Term
| Loops & Thiazides (action of) |
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Definition
| prevent Na/Cl reabsorption which pulls water into the renal tubule to be excreted as urine |
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Term
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Definition
| alter Na+ and K+ exchange in the distal tubule to conserve potassium. Always combined with a loop or thiazide to prevent hypokalemia during diuretic therapy |
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Term
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Definition
| Create an osmotic pressure within renal tubule which pulls in water to be excreted as urine; same principal within cranial capillaries: creates osmotic force that pulls excess fluid from the brain into the vascular system |
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Term
| Loops & Thiazides (side effects) |
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Definition
volume depletion; decreased BP; electrolyte imbalances
K+ sparing: hyperkalemia |
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Term
| K+ sparing (side effects) |
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Definition
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Term
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Definition
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Term
| Which loop, thiazide, or potassium sparing diuretics produce the greatest amount of diuresis? Why? |
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Definition
| Loops b/c they have the ability to affect the greatest percentage of Na absorption |
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Term
| What things must be monitored during diuretic therapy? |
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Definition
| Blood pressure weight electrolytes: Na, K, Cl intake/output |
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Term
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Definition
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Term
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Definition
| Hydrochlorothiazide (Hydrodiuril) |
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Term
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Definition
| Spironolactone (Aldactone) |
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Term
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Definition
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Term
| Why are diuretics used? Are they used or contraindicated in heart failure? |
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Definition
To eliminate excess fluid from the body: pulmonary edema; edema of hepatic or cardiac origin; to aid in hypertension therapy.
Diruetics are used in heart failure except mannitol. |
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Term
| 3. Why do we monitor potassium levels in patients taking diuretics? Why is it especially important to monitor potassium when the patient is taking digoxin and diuretics? |
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Definition
| Hypokalemia is a common side effect of diuretic therapy; thus monitoring K+ levels is essential especially in patients taking digoxin because K+ competes with digoxin for receptor sites in the heart. If K+ levels are low, then that will allow more dig to bind to receptors which could cause toxic effects including ventricular arrhythmias |
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Term
| What blood pressure numbers would indicate prehypertension, Stage I, & Stage II hypertension? |
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Definition
| Pre: 120-139/80-89 Stage I: 140-159/90-99 Stage II: greater than 160/100 |
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Term
| How do ACE inhibitors and Angiotensin II Receptor Blockers (ARBs) work to treat HTN/heart failure? |
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Definition
| ACEs prevent the conversion of angiotensin I to angiotensin II and ARBs block angiotensin II receptors which both lead to decreased vasoconstriction and decreased Na & water retention |
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Term
| What are the prototypes ARB's and ACE inhibitors? |
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Definition
| ACE prototype: Captopril (Capoten) ARB prototype: Losartan (Cozaar) & Valsartan (Diovan) |
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Term
| What are the major adverse effects of ACE & ARB prototypes? |
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Definition
| First dose hypotension; dizziness; Hyperkalemia with ACEs; Angioedema |
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Term
| What are important nursing implications for ARB's and ACE inhibitors? |
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Definition
| Nursing implications: monitor BP; educate on K+ salts & high K+ foods for ACEs; no use during pregnancy; if angioedema occurs the patient should not be given that class of drugs again (allergy) |
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Term
| How do Calcium Channel Blockers work to treat HTN? |
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Definition
| Block calcium channels of vascular smooth muscle to control contraction which leads to vasodilation. |
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Term
| What are the prototypes Calcium Channel blockers? |
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Definition
Prototypes – Verapamil (cardiac effects ~ can be used for dysrythmias)
Nifedipine (little cardiac effect) |
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Term
| What are the major adverse effects of the Ca+ Channel Blocker prototypes? |
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Definition
| Adverse effects: flushing, headache, peripheral edema; constipation |
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Term
| What are important nursing implications for calcium channel blockers? |
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Definition
| Nursing implications: monitor BP; increase fluids/fiber to prevent constipation; education re: swallowing sustained release formulation tablets whole |
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Term
| What is Digoxin used for? |
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Definition
Heart failure – to increase cardiac contractility
Atrial fibrillation |
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Term
| What is its mechanism of action of digoxin? |
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Definition
| Promotes Ca+ accumulation within cardiac muscle cells which increases force of contraction. Indirectly decreases afterload and preload |
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Term
| How do we know if our treatment with Digoxin is effective? |
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Definition
| Decreased HR; decreased peripheral edema (possibly decreased weight) |
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Term
| What are important nursing implications of Digoxin? |
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Definition
· Initial therapy begins with digitalization – loading dose to decrease time to plateau as half life is 1.5 days
· Count HR for one full minute before administration – hold and contact MD if rate is less than 60
· Monitor K+ levels – educate re: high K+ foods and salt substitutes
· Monitor dig levels |
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Term
| Which medication is primarily used for angina pectoris? What is the mechanism of action of this drug? |
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Definition
| nitroglycerine. Dialates veins. |
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Term
| Discuss important administration and nursing implications for Nitroglycerine. |
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Definition
Many administration routes: sublingual, buccal, transdermal, PO, IV
Tolerance develops quickly – when taking scheduled doses, there must be at least an 8 hour “nitro free” period
Acute anginal attacks: 1st sublingual dose…call 911 if no relief in 5 min and take 2nd dose |
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Term
| What do anticoagulant drugs do? |
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Definition
| Decrease coagulation (lengthen clotting time) which decreases blood viscosity & prevents intravascular clot formation |
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Term
| What are the major adverse effects of the anticoagulants discussed? |
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Definition
| Bleeding – Hemorrhage; thrombocytopenia |
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Term
| How is Heparin administered and monitored? |
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Definition
IV, SC
Activated Partial Thromboplastin Time (APTT) should be increased |
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Term
| What is the antidote to Heparin? |
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Definition
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Term
| How does Heparin differ from the Low Molecular Weight Heparins? |
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Definition
No APTT monitoring required
Once daily dosing via SC injection – home therapy
Less risk of bleeding than unfractioned heparin |
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Term
| How is Coumadin administered and monitored? |
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Definition
PO only
Prothrombin Time (PT) should be increased INR should be between 3-4.5 |
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Term
| What is the antidote to Coumadin? |
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Definition
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Term
| What is the definition of high cholesterol (numbers for HDL, LDL, & total cholesterol)? |
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Definition
| HDL > 60 LDL > 100 total cho < 240 |
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Term
| HMG-CoA reductase inhibitors mechanism of action. |
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Definition
| Limits the rate of Cho production and increases LDL receptor sites in the liver |
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Term
| HMG-CoA reductase inhibitors adverse effects. |
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Definition
| Adverse effects rare: heatotoxicity, myopathy |
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Term
| HMG-CoA reductase inhibitors administration and nursing implications. |
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Definition
Administered PO at night
Life long therapy; liver function monitoring; education re: diet & exercise |
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Term
| Bile Acid-Binding Resins mechanism of action. |
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Definition
| Form complex with bile acids in intestine…decreased bile triggers liver to produce more which requires cholesterol |
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Term
| Bile Acid-Binding Resins adverse effects. |
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Definition
| Adverse effects: GI related – constipation, bloating, indigestion; decreased absorption of fat soluble vitamins. Can bind with certain medications in GI tract |
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Term
| Bile Acid-Binding Resins administration and nursing implications. |
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Definition
Administered PO with plenty of fluid
Timing of other drug administration – one hour before or four hours after bile acid binders |
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Term
| Nicotinic Acid mechanism of action. |
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Definition
| Decreases production of VLDL |
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Term
| Nicotinic Acid adverse effects. |
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Definition
| facial flushing/itching due to prostaglandin mediation cutaneous vasodilation (diminishes over time); GI upset |
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Term
| Nicotinic Acid administration and nursing implications. |
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Definition
| Administered PO with or after meals |
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Term
| Hydralazine (Apresoline), Nitroglycerin, Sodium Nitroprusside class? |
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Definition
|
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Term
| Verapamil(Isoptin), Nifedipine(Procardia), Diltiazem (Cardizem) class? |
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Definition
|
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Term
| Heparin, Warfarin (Coumadin) class? |
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Definition
|
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Term
| digitoxin, digoxin and deslanoside class? |
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Definition
|
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Term
| digitoxin, digoxin and deslanoside class? |
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Definition
|
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Term
| Lisinopril, catopril, elanopril class? |
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Definition
|
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Term
| Valsartan(Diovan), Losartan(Cozaar), Candesartan(Atacand) class? |
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Definition
| ARB's AngiotensinII receptor Blockers |
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Term
| rosuvastatin (CRESTOR), lovastatin (Mevacor), atorvastatin (Lipitor), pravastatin (Pravachol), fluvastatin (Lescol), pitavastatin (Livalo), and simvastatin (Zocor) class? |
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Definition
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Term
Cholestyramine (Questran)
Colesevelam (Welchol)
Colestipol (Colestid)
Class? |
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Definition
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Term
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Definition
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Term
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Definition
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