NUR2474 Module 6 Quiz Review/NUR2474 Module 6 Quiz Review

There are many negatively worded questions this time around. Please pay attention to the wording. 1. Cholestyramine (mechanism of action, indications, side and adverse effects, administration, monitofring, food/drug interactions) a. Bile-Acid Sequestrant b. Mechanism of action i. May decrease uptake of fat-soluble vitamins ii. Does not significantly reduce the absorption of stains, warfarin, digoxin, and most other drugs studied. iii. Reduces LDL cholesterol, Increases VLDL levels in some patients iv. Increased LDL receptors on hepatocytes v. Prevents reabsorption of bile acids vi. Trap cholesterol in bile salts and make you secrete it vii. Form insoluble complexes with bile salts, prevents reabsorption of bile acids, therefore accelerating their excretion. viii. Do not neutralize stomach acid, but they line your stomach creating a barrier. c. Indications i. Reduces LDL cholesterol (in conjunction with modified diet and exercise d. Side/Adverse Effects i. GI effects 1. Constipation (common) a. Educate about increasing fluids and fiber ii. Hepatotoxicity e. Administration i. Take medications that may interact at least one hour before taking bile- sequestrants or 4 hours after. ii. Come as a powder and need to be mixed in a drink 1. Swallowing dry may cause esophageal irritation and impaction. iii. Often combined with statins iv. Dosage range: 4-24 g/day v. Cholesterol drugs should only be given when modifiable efforts have failed. f. Monitoring i. Cholesterol levels 1. Once patient is started on pills, redraw cholesterol ii. Labs 1. Lipid panel a. Normal cholesterol level: i. 200 mg/dl b. LDL c. HDL i. 130 mg/dl i. Females: 35-80mg/dl ii. Males: 35-65mg/dl d. Triglycerides i. 150mg/dl in people with heart disease g. Food/drug interactions i. Interferes with absorption of many medications such as levothyroxine, phenytoin, fat-soluble vitamins (A, D, E, K), and oral contraceptives. ii. Form insoluble complexes with thiazide diuretics, digoxin, warfarin, and some antibiotics. 1. Angina pectoris condition (symptoms, pathophysiology) a. Symptoms i. Sudden pain beneath sternum, often radiating to left shoulder and arm ii. Women may not experience heart pain the same as men. iii. Older adults may not experience pain the same. b. Pathophysiology i. Chronic Stabile Angina (exertional)- “weak heart” 1. Emotional excitement 2. Large meals 3. Cold exposure 4. Coronary artery disease (CAD) 5. Treatment a. Increase cardiac O2 supply, decrease O2 demand b. Organic nitrates, beta-blockers, calcium-channel blockers, Ranolazine ii. Variant Angina (Prinzmetal’s [Vasospastic]) 1. Coronary artery spasm 2. Treatment a. Increase cardiac O2 supply b. Calcium-channel blockers, organic nitrates iii. Unstable Angina (medical emergency) 1. Symptoms of angina at rest 2. New-onset exertional angina 3. Intensification of existing angina 4. Treatment a. Maintain O2 supply, decrease O2 demand, anti-ischemic agent, antiplatelet therapy, anticoagulation therapy 2. Nitroglycerin (mechanism of action, indications, side and adverse effects, administration, monitoring, food/drug interactions) a. Anti-ischemic therapy b. Mechanism of action i. Vasodilator ii. Acts directly on vascular smooth muscles to promote vasodilation iii. Dilates arteries=more blood flow to heart c. Indications i. Stable angina ii. Variant angina 1. Relaxes or prevents spams in coronary arteries, increases O2 supply, does not reduce O2 demand iii. Sustained chest pain iv. IV for preoperative control of BP and treatment of HF with MI, unstable angina and uncontrolled exacerbations of chronic angina. d. Side/Adverse Effects i. Severe headache ii. Orthostatic hypotension iii. Reflex tachycardia e. Administration i. 3 doses sublingually every 5 minutes (tablet or spray) followed by IV therapy if persistent ischemia or hypertension occurs ii. Preparations 1. Sublingual 2. Sustained-release oral capsules 3. Transdermal/Topical ointment a. Take off for 8 hours every day to prevent tolerance buildup. 4. Translingual spray 5. IV infusion iii. Handle with gloves only as it can dissolve through membranes of the skin f. Educate i. not to chew tab ii. change positions slowly iii. chest pain is common iv. adequate rest not to overwork heart v. Chronic stable angina 1. Take medication before you know the heart will be overworked. 2. Take prophylactically: before pain starts then go to ER! g. Monitoring i. Check VS between doses 1. Hold medication if BP is 90 systolic or 60 diastolic 2. Hold medication if HR is 60 ii. Withdrawal long-acting preparations slowly! h. Food/drug interactions i. Phosphodiesterase type 5 inhibitors (Viagra, Cialis) 1. Unconscious, severe hypotension, cardiovascular collapse ii. Hypotensive drugs iii. Beta-blockers, verapamil, diltiazem i. Storage instructions i. Dark/cool/dry place, original container 1. No heat or light exposure ii. Once opened, only good for 30 days 3. DVT (Deep vein thrombosis) a. Signs and symptoms i. Throbbing or cramping, usually in calf or thigh, swelling, redness, warmth, swollen veins that are hard or sore when touched. 4. Heparin (mechanism of action, indications, side and adverse effects, administration, monitoring, food/drug interactions), labs, antidote a. Mechanism of action i. Enhances antithrombin ii. Rapid-acting anticoagulant iii. Suppresses coagulation by helping antithrombin inactivate clotting factors (thrombin and factor Xa) b. Indications i. Preferred anticoagulant during pregnancy and when rapid coagulation is required. 1. Does not cross the placenta ii. Pulmonary embolism (PE) and massive DVTs iii. Patient undergoing open heart surgery or renal dialysis iv. Evolving stroke v. Low-dose therapy postoperatively to prevent venous thrombosis vi. Disseminated intravascular coagulation (DIC) 1. “death is coming” 2. Fibrin clots form throughout the vascular system and in which bleeding tendencies may be present; bleeding may occur because massive fibrin production consumes available supplies of clotting factors. vii. Adjunct to thrombolytic therapy of acute MI c. Side/Adverse Effects i. Hemorrhage is the most common ii. Heparin-induced thrombocytopenia (HIT) iii. Hypersensitivity reactions d. Contraindications: i. Thrombocytopenia ii. Uncontrolled bleeding iii. During and immediately after surgery of the eye, brain, or spinal cord. e. Administration i. Injection ONLY ii. IV 1. Continuous/intermittent iii. Deep subcutaneous (subQ) f. Food/drug interactions i. Antiplatelet agents (aspirin, NSAIDs, other anticoagulants) ii. Garlic, ginger, glucosamine, or ginkgo biloba g. Monitoring i. Labs 1. Therapeutic aPTT levels for patients on Heparin therapy h. Antidote a. 60-80 seconds b. Patient not on heparin: 30-40 seconds c. If aPTT (activated partial thromboplastin time) is 80, too much heparin in body, lower the dose and recheck. 1. Platelets a. Thrombocytopenia: if patients platelet counts are too low, medication should be lowered or stopped to prevent bleeding out. i. Protamine sulfate 6. Hemoglobin/hematocrit values (causes of low values) a. Normal values i. Hemoglobin 1. Female: 12.0-15.5 g/dL 2. Male: 13.5-17.5 g/dL ii. Hematocrit 1. Female: 35.5%-44.9% 2. Male: 40.7%-50.3% or 38.3%-48.6% b. Causes of low values i. Hemoglobin 1. iron, vitamin b12, or folate deficiency, bone marrow damage a. menarche, people on blood thinners, kidney failure, anemia ii. Hematocrit 1. iron, vitamin b12, or folate deficiency, bone marrow damage 2. anemia, vitamin/mineral deficiency, leukemia, lymphoma, blood loss, overhydration 7. Warfarin (mechanism of action, indications, side and adverse effects, administration, monitoring, food/drug interactions) a. Mechanism of action i. Anticoagulant ii. Suppresses coagulation by decreasing production of four clotting factors, namely iii. Blocks biosynthesis of factors VII, IX, X, and prothrombin (vitamin K-dependent factors) iv. Vitamin K antagonist v. Oldest oral anticoagulant (delayed onset) b. Indications i. Not useful in emergencies because it takes time to work 1. If rapid treatment is needed, heparin is the first-line drug ii. Long-term prophylaxis of thrombosis 1. Prevention of venous thrombosis and associated PE 2. Prevention of thromboembolism (patients with heart valves) 3. Prevention of thrombosis during AFib iii. Reduce risk of recurrent transient ischemic attacks (TIAs) and recurrent Mis c. Side/Adverse Effects i. Hemorrhage (vitamin K for toxicity) ii. Fetal hemorrhage and teratogenesis from using during pregnancy iii. Use caution during lactation- limit or eliminate use iv. Possible undesired responses 1. Skin necrosis 2. Alopecia 3. Urticaria 4. Dermatitis 5. Fever 6. GI disturbances 7. Red-orange urine (not confused with hematuria) v. Long-term use (more than 12 months) may waken bones=increased risk of fractures. d. Administration e. Food/drug interactions i. Drugs that increase or decrease anticoagulant effects ii. Drugs that promote bleeding iii. Vitamin K food sources 1. Mayonnaise, canola oil, soybean oil, green leafy vegetables. a. Patients do not need to avoid these, they should just keep diet consistent. 2. If vitamin K intake increases, warfarin dose should increase; if vitamin K intake decreases, warfarin dose should decrease as well. f. Therapeutic levels i. INR 1. Normal: 1 2. On warfarin: 2-3 3. If INR is 2, not enough warfarin, increase dose 4. If INR 3, too much warfarin, decrease dose ii. PT 1. Normal: 11-12.5 seconds 2. On warfarin: 16-31 seconds (1.5-2.5 times more than normal) g. Monitoring i. Labs 1. INR, PT, hemoglobin, hematocrit ii. Signs of bleeding 1. Urine, stool 2. Uncontrollable bleeding, wont stop 3. Petechiae, bruising, pallor, weakness, bloody noses, bleeding around mouth, eyes, ears h. Antidote i. Vitamin K i. Patient teachings