agents only). Decreased development of overt HF (enalapril only). Improved survival and reduced development of overt CHF after MI (selected agents only). Decreased risk of death from cardiovascular causes or MI in patients with stable CAD (perindopril only). Decreased risk of MI, stroke or death from cardiovascular causes in high-risk patients (ramipril only). Decreased progression of diabetic nephropathy (captopril only).

Hint 3

Therapeutic: antihypertensives
Pharmacologic: ACE inhibitors
Adverse Reactions/Side Effects:
Resp: cough
CV: hypotension
GI: taste disturbances
Hemat: AGRANULOCYTOSIS
Misc: ANGIOEDEMA

Front 4

What is the drug class, therapeutic effects, and rationale for use in HF for the prototype drug losartan (Cozaar)?

Back 4

Drug Class:
Rationale for Use in HF:
Therapeutic Effects: Lowering of BP. Slowed progression of diabetic nephropathy (irbesartan and losartan only). Reduced cardiovascular death and hospitalizations due to CHF in patients with CHF (candesartan and valsartan only). Decreased risk of cardiovascular death in pts with left ventricular systolic dysfunction who are post-MI (valsartan only). Decreased risk of stroke in pts with HTN and left ventricular hypertrophy (effect may be less in black patients) (losartan only).

Hint 4

Therapeutic: antihypertensives
Pharmacologic: angiotensin II receptor antagonists
Adverse Reactions/Side Effects:
CNS: dizziness
CV: hypotension
Misc: ANGIOEDEMA

Front 5

What is the drug class, therapeutic effects, and rationale for use in HF for the prototype drug nesiritide (Natrecor)?

Back 5

Drug Class: B-type natriuretic peptide
Rationale for Use in HF: Reduces preload/afterload
Therapeutic Effects: Dose-dependent reduction in pulmonary capillary wedge pressure (PCWP) and systemic arterial pressure in patients with HF with resultant decrease in dyspnea.

Hint 5

Therapeutic: none assigned
Pharmacologic: vasodilators (human B-type natriuretic peptide)
Adverse Reactions/Side Effects
Resp: APNEA
CV: hypotension

Front 6

What is the drug class, therapeutic effects, and rationale for use in HF for the prototype drug carvedilol (Coreg)?

Back 6

Drug Class: B-Adrenergic blocker
Rationale for Use in HF: Use limited to low dose in otherwise stable pts; reduces adrenergic overstimulation
Therapeutic Effects: Decreased heart rate and blood pressure. Improved cardiac output, slowing of the progression of CHF and decreased risk of death.

Hint 6

Therapeutic: antihypertensives
Pharmacologic: beta blockersAdverse Reactions/Side Effects
CNS: dizziness, fatigue, weakness
CV: BRADYCARDIA, CHF, PULMONARY EDEMA
GI: diarrhea
GU: erectile dysfunction
Endo: hyperglycemia

Front 7

Drugs that ↑(CHF) cause Na & water retention or expand intravascular volume?

Back 7

albumin, androgens, corticosteroids, diazoxide, estrogens, guanethidine, mannitol, methyldoap, minoxidil, NSAID's

Front 8

Common signs of digoxin toxicity in children?

Back 8

N/V, anorexia, bradycardia, and dysrhythmias

Hint 8

Digoxin
Special consideratins for children

Front 9

Digoxin is not given if the pulse is below ___ to ___ beats/min in infants and young children or below ___ beats/min in older children.

Back 9

90 to 100; 70

Hint 9

Digoxin
Special consideratins for children

Front 10

When adm ______ to children, double check all calculations with another HCP.

Back 10

digoxin

Hint 10

Digoxin
Special consideratins for children

Front 11

Early signs of HF in children include?

Back 11

tachycardia, increased fatigue and irritability, a sudden weight gain, respiratory distress, and profuse scalp sweating,

Hint 11

Digoxin
Special consideratins for children

Front 12

Cardiac Drugs that can cause dysrhythmias?

Back 12

amiodarone, disopyramide, dofetilide, ibutilide, procainamide, quinidine, sotalol

Hint 12

Drugs That Can Cause Cardiac Dysrhythmias:
Durgs That Prolong QT Interval

Front 13

Antipsychotics that can cause dysrhythmias?

Back 13

chlorpromazine, haloperidol, mesoridazine, pimozide, risperidone, thioridazine

Hint 13

Drugs That Can Cause Cardiac Dysrhythmias:
Durgs That Prolong QT Interval

Front 14

Antidepressants that can cause dysrhythmias?

Back 14

amitriptyline, desipramine, imipramine, maprotiline, nortriptyline

Hint 14

Drugs That Can Cause Cardiac Dysrhythmias:
Durgs That Prolong QT Interval

Front 15

Other drugs that can cause dysrhythmias?

Back 15

chloroquine, clarithromycin, domperidone, droperidol

Hint 15

Drugs That Can Cause Cardiac Dysrhythmias:
Durgs That Prolong QT Interval

Front 16

Drugs removed from market or limited availability that can cause dysrhythmias?

Back 16

astemizole, bepridil, cisapride, sparfloxacin, terfenadine

Hint 16

Drugs That Can Cause Cardiac Dysrhythmias

Front 17

Drugs causing bradycardia and/or AV block?

Back 17

β-adrenergic blockers, digoxin, diltiazem, verapamil

Hint 17

Drugs That Can Cause Cardiac Dysrhythmias

Front 18

Drugs causing tachycardia?

Back 18

Amphetamines, Antihypertensives (via reflex tachycardia), β-adrenergic agonists, caffeine, pseudoephedrine, Stimulants, theophylline, Withdrawal of β-adrenergic blockers

Hint 18

Drugs That Can Cause Cardiac Dysrhythmias

Front 19

Group I-A Antidysrhythmic drugs:

Back 19

disopyramide, procainamide, quinidine

Hint 19

Antidysrhythmics:
Used to tx abnormal electrical activity in the heart by limiting cardiac electrical activity to normal conduction pathways and ↓ abnormally rapid heart rates

Front 20

Group I-B Antidysrhythmic drugs:

Back 20

lidocaine, tocainide, mexiletine

Hint 20

Antidysrhythmics:
Used to tx abnormal electrical activity in the heart by limiting cardiac electrical activity to normal conduction pathways and ↓ abnormally rapid heart rates

Front 21

Group I-C Antidysrhythmic drugs:

Back 21

flecainide, propafenone

Hint 21

Antidysrhythmics:
Used to tx abnormal electrical activity in the heart by limiting cardiac electrical activity to normal conduction pathways and ↓ abnormally rapid heart rates

Front 22

Group I (A,B,C) Antidysrhythmic drugs:

Back 22

moricizine (The only class I drug); Used to manage life threatening ventricular arrhythmias, such as sustained ventricular tachycardia; possess local anesthetic and myocardial membrane stabilizing effects; adverse reactions- the appearance of a proarrhythmia that occurs when another arrhythmia is present

Hint 22

Antidysrhythmics:
Used to tx abnormal electrical activity in the heart by limiting cardiac electrical activity to normal conduction pathways and ↓ abnormally rapid heart rates

Front 23

Group II Antidysrhythmic drugs:

Back 23

propranolol

Hint 23

Antidysrhythmics:
Used to tx abnormal electrical activity in the heart by limiting cardiac electrical activity to normal conduction pathways and ↓ abnormally rapid heart rates

Front 24

Group III Antidysrhythmic drugs:

Back 24

bretylium, amiodarone, dofetilide, sotalol

Hint 24

Antidysrhythmics:
Used to tx abnormal electrical activity in the heart by limiting cardiac electrical activity to normal conduction pathways and ↓ abnormally rapid heart rates

Front 25

Group IV Antidysrhythmic drugs:

Back 25

diltiazem, verapamil, adenosine

Hint 25

Antidysrhythmics:
Used to tx abnormal electrical activity in the heart by limiting cardiac electrical activity to normal conduction pathways and ↓ abnormally rapid heart rates

Front 26

______ is contraindicated in a number of cardiac rhythm disturbances, including Adams-Stokes syndrome (sudden, recurring episodes of LOC, caused by the transient interruption of cardiac output by incomplete or complete heart block), Wolff-Parkinson-White syndrome (a supraventricular tachycardia), and severe AV block.

Back 26

Lidocaine

Hint 26

Sodium channel blockers
Class 1B

Front 27

The sodium channel blockers moricizine (Ethmozine), flecainide (Tambocar), and propafenone (Rythmol) can cause ______, as an adverse affect.

Back 27

proarrhythmias; Tambocar/Rythmol gives pt a metallic taste

Hint 27

Sodium channel blockers
Class 1, 1C respectively

Front 28

Tikosyn, Corvert, and Betapace adverse effects include ______ ______ ______ and prolonged ___ interval.

Back 28

torsades de pointes; QT

Hint 28

Antidysrhythmics
Class III

Front 29

Hypovolemia s/sx:

Back 29

hypotension, weak pulse, tachycardia, clammy skin, repid respirations, and reduced urinary output

Front 30

Hyponatremia s/sx:

Back 30

love serum sodium levels (normal range 135 to 1415 mEq/L, lethargy, disorientation, muscle tenseness, seizures, and coma

Front 31

Hypocalcemia s/sx:

Back 31

love serum calcium levels (normal range 8.5 to 10 g/dL, irritability, vomiting, diarrhea, twitching, hyperactive reflexes, cardiac dysrhythmias, tentany, and seizures

Front 32

Hypomagnesemia s/sx:

Back 32

low serum magnesium levels (normal range 1.5 to 2.5 mEq/L, NV, lethargy, uuscle weakness, tremors, and tetany

Front 33

Hyperkalemia s/sx:

Back 33

above-normal values for K+ (normal range 3.5 - 5.0) serum levels, nausea, diarrhea, muscle weakness, postural hypotension, and ECG changes

Front 34

Expected outcomes for diuretic therapy:

Back 34

Return to normal electrolyte values; demonstrate normal cardiac output AEB VS (BP 120/80 mm Hg, P>60<100, RR 12-20 BPM),, and appropriate fluid balance ratios; absence of adventitious lung sounds and dependent edema; no adverse effects of diuretic therapy; effectively manage the therapeutic regimen including med compliance, daily wts., monitoring VS, low Ns diet, changing positions slowly, reporting adverse effects appropriately, and maintaining prescriber visits for monitoring and following up care

Front 35

Fruits rich in K+:

Back 35

apple, raw, with skin; banana, medium, cantaloupe; dates, dried; figs, dried; orange, navel; prunes, dried; raisins, seedless;

Front 36

Vegetables rich in K+:

Back 36

Artichoke, boiled; asparagus, boiled; avocado, raw; broccoli, raw; brussels sprouts, boiled; carrots, raw; corn, yellow, boiled; mushrooms, boiled; patato, baked wth skin; spinach, boiled; sweet potato, baked; tomato, raw

Front 37

Meat, poultry, and fish rich in K+:

Back 37

Beef, top round, lean, broiled; chicken, dark meat, roasted, witout skin; chicken, light meat, roasted, without skin; halibut, baked; salmon, beaked; trout, rainbow, baked

Front 38

Drinks rich in K+:

Back 38

Milk, whole, skim; orange juice, fresh

Front 39

While on diuretics move carefully from a sitting or lying position to an upright position because of positional ______ hypotension

Back 39

orthostatic

Hint 39

Client Edu for Diuretic Therapy

Front 40

While on diuretics alcohol ingestion, hot weather, and standing or lying for long periods also increases the risk of ______ hypotension.

Back 40

orthostatic

Hint 40

Client Edu for Diuretic Therapy

Front 41

While on diuretics weigh ______ on arising on the same scale in similar clothing. Report any overnight ___ lbs increase to the prescriber.

Back 41

daily; 2

Hint 41

Client Edu for Diuretic Therapy

Front 42

While on diuretics take you ______ & ______ as often as directed by your prescriber. Maintain a record to take for office visits.

Back 42

P & BP

Hint 42

Client Edu for Diuretic Therapy

Front 43

While on diuretics electrolyte imbalances may occur, particulaly ______ (loop idiuretics, thiazide and thiazide-like diuretics) or ______ ( potassium-sparing diuretics).

Back 43

hypokalemia; hyperkalemia

Hint 43

Client Edu for Diuretic Therapy

Front 44

While on diuretics ______ changes may be required to support a high potassium (except for potassium-saring diuretics) and low sodium diet

Back 44

Dietary

Hint 44

Client Edu for Diuretic Therapy

Front 45

While on diuretics ______ of mouth may occur. Use sugarless candies or small sips of water or ice chip for relief (unless on fluid restriction).

Back 45

dryness

Hint 45

Client Edu for Diuretic Therapy

Front 46

While on diuretics maintain regular dental checkups to monitor the development of ______ and ______ disease, which may occur as the result of xerostomia (cotton mouth).

Back 46

caries & gum

Hint 46

Client Edu for Diuretic Therapy

Front 47

While on diuretics ______ may be prevented by a high-fiber diet, adequate amounts of fluid (unless restricted), moderate exercise, and establishing a routine.

Back 47

constipation

Hint 47

Client Edu for Diuretic Therapy

Front 48

While on diuretics If constipation becomes problematic, ask your precriber for a recommendations for a ______ ______ or ______

Back 48

stool softener or laxative

Hint 48

Client Edu for Diuretic Therapy

Front 49

Indepth interview is indicated to determine if client is a candidate for therapy for ______ agents.

Back 49

thrombolytic eg, streptokinase, Eminase

Hint 49

thrombolytic Agents or Fibrinolytics

Front 50

Genetic markers may explain the observation of improved outcomes in some ______ clients.

Back 50

black

Hint 50

Special Considerations for pharmacogenetics

Front 51

Angiotensin-converting enzyme inhibitors are more likely to produce ______ in women than in men. hei finding is believed to be ______ based

Back 51

cough; genetically

Hint 51

Special Considerations for Pharmacogenetics

Front 52

Early signs of HF in ______ include tachycardia (especially during rest and minimum activity), increased fatigue and irritability, a sudden weight gain, respiratory distress, and profuse scalp sweating, especially in ______.

Back 52

children; infants

Hint 52

Digoxin:
Special Considerations for children

Front 53

Individualize dosing with very close ______, especially in ______.

Back 53

monitoring; infants

Hint 53

Digoxin:
Special Considerations for children

Front 54

Be extremely careful in ______ digoxin doses; a placement error of one decimal point can increase the dose 10-fold. Double check all calculations with another ______.

Back 54

calculating; nurse, pharmacist, or physician

Hint 54

Digoxin:
Special Considerations for children

Front 55

Common signs of digoxin toxicity in children include:

Back 55

NV, anorexia, bradycardia, and dysrhythmias

Hint 55

Digoxin:
Special Considerations for children

Front 56

Digoxin is not given if the pulse is below ___ to ___ beats/min in infants and young children or below ___ beats/min in older children.

Back 56

90 to 110; 70

Hint 56

Digoxin:
Special Considerations for children

Front 57

If the child is monitored by an ECG, obtain a ______ strip to attach to includ in the chart for rate and rhythm analysis, such as prolongation of the PR interval and dysrhythmias

Back 57

rhythm

Hint 57

Digoxin:
Special Considerations for children

Front 58

Give digoxin on a regular time schedule, either ___ hour before or ___ hours after feedings

Back 58

1; 2

Hint 58

Digoxin:
Special Considerations for children

Front 59

Older adults often have a reduced tolerance for ______; thus ______ dosages may be necessary to reduce the potential for durg toxicity because of an age-related decrease in renal function and decreased volume of distribution because of decreased muscle mass

Back 59

digoxin; lower

Hint 59

Digoxin
Special Considerations for Older Adults

Front 60

Early toxic signs in GERI pts often include:

Back 60

anorexia, NV, difficulty with reading, which mappear as visual alterations such as green and yellow vision, double vision, or seeing spots or halos; HA; dizziness; fatigue; weakness; confusion; depression; increased nervousness; and diarrhea

Hint 60

Digoxin
Special Considerations for Older Adults

Front 61

Decreased ______ and ______ are reported in approximately 35% of males as a result of the etrogen-type effects of digoxin.

Back 61

libido and impotency

Hint 61

Digoxin
Special Considerations for Older Adults

Front 62

______ enlargement and tenderness also are reported in males

Back 62

breast

Hint 62

Digoxin
Special Considerations for Older Adults

Front 63

Exercise ______ serum levels of digoxin because of increased uptake in skeletal muscles. The RN must be cognizant of the physical activity of pts who are taking digoxin.

Back 63

reduces

Hint 63

Digoxin
Special Considerations for Older Adults

Front 64

______, which are commonly taken by older adults, may reduce the absorption of digoxin. Do not administer these drugs ______.

Back 64

Laxatives; concurrently

Hint 64

Digoxin
Special Considerations for Older Adults

Front 65

Dietary bran fiber may affect digoxin ______; have pts take digoxin ___ hour before or ___ hours after having bran

Back 65

bioavailability; 1; 2

Hint 65

Digoxin
Special Considerations for Older Adults

Front 66

Antidiotics with Na content:

Back 66

Tica 120-150 mg/g
Velosef 136 mg/g
Rocephin 83 mg/g

Hint 66

Sodium Content of Selected Prescription and OTC Meds

Front 67

OTC meds with Na content:

Back 67

Alka-Seltzer (Lemon-Lime, Original) 0.5g-567mg/tablet

Hint 67

Sodium Content of Selected Prescription and OTC Meds

Front 68

Food supplements with Na content:

Back 68

Sustacal 924-940 mg/L
Meritene 880-1078 mg/L Ensure 844 mg/L;

Hint 68

Sodium Content of Selected Prescription and OTC Meds

Front 69

Take the ______ pulse before adm any cardiac gllycosides eg, digoxin. Do not give if pulse is below ___ bpm. Do not give digoxin ___.

Back 69

apical; 60; IM