NUR 2407 Pharmacology Exam 3 Study Guide

NUR 2407 Pharmacology Exam 3 Study Guide Pharm Exam 3 Study Guide – PLEASE STUDY HARD!!!!!!! Cardiac 1. Digoxin – client teaching, side/adverse effects, normal Digoxin levels and s/s of Digoxin toxicity digoxin (Lenoxin)  For A-fib and CHF – Slows and strengthens the heart. Hold for HR60  Can be PO or IV (IV must be administered slowly – over 5 minutes).  Narrow therapeutic window 0.5 – 2.0 ng/mL digoxin immune Fab (Digibind) is the antidote. Side/Adverse Effects: N/V, loss of appetite, GI symptoms, malaise S/S Dig toxicity: Visual illusions (white, green/yellow halos around objects, confusion, delirium, PVC’s, cardiac dysrhythmias. Client Teaching: Report HA, Visual Disturbances, seeing Halos. How to take pulse and to hold medication is 60. 2. Potassium levels, considerations and precautions related to levels, and when taking with HCTZ or potassium supplements Normal K+ = 3.5-5.2mEq/L Critical 2.5mEq/ Hypokalemia 3.5 mEq/L Hyperkalemia 5.2mEq/L S/S – Hypokalemia S/S - Hyperkalemia Cardiac Dysrhythmias, twitching, Muscle weakness, lethargy, Fatigue, paresthesia, dyspnea, anorexia, dysrhythmias. Cramping, diarrhea. Considerations/Precautions: Hold medication if level is too low. Contraindicated with other thiazides or sulfonamides, anuria. When taking with HCTZ or K+ supplements: Monitor K+ levels (K+ loss is the main concern.) Pt. needs to increase K+ intake for prevention of hypokalemia and dysrhythmias. Foods HIGH in K+: Dark leafy greens (Spinach, Kale, etc), Potatoes with skins, Tomatoes, Dried Apricots, Avocados, Bananas, Mushrooms, Orange/Grapefruit juice, beets, K+ based salt substitutes Strawberries Avoid alcohol, increases risk of OrthoHypo 3. ACE Inhibitor: lisinopril (Zestril)-client teaching All end in -pril  Use: Decrease workload of the heart, decrease BP. Often used in concurrence with thiazide diuretics.  Adverse Effects: Hypotension, orthohypo, Persistent dry cough, angioedema, Hyperkalemia in diabetics, renal failure and with potassium-sparing diuretics. Client Teaching: Monitor BP following first dose. Report dry, non-productive cough is continued for long period. Report decreased taste, intake, or weight loss. Report sore throat or other infections to MD. Report angioedema, rash, orthostatic hypotension. Do NOT use alcohol. NSAIDS decrease efficiency. Avoid foods high in K+ or K+ supplements. 4. Calcium channel blockers (nifedipine) – client teaching  Use: Controls HTN and angina. Dilates coronary arteries, decreases HR, BP.  Adverse Effects: HA (due to Vasodilation), constipation, peripheral edema, rebound Hypotension. Client Teaching: Avoid grapefruit juice (increases concentration of meds in blood). Avoid Calcium based Antacids (decreases effects of CCBs). Avoid caffeine, aspirin, St. John’s Wort, laxatives. Educate pt on how to properly take pulse, notify MD 50pbm. Change positions slowly. Maintain good oral hygiene to prevent gingival hyperplasia. Report any angina. Wear sunscreen when outside