NUR 2474 Rasmussen Pharm Exam 2 | 217 Questions and Answers(A+ Solution guide)

NUR 2474 Rasmussen Pharm Exam 2 Loop Diuretics - Furosemide Thiazide Diuretics - Hydrochlorothiazide (HCTZ) K Sparing Diuretics - Spironolactone ACE Inhibitors - lisinopril, captopril Angiotensin 2 Receptor Blockers - Losartan Calcium Channel Blockers heart and vessels - Verapamil, Dilitizaem Calcium Channel Blockers vessels only - nifedipine Beta Blockers - Metoprolol Cardiac Glycosides - Digoxin K channel blocker - Amiodarone HMG-CoA Reductase Inhibitors - Lovastatin Bile Acid Sequestrants - Cholestyramine Colesevelam ColestipolNitrates - Nitroglycerin Anticoagulant - Heparin Long term anticoagulant - Warfarin Direct thrombin inhibitors - Dabigatran Leukopoietic Growth Factors - filgrastim Drugs for hemophilia - Factor VIII, Factor IX concentrates, desmopressin Antidote: Digoxin - Digibind Antidote: Heparin - protamine sulfate Antidote: Warfarin - Vitamin K Steroids - Prednisone, Fluticasone Leukotriene Modifiers - Montelukast Short Term Bronchodilator - Albuterol Long term bronchodilator - Salmeterol Methylxanthines - TheophyllineAnticholinergics - Ipratropium Tiotropium H2 receptor antagonists -Cimetidine Ranitidine Famotidine Nizatidine PPI - Omeprazole Pantoprazole Mucosal Protectants - Sucralfate Types of Antacids - Aluminum salts Magnesium salts Calcium salts Sodium bicarbonate Bulk forming laxatives - Psyllium Stimulant laxatives - Senna Surfactant laxatives - docusate sodium Serotonin agonists - ondansetron Patient Education on using inhalers - For any patient prescribed an inhaler, the RN should ensure the client can self administer the medication.Teach back needed The patient should wait 1-2 minutes between puffs The patient should wait 5 minutes between 2 different inhalers The patient should take a bronchodilator before a corticosteroid medication (B before C) The patient must keep track of doses on their inhaler If opening a new inhaler, the patient should shake it and test before use. If dexterity is limited, a spacer can be used to get more medication in the airway. If the patient uses a steroid, they must wash their mouth out after use. If not, fungal infection may occur The patient should hold breath 10 seconds after receiving a puff. short-term asthma treatment - Bronchodilator: albuterol Acts as a rescue inhaler during asthma attacks. Onset is in 5 minutes and will last longer. Xanthine Derivatives: theophylline Dilates airways Can have high drug interactions in the body IV/ inhaled glucocorticoids. long term asthma treatment - Bronchodilator: salmeterol. Used to control symptoms of asthma Never is used alone (often with steroid) Anticholinergics: ipratropium bromide For long term asthma prevention Works very slowly. Corticosteroids: fluticasone Non bronchodilation Can take several weeks to showCOPD treatment - Bronchodilator- short acting albuterol Steroid Must keep o2 saturation between 88-92% Most asthma treatments require what? - Combination of medications- most medications cannot be used alone (need bronchodilator plus steroid) Rescue inhalers - Quickly relax airways. albuterol, epinephrine, metaproterenol, IV steroid Long term inhalers - salmeterol, ipratropium, theophylline, montelukast ,fluticasone Treatment of acute asthma attack - Oxygen use Short acting bronchodilator- albuterol Corticosteroid- ipratropium bromide IV Will relieve hypoxemia, reduce airway inflammation, and relieve obstruction. Bronchodilator mechanism of action - mimics the sympathetic NS and opens up the lungs and stimulates beta receptors Fast acting vs. long term asthma relief - Fast acting: used for acute asthma relief, Long acting is for chronic asthma management and COPD AE of bronchodilators - tachycardia, angina, tremors, nervous and shaky feeling, hyperglycemia. Pt teaching for bronchodilators - ensure patient takes medication as prescribed and does not overuse short acting bronchodilator. Never use it alone with asthma treatment.Glucocorticoid mechanism of action - works to stop the inflammatory process in the lungs, preventing bronchoconstriction. Stabilizes WBC membranes that release bronchial constricting substances, increases bronchial smooth muscle beta adrenergic stimulation. Forms of Glucocorticoids - Inhaled: used for asthma and is the most tolerated and fast acting, but can also be IV for systemic effects on the body. AE of glucocorticoids - throat and mouth irritation, dry mouth, oral fungal infections. Pt teaching for glucocorticoids - must teach patients to rinse mouth out after steroid use to prevent oral fungal infections, take bronchodilator 5 mins before steroid. Tiotropium mechanism of action - treats maintenance therapy and bronchospasm in patients with COPD. Will block muscarinic receptors in lungs how can we administer tiotropium? - inhaler What should we not use tiotropium for? - asthma Tiotropium onset and therapeutic level timeframes - Therapeutic effects start 30 min post inhalation, peaks in 3 hrs, and lasts 24 hrs. With consistent dosing, bronchodilation will improve after 8 days. Anticholinergic side effects - blurred vision, dry mouth, tachycardia, constipation, urinary retention How can we help aid patient experiencing anticholinergic effects? - give hard candy or fluids to suck on OTC sympathomimetics and cardiac patients - Sympathomimetics stimulate the immune system and cause vasoconstriction widespread and interfere with BP. Found in many cold and allergymedications. Patients with cardiac problems must have caution with use of these drugs and hypertension treatment. Treatment principles of cold symptoms in children - Must treat individual symptoms. Many medications used OTC to treat colds are combination medications. In children, it can be dangerous if used as a combination medication for a cold. The parent should treat the symptoms only with individual agents and only with agents indicated for pediatric use. Best preventions of NSAID induced ulcer formation? - Use PPI or H2receptor blocker and stop NSAID if possible NSAID use increases what? - Ulcer formation Antacids: Mechanism of Action - Do not prevent the overproduction of acid but instead help to neutralize acid secretions Promote gastric mucosal defense mechanisms Stimulate secretion of: -Mucus: protective barrier against HCl -Bicarbonate: helps buffer acidic properties of HCl -Prostaglandins: prevent activation of proton pump Adverse effects of antacids - constipation, diarrhea, metabolic alkalosis, renal calculi H2 receptor blocker mechanism of action - works to block H2 receptors, reduce H ion secretion in parietal cells, suppress acid secretion and increase stomach pH Adverse effects of H2 receptor blocker use - CNS confusion and depression in older adults, decreased libido, impotence and gynecomastia.IV bolus= hypotension and dysrhythmias antacids and cimetidine - Antacids will reduce absorption of cimetidine. The patient must wait 1 hr before taking cimetidine and antacids What should a patient do before purchasing any OTC medications - Consult HCP GERD treatment principles - GERD there is a problem with the lower esophageal sphincter, allowing for acid to go up into the esophagus from the stomach. Will use PPI if anything to help. Once patient stops PPI, they can relapse and have GERD symptoms Relapse of GERD is often why medications are taken for long term maintenance. However, short term use may occur also. PPI mechanism of action - help to prevent movement of hydrogen ions from cells into the stomach. causes all gastric acid secretions to be blocked (no HCl is produced!) PPI uses - GERD, esophagitis, short term gastric and duodenal ulcers, NSAID ulcers, stress ulcers, H. pylori formed ulcers. Adverse effects of PPI - HA, GI effects- D,N,V, pneumonia, osteoporosis, fractures, hypomagnesemia, , gastric cancer. Route to give PPI - PO IV NG PPI and use in older adults - encourage older adults to consume adequate calcium and vitamin D on PPI, as therapy can increase risk for fractures and osteoporosis.Sucralfate mechanism of action - It works by attaching and binding to the base of ulcers, forming a proactive barrier over the area. It can then protect areas from pepsin that can break down proteins and make ulcers worse. Sucralfate uses - treats stress ulcers and PUD. Adverse effects of sucralfate use - constipation, nausea, dry mouth. What must we do when administering sucralfate? - must give other drugs 2 hrs before due to impairment of other drug absorption What should we do first before giving a patient medications such as laxatives for constipation? - assessment rule out other causes of constipation such as from medications, small bowel obstruction- must take X-ray and listen to bowel tones Constipation is - occurring when the patient has hard stools, infrequent stools, excessive straining, and unsuccessful defecation. Can diet be a cause of constipation? - yes- having a diet in low in fiber and fluids can cause it Treatment is to correct the diet Purpose of laxative use -They can reduce painful bowel elimination. Decrease strain to prevent vasovagal stimulation. Empty the bowel before treatment procedures Obtain a fresh stool sample. Assist with loss of bowel tones. Bulk forming laxative administration and principles - Works by absorbing water to increase bulk and soften stool. It also causes bowel distention to initiate reflex bowel activity. The patient should take with full cup of water to aid in actionHow do opiate laxatives work? - Works to decrease bowel motility and reduce pain by relief of muscle spasms. They also decrease transit time of stool through the bowel, allowing more time for water and electrolytes to be absorbed. Opiate laxatives use - patients with frequent diarrhea, to decrease stool in ileostomy and decrease diarrhea from opioid withdrawal. Important opiate laxative consideration - If a patient takes too much of an opiate due to its dependent effects, a patient may experience s/s similar to morphine and may cause an increased constipation. The patient will need naloxone to help reverse this cause. Senna mechanism of action - stimulates the intestines and works to increase peristalsis via intestinal nerve stimulation. What side effect is important to teach patient regarding Senna use? - must teach the patient they may have a yellow/brown or pink color to the urine that is harmless. Surgical patients and use of stool softeners - Stool softeners will help the stool pass easier through the hypoactive bowel. It will not stimulate bowel activity. Will help with post surgical constipation. Ondansetron mechanism of action - blocks receptors located in the vagal nerve, GI tract, and chemoreceptor trigger zones in the CNS. Ondansetron treats... - nausea and vomiting, CINV, post op NV Side effects of ondansetron - HA, diarrhea, dizziness, prolonged QT interval, risk of torsades de pointes concurrent use of furosemide and digoxin causes what? - hypokalemia- must cease use of furosemide and switch to spironolactone and monitor K levels and EKG readings. Give K supplement to increase K levels if neededLoop diuretics do what? - block absorption of Na, K ,Cl and water, Causes rapid diuresis. Both Loop diuretics and K sparing diuretics treat what? - HF Hypertension. edema AE of loop diuretics - hypotension ,dehydration, hyponatremia, hypokalemia, hypochloremia What should we give patient taking loop diuretic to increase K levels? - K supplements K sparing diuretics do what? - block absorption of Na and water, and causes the body to hold onto K. Excretes water and Na only AE of K sparing diuretics - hypotension, hyperkalemia (the person holds onto more potassium), drowsiness, metabolic acidosis, gynecomastia, breast tenderness, irregular menstrual cycle, impotence. What nursing interventions should we do with the patient taking K sparing diuretics / - monitor ECG so we can assess for arrhythmia related to high K levels, no salt substitutes should be used Concurrent use of Furosemide and Gentamicin causes what? - increased ototoxicity- pt must report s/s of tinnitus or hearing loss What causes angioedema? - ACE inhibitors and A2RB use S/S of angioedema - facial and tongue swelling. Can be fatal. Patient education regarding angioedema - The patient with angioedema must discontinue ACE inhibitors or A2RB drugs and never use them again.ACE inhibitors and coughing - Side effect of drug. Can be irritating. Due to increased bradykinin. Can give cough drops to help but if the patient doesn't tolerate coughing, we must switch them to another medication Side effects of ACE inhibitors - 1st dose hypotension, dry cough, angioedema, hyperkalemia, fetal injury. Pt teaching for 1st dose hypotension with ACE - change position slowly Dry cough relief for ACE use - Sucking on hard candy or cough drop. However, if they cannot handle the medication because of a cough, they must notify the provider to switch medication. Angioedema teaching for patient taking ACE - report s/s. never use ACE drugs again Hyperkalemia ACE teaching - The medication causes K retaining. They must avoid foods high in potassium. They also must avoid salt substitutes as they are full of potassium. Fetal harm patient teaching with ACE use - notify HCP if they are pregnant or plan to be pregnant while on the medication. K sparing diuretic use and ACE use - It will interact and cause even more levels of high potassium since both drugs cause body to hold onto potassium. The patient must take another diuretic in this case. ACE vs ARB - ACE has dry cough ARB does not have dry cough Nifedipine and Metoprolol concurrent use is for... - prevention of reflex tachycardia Beta Blockers mechanism of action - bind to beta 1 and 2 receptors and block responses. This causes decreased HR, decreased contractility, decreased cardiac output, decreased SA to AV node conduction. It also decreases peripheral resistance and decreases renin release.Beta Blocker uses - hypertension, angina, PSVT, HF, cardioprotection, migraines, anxiety. Beta blocker side effects - low HR, AV block slowed conduction, bronchoconstriction and bronchospasm, hypoglycemia, orthostatic hypotension, impotence, depression. Which patient populations do we not use Beta blockers with - those with heart block, bradycardia, COPD, asthma Calcium channel blockers mechanism of action - work to block calcium channels in smooth muscle, causing vasodilation, block calcium channels in myocardium, decrease contraction and HR and conduction, decrease afterload, increasing perfusion. Calcium channel blockers indications - hypertension, angina, SVT, Afib, aflutter. Adverse effects of calcium channel blockers - hypotension, reflex tachycardia- use metoprolol, dizziness, peripheral edema, gingival hyperplasia calcium channel blocker administration interventions - Must monitor BP and HR and hold the med if apical HR is higher than 100 and SBP is less than 90, change positions slowly, monitor weight, give regular oral care. Can we give a patient calcium channel blocker and grapefruit juice? - No- it will interact with drug Treatment of hypertension in diabetics - In patients who are diabetic and hypertensive, the target BP is the same as the population (less than 120/80). Preferred drugs are ACE,A2RB,CCB, low dose diuretics. Some of the medications may suppress glycemic index and cause hypo/hyperglycemia. Use diuretics with can happen if a patient takes furosemide and antihypertensive? - Hypotension- furosemide rids the body of fluid, dropping BP and antihypertensives often cause vasodilation, dropping BP also. Additive effect Digoxin therapeutic range - 0.5-2 mg Potassium normal range - 3.5-5.0 What to assess when giving digoxin to patient - assess vitals first and potassium levels, obtain apical heart rate for 60 seconds. Will hold drugs if HR is less than 60 and the BP less than 90/60. Digoxin toxicity early s/s -N,V,D, GI effects, anorexia, abdominal pain. Digoxin toxicity late s/s - decrease HR, vision changes- halos, green yellow blue vision, flickering lights. What should we do after giving patient digibind for digoxin toxicity? - Monitor lab values of serum digoxin level since they go down slowly. Has to be in therapeutic range Amiodarone Mechanism of Action - Blocks potassium channels & to a smaller degree sodium channels; slows repolarization, increases duration of action potential, prolongs refractory period Amiodarone treats - works to reverse dysrhythmias, v fib, unstable ventricular tachycardia. Adverse effects of amiodarone - pulmonary toxicity, cardiotoxicity, teratogenesis, corneal deposits, optic neuropathy Should we give patient amiodarone and grapefruit juice? - No- drug and juice will interact what happens to drug levels of amiodarone when we give cholestyramine? - decreased amiodarone levelsGoal of dysrhythmia treatment - Goal: put patient in healthy sinus rhythm Remember that all drugs that treat dysrhythmias can also cause other dysrhythmias! Magnesium Elimination - kidneys- may be in larger amounts when a loop diuretic or thiazide is used since it will rid body quickly of electrolyte HMG-CoA Reductase Inhibitors Mechanism of action - Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol Lower the rate of cholesterol production. effective in lowering LDL and elevating HDL, reducing TG levels. Also has cardiac benefits of promoting plaque stability or less growth, reducing risk for CV events, and increasing bone formation. Adverse effects of HMG-COA statins - HA, rash, GI effects Rare: myopathy or rhabdomyolysis- muscle breakdown, liver toxicity, new onset diabetes and cataracts with older patients. What should we not do when giving a statin? - Do not use other lipid lowering drugs or in pregnancy. NO GRAPEFRUIT JUICE! Colesevelam mechanism of action - Prevents intestinal reabsorption of bile acids; liver must consume cholesterol to make replenish lost bile. Colesevelam and insulin - This drug is also used for adjunct therapy in patients with type 2 diabetes and insulin in hyperglycemia. All cholesterol drugs administration time is... - once daily, in the evening meal or before bed- it will mimic body's natural production time of cholesterolHMG-CoA Reductase Inhibitors- what to report to the provider - Inform about the risk of myopathy and to notify the provider if muscle pain occurs. Cholesterol lowering agents patient education - May take a couple weeks to see lipid level changes. Best course of action is to maintain a diet and exercise regimen. Should have a lipid plasma test 2x a year that prevents us fasting. Screen every 5 years or more often. Take cholesterol medications at night or at evening meals. Stress reduction is needed. Stop smoking TLC diet low cholesterol and fat Lifestyle modifications are first line, then meds. Give with full glass of water Cholestyramine administration - must dilute medication and dilute fluid in water and drink. Nitroglycerin administration - large 1st pass effect in oral forms. Tolerance will develop fast. Place under tongue if PO and let dissolve. Burning means the drug is working. Nitroglycerin patches - can remove for 8 hrs. a day. Remove the old patch before the new one, rotate sites on the upper body. Nitroglycerin cream - wear gloves while applying, remove all excess formula. Nursing care for patient using nitroglycerin in hospital - check vital signs before each dose if possible, give 5 minutes apart, hold drugs if HR is less than 60 or greater than 100 or BP less than 100/60. check med record or with patient to see if taking PDE5 drugs Nursing care for patient taking nitroglycerin not in hospital - stop activity and sit down, take a sublingual tablet, and wait 5 minutes. If no relief, take a 2nd tablet and call 911, still no relief, take a 3rd tablet and wait for EMS. DO NOT TRY TO DRIVE SELF TO HOSPITAL OR HAVE FAMILY TAKE YOU.How do we store nitroglycerin? - in an airtight, dark glass bottle in a cool, dark place. Potency of the drug can be lost in 6 months after opening. Nitroglycerin mechanism of action - vasodilates, acts directly on vascular smooth muscle to promote vasodilation. Lowers oxygen demand. Nitroglycerin is used to treat? - angina Adverse effects of nitroglycerin - HA, orthostatic hypotension, reflex tachycardia What drugs interact with? - PDE5 inhibitors- these drugs can be used for erectile dysfunction but can also be used for cardiac reasons also What must we ask any male who comes in with chest pain? - If they use PDE5 drugs- if they do, we must hold nitroglycerin. What could happen if the patient takes nitroglycerin and does not tell us they take PDE5 drugs? - Hypotension Hemophilia treatment is focused on... - providing plasma and recombinant factor VIII and IX to those who do not have it Adverse effects for Hemophilia treatment with factor VIII/IX therapy - allergy medication induced effects such as hives, stuffy nose, fever How can we treat Factor VIII/IX adverse effects? - give diphenhydramine How does heparin work? - inhibit action or formation of clotting factors, preventing a clot from forming. They have no direct effect on a blood clot that is already formed.What is heparin used to treat? - Used for procedures where anticoagulation is required, PE, strokes, DVT, open heart surgery, renal dialysis, DIC. Forms of heparin therapy are... - Unfractioned IV drip, low molecular weight SubQ therapy Adverse effects of heparin use - Hemorrhage, Heparin Induced Thrombocytopenia, Allergic reactions. What must we monitor while giving patient heparin? - s/s bleeding, low platelet or WBC counts, aPTT level aPTT normal range - 60-80 What happens if we have a aPTT level less than 60 - increase drug dose What happens if we have a aPTT level greater than 80 - decrease drug dose Vitals signs in a bleeding patient consist of... - low BP, high HR, high RR Warfarin mechanism of action - used for inhibiting clotting factors and to prevent DVTs long term. Works long term and effect may take 3-4 days to work (long half life). Adverse effects of Warfarin - hemorrhage, teratogenesis during pregnancy, purple toes. How should we administer Warfarin? - PO, in the evening, same time each day, with or without food. Lab values we monitor with Warfarin - PT/INRNormal range for PT/INR level - PT/INR: PT= 18-24, INR 2-3 What should we do if we have an INR level lower than 2? - increase drug What should we do if we have an INR level above 3? - decrease dose Interactions with Warfarin therapy - any drug to increase anticoagulant effects (blood thinners), drugs that promote bleeding, decrease anticoagulant effects, heparin, aspirin, acetaminophen. Why may we initiate iron therapy? - a patient has low iron levels, isn't getting enough dietary iron, they are bleeding, pregnancy and need higher amounts Iron comes in... - many different forms- IV, PO, etc Adverse effects of Iron therapy - GI effects, staining of the teeth. metallic taste, black stool What should we teach our patients prior to iron therapy? - The solution may be black and thick, stool may be black. What should we use to give iron therapy? - filter Iron therapy toxic effects -N,V,D,shock, acidosis, gastric necrosis, hepatic failure, Pulmonary edema, vasomotor collapse. What must we do when taking iron along with antacids, tetracycline and ascorbic acid? - takes medications and iron 1 hr apart normal hemoglobin levels - Male: 13-18 g/100mL Female: 12-16 g/100mLnormal hematocrit levels - Male: 45%-52% Female: 37-48% Normal RBC count - 4-6 million Anemia labs - Low Hemoglobin, Low RBC count, low vitamin B12, low hematocrit Anemia is - based on various causes, but after it is due to having small, pale RBCs. May need more of a certain vitamin component. Maybe hemolysis also. Filgrastim mechanism of action? - stimulate WBC production. It reduces severe neutropenia and reduces need for infection, hospitalization and IV abx and immune suppression in cancer patients Adverse effects of filgrastim - Bone pain Leukocytosis What do we need to do if patient reports bone pain or infection? - give acetaminophen or decrease dosage Dabigatran mechanism of action - directly prevents clots from forming Dabigatran treats... - A fib, prevents VTE follow surgery and prevents DVT/PE Dabigtran Adverse effects - bleeding, dyspepsiaImportant nursing considerations for dabigatran - does not monitor anticoagulation, little risk of adverse events, same dose can be used for all patients regardless of age or weight. no antidote. give with or with food PO Rivaroxaban mechanism of action - oral anticoagulant that causes inhibition of factor Xa. It works fast, has fixed dosage, lower bleeding risk, few drug interactions, and no need for monitoring. Intended for prevention of DVT/PE, prevention of stroke and PE in AFib patients Adverse effect of rivaroxaban - bleeding is the most common adverse effect and can occur at any site. Increased with any drug that impedes hemostasis. Antidote for rivaroxiban - none- use activated charcoal S/S bleeding - petechial, ecchymosis, tarry stool, coffee ground emesis, bleeding out of unusual places, hematuria, tachycardia, hypotension. Bleeding precautions - use soft toothbrush, electric razor, wear good soled shoes, have safe environment, wear medical alert bracelet, do not strain while on toilet, no contact sports, decrease invasiveness of procedures such as needlesticks, blow nose gently, observe for s/s of bleeding If the K level is above 5.... - give K wasting diuretic If K level is less than 3.5... - give K sparing diuretic What to assess with all patients receiving medication causing abnormal K levels? - telemetry for arrthymia Na levels - 135-145 What do kidney labs assess? - does the kidney filter well? Is it functioning and can handle drug effects?Kidney Labs - BUN: 7-20 CRE: 0.8-1.4 SPECG: 1.005-1.030 GFR 125ml/ hr WBC is - Low WBC count means... - immunosuppression and high risk for infection High WBC count means... - active infection someplace Platelet normal range - 150,000-400,000 what happens if we have a low platelet level? - risk for bleeding Normal triglyceride levels - 150 mg/dL Normal HDL levels - 40 mg/dL Normal LDL levels - 100 mg/dL what can influence cholesterol levels? - physical activity, dieting, smoking