Pharmacology Hesi 2023/2024 Exam With Questions and Complete Solutions

Digoxin (Lanoxin) Inotropic and Chronotropic Effects: • Positive Inotrope: Increases the strength of heart contractions. • Negative Chronotrope: Decreases the heart rate. • Assessment: Measure the apical pulse for a full minute to evaluate the effects. ________________________________________ Client with Long-Term Use of Digoxin and Furosemide (Lasix) Risk of Digoxin Toxicity: • Interaction: Long-term use of furosemide can cause hypokalemia (low potassium levels), heightening the risk of digoxin toxicity due to the interplay between potassium levels and digoxin’s effects. ________________________________________ Interaction Between Digoxin and Dronedarone (Multaq) Effect of Co-Administration: • Outcome: When taken together, digoxin levels can rise in the blood, potentially intensifying its effects and increasing the risk of adverse reactions. ________________________________________ Normal Digoxin Levels • Therapeutic Range: 0.5-2 ng/mL, which is essential for effective treatment and toxicity prevention. ________________________________________ Normal Serum Potassium Levels • Range: 3.5-5.0 mEq/L, crucial for maintaining electrolyte balance and preventing complications. ________________________________________ Risks with Low Potassium or Magnesium Levels Impact on Digoxin: • Risk: Low levels of potassium or magnesium can increase the likelihood of digoxin toxicity, emphasizing the need for careful monitoring of these electrolytes. What are the signs and symptoms for digoxin toxcitiy? anorexia, bradycardia, headache, dizziness, confusion, nausea, and visual disturbances such as blurred, yellow, or halo vision. When should you hold off on giving digoxin drug therapy? if apical pulse is less than 60 What effects do Calcium channel blockers (-dipine; amlodipine (Norvasc), nifedipine (Procardia) cause produce vasodialation and reflex tachycardia (lowers BP but increases HR) Verapamil and diltiazam produce vasodialation and cardiosuppresssion (lowers BP and Lowers heart rate) Beta blockers have the drug ending -OLOL such as atenolol, propanolol, esmolol, ect.) Beta 1 blocks receptors in the heart Beta 2 blocks receptors in the lungs Beta blockers can be non selective so be aware of any respiratory conditions such as asthma, emphysema COPD, ect. A nurse should always check _____ and _____ before giving a beta blocker AP and BP do not give if HR is below 60 never stop abruptly Why do you never stop taking a Beta BLocker abruptly Must taper because angina or MI can orccur When would a nurse hold HTN medication Labetalol? A patient with a low pulse rate. Side effect of Labetalol (beta blocker) is weight gain / fluid retention montioring weight is one of the best indicators of loss/gain 1kg is equivalent to 1,000 mL It is important to assess _____ when taking a beta blocker such as Labetalol pulmonary is it OK to give nitroglycerin to a patient who is hypertensive? Yes If an ICU patient on a nirto drip becomes hypotensive what immediate action should the nurse take? titrate (decrease the rate) of the nitro drip. This drug is used for a rapid diuresis in emergencies to decrease pulmonary edema Furosemide (Lasix) a loop diuretic Furosemide (Lasix) can cause hypokalemia When taking furosemide (Lasix) a nurse should assess for what signs of hypokalemia? muscle cramps and muscle weakness Hypotension F/E abnormalities dehydration Side effects with aminoglycosides (-mycin drugs) dizziness head ache tinnitus N/V/D low potassium hyperglycemia ototoxicity Foods containing potassium dried fruits, fish, leafy veggies, squash, beans, meats, nuts, bananas, potatoes, dairy products It is important to use a large vein, such as AC (antecubital when administering __________ because it can irritate the vein potassium It is important to notify the nurse immediately is burning at the IV site when giving potassium because this can result in necrosis of the tissue Can potassium be given in a fast IV push? NO, always diluted at a rate of 10 mEq/hr for peripheral 20 mEq/hr for central line Requires an infusion pump IV site should be assessed every hour Which antihypertensives will raise potassium? ACEs (-pril) ARBs (-sartan) and other renin inhibitors