NUR 354 Pharm II Exam 2 Review PDF
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Uploaded by SharpestClimax
Arizona College of Nursing
James Jonez
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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])