MED SURG Exam 1 Study Guide
Medications (Indications, Administration, Contradictions, Actions of:)
Nitroglycerin:
● ACTION:
○ Vasodilator → decrease preload and afterload – hypotension
● ROUTE + PATIENT TEACHING:
○ Sublingual (fastest avoids first pass), topical, IV
○ Lying down
○ Teach place under tongue (no swallowing, let dissolve)
○ PRN not daily; every 5 min 3x PRN max
○ Call 911 do not drive after after 3rd doesn’t work
● SIDE EFFECT:
○ Throbbing headache (normal bc vasodilation occuring)
○ HYpotension → check BP
● STORAGE:
○ Store nitroglycerin out of reach of sunlight
○ Replace every 6m or so
○ Always have it with them
● CONTRADICTIONS:
○ Viagra
Digoxin
● USES/ACTION:
○ For HF pt. And A-fib
○ A-fib (atrium pumping too fast) → acts to decrease conduction speed → slows
down HR → no fibrillation
○ HF increases contractility (pumps harder but slower)
● SIDE EFFECTS:
○ Bradycardia – expected
○ Digitalis toxicity – blurred or yellow halos, n/v, headache, dizziness, delirium,
confusion, weakness → hold dose, get order for digibind aka digoxin-immune fab
(antidote)
● CONSIDERATIONS
○ Hold if HR <60
○ Contraindication – if taking diuretics bc losing K+ → enhances digoxin action
,Beta-Adrenergic Blockers (-lols)
● USE
○ To treat hypertension
○ Selective b-blockers have less side effects
● S/E AND ADVERSE EFFECTS
○ Drowsiness, dizziness, headache, depression, fatigue (normal do not alert MD),
nausea, diarrhea, erectile dysfunction
○ Adverse Reactions: Bradycardia, tachycardia, hypotension, chest pain, heart
failure, dyspnea
● CONSIDERATIONS
○ Hold if HR <60 and SBP <90
○ Watch for signs of HF (uncompensated HF → will slow down HR and decrease
contraction force which is bad for HF)
Lasix (AKA furosemide)
● TYPE
○ Loop diuretic
○ Diuretic potassium wasting
○ Spironolactone is the ones that spares k → everything else wastes it
● USES
○ Used for immediate diuresis → for acute symptoms
○ HTN, acute pulmonary and peripheral edema, HF
Morphine (opioid)
● Reduces preload and afterload → vasodilates
● Relieves dyspnea and anxiety
● Monitor BP and respirations
● ACTION
○ Depression of the CNS; depression of pain impulses by binding with opiate
receptors in the CNS
● INDICATION
○ Relieve moderate to severe pain; dyspnea, relieve anxiety preoperatively
● SIDE EFFECTS
○ Constipation, drowsiness, urinary retention
, ○ Adverse Effects: Orthostatic hypotension, tolerance, psychological dependence
○ Life-threatening: Respiratory depression
● NURSING CONSIDERATIONS
○ Have naloxone available as an antidote to reverse respiratory depression
Aspirin
● USE
○ To reduce pain, inflammatory symptoms, fever, and thrombus prophylaxis (81mg)
● SIDE EFFECTS
○ Bleeding: observe signs of bleeding – petechiae, black tarry/bright red/melena
stools, bursing
○ Tinnitus (ringing of the ears), vertigo (dizziness) and bronchospasm – especially
in asthma patients –are symptoms of aspirin overdose or hypersensitivity to
aspirin
○ Do not give to children with flu-like symptoms of hashimoto's disease → Reye’s
Syndrome
Plavix (clopidogrel)
● USES
○ Post-PCI
○ Needed bc immune response to stent → inflammation and clotting
○ Dual antiplatelet therapy (DAPT) → aspiring (indefinitely) and ticagrelor or
clopidogrel
ACE Inhibitors (-pril)
● USE
○ Primary drug of choice for RAAS inhibition
○ For HTN
Dobutamine
● B-agonists – positive inotrope → increases contractility, short-term use for HF during the
stage the heart can’t naturally contract anymore
● Similar to dopamine and norepi (produce a sympathetic response)
Medications (Indications, Administration, Contradictions, Actions of:)
Nitroglycerin:
● ACTION:
○ Vasodilator → decrease preload and afterload – hypotension
● ROUTE + PATIENT TEACHING:
○ Sublingual (fastest avoids first pass), topical, IV
○ Lying down
○ Teach place under tongue (no swallowing, let dissolve)
○ PRN not daily; every 5 min 3x PRN max
○ Call 911 do not drive after after 3rd doesn’t work
● SIDE EFFECT:
○ Throbbing headache (normal bc vasodilation occuring)
○ HYpotension → check BP
● STORAGE:
○ Store nitroglycerin out of reach of sunlight
○ Replace every 6m or so
○ Always have it with them
● CONTRADICTIONS:
○ Viagra
Digoxin
● USES/ACTION:
○ For HF pt. And A-fib
○ A-fib (atrium pumping too fast) → acts to decrease conduction speed → slows
down HR → no fibrillation
○ HF increases contractility (pumps harder but slower)
● SIDE EFFECTS:
○ Bradycardia – expected
○ Digitalis toxicity – blurred or yellow halos, n/v, headache, dizziness, delirium,
confusion, weakness → hold dose, get order for digibind aka digoxin-immune fab
(antidote)
● CONSIDERATIONS
○ Hold if HR <60
○ Contraindication – if taking diuretics bc losing K+ → enhances digoxin action
,Beta-Adrenergic Blockers (-lols)
● USE
○ To treat hypertension
○ Selective b-blockers have less side effects
● S/E AND ADVERSE EFFECTS
○ Drowsiness, dizziness, headache, depression, fatigue (normal do not alert MD),
nausea, diarrhea, erectile dysfunction
○ Adverse Reactions: Bradycardia, tachycardia, hypotension, chest pain, heart
failure, dyspnea
● CONSIDERATIONS
○ Hold if HR <60 and SBP <90
○ Watch for signs of HF (uncompensated HF → will slow down HR and decrease
contraction force which is bad for HF)
Lasix (AKA furosemide)
● TYPE
○ Loop diuretic
○ Diuretic potassium wasting
○ Spironolactone is the ones that spares k → everything else wastes it
● USES
○ Used for immediate diuresis → for acute symptoms
○ HTN, acute pulmonary and peripheral edema, HF
Morphine (opioid)
● Reduces preload and afterload → vasodilates
● Relieves dyspnea and anxiety
● Monitor BP and respirations
● ACTION
○ Depression of the CNS; depression of pain impulses by binding with opiate
receptors in the CNS
● INDICATION
○ Relieve moderate to severe pain; dyspnea, relieve anxiety preoperatively
● SIDE EFFECTS
○ Constipation, drowsiness, urinary retention
, ○ Adverse Effects: Orthostatic hypotension, tolerance, psychological dependence
○ Life-threatening: Respiratory depression
● NURSING CONSIDERATIONS
○ Have naloxone available as an antidote to reverse respiratory depression
Aspirin
● USE
○ To reduce pain, inflammatory symptoms, fever, and thrombus prophylaxis (81mg)
● SIDE EFFECTS
○ Bleeding: observe signs of bleeding – petechiae, black tarry/bright red/melena
stools, bursing
○ Tinnitus (ringing of the ears), vertigo (dizziness) and bronchospasm – especially
in asthma patients –are symptoms of aspirin overdose or hypersensitivity to
aspirin
○ Do not give to children with flu-like symptoms of hashimoto's disease → Reye’s
Syndrome
Plavix (clopidogrel)
● USES
○ Post-PCI
○ Needed bc immune response to stent → inflammation and clotting
○ Dual antiplatelet therapy (DAPT) → aspiring (indefinitely) and ticagrelor or
clopidogrel
ACE Inhibitors (-pril)
● USE
○ Primary drug of choice for RAAS inhibition
○ For HTN
Dobutamine
● B-agonists – positive inotrope → increases contractility, short-term use for HF during the
stage the heart can’t naturally contract anymore
● Similar to dopamine and norepi (produce a sympathetic response)
