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Pharm exam 3 11/18
| Question | Answer |
|---|---|
| Veraparmil & Diltiazem | limited usefulness, used tx of angina, HTN, & SVT (Prinzmetal’s angina) Short-term management of atrial fib; MOA:Inhibit slow-channel (Ca-dependent) pathways Depress phase 4 depolarization ↓ AV node conduction, ↓ force of contraction, ↓ HR |
| Digoxin | Serum: Very narrow window-0.5–2 ng/mL NI: BP, Apical pulse 60 sec, Heart/breath sounds, Weight, I&O, EKG & labs: K, Na, Mg, Ca, renal/liver func tox: hr dys; H/A, fatigue, confusion, seizure; colored vision, halo vision, flickering lights; Anorexia, N/V |
| Lidocaine | antidysrhythmic; class 1B Indication- Used for ventricular dysrhythmias only; PVC, V. tachycardia, V. fibrillation ADR- brady, dysrhythmias, hypotension, agitation, anxiety, seizure, metallic taste |
| Quinidine Sulfate | Indication- Used for Afib, PAC, PVC, VT, Wolff-Parkinson-White syndrome ADR- Blurred vision; heartburn; stomach discomfort; N/V/D; allergic rxn; dark urine; dizzy; fainting; dysrhythmia; HA; hearing loss; mood changes; pale stools; tinnitus; jaundice |
| Procainamide | antidysrhythmic; class 1A ADR- hypotension, rash, N/D, agranulocytosis, SLE-like syndrome |
| Adenosine | Antidysrhythmic; class 1A Indication- ↓conduction through the AV node; Used to convert SVT NI- half life>10s; fast IV push ADR- asystole (few seconds)*; bradyc, Vfib; VT; Afib; complete heart block; bronchospasm; flushing; dyspnea; chest pressure; N/ |
| Aminodarone | antidysrhythmic Indication-Used for dysrhythmias that are difficult to treat Life-threatening VT or V fib, A fib —resistant to other drugs Classification- class 3 |
| Inotropic | Force or energy of muscular contractions |
| Chronotropic | Rate of the heartbeat |
| Dromotrpic | The conduction of electrical impulses |
| Prodrug | Inactive in their administered form and must be metabolized in liver to become active & effective |
| Milrinone | Phosphodiesterase Inhibitors Indiction- dysrhythmias (Ventricular); short term management of HF; ICU NI- Use an infusion pump; Monitor I&O, HR, RR BP, daily weights, etc.; Do not mix with dextrose ADR- ↓ BP, angina, hypokalemia, tremor, thrombocytopen |
| Nesiritide | B-Type Natriuretic Peptide Indication- Arterial and venous dilatation and diuretic effect. Not 1st line of treatment. Used in ICUs Admin- |
| Inamrinone | Indication- short term management of HF; ICU Classification- Phosphodiesterase Inhibitors MOA- Inhibits the enzyme phosphodiesterase → ↑ cAMP intracellular → positive inotropic response and vasodilation. Also ↑ calcium → ↑ force of contraction |
| 1ST line tx for Congestive heart failure: | ACE inhibitors |
| Normal, prehypertensive, HTN | Normal- <120 & < 80 Prehypertension: 120- 139/80 - 89 Stage 1 hypertension: 140 – 159/90 - 99 Stage 2 hypertension: >160/100 |
| Ace inhibitor | Angiotensin Converting Enzyme Inhibitors MOA- Alters Renin-Angiotensin-Aldosterone System; ↓ angiotensin-converting enzyme- converts angiotensin I →angiotensin II *Angiotensin II is a potent vasoconstrictor by acting on receptors within blood vessels |
| Alpha Blockers | doxazosin (Cardura) (most common used) & terazosin (Hytrin) – for BPH, prazosin (Minipress), tamsulosin (Flomax) MOA- Block the a1-adrenergic receptors → art. & venous vasodilation → ↓ PVR & pulmonary venous pressure and ↑ cardiac output |
| AntiHTN can be given when pregnant? | Methyldopa (Aldomet) |
| Loop Diuretic | MOA- Act directly on the ascending limb of the loop of Henle to inhibit Cl- & Na+ reabsorption NI – I/O; potassium >3 mEq/L; monitor serum K levels; monitor for hyperglycemia, daily weight, labs, change pos slowly |
| Thiazide: Indication | HTN (one of the most prescribed group of drugs for this); Edematous states; Idiopathic hypercalciuria; Diabetes insipidus; Heart failure due to diastolic dysfunction; shouldn't be used if creatinine clearance>30- 50 mL/min (normal is 125 mL/min) |
| Spironolactone | Work in collecting ducts and distal convoluted tubules Interfere w/ Na/K exchange; bind/block aldosterone receptors Block the reabsorption of Na/H2O usually induced by aldosterone Prevent K being pumped into the tubule→ no secretion;↑ excretion of Na/ |
| Carbonic anhydrase inhibitor (CAI) | ADR:Metabolic acidosis; Anorexia; Hematuria; Photosensitivity; Melena (blood in stool); Hypokalemia; Drowsiness; Paresthesias; Urticaria NI: I/O; potassium >3 mEq/L; monitor serum K levels/ for hyperglycemia, daily weight, labs, change pos slowly |
| Osmotic Diuretic: | Work mostly in the proximal tubule & descending loop (entire nephron) Nonabsorbable solute → osmotic effect Pull water into renal tubules from surrounding tissues Inhibits tubular resorption of H2O & solutes → ↑ diuresis; vasodilation → ↑ renal bl. flo |
| Anticoagulation | Purpose:To prevent arterial and venous clot formation/establish thrombus/embolus; Doesn't lyse existing clots;Inhibit the action or formation of clotting factors Contraind: Thrombocytopenia/ bleeding; Warfarin–preg; LMWH – w/ indwelling epidural catheter |
| Coumadin: | Drug levels: Monitored PTT {1.5 – 2.5} & INR {2 – 3 ½} Antidote: Vitamin K important Nursing Admin: |
| Lovenox: | Drug lvl: adjust when creatinine< 30 mL/min Antidote: Protamine sulfate Admin:Given SQ & rotate injection sites; More predictable anticoagulant response; Doesn't require frequent laboratory monitoring; Used as a bridge therapy b/n warfarin and surgery |
| Heparin: | Drug levels:Type 1 HIT: < 1000,000/mm3 or 50% below baseline value Antidote: Protamine sulfate Admin: don't massage/aspirate, lab values |
| Thrombolytic Therapy | prevent bruising, bleeding, or tissue injury Monitor for bleeding from gums, mucous membranes, nose, injection sites Observe for signs of internal bleeding |
| Antithrombolyic | ADR:Monitor for signs of excessive bleeding Bleeding of gums while brushing teeth, unexplained nosebleeds, heavier menstrual bleeding, bloody or tarry stools, bloody urine or sputum, vomiting blood; N/V and abdominal pain/cramps; Thrombocytopenia |
| What herbal therapy should be avoided w/ anticoagulants? | Capsicum pepper, Garlic, Ginger, Gingko, Ginseng, Feverfew |
| Nitroglycerine (NTG)- ADR | HA - ↓ in intensity & frequency w/ continued use Tachycardia, postural hypotension If vasodilate too rapidly → reflex tachy; Large shift of blood volume → stimulate baroreceptors→ compensate w/ ↑ HR Contact dermatitis; Remove for 8 hrs at night. |
| Verapamil & Diltiazem- NI | Obtain a thorough drug and medical history Measure baseline BP, P, I&O, and cardiac rhythm Measure serum potassium levels before initiating therapy During- monitor cardiac rhythm & all vitals limit caffeine |
| Digoxin- cont'd | antidote- Digoxin Immune Fab (Digibind) indication- heart failure & control ventricular response to atrial fibrillation or flutter Drug-food- high fiber food |
| digoxin (drug-drug) | antacid, diruetics, heart rythym meds, Epi, steroids, Ca channel blockers, beta blocker, antibiotic, cold meds, alprazolam (Xanax); cancer medications, clonidine; Ca supplements; amphotericin B; cholestyramine; guanabenz, guanfacine; indomethacin; |
| digoxin (drug-drug cont'd) | isoproterenol; itraconazole; levothyroxine; methyldopa; metoclopramide; neomycin; rifampin; sulfasalazine |
| ACE inhibitors MOA cont'd | causes ↓ aldosterone secretion from the adrenals → ↓ water & sodium reabsorption → ↑ bl volume, ↑ preload, & ↑ BP; prevents the breakdown of vasodilatation substance (bradykinin) → ↓ PVR & vasodilation → ↓ BP |
| ACE inhibitors | Indication- Often used as first-line drugs for HF & HTN; slow progression of left ventricular hypertrophy after an MI (cardioprotective); Renal protective effects in patients with diabetes |
| Alpha blockers | NI- Educate about lifestyle changes that may be needed; Weight loss, Stress management, Supervised exercise, Diet; Monitor WBC, K+ levels, Na+ levels, urinary protein levels; Monitor for therapeutic effects |
| loop diuretics | ADR- Dizziness, HA, tinnitus, blurred vision, N/V/D, Agranulocytosis, neutropenia, thrombocytopenia, hypokalemia, hyperglycemia, hyperuricemia, electrolyte disturbance, ototoxicity |
| Thiazide | NI- I/O; potassium >3 mEq/L; monitor serum K levels; monitor for hyperglycemia, daily weight, labs, change pos slowly Drug-drug interaction- Corticosteroids; Lithium; Digoxin; Diazoxide; NSAIDS; Oral hypoglycemia |
| Spironolactone | NI- I/O; potassium >3 mEq/L; monitor serum K levels; monitor for hyperglycemia, daily weight, labs, change pos slowly ADR- Dizziness, headache; Cramps, n/v/d; urinary frequency, weakness, **hyperkalemia** |
| Carbonic anhydrase inhibitor (CAI) | block the action of carbonic anhydrase, thus preventing the exchange of H+ ions with sodium & water distally to glomerulus; ↓ H+ ion concentration in renal tubules → ↑ excretion of bicarb, Na, H2O & K; Resorption of H2O is ↓ & urine volume is ↑ |
| osmotic diuretic | NI: Intravenous infusion only. Filter is required; May crystallize when exposed to low temperatures (keep in warm area) |
| Thrombolytic Therapy- ADR | bleeding- Internal, Intracranial, Superficial; N/V, hypotension, anaphylactic reactions; Cardiac dysrhythmias |
| Nitroglycerine (NTG)- MOA | Cause vasodilation due to relaxation of smooth muscles → ↓ myocardial O2 demand; Potent dilator on coronary arteries; Prevents & tx angina; Alleviate coronary artery spasms |
| Nitroglycerine (NTG)- NI | Sublingual NTG: Never to chew or swallow, burning sensation - potent Capsules or ER meds – no crush or alteration Aerosol (sprays) – do not shake canister; Avoid inhaling or swallowing until drug is dispersed; Avoid ETOH,saunas, excessive exertions |
| Nitroglycerine (NTG)- NI | Keep a fresh supply of NTG on hand; potency is lost in about 3-6 months; Topical/ TD forms– site rotation/remove old med Occlusive covering. Used clean, non-hairy and nonirritating skin. Apply same time each day. Not below the knees or elbows. |
| Nitroglycerine (NTG)- NI | Constipation is a common problem; instruct patients to take in adequate fluids and eat high-fiber foods Store in an airtight, dark glass bottle with a metal cap and no cotton filler to preserve potency. Avoid moisture, light, heat and air. |
Created by:
ethompso08
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