Pharm II - Exam 1 REVIEW (Questions and Answers)

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NUR 3251 Pharm II - Exam 1 REVIEW Module 1 4, 6, 7, 8, 10, 11, 15, 16, 17, 18, 20, 1. A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemi... de. Which of the following instructions should the nurse include? A. Take aspirin if headaches develop. B. Eat foods that contain plenty of potassium. C. Expect some swelling in the hands and feet. D. Take the medication at bedtime. 2. A nurse is caring for a client whose serum potassium level is 5.3 mEq/L. Which of the following scheduled medications should the nurse plan to administer? A. Lisinopril B. Digoxin C. Furosemide D. Potassium iodide 3. A nurse is providing teaching to a client who has renal failure and an elevated phosphorous level. The provider instructed the client to take aluminum hydroxide 300 mg PO three times daily. For which of the following adverse effects should the nurse inform the client? A. Constipation C. Headache D. Muscle spasms 4. A nurse is providing dietary teaching for a client who takes furosemide. The nurse should recommend which of the following foods as the best source of potassium? A. Bananas B. Cooked carrots C. Cheddar cheese D. 2% milk 5. A nurse is caring for a client who has a prescription for potassium chloride (KCL) 20 mEq PO daily. The nurse reviews the client's most recent laboratory results and finds the client's potassium level is 5.2 mEq/L. Which of the following actions should the nurse take? A. Give the ordered KCL as prescribed.B. Omit the KCL dose and document it was not given. C. Call the prescribing physician and inform her of the client's serum potassium level results. D. Call the lab to verify the client's results. 6. A nurse is providing teaching for a client who is on diuretic therapy and has a new prescription for potassium chloride (KCL) 20 mEq extended-release PO daily. Which of the following instructions should the nurse provide about the new prescription? A. Take the extended-release tablets on an empty stomach. B. Add an antacid if the medication causes indigestion. C. Take the extended-release tablets whole. D. Expect urinary output to decrease while on this medication. 7. A nurse is completing a medication history for a client who reports using overthe-counter calcium carbonate antacid. Which of the following recommendations should the nurse make about taking this medication? A. Decrease bulk in the diet to counteract the adverse effect of diarrhea. B. Take the medication with dairy products to increase absorption. C. Reduce sodium intake. D. Drink a glass of water after taking the medication. 8. A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. Which of the following instructions should the nurse provide? A. Check the pulse after medication administration. B. Take the medication with meals C. Rinse the mouth after administration. D. Limit caffeine intake 9. A nurse is caring for a client who has poison ivy and is prescribed diphenhydramine. Which of the following instructions should the nurse give regarding the adverse effect of dry mouth associated with diphenhydramine? A. "Administer the medication with food." B. "Chew on sugarless gum or suck on hard, sour candies." C. "Place a humidifier at your bedside every evening." D. "Discontinue the medication and notify your provider." 10. A nurse is preparing to administer dextrose 5% in water (D5W) 150 mL IVto infuse over 3 hr. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) 8 gtt/min 11. A nurse is preparing to administer potassium chloride 20 mEq suspension PO daily. The amount available is potassium chloride suspension 10 mEq/mL. How many mL should the nurse administer? 2 mL Module 2 3, 9,12, 13, 14, 19 12. A nurse is assessing a client who is receiving dopamine IV to treat left ventricular failure. Which of the following findings should indicate to the nurse that the medication is having a therapeutic effect? A. Systolic blood pressure is increased B. Cardiac output is reduced C. Apical heart rate is increased D. Urine output is reduced 13. A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? A. Hyperglycemia B. Adrenocortical insufficiency C. Severe dehydration D. Rebound pulmonary congestion 14. A nurse is teaching a client about taking diphenhydramine. The nurse should explain to the client that which of the following is an adverse effect of this medication? A. Sedation B. Constipation C. Hypertension D. Bradycardia.15. A nurse is monitoring a client who received epinephrine for angioedema after a first dose of losartan. Which of the following data indicates a therapeutic response to the epinephrine? A. Respirations are unlabored. B. Client reports decreased groin pain of 3 on a 1 to 10 scale. C. The client's blood pressure when arising from resting position is at premedication levels. D. The client tolerates a second dose of medication with no greater than 1+ peripheral edema. 16. A nurse is preparing to transfuse one unit of packed RBC to a client who experienced a mild allergic reaction during a previous transfusion. The nurse should administer diphenhydramine prior to the transfusion for which of the following allergic responses? A. Urticaria B. Fever C. Fluid overload D. Hemolysis 17. A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor the client for which of the following electrolyte imbalances? A. Hypernatremia B. Hyperuricemia C. Hypercalcemia D. Hyperchloremia Module 3 1, 2, 4, 5, 8 18. A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first? A. Check the client's vital signs. B. Request a dietitian consult. C. Suggest that the client rests before eating the meal. D. Request an order for an antiemetic. 19. A nurse is caring for a client who is taking lisinopril. Which of the followingoutcomes indicates a therapeutic effect of the medication? A. Decreased blood pressure B. Increase of HDL cholesterol C. Prevention of bipolar manic episodes D. Improved sexual function 20. A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include? A. Take aspirin if headaches develop. B. Eat foods that contain plenty of potassium. C. Expect some swelling in hands and feet D. Take the medication at bedtime. 21. A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide? A. Do not use salt substitutes while taking this medication. B. Take the medication with food. C. Count your pulse rate before taking the medication. D. Expect to gain weight while taking this medication. Module 4 22. A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make? A. "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." B. "I will call the provider to get a prescription for discontinuing the IV heparin today." C. "Both heparin and warfarin work together to dissolve the clots.". D. "The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay." Rationale: Discontinuing the IV heparin is not indicated at this time. 23. A nurse is caring for a client who has thrombophlebitis and is receiving heparinby continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? A. "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level." B. "A pharmacist is the person to answer that question." C. "Heparin does not dissolve clots. It stops new clots from forming." D. "The oral medication you will take after this IV will dissolve the clot." 24. A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide? A. "Crushing the medication might cause you to have a stomachache or indigestion." B. "Crushing the medication is a good idea, and I can mix it in some ice cream for you." C. "Crushing the medication would release all the medication at once, rather than over time." D. "Crushing is unsafe, as it destroys the ingredients in the medication." 25. A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin? A. Hemoglobin (Hgb) B. Prothrombin time (PT) D. Activated partial thromboplastin time (aPTT) 26. A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching? A. "I have started taking ginger root to treat my joint stiffness." B. "I take this medication at the same time each day." D. "I had my INR checked three weeks ago." 27. A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin? A. The client follows a low-fat diet to reduce cholesterol. B. The client drinks a glass of grapefruit juice every day. C. The client sprinkles flax seeds on food 1 hr before taking the anticoagulant. D. The client uses garlic to lower cholesterol levels.28. A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take? A. Use a 22-gauge needle to inject the medication. B. Use a 1-inch needle to inject the medication. C. Inject the medication into the abdomen above the level of the iliac crest. D. Massage the injection site after administration of the medication. 29. A nurse is caring for a client who is postoperative following hip arthroplasty. The nurse should anticipate which of the following prescriptions for this client? A. Aspirin B. Clopidogrel C. Enoxaparin D. Alteplase 30. A nurse is preparing to administer heparin 2,000 units by IV bolus. Available is heparin injection 5,000 units/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.) 0.4 mL 31. A nurse is caring for a client who is receiving heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose? A. Iron B. Glucagon C. Protamine D. Vitamin K 32. A nurse is obtaining a medical history from a client who is to start warfarin therapy and currently uses herbal supplements at home. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin? A. Feverfew B. Black cohosh C. Echinacea D. Flaxseed 33. A nurse is preparing to administer a continuous heparin infusion at 1600 units/hr. Available is heparin 25,000 units in dextrose 5% in water (D5W) 500mL. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. 32 mL/ Hr 34. A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse plan to take? A. Insert the needle at a 45o angle. B. Aspirate for a blood return before depressing the plunger. C. The nurse should not expel the air bubble in the prefilled syringe. D. Administer the medication 2.54 cm (1 in) from the umbilicus. 35. A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which of the following medications should the nurse plan to administer for DVT prophylaxis? A. Aspirin PO B. Enoxaparin subcutaneous C. Heparin infusion D. Warfarin PO 36. A nurse is caring for a client who has cirrhosis and a prothrombin time of 30 seconds. Which of the following medications should the nurse plan to administer? A. Vitamin K B. Heparin C. Warfarin D. Ferrous sulfate 37. A nurse is teaching a client who reports taking gingko biloba to improve his memory. Which of the following adverse effects should the nurse include? A. Bad breath B. Decreased alertness C. Breast enlargement D. Bleeding gums Module 5 38. A nurse is caring for a client who is on warfarin therapy for atrial fibrillation. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer? A. Epinephrine B. AtropineC. Protamine D. Vitamin K 39. A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider? A. The client has a history of hypothyroidism. B. The client has a history of bronchial asthma. C. The client has a history of hypertension. D. The client has a history of migraine headaches. 40. A nurse in a coronary care unit is admitting a client who has had CPR following a cardiac arrest. The client is receiving lidocaine IV at 2 mg/min. When the client asks the nurse why he is receiving that medication, the nurse should explain that it has which of the following actions? A. Prevents dysrhythmias B. Slows intestinal motility C. Dissolves blood clots D. Relieves pain 41. A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication? A. Hyperthermia B. Hypotension C. Ototoxicity D. Muscle pain 42. Agent(s) may be effective in terminating paroxysmal supraventricular tachycardia (PSVT)? A. adenosine (Adenocard) B. methoxamine (Vasoxyl) C. propranolol (Inderal) D. all of the above 43. The nurse suspects the client may have toxic levels of digoxin in the bloodstream when what is assessed? (select all that apply) Chapter 44 a. Irregular heart rhythms b. Nausea c. Anorexiad. Cough e. Peripheral edema 44. Which medications are included in first-line therapy for heart failure (select all that apply) – CHAPTER 48 a. Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) b. Aldosterone antagonists c. Beta blockers d. Cardiac glycosides e. Diuretics 45.A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? a. It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level. b. A pharmacist is the person to answer that question. c. Heparin does not dissolve clots. It stops new clots from forming. d. The oral medication you will take after this IV will dissolve the clot. 46. A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin? a. Hemoglobin (Hgb) b. Prothrombin time (PT) c. Bleeding time d. Activated partial thromboplastin time (aPTT) 47. A nurse is caring for a client who is having thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparins effects? Protamine Sulfate 48. Magnesium 1. Required for cellular energy metabolism 2. Functioning of the sodium/potassium-adenosine triphosphatase (ATPase) pump 3. Membrane stabilization 4. Nerve conduction 5. Ion transport49. Magnesium Sulfate Injections: 1. Control low blood levels of magnesium 2. Used for pediatric acute nephritis and 3. Used to prevent seizures in pre-eclampsia, eclampsia, or toxemia of pregnancy 4. Used to treat torsades de pointes, asthma exacerbations, constipation, and barium poising 5. Given by injection into a vein or muscle as well as by the mouth 6. Common Adverse Effects: a. Circulatory collapse b. Respiratory paralysis c. Low core body temperature (Hypothermia) d. Excess fluid in the lungs (pulmonary edema) – back flow into the lungs e. Depressed/poor reflexes f. Low blood pressure (hypotension) g. Flushing h. Drowsiness 50. Magnesium Deficiency cause: 1. Insomnia 2. Anxiety 3. Muscle cramping 4. Constipation 51. 7 (Seven) Symptoms of magnesium deficiency 1. Muscle Twitches and Cramps 2. Mental Disorders 3. Osteoporosis 4. Fatigue and Muscle Weakness 5. High Blood Pressure 6. Asthma 7. Irregular Heartbeat 52. Calcium 1. Helps form and maintain teeth and bones 2. Proper levels of calcium in the body helps prevent osteoporosis 3. Supplementation is required when there is not enough calcium in the diet53. Calcium Gluconate 1. A mineral supplement and medication 2. Used by injection into a vein to treat low blood calcium, high blood potassium and magnesium toxicity 54. Potassium Chloride 1. Prevent or to treat low blood levels of potassium (Hypokalemia) 2. Most common type used to treat deficiency 55. Potassium 1. Levels can be low due to a disease or from taking certain medicines 2. Or after a prolonged illness with diarrhea or vomiting 3. Recommended Daily Intake is 4,7000 mg 4. Most supplement come in 90 mg to 99 mg doses, and higher-dose pil usually contain smaller “active” amounts 5. They are minerals that carry an electric charge when dissolved in body fluids such as BLOOD. 6. Most of the body’s potassium located inside the cells. 7. Necessary for the normal functioning of cells, nerves, and muscles 56. Sodium Bicarbonate 1. An Antacid 2. Used to relieve heartburn and acid indigestion 3. Used to also make your blood or urine less acidic in certain conditions. 4. 8.4% sodium bicarbonate = same osmolarity as 6% NaCl twice as powerful as 3% NaCl 5. Side Effects: a. Cerebral hemorrhage b. Swelling (edema) c. High blood sodium levels d. Low blood calcium levels e. Low blood potassium levels f. Muscle spasms (associated with low calcium levels 57. Insulin 1. Helps control blood glucose levels by signaling the liver and muscle and fat cells to take in glucose from the blood. 2. Helps cells to take in glucose to be used for energy 3. Stores glucose as glycogen58. A nurse is caring for a client who has a prescription for 3,000 ml of dextrose 5% of 0.45% sodium chloride to infuse IV over 24 hr. The nurse initiates an IV infusion of 1,000 mL of this fluid at 0800. At what time should the nurse prepare to initiate the second 1,000 mL bag? 1600 59. Sodium Polystyrene Sulfonate (Kayexalate) 1. Excreted in bowel movements assure efficacy 2. Used to treat hyperkalemia 3. In a class of medications called Potassium-Removing Agents 4. Removes excess potassium from the body 5. Adverse Effects: Common side effect = loss of appetite a. Nausea b. Vomiting c. Constipation d. Diarrhea 60. What is the max infusion rate (mEq/hr.) for potassium chloride?  As much as 400 mEq may be administered in a 24-hour period while monitoring blood electrolyte concentrations carefully. 61. Why must the IV site be monitored when IV Potassium Chloride is infusing?  It is a vesicant medication  A vesicant is defined as a drug that is capable of causing tissue injury. 62. What is done if infiltration of IV potassium chloride is suspected? Stop infusion immediately?”  Stop infusion immediately 63. What is an indication for use non-selective adrenergic blocking agents? A. Essential hypertension B. Malignant hypertension C. Secondary hypertension D. Malignant hyperthermia Rationale: The alpha- and beta-adrenergic blocking agents block all of the receptor sites within the SNS, which results in lower blood pressure, slower pulse, and increased renal perfusion with decreased renin levels. These drugs are indicated for the treatment of essential hypertension.64. Alpha1- selective adrenergic blocking agents are to be used with caution in what population of patients? A. Those with hepatic disease B. Those with hypotension C. Those with congestive heart failure D. Those with respiratory distress Rationale: Alpha1-selective adrenergic blocking agents are used with caution in patients who have CHF or renal failure. 65. You are caring for a child who has been diagnosed with a heart problem. Propanolol has been ordered for this patient. What would be considered in calculating a child’s dose? A. Child’s body weight and age B. Child’s body mass C. Child’s age in months and height D. Child’s age and body mass index Rationale: Children are at greater risk for complications associated with the use of adrenergic blocking agents, including bradycardia, difficulty breathing, and changes in glucose metabolism. The safety and efficacy for use of these drugs has not been established for children younger than 18 years of age. If one of these drugs is used, the dosage for these agents needs to be calculated from the child’s body weight and age. 66. Please answer the following questions as true or false. The use of a loop diuretic is the first drug used in the Step Care Management program to treat hypertension. False Rationale: A somewhat controversial study, the ALLHAT study, reported in 2002 that patients taking the less expensive, less toxic diuretics did better and had better blood pressure control than patients using other antihypertensive agents. Replications of this study have supported its findings and the use of a thiazide diuretic is currently considered the first drug used in the Step Care Management of Hypertension.67. The mechanism of action of an ACE inhibitor is the blocking of ACE from converting angiotensin I to angiotensin II. What does this cause? A. Decrease in serum potassium levels B. Decrease in aldosterone production C. Sodium and fluid loss D. Increase in blood pressure Rationale: Blocks ACE from converting angiotensin I to angiotensin II, leading to a decrease in blood pressure, a decrease in aldosterone production, and a small increase in serum potassium levels along with sodium and fluid loss 68. The nurse is caring for a 27-year-old African American woman who was just prescribed an ACE inhibitor for management of her hypertension. What should be advised related to contraception? A. The use of spermicidal jellies is recommended. B. The mini pill is the contraception method of choice. C. Use barrier contraceptives to prevent pregnancy while taking these drugs. D. No special precautions need to be taken. Rationale: The safety for the use of these drugs during pregnancy has not been established. ACE inhibitors, ARBs, and renin inhibitors should not be used during pregnancy, and women of child-bearing age should be advised to use barrier contraceptives to prevent pregnancy while taking these drugs. 69. Please answer the following statement as true or false. The primary treatment for congestive heart failure is to make the heart beat harder and faster. False Rationale: Primary treatment involves increasing muscle contractility, bringing the system back into balance 70. The nurse is caring for a patient who has presented to the emergency department with signs and symptoms of an acute MI. While making an initial assessment of this patient the nurse notes the patient has had adverse reactions to digoxin and a history of congestive heart failure. The physician writes admission orders. Which of the following drugs would be of concern?A. Furosemide (Lasix) B. Milrinone (Primacor) C. Propranolol (Inderal) D. Aspirin Rationale: They are contraindicated in the following conditions: severe aortic or pulmonic valvular disease, which could be exacerbated by increased contraction; acute MI, which could be exacerbated by increased oxygen consumption and increased force of contraction; fluid volume deficit, which could be made worse by increased renal perfusion; and ventricular arrhythmias, which could be exacerbated by these drugs. 71. The patient asks the nurse to explain the type of angina he is experiencing. The nurse explains the pain is due to the imbalance of myocardial supply and demand. What type of angina does this describe? A. Unstable B. Prinzmetal’s C. Stable D. Ischemic 72. Please answer the following statement as true or false. Older adults are more likely to develop adverse effects associated with the use of these drugs—dysrhythmias, hypertension, and congestive heart disease. False Rationale: Older adults frequently are prescribed one of these drugs. They are more likely to develop adverse effects associated with the use of these drugs— arrhythmias, hypotension, and congestive heart disease. Safety measures may be needed if these effects occur and interfere with the patient’s mobility and balance. 73. What client education is important for the client taking potassium chloride?  Administer with plenty of fluid to decrease stomach irritation and discomfort. Some dietary sources of potassium include leafy green vegetables (e.g., spinach, cabbage), tomatoes, cucumbers, zucchini, fruits(e.g., apples, oranges, and bananas), root vegetable (e.g., carrots, radishes), beans, and peas. 74. Adrenergic agent - Adrenergic drugs acts either by enhancing or reducing the activity of the various components of the sympathetic divisions of the ANS.  Sympathomimetic or adrenergic stimulants, Sympatholytics, antiadrenergic or adrenegic blocking agents. 75. Adrenergic agonist - are drugs that lead to stimulation of the adrenergic receptors. In doing so, adrenergic agonists generally simulate activation of certain aspects of the sympathetic nervous system and are thus also known as "sympathomimetics". 1. Effectiveness of adrenergic agonists monitored? a. You know they work if your patient is still alive. b. Adrenergic drugs stimulate the nerves in your body’s sympathetic nervous system (SNS). i. This system helps regulate your body’s reaction to stress or emergency. ii. During times of stress, the SNS releases chemical messengers from the adrenal gland. iii. These chemical messengers act on your body to increase heart rate, sweating, and breathing rate and to decrease digestion. This is called the “fight or flight” response. 2. Adrenergic drugs can help do the following: o increase blood pressure o constrict blood vessels o open the airways leading to the lungs o increase heart rate o stop bleeding 3. Types of adrenergic drugs and their uses  Each type of adrenergic drug treats different conditions depending on which receptors are targeted.  The specific action of the drug also depends on whether the drug acts directly as a chemical messenger or indirectly by stimulating the release of chemical messengers. A. Bronchodilators1. Bronchodilators open up the bronchial tubes, or air passages. These adrenergic drugs act on the beta receptors directly. 2. When they bind with beta-2 receptors, they cause the airways leading to the lungs to open up. This helps improve breathing in patients with respiratory diseases such as: o asthma o chronic obstructive pulmonary disease (COPD) o emphysema o bronchitis 3. Examples of bronchodilators include: 1) albuterol 2) formoterol 3) levalbuterol 4) olodaterol 5) salmeterol B. Vasopressors 1. Vasopressors can act on the alpha-1, beta-1, beta-2 adrenergic receptors, and dopamine receptors. 2. These drugs stimulate smooth muscle contraction in the blood vessels which causes your blood vessels to become narrow. 3. This effect also causes your blood pressure to increase. i. Increasing blood pressure can help treat shock. ii. Narrowing blood vessels can help stop bleeding. iii. It can also help keep anesthetics (drugs that numb your body) from spreading by closing off nearby blood vessels. 4. Certain vasopressors may also be used for colds or allergies. They can shrink the swollen blood vessels in the mucous membranes of your nose. 5. Often referred to as nasal decongestants. 6. Examples of different vasopressors include: 1) ephedrine 2) epinephrine 3) dopamine 4) phenylephrine 5) pseudoephedrine6) oxymetazoline C. Cardiac stimulators 1. Used to stimulate and restore the heartbeat. 2. They’re used if your heart stops beating suddenly because of electrocution, suffocation, or drowning. a. When this happens, epinephrine can be injected directly into your heart to help make it start beating again. 76. Dopamine 1. Catecholamines: a. Natural: Adrenaline, Noradrenaline, Dopamine b. Synthetic: Isoprenaline, Dobutamine 2. Non-Catecholamines: a. Ephedrine, b. Amphetamines, c. Phenylepherine, d. Methoxamine, e. Mephentermine 3. Also called sympathomimetic amines as most of them contain an intact or partially substituted amino (NH2) group 4. It is a neurotransmitter made in the brain. Basically, it acts as a chemical messenger between neurons. 5. Released when your brain is expecting a reward. 6. When you come to associate a certain activity with pleasure, mere anticipation may be enough to raise dopamine levels 77. Dobutamine (Dobutrex) 1. A positive inotropic agent 2. A medication used in the treatment of cardiogenic shock and severe heart failure. 3. It may also be used in certain types of cardiac stress tests. 4. Given by injection into a vein or intraosseous as a continuous infusion 78. Epinephrine 1. EPI pen for bee sting causes: a. rapid peripheral vasoconstriction, b. dilates the bronchi, andc. blocks the effects of histamine. 2. Epinephrine is also known as adrenaline. 3. Mainly made in the adrenal medulla so acts more like a hormone 4. Major Use of Epinephrine: a. Used in emergencies to treat very serious allergic reactions to insect stings/bites, foods, drugs, or other substances. b. It acts quickly to improve breathing, stimulate the heart, raise a dropping blood pressure, reverse hives, and reduce swelling of the face, lips, and throat Routes of Administration: a. In the heart, it increases the rate and force of contraction, thus increasing the output of blood and raising blood pressure. b. In the liver, it stimulates the breakdown of glycogen to glucose, resulting in an increase in glucose levels in the blood. i. Adverse Reactions: a. anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and respiratory difficulties b. Effects last 10-20 minutes Epinephrine and norepinephrine are very similar neurotransmitters and hormones. 1. Epinephrine has slightly more of an effect on your heart, 2. Norepinephrine has more of an effect on your blood vessels. 3. Both play a role in your body's natural fight-or-flight response to stress and have important medical uses as well 1. Common side effects of norepinephrine include: a. Slow heart rate. b. High blood pressure (hypertension) c. Irregular heartbeats (arrhythmias) d. Confusion. e. Anxiety. f. Shortness of breath, with or without respiratory difficulty. g. Headache. h. Nausea and vomiting.  When fluid resuscitation is unsuccessful, vasopressor drugs can be administered to increase BP and improve tissue perfusion 79. Norepinephrine (levophed)1. It is Vasoconstrictors 2. increase the work of the heart and decrease peripheral perfusion 3. it is a naturally occurring chemical in the body that acts as both a stress hormone and neurotransmitter (a substance that sends signals between nerve cells). 4. It's released into the blood as a stress hormone when the brain perceives that a stressful event has occurred. 5. If infusion rate is too high – BP will become elevated 80. Diphenhydramine 1. Do not relieve cold symptoms 2. Class of medications = antihistamines. 3. Works by blocking the action of histamine, a substance in the body that causes allergic symptoms 4. used to relieve symptoms of allergy, hay fever, and the common cold. i. Symptoms include rash, itching, watery eyes, itchy eyes/nose/throat, cough, runny nose, and sneezing. 5. Also used to prevent and treat nausea, vomiting and dizziness caused by motion sickness. 81. Cetirizine Zyrtec 1. Popular over-the-counter antihistamines. 2. Doctors consider them safe and effective treatments for minor allergies. Both are second-generation antihistamines 3. Has similar efficacy and onset of action as compared with diphenhydramine in treating acute food allergic reactions. 4. Longer duration of action compared with diphenhydramine 5. A good treatment option for acute food allergic reactions 82. Fexofenadine (Allegra) 1. The least sedating of second-generation antihistamines and least likely to have synergistic effects with alcohol 2. Allegra works within two hours and Zyrtec works within one hour. 3. Several studies have found cetirizine (Zyrtec) to be more effective than fexofenadine (Allegra) at relieving symptoms of allergic rhinitis and urticaria 4. Have a longer duration of action. 83. Loratadine (Claritin)84. Promethazine 1. A histamine H1 antagonist that can be used for its ability to induce sedation, reduce pain, and treat allergic reactions 2. Used to prevent and treat nausea and vomiting related to certain conditions (such as before/after surgery, motion sickness). 3. Also used with other medication to treat severe allergic reactions (anaphylaxis) and reactions to blood products 85. Corticosteroids (prednisone, cortisone, dexamethasone, methylprednisolone) 1. Are synthetic drugs that are used to treat a wide variety of disorders a. including asthma, arthritis, skin conditions and autoimmune diseases. 2. The drug mimics cortisol, a hormone that's naturally produced by the adrenal glands in healthy people. 3. What is the mechanism of action of corticosteroids?  Nursing diagnosis will be risk for infection r/t immunosuppression  Corticosteroids are classified as either: glucocorticoids (antiinflammatory) which suppress inflammation and immunity and assist in the breakdown of fats, carbohydrates, and proteins.  Mineralocorticoids (salt retaining) that regulate the balance of salt and water in the body 4. Describe the difference in using corticosteroids for short-term versus long-term use?  Short term use of oral corticosteroids defined as less than 30 days duration. Often a dose pack is given over a 9 day period with a taper. 5. Why are corticosteroids useful for managing anaphylaxis? Pericarditis? Asthma? Rheumatoid arthritis?  Epinephrine is essential, antihistamines are optional, and steroids are expendable.  Epinephrine is the standard first-line treatment for patients with anaphylaxis, but its use is often replaced or delayed by administration of antihistamines and corticosteroids NO to pericarditiso Corticosteroids are not recommended as first-line therapy for acute pericarditis as they appear to encourage recurrences.  Serum CRP should be considered to guide the treatment length and assess the response to therapy. Evaluation of response to antiinflammatory therapy is recommended after one week Inhaled corticosteroids  These anti-inflammatory drugs are the most effective and commonly used long-term control medications for asthma.  They reduce swelling and tightening in your airways.  You may need to use these medications for several months before you get their maximum benefit  Corticosteroids are steroidal medications given to RA patients to reduce inflammation and help regulate autoimmune activity.  Corticosteroids referred to as glucocorticoids value 6. What are the adverse effects of corticosteroids on the CNS, cardiovascular system, musculoskeletal system, endocrine system, eyes, GI tract, skin, immune system, and fluid/electrolyte balance?  Steroids – particularly IV (methylprednisolone) can cause hyperglycemia, infection, as well as GI bleed 7. Why must long-term corticosteroids be tapered off?  If you take prednisone for more than a few weeks, your adrenal glands decrease cortisol production. A gradual reduction in prednisone dosage gives your adrenal glands time to resume their normal function 86. Why are antihistamines used to manage anaphylaxis? 1. Chlorphenamine and Cetirizine are fast acting antihistamines and take 15-20 minutes to work. 2. For anyone at risk of a severe allergic reaction (known as anaphylaxis), an adrenaline auto-injector (AAI) will be prescribed as well as antihistamines 3. What are the adverse effects of antihistamines including systemic effects?  Side effects common to all antihistamines include: o Dizziness. o Dry mouth. o Dry eyes. Due to their significant side effect profile, special precautions should be used in patients with: o Seizures. o Glaucoma. o Problems passing urine or men with prostate problems. o Thyroid disorders. o High blood pressure. o Diabetes 4. What medications interact with antihistamines to cause additive CNS depression?  Atropine; Hyoscyamine; Phenobarbital; Scopolamine: (Moderate)  Additive CNS depression may occur if barbiturates are coused with sedating antihistamines, such as clemastine 5. Describe the nursing considerations for clients receiving antihistamines. a. Nursing interventions for patients using antihistamines include the following:  Proper administration.  Drug effectiveness.  Relief from dry mouth.  Safety measures.  Increase fluid intake.  Ensure voiding.  Skin care.  Avoid alcohol. 87. What are the indications for the use of promethazine? a. Promethazine is used with other medications to treat anaphylaxis (sudden, severe allergic reactions) and symptoms of the common cold such as sneezing, cough, and runny nose. b. Promethazine is also used to relax and sedate patients before and after surgery, during labor, and at other times  What are the risks associated with the administration of promethazine IV?o Phenergan Injection can cause severe chemical irritation and damage to tissues regardless of the route of administration. o Irritation and damage can result from perivascular extravasation, unintentional intra-arterial injection, and intraneuronal or perineuronal infiltration 88. Digoxin a. Used to treat heart failure, usually along with other medications. b. It is also used to treat certain types of irregular heartbeat (such as chronic atrial fibrillation). c. Treating heart failure may help maintain your ability to walk and exercise and may improve the strength of your heart. What is the mechanism of action of digoxin? AV Node Inhibition: Digoxin has vagomimetic effects on the AV node. By stimulating the parasympathetic nervous system, it slows electrical conduction in the atrioventricular node, therefore, decreases the heart rate. When is digoxin used? Digoxin is used to treat heart failure, usually along with other medications. It is also used to treat certain types of irregular heartbeat (such as chronic atrial fibrillation). Treating heart failure may help maintain your ability to walk and exercise and may improve the strength of your hearing What must the nurse check prior to the administration of digoxin? Heart rate - apical What teaching is essential for the client taking digoxin? Teach patient to take pulse and to contact health care professional before taking medication if pulse rate is <60 or >100. Pedi: Teach parents or caregivers that changes in heart rate, especially bradycardia, are among the first signs of digoxin toxicity in infants and children What are signs of digoxin toxicity?  Patients with atrial fibrillation (AFib) who are given digoxin to control their symptoms have an increased risk of death, whether or not they have a diagnosis of heart failure, compared with patients not taking the drug, and this risk increases with higher levels of digoxin in the bloodstream  Signs Include: o Confusion.o Irregular pulse. o Loss of appetite. o Nausea, vomiting, diarrhea. o Fast heartbeat. o Vision changes (unusual), including blind spots, blurred vision, changes in how colors look, or seeing spots What are the adverse effects of digoxin?  Digoxin has numerous and multifarious side-effects.  The most dangerous are severe (but rare) ventricular arrhythmias that may be accompanied by a complete atrioventricular block.  Frequent side-effects are the loss of appetite, nausea, an upset stomach, bradycardia and ventricular extrasystoles How does hypokalemia increase the risk for digoxin toxicity?  People with heart failure who take digoxin are commonly given medicines called diuretics.  This drug removes excess fluid from the body. Many diuretics can cause potassium loss.  A low level of potassium in the body can increase the risk of digitalis toxicity  In states of hypokalemia, or low potassium, digoxin toxicity is actually worsened because digoxin normally binds to the ATPase pump on the same site as potassium.  When potassium levels are low, digoxin can more easily bind to the ATPase pump, exerting the inhibitory effects. 89. Captopril 1. used to treat kidney disease (nephropathy) caused by diabetes in patients with type 1 diabetes and retinopathy (eye disease). 2. Captopril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. 3. Captopril, sold under the brand name Capoten among others, is an angiotensin-converting enzyme (ACE) inhibitor used for the treatment of hypertension and some types of congestive heart failure. 90. Enalaprila. ACE inhibitors and ARBs have been shown effective in preventing or at least slowing the process of renal disease in patients with diabetes by interfering with the renin-angiotensin system. b. ACE inhibitors and ARBs lower intraglomerular pressure by decreasing efferent arteriolar pressure c. Enalapril is a medicine used to reduce high blood pressure and to prevent or treat heart failure. d. If you have high blood pressure, taking enalapril will help prevent a future heart attack or stroke. e. It is also used alone or in combination with other medications to treat high blood pressure and heart failure. f. Enalapril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. 1.What are the most prominent adverse effects of ACE inhibitors (ACEI)?  Cough  Red, itchy skin or rash  Dizziness  lightheadedness or faintness upon rising  Salty or metallic taste or a decreased ability to taste.  Physical symptoms  Swelling of your neck, face, and tongue. ...  High potassium levels. ...  Kidney failure 2.What is the effect of ACE Inhibitors on the kidneys?  In addition to a possible elevation in free water excretion, ACE inhibitors have other renal actions in heart failure, including changes in the glomerular filtration rate (GFR), reduced potassium excretion that can lead to hyperkalemia, and variable effects on the natriuretic response to diuretics  In conditions in which glomerular filtration is critically dependent on angiotensin II-mediated efferent vascular tone (such as a post-stenotic kidney, or patients with heart failure and severe depletion of circulating volume), ACE inhibition can induce acute renal failure, 3.How do ACE Inhibitors impact the management of heart failure?  ACE inhibitors work by blocking the formation of angiotensin II. In people with heart failure, this lowers blood pressure and reduces sodium retention.  ACE inhibitors reduce the stress on the heart and allow the weakened heart muscle to pump more efficiently4.What is a life-threatening adverse effect of ACE Inhibitors?  In rare cases, particularly for black people, women and smokers, ACE inhibitors can cause some areas of the tissues to swell (angioedema).  If swelling occurs in the throat, it can be life-threatening. 5.What are adverse effects of ACE Inhibitors?  If side effects do occur, they may include: o Dry cough o Increased potassium levels in the blood (hyperkalemia) o Fatigue o Dizziness from blood pressure going too low o Headaches o Loss of taste 6.What is a common adverse effect of ACE Inhibitors that may impact medication adherence?  A common adverse effect of angiotensin-converting enzyme inhibitors (ACEI) is a persistent dry cough. 7.What labs should be monitored in clients on ACE Inhibitors?  When you start on an ACE inhibitor, you will need blood tests to monitor your kidney function and potassium levels.  Be aware: If you take an ACE inhibitor, keep a written log of your heart rate (pulse) and blood pressure. 8.What medications interact with ACE Inhibitors and should not be used with them?  Salt substitutes: They have potassium, and ACE inhibitors make your body retain potassium.  Over-the-counter nonsteroidal anti-inflammatory drugs or NSAIDs (like acetaminophen, aspirin, ibuprofen, and naproxen): These may cause your body to retain sodium and water and make ACE inhibitors not work as well 91. Lisinopril  Lisinopril is used to treat hypertension, congestive heart failure and to improve survival after a heart attack 92. Losartana. ARBs can decrease your risk of heart attack, stroke, or death from a cardiac event. b. If you have kidney disease, ARBs may be one of the more effective treatments for high blood pressure. c. ARBs may help protect against cognitive decline d. Losartan is used to treat high blood pressure (hypertension) e. It belongs to a class of drugs called angiotensin receptor blockers (ARBs). What is the effect of angiotensin receptor blockers (ARBs) on the blood vessels?  The concomitant use of NSAIDs and ACE inhibitor (ACEI) has been associated with reducing the anti-hypertensive effects of the ACEI, as well as carrying the potential to inflict acute renal damage.  The presumed mechanism of these effects on the kidneys and blood pressure stem from NSAIDs effect on prostaglandins (PG).  These effects are typically not seen in normotensive patients or those with normal renal function, but occur more in patients with kidney or blood pressure pathologies What effect does aldosterone have on the kidneys?  Aldosterone affects the body's ability to regulate blood pressure.  It sends the signal to organs, like the kidney and colon, that can increase the amount of sodium the body sends into the bloodstream or the amount of potassium released in the urine or the amount of potassium concentrations in the ECF.  The restoration of sodium levels, blood volume, and renal perfusion then inhibits further release of renin What is the effect of ARBs on serum potassium?  Suppression of angiotensin II leads to a decrease in aldosterone levels.  Aldosterone deficiency facilitates the shift of potassium out of the cells and into the plasma and increase serum potassium levels What are ARBs primarily used to manage?  ARBs (short for angiotensin II receptor blockers) are mainly used to treat high blood pressure and heart failure.  They work as well as ACE inhibitors for treating high blood pressure, but may be a better choice for you if you are having side effects to ACE inhibitorsWhat do the generic names of ARBs end in?  -Tan 93. Valsartan 1. Do not take valsartan if you are pregnant. 2. If you become pregnant while you are taking valsartan, stop taking valsartan and call your doctor immediately. 3. Valsartan may cause death or serious injury to the fetus when taken in the last 6 months of pregnancy 4. It is used in adults and in children age 6 years and older alone or in combination with other medications to treat high blood pressure. 5. It is also used in adults to treat heart failure (condition in which the heart is unable to pump enough blood to the rest of the body) and to improve survival after a heart attack. 6. Valsartan is in a class of medications called angiotensin II receptor antagonists. 7. It works by blocking the action of certain natural substances that tighten the blood vessels, allowing the blood to flow more smoothly and the heart to pump more efficiently. 94. Candesartan 1. For migraine prevention, candesartan (Atacand), is as effective as the frequently prescribed beta blocker propranolol (Inderal). 2. Candesartan is less likely to cause weight gain than other migraine preventives 2 and is available as a generic. 3. Candesartan is used to treat high blood pressure (hypertension). 4. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. 5. Candesartan belongs to a class of drugs called angiotensin receptor blockers (ARBs). 95. Spironolactone  Used to treat certain patients with hyperaldosteronism (the body produces too much aldosterone, a naturally occurring hormone); low potassium levels; heart failure; and in patients with edema (fluid retention) caused by various conditions, including liver, or kidney disease 96. Furosemide a. Furosemide, like other loop diuretics, acts by inhibiting the luminal NaK-Cl cotransporter in the thick ascending limb of the loop of Henle, bybinding to the chloride transport channel, thus causing sodium, chloride, and potassium loss in urine. b. It is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, and liver disease. c. It is a potent loop diuretic that works to increase the excretion of Na+ and water by the kidneys by inhibiting their reabsorption from the proximal and distal tubules, as well as the loop of Henle What is the effect of loop diuretics on fluid balance in clients with heart failure?  Loop diuretics remain the mainstay therapy for fluid removal in patients with HF.  They exert their action by inhibiting the sodium-potassium-chloride cotransport system located within the thick ascending limb of the loop of Henle What are the adverse effects of loop diuretics?  Adverse effects for loops diuretics typically occur from electrolyte imbalances secondary to the diuresis effects which include: o hyponatremia, hypokalemia, hypochloremia, hypomagnesemia, metabolic alkalosis, prerenal azotemia, dehydration, hypertriglyceridemia, hypercholesterolemia, hyperuricemia, gout, restlessness, headache, dizziness, vertigo, postural hypotension, and syncope.  Other adverse reactions include skin photosensitivity, interstitial nephritis, tinnitus, ototoxicity, deafness, and in patients with renal failure who receive high doses, myalgias, and muscle soreness How do loop diuretics affect electrolyte balance?  See above What labs must be monitored in clients taking loop diuretics?  Electrolytes; triglycerides How does the nurse monitor the effectiveness of loop diuretics?  Assess fluid status.  Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes.  Notify health care professional if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs. Monitor BP and pulse before and during administration What teaching is completed for the client that is taking loop diuretics?  Loop diuretic therapy may cause drowsiness.  Standing abruptly from a lying position causes hypertension.  Standing quickly from a lying position can cause postural hypotension.  Loop diuretic therapy may cause hearing loss with abrupt position changes What are the first-line drugs for all patients with signs of volume overload or with a history of volume overload?  Lasix Calculate the following:  Ordered 80mg furosemide IV push: available furosemide 10mg/10ml. How many ml will the nurse administer and at what rate? o 80 mL What is the risk of administering furosemide rapid IV push?  Too rapid administration of high doses (greater than 500 mg administered over less than 10 minutes) may precipitate hypotension, cardiac arrhythmia and sudden death How are potassium sparing diuretics used to manage heart failure?  Potassium sparing diuretics reduce the incidence of serious ventricular arrhythmias in patients with heart failure (particularly those who are on digoxin) and hypertension (particularly in patients with left ventricular hypertrophy) What is the effect of potassium sparing diuretics on serum potassium?  Because potassium-sparing diuretics do not promote the secretion of potassium during diuresis they do not cause hypokalemia (low potassium levels).  However, there is a risk of hyperkalemia (high potassium levels) if they are used with other agents that also retain potassium What are components of client teaching for potassium sparing diuretics?  There are very few people who are not able to take these medicines.  They should not be taken by anyone who has high levels of potassium in their blood, severe kidney problems, or Addison's disease. In addition, potassium supplements should not be taken with these medicines What medications must be used with caution in clients taking potassium sparing diuretics?  Potassium supplements should be avoided, except under very close supervision, in those taking potassium-sparing diuretics.  The use of the immunosuppressants ciclosporin and tacrolimus with potassium-sparing diuretics or aldosterone antagonists also increases the risk of hyperkalemia Why do potassium sparing diuretics have endocrine effects?  Endocrine and metabolic: glucose intolerance, hyperuricemia as a side effect of all potassium-sparing diuretics 97. Dopamine 1. is a precursor of norepinephrine and epinephrine and is a brain neurotransmitter synthesized in substantia nigra and ventral tegmental areas of the brain. 2. There are 5 types of dopamine and they have varying functions including: pleasure, motivation, cognition, memory, learning, and fine motor control. 3. Dopamine is a type of neurotransmitter. a. Your body makes it, and your nervous system uses it to send messages between nerve cells. That's why it's sometimes called a chemical messenger. 4. Dopamine plays a role in how we feel pleasure. It's a big part of our unique human ability to think and plan. 5. Along with eating a balanced diet, many possible supplements may help boost dopamine levels, including 6. probiotics, fish oil, vitamin D, magnesium, ginkgo and ginseng 7. 10 Ways to Boost Dopamine and Serotonin Naturally i. Exercise. Regular exercise for at least 30 minutes each day improves one's overall mood. ii. Spend Time in Nature. In previous generations, humans spent most of their time outdoors. iii. Nutrition. Diet can also influence one's mental health. iv. Meditation. v. Gratitude. vi. Essential O. Goal Achievement. viii. Happy Memories. 98. Metoprolol 1. The main difference between metoprolol tartrate and metoprolol succinate is that metoprolol tartrate is only available as an immediaterelease tablet which means it must be taken several times per day, whereas metoprolol succinate is an extended-release tablet that can be taken once a day 2. However, metoprolol tartrate may be more effective as a treatment for acute heart attacks while metoprolol succinate may be more effective as a treatment for chronic heart failure 3. Metoprolol is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins). 4. It is used to treat angina (chest pain) and hypertension (high blood pressure). 5. Also used to lower your risk of death or needing to be hospitalized for heart failure 99. Carvedilol a. Beta blockers treat high blood pressure and other conditions, such as heart problems. b. Beta blockers, also known as beta-adrenergic blocking agents c. Carvedilol is used to treat high blood pressure and heart failure. d. It is also used after a heart attack to improve the chance of survival e. A number of beta blockers, including atenolol (Tenormin) and metoprolol (Toprol, Lopressor), were designed to block only beta-1 receptors in heart cells. f. Since they don't affect beta-2 receptors in blood vessels and the lungs, cardio selective beta blockers are safer for people with lung disorders g. However, for most patients with uncomplicated hypertension low-dose thiazide-type diuretics should be first-line therapy. Beta blocking drugs and ACE inhibitors are effective when used with a diuretic How do beta blockers work to manage heart failure?  Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline.  Beta blockers cause your heart to beat more slowly and with less force, which lowers blood pressure. Beta blockers also help open up your veins and arteries to improve blood flow. What is the difference between selective and nonselective beta blockers?  The first generation of beta-blockers were non-selective, meaning that they blocked both beta-1 (β1) and beta-2 (β2) adrenoceptors.  Second generation beta-blockers are more cardioselective in that they are relatively selective for β1 adrenoceptors.  Note that this relative selectivity can be lost at higher drug doses.  Finally, the third generation beta-blockers are drugs that also possess vasodilator actions through blockade of vascular alpha-adrenoceptors. What are the adverse effects of beta blockers on the CNS?  Beta-blockers block the hormones adrenaline and noradrenaline in the sympathetic nervous system.  The sympathetic nervous system is part of the autonomic nervous system.  It activates the 'fight-or-flight' response.  Adrenaline and noradrenaline prepare the muscles in the body for exertion What adverse effect may impact the sexuality of clients on beta blockers?  Beta blockers can cause side effects such as trouble getting or keeping an erection. This side effect is less common with other classes of blood pressure Why must beta blockers be used with caution in clients with asthma and diabetes?  Beta blockers are widely used in the management of cardiac conditions and thyrotoxicosis, and to reduce perioperative complications.  Asthma and chronic obstructive pulmonary disease (COPD) have been classic contraindications to the use of beta blockers because of their potential for causing bronchospasm  Since beta-blockers slow your heartbeat, your heart's response to low blood sugar may not be as obvious. Why must beta blockers be tapered off after chronic therapy?  It is vital to counsel the patients to avoid stopping beta-blocker abruptly as it may lead to increased risk rebound hypertension, angina, tachycardia, and most importantly, myocardial ischaemiaWhat client teaching is completed for those on beta blockers?  Take your medicines exactly as prescribed.  Always tell your doctor if you think you are having a side effect from your medicine.  Check with your doctor before you use any over-the-counter medicines.  Some people feel tired when they take beta-blockers  Do not suddenly discontinue How will the nurse evaluate effectiveness of beta blockers? 100. Isosorbide dinitrate 1. Isosorbide dinitrate is used to prevent chest pain (angina) in patients with a certain heart condition (coronary artery disease). 2. This medication belongs to a class of drugs known as nitrates. 3. It works by relaxing and widening blood vessels so blood can flow more easily to the heart Nitrates are contraindicated with the use of which classification of medications?  Sildenafil, tadalafil, vardenafil, and avanafil: Taking any of these drugs with nitroglycerin can cause very low blood pressure.  Ergotamine: Taking these drugs together can cause more chest pain.  Riociguat: Taking these drugs together can cause very low blood pressure What is the main effect of nitrates on the blood vessels?  Nitrates are a vasodilator.  Vasodilators widen (dilate) the blood vessels, improving blood flow and allowing more oxygen-rich blood to reach the heart muscle.  Nitrates also relax the veins to ease the workload on the heart when blood is returning to the heart from the arms and legs What are the adverse effects of nitrates? 101. Nitroglycerin 1. Headache, dizziness, lightheadedness, nausea, and flushing may occur as your body adjusts to this medication. 2. Headache is often a sign that this medication is working3. Nitroglycerin sublingual tablets are used to treat episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart). 4. It is also used just before activities that may cause episodes of angina in order to prevent the angina from occurring 102. Hydralazine 1. Hydralazine, sold under the brand name Apresoline among others, is a medication used to treat high blood pressure and heart failure. 2. This includes high blood pressure in pregnancy and very high blood pressure resulting in symptoms. 3. It has been found to be particularly useful in heart failure, together with isosorbide dinitrate, for treatment of people of African descent. 4. It is given by mouth or by injection into a vein. 5. Effects usually begin around 15 minutes and last up to six hours 103. Warfarin-Coumadin  Warfarin, and superwarfarins, are vitamin K antagonists that primarily act through inhibition of 2,3 vitamin K epoxide reductase and cause a deficiency of active vitamin K.  The active vitamin K deficiency leaves coagulation factors II, VII, IX, X, and proteins C and S inactive  Warfarin competitively inhibits the vitamin K epoxide reductase complex 1 (VKORC1), which is an essential enzyme for activating the vitamin K available in the body.  Through this mechanism, warfarin can deplete functional vitamin K reserves and therefore reduce the synthesis of active clotting factors. What medication is used to reverse warfarin?  Vitamin K and FFP for warfarin What are indications for the use of warfarin?  Warfarin sodium tablets, USP are indicated for: Prophylaxis and treatment of venous thrombosis and its extension, pulmonary embolism (PE).  Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation (AF) and/or cardiac valve replacement.What is the onset of action of warfarin? How does this impact use of the medication?  The onset of action is typically 24 to 72 hours.  A peak therapeutic effect is seen 5 to 7 days after initiation.  However, the patient's international normalized ratio (INR) may increase within 36 to 72 hours after initiating treatment. Discuss the dietary teaching that is completed for clients taking warfarin. Foods to limit while taking warfarin  Kale.  Spinach.  Brussels sprouts.  Parsley.  Collard greens.  Mustard greens.  Endive.  Red cabbage 104. Rivaroxaban-Xarelto  Inhibition of Factor Xa interrupts the intrinsic and extrinsic pathway of the blood coagulation cascade, inhibiting both thrombin formation and development of thrombi.  Rivaroxaban does not inhibit thrombin (activated Factor II), and no effects on platelets have been demonstrated. What are benefits and risk to the use of rivaroxaban and dabigatran? Xarelto  Rivaroxaban and dabigatran are associated with less risk of intracranial hemorrhage than warfarin but more risk of gastrointestinal bleeding 105. Dabigatran (Pradaxa)  Reversibly binds to the active site on the thrombin molecule, preventing thrombin-mediated activation of coagulation factors.  It may have less of an antagonistic effect on thrombin-mediated platelet aggregation106. Heparin  The anticoagulant agent heparin inhibits thrombosis by interacting with antithrombin III What medication is used to reverse Heparin?  Protamine sulfate is a medication that is used to reverse the effects of heparin.  It is specifically used in heparin overdose, in low molecular weight heparin overdose, and to reverse the effects of heparin during deli [Show More]

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