NUR 354 Pharm II Exam 2 Review PDF

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])