pharm-exam-3

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Fortis Institute, Port Saint Lucie *

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GNUR100

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Health Science

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Feb 20, 2024

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Pharm exam 3 pharmacology (Fortis College) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Pharm exam 3 pharmacology (Fortis College) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Jasmine Smith (Smithjasmine159@gmail.com) lOMoARcPSD|37230089

NUR 100 Pharmacology Exam 3 Outline Know about digoxin- Cardiac glycosides- used for heart failure, cardiogenic shock, antarrhythmic, a fb. Assess apical pulse for 1 minute before giving. Therapeutc drug level 0.5-2.0 mg/mL, >2 is TOXIC- caused by DIG: Decreased potassium (hypokalema) Injured kidneys, GFR decreased. Signs of toxicity: Early signs are nausea, vomitng, diarrhea. Then blurred vision, yellow or green vision, halo efect around dark objects. Headache, drowsiness, confusion, disorientaton. Antdote is DIGIBIND. Amiodarone (Cordarone) Ant arrhythmic drug, used to treat ventricular fbrillaton. cannot give lidocaine if patent is taking ant arrhythmic. Adverse efect of amiodarone is pulmonary fbrosis What do beta adrenergic blockers do? Acebutolol, metoprolol, propranolol, nadolol- used to treat hypertension, stable angina, chronic heart failure, dysrhythmias. Blocks norepinephrine and epinephrine. Blocks negatve efects of the sympathetc nervous system. Beta blockers can be selectve or non-selectve, blocking beta 1(heart) or beta 2(lungs) Side efects: Orthostatc hypotension, dizziness, dry cough, elevated potassium. Coumadin and Lopid Coumadin: Used to prevent new clots, prevents current clots from getng bigger. Does not dissolve clot or thin blood, used for clients who are at increased risk of clot formaton. Interferes with producton of Vit K, which is used in the liver to make clotng factors. Antdote is Vit K. Therapeutc range INR 2-3 Lopid: Cholesterol lowering medicaton, also known as gemfbrozil- if giving Lopid with with Coumadin, it can increase bleeding tendency by enhancing the acton of the Coumadin. What should you do if a drug does not have it’s desired efect? Observe patent for adverse reactons, ABCs, Call physician to administer antdote? Obtain lab order? Isosorbide monottrate Nitrate drug class, also known as Imdur, is a long actng treatment, used for angina preventon, occurs when too litle blood and oxygen get to the heart. This medicaton relaxes blood vessels, letng more blood and O2 reach the heart. May cause dizziness/orthostatc hypotension- change positons slowly. Teaching about sublingual nitroglycerin Do not swallow or chew tablets, keep medicaton in the original container (dark, glass botle) and store in a cool, dry place. Do not take with erectle dysfuncton medicaton as it can cause possibly fatally low blood pressure. Why would a heart failure patent take two diferent diuretcs? Downloaded by Jasmine Smith (Smithjasmine159@gmail.com) lOMoARcPSD|37230089

Heart failure causes fuid retenton and is treated with diuretcs, a patent will require 2 diferent diuretcs to keep potassium balanced while stll draining fuid. Lasix is potassium wastng, and and spironolactone is potassium saving. How do you treat adverse efects of Niacin? Niacin is Vitamin B3, it can be found in meats, fsh, enriched grains, nuts, seeds, and legumes. Niacin is used to lower cholesterol. Can give ASA for fushing and itching. What do you have to check before initatng a statn drug? Liver functon test LFT- monitor : ALT 7-56 U/L. AST 5-40 U/L. ALP 40-120 U/L.- must be done before statns can be given. Ace inhibitor side efects Dry and persistent cough could develop. Loop diuretc monitoring Loop diuretcs are potassium wastng, can cause hypokalemia, monitor level, 3.5-5.0. Obtain baseline vitas, give lasix slowly, rapid administraton can cause ototoxicity. Potassium is an intracellular electrolyte, sodium is an intracellular electrolyte. Nestritde (Natracor) infusion acutely decompensated HF in hospitalized patents who have dyspnea at rest or with minimal actvity; has been used with digoxin, diuretcs, and ACE inhibitors. Should not be used for intermitent outpatent infusion, scheduled repettve use, as a diuretc or to improve renal functon. Monitor BUN and serum creatnine. May cause ↑ in serum creatnine; ↑ serum creatnine may be dose- related High Alert: Intravenous vasoactve medicatons have an increased potental for causing harm. Have second practtoner independently check original order, dose calculatons, and infusion pump setngs. Administer only in setngs where BP can be closely monitored. Adenosine (Adenocard) slows supraventricular tachycardias by decreasing electrical conducton through the av node without causing negatve inotropic efects - acts directly on sinus pacemaker cells and vagal nerve terminals to decrease chronotropic (heart rate) actvity place patent in mild reverse trendelenburg positon before administraton of drug - inital bolus of 6 mg given rapidly over 1 to 3 sec followed by NS bolus of 20 mL; then elevate the extrimity a second dose (12 mg) may be fven in 1 to 2 minutes if needed. Warfarin (Coumadin) Downloaded by Jasmine Smith (Smithjasmine159@gmail.com) lOMoARcPSD|37230089

Lab Test Consideratons: Monitor PT, INR and other clotng factors frequently during therapy. Therapeutc PT ranges 1.3-1.5 tmes greater than control; however, the INR, a standardized system that provides a common basis for communicatng and interpretng PT results, is usually referenced. Normal INR (not on antcoagulants) is 0.8-1.2. An INR of 2.5-3.5 is recommended for patents at very high risk of embolizaton Enoxaparin (Lovonox) teaching Administer deep into subcutaneous tssue. Alternate injecton sites daily between the lef and right anterolateral and lef and right posterolateral abdominal wall Inject entre length of needle at a 45° or 90° angle into a skin fold held between thumb and forefnger; hold skin fold throughout injecton. Do not aspirate or massage. Rotate sites frequently. Do not administer IM because of danger of hematoma formaton. Antdotes for heparin and coumadin Vitamin K (antdote for warfarin) (antdote for Heparin)protamine sulfate Antcoagulants versus antplatelets Antcoagulants, such as heparin or warfarin (also called Coumadin), slow down your body's process of making clots. Antplatelets, such as aspirin and clopidogrel, prevent blood cells called platelets from clumping together to form a clot. Antplatelets are mainly taken by people who have had a heart atack or stroke Hydrochlorothiazide Give hydrochlorothiazide in the morning and early in the evening to avoid nocturia. Monitor fuid intake and output, daily weight, blood pressure, and serum levels of electrolytes, especially potassium. Assess for signs of hypokalemia, such as muscle spasms and weakness. Monitor BUN and serum creatnine levels. Frequently monitor blood glucose level as ordered in diabetc patents, and expect to increase antdiabetc drug dosage, as needed. If patent has gouty arthrits, expect an increased risk of gout atacks during therapy. Nifedipine (Procardia) selectvely blocks calcium channels in myocardial and vascular smooth muscle, resultng in less oxygen utlizaton by the heart, an increase in cardiac output, and fall in BP. grapefruit juice enhances absorpton - melatonin may increase BP and HR Teaching for sustained released medicaton Do not crush or chew, must take medicaton whole. Pernicious anemia Downloaded by Jasmine Smith (Smithjasmine159@gmail.com) lOMoARcPSD|37230089

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