NUR 521 Module 4 Study Guide

NUR 521 Module 4 Study Guide Each chapter has questions that link to the study guide questions and are on the module quiz. Chapter 19: Hypertension Chapter 22: Heart Failure Chapter 23: Arrhythmias 1. Review the m ...

NUR 521 Module 4 Study Guide Each chapter has questions that link to the study guide questions and are on the module quiz. Chapter 19: Hypertension Chapter 22: Heart Failure Chapter 23: Arrhythmias 1. Review the mechanism of action of each of the following medications. What adverse effects and drug-associated diseases are problematic? A. Clonidine-Used for : HTN, CA+ related pain(adjunct Tx),Tourette, ADHD alpha-2 agonist, central Interaction Characteristics:  affects growth hormone diagnostic test results  antihypertensive agent  bradycardia  CNS depression  hypotensive effects  interferes w/ radiolabeled norepinephrine analog effect Appropriate Use dilute 500 mcg/mL strength product prior to use in an appropriate solution Obstetrical, Postpartum, or Perioperative Use weigh risk/benefit; epidural clonidine generally not recommended for obstetrical, postpartum, or perioperative pain management due to risk of hemodynamic instability, esp. hypotension and bradycardia Safety/Monitoring . Monitoring Parameters oral use: Cr at baseline; vital signs frequently if cardiac conduction disturbance; HR, BP at baseline in ADHD pts, after dose increases, then periodically epidural use: Cr at baseline; vital signs frequently, esp. during 1st few days of tx Look/Sound-Alike Drug Names clonidine confused with: Cardizem; cetirizine; clobazam; clonazepam; colchicine; Klonopin Pregnancy/Lactation Pregnancy Clinical Summary caution advised during pregnancy; risk of teratogenicity not expected, though possible risk of decr. birth wt based on limited human data; risk of embryo-fetal death based on animal data at 0.067x to 8x MRHD Lactation Clinical Summary NUR 521 Module 4 Study Guide (Chapters 19, 20, 22, 23, 50, and 51) Page 1 of 21consider alternative while breastfeeding; inadequate human data available to assess risk of infant harm or effects on milk production B. Metoprolol-Tx: HTN, angina, CHF, migrane prophylaxis BETA BLOCKER Interaction Characteristics:  CYP2D6 substrate  antihypertensive agent  bradycardia  hyperglycemia  hypoglycemia  prolongs PR interval Avoid Abrupt Cessation severe angina exacerbation, MI, and ventricular arrhythmias in angina pts after abrupt D/C; taper gradually over 1-2wk and monitor when D/C chronic tx, especially in ischemic heart dz; restart tx even temporarily if angina worsens or acute coronary insufficiency develops; warn pts to avoid tx interruption or D/C w/o MD advice; avoid abrupt D/C in all pts in case of unrecognized CAD Safety/Monitoring . Monitoring Parameters BP, HR Look/Sound-Alike Drug Names metoprolol confused with: atenolol; metoclopramide; metolazone; metronidazole; misoprostol metoprolol succinate confused with: metoprolol tartrate Pregnancy/Lactation Pregnancy Clinical Summary caution advised during pregnancy, esp. in 2nd and 3rd trimesters; risk of teratogenicity not expected based on limited human data; possible risk of intrauterine growth restriction and neonatal adverse effects, incl. bradycardia and hypoglycemia, based on limited or conflicting human data Lactation Clinical Summary may use while breastfeeding; no known risk of infant harm based on limited human data and drug properties; no human data available to assess effects on milk production C. Amlodipine: Tx: HTN,CAD Contraindications / Cautions .  hypersens. to drug/class/compon. NUR 521 Module 4 Study Guide (Chapters 19, 20, 22, 23, 50, and 51) Page 2 of 21 caution in elderly pts  caution if hepatic impairment  caution if severe CAD  caution if severe aortic stenosis CCB, dihydropyridine Interaction Characteristics:  CYP3A4 substrate  CYP3A4 inhibitor, weak  antihypertensive agent Contraindicated  cisapride Adverse Reactions . Serious Reactions  angina exacerbation  MI  hypotension, acute  hepatitis  hypersensitivity rxn  erythema multiforme Common Reactions  peripheral edema  fatigue  palpitations  dizziness  nausea  flushing  eczematous eruptions (chronic use, elderly pts) Safety/Monitoring . Monitoring Parameters BP at baseline, then periodically Look/Sound-Alike Drug Names amlodipine confused with: amiloride; amiodarone; amitriptyline; felodipine; memantine Pregnancy/Lactation Pregnancy Clinical Summary caution advised during pregnancy; inadequate human data available to assess risk; no known risk of teratogenicity based on animal data at up to 20x MRHD, though risk of embryo-fetal death based on animal data at 10x MRHD Lactation Clinical Summary caution advised while breastfeeding; no known risk of infant harm based on limited human data; no human data available to assess effects on milk production