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PharmTest3 Flashcards

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1
Q

Captopril (Capoten)

A

Renen-Angeotension antagonist (ACE inhibitor)

HTN, CHF

Contraindications: renal disease. Caution with pregnancy

AE: Angioedema

Nursing: Hyperkalemia, first dose effect. DRY COUGH (Stop and switch). Take 1hr before meal or 2 hr after.

Monitor Renal and K+. Monitor Diuretics and ACE inhibitors

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2
Q

Losartan (Cozaar)

A

ARB- Block Angiotension II
Prevents vasoconstiction

Nursing: NO COUGH- med of choice for switching from ACE.
No grapefruit juice
No pregnancy

AE: Throbocytopenia, angeioedema, rhabdo, hyperkalemia

Monitor: Clay colored stools, dark urine

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3
Q

Hydrochlorothiazide (HydroDiuril)

A

Thiazide Diuretics- Early distal tubule.

Contraindications: GFR <25, Lupus, sulfide allergy, gout

SE: Hypokalemia/ Hyponatremia, hypovolemia, hypomagnesia,

Hyperglucemia, hypercalcemia, hyperuricemia, hyperlipidemia

Nursing: Plan around dosing. Encourage fluid intake. Monitor electrolytes

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4
Q

Furosemide (Lasix)

A

Loop Diuretic (Loop of henley)

Contraindications: Anuria in CRF

SE: Hypokalemia, hyponatremia, hypovolemia, hypomagnesia

Hyperglycemia, hypercalcemia, hyperuricemia

Ototoxicity,

Nursing: Administer IV slowly, monitor BP, I&O, check potassium

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5
Q

Triamterene (Dyrenium)

A

Potassium Sparing- can give with other diuretics. Manages edema and HTN

SE: Hyponatremia, Hypovolemia, HYPERKALEMIA

Nursing: Warn patient of intake of potassium. (Salt substitutes) Encourage fluid intake. Fatal if combined with K+ supplements.

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6
Q

Mannitol (Osmitrol)

A

Osmotic Diruetic

-Increases plasma osmolarity, glomerular filtration, tubular fluid. (Front of Nephron)

Inhibits reabsorption of H2O

Use with: ARF, Increased intraocular pressure.

Contraindications: Anemia, Pulmonary edema, bleeding. ANURIA (CKD)

Nursing: Check for crystallization

SE: Hypokalemia, hyponatremia, hypovolemia, hypomagnesia,

Hyperglycemia, hypercalcemia, hyperlipidemia

SE: CHF, dizziness, GI problem

Nursing: Warm and give with filter.

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7
Q

Acetazolamide (Diamox)

A

Carbonic Anhydrase Inhibitors- (Weak) Inhibits bicarb reabsorption

Use: Glaucoma, hydrocephalus, Petit mal seizure, OD of ASA & phenobarbitol

SE: Hyponatremia, hypovolemia, hypokalemia,
METABOLIC ACIDOSIS

Nursing: Monitor blood work- may have to give QOD

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8
Q

S/S Hypovolemia

A

Excessive thirst: Check B/p
Oliguria
Hypotension
Dry skin and mucous membrane

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9
Q

S/s Hyponatremia

A
  • Anxiety
  • Increased thirst
  • Drowsiness, confusion, stupor
  • Muscle weakness, twitching, convulsions
  • ABD cramps
  • Oliguria
  • Hypotension/tachycardia
  • Difficult to correct
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10
Q

S/s of hypokalemia

A
  • Increased thirst (Hypo anything= thirst)
  • Muscle cramps or pain
  • Flaccid paralysis or tetany
  • Paralytic ileus
  • Cardiac arrhytmia
  • lethargy, depression, irritability, confusion
  • Anorexia, nausea, vomiting
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11
Q

S/s HYPERkalemia

A
  • Mental confusion/anxiety
  • Fatigue
  • Weakness/heaviness
  • Paresthesia (tingling/pricklies)
  • Cardiac arrhythmia
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12
Q

Metabolic Alkalosis

A
  • Slow, shallow respiration
  • Hypertonic muscles, tenany, convusions,
  • Arrhythmias
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13
Q

Normal B/P

A

<80

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14
Q

Prehypertension

A

120-139/80-89

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15
Q

HTN Stage 1

A

140-159/90-99

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16
Q

HTN Stage 2

A

> 160/>100

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17
Q

Essential HTN

A

Primary- predestined to have this

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18
Q

Secondary HTN

A

Caused by another disease or condition

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19
Q

Essential HTN factors

A
  • Heredity
  • Sodium
  • Smoking-
  • Type A stressful
  • Stress
  • Atherosclerosis
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20
Q

Secondary

A

Pheochromocytoma- tumor of adrenal medulla

  • Coarctation of the Aorta
  • Preeclampsia

All of these are reversible with medical treatment (or having baby

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21
Q

Major organs affected by HTN

A

Eyes, brain, heart, kidney

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22
Q

Step 1 HTN protocol

A

Use of single agent if P/P 140/90 for 3-6 mo

  • diuretic
  • Ace
  • Beta Blocker
  • Alpha adrenergic agonist
  • alpha-adrenergic blocker
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23
Q

Step 2 of HTN protocol

A

Peripheral adrenergic inhibitors

  • direct-acting vasodialators
  • Calcium channel blockers
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24
Q

Step 3 of HTN

A

Increase drug dose
Try another drug
Add another drug from a different class

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25
Step 4 of HTN
MOAR DRUGS
26
Propanolol (Inderal)
Beta Blocker -Decreases peripheral resistance - Reduced plasma renin activity Tx: Afib, aflutter, tacy, narrow angle glaucoma, angina, PTSD Contraindication (Beta Blocker) -Cardiac failure, bradycardia, asthma and COPD, ^Hypoglycemia Nursing- Check BP and P, do not discontinue suddenly. Prolongs life in MI. May
27
Clonidine (Catapres)
Alpha Adrenergic Blocker Decreases sympathetic outflow Contraindications: Pregnancy, tricyclic antidepressant AE: Dry mouth, dizziness, sedation, n/v decreased HR and BP Nursing: take at night, do not take with cold medication.
28
Hydralazine (Apresoline)
Vasodialator- diates arterioles without affecting sympathetic nervous system or adrenergic receptors -Peripheral vasodialation AE: triggers reflex tachyardia, and may require a beta blocker Nursing: Give with Vit B6 to counteract peripheral neuritis May cause Lupus (Rash, fatigue, swollen joints
29
Nitroprusside (Nipride)
Direct acting vasodilator May trigger Reflex Tachycardia (BBlocker) EMERGENT SITUATION ONLY AE: Draw levels to monitor cyanide poisoning, Nursing: Monitor for red venous blood, dyspnea, confusion (Cyanide poisoning) Light sensitive, brown bag it
30
Drugs triggering reflex Tacycardia
Nitroprusside (Nipride) | Hydralazine (Apresoline)
31
Cadiac Impulse Follows...
- SA Node - AV Node - Bundle of HIS - Bundle Branches - Purkinje Fibers
32
Quinidine
Class IA Antiarrhythmic Slows conduction, prolongs repolarization. Bidirectional block Tx: Atrial fibrillation, Atrial flutter Contra: Myasthenia gravis, severe heart conditions Nursing: give without food, monitor ECG, Monitor K+
33
Amiodarone (Pacerone, Cardarone)
Class III Antiarrrhythmic/ Calcium Channel blocker Use: ONLY life-threatening arrhythmias Contraindication: 2-3rd heart block, pregnancy AE: Pulmonarytoxicity, ^^arrythmia, liver disease Drug interactions: Digoxin, flecainide, warfarin, grapefruit juice Nursing: Take with food, notify physician for cough or SOB
34
Verapamil (Calan)
Calcium Channel Blocker (Bidirectional block) Effect: slow HR, Decrease BP Use: Cardiac arrthmia, angina, htn Contra: Depressed cardiac function, 2-3rd heard block, CHF, shock Adverse: constipation Nursing: Light sensitive, give with dig
35
Nitroglycerine
Vasodialator: relaxes vascular smooth muscle (ARTERIAL AND VENOUS) - decreased preload - Decreased O2 demand Use: CHF and angina SE: Headache, hypotension, reflex tachycardia, burning or tingling, dematitis Nursing: Light sensitive, lie down during tx, Nitrates: 10/24 hr must be without nitrite application
36
Digoxin
Slows and strengthens heart beats Contractility up, hr down, conductivity down AE: cardiac toxicity, hypokalemia, hyper calcemia, TX: CHF and cardiac arrhythmias. Nursing: Range 0.5-2ng/ml. If toxicity results from hypokalemia, give K+
37
Digitoxicity
GI: Anorexia, n/v Neurological- H/a, restlessness, confusion, blurred vision, halos around lifghts. Cardiac- Atrial arrhytmia, ventricular arrhtymia, SA block, heart block, bradycardia ANTIDOTE: DIGIBIND
38
Nesiritide (Natrecor)
Treats: CHF. Use with acute, decompensate HF Contra: cardiogenic shock, Low BP. AE: Low bp, cramps, Increased creatinine Nursing: Monitor closely (ICU) ecg, and BP.
39
Sodium Polystyrene Sulfonate (Kayexalate)
Use: Potassium-removing drug for kyperkalemia Contra: Pts who cannot tolerate increased salt intake AE:Hypokalemia, constipation Interactions: Do not give with antacids, laxatives Nursing: If giving as enema, give cleansing enema first Monitor serum potassium and ECG
40
Clotting: Intrensic
Initiated by injury to the epithelial lining of the blood vesses
41
Clotting: Extrensic
Traumato the vascular wall or to tissues outside the blood vessel
42
Vitamin K
- Fat soluble - Made by E-coli in gut - stored in liver - ABT that kills ecoli can affect production
43
Heparin Sodium
Low dose: inactivates factor X High Dose: prevents fibrinogen to fibrin Lasts: 4-6 hr Indications: pre/post op, DIC, Thrombus, emboli, Management of MI and ischemis stroke Nursing: Do not mix, double check dose. HOLD platelets under 100k may give during pregnancy
44
Normal clotting time
30-40sec
45
APPT
45-80sec
46
Antidote to Heparin
Protamine Sulfate (Give slow)
47
Warfarin (Coumadin)
Inhibits Vit K Half life 36 hours, takes time to build up. PROTEIN BOUND. Tx:DVT, PE, acute MI Multiple drug interactions. PREG CAT X Nursing: educaton, minimize bleeding, avoid trauma, avoid leafy greens in excess
48
PT Goal
13-30
49
INR goal
2-3
50
Coumadin antidote
Vitamin K
51
Clopidogrel (Plavix)
Inhibits platelet aggregation in arteries CI: active bleeding. Interactions: many Monitor: plt, wbc, bleeding time
52
Alteplase
Breaks up blood clots in emergent situations: MI, Ischemic stroke, PE CI: Internal bleeding, HTN Recent pregnancy Nursing: Monitor APTT and PT Antidote: Amicar
53
Aminocarproic acid (Amicar)
Tx life threatening bleeding Confirm DIC with lab testing Nursing: monitor for emboli and arrythmia
54
Pentoxifylline (Trental)
Improved microcirculation by increasing flexibility of RBC. Reduces blood viscosity. Use: Symptomatic PVD and claudication AE: Tachycardia
55
Recommended total cholesterol
Total--- below 200mg/dl
56
Recommended LDl cholesterol
LDL---below 130
57
Cholestyramine
Bile acid Sequesterants: inhibits bile reabsorption Treats: Elevated cholesterol, loose stool, works in GI tract Education: Takes several weeks to kick in. Monitor liver enzymes. Watch for jaundice, dark urine, clay colered stools
58
Nicotinic Acid (Niacin)
Vitamin B3 Reduces coronary events Lowers LDL, lowers Triglycerides, raises HDL Contra: Hepatic dysfunction, peptic ulcer, hypotension, gout, Education: causes flushing
59
Lovastatin (Mevacor)
HMG-CoA reductase that stimulates cholesterol production High first past effect. High protein bound. Contraindication: Liver disease, pregnancy, breastfeeding AE: Muscle and joint aches, myopathy, Rhabdo Nursing: LFT, monitor liver issues. Take at night
60
Neoplasm
Any new tissue growth in which the growth is uncontrolled or progressive
61
Five stages of CA
``` G1- presyntheis S- Synthesis G2- postsynthetic phase M-Mitosis G0-resting ```
62
Gompertzian Kinetics
Cancer cells lack of normal regulating factors leading to abnormal growth
63
Due to their growth rate, these cells are also highly susceptible to chemotherapeutic drugs
Bone marrow Hair follicles GI Epithelium cells
64
Desseminated Cancers
Leukemia, lymphoma Have high growth rate and respond well to chemo
65
Managing Neutropenia in a chemo patient
Sanitation Isolation Monitor WBC Administer Neupogen
66
Managing Hyperuricemia
Avoid purines | Administer Allopurinol
67
Fluorouacil (5-FU)
S Cycle. Acts like thiamine deficiency TX: Solid tumors like bladder, breast, prostate, pancreatic Contra: poor nutritional status, decreased bone marrow, serious infection AE: Allopecia, photosensitivity, Education: Monitor CBC, myleosuppression, loss of hair, oral care
68
Vincristine (Oncovin)
M phase Treats: Lung, breast, cervical, NEVER GIVE INTRATHECALLY CI: Charcot-marie-tooth AE: Tissue necrosis after extravation. neurotoxic effects, paralytic illeous Nursing: Light sensitive, monitor site, use splash guard
69
Etoposide (Vepesid)
Mandrake plant Treats: Testicular tumors, lung ca, lymphoma, Hodgkins SE: Myelosuppression, neuropathcy, dyspnea and bronchospasm when too fast. Kills babies Nursing; causes metallic taste, monitor cbc
70
Paclitaxel (Taxol)
G2 stage "22 Micron in line filter" Tx: ovarian and breast ca, kaposi's sarcoma SE: Certain alopecia, cardiotoxicity, extravasation Nursing: Anaphalaxsis 10%. Give steroids, benedryl, H2blocker, MUST DO
71
Cyclophoshamide (Cytoxan)
Mustard gas- non specific Patient teaching: Vigerous hydration and diuresis, 10-12 glasses of water/day Contra: bone depression, infx, nursing and pregnancy AE: cystitis Safety: obtain Ht and weight to determine dose
72
Carmustine (BCNU)
Nonspecific Tx: Brain tumors, malignant melanoma AE: Irreversible pulmonary fibrosis. Monitor PFT CI: poor pulmonary function Nursing: Give slowly, place in glass
73
Doxorubicin (Adriamycin)
Inhibits DNA and RNA Fights solid tumors. (S cycle) AE: Irreversable mypopathy, turns urine and tears red and pink. Alopecia
74
Prednisone-Dexamethosone (Decadron)
Corticosteroid Tx: breast CA and lymphocytic proliferations SE: fluid/electrolyte imbalance, diabetes, peptic ulcer CI: fungal infections Education: Give with food, do not stop suddenly,
75
Tamoxifen (Nolvadex)
Estrogen blocker Tx: Advanced CA SE: Chemically induced menopause, hypercalcemia Teaching: Manage s/e of menopause, avoid calcium suppliments, stay away from spice, possible risk endometrial cancer
76
Interferon alfa-2a (Rofron-a)
Antiviral, antiproliferation, cytotoxic properties, Tx: Hairy leykemia, bladder ca, Kaposi's sarcoma SE: Flu, cardio/neurotoxicity
77
Allopurninol (Zyloprim)
Prevents uric acid production Tx: Gout AE: Itch, rash (Serious) Nursing: Diet limitation, increase fluids (2-3L)
78
Colchicine
Antiinflamatory Tx: Gout CI: cardiac, hepatic, renal disease AE: blood dyscrasias Nursing: diet and alcohol restriction. Take colcine at first sign of the attack, then as it starts to resolve.
79
Probenecid
Increases urate excretion Tx: Chronic (not acute) gout Ci: Blood dyscrasia or kidney stone, chemo or radiation Nursing: avoid cranberry juice, vit C, encourage diabetics to use finger sticks
80
Epoetin Alfa (Epogen or Procrit)
Stim RBC production Contra: Uncontrolled HTN, SE: Clotting Nursing: monitor Hgn, folic acid, b12 Education: stress labs, supplements Safety: May lead to szr if hgn raised too quickly
81
Filgrastim
Colony stimulating factor- stim WBC Adverse effects: Medullary bone pain, Older patients more at risk Nursing: Do not skanke, do not dilute, educate on risk of infection until WBC up
82
If you OD on aspirin, you will receive ______
Acetazolamide (Diamox)
83
If you OD on Phenobarbitol for your seizures, you will receive ______
Acetazolamide (Diamox)
84
Should not take cold medication with this BP medication
Clonidine
85
Cyanide poisoning may result from
Nitroprusside
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