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Pharmacology
CV - part I
92
Nursing
Undergraduate 3
10/31/2009

Additional Nursing Flashcards

 


 

Cards

Term
"tropic" effects include
Definition

intotropic

chronotropic

dromotropic

effects

Term
inotropic effects
Definition
drugs that influence the force or energy of muscular contractions, particularly contractions of heart muscle
Term
Positive intropic drugs cause
Definition
increased myocardial contractility
Term
chronotropic effects
Definition
drugs that influence the rate of the heartbeat
Term
postivie chronotropic effects cause
Definition
increased HR
Term
negative chronotropic drugs cause
Definition
decreased HR
Term
dromotropic effects
Definition
drugs that influence the conduction of electrical impulses
Term
positive dromotropic drugs cause
Definition
enhanced conduction of electrical impulses in the heart
Term
cardiac glycosides help patients manage
Definition
systolic HF
Term
Primary effect of cardiac glycosides
Definition

 

inhibits sodium-potassium ATPase pump which increases cellular sodium and calcium concentrations - overall effect is enhanced myocardial contraction

Term
Secondary effect of cardiac glycosides
Definition

Augments vagal (cholinergic or parasympathetic) tone: results in increased diastolic filling b/w heartbeats the reduce HR – this further enhances cardiac efficiency and output




Term
An additive effect of cardiac glycosides
Definition

Change the electrical conduction properties of the heart: decrease the rate of electrical conduction and prolong the refractory period in the conduction system - this affects the conduction system and cardiac automaticity


 

Particularly affects conduction b/w the atria and the ventricles (SA node to AV node): Cardiac cells remain in a state of depolarization longer and are unable to start another electrical impulse – reduces the HR and improves cardiac efficiency

 

Term

What are the 3 "tropic" effects of digoxin (Lanoxin)?

Definition

Positive inotropic effect resulting in an increase in the force and velocity of myocardial contraction without a corresponding increase in oxygen consumption.


A negative chronotropic effect producing a reduced HR.


A negative dromotropic effect that decreases automaticity at the SA node, decreases AV nodal conduction, reduces conductivity at the bundle of His, and prolongs the atrial and ventricular refractory periods.

Term
Indications of cardiac glycoside
Definition

systolic HF, supraventricular tachycardias

Term
AEs of cardiac glycosides
Definition

Very narrow therapeutic window: normal level is 0.8-2 ng/ml


Bradycardia, A/N/V, colored vision, halo vision are classic!


CV - Any type of dysrhythmia, including bradycardia or tachycardia

CNS - HA, fatigue, malaise, confusion, convulsions

Eye - Colored vision (i.e., green, yellow or purple), halo vision or flickering lights

GI - Anorexia, nausea, vomiting, diarrhea

Term

What electrolyte imbalance increases digoxin toxicity? 

Definition

Potassium [K=]

 

High K, low dig therapeutic effects

Low K, high dig therapeutic effects

 

(hyperkalemia – serum level over 5 mEq/L

hypokalemia - serum level below 3.5 mEq/L)

Term
Toxicity and OD Management of Digoxin therapy
Definition

Antidote: Digoxin immune Fab or Digibind – IV only


 

Can’t be given unless you know what their dig level is – dosed based on dig level in body.

(order labs before you give med so you know this level)

Term
Interactions with Cardiac Glycoside Therapy
Definition

Additive interactions with other meds that are used to affect the heart.


K+ wasting diuretics increase dig toxicity.


Some antilipemics decrease absorption of dig.  


Antidysrhythmics, sympathomimetics, loop diuretics, laxatives, adrenal steroids and thiazide diuretics - increase dig toxicity


Antacids, antidiarrheals, barbiturates - reduce therapeutic effects

 


Anticholinergics - increased therapeutic effects


Beta-blockers - enhanced bradycardic effect of dig


Calcium channel blockers - enhanced bradycardic and inotropic effects of dig


Some antidysrhythmics: quinidine, verapamil, amiodarone - increase dig levels (dose should be reduced by 50%)

 

Term

Why check apical pulse for 1 full min prior to giving digoxin? 

Definition

Documentation needed for any irregularities, a pulse rate less than 60 beats/min or more than 100 beats/min as a baseline and identification marker for toxicity.

Term

Why check breath sounds and edema with dig therapy?

Definition

This assessment checks for fluid levels – important because of the narrow therapeutic window for dig therapy.

Term

Your client eats 2 bowls of bran cereal every AM with his digoxin.  Is this good or bad?  Why?

Definition

This is a bad thing – bran alters the absorption of dig

Term
Patient Teaching Tips for dig therapy
Definition

  • Pts should always take radial pulse before admin
  • Elderly and physically or mentally challenged are more at risk for interactions with other meds, adverse effects and toxicity.
  • Pts should be encouraged to keep a journal with details about med administration and effects/changes in body functioning.
  • Pts are encouraged to contact physician with unusual complaints, A/N/V or erratic pulse (<60 beats/min or >100 beats/min)
  • Pts should report any changes in vision
  • Pts should report any changes in heart beat, dizziness, fainting, blackouts and weight gain (2lbs or more in 24hrs, 5lbs or more in 1 week)
  • Pts should weigh themselves daily
  • If symptoms worsen, notify HCP
  • Pts should wear a medical alert bracelet with up to date information
  • Dig should be taken once at day, at the same time every day
  • No double dosing, not skipping dose, if dose has been missed by more than 12 hrs: contact HCP.
  • Med should not be abruptly stopped
  • Consume foods high in potassium, esp if taking a potassium-depleting diuretic
  • Avoid using antacids, eating milk products for 2 hrs before or after taking med to avoid interference with drug

Term
3 Classes of Antianginal Agents
Definition
Nitrates, Beta-blockers, Calcium channel blockers
Term
Nitrates: Key Drug Name and Mechanism of Action
Definition

nitroglycerin (Nitrostat, Nitro-Bid)


Dilate all blood vessels, especially venous vascular beds.  ***Potent dilating effect on coronary arteries.

Term
Beta-blockers: Key Drug Name and Mechanism of Action
Definition

atenolol (Tenormin)

 

Block the beta receptors of the heart to slow the HR (slows firing of SA node, slow conduction to AV node and reduce myocardial contractility)

Term
Calcium channel blockers:Key Drug Name and Mechanism of Action
Definition

diltiazem (Cardizem)

 

 

Blocks Ca++ in the excitation-contraction process of heart and vascular muscle cells >>> promotes contraction of heart and vessels (vasodilation). 

 

Also decreases automaticity of and conduction thru SA and AV node >>> decreases/slows heart rate. 

Term
Nitrates: Indications
Definition

Angina

(prevention and treatment

Term

Nitrates: AEs

 

Definition

HA - real common, reflex tachycardia (compensatory mechanism to increase cardiac output).


Nitrate tolerance.  

Term
What is nitrate tolerance and how do you prevent it?
Definition

 

Patient becomes tolerant to the effects of the nitrate treatment.

Can often occur quickly.


Prevention: a regular nitrate-free period is arranged to allow certain enzymatic pathways to replenish themselves.

Ex- remove transdermal patch at night and apply new patch in the morning (8hr nitrate-free period).

Term

Beta-blockers: Indications

Definition

Treatment of typical exertional angina (caused by exercise), MI, HTN, cardiac dysrhythmias and essential tremor

Slow contractility, HR and conduction.

Term
Beta-blockers: AEs
Definition

Blocking of beta-1 receptors: decreases in HR, CO and contractility


Blocking of beta-2 receptors: bronchoconstriction and increased airway resistance in pts with asthma or COPD.


Beta blockers mask tachycardia associated with hypoglycemia.

Can cause both hypoglycemia and hyperglycemia


CV - Bradycardia, hypotension, 2nd or 3rd degree heart block, HF


CNS - Dizziness, fatigue, mental depression, lethargy, drowsiness, unusual dreams


Metabolic - Altered glucose and lipid metabolism

 

Other - Wheezing, dyspnea, impotence


Term
Calcium Channel Blockers (CCBs): Indications
Definition

First-line drug for: angina, HTN and supraventricular tachycardia


Particularly effective for tx of coronary artery spasms.


Also used for short-term management of A fib. and flutter, migraine, HA and Raynaud’s disease.


dihydropyridine CCB nimodipine is indicated solely for cerebral artery spasms associated with aneurysm rupture.

Term
Calcium Channel Blockers (CCBs): AEs
Definition

Peripheral edema, bradycardia, and HF are common.

(Related to the over-expression of the therapeutic effects of CCBs)

Term
Nursing Process Considerations: Antianginals
Definition

  • A complete health and medication history should be completed along with wt, ht and vital signs.
  • A systolic BP of less than 90mmHg should be reported to the HCP before a dose of these drugs are given
  • Pts chest pain should be thoroughly assessed (possible ECG).
  • In teaching pt, emphasize significant drug interactions with nitrates and importance of of blood pressure control (esp worsening of symptoms)
  • Beta-blockers should not be used in pts with asthma or resp trouble; also concern in pts with hyperthyroidism, impaired renal or liver func, PVD or diabetes
  • Assess wt gain (concern: 2lbs or more in 24hrs, 5lbs or more in 1wk)

Term
Antihypertensives: Key Drugs
Definition

clonidine (Catapres)


captopril (Capoten)


losartan (Cozaar)


hydralazine HCl (Apresoline)

 

Term

Antihypertensives: clonidine (Catapres)

 

Classification and Mechanism of Action

Definition

Alpha-2 adrenergic receptor stimulator (agonist)


Works by stimulating the alpha-2 adrenergic receptors in the brain which reduce sympathetic outflow from the CNS which reduces BP  

Term

Antihypertensives: captopril (Capoten)

Classification and Mechanism of Action

Definition

Angiotensin-converting enzyme inhibitor (ACE inhibitor)


Inhibit angiotensin-converting enzyme which is responsible for converting angiotensin I (AI) to angiotensin II (AII).

 

Reduce BP by decreasing SVR (a measure of afterload) and preload -- prevent breakdown of vasodilating substances and prevent the formation of AII (a potent vasoconstrictor)

Term

Antihypertensives: losartan (Cozaar)

Classification and Mechanism of Action

Definition

Angiotensin II receptor blocker (ARB)


Block binding of AII to type 1 AII receptors, thereby block vasoconstriction and secretion of aldosterone

Term

Antihypertensives: hydralazine HCl (Apresoline)

 

Classification and Mechanism of Action

 

Definition

Vasodilator

 

Directly elicit peripheral vasodilation – reduction of SVR (hypotensive effects)

 

Term

Adrenergic Agents: Key drug 

 

Definition

(adrenergic agents include: alpha1 blockers, centrally acting agents, peripherally acting agents)

 

 

Key drug: clonidine (Catapres) - an alpha-2 adrenergic receptor stimulator (agonist)

 

Term
Adrenergic Agents: AEs
Definition

Pts experience sedation and drowsiness -  sympathetic outflow from CNS is reduced which reduces BP

(body is less stimulated, systems are slowed)

 

Orthostatic hypotension - a sudden drop in BP during changes in position.

 

Term
Adrenergic Agents: Interactions
Definition

CNS depressants - Alcohol, benzodiazepines and opioids

(enhance CNS depression)

Term
ACE Inhibitors (the "prils"): Renin-Angiotensin-Aldosterone System (RAAS)
Definition

These drugs block the angiotensin-converting enzyme (ACE) - ultimately prevents vasoconstriction and aldosterone secretion.


(Aldosterone - responsible for reabsorption of salt and water and excretion of potassium in the kidneys)

 

Term

ACE Inhibitors (the "prils"): Indications

 

Drug of choice for what population?

Definition

HTN, stop progression of ventricular remodeling post MI (“cardioprotective effect”).

 

“Pro-drug” – not effective until metabolized by the liver.


Drug of choice for:

Hypertensive patients with HF and diabetic pts

(protect/preserve the kidneys)

 

 

Term
ACE Inhibitors (the "prils"): AEs
Definition

Persistant, non-productive cough is a classic side effect – “ACE” cough (coughing all the time).


CNS - Fatigue, dizziness, mood changes and HA


CV - Significant decrease in BP - hypotension


Other - Loss of taste, proteinuria, hyperkalemia, rash, pruritus, anemia, neutropenia, thrombocytosis and agranulocytosis

Pts with severe HF: renal failure

Potentially fatal: angioedema (strong vascular reaction involving inflammation of submucosal tissues, which can progress to anaphylaxis)

 

Term

ACE Inhibitors (the "prils"): Interactions

 

Any ideas why hyperkalemia may occur when ACE inhibitors are given with K+ sparing diuretics or K+ supplements?  (Hint: take a look at RAAS - what does aldosterone do?)

Definition

Lots of drug interactions. 

 

Aldosterone increases renal excretion of potassium – ACE inhibitors block its secretion from the adrenal gland and so K+ builds up in the body, leading to hyperkalemia.

 

Term
ACE Inhibitors: Contraindications
Definition

 

 

Pregnancy, lactation

Hyperkalemia

Known allergy or hypersensitivity

 

Term
ACE Inhibitors: Key Drug
Definition

captopril (Capoten)

 

Term

Angiotensin II receptor blocker (ARB) ("sartan" drugs): Key drug

Definition
Term

Angiotensin II receptor blocker (ARB) ("sartan" drugs): AEs

 

What do they cause?

 

 

Definition

Do not protect the heart and kidneys like the ACE Inhibitors do

Don't cause the classic cough like ACE-I do  

 

But they do cause:

Most common: upper respiratory infections and HA.

Occasionally: insomnia, dizziness, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue.

Rarely: Anxiety, muscle pain, sinusitis, cough and insomnia.

Term
Antihypertensives: CCB effects
Definition

3 negative tropic effects: HTN, Angina, tachydysrhythmias, prevention of cerebral artery spasms post-CVA


Block intracellular calcium influx

Term
Antihypertensives: Diuretic Effects
Definition

furosemide (Lasix) – most effective diuretic


Block chloride absorption – blocks sodium – water follows sodium and is peed out (unfortunately, potassium is also peed off)

Run the risk of hypokalemia


Increase renal prostaglandins – kidneys work more effectively

Potency depends where the diuretic works – strongest are the loop diuretics (Loop of Henle), least effective are in the distal collecting duct


Used for rapid diuresis, with kidney failure and FVE

 

Treat HF and HTN by vasodilation (pee extracellular fluid off)– decreasing blood pressure and preload

Reduce afterload, BP and preload


 

 

Term

Antihypertensives: Diuretics

 

Nursing Considerations

Definition

Check BP, I&O (urine output) and daily weights


Antagonized by NSAIDs

 

Term

Antihypertensives: Diuretics

 

Contraindications

Definition

Allergy


End stage liver failure


Severe electrolyte imbalances

 

Term

Antihypertensives: Diuretics

 

AEs

 

Definition

Electrolyte imbalances: hypokalemia


CNS – HA, dizziness, tinnitus


 

 

Term

Antihypertensives: Diuretics

 

Toxicity

Definition

 

Tx: fluid and potassium

 

Hypokalemia – heart gets irritable without potassium (PVCs)


Neurotoxicity and nephrotoxicity

Best test of nephrotoxicity – check creatinine level (high=something wrong with kidneys)

 

Ototoxicity (cranial nerve toxicity) – permanent hearing loss


 

Term

Antihypertensives: Vasodilators

 

Key Drug

Definition

hydralazine HCl (Apresoline)

 

Term

Antihypertensives: Vasodilators

 

What else can this class of drugs be used for?

Definition

Minoxidil (Rogaine): in topical form, used to restore hair growth.

Term

Antihypertensives: Vasodilators

 

AEs

 

Definition

 dizziness, HA, anxiety, tachycardia, edema, nasal congestion, dyspnea, etc.


Minoxidil: 

T-wave changes on ECG

Cardiac tamponade

Breast tenderness or gynecomastia (men grow breasts)


Nipride:

Potential for cerebral steal and/or coronary steal - can causes profound hypotension

Cyanide toxicity – metabolized down to cyanide

Term

Antihypertensives: Vasodilators

 

Indications

 

Definition

Severe HTN

 

 

Parenteral form is generally reserved for treatment of severe or malignant HTN

Term

Antihypertensives: Vasodilators

 

Contraindications

 

Definition

Hypotension


CAD or AMI – steals blood from organs

 

Term

Antihypertensives: Vasodilators

 

Nursing Considerations

 

Definition

Assessment parameters (monitor the following)

 

  • Pulse, BP, resp – hold parameters
  • Want to keep BP about 130/80
  • Serum electrolytes
  • Potassium and sodium
  • Renal and hepatic func
  • ACE inhibitors are highly metabolized in these areas
  • Importance of ophthamoscopic exam
  • Blood is pulled away from retinal - retinopathy
  • Peripheral edema
  • Blood pools in extremities when drug is working too well
  • I&O and daily weights
  • Dilation is causing weight gain – drug is working too well

 

 

Term

Antihypertensives: Vasodilators

Why assess respiratory status and K+ serum levels prior to giving captopril (Capoten)?

 

Definition

ACE inhibitors have the AE of a dry, hacking, chronic cough.


 

 

Term

Antihypertensives: Vasodilators

 

Why should pts not abruptly discontinue taking these drugs?

 

Definition
Abrupt withdrawal is a serious concern - all antihypertensive drugs have some vasodilatory action and abruptly stopping dosages can have negative effects on the circulatory system.
Term

Antihypertensives: Vasodilators

 

You are preparing to administer hydralazine (Apresoline) to your elderly client.  What is important to assess first?

 

Definition

Baseline neurologic assessment with noting of level of consciousness and cognitive ability – elderly are esp sensitive to drug’s ability to lower BP (more problems with hypotension, dizziness and syncope)

 

 

Term

Diuretic Agents: Carbonic Anhydrase Inhibitors

 

Effects

Definition

Sodium is exchanged for hydrogen ions in the proximal tubules of the nephrons of the kidney.

Water follows sodium in the exchange.

Without hydrogen, the salt exchange and the retention of water that follows the sodium cannot occur.


Carbonic anhydrase helps make hydrogen available for this exchange.

 

Term

Diuretic Agents: Loop Diuretics

 

Key Drug

Definition
furosemide (Lasix)
Term

Diuretic Agents: Loop Diuretics

 

Mechanism of Action

Definition

Advantage: work even if creatinine clearance is low (< 25 mL/min; nl is 125 mL/min) and if there minimal kidney function (3% or more)

Term

Diuretic Agents: Loop Diuretics

 

Indications

Definition

Edema with HF and hepatic or renal disease


HTN

Term

Diuretic Agents: Loop Diuretics

 

AEs

Definition

CNS - Dizziness, HA, tinnitus, blurred vision


GI - Nausea, vomiting, diarrhea


Hematologic - Agranulocytosis, thrombocytopenia, neutropenia


Metabolic - Hypokalemia, hyperglycemia, hyperuricemia

Term

Diuretic Agents: Loop Diuretics

 

Drug Interactions

Definition

Aminoglycosides, capreomycin, chloroquine, vancomycin - increased neurotoxicity, esp ototoxicity

 

Corticosteroids, digoxin - additive hypokalemia, increased dig toxicity

 

lithium - increased lithium toxicity

 

NSAIDs - decreased diuretic activity

 

Sulfonylureas - hyperglycemia

Term

Diuretic Agents: Loop Diuretics

 

What happens when given with ibuprofen (NSAID)? 

Definition

Inhibits full effect of diuretic

Term

Diuretic Agents: Loop Diuretics

 

What happens when given with digoxin?

Definition

Additive hypokalemia and increased dig toxicity.

Term

Diuretic Agents: Osmotic Diuretics

 

Key Drug

Definition
mannitol (Osmitrol)
Term

Diuretic Agents: Osmotic Diuretics

 

Mechanism of Action

 

Definition

Produces osmotic pressure in the GF >>> pulls fluid into tubules >>> diuresis

Term

Diuretic Agents: Osmotic Diuretics

 

Indications

 

Definition

Osmotic diuretic of choice.


Non-absorbable – leaches out fluid and promotes diuresis

(No significant electrolyte block)


Effective in getting rid of fluid – esp. fluid on the brain (cerebral edema – closed head injuries)


Early, oliguric phase of acute renal failure, increased incranial pressure and cerebral edema.

Term

Diuretic Agents: Osmotic Diuretics

 

AEs

 

Definition

Convulsions, thrombophlebitis, pulmonary congestion.

Term

Diuretic Agents: Osmotic Diuretics

 

Contraindications

 

Definition

End-stage renal disease (ESRD)

Active intracranial hemorrhage


Keep it warm and push through a filter – it crystallizes just below room temp

 

Term

Diuretic Agents: Potassium-Sparing Diuretics

 

Key Drug

Definition
spironolactone (Aldactone)
Term

Diuretic Agents: Potassium-Sparing Diuretics

 

Mechanism of Action

 

Definition

Binds to aldosterone receptors (blocks aldosterone) >>> blocks resorption of Na+ and water, spare potassium

Term

Diuretic Agents: Potassium-Sparing Diuretics

 

Indications

 

Definition

Hyperaldosteronism

HTN

Reverse potassium loss caused by potassium-wasting (i.e., loop, thiazide) diuretics

Used in combo with potassium-wasting drug to keep therapeutic levels

Provide diuresis without causing electrolyte imbalance

Cardio-protective

Term

Diuretic Agents: Potassium-Sparing Diuretics

 

AEs

 

Definition

CNS -Dizziness, HA

 

GI - Cramps, nausea, vomiting, diarrhea


Other - Urinary frequency, weakness, hyperkalemia, dysamennorhea in women and men grow breasts

Term

Diuretic Agents: Potassium-Sparing Diuretics

 

Interactions

 

Definition

Admin of ACE-I or potassium supplements in combination with potassium-sparing diuretics can result in hyperkalemia.

ACE-I block secretion of aldosterone (hormone that promotes K+ wasting)

Potassium-sparing diuretics keep K+ from being excreted

Potassium supplements increase serum K+ levels


All these factors can lead to build-up of K+ in the serum without proper excretion, which can lead to hyperkalemia.

 

Term

Diuretic Agents: Thiazides

 

Key Drug

Definition

hydrochlorothiazide (HydroDIURAL)

 

Term

Diuretic Agents: Thiazides

 

Mechanism of Action & Drug Effects

 

Definition

Inhibit resorption of Na+, K+, Cl- >>> osmotic water loss.  Direct relaxation of arterioles >>> reduces afterload.

 

Works best with adequate creatinine clearance (> 50 mL/min).

 

Term

Diuretic Agents: Thiazides

 

Indications

 

Definition

HTN


Edematous states


Idiopathic hypercalciuria


Diabetes insipidus

 

Term

Diuretic Agents: Thiazides

 

AEs

 

Definition

Orthostatic hypotension


Dehydration


Impotence, decreased libido

 

Term

Diuretic Agents: Thiazides

 

What are the electrolyte and metabolic disturbances associated with this drug? 

 

 

Definition

Reduced K= levels (hypokalemia)


Elevated levels of: Ca2=, lipids, glucose and uric acid

 

Term

Diuretic Agents: Thiazides

 

Interactions

Definition

Corticosteroids, dig and oral hypoglycemics

 

Term

Diuretic Agents: Thiazides

 

Nursing Implementation: What are 3 things you'll do when giving this drug?

 

Definition

  • Administration: PO – give with food to minimize gastric upset; IV– confirm rates and use infusion pump.
  • Baseline vitals (BP, pulse, I & O [hydration status], capillary refill, daily weights) and continue to be monitored as well as heart rate and rhythm.
  • Assess for signs and symptoms of constipation (FVD), cardiac irregularities, nocturia and hyperkalemia (nausea, vomiting, diarrhea, and abdominal cramping)

 

 

Term

Diuretic Agents: Thiazides

 

Nursing Assessment: What are 3 things you'll want to assess with this drug?

 

Definition

  • Physical assessment with documentation of baseline fluid volume levels, postural BPs, skin turgor, status of moisture levels of mucous membranes and capillary refill; kidney and liver function.
  • Labs: serum potassium, sodium, chloride, magnesium, calcium, uric acid and creatinine levels should be measured and documented; ABGs and blood pH.
  • Discuss cautions, contraindications and interactions associated with the diuretics (esp loop diuretics – adversely react with other meds that are ototoxic or nephritic)

 

 

Term

Diuretic Agents: Thiazides

 

Patient Teaching Tips

Definition

  • Maintain proper nutritional intake and fluid volume status – eat potassium-rich foods.
  • Foods high in potassium: bananas, oranges, dates, raisins, plums, fresh veggies, potatoes (white and sweet), meat, fish, apricots, whole grain cereals and legumes.
  • Potassium supplements may be recommended.
  • Frequent lab tests at the beginning of therapy.
  • Pts need to change positions slowly (orthostatic hypotension) and give meds at night (nocturia).
  • Forcing fluids may be needed to keep levels therapeutic.
  • Pts should report any unusual effects of problems to their HCP immediately.
  • Pts should keep a daily journal to monitor changes (if any).
  • Prevent constipation with an increase in fiber, bulk, roughage and fluids (if not contraindicated)
  • Pts should avoid hot climates and spaces (saunas, hot tubs) that may cause excessive fluid loss.
  • Pts educated about signs and symptoms of hypokalemia – weakness, leg cramps, and other cramping.
  • Pts educated on monitoring pulse when taking dig and diuretics and be educated on dig toxicity.
  • Pts with diabetes mellitus who are taking thiazide and/or loop diuretics must be educated about close monitoring of blood glucose levels.

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