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Dehouske Meds Lect
Safety in Meds: Drug Therapy
| Question | Answer |
|---|---|
| 3 Medicinal Categories of Treatments for Angina Pectoris | * Nitrates * Beta Blockers * Calcium Channel Blockers |
| What is the treatment for stable angina pectoris? | rest, nitroglycerin, or both |
| Unstable Angina Pectoris is associated with what disease in which there is a deficiency of blood flow to the heart muscle secondary to corornary arteries narrowed by fatty buildup? | atherosclerosis |
| What is the treatment for unstable angina pectoris? | ER evaluation, observation on cardiac unit |
| What disease occurs when weak heart muscles do not pump an adequate amt of blood thru/o body, causing back up into the lungs, legs, liver, etc? | Heart (pump) failure |
| List 3 causes of heart failure. | atherosclerosis, hypertension, myocardial infarction |
| 4 meds & 3 other things used in the treatment of heart failure | * ACE inhibitors * Beta-blockers * Digoxin * Diuretics * rest, diet, lifestyle changes |
| In heart failure, blood flow slows, causing venous return to decrease; slowing blood flow also effects kidneys ability to dispose of Na+ & H20... what is the resulting sign? | edema |
| What is the mean arterial pressure? | This describes an average blood pressure in an individual and is defined as the average arterial pressure during a single cardiac cycle. * perfusion pressure seen by the organs in the body |
| What is the normal MAP range? What is the minimum necessary to perfuse the heart, brain, & kidneys? | 70-110; minimum is 60 |
| Ischemia occurs when the MAP increases or decreases significantly and will have decreased blood flow? | decreases |
| What is the formula for MAP? | [systole + 2(diastole)]/3 |
| List 3 aspects of the heart that affect how it functions: | * Preload * Afterload * Contractility |
| What is the stretching of the heart chambers to accommodate incoming blood and depends on the amt coming in (volume of blood returned to heart thru the vena cavae before it beats)? | Preload |
| The work required to overcome resistance of flow in the aorta and arteries is the: | Afterload |
| PVR | peripheral vascular resistance: refers to resistance to flow that must be overcome to push blood thru the cardiovascular system. |
| What is the intrinsic ability of the heart to contract independent of preload and afterload? Also: the strength of the heart pump, the forcefulness of heart muscle contraction | contractility |
| Catecholamines, such as ___ & ___ enhance contractility, causing an increase in intracellular ? ions during contraction | norepinephrine, epinephrine, calcium |
| Cardiovascular agents decrease blood pressure (afterload) and improve cardiac function by: | * decreasing intravascular volume * decreasing venous return (preload) * decreasing afterload |
| Angiotensin II is a potent vaso (constrictor or dilator)? | vasoconstrictor |
| What is the action of ACE inhibitors that makes them effective? | Their action is to prevent the conversion of angiotensin I in the kidneys to angiotensin II |
| How do ACE inhibitors prevent conversion of Angiotensin I to II? | * by decreasing peripheral vascular resistance * by decreasing secretion of aldosterone, which results in less Na+ and H20 retention * decreasing systemic vascular resistance (afterload) |
| What is the normal function of aldosterone? | to increase reabsorption of Na+ & H20 & secretion of K+ in distal convoluted tubules of the kidneys: increases BP & blood volume |
| What suffix do ACE inhibitors end in? | "pril" |
| What are the indications of ACE inhibitors? | mild to moderate hypertension; heart failure |
| What is special about the effects of ACE inhibitors? | They decrease peripheral vascular resistance without increasing cardiac output, heart rate, and contractility |
| List side effects of ACE inhibitors: | * dizziness * orthostatic hypotension * GI distress * nonproductive cough (tickle in throat) * headache |
| List adverse reactions to ACE inhibitors: | * persistent cough: most common * ANGIOEDEMA: swelling of airways requires immediate evalutation & discontinuation of med |
| Which labs are to be monitored when a client is taking ACE inhibitors? | * BUN * creatinine * serum electrolytes |
| What assessments should be monitored when a client is taking ACE inhibitors? | * monitor B/P and P * monitor weight to keep an eye on possible fluid overload |
| Describe the first dose phenomenon, how quickly it occurs, and what should the client be instructed to do if it occurs. | * Can lower BP significantly * Occurs within the first couple of hours after the first dose is taken * Client should take it easy if dizzy and return to doctor if symptoms seem too much to handle. |
| List some points to educate the patient about when given ACE inhibitors: | * Take meds same time each day * Do not stop taking meds abruptly * Avoid high K+ foods (salt substitutes) * Change positions slowly * Avoid driving (dizziness) * Altered taste resolves in 8-12 wks |
| What SxS of ACE inhibitors should a patient notify the MD about? | * rash * mouth sores * swollen feet, face, tongue, etc. * irregular heart beat |
| What type of medication is Enalapril and what is one of its trade names? | * Vasotec is an ACE inhibitor |
| What are indications for Enalapril / Vasotek | * managment of HTN and CHF * reduction of death of cells and development of CHF following MI * Slows progression of left ventricular dysfunction |
| Adverse Reactions of Enalapril | * ANGIOEDEMA * dry cough * proteinuria * hypotension * taste disturbance * elevated creatinine & K+ levels |
| The following category of meds, discovered in 1857, relax vascular smooth muscle, cause generalized vasodilation, & prevent & relieve angina episodes. | Nitrates |
| What is the first choice in the treatment of acute angina? | Nitrates |
| How do nitrates work? | * Relax arterial & venous smooth muscle --> vasodilation * decrease preload causing decrease in blood volume in heart chambers * cardiac output decreases b/c of less blood to eject |
| What is the half-life of nitroglycerin? | 1-4 minutes |
| What is nitroglycerin used to treat and routes of each (IV, PO, etc)? | * acute angina (sublingual, IV) * chronic angina (oral, buccal, transdermal) * acute MI (adjunct Tx: IV) * CHF (adjunct Tx: PO) |
| Side effects of Nitroglycerin: | * dizziness * hypotension * tachycardia * headache |
| What are some things to remember when administering sublingual nitroglycerin tablets? | * Hold pill under tongue until dissolved * Do not eat, drink, smoke until pill dissolves completely * Do NOT handle pills!!!! |
| Implementation for nitroglycerin use: | * Assess the pain (angina) * Monitor B/P & P before & thru/o admin |
| What are some things to remember when administering nitroglycerin patches or ointment? | * Apply patch to hairless sites & avoid distal extremeties * Rotate site * Wear gloves when handling * Remove old patch & clean site before applying new one * Remove patches for 12-14 hrs to prevent tolerance * Admin w/ pt in sitting position |
| Patient/Family Teaching for Nitroglycerin: position? headaches? storage of tablets? | * Change position slowly * Treat headaches w/ Tylenol or Aspirin * Store tabs in original container * Avoid exposure of tabs to heat, air, moisture * Open bottle as little as possible * Avoid handling * Do not keep close to warm body |
| Describe functions of Beta 1 Adrenergic Receptors: | * Improve conduction of the heart * Increase contractility of force of heart beat * Increase heart rate * Affect heart * Beta blockers act mainly on these receptors |
| Describe functions of Beta 2 Adrenergic Receptors | * Cause relaxation, dilation in bronchial and vascular smooth muscle * May be selective or non-selective |
| What suffix to Beta-Adrenergic Blockers often end in? | "olol" |
| Define prophylaxis | a measure used to prevent a disease or condition |
| Indications of Beta Blockers: | * hypertension * angina pectoris * tachyarrhythmias * MI prevention * CHF management * Hyperthyroidism * migraine prophylaxis * anxiety |
| How do Beta Blockers work? | * Compete with symp neurotrans for receptor sites * Cause: decreased heart rate, decreased contractility, and decreased rate of AV conduction |
| Side effects of Beta Blockers: | * lethargy * GI disturbance * bradycardia * CHF * decreased B/P * depression |
| Metoprolol is what type of drug and what is one trade name? | Lopressor is a Beta Blocker |
| How does Metoprolol work? | * Acts on selective Beta 1 receptors by blocking stimulation * Normally does not affect Beta 2 |
| Side Effects of Metoprolol: | * fatigue * weakness * impotence * depression * hypotension |
| Adverse Effects of Metoprolol: | * bradycardia (must intervene if below 50 bpm) * decreased myocardial contraction can lead to CHF or pulmonary edema |
| Implemention while administering Metoprolol: | * Assess apical pulse (hold med if below 50 * Assess B/P * Assess fluid status (I&O, daily weight) |
| Teaching for Metoprolol: | * Take as directed * Do not stop taking abruptly: may cause dangerous arrhythmias * Change positions slowly |
| What type of drug introduced in the 16th century is one of the most widely used meds and acts to decrease intravascular volume by increasing urine production? | Diuretics |
| How do diuretics work to help the heart? | * They decrease the volume of blood returning to the heart, keeping the left ventricle from overfilling: allows contraction to be more efficient and increases cardiac output |
| What type of drug is Furosemide and what is another name for it? | This is a diuretic also called Lasix |
| What are the indications for using Furosemide? | * Used in the Tx of CHF & HTN |
| What are the differences in taking Furosemide by mouth versus IV? | * PO: takes longer to work (30-60 min), but lasts much longer (6-8 hours) * IV: acts quicker (5 min), but lasts much shorter (1-2 hrs) |
| Adverse Reactions of Furosemide? | * dehydration * hypokalemia * hypochloremia * hypomagnesemia * hyponatremia * hypovolemia * metabolic acidosis |
| What is the most important thing to check before administering furosemide (Lasix)? | Electrolytes must be stable b/c drug affects them dramatically |
| Implementation for use of Furosemide? | * Assess fluid status B4 admin * Monitor B/P & P B4 admin * Monitor electrolytes, renal & hepatic function & glucose levels * Assess patient receiving Digoxin for NV, muscle cramps: risk for toxicity * HYPOKALEMIA precipitates digoxin toxicity |
| Deafness can occur if Furosemide is given too fast by IV... this is called | ototoxicity |
| Patient Education regarding Lasix and Hydrochlorothiazide | * Take meds in AM to prevent sleep problems * Take with food * Change positions slowly * Monitor weight * Use sunscreen: light sensitivity * Report muscle weakness, cramps, NVD, dizziness: may indicate electrolyte imbalance |
| 1 kg = __ L of fluid loss | 1 |
| Hydrochlorothiazide (HCTZ) is what type of drug? | a thiazide diuretic |
| How does HCTZ work? | This drug inhibits Na+ and H20 retention at distal tubules * Effects more electrolytes than some diuretics * Is a less potent diuretic |
| Adverse Reactions of hydrochlorothiazide: | * hypokalemia * hyperuricemia * Increase serum cholesterol, LDL, triglycerides |
| How do Calcium Channel Blockers work? | * these meds block calcium entry into cells of vascular smooth musc & myocardium, dilate coronary arteries * decrease AV conduction * cause systemic vasodilation * decrease B/P |
| What type of drug is diltiazem and what is one trade name? | * This drug is a calcium channel blocker * One trade name for it is Cardizem |
| List some adverse effects of diltiazem | * arrhythmias * CHF * Stevens-Johnson syndrome * peripheral edema |
| Implementation for diltiazem includes: | * Monitor B/P and P * Monitor I&Os, daily weights * Monitor EKGs for bradycardia * Change positions slowly * Monitor K+ levels * Assess Sxs Digoxin toxicity * Do not crush time-release tablets |
| Digoxin is what type of drug and what is a trade name for it? | * This drug, Lanoxin, is a cardiac glycoside |
| How does digoxin work? | * slows AV node conduction * decreases conduction thru SA & AV nodes resulting in decreased heartrate * strengthens & increases force of contraction, thus increasing cardiac output |
| Side effects of digoxin: | * fatigue * bradycardia * anorexia * nausea * vomiting * arrhythmias |
| This cardiac glycoside has a very long half life and has a narrow margin of safety: must be given exactly as ordered. | Digoxin |
| Digoxin is often given with which diuretic and thus must ensure normal K+ levels before administering. | Lasix |
| Implementation of Digoxin: | * Loading dose admin over 12-24 hours * Monitor apical pulse for 1 full minute before admin * Hold med if rate is below 60 bpm * Monitor K+, Mg++, & Ca++ levels * Monitor hepatic / renal fxn |
| What amount constitutes Digoxin toxicity? | 0.5-2 ng/mL: drug levels may be drawn 4-10 hours after administration |
| Signs and symptoms of digoxin toxicity: | * abdominal pain * NV * visual disturbances * bradycardia * other arrhythmias * associated with low K+: slows heart rate |
| What type of drug does NOT dissolve clots but prevents clot formation and extension? | Anticoagulants |
| Anticoagulants are involved in the prevention of what? | * DVT * PE * Embolism secondary to AFib, stroke, MI |
| When are anticoagulants contraindicated? | In patients with: * coagulation disorders * trauma * recent surgery * malignancy * active bleeding * ulcer disease |
| Heparin is what type of drug and how does it act? | This drug is an anticoagulant and works to prevent conversion of prothrombin to thrombin (normal process of making a clot) * low doses are used to prevent DVT in bedrest clients: 5000 units q 8-12 hours |
| Adverse Reactions of heparin: | Bleeding, anemia, thrombocytopenia |
| Before administering heparin what must be done with another licensed medical professional? | Must verify that correct dose is about to be given |
| Implementation for heparin: | * Monitor PTT before & thru/o therapy * Monitor platelet count q 2-3 days |
| When administering heparin, what types of injections should be avoided? Where should injections be administered? | * Venipuncture and IM injections * Injections should be given in the abdomen, but rotated to prevent trauma to area |
| Never do what that would cause more tissue trauma or bleeding after administering heparin? | * Do not rub site or aspirate |
| How long is the half-life of heparin? What is antidote for heparin? | * Half-life is 2-6 hours * Antidote is protamine sulfate |
| What type of drug is Warfarin and list one common trade name? | This drug, trade name Coumadin, is an anticoagulant |
| How does warfarin work? | * This drug interferes with hepatic synthesis of Vitamin K dependent clotting factor |
| What is the half-life of Coumadin? | * The half-life is 0.5-3 days |
| What are some adverse reactions to Warfarin? | * bleeding |
| What tests should be monitored when administering warfarin? | * Monitor PT and INR (International Normalized Ratio) |
| Prothrombin time values of ___ x the baseline are considered therapeutic. | 2-3 |
| INR values should be below ___ if not on anticoagulants and between ___ if on anticoagulants. | 2; 2-3 |
| The antidote for warfarin is what? What internal fluid is also efficient? | * aquamephyton (Vit K) * whole blood |
| This drug, when taken by mouth, may take 3-5 days to reach effective levels and is thus often mixed with heparin. | Warfarin |
| What must one carry with them when taking warfarin? | medical ID |
| MDs used to tell patients taking warfarin to eat less foods with this vitamin, yet now adjust the drug dosage to patient's normal diet. | vitamin K |
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