Term
| Which drug classification is Digoxin? |
|
Definition
|
|
Term
| What is another name for Digoxin? |
|
Definition
|
|
Term
| What are the 3 actions of Digoxin? |
|
Definition
Chronotropic Effect > Decrease HR
Inotropic Effect > Improve Contractility
Indirect effect on kidney > increases renal blood flow |
|
|
Term
| What are the uses for uses for Digoxin? |
|
Definition
1. Congestive heart failure
2. Atrial & Supra-Ventricular arrhythmias
3. Atrial Fibrilations |
|
|
Term
| What is the dose for Digoxin? |
|
Definition
|
|
Term
| How often should you give Digoxin? |
|
Definition
| Once a day or QOD (everyotherday) |
|
|
Term
| What is the half life of Digoxin? |
|
Definition
|
|
Term
| Where is Digoxin excreted? |
|
Definition
| The Kidney's....if the kidney's are bad, give it every other day (QOD) |
|
|
Term
| What is the nursing implication for checking apical pulse with Digoxin? |
|
Definition
| With hold if heart rate is under 60 beats/min |
|
|
Term
| Who is digoxin toxicty common in? |
|
Definition
-The eldery
-People with low serum Potassium (K+)
-Acid-base imbalance
-Hypoxemia |
|
|
Term
| What are the sxs of Digoxin toxicity? |
|
Definition
-Anorexia
-N & V
-Visual disturbances (yellow-green halo's)
-Arrhythmias --> brady/PVC
-EKG Changes |
|
|
Term
| Which measurment device should you use for accurate measurement of Digoxin? |
|
Definition
|
|
Term
| What is the Antidote for Digoxin? |
|
Definition
|
|
Term
| Do you give a loading dose with Digoxin? |
|
Definition
|
|
Term
| Which electrolyte should you check when a patient is on Digoxin? |
|
Definition
|
|
Term
| What is the use of Heparin? |
|
Definition
| To Prevent new clots from forming, but DOES NOT dissolve clots |
|
|
Term
| What is the name for "mini dose" Heparin? |
|
Definition
|
|
Term
| Who might Heparin be used on? |
|
Definition
Immbolized & post-surgical patients.
Ex. Hip/knee joint replacements |
|
|
Term
| What is the action of Heparin? |
|
Definition
| Interferes with conversation of prothrombin --> to thrombin |
|
|
Term
| Which is faster acting, Heparin or Coumadin? |
|
Definition
|
|
Term
| How would you check if Heparin is working? |
|
Definition
PTT (Partial Thromboplastin Time)
PTT Value should be double the time for clotting; if a patient normally clots in 30 seconds, it should take him/her 60 seconds on Heparin |
|
|
Term
| What measurement is Heparin usually given in? |
|
Definition
|
|
Term
| What is the Antidote for Heparin? |
|
Definition
|
|
Term
| What should you do if patient is getting IV Heparin? |
|
Definition
| Standby the patient to notice if you need to give Antidote |
|
|
Term
| What should you ALWAYS do if giving Heparin? |
|
Definition
|
|
Term
| What are some implications for Sub Q Heparin? |
|
Definition
Rotate sites daily or every dose
DON'T rub injection site; causes bruising
DON'T aspirate or pull back plunger when inject drug
Use precise calibrated syringe
Double Check dose |
|
|
Term
| Which route does Heparin NOT absorb well with? |
|
Definition
|
|
Term
| What are some implications for Heparin during Continuous IV? |
|
Definition
-Calibrated infusion pump for IV
-NEVER mix ATB or other medication with IV; incompatibility |
|
|
Term
| When can you use Heparin in addition to post-op patients? |
|
Definition
Open heart surgery
Bypass machines
Dialysis |
|
|
Term
| Which anti-coagulants is used for long term treatment? |
|
Definition
|
|
Term
| Which route is Coumadin taken? |
|
Definition
|
|
Term
| How long is Coumadin's(warfarin) half life? |
|
Definition
|
|
Term
| When should you start Coumadin? |
|
Definition
| 1-2 days BEFORE Heparin infusion stopped |
|
|
Term
| What the actions of Coumadin? |
|
Definition
Interferes with clotting factors (Vitamin K synthesis in liver)
-This is why alcoholics bleed a lot; can't clot well b/c can't produce Vitamin K |
|
|
Term
| What are the side effects of Anticoagulants? |
|
Definition
| BLEEDING! Any site, anywhere, is possible (can be internal or external) |
|
|
Term
| What happens if patient is on too much Coumadin? |
|
Definition
| The patient will bleed easily |
|
|
Term
| What is the Antidote for Coumadin? |
|
Definition
|
|
Term
| Which test is most accurate for a patient on Coumadin? |
|
Definition
| INR (International Normalized Ratio) = MORE ACCURATE than PT |
|
|
Term
| What does it mean when a patients Coumadin PT time is more than 2x? |
|
Definition
| They are on a higher dose which can lead to easy bleeding |
|
|
Term
| How long does it take for Coumadin to get to therapeutic levels? |
|
Definition
|
|
Term
| General implications of Anti-Coagulants? |
|
Definition
1.Avoid ASA; thins blood
2. NO straight edge razors (use electric)
3. Use soft bristle or cotton swab toothette
4. MEDIC-ALERT BRACELET
5. Check with Dentist/Dr. before dental work/surgery
6. AVOID during pregnancy & birth control pills (BCP)
7. Never give IM! Or other injections because of bleeding |
|
|
Term
| Ho long should you put pressure on venipuncture site while on an anti-coagulant? |
|
Definition
|
|
Term
| What can happen if patient is on Steroids while taking anti-coagulants? |
|
Definition
|
|
Term
| What are the Observations for bleeding sites while on anticoagulants? |
|
Definition
-Nosebleed (Epistaxis)
-GI -> vomiting
-Black tarry stool/Emesis
-NO IM injections b/c CAN'T STOP bleeding after venipuncture
-Internal bleeding
-Blood in urine(Hematuria) or tissues |
|
|
Term
| Are all Heparin bottle sizes the same doses? |
|
Definition
| No, although they come in the same bottle, the units may differ significantly |
|
|
Term
| Should you take ASA with anti-coagulants? |
|
Definition
|
|
Term
| Should you use a straight edge razor while on anti-coagulants? |
|
Definition
|
|
Term
| Should you take anti-coagulants during pregnancy or when on BCP |
|
Definition
|
|
Term
| Why should you take precautions for Steroid use while on anti-coagulants? |
|
Definition
| Risk of GI Ulcers/bleeding |
|
|
Term
| Which drug classification does Nitrates fall under? |
|
Definition
|
|
Term
| What 3 drugs fall under Nitrates? |
|
Definition
-Nitrates
-Isordil
-Amyl Nitrate (inhaled) |
|
|
Term
| What are the routes for Nitrates? |
|
Definition
-Sublingual (faster than oral)
-Skin patch (transderm Nitro patch)
-Paste (Nitroglycerin ointment)
-IV (continuous gtt.) |
|
|
Term
| What are the actions of Nitrates? |
|
Definition
-Dilation of blood vessels --> distal blood flow circulation improves & decreases the hearts workload (if no peripheral resistance, blood pools in extremities)
-Decreases BP -->reflex stimulus of increase rate of contraction/HR |
|
|
Term
| What are Nitrates used for? |
|
Definition
-Angina pectoris (decreases duration & intensity of pain)
-Prophylactically = decreases frequency of anginal attacks
-Prevent/delay MI onset |
|
|
Term
| What are 6 side effects of Nitrates? (Think of the action) |
|
Definition
-Flushing (from vasodilation)
-Throbbing HA (from vascular congestion of cerebral blood vessels)
-N&V (from blood being diverted)
-Faint, dizzy (from decreased BP)
-Reflex tachycardia (from decrease pressure in aortic/carotid sinuses = compensatory mechanism)
-Orthostatic hypotension (from vasodilation) |
|
|
Term
| What are Nitrates susceptible to? |
|
Definition
|
|
Term
| How long is the medication good for? |
|
Definition
|
|
Term
| What should you check when patient is on Nitrates? |
|
Definition
|
|
Term
| What are the implications for Nitrates when given sublinqual? |
|
Definition
-Lie Down & stop activity
-Wait 5 minutes until chest pain goes away
-If pain hasn't gone away, take 2nd nitrate
-If still in plain, DON'T drive to hospital --> Call 911!!!! |
|
|
Term
| What are the nursing implications for Nitrates when given in skin patch form? |
|
Definition
-Measure in inches, NOT mg
-Put on non-hairy area
-Remove old patch to AVOID double-dosing
-Longer-term absorptioin
-Common side effect: Headache --> Don't stop Nitro,; give Aspirin
-Pt can get drug tolerance if kept on patch all day --> take off for 12hrs |
|
|
Term
| What are the implications for Nitrates when given in paste form? |
|
Definition
-Wear gloves --> if nurse get on hands, will get Headache
-Short 1/2 life
-give every 4-6hrs |
|
|
Term
| When would you give Nipride IV? |
|
Definition
When a patient is about to have a heart attack. It decreased pre & afterload
-For acute heart attacks |
|
|
Term
| What drug classification is Beta- Blockers? |
|
Definition
|
|
Term
| What drug classification is Alpha Blockers? |
|
Definition
|
|
Term
| What drug classification is Ca2+ Channel Blockers? |
|
Definition
|
|
Term
| What drug classification is ACE Inhibitors? |
|
Definition
|
|
Term
| What drug classification is Smooth Muscle Relaxer? |
|
Definition
|
|
Term
| What drug classification is Central Brainstem ACtion/Central acting alpha agonsits? |
|
Definition
|
|
Term
| What drug is Propranolol (inderal), Atenolol, Timolol, Metoprolol (Lopressor), & Nadolol (Corgard) |
|
Definition
|
|
Term
| What drug is Prazosin (Minipress)? |
|
Definition
| Alpha-Adrenergic Blockers |
|
|
Term
| What is the action of Alpha Blockers (Prazonsin/Minipress)? |
|
Definition
|
|
Term
| What is the action of Beta Blockers? |
|
Definition
| Lowers CO & HR; thus decreases coronary blood flow & 02 to the heart (it decreases the amount of 02 the heart requires, so that the heart doesn't pump as hard) |
|
|
Term
| What are the uses for Beta Blockers? |
|
Definition
Angina(chest pain) b/c decrease 02 consumption & Myocardial demand/makes heart work less hard
-High BP
-Migraines
-After MI = "Cardioprotective" b/c blocks stimulation of catecholamines |
|
|
Term
| Which side effects might you find with Beta blockers? |
|
Definition
-Orthostatic hypotension
-With multiple meds, watch for cumulative anti-hypertensive effects
-Decrease in renal blood flow (i.e decreases urine output, weight gain)
-Sedation
-Decreases sexual performance (because of vasocontriction)
-Impaired ejaculation & gynecomastia
-Increased blood sugar (NOT for diabetics) |
|
|
Term
| Who is beta blockers contraindicated for? |
|
Definition
| Asthmatics: b/c blocks "BETA" effect and sever CHF --> cause bronchoconstriction |
|
|
Term
| What are the implications for Alpha blockers? |
|
Definition
-Watch for orthostatic BP
-NO OTC meds (cold meds)
-AVOID caffeine
-DON'T stop abruptly |
|
|
Term
| What is Calcium channel blockers used for? |
|
Definition
-Essential HTN(hypertension)
-Angina
-Arrhythmias (atrial tachycardias) |
|
|
Term
| What are the actions for Calcium Channel Blockers? |
|
Definition
-Inhibit Ca2+ influx in the heart cells
-Blocks contriction --> causing vasodilation
-Lowers BP & peripheral resistance |
|
|
Term
| What are the side effects of Ca2+ channel blockers? |
|
Definition
-Same as Beta blockers
-Orthostatic hypotension
-With multiple meds, watch for cumulative/additive effects (decreases BP too low)
-Decreases renal blood flow (i.e. decreases urine output, weight gain)
-Sedation
-Decreases sexual performance (b/c vasocontriction)
-Impaired ejaculation & gynecomastia |
|
|
Term
Which three drugs have the following same side effects?
-Same as Beta blockers
-Orthostatic hypotension
-With multiple meds, watch for cumulative/additive effects (decreases BP too low)
-Decreases renal blood flow (i.e. decreases urine output, weight gain)
-Sedation
-Decreases sexual performance (b/c vasocontriction)
-Impaired ejaculation & gynecomastia |
|
Definition
| Beta blockers, calcium channel blockers, ace inhibitors |
|
|
Term
What drugs do...______...fall under?
Verapamil (Calan)
Diltiazem (cardizem SR)
Nifedipine (Procardia) |
|
Definition
|
|
Term
| What drugs do Captopril(Capoten), & Enalapril(Vasotec), fall under? |
|
Definition
|
|
Term
| What are the actions of ACE Inhibitors? |
|
Definition
-Inhibits formation of Angiotensin II
-Decreases aldosterone secretion
-Inactivates bradykinin |
|
|
Term
| What are the uses for ACE Inhibitors? |
|
Definition
-HTN (if normal kidney function)
-1st line of drug: CHF
-Decreases workload of failing heart
-Decreases pre and afterload |
|
|
Term
| What are the side effects of ACE Inhibitors? |
|
Definition
-Same as Beta blockers
-Orthostatic hypotension
-With multiple meds, watch for cumulative/additive effects (decreases BP too low)
-Decreases renal blood flow (i.e. decreases urine output, weight gain)
-Sedation
-Decreases sexual performance (b/c vasocontriction)
-Impaired ejaculation & gynecomastia |
|
|
Term
| What drugs do Hydralazine & Minoxidil fall under? |
|
Definition
|
|
Term
| What drugs do Clonidine (Catapress) & Methyldopa (Aldomet) fall under? |
|
Definition
| Central Brainstem Action / or Central acting alpha adrenergic agonists |
|
|
Term
| What are the actions of CBA (Central Brainstem Action) |
|
Definition
-Direct effect to lower BP by supressin sympathetic action = decreased HR & peripheral resistance
-DON'T interfere with CV blood vessel |
|
|
Term
| What should you watch when on IV Nitroglycerin compounds such as nitroprusside infusion (Nipride)? |
|
Definition
-LIFE THRATENING --> BP = 260/140
-Must be on BP monitoring machine for constant monitoring
-MUST be on IV infusion pump for concise accurate delivery of drug IV
-Usually for ICU/ER |
|
|
Term
| Why use Multiple BP meds? |
|
Definition
-Various sites of action
-Lower doses possible with several types
-With several, sometimes can offset side effects of other |
|
|
Term
| When should you typically give anti-hypertensive medication? |
|
Definition
| Give in the Evening to AVOID daytime sedation |
|
|
Term
| With anti-hypertensive, when should you call the doctor for a different treatment? |
|
Definition
| When there are unwanted side effects like impotence |
|
|
Term
| When should you hold BP medication? |
|
Definition
| When systolic is <90 (or 30 mmHG |
|
|
Term
| When a patient is on BP medication and has a dry mouth, what should you do? |
|
Definition
|
|
Term
| Should you ever stop BP medication abruptly? |
|
Definition
| NO! b/c rebound BP increases |
|
|
Term
| What should you do if you forget to give patient BP med on time? |
|
Definition
| DON'T Double DOSE! take the regular dose next time |
|
|
Term
| How should you start BP Meds? |
|
Definition
| Start meds @ lowest does, then work up |
|
|
Term
| How long can it take for BP meds to take effect? |
|
Definition
|
|
Term
| What should you check before giving BP meds? |
|
Definition
|
|
Term
| How should you space out BP meds? |
|
Definition
| Spread out doeses (i.e tid = 6am/2pm/10pm) |
|
|
Term
| What are the implications for Ca2+ channel blockers? |
|
Definition
NICE b/c they DON'T increase triglycerides like beta-blockers do
-Patient response varies
-NIFEDIPINE SL: **CAUTION** poke hole in capsule with large needle & sqeeze under tongue = for sudeen attack of Extreme HTN
-DANGER = get MI (heart attack) |
|
|
Term
| What diuretics do Furosemide (lasix) & Bumex belong to? |
|
Definition
|
|
Term
| What diuretics do Hydrocholorothiazide (HCT) & Hydrodiuril belong to? |
|
Definition
|
|
Term
| What diuretics do Spironolactone(Aldactone) belong to? |
|
Definition
|
|
Term
| Where is the site of action for Loop Diuretics? |
|
Definition
|
|
Term
| What are the routes for Lasix? |
|
Definition
|
|
Term
| What are the doses for Lasix? |
|
Definition
| 20-40 BID (160-320mg = very high) |
|
|
Term
| What are the actions of Loop Diuretics? |
|
Definition
Blocks Na+ & Cl- reabsorption --> meaning it takes water with it and causes less volume in the blood
-Decreases blood volume & BP b/c get rid of fluid (K+ follows)
-Decreases Peripheral Vascular Resistance? |
|
|
Term
| What are the side effects of Loop Diuretics? |
|
Definition
-Dehydration
-Hypotension
-Hypokalemia (especially with Digoxin = Dig-toxitiy)
-Oto-toxicity
-Hyperuremia (Gouty arthritis)
-Hyperglycemia (Diabetics) |
|
|
Term
| What are the implications for Loop Diuretics? |
|
Definition
-Check Serum Potassium (K+)
-Teach about side effects: Low Potassium --> need K+ supplements; (oranges & bananas NOT enough) |
|
|
Term
| What is the site of action for Thiazide drugs? |
|
Definition
|
|
Term
| What is the action of Thiazide drugs? |
|
Definition
-Inhibits reasborption
-Direct arteriovasodilators |
|
|
Term
| What are the uses of Thiazides? |
|
Definition
-CHF (congestive heart failure)
-HTN (Hypertension)
-Liver cirrhosis
**Used frequently** |
|
|
Term
| What are the side effects of Thaizides? |
|
Definition
-Hyperuremia(Gouty arthritis)
-Hyperglycemia (diabetics)
-Dizziness
-Fluid loss
-Headaches (HA)
-Impotence
-Decreased Libido
-Hypokalemia
-Gout
-Increased blood sugar |
|
|
Term
| What drug should you avoid ingesting high Na+ foods with? |
|
Definition
|
|
Term
| Which drug should weight yourself weekly? |
|
Definition
|
|
Term
| Which drug should you assess outputs for? |
|
Definition
Diuretics
(i.e. empty Foley before IV lasix, put commode by bedside) |
|
|
Term
| What are general things to look for with Diuretics? |
|
Definition
-Weight at home weekly
-Assess outputs
-Check hearing (with aminoglycosides = ringing of ears)
-Check skin
-Check mouth care (lemon drops)
-Avoid high Na+ foods
-Don't give extra fluids when mouth dry
-Check BP for hypotension (b/c decreased fluid volume)
-LABS: check uric acid buildup |
|
|
Term
| What should you never combine with K+ sparing diuretics? |
|
Definition
NEVER combine with K+ supplements
-Also watch for Na+ substitutes |
|
|
Term
| What is the action of K+ sparing diuretics? |
|
Definition
-Inhibit aldosterone
-Blocks receptors
-Interfere with Na+/K+ exchange --> retains K+ (check sign of kidney failure) |
|
|
Term
| What are the side effects of K+ sparing diuretics? |
|
Definition
|
|
Term
| The drug category is Atropine in? |
|
Definition
|
|
Term
| The drug category is Quinidine in? |
|
Definition
|
|
Term
| The drug category is Pronestyl in? |
|
Definition
|
|
Term
| The drug category is Bretylium in? |
|
Definition
|
|
Term
| The drug category is Lidocaine in? |
|
Definition
|
|
Term
| The drug category is Aminodarone in? |
|
Definition
|
|
Term
| What is the dose for Atropine? |
|
Definition
| slow IV bolus 0.3-0.6 mg q5hrs until reach 2mg |
|
|
Term
| what is the action of Atropine? |
|
Definition
| Increases HR at the SA Node --> blocks Vagal action |
|
|
Term
| What are the uses for Atropine? |
|
Definition
| Only Drug used for Bradycardia (the drug is used to increase heart rate) |
|
|
Term
| What are the side effects of Atropine? |
|
Definition
-Dry mouth
-Urinary retention
-(If NOT high enough dose) = paradoixal/inconsistent slowing of HR |
|
|
Term
| What are the implications for Atropine? |
|
Definition
| BP should be monitored closely |
|
|
Term
| What are the uses of Quinidine? |
|
Definition
-Extra ventricular beats (PVC's)premature ventricular contractions
-Supraventricular rhythms disturbances (atrial Fibrillation) |
|
|
Term
| What are the actions of Quinidine? |
|
Definition
-Directly dpresses automaticity & decreases conductivity
-1st degree effect = increase refractoriness
-2nd degree effect = (with low dose) increased AV conduction |
|
|
Term
| What are the side effects of Quinidine? |
|
Definition
VERY TOXIC!!!(dose-related)
-Diarrhea
-N&V
-Tinnitus
-Headache (HA)
-Vertigo
-Visual Disturbances
-EKG's irregularities (prolongs QT interval) |
|
|
Term
| What are the implication of Quinidine? |
|
Definition
-Oral: give with meals
-Rearly parenterally
-Check BP until maintenance; bed flat initially decreases BP
-ALERT: hypersensitivity (hyperthermia, anaphylaxis) |
|
|
Term
| What are the uses for Pronestyl? |
|
Definition
| Ventricular arrhythmias (PVCs) |
|
|
Term
| What are the actions of Pronestyl? |
|
Definition
Similar to Quinidine
-Route: ORAL, Proscan SR (sustained/slow release) |
|
|
Term
| What are the side effects of Pronestyl? |
|
Definition
-Decreased BP
-Lupus side effects: fever, arthralgias, butterfly rash on cheeks
-Anti-cholinergic effects: urinary retention |
|
|
Term
| What are the uses for Bretylium? |
|
Definition
| ~50% effective for Ventricular Fibrillation |
|
|
Term
| What is route for Bretylium? |
|
Definition
| -Route: IV Bolus q15-30 min; IM |
|
|
Term
| What are the side effects of Bretylium? |
|
Definition
-Lower BP
-Vertigo
-Syncope |
|
|
Term
| What are the implications for Bretylium? |
|
Definition
| -EKG & BP monitoring in ICU |
|
|
Term
| What is the use of Lidocaine? |
|
Definition
IMMEDIATE control of PVC's
-Numbs area in heart, so NO extra heart sounds |
|
|
Term
| What is the action of Lidocaine? |
|
Definition
| Depresses automaticity of ventricles (Doesn't depress contractility) |
|
|
Term
| What is the route/dose of Lidocaine? |
|
Definition
| ~50-100mg IV Bolus --> follwed immedieatly by continuous infusion b/c short 1/2 life((usually lower does if Liver problems)) |
|
|
Term
| What are the side effects of Lidocaine? |
|
Definition
SEVERE!!!!!!
-CNS: Pareshesias, muschle twitching, Convulsions, visual disturbances |
|
|
Term
| What are the uses for Amiodarone? |
|
Definition
Originally for Ventricular arrhythmias (PVC's)
-Now aslo for Atrial Fibrillations (like Digoxin |
|
|
