Pharmacology Final Exam Study Guide 3,GRADED A

Pharmacology Final Exam Study Guide 3 Digoxin discharge teaching, what must a client know how to do? ANTIDOTE = digoxin immune Fab (Digibind) **check apical pulse for a full minute before administering medication** - ...

Pharmacology Final Exam Study Guide 3 Digoxin discharge teaching, what must a client know how to do? ANTIDOTE = digoxin immune Fab (Digibind) **check apical pulse for a full minute before administering medication** -hold for heart rate below 60 bpm -does not affect blood pressure -encourage patient to eat high potassium diet -monitor for S/S of digoxin toxicity: N/V, vision changes (green halo vision), bradycardia, dysrhythmias, confusion >>educate patients to have digoxin levels checked (toxic level= >2ng/ml) How to monitor and interpret labs for potassium wasting diuretics. Normal potassium ranges. Nursing interventions, potassium rich foods *THIAZIDE DIURETIC promotes sodium, chloride, and water excretion (diuresis) Treats: HTN and peripheral edema does not treat immediate emergency diuresis First drug of choice for peripheral edema spares calcium= hypercalcemia affect glucose tolerance = hyperglycemia Only use in patients with NORMAL RENAL FUNCTION *LOOP DIURETICS act on loop on henle inhibit chloride transport of sodium into circulation sodium and water are lost along with potassium, calcium, and magnesium >>very potent<< can affect blood glucose and uric acid levels only prescribe if HCTZ treatment fails *FUROSEMIDE (LASIX) used to treat edema not used for hypertension Take potassium supplement with therapy Take in AM Daily weight (report gain >2 lbs. in 24 hours) BP and Heart rate Monitor lung sounds for fluid overload can be used IV for emergency > pulmonary edema, and acute heart failure monitor electrolyte levels caution to CHANGE POSITION SLOWLY IV Administration: push SLOWLY! DO NOT EXCEED 20mg/min [administering too rapidly can cause hearing loss (Cranial nerve 8)] * NORMAL RANGES Potassium: 3.5-5 Sodium: 135-145 Actions of ACE inhibitors, think about chronotropic, inotropic etc. “PRIL” Medications Prevent angiotensin I (weak) from converting into angiotensin II (potent) and PREVENTS the release of aldosterone. Aldosterone promotes retention of sodium and water. RESULTS: prevent vasoconstriction Promotes diuresis of sodium and water this improves circulation and improves cardiac functions USES: HTN & HF * African American * Use combo therapy with diuretic to see results LISINOPRIL Side effects: dry cough, first dose hypotension, ANGIOEDEMA, hyperkalemia what meds should you not take with grapefruit juice-we did not cover this in depth, but calcium channel blockers should not be taken with grapefruit juice. Client teaching with use of nitro and other vasodilators-should they continue to perform a task causing pain? MUST BE PROTECTED FROM HEAT AND LIGHT (deactivate) - Available IV, transdermal, sublingual Side effects- headache, hypotension, dizziness, faintness Teach- sit or lie down before taking medication IF PAIN PERSIST AFTER 10 MINUTES CALL 911! How do calcium channel blockers work in the heart, the rest of the body? (CCB) calcium channels are found in myocardium and vascular smooth muscle cells -Free calcium ^^ muscle contractility -Peripheral resistance -Blood pressure ~CCB block calcium channel in vascular smooth muscle , which promotes VASODILATION **HIGHLY PROTEIN BOUND** (ex. Phenytoin, warfarin) Long half life Work better in African American >>DO NOT TAKE WITH GRAPEFRUIT JUICE<< VERAPAMIL Treat: supraventricular tachydysrhythmias prevent PSVT, angina, and hypertension Contraindicated : cardiogenic shock, 2nd and 3rd degree AV block, severe hypotension, heart failure DILTIAZEM Treat: PVST, afib, atrial flutter Contraindicated: 2nd and 3rd degree AV block, hypotension When to hold beta blockers-what do they impact? HR, BP “OLOL” drugs *reduce cardiac output, decrease HR and force* -with continued use vascular resistance is diminished and BP is reduced CHECK: HR and BP before administration HOLD IF apical pulse <60bpm, SBP<90 -reduce heart rate, contractility, and renin release ** African American ** so not respond well to beta blockers alone to control HTN should be on combo diuretic and beta blocker NON-SELECTIVE BETA BLOCKERS: propanolol, carvidilol, inhibit beta 1 [heart] and beta 2 [lungs] BP decreases secondary to heart rate decrease BRONCHOCONSTRICTION Contraindicated: ASTHMA SELECTIVE BETA BLOCKERS: atenolol, metoprolol Acts on beta 1 [heart] Adverse effects: bradycardia, hypotension, hypoglycemia, thrombocytopenia, complete heart block, bronchospasm (CAUTION ASTHMA), agranulocytosis Minipress teaching “Praxosin” * Alpha Adrenergic Blockers* When taken with nitroglycerin can cause hypotension resulting in syncope -educate patient to change positions slowly When should we tell clients to take diuretics? Morning, afternoon, bedtime? Take in the AM! Use of potassium as a supplement, when to give, when to hold For a patient taking potassium wasting diuretics such as HCTZ and LASIX and taking potassium supplement, what would you do if the serum potassium level came back 5.0?- HOLD notify MD If patient on potassium wasting diuretic and serum potassium comes back 2.8 what would you do?- call MD. >hold lasix, give potassium supplement Antidote for heparin (protamine sulfate) and Coumadin (vit K) Importance of daily weights in monitoring heart failure Why do patients taking diuretics need to report a weight gain of >2lbs in 24 hours? could be onset of worsening heart failure or pulmonary edema Interactions of Coumadin and antibiotics, what happens to INR levels and what may we need to do? Alterations in INR Increase risk of bleeding Give VITAMIN K Side effects of ACE inhibitors **cough** **cough** Cough When to hold digoxin, what are the side effects of digoxin, client complaints/symptoms the 3 effects on heart muscle: 1. positive inotropic= ^ myocardial contraction 2. negative chronotropic = decrease heart rate (allow for fill time) 3. negative dromotropic = decreased conduction of heart cells-check apical pulse for a full minute before administering medication Side Effects: nausea , abdominal pain, palpations, and visual halos. -hold for heart rate below 60 bpm digoxin (Lanoxin) has a narrow what? therapeutic window Remember salt substitutes are often made of potassium, which type of diuretic should you avoid. Potassium Sparing Diuretics- spironolactone, amliroride, triamterene -weaker than thiazides, or loops -mild diuretic - combo therapy -interfere with sodium- potassium pump controlled by aldosterone -if potassium is>5.3 the potassium sparing diuretic should be DC’d SPIRONOLACTONE *aldosterone antagonist* potassium retaining effect -results include regular heart rate, decreased possibility of myocardial fibrosis Adverse effects: life threatening kyperkalemia if given with ACE inhibitors Side effects of nitrates, #1 thing people c/o is headache headache, hypotension, dizziness, faintness Viagra should not be used with nitro, why? Decreased blood pressure- deadly Use of lidocaine (action) in ventricular ectopy Sodium Channel Blocker: lidocaine used for acute ventricular dysrhythmias following an MI and cardiac surgery used for short burst of ventricular ectopy(unusual beat) Remember to consult the physician, you cannot just give medication without orders. Even dietary recommendations can be considered orders Medications that can make heart failure worse. Stated differently, what meds may cause fluid retention? Steroids can cause worsening of fluid in the lungs Ipratropium side effects-It is an anticholinergic med, so what might you expect? Side Effects: dry mouth, constipation, dizziness, decreased urination, blurred vision this medication is an anticholinergic and is going to dilate or open up your airways Client teaching for montelukast, remember this is not used for an emergency *Leukotriene inhibitiors* anti-inflammatory effects used for prophylaxis and maintenance NOT FOR RESCUE Use of Robitussin and codeine, what client would this be recommended for? *Antitusive* - Supresses cough -Reduces secretions HIGH DOSES CAN CAUSE HALLUCINATIONS -Should not be used in patients with a productive cough Side effects of theophylline-similar to that of adrenergics *Methylxanthine Derivatives* stimulates CNS and respiration dialates coronary and pulmonary vessels causes tachycardia NARROW THERAPUTIC WINDOW- potential for severe adverse reactions Client teaching for inhaled steroids-rinsing and using the spacer Insures more of the med gets to the lungs Rinse in order to avoid yeast infections in the mouth, i.e. thrush Side effects of inhaled steroids Fungal infection of the mouth- Thrush Use of inhaled albuterol (action) type of medication-used in emergencies for tight airways. Tight airways are indicated on assessment by what sounds? short acting beta agonist- for RESCUE ONLY causes bronchodialation can ^^ BP and Pulse Use of reglan, what is the action? Reglan has direct acting cholinergic effects and blocks dopamine in the CNS -serotonin and dopamine blocker -accelerates gastric emptying amplifies parkinson's and depression anti-emetic management of GERD tx of post surgical & diabetic gastric stasis Side effects of long term use of Phenergan (EPS) -NMS (neuroleptic malignant syndrome) -confusion/disorientation -sedation -involuntary movements -tinnitus -extrapyramidal reactions Side effects of lomotil- Hint contains atropine Anticholinergic effects: constipation, urine retention, tachycardia & pupil dilation Side effects of milk of magnesia, when to use, remember it contains magnesium. Could it alter his electrolytes? If so, what would we be looking for? Renal insufficiency and the use of medications related to GERD, Amphojel, Alkaseltzer, TUMS, Gaviscon both magnesium and aluminum antacids can accumulate in renal failure Nurse teaching, especially when to teach clients to take pantoprazole and why -avoid alcohol -avoid NSAIDs -notify of black tarry stool, rash, abd. cramping, or fever -take before meals -DO NOT crush -may enhance other medications Use of OTC antacids, can they change absorption? -monitor calcium intake, excessive calcium can cause kidney stones Nurse teaching for sucralfate, when should it be taken must be dissolved, NOT CRUSHED -take 30-60 mins before meals -use for 4-8 weeks to ensure ulcer healing -bulk diet, high fluids -assess for abd. pain & blood in the stool Please note the impact of magnesium and the use of milk of mag Electrolyte imbalance Action of H2 blockers Nursing interventions for those with GERD Side effects of calcium supplements, particularly if they complain of flank pain Hypercalcemia can induce renal caliculi (kidney stones) Side effects of Zofran. assess for: -nausea & vomiting -abdominal distention -bowel sounds prior to and after admin -extrapyramidal symptoms (shuffling walk, facial grimacing, rigidity, trembling hands) monitor ECG in pts. w/HF & bradyarrhythmias Vicodin contains Tylenol, consider this when dosing your clients with Tylenol and Vicodin. Max dose Tylenol is usually 3-4 grams/day Client teaching for salmeterol, is it a short acting inhaler? Long Acting Beta Agonist *salemeterol LABA* prophylaxis and maintenance therapy NOT FOR RESCUE NOT FOR MONOTHERAPY can use in COPD Inhaler use is short acting, then long acting 1. ICS inhaled corticosteroid 2. SABA short acting beta agonist 3. LABA long acting beta agonist Teaching for use of Atrovent Nursing interventions for those getting IV atropine (think about what the side effects are), it is never given as a preventative med sponges for mouth Digoxin will not have a direct effect on BP-remember your inotropic actions, etc 1. positive inotropic= ^ myocardial contraction 2. negative chronotropic = decrease heart rate (allow for fill time) 3. negative dromotropic = decreased conduction of heart cells Client teaching for use of beclomethasone inhalers Wash your mouth afterward