NUR 354 Pharm II Exam 2 Review PDF

Summary

This document is a study guide for NUR 354 Pharmacology II Exam 2. It includes information on medications, their actions, and possible side effects. This is for an undergraduate course in nursing at an Arizona college.

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lOMoARcPSD|40142722 NUR 354 Pharm II Exam 2 Review Pharmacology II (Arizona College of Nursing) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by James Jonez ([email protected]) ...

lOMoARcPSD|40142722 NUR 354 Pharm II Exam 2 Review Pharmacology II (Arizona College of Nursing) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by James Jonez ([email protected]) lOMoARcPSD|40142722 NUR354 Pharm II Exam 2 Study Guide  MI o Pathophysiology  Sudden reduced blood flow to the heart caused by cell death (necrosis) by ischemia (lack of oxygen) due to a clot or obstruction/occlusion o Reteplase  Route  IV Bolus  Classification  Thrombolytics  Complications  Gingival bleeding  Epistaxis  Ecchymosis  Bleeding at IV sites  Intracranial hemorrhage  Bleeding GI, GU  Dysrhythmias o Beta blockers  Prototype Drug: Atenolol  Pharmacological action/Pathophysiology  Dilate arteries, lower BP to decrease workload of the heart  Decrease HR, reduce workload and dilate coronary arteries  Angina o Pathophysiology  Reduced blood flow to the heart caused by ischemia due to clot or obstruction/occlusion o S/S  Stable angina  Occurrences are fairly predictable to frequency, intensity, and duration  Unstable angina  Chest pain arise more frequently, become more intense and occur during periods of rests  Silent ischemia  Absent of chest pain  Asymptomatic o Nitroglycerin  Patient assessment/findings  Monitor BP and pulse  Monitor with ECG  Patient/family education/instructions Downloaded by James Jonez ([email protected]) lOMoARcPSD|40142722 NUR354 Pharm II Exam 2 Study Guide   Contraindications  Should NOT be given pts. with preexisting hypotension or with high ICP or head trauma  Pericardial tamponade and constrictive pericarditis  Pts. with glaucoma as it may increase ICP  Dehydration or hypovolemia should be corrected before nitroglycerin otherwise serious hypotension may result  Adverse effects/common SE  Headache **  Orthostatic Hypotension  Reflex tachycardia  Tolerance  Burning/tingling of tongue  Expected outcome  HR will become within normal ranges   Route(s) of administration  IV if in ICU  Topical ointment  Transdermal *  PO  Sublingual; under the tongue 3x every 5 mins; call 911 if first *  Buccal o PCIs  Percutaneous Coronary Intervention  Atherectomy (removing the plaque) or angioplasty (compressing the plaque against the vessel wall)  Stent may be inserted  Priority actions  12 leaps for ECG   RAAS (Renin-Angiotensin-Aldosterone-System) o Hormones involved  Aldosterone o How it works  Manages our BP; to increase BP with Angiotensin II  Steps:  BP drops  Sympathetic nervous system (fight or flight) is stimulated  Kidneys release renin from juxtaglomerular cells  Activated angiotensinogen in liver and creates Angiotensin I  ACE converts Angiotensin I to Angiotensin II which secretes Aldosterone Downloaded by James Jonez ([email protected]) lOMoARcPSD|40142722 NUR354 Pharm II Exam 2 Study Guide  Angiotensin II constricts vessels, which increase blood volume and increase BP o Kidneys keep sodium and water reabsorption which increase blood volume o Increased aldosterone, found in adrenal cortex it is going to help kidneys absorb sodium and water o Posterior pituitary gland produces anti diuretic hormone (ADH) and causes body to keep water o Organs involved  Kidneys  Brain  Lungs  Adrenal glands  Heart and vascular system  Hypertension o Pathophysiology of  Cardiac output 5-6 liters per minute  Peripheral resistance  ANS regulates BP  Constriction of vessels leads to increase resistance and increases BP  Dilation of vessel leads to decrease resistance and decreases BP  Blood volume  Increased volume = increased BP  Decreased volume = decreased BP o Assessment findings  AHA guidelines  o Patient teaching  Safety  Change positions slowly; orthostatic hypotension  If diabetic; monitor glucose more frequently  Call assistance before getting out of bed  Know how to take and monitor pulse and BP  Stop taking meds if BP is 90/60 or less Downloaded by James Jonez ([email protected]) lOMoARcPSD|40142722 NUR354 Pharm II Exam 2 Study Guide  Do not abruptly discontinue  Polypharmacy – why  Depending on level of hypertension you have; you might need to include more than one medication to relieve symptoms of hypertension o Nonpharmacological treatments  Nursing education  Limit alcohol  Restrict sodium/increase potassium  Reduce saturated fat and cholesterol  Increase physical activity  Stop tobacco use  Reduce stress o ACEs  Prototype Drug: Lisinopril  Ends with -PRIL **  (benazepril, captopril, enalapril, ramipril, fosinpril, moexpriil, perindopril, quinapril, trandolapril)  Pharmacological action  Blocks effects of angiotensin II  Black box warning  Fetal injury  Therapeutic use(s)  HTN  Heart failure  Myocardial infarction  Diabetic and nondiabetic nephropathy   Expected outcome   Adverse effects/common  Cough**  AKI (acute kidney injury)  Angioedema (swelling of the mouth, eyes, throat)  Hyperkalemia  Rash and dysgeusia (altered taste)  Neutropenia  Severe hypotension  Headache  Patient education/instructions/understanding  How to take/monitor pulse and BP  Change positions slowly when lying to sitting to standing  Call for assistance before getting out of bed  Monitor glucose more frequently if diabetic  Do not stop meds abruptly Downloaded by James Jonez ([email protected]) lOMoARcPSD|40142722 NUR354 Pharm II Exam 2 Study Guide  Stop taking meds if BP is 90/60 or less  Carry ID card indicating medications  Need to follow up for lab work  Assessment/labs  Monitor VS  daily weights  ECG  heart/lung sounds  I&O, BMs  Assess for nausea, headache, dizziness, muscle weakness  Assess for angioedema  Labs: Monitor electrolytes, glucose, liver/kidney function  Assess for bradycardia. Hypotension, reflex tachycardia, decreased urine output, seizures o ARBs  Prototype Drug: Losartan  Ends with -SARTAN (azilsartan, candesartan, eprosartan, irbesartan, Olmesartan, telmisartan, valsartan,) **  Black box warning  Fetal injury and death may occur when ARBs are taken during pregnancy; as soon as pregnancy is detected, discontinue ASAP  Expected outcome  Pt. will maintain BP with normal range  Pt. will maintain normal range for electrolytes, glucose, liver/kidney functions  Patient education/instructions/understanding  Change positions slowly when lying to sitting to standing  Call for assistance before getting out of bed  Properly monitor pulse and BP  Monitor glucose more frequently if diabetic  Do not stop meds abruptly  Stop taking meds if BP is 90/60 or less  Carry ID card indicating medications  Need to follow up for lab work o Beta blockers  Prototype Drug: metoprolol  Ends with -OLOL (acebutolol, atenolol, betaxolol, bisoprolol, nadolol, nebivolol, pindolol, propranolol, timolol)  Adverse effects  Bradycardia  Heart failure  Pulmonary edema o Ca channel blockers  Prototype Drug: nifedipine Downloaded by James Jonez ([email protected]) lOMoARcPSD|40142722 NUR354 Pharm II Exam 2 Study Guide Ends with -DIPINE (amlodipine, felodipine, nicardipine, nisoldipine) Also, diltiazem and verapamil Pharmacological action(s)  Nifedipine: o Blocks calcium channels in blood vessels, vasodilates peripheral arterioles and arterioles/arteries of heart  Diltiazem: o Blocks calcium channels in the heart, SA and AV nodes decreases force of contraction and HR  Expected outcome  Assessment specifics  Monitor BP and HR ***  Myalgia (muscle pain)  Arthralgia (joint stiffness)  Edema  Constipation  Assess for bradycardia. Hypotension, reflex tachycardia, decreased urine output, seizures o Alpha 1 blocker  Prototype Drug: doxazosin  Ends with -OSIN (prazosin, terazosin)  Patient education/instructions/understanding  Change positions slowly when lying to sitting to standing  Call for assistance before getting out of bed  Properly monitor pulse and BP  Monitor glucose more frequently if diabetic  Do not stop meds abruptly  Stop taking meds if BP is 90/60 or less  Off label treatment  Prazosin and terazosin are used for BPH and nightmares o Direct vasodilators  Prototype Drug: hydralazine  Action  Direct acting peripheral arteriolar vasodilator  Expected outcome  Patient education/instructions/understanding  Change positions slowly when lying to sitting to standing  Call for assistance before getting out of bed  Properly monitor pulse and BP  Monitor glucose more frequently if diabetic  Do not stop meds abruptly  Stop taking meds if BP is 90/60 or less  Route  Available in oral, IM or IV Downloaded by James Jonez ([email protected]) lOMoARcPSD|40142722 NUR354 Pharm II Exam 2 Study Guide  Usually for IV Push  Pediatric administration/AE  Diuretics/Renal o How and where each class flows through the kidneys (actions of each class)  Osmotic diuretics:  Act on the proximal tubule and the loop of Henle, to create an osmotic force that pulls water into the nephron and increases the excretion of nearly all electrolytes  Loop diuretics:  Act on the ascending limb of the loop of Henie to block reabsorption of sodium, chloride, and water. Excretion of potassium is increased  Thiazide diuretics:  Act on the early distal tubule to block the reabsorption of sodium, chloride and water. Excretion of potassium is increased  Potassium-sparing diuretics:  Act on the late distal tubule and collecting ducts to block the reabsorption of sodium and reduce the secretion of potassium o CKD  Patient education/instructions/understanding  Protein restriction and reduction of sodium, potassium, phosphorus and magnesium intake  Pts. also with diabetes need to control blood glucose through intensive insulin therapy  Adjust dosage of medications may be necessary o Diseases that would be prescribed these drugs  Heart Failure  HTN  Pulmonary Edema  AKI and CKD o Thiazide  Prototype Drug: Hydrochlorothiazide (Microzide)  Other Thiazides: chlorothiazide, bendroflumethiazide, methyclothiazide, indapamide, metolazone, chlorthalidone  Therapeutic Class: Drug for HTN and edema  Pharm Class: Thiazide diuretic  How they work/action  Acts on the kidney tubule and blocks Na and Cl. Prevents H2O  Contraindications/interactions  Contraindications: o Anuria o Hypersensitivity to thiazides or sulfonamides o Pre-eclampsia or other pregnancy induced HTN Downloaded by James Jonez ([email protected]) lOMoARcPSD|40142722 NUR354 Pharm II Exam 2 Study Guide  Interactions: o Drug to drug:  Other antihypertensives; Chlorthalidone  May reduce the effectiveness of anticoagulants, sulfonylureas, and antibiotics including insulin  Cholestyramine and colestipol decreases absorption of hydrochlorothiazide  Hydrochlorothiazide increases risk of nephrotoxicity from NSAIDs  Carbamazepine o Labs:  May increase glucose, cholesterol, bilirubin, triglyceride, and calcium.  May decrease magnesium, potassium and sodium levels o Herbal/food:  Ginkgo biloba  Hawthorn  Assessment/labs  Daily weights  I&O  Monitor BP  Monitor VS  Monitor electrolytes, glucose, ECG  Monitor for orthostatic hypotension  Labs: o Electrolytes o Glucose o BUN o Serum uric acid levels o Loop  Prototype Drug: Furosemide (Lasix)  Other Loops: bumetanide, ethacrynic acid, torsemide  Therapeutic Class: Drug for heart failure and HTN  Pharm class: Loop Diuretic  How they work/action  Blocks Na and Cl in the nephron loop. Prevents H2O  Patient education/instructions/understanding  Diet high in potassium (dried fruits, nuts, spinach, bananas, citrus)  Limit sodium intake  If diabetic; monitor blood glucose frequently as furosemide increases blood glucose  Change positions slowly; orthostatic hypotension  Take medications exactly as directed  Dry mouth care Downloaded by James Jonez ([email protected]) lOMoARcPSD|40142722 NUR354 Pharm II Exam 2 Study Guide  Take in the mornings to prevent nocturia  Assessment/reassessment/labs  Given IV/PO  Monitor for BP  I&O  daily weights  Edema and skin turgor  Monitor electrolytes, creatinine  Labs: o Electrolytes o Glucose o BUN o Uric acid levels o Renal/hepatic function  Expected outcome  Increased urine output  Decreased edema  Decreased BP  Reduced ICP  Prevention of hypokalemia  Adverse effects/serious  Ototoxicity  Hypokalemia  Hyperglycemia  Hyperuricemia  Low Ca/Mg levels  Dehydration o Potassium sparing  Prototype Drug: Spironolactone (Aldactone)  Other potassium sparing: eplerenone  Therapeutic Class: Antihypertensive; drug for reducing edema  Pharm Class: Potassium sparing diuretic; aldosterone antagonist  How they work/action  Blocks aldosterone; Na and H2O excreted, and potassium is retained  Contraindications/interactions  Caution with kidney/liver disease  Pts with serious CKD or hyperkalemia  Pregnancy and lactation  Do not give if anuric (no urine)  Interactions: o Drug to drug:  Aspirin and other salicylates may increase potassium levels and can leave spironolactone toxicity Downloaded by James Jonez ([email protected]) lOMoARcPSD|40142722 NUR354 Pharm II Exam 2 Study Guide  Concurrent use with digoxin may decrease effects of digoxin  Ace inhibitors and ARBs may result in hyperkalemia  Use with other antihypertensives and other diuretics may result in hypotensive effect o Herbal/food:  Hawthorn  Assessment/labs  Monitor for BP  I&O  daily weights  Edema and skin turgor  Monitor electrolytes especially potassium  Caution with ACE inhibitors, ARB  Labs: o Electrolytes and creatinine o Renal function  Urine output challenges/outcomes  Challenges: o May lead to hyperkalemia  Outcomes: o Excessive urine output o Nephrotoxic drugs Pg. 323  Aminoglycoside  NSAIDs  Analgesics, antipyretics  Antibiotic  Antiviral and antiretrovirals  Antifungals  ACE inhibitors  Contrast agents  Immunosuppressants Downloaded by James Jonez ([email protected]) lOMoARcPSD|40142722 NUR354 Pharm II Exam 2 Study Guide  Hydrochlorothiazide: what should the nurse monitor to prevent adverse effects: Potassium and Sodium  Administered furosemide PO when should the nurse expect to see results: 60 mins  Topical nitroglycerin what actions should include applying this medication: gloves, rotate sites, apply to a non-hairy site  What priority teaching topic for a client who has CKD and is prescribed furosemide: Monitor weight  Teaching new grad about use of diuretics which are correct about the therapeutic uses of diuretics: liver failure heart failure and hypertension  Beta blockers what should the nurse include in teaching: reduce workload of your heart  Treatment options for MI, what is considered a definitive treatment for MI: PCI  A nurse is caring for groups of clients who should the nurse implement first: sublingual nitroglycerin to a CAD pt. who repots dull chest pain  Blood pressure 90/60 HR 46/min what should the nurse take: prepare to administer atropine 0.5 mg IVP  HR being prescribed with lisinopril what teaching related to medication is important to review discharge: teach client to rise slowly and sit on side of bed for several min before rising  Immediate action for lisinopril: Creatine 2.1  HR has developed chronic dry cough, which prescribed medications: enalapril Downloaded by James Jonez ([email protected])

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