NUR 2407 PHARMACOLOGY FINAL EXAM 3 STUDY GUIDE
VERSION 2
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 HR<60
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,
5. Nitroglycerin – client teaching, side/adverse effects, contraindications
Use: Reduce angina. Short acting for acute, long acting for severe
recurrent episodes.
Side/Adverse Effects:
Dizziness, HA (dilation of cerebral vessels), Hypotension, Reflex
Tachycardia, flushing, blurred vision
Contraindications:
Do not give to pt with hypotension, high intracranial pressure, head
trauma, or taking ED medications due to synergistic effect.
Client Teaching:
Only take 1 SL q 5 min b/c of rapidly dropping BP – up to 3!! Sit
down and rest. If not effective, call EMS.
Change positions slowly.
Do not drink alcohol while taking this med.
HA is normal side effect.
VERSION 2
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 HR<60
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,
5. Nitroglycerin – client teaching, side/adverse effects, contraindications
Use: Reduce angina. Short acting for acute, long acting for severe
recurrent episodes.
Side/Adverse Effects:
Dizziness, HA (dilation of cerebral vessels), Hypotension, Reflex
Tachycardia, flushing, blurred vision
Contraindications:
Do not give to pt with hypotension, high intracranial pressure, head
trauma, or taking ED medications due to synergistic effect.
Client Teaching:
Only take 1 SL q 5 min b/c of rapidly dropping BP – up to 3!! Sit
down and rest. If not effective, call EMS.
Change positions slowly.
Do not drink alcohol while taking this med.
HA is normal side effect.
