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Questions and Answers
Which side effect is commonly associated with diphenhydramine?
Which side effect is commonly associated with diphenhydramine?
What is a nursing consideration for patients using intranasal glucocorticoids?
What is a nursing consideration for patients using intranasal glucocorticoids?
What does LABA stand for in respiratory pharmacology?
What does LABA stand for in respiratory pharmacology?
What can be an indicator of theophylline toxicity?
What can be an indicator of theophylline toxicity?
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Which medication is used as a short-acting beta-2 agonist (SABA) for acute asthma attacks?
Which medication is used as a short-acting beta-2 agonist (SABA) for acute asthma attacks?
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What is the primary purpose of statins in the treatment of cardiovascular diseases?
What is the primary purpose of statins in the treatment of cardiovascular diseases?
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What laboratory tests are critical to monitor in patients taking statins?
What laboratory tests are critical to monitor in patients taking statins?
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Which of the following is an absolute contraindication for the use of statins?
Which of the following is an absolute contraindication for the use of statins?
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What is the most serious adverse effect associated with statin use, and what symptom indicates this complication?
What is the most serious adverse effect associated with statin use, and what symptom indicates this complication?
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Which dietary recommendations should patients on statins follow?
Which dietary recommendations should patients on statins follow?
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What laboratory test is routinely monitored for patients taking warfarin?
What laboratory test is routinely monitored for patients taking warfarin?
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What is the recommended method of administration for enoxaparin?
What is the recommended method of administration for enoxaparin?
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Which anticoagulant does NOT require regular lab monitoring?
Which anticoagulant does NOT require regular lab monitoring?
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What is the antidote for warfarin overdose?
What is the antidote for warfarin overdose?
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What serious side effect is associated with the use of antiplatelet medications such as clopidogrel?
What serious side effect is associated with the use of antiplatelet medications such as clopidogrel?
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Which diuretic type does Furosemide belong to?
Which diuretic type does Furosemide belong to?
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What dietary consideration should be followed when taking potassium-sparing diuretics?
What dietary consideration should be followed when taking potassium-sparing diuretics?
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Which of the following effects can Spironolactone have?
Which of the following effects can Spironolactone have?
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What is a common side effect of Ferrous Sulfate?
What is a common side effect of Ferrous Sulfate?
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Which factor primarily stimulates red blood cell production?
Which factor primarily stimulates red blood cell production?
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What substance would require a decreased dose of theophylline due to increased blood levels?
What substance would require a decreased dose of theophylline due to increased blood levels?
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Which inhaler type is classified as a long-acting anti-cholinergic?
Which inhaler type is classified as a long-acting anti-cholinergic?
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What is the mechanism of action for Montelukast?
What is the mechanism of action for Montelukast?
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Which step is NOT part of the instructions for using a Metered Dose Inhaler (MDI)?
Which step is NOT part of the instructions for using a Metered Dose Inhaler (MDI)?
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When should Montelukast be taken for optimal effectiveness?
When should Montelukast be taken for optimal effectiveness?
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What is the effect of a negative inotrope on the heart?
What is the effect of a negative inotrope on the heart?
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Under what condition should a dose of metoprolol be held?
Under what condition should a dose of metoprolol be held?
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Which statement about selective and non-selective beta blockers is true?
Which statement about selective and non-selective beta blockers is true?
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What is a key teaching point for patients taking beta blockers?
What is a key teaching point for patients taking beta blockers?
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What is the role of Angiotensin II in the body?
What is the role of Angiotensin II in the body?
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What is the therapeutic range for digoxin levels?
What is the therapeutic range for digoxin levels?
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Which symptom is indicative of digoxin toxicity?
Which symptom is indicative of digoxin toxicity?
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What lab value indicates that a patient on heparin may be at risk for bleeding?
What lab value indicates that a patient on heparin may be at risk for bleeding?
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Which of the following is the antidote for heparin?
Which of the following is the antidote for heparin?
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How do low potassium levels affect digoxin therapy?
How do low potassium levels affect digoxin therapy?
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What is a significant risk associated with high doses of codeine?
What is a significant risk associated with high doses of codeine?
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Which of the following is a primary use for acetylcysteine?
Which of the following is a primary use for acetylcysteine?
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Which antihistamine is known for causing paradoxical excitation, especially in children?
Which antihistamine is known for causing paradoxical excitation, especially in children?
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What is a common side effect of dextromethorphan when taken in high doses?
What is a common side effect of dextromethorphan when taken in high doses?
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What is a critical consideration when administering guaifenesin?
What is a critical consideration when administering guaifenesin?
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Which condition is a contraindication for the use of the drug being discussed?
Which condition is a contraindication for the use of the drug being discussed?
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What is a side effect associated with fibrates?
What is a side effect associated with fibrates?
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What lab values should be monitored for a patient taking gemfibrozil?
What lab values should be monitored for a patient taking gemfibrozil?
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How does ezetimibe help in cholesterol management?
How does ezetimibe help in cholesterol management?
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What effect do beta blockers have on adrenergic receptors?
What effect do beta blockers have on adrenergic receptors?
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What side effect is specifically associated with amlodipine?
What side effect is specifically associated with amlodipine?
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For which population group do calcium channel blockers show greater effectiveness compared to other antihypertensive classes?
For which population group do calcium channel blockers show greater effectiveness compared to other antihypertensive classes?
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What is an important consideration when using a transdermal nitroglycerin patch?
What is an important consideration when using a transdermal nitroglycerin patch?
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How should sublingual nitroglycerin be administered?
How should sublingual nitroglycerin be administered?
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Which symptom is common following the administration of nitroglycerin?
Which symptom is common following the administration of nitroglycerin?
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Study Notes
Antihyperlipidemic
-
HMG-CoA reductase Inhibitors ("statins")
- Atorvastatin: Used for primary prevention of cardiovascular disease, and risk of MI or stroke
- Take in the evening
- Important labs to monitor: Liver labs, AST, ALT
- Absolute contraindication: Pregnancy
- Diet recommendations: Avoid grapefruit juice, Avoid alcohol
- Side Effects: Rash, Diarrhea, Abdominal cramps, Rhabdomyolysis
- Most serious adverse effect: Rhabdomyolysis - muscle pain
- What do statins treat? High cholesterol
- Atorvastatin: Used for primary prevention of cardiovascular disease, and risk of MI or stroke
-
Bile Acid Resins
- Cholestyramine:
- Side effects: Constipation, Headache, Gall stones, GI upset, Dyspepsia
- Drug of choice for pregnant women
- Treatment: High cholesterol
- Mechanism: Works in the intestines
- Considerations: Drink fluids (constipation)
- Cholestyramine:
Anticoagulants
-
Enoxaparin
- Monitoring: APTT (45 to 90 degrees)
- Administer: Subcutaneous tissue
- Considerations: Do not administer IM, Rotate injection sites
- Important to Know: Takes 2 to 3 weeks to work
-
Warfarin
- Mechanism: Interferes with hepatic synthesis of Vitamin K, Prolongs clotting time
- Antidote: Vitamin K
- Lab Monitoring: INR
-
Rivaroxaban
- Lab Monitoring: Not frequently needed
-
SE: SYNCOPE
- Lab Monitoring: ALT & AST
Antiplatelets
-
Clopidogrel
- Mechanism: Inhibits platelet aggregation
- Caution: Bleeding risk, hepatic impairment, History of GI bleeding
-
Aspirin
- Mechanism: Antiplatelet
Anticoagulant Antagonists
-
Phytonadione (Vitamin K)
- Antidote: Warfarin
-
Protamine Sulfate
- Antidote: Heparin
Renal Medications
- Diuretics
- Loop - Furosemide (Loop diuretic): Potassium-Wasting diuretic
- Potassium-Sparing - Spironolactone: Potassium sparing diuretic, avoid potassium-rich foods
- Thiazides - Hydrochlorothiazide (HCTZ): Thiazide diuretic
Dietary Considerations for Potassium-Wasting vs. Potassium-Sparing Diuretics
- Potassium-Wasting: Encourage consistency of vitamin K intake
- Potassium-Sparing: Avoid vitamin K foods, Avoid salt substitutes (like Mrs.Dash)
Potassium-Rich Foods
- Leafy greens (spinach, cabbage, broccoli, squash)
Diuretic with Antiandrogenic Effects
- Spironolactone (can cause gynecomastia and irregular menses)
Hematopoietic Growth Factors
-
Erythropoietin
- Mechanism: Stimulates erythropoiesis (red blood cell production)
Ferrous Sulfate (Iron)
- Mechanism: Increases iron levels
- Administration: Administer 1 hour before or after meals
- Considerations: May cause constipation, May cause black/dark stools and stained teeth
- Importance: Oral hygiene is important
- Labs to monitor: Hematocrit, Hemoglobin
Role in RBC Formation
- Erythropoietin and iron play a role in red blood cell formation
Inhaler Information
-
Theophylline
- Factors that increase theophylline blood levels (require decreased dose): Chocolate and caffeine
- Factors that decrease theophylline blood levels (require increased dose): Smoking
Inhaler Types and Instructions
- Ipratropium: Short-acting anti-cholinergic
- Tiotropium: Anti-cholinergic (long-acting)
-
Metered Dose Inhaler (MDI) Instructions:
- Exhale
- Shake
- Prime
- Inhale with spacer
- Hold breath for 10 seconds
- Rinse mouth
-
Dry Powder Inhaler (DPI) Instructions:
- Do not exceed dosage recommendations
- Wash mouth for thrush
Antiasthma/Anti-inflammatory Agents
- Fluticasone/Salmeterol
- Montelukast: Used when other options haven't been effective
Montelukast - Mechanism of Action, Nursing Considerations, and Teaching Reinforcement
- Mechanism of Action: Blocks leukotriene receptors, decreasing inflammation
- Nursing Considerations: Safe for 12 months, Can be chewable or granulated
- Teaching Reinforcement: Take two hours prior to exercise
Considerations when multiple inhaler classes are ordered:
- Check the order
- See what it is used for
Beta-Blockers
- Negative Inotropic: Force of contraction
- Negative chronotropic: Timing
- Negative Dromotropic: Electricity
- Metoprolol (Selective) - Hold dose if BP lower than 60 systolic and pulse < 60 bpm
- Propranolol (Non-Selective) - Monitor Blood Sugar because it masks signs & symptoms
- Important to know: Selective beta blocker works on certain receptors, whereas a non-selective one will not bind to certain ones & will mask other systems
- Carvedilol affects: Beta 1, Beta 2, and Alpha 1
- Heart Failure: Don't want patients taking beta-blockers if they have acute heart failure
- Important Teaching: Don't stop abruptly
- Off label uses: Migraines and tremors
Explain the RAAS system:
- Renin release: Triggers when blood pressure is low
- What does renin do? Catalyzes the conversion of angiotensinogen to angiotensin I
-
What is ACE, where is it found, and what does it do?
- Angiotensin-converting enzyme is found in the lungs and converts angiotensin I to angiotensin II
- Function of Angiotensin II: It vasoconstricts and increases aldosterone secretion
- Aldosterone: Comes from the adrenal gland and causes sodium retention (and water retention) and potassium excretion
-
Angiotensin Converting Enzyme Inhibitors (ACE-I) "pril"
- Lisinopril
Cardiac Glycosides
- Digoxin: No longer used as first-line therapy, Therapeutic range: 0.5-2.0 ng/mL
- Relationship with Potassium Levels: Low potassium levels increase the risk of digoxin toxicity
- Symptoms of Digoxin Toxicity: Bradycardia, Hypokalemia, Anorexia, Nausea/Vomiting (N/V), Yellow-green halos, Arrhythmias
Antiarrhythmic
- Amiodarone
Anticoagulants
-
Heparin
- Mechanism: Prolongs clotting time
- Antidote: Protamine Sulfate
- Lab Monitored: Activated Partial Thromboplastin Time (APTT)
-
APTT Interpretation:
- ↑ APTT = Too long for clotting, risk for bleeding
- ↓ APTT = Increase dosage because clotting is happening too fast
-
Fibrates
- Gemfibrozil: Decreases (↓) triglyceride production by the liver, ↑ good HDL levels
- Labs to monitor: BUN, Creatinine, ALT, AST
- Side effects: Abdominal pain, Nausea, Gall stones, Diarrhea, Epigastric pain, Renal/hepatic impairment, Gall bladder disease, Concurrent use of statins
-
Other
- Ezetimibe: Do not take if pregnant, Liver disease impairment
- Niacin: Contraindication if pregnant
-
Role in Cholesterol Management:
- Ezetimibe: Ezetimibe inhibits the absorption of cholesterol in the small intestine
- Niacin: Stops the removal of HDL- good cholesterol
- Vitamin B3
- Common Side Effect of Niacin: Nausea, vomiting, dizziness
- How to Manage Side Effects of Niacin: Drink flat soda, eat crackers
Antihypertensive: Beta Blockers
- Metoprolol (selective): Beta 1 blocker
- Propranolol (Non-selective): Beta 1 and Beta 2 blocker
- Considerations: Monitor Blood Sugar because it masks signs & symptoms
What is a beta blocker blocking?
- Blocks the stimulation of beta-1 (myocardial (heart)) and beta-2 (lungs) adrenergic receptors
Calcium Channel Blockers (CCB)
-
Side effects specific to CCB (calcium channel blockers) verapamil vs amlodipine:
- Amlodipine: Pedal edema, gingival hyperplasia
- Verapamil: Hypotension, palpitations, constipation
- Effectiveness: For African Americans, CCB's have greater effectiveness as compared to other antihypertensive classes.
- Dietary modifications: Drink fluids
Antianginal: Nitroglycerin (discuss forms)
- Mechanism of Action of NTG: Increases coronary (heart) blood flow
- Routes of administration: Patch (transdermal), IV solution, Pill (oral), Translingual sprays, Under the tongue (sublingual)
- Transdermal patch considerations: Remove patch at bedtime for 8-12 hours, so there is no tolerance development
-
Sublingual NTG administration:
- Drink water before administering tablet
- Do not chew tablet
- Give 1 tablet every 5 minutes (3 times), call 911 if pain isn't relieved or if it worsens after first dose
- Store at room temperature, out of sun, remove cotton
- Important to know about sublingual NTG: No first-pass effect when taking properly
- Managing pain: Give acetaminophen for headache
Antititussives
-
Codeine:
- Mechanism: Relieves cough
- Considerations: Important to drink fluids, Monitor cough for 1 week, Increase fiber intake
- Important to know: Inhibits cough reflex and leads to respiratory depression if high doses are taken
-
Dextromethorphan:
- Mechanism: Depresses cough receptors in the throat, lungs, trachea
- Considerations May cause hallucinations in high doses
- Important to know: Encourage fluid intake, and monitor for dizziness
- Important to know: Avoid driving
Expectorants
-
Guaifenesin:
- Mechanism: Loosens mucus from respiratory tract
- Considerations: Avoid taking with CNS depressants or alcohol
- Side Effects: May cause skin rash, headaches, or difficulty breathing (NIV)
- Important to know: Safe in all ages, including pregnancy, and can be used during breastfeeding
Mucolytics
-
Acetylcysteine (oral, IV, topically by nebulizer):
- Considerations: Oral administration is better tolerated
- Important to assess: Bilirubin levels
- Indications: Overdose on acetaminophen, COPD, Asthma, cystic fibrosis
Antihistamines
-
Diphenhydramine:
- Side Effects: Dizziness, hypotension, dry mouth, nausea, photosensitivity, Paradoxical excitation in children, constipation
-
Cetirizine:
- Important to know: Anticholinergic effects minimal, and sedation is dose-related
Difference between Antihistamines:
- First-generation (Diphenhydramine): More side effects
- Second-generation (Cetirizine): Fewer side effects
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Description
This quiz covers important medications used to manage cholesterol levels and prevent blood clots. Key drug classes include statins and anticoagulants, along with their side effects, monitoring parameters, and dietary considerations. Perfect for students learning about pharmacology and clinical applications.
