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What does a loop diuretic do?
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What are loop diuretics used for?
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Marian pharm quiz 4
Quiz #4
| Question | Answer |
|---|---|
| What does a loop diuretic do? | Increases water excretion |
| What are loop diuretics used for? | pumonary edema, edema, HTN, ascites |
| Adverse effects/Precautions with loop diueretics? | *Hypokalemia* dehydration, hypotension, ototoxic, addivtive effect with other antihypertensives |
| Loop Diuretic drugs | Loop-Lasix (Furosemide), Potassium Sparing (Aldactone), HCTZ (Hydrochlorothiazide), Osmotic (Mannitol), Bumetanide (Bumex) |
| Nursing Interventions for Loop diuretics | Monitor weight, Na restriction diet, Monitor electrolytes Na ****K losing***, monitor BP, decrease effectiveness with NSAID |
| Potassium Sparing Diuretics does what? | cause loss of sodium in the urine |
| What is the use of potassium sparing diuretics? | treat HTN and edema |
| What drug decreases sodium rention and decreases potassium excretion? | Aldactone |
| Adverse Effects of Aldactone | Hyperkalemia |
| Nursing interventions for Aldactone | monitor BP, monitor weight, may use with other diuretic, monitor K+, monitor K+ intake, NO Salt SUBSTITUTES! |
| Osmotic Diuretics | Mannitol |
| What does Osmotic Diuretics help do? | helps prevent renal failure with prolonged surgery |
| Osmotic diuretic pulls fluid from where? | exravascular sites into blood stream |
| What does Osmotic diuretcs treat? | oliguria and anuria |
| What are Vasodilators used for? | severe HTN(crisis) and emergencies as well as with chronic HTN |
| Vasodilators are usually given IV because? | produce controlled hypotension |
| Vasodilators can cause direct vasodilation or vasconstriction? | vasodilation |
| Vasodilators will cause what kind of heart rhythem? | tachycardia |
| What drugs are vasodilators? | Hydralazine (Apresoline) Sodium nitroprusside (Nipride) |
| What is a precaution with Vasodilator? | Cyanide poisoning |
| What is angina? | syndrome of substernal chest pain produced when O2 demands of the heart exceed O2 supply |
| How is stable angina releived? | rest or nitroglycerin |
| What kind of angina is more severe in symptoms and less responsive to treatment and may cause myocardial infarction? | unstable angina |
| First line of defense in prevention and treatment of Angina | organic nitrates |
| what is the action of organic nitrates? | relaxes smooth muscle in the blood vessel walls |
| What are the uses for Organic Nitrates? | acute anginal attacks, unstable angina, chronic angina |
| What may develop with sustanined long-term use with Organic Nitrates? | Tolerance |
| What are some adverse effects oF nitrates? | headache, hypotension, dizziness, weakness, N/V and facial flushing |
| What are the precaustions of Nitrates? | head trauma with increased intracranial pressure, pt with hypotension |
| Nursing interventions for Nitrates | Assess pain (location, onset, type, frequency, intensity, pattern, radiation), check APICAL pulse and BP (hold and notify if <90mmHg Systolic), wear clothes with patches (on 12 off 12, assess skin, check removal of previous patch), call nurse |
| Nitroglycerine SL tabs must do what to be effective? | fizzle or burn |
| How should Nitroglycerine tablets be stored? | from heat and light (in brown bottle) |
| Smoking should be avoided with Nitroglycerine tablets because of? | vacsoconstriction |
| Spray NTG can go under or on tongue but should not be? | Inhaled |
| Why should Beta Blockers should never be used in an emergency? | They do not act quickly to treat accute attacks |
| What kind of medication is used for chronic stable angina? | Beta Blockers |
| What are Beta Blocker Drugs? | Propranolol hydrochloride (Inderal) and Atenolol (Tenormin) |
| What do Beta Adrenergic Blockers do? | act to interrupt stimulation to beta 1 and 2 receptors by competing with norephinephrine for available beta adrenergic receptor sites |
| What do Beta Blockers? | inhibit beta 2 receptors cause vaso dilatation in skeletal muscle arteriles and are used to control angina pectoris |
| What do calcium channel blockers do? | Act on contractile and conductive tissue to the heart |
| What are the Calcium channel blocker drugs? | Amlodipine (Norvasc), Nifedipine (Procardia), and Nicardipine (Cardine) |
| What does the Calcium Channel blocker improve in the body? | blood supply to the myocardium and decrease workload |
| What are the interventions for Calcium channel blockers? | monitor pulse and BP, Assess effectiveness |
| Beta Blockers and calcium channel blockers are also used for? | dysrhythmias, HTN, CHF |
| What does Antiplatelet drugs do? | decrease platelet aggregation to prevent MI |
| What are the cautions with Antiplatelet drugs? | surgery and injury |
| What are the names of two Antiplatelet drugs? | Aspirin (ASA) and Colpidogrel (Plavix) |
| What are the nursing interventions with Antiplatelet drugs? | monitor bleeding, safety precaustions |
| What do Anticoagulants do? | Interfere with coagulation cascade |
| What are anticoagulants used for? | throbotic disorders, prevent clot extension and formation |
| What are the cautions with anticoagulants? | bleeding disorders, ulcers, pregnancy |
| Name two drugs that are anticoagulants | Heparin and low molecular weight heparin |
| Why is Heparin given? | to prevent conversion of prothrombin to thrombin |
| What route is Heparin given? | IV or SQ |
| What labs need to be checked for heparin and what is the therapeutic range? | PTT and 1.5-2.5 control |
| What is used for overdose with heparin? | protamine sulfate |
| Where is heparin given? | abdomen no rubbing |
| What is the name of the low molecular weight heparin drug? | enoxaparin (Lovenox) SQ |
| What needs to be monitored when a pt is getting Lovenox? | platelet counts |
| Do not remove what from the syringe when giving Lovenx? | air bubble |
| What site is preferred when giving Lovenox? | abdomen |
| What does an anticoagulant interfere with? | with vit K dependent clotting |
| How is an anticoagulant given? | PO |
| What kind of drug is Warfarin (Coumadin) | anticoagulant |
| How many days does it take for an anticoagulant to take effect? | 3-5 days |
| What lab tests are you monitoring for an anticoagulant? | PT (1.3-1.5 X control) or INR (2-3) |
| Antidote for an anticoagulant is? | Vitamin K |
| Dosage for anticoagulants can be adjusted? | Daily |
| Thrombolytics is known as what kind of buster? | clot |
| What does a Thrombolytics do? | dissove clots, reestablish blood flow, prevent or limit tissue damage |
| What are Thrombolytics used for? | acute MI and stroke |
| What are the adverse effects of Thrombolytics? | bleeding |
| What are the precautions for Thrombolytics? | pregnancy, deleivery with in 10 days and bleeding |
| Name a Thrombolytics drug | Streptokinase (Steptase) |
| What are the nursing interventions for Thrombolytics? | Give immediately follwing symptoms, check bleeding every 15 min during first hour, every 30 for the next hr, then every 4, Oral temps only, check pulses every hr, maintain bed rest and avoid trauma |
| Automaticity for the heart is also called the? | SA node... produces the beat |
| Cardiac Electrophysiology is dependent on flow of what in and out of the cell? | Na and Ca into cell and K+ out of the cell |
| Conductivity in cardiac electrophysiology is what? | abnormal when somewhere besides AV node becomes the pacer |
| What is it called when somewhere else besides the AV node becomes the pacer? | ectopic focus |
| What are the uses of antidysrhythmics? | convert atrial fibrillation or atrial flutter, maintain normal sinus rhythm after conversion, supprss fast rate, and dangerous life threatning arrhythmias |
| What is the prototype for antidysrhythmics? | Class 1A-Quinidine |
| Class 1A-Quinidine does what? | Sodium channel blocker, blocks sodium channel in the myocardium and slow the heart rate |
| Class 1B-Lidocaine does what? | Effect on Ventricle and decreases automaticity |
| What does Class II-Beta Blockers-Propanolol do? | decreased sympathetic stimulation of Beta receptors in heart, decreased SA and AV node conduction and is given long term |
| What is the BBW for Class III Antidysrhythmics? | Pulmonary toxicity |
| Name a Potassium Channel Blocker drug | Amiodarone |
| Amiodarone-IV-ACLS for VT/VF does what? | vasodilation, decreased vascular resisitance, prolongs conduction, decreases HR and decreases contraction of the Left Ventricle |
| Amiodarone-Oral does what? | delayed action 3 days to 3 weeks, loading dose |
| What allergies should you watch for with amiodarone-Oral? | Iodine Rich |
| Amiodarone-Oral can cause what dysfunction? | Thyroid |
| What kind of deposits can Amiodarone-Oral cause? | corneal deposits |
| What can happen to a person's nose if they are taking Amiodarone-Oral? | Blue nose |
| Name an unclassified Antidysrhythmic drug | Adenosine |
| What is Adenosine for? | PSVT |
| How would you give Adenosine? | must be given very fast IV push because 1-2 life is less than 10 seconds |
| Adenosine is the 2nd line after __________ maneuvers in ACLS guidelines are. | vagal |
| Two drugs are in Class IV Antidysrhythmics: Name the two calcium channel blockers | Verapamil and Diltiazem only |
| What does Verapamil and Diltiazem do? | Block Calcium from moving into heart muscle, slows conduction through SA and AV nodes, slowes HR |
| Verapamil and Diltiazem are only effective for what kind of heart rate? | SVT (HR >140) |
| Name the cardiac failure drugs | Cardiac Glycosides (Digoxin), Phosphodiesterase (Milrinone) and Human B Natriuretics (Nesiritide (Natrecor) |
| Name the antihypertensive drugs | ACE inhibitor "prils", ARB "sartans", Beta Blockers "LOL", Calcium Channel Blocker "pine", Diuretics |
| Name the calcium channel blocker drugs | Nifedipine (Procardial), Amiodipine (Adalat, Norsac), Isradipine (Dynacirc) |
| Name the diuretic drugs | Loop-Lasix (Furosemide), potassium sparing (Aladactone), HCTZ (Hydrochlorethiazide), Osmotic (Mannitol) |
| Name the antianginal drugs | Nitrates-Nitrogycerine (Nitrobid), Isosorbide dinitrate (Isordil), Isosorbide momonitrate (Ismo, Beta Blockers "LOL" drugs and Calcium channel blockers "pine" drugs |
| major S/S of heart failure | dysna and fatigue |
| Impaired contraction has to do with which number in the BP? | systolic |
| Imparied relaxation has to do with which number in the BP? | diastolic |
| When compensation in Heart failure occurs, what is increased first? | Increase sympathetic stimulation (catecholamines)>natural body |
| What system is activated with the compensation in heart failure? | Renin-Angiotension-Alfosterone |
| Drugs to teat chronic heart failure | Diuretics, ACE inhibitors, ARB's, cardiac glycosides-digoxin... |
| What route is Digoxin (Lanoxin)given? | Oral or IV; not IM |
| When taking Digoxin, what can not be switched back and forth? | liquid and tablet medication |
| How does Digoxin work? | slows down ventricular contraction: decreases beats, direct stimulation of the vagus nerve: slow it down, increase efficiency of the heart contraction and vagal stimulation combination: decreases tachycardia that the body is using to compensate |
| *****Indications for Digoxin***** | Mangagement of CHF, Afib-cardiac failure and a flutter |
| Contraindications for Digoxin | Severe myocarditis-need heart transplant Ventricular arryhthmia (VF or VT Electroyte imbalances (b/c of Na + Ca) Risk of fatal dysrhythmias (WPW and adams stokes Renal impairment |
| REversal drug for digoxin toxicity | Digibind |
| Digoxin S/S are? | N/V, anorexia, abdominal discomfort, blurred vision, mental status changes, arrythmias |
| Hypothryroidism can slow digoxin metabloism and lead to toxicity due to what? | accumulation of the drug |
| Therapeutic range for Digoxin | Narrow therapeutic range 0.5-2 ng/ml |
| Hold dose for Digoxin when pulse is <_______ in adults and <______ in younger children. | <60 for adults and <100 for younger children |
| Hypertension drugs do what? | drugs to reduce BP, reduce cardiac output and/or reduce peripheral resistance |
| Therapeutic Regimens for HTN; Lifestyle modification | Wt loss, 2gm Na diet, no smoking and exercise |
| Prevention/Treatment of Digitoxicity | smaller doses in elderly and hypothroidism, discontinue digoxin-dont just decrease the dose *Stop it!*, monitor for cardiac arrhythmias, toxicity can occure at lower levels |
| Goal of treatment for HTN; what should BP be? | Normal systolic >140mm/Hg and diastolic >90mm/Hg |
| What is the goal of treatment for a diabetic pt with HTN? | 130/80 |
| First choice drug with HTN? | Thiazide Diuretic +/- ACE, ARB, BB or CCB |
| What does an ACE inhibitor do to the angiotension I and II? | Inhibits the conversion of angiotension I to angiotensin II |
| What is reduced in the ACE inhibitor? | peripheral vascular resisitance and lowers BP |
| What increases and is excreted in the ACE inhibitor? | renal sodium is increased and water excretion (Aldosterone) |
| ACE inhibitors Drugs | Catatopril (Capoten), Lisinopril (Prinivil),Quinapril (accupril), Ramipril (Altace), Enalapril (Vasotec) |
| Adverse effects for ACE inhibitors | severe hypotension, renal tubular damage, *cough-dry/hacky** |
| What is a caution of ACE inhibitors? | renal disorders |
| How many times a day do you take ACE inhibitors? | One time daily dosing |
| Nursing interventions for ACE inhibitors | monitor BP, check wt, I&O hospital, risk of rebound HTN with abrupt stop, schedule follow up appt |
| angiotension II receptor blockers do what? | complete with angiotension II for tissue binding sites, blocking the vasoconstriction and aldosterone secretion thus lowering BP |
| Angiotension II Receptor blockers have similar effects as what other inhibitor? | ACE |
| Angiotenison II receptor blocker is used to treat what? | HTN |
| Name some adverse effects for angioteniosn II receptor blockers | sever HTN and less cough |
| Name some cautions of angiotension II receptor blocker | Liver and dysfunction |
| name ARB Drugs | Losartan potassium (Cozaar), Candesartan (Atacand), Iresartan (Avapro) "sartans" |
| Nursing interventions for ARB drugs | montior BP, weight, follow up |
| Name the Diuretic drugs | loop Diuretics (Lasix), Potassium sparing (Aldactone), Thiazide-Hydrochlorothiazide (HCTZ) and Osmotic (Mannitol) |
| What does a diuretic do? | Increases the renal excretion of water, Na+ and other |
| Name all the classes for Antidysrhythmics | Class I-Na Channel Blocker Class II-Beta Adrenergic Blockers Class III-Potassium Blockers Class IV-Calcium channel blockers unclassified |
| What drugs are in the Class I Na channel blocker | Quinidine(protype), Lidocaine (Xylocaine), Flecainide (Tambocor) |
| What drugs are in the class II Beta Adrenergic blockers? | Atenolol (Tenormin, Metoprolol (Lopressor) Propanolol (Inderal) |
| What drugs are in the class III Potassium Blockers? | Aminodarone (Cordarone) |
| What drugs are in the class IV calcium Channel blockers? | Diltizem (Cardizem) and Verapamil (Calan) |
| What are the names of the unclassified drugs in the Antidysrhythmics? | Adenosine (Adenocard) and magnesium sulfate |
| Name the antianginal drugs | Nitrates: Nitrogycerinel (Nitrobid), Isosorbide dinitrate (Isordil) and Isosorbide mononitrate (Ismo), Beta Blockers and Calcium channel blockers |
| Name the Coagulation drugs | Anticoagulants, Antiplatelet and Thrombolytic |
| Name some anticoagulant drugs | heparin, warfarin (Coumadin) and enoxaparin (Lovenox) |
| Name some antiplatelet drugs | ASA, chlpidogrel (Plavix), Ticloipidine (Ticlid) |
| Name a Thrombolytic drug | steptokinase (Streptase) |
| HCTZ drugs are related to_____________ there is known cross sensitivity | Sulfonamides |
| Nursing interventions with Diuretics | Monitor I&O, monitor wt, monitor BP |
| When should Diuretics be given to the pt? | Early morning |
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aconner1
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