NR 293 Week 4 Concepts; Clotting

Prepare: Coagulation Modifiers Coagulation Modifiers • Coagulation modifiers are a group of medications that both promote and prevent clot formation as well as lysing a preformed clot and reversing the action of anticoagulants. Warfarin • Warfarin is an anticoagulant medication whose mechanism of action is to prevent clot formation by inhibiting particular clotting factors. Coagulation Modifier Drugs • Coagulation modifier drugs is a class of medication that includes medications? Self Check: Hemostasis Review Coagulation Cascade System • The coagulation cascade system is triggered by an injury to a blood vessel, which then triggers either an intrinsic or an extrinsic pathway of intricate steps, each step triggering the next when clotting factors are/is activated. The ultimate result of this system is a large concentration of fibrin. Reverse of the Coagulation Process • The reverse of the coagulation process is the fibrinolytic system. Fibrinolysis is the breakdown of thrombi. This is an important part of hemostasis in order to prevent excessive coagulation, blocked blood vessels, or mobilized thrombi called an embolus. Self Check: Coagulation Modifier Drugs Coagulation Modifiers • The coagulation modifier drugs are broken down into several subclasses or categories based on their hemostasis reversal or promotion action. Which items are mechanisms of action for this class of drug? Select all that apply. Self Check: Mechanism of Action Mechanism of Action • Which one of these coagulation modifier drugs has a mechanism of action that is to lyse a thrombus that has already formed? Match it to its subclass. Reversal Drug • Which of these medications is a coagulation modifier whose subclass is a reversal drug? Select all that apply. Reflect: Coagulation Modifiers Antifibrinolytics • What is another term for antifibrinolytics? Promoting Coagulation • A coagulation modifier drug whose mechanism of action is to promote coagulation of the blood is called a(n) ___________ and is used to _________. Anticoagulants • What is another term for anticoagulant? Coagulation Modifier Drugs and Subclasses • Match the coagulation modifier drug’s subclass to the correct medications. Note: Several of the subclasses have more than one medication listed as correct choices. Reversal and Coagulation Modifier Drugs • Choose the correct word(s) from the drop-down list to complete the following statements regarding reversal drugs. Indications for Use • Match the indications for use of coagulation modifying drugs by dragging the class on the right to the correct description. Hemostasis Vocabulary • From the drop-down menu, select the term that best fits the definition. Subclasses • Match the coagulation modifier drug’s subclass to its mechanism of action. Anticoagulants (warfarin; heparin) Prepare: Anticoagulants Actions of Anticoagulants • Anticoagulants perform which of the following actions? Anticoagulant Subclasses • Which of these anticoagulants belongs to the subclass heparins? Coumarins • How do coumarins prevent thrombus formation? Self Check: Thromboembolic Event • Which of the following patients is least at risk of a thromboembolic event? Self Check: Heparin Heparin Toxicity • Which of the following statements are correct regarding heparin toxicity? Select all that apply. Increased Anticoagulants • Which of the following medications when taken with heparins, can cause an increased anticoagulant effect (bleeding risk)? Self Check: Warfarin (Coumandin) Warfarin • Which of the following statements regarding warfarin are accurate? Select all that apply. Self Check: Black Box Warnings • Match the following anticoagulants with its black box warning. Reflect: Anticoagulants Adverse Effects • Which of the following are medications used for treatment of adverse effects associated with heparin? Select all that apply. About Anticoagulant Medications • Match each anticoagulant medication or subclass/category to its true statement. Adverse Effects • What are the most common adverse effects for anticoagulants in general? Select all that apply. Statements About Heparin • Drag the below statements into the correct column, indicating which are true and which are false, regarding the subclass of anticoagulants known as heparins? Selective Xa Inhibitors • Which of these medications is an oral selective Xa inhibitor that is used for prevention of strokes in patients with atrial fibrillation (a-fib)? Indications of Use • Given their general mechanism of action, anticoagulants are indicated for which of these uses? Select all that apply. Categories of Heparins • Which of the following are categories of heparins? Select all that apply. Antiplatelets (clopidogrel) Prepare: Antiplatelets Antiplatelets • How do antiplatelets prevent clot formation? Mechanism of Action • Which of the following statements is true regarding acetylsalicylic acid’s antiplatelet mechanism of action? Select all that apply. Indications of Use for clopidogrel • Which of the following are indications for use of clopidogrel? Select all that apply. Self Check: Mechanism of Action • Which of the following is true regarding the mechanism of action of antiplatelets? Self Check: Aspirin Acetylsalicylic acid Self Check: Antiplatelet Subclass Antiplatelet Subclass • Which of the following statements are accurate regarding the antiplatelet subclass glycoprotein (GP) IIb/IIIa inhibitors? Select all that apply. Self Check: clopidogrel (Plavix) Clopidogrel • Which of the following statements is true regarding clopidogrel? Adverse Effects • Which of the following are common adverse effects of clopidogrel? Select all that apply. Reflect: Antiplatelets Adenosine Diphosphate (ADP) Receptor Inhibitor Medications • Which of the following statements are true regarding ADP Inhibitor medications clopidogrel, prasugrel, and ticagrelor? Select all that apply Platelet Adhesion and Aggregation • Place the steps of the platelet aggregation process in order, from the point of the damaged blood vessel to the point of clot formation. Dipyridamole • Which of the following statements is true regarding dipyridamole? Select all that apply. Clopidogrel • Clopidogrel is a(n) oral medication in the adenosine diphosphate (ADP) receptor inhibitor subclass whose mechanism of action is to alter the platelet membrane preventing it from receiving the signal to aggregate. Antiplatelet • Choose which antiplatelet corresponds with each statement. Effectiveness of clopidogrel • Which of the following medications can reduce the effectiveness of clopidogrel? Select all that apply. Adverse Effects • Antiplatelets are contraindicated in patients with which of the following? Select all that apply. Contraindications for acetylsalicylic acid • Acetylsalicylic acid is contraindicated in which of the following scenarios? Select all that apply. Nursing Application: Coagulation Modifiers Prepare: Nursing Application for Coagulation Modifiers Black Box Warnings • The nurse should be aware that black box warnings are present for which antiplatelet medications? Select all that apply. Therapeutic Effects • Which assessment findings indicate a therapeutic response to coagulation modifying drugs? Select all that apply. Main Complication • Which of the following is a main complication of all anticoagulant and antiplatelet therapy that the nurse caring for a patient receiving coagulation modifier drugs should assess for? Self Check: Indications of Use • Anticoagulants are prescribed to prevent or treat which conditions? Select all that apply. Self Check: Nursing Assessment for Coagulation Modifiers Thromboembolic Events • Which assessment finding is an unreliable measure of thrombosis? Physical Assessment Results • The nurse is assessing a client who has been taking anticoagulant medication for the past six (6) months. Based on the assessment findings what is the next action the nurse should take? Self Check: Regular Lab Tests • A client who recently began anticoagulation medication asks the nurse why they need to get their laboratory values checked so often. What is the best response by the nurse? Select all that apply. Self Check: Warfarin • What information should be included on a teaching plan for clients taking warfarin? Reflect: Nursing Assessment for Coagulation Modifiers Preventing Bruising, Bleeding, and Tissue Injury • When planning discharge teaching for a client on coagulation modifying drugs, the nurse should include which information? Select all that apply. Risk Factors and Contraindications • Match the assessment findings associated assessment criteria with the reason behind it. Subjective and Objective Data • The nurse recognizes which assessment findings as contraindications to coagulation modifying drugs? Select all that apply. Antidote to Heparin • When caring for a client receiving heparin, the nurse assures that which antidote is readily available? Safety While Taking warfarin • Which images below should be provided to a client with low literacy skills to help them remain safe while taking warfarin? Select all that apply. Main Complication • Clients taking anticoagulation modifying drugs should immediately report which symptoms to their healthcare provider? Select all that apply Mechanism of Action and Nursing Implications • Which statements are true regarding clopidogrel? Select all that apply. Drug Classes Match the drug name to its drug class. If you can’t see the picture well • Anticoagulants: Prevent clot formation by inhibiting particular clotting factors • Antiplatelets: Prevent clot formation by interfering with platelet function • Antifibrinolytics: Promote the coagulation of blood (used in the management of excessive bleeding) • Hemorheologics: Reduce blood viscosity (thickness) • Reversal Drugs: Antidotes Week 4 Concepts: Perfusion Prepare: Antihypertensives Medications in Class • Which medication is used to treat hypertension? Prevalence of Hypertension • Which statements about hypertension in the United States are supported by facts? Select all that apply. Goals of Treatment • What are the goals of antihypertensive therapy? Select all that apply. Self Check: Medication Classes and Drugs in the Class • Complete each sentence by selecting the word or phrase that makes the sentence true from the drop down menu. Self Check: Life-Threatening Effects of Antihypertensive • Indicate which listed side/adverse effects may be caused by the listed antihypertensive medication class by placing a check in the appropriate column. Self Check: Antihypertensive Therapy During Pregnancy • Which antihypertensive medications are contraindicated during pregnancy and lactation? Select all that apply. Self Check: Antihypertensive Contraindications • Which antihypertensive medication is contraindicated for an older adult with an esophageal stricture? Self Check: Azathioprine Contraindications Doxazosin Contraindications • Indicate which listed medication(s) or over the counter product(s) may cause each interaction listed when administered with doxazosin by placing a check in the appropriate column. Select all that apply for the interaction. Reflect: Antihypertensives Therapeutic Use • When counseling a 68-year-old male who is taking doxazosin and denies any history of hypertension, the health care provider asks if he has history of which other condition? Antihypertensive Drugs and Classes Drag the medications to the classification in which each belongs. Complications of Hypertension • Mr. James, an older adult with hypertension and chronic kidney disease, is talking with a group of young men newly diagnosed with hypertension about coping with the diagnosis of a lifelong alteration in health. When a participant asks Mr. James what he would do differently if he had the chance, which statement from Mr. James reinforces the importance of medication compliance? Mechanism of Action • Which effects of angiotensin II do angiotensin II blocking medications (ARBs) stop in order to decrease blood pressure? Select all that apply. Adverse Effect/Event OR Contraindications • Indicate which listed medication(s) or over the counter product(s) may cause each interaction listed when administered with losartan by placing a check in the appropriate column. Select all that apply for each interaction. Safe Administration • While reviewing the health history of an individual taking an antihypertensive, the health care provider is concerned that which over-the-counter product may interfere with blood pressure medicine? Select all that apply. Adherence • An individual diagnosed with hypertension six months ago is frustrated that their blood pressure is still elevated despite having tried several medications. When asked what is taking so long, what is the best response by the health care provider? Angiotensin II Blockers (ARBs) • When providing hypertension screening and education a health care professional shares that which medications are in the ARB class? Select all that apply. Adrenergics (carvedilol, clonidine, doxazosin) Prepare: Adrenergics Medications in Class • Which medications are included in the adrenergic antihypertensives class? Select all that apply. Adverse Effects of clonidine • Which condition may result from stopping clonidine therapy abruptly? Carvedilol Indications • In addition to hypertension, carvedilol is also prescribed to treat heart failure and impaired left ventricular function after a myocardial infarction (MI). Self Check: Indications and Interactions Indications for carvedilol and clonidine • Select the indications for use of carvedilol and clonidine by placing marks the appropriate column(s). Select all that apply for each medication. Interactions with carvedilol • The beta blocking effects of carvedilol are responsible for causing hyperglycemia by interfering with receptors in the pancreas. Self Check: Classes and Dosing Classes and Medications of Adrenergic Antihypertensives • Match the medication to the class in which it belongs. Dosing for clonidine • Use the drop down menus to fill in the missing information related to dosing of clonidine. Dosing for carvedilol • Use the drop down menus to fill in the missing information related to dosing of carvedilol. Reflect: Adrenergics Response to Treatment • During a follow up visit with the health care provider a person taking carvedilol reports the following information. Which indicates a possible complication due to the medicine? Safe Administration of clonidine • In which individual should clonidine be used with caution? Metabolism of carvedilol • An individual taking carvedilol for the last three weeks is reporting an increasingly dry mouth, unusual issues with constipation, and becoming extremely dizzy within five minutes of jogging for exercise. When asked, the person confirms that these symptoms started after the medication was prescribed and have been increasing since. The health care provider suspects a genetic enzyme disorder as the reason for the current symptoms and recommends the individual discontinue the dose of carvedilol slowly. Adverse Effect/Event Or Contraindications • A client calls the health care provider at 2 p.m. stating, “I forgot to take my daily blood pressure pill at 8 a.m. like I usually do. Should I take it now?” Which of response by the healthcare provider is best? Linking Side Effects to Medications • An individual with diabetes and hypertension is seen in urgent care with severe hypoglycemia. She is concerned that her usual symptoms of low blood sugar were not present, allowing her levels to drop to the point she became faint. Which of her current medications may contribute to the masking of her hypoglycemia? Pharmacokinetics of clonidine • Use the drop down menus to fill in the missing pharmacokinetic information of clonidine. Pharmacokinetics of Carvedilol • Use the drop down menus to fill in the missing pharmacokinetic information of carvedilol. Side Effects of carvedilol • While caring for a client with hypertension who has recently started taking carvedilol, the client reports, “This medication seems to give me a rash.” Which of the following statements by the health care provider is best? Angiotensin-Converting Enzyme (ACE) Inhibitors (enalapril) Prepare: ACE Inhibitors Indications for Use – Angiotensin Converting Enzyme Inhibitors • Which of the angiotensin converting enzyme (ACE) inhibitors have been shown to reduce the risk of death or development of heart failure (HF) following a myocardial infarction (MI)? Select all that apply. Therapeutic Effects of Angiotensin Converting Enzyme (ACE) Inhibitors • In addition to hypertension, ACE Inhibitors are also prescribed to prevent left ventricular hypertrophy after a myocardial infarction and decrease the morbidity and mortality associated with heart failure. Pharmacokinetics of Angiotensin Converting Enzyme (ACE) Inhibitors • Which of the oral ACE inhibitor medications are ready to be used by the body as soon as they are absorbed? Select all that apply. Self Check: Indications, Mechanism of Action, and Expected Results Therapeutic Effects of ACE Inhibitors • Click on the cells that contain the therapeutic effects of ACE inhibiting medications. Select all that apply. Mechanism of Action of Angiotensin Converting Enzyme (ACE) Inhibitors • By which mechanisms do ACE inhibitors cause systemic vasodilation and lower blood pressure? Select all that apply. Self Check: Contraindications, Adverse Effects, and Interactions Effectiveness of Angiotensin Converting Enzyme (ACE) Inhibitors • Indicate which medications will increase or decrease the effectiveness of ACE inhibitors by clicking the radio button in the correct column. Self Check: Safety Considerations, Routes of Administration, and Other Meds in Class Contraindications of Angiotensin Converting Enzyme (ACE) Inhibitors • ACE inhibitors should be used cautiously in individuals with liver disease and those with a family history of angioedema. Self Check: Pharmacokinetics and Dosing Dosing for captopril • Use the drop down menus to fill in the missing information related to dosing of captopril. Reflect: ACE Inhibitors Safe Administration of captopril • Which statement by an individual taking prescribed captopril indicates further teaching is required? Linking Side Effects to Medications • A person is prescribed an Angiotensin Converting Enzyme (ACE) Inhibitors after experiencing a myocardial infarction. What effects on the body will this medication achieve? Select all that apply. Mechanism of Action of Angiotensin Converting Enzyme (ACE) Inhibitors • How does captopril impact the vasoconstriction, aldosterone secretion, and renin release that occur as a result of the renin-angiotensin-aldosterone system? Select all that apply. Side Effects of Angiotensin Converting Enzyme (ACE) Inhibitors • A patient states they are experiencing an annoying, persistent dry cough that started once they begin taking an ACE inhibitor. The patient is not experiencing any other signs and symptoms. What is the best response by the health care provider? Benefits of Angiotensin Converting Enzyme (ACE) Inhibitors • Which individual would benefit most from an ACE inhibitor? Pharmacokinetics of Angiotensin Converting Enzyme (ACE) Inhibitors • Which ACE inhibitor is not metabolized by the liver and is eliminated unchanged in urine? Pharmacokinetics of Enalapril • Use the drop down menus to fill in the missing pharmacokinetic information of enalapril. Adverse Effects of Angiotensin Converting Enzyme (ACE) Inhibitors • An individual taking an ACE inhibitor for the last three weeks reports swelling of the lips, eyes, and tongue that started about 30 minutes before they called the prescribing health care provider. Nursing Application: Antihypertensives Prepare: Nursing Application for Antihypertensives Indications • While reviewing the medication list for a newly admitted patient the nurse notes they are taking a calcium channel blocker. Based on knowledge of the medication, the nurse inquires if the patient has a history of which conditions? Select all that apply. Angina pectori. Initial Assessment – Hypertension • The initial nursing assessment of a patient diagnosed with hypertension should including questions about which underlying causes? Select all that apply. Goals of Treatment • What teaching point is a priority when the nurse is teaching a client who is taking an angiotensin converting enzyme (ACE) inhibitor? Self Check: Assessing Risks During Antihypertensive Therapy • While obtaining subjective assessment data from a patient with hypertension whose blood pressure has not reached goal after three months of therapy, the nurse asks the patient about changes they have made to their diet and exercise. What is the rationale for this question? Self Check: Monitoring Side Effects of Antihypertensives • An hour after administering the daily dose of an antihypertensive to a 64-year-old patient the nurse is asked to help them to the bathroom. What priority action will the nurse take before completing the request? Self Check: Patient Education – Risk for Side Effects of Antihypertensives • The nurse volunteering at a community picnic on a hot, humid day is treating an older adult experiencing dizziness and hypotension. After the patient is feeling better and their blood pressure has returned to normal, what information will the nurse provide to help the patient avoid a recurrence? Self Check: Evaluating Antihypertensive Therapy Select the values from the drop down menus that accurately complete the sentence. • Blood pressure control is achieved when the systolic pressure is 120-139 millimeters of mercury (mm Hg) with a diastolic pressure of 80-89 mm Hg, or at lowest level tolerated by the individual. Reflect: Nursing Application for Antihypertensives Adherence and Antihypertensives • Many individuals who are aware they have hypertension are not being treated. The nurse understands that which factors can impact how well a patient adheres to the prescribed treatment plan? Select all that apply. Dosing • A client with newly discovered hypertension has an average blood pressure (BP) reading of 158/98 millimeters of mercury (mm Hg) after 3 months of exercise and diet modifications. Which management strategy will be a priority for this patient? Side Effects • A patient who has a prescription for methyldopa is being tapered off the medication. The nurse includes which statement in the patient teaching? Adjusting Dosage • A hypertensive client who has been prescribed captopril states, “The doctor keeps changing my pills and none are working. I feel like a guinea pig.” Which response by the nurse would be most appropriate? Drug-Drug Interaction • A patient has a new prescription for an angiotensin converting enzyme (ACE) inhibitor. During a review of the patient’s list of current medications, which would cause concern for a possible interaction with this new prescription? Select all that apply. Mechanism of Action • The nurse is providing discharge instructions to a patient who will be taking an adrenergic antihypertensive at home. Which statements by the patient demonstrate they understood your discharge instructions? Select all that apply. Assessing for Adverse Effects • The nurse is administering antihypertensive drugs to older adult patients. The nurse knows that which adverse effect is of most concern for these patients? Safe Administration • When giving antihypertensive drugs, the nurse will consider giving the first dose at bedtime for which class of drugs? Antianginals Prepare: Antianginals Medications in Class – Beta-Adrenergic Blockers • Which antianginal medications belong to the classification of beta-adrenergic blockers? Mechanism of Action of Antianginals • Some medications used to treat angina work by slowing the heart rate to allow the myocardial cells to receive oxygen. Causes of Angina • Match the type of angina to the pathophysiologic processes that causes it. Self Check: Preventing Angina • Which antianginal medications are used to prevent future episodes of angina? Select all that apply. Self Check: Treatment Outcomes • What are the goals of antianginal therapy? Select all that apply. Self Check: Contraindications for Antianginals • Which medical conditions are considered contraindications to antianginal therapy? Select all that apply. Self Check: Dosing for Metoprolol • Use the drop down menus to fill in the missing information related to the dosing of metoprolol. Self Check: Pharmacokinetics of Ranolazine • Use the drop down menus to fill in the missing information related to the pharmacokinetics of ranolazine. Reflect: Antianginals Adam’s Angina Answer the following questions about Adam’s knowledge and experience with his angina. • Adam, who has a history of stable angina, is getting ready to walk in a local park. Which preparations indicate the he understands self-care actions related to his health condition? Select all that apply. • During his walk, Adam experiences chest pain similar to past anginal episodes. Which actions should he take now? Select all that apply. • Adam’s chest pain is not changed after taking their antianginal medication to the maximum dose prescribed. What action should he take next? Side Effects of Beta Blockers • Which signs and symptoms would demonstrate a person is experiencing an overdose of a beta blocker medication? Select all that apply. Metoprolol Administration • Metoprolol is available for administration by which routes? Select all that apply. Over-the-counter and ranolazine • Which over-the-counter item should not be consumed by an individual taking ranolazine for unstable angina? Select all that apply. Dosing for ranolazine • Use the drop down menus to fill in the missing information related to the dozing of ranolazine. Pharmacokinetics of metoprolol • Use the drop down menus to fill in the missing information related to the pharmacokinetics of metoprolol. Nitrates and Nitrites (isosorbide dinitrate, nitroglycerin) Prepare: Nitrates nitroglycerin Safety • When teaching an individual with angina to administer translingual nitroglycerin, which information regarding safety should be included? Preparations of nitroglycerin • Select the routes by which nitroglycerin may be administered. Indications for Nitrates • In addition to angina, for what condition is isosorbide dinitrate indicated? Select all that apply. Self Check: isosorbide dinitrate (Isordil) Therapeutic Effects of isosorbide dinitrate • Which statement provides subjective data that the recently prescribed isosorbide dinitrate is having the desired therapeutic effect on the individual speaking? Select all that apply. Administration Routes for isosorbide dinitrate • By what routes can isosorbide dinitrate be administered? Select all that apply. Pharmacokinetics of isosorbide dinitrate • Use the drop down menus to fill in the missing information related to the pharmacokinetics of isosorbide dinitrate. Safe Administration of isosorbide dinitrate • In which individuals should caution be used when administering isosorbide dinitrate? Select all that apply. Self Check: Administration Schedule for Nitrates • An individual taking three doses of isosorbide dinitrate asks the health professional why this medication is taken once every six hours, rather than in the morning, with lunch, and before going to bed like another medication they take. What is the best response by the health professional? Reflect: Nitrates Evaluating Effectiveness: rapid acting nitrate • A nurse is monitoring a patient with angina for therapeutic effects of a rapid-acting nitrate given for chest pain. Which assessment finding indicates that the medication has been effective? Adverse Effects: isosorbide dinitrate • The nurse prepares discharge teaching for a client receiving isosorbide dinitrate for treatment of angina. What information to lower potential side effects of the medication will the nurse include? Pharmacokinetics of nitroglycerin • Use the drop down menus to fill in the missing information related to the pharmacokinetics of nitroglycerin. Managing Nitrate Tolerance • Scheduling a daily nitrate free period allows plasma and tissue nitrate levels to fall, allowing cells to recover to a responsive state when the next dose is administered. These nitrate free periods are used to offset tolerance that can develop with longterm continuous administration of nitrates. Adverse Effects: Nitrates • The nurse cautions the client receiving isosorbide dinitrate for treatment of angina that long-term use can lead to the development of which condition? Safe Administration: nitroglycerin • What precautions does the nurse take to protect themselves when preparing and administering nitroglycerin ointment? Dosing: nitroglycerin • An individual with a history of angina takes sublingual nitroglycerine to relieve chest pain ranked 6/10. Five minutes later, the chest pain is 4/10. What action should be taken next? Safe Administration: nitroglycerin • After the nurse has finished teaching a patient about the use of sublingual nitroglycerin, which patient statement indicates that the teaching has been effective? Calcium Channel Blockers (diltiazem, amlodipine, verapamil) Prepare: Calcium Channel Blockers (CCB) Chemical Classifications of calcium channel blockers (CCBs) • Select the chemical classifications of calcium channel blockers by clicking on the correct answers. Calcium and Muscle Contraction • Extracellular calcium is required for the contraction of cardiac and smooth muscle cells. Indication for Calcium Channel Blockers (CCBs) • In addition to angina, for what conditions are calcium channel blocker medications indicated? Select all that apply. Self Check: Calcium Channel Blockers Mechanism of Action for Calcium Channel Blockers (CCBs) • By decreasing the systemic vascular resistance, calcium channel blockers decrease the workload of the heart and myocardial demand for oxygen. Drug-Drug Interactions for Calcium Channel Blockers • An individual taking nifedipine for blood pressure regulation has a new prescription for digoxin. The health care provider anticipates that this combination of medications may have which effects? Select all that apply.   Self Check: Administration Routes for diltiazem • By what routes can diltiazem be administered? Select all that apply. Self Check: Pharmacokinetics of verapamil • Use the drop down menus to fill in the missing information related to the pharmacokinetics of verapamil. Self Check: Dosing Considerations for amlodipine • Which individuals may require a lower dose of amlodipine? Select all that apply. Reflect: Calcium Channel Blockers (CCB) Mechanism of Action • Which calcium channel blockers below are known as the dihydropyridines and are known to be more vascular selective? Select all that apply. Generic and Trade Names or Classes • Drag the medications to the classification in which each belongs. Indications for Use • A patient with angina has been given a prescription for a calcium channel blocker. The nurse knows that this class of drugs is used to treat which type of angina? Safe Administration • A patient taking diltiazem to treat an irregular heart rhythm should not take their medication and notify the prescribing health care provider if which conditions are present when checking his pulse and blood pressure? Select all that apply. Indications for Use: Calcium Channel Blockers (CCBs) • Routine oral hygiene is necessary to prevent which adverse effect associated with calcium channel blocker therapy? Mechanism of Action • An individual asks how their diltiazem works to help their angina. What is the best response by the health professional? Side Effects • The nurse is counseling a client who is to start taking amlodipine for hypertension. Which statement by the client indicates that further teaching is needed? Nursing Application: Antianginals Prepare: Nursing Application for Antianginals Initial Assessment for Angina • The initial nursing assessment of a patient diagnosed with angina should including questions about which underlying causes? Select all that apply. Indications for Use for Antianginals • In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed shortacting and long-acting nitrates. Which patient statement indicates that the teaching has been effective? Goals of Treatment for Angina • The teaching plan for a client being started on long-acting nitroglycerin includes the drug’s mechanism of action. The nurse teaches that this drug relieves chest pain by which action? Self Check: Ongoing Assessment Assessing Risks During Antianginal Therapy • While obtaining subjective assessment data from a patient with rheumatoid arthritis and angina whose episodes of chest pain have decreased only marginally after three months of treatment with sublingual nitroglycerin, the nurse asks the patient if they are having any difficulty placing the small tablet beneath the tongue. What is the rationale for this question? Select all that apply. Expected Outcomes: Acute Anginal Attack • Which action is the first priority of care for a client exhibiting signs and symptoms of angina? Self Check: Nursing Diagnosis and Outcomes Identification Assessment and Planning for Angina • Which assessment data collected by the nurse who is admitting a patient with chest pain suggests that the pain is caused by angina? Self Check: Patient Education Patient Education: Risk for Side Effects of Antianginals • While attending a community picnic on a hot day, and older adult with stable angina had an episode of chest pain and took a sublingual nitroglycerine tablet, which relieved the pain. Thirty minutes later, the individual experienced dizziness and hypotension and was brought to the first aid tent for care. After the patient is feeling better and their blood pressure has returned to normal, what information will the nurse provide to help the patient avoid a recurrence? Self Check: Evaluation of Antianginals Evaluating Antianginal Therapy • Select the values from the drop down menus that accurately complete the sentence. Reflect: Nursing Application for Antianginals Risk for Complications • While assessing a patient with angina with a new prescription for selective beta-1 blocker therapy, the nurse is aware that the presence of which conditions may place this person at risk for complications? Select all that apply. Drug-Drug Interactions: isosorbide dinitrate • The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbide dinitrate as treatment for anginal pain. Which substances could result in a drug-drug interaction? Select all that apply. Assessing for Side Effects • A patient with diabetes, hypertension, and stable angina is being discharged home. The patient will be taking a nonselective beta blocker and insulin per sliding scale. Which statement by the patient demonstrates they require additional education about the side effects of the beta blocker? Calcium Channel Blockers A patient with angina has been given a prescription for a calcium channel blocker. The nurse knows that this class of drugs is used to treat which type of angina? Patient Education • Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem? Safe Administration • A male patient admitted to the emergency department with intermittent chest pain provides a list of prescription medications to the nurse. Concurrent use of which medications has the most immediate implications for the patient's care? Select all that apply. Mechanism of Action • A patient is prescribed metoprolol. Which statement by the patient requires the nurse to re-educate the patient on how to take the medication properly? Withholding Antihypertensive • The nurse is preparing to administer a morning dose of atenolol to a patient with hypertension and angina. The nurse withholds the medication and notifies the prescribing health care provider based on which cues discovered during the focused assessment? Select all that apply. Heart Failure Medications Prepare: Heart Failure Medications Goals of Treatment: Heart Failure • Select the conditions outside the heart for which heart failure medications may be prescribed. Select all that apply. Cardiac Function Terminology • Match the term related to cardiac function to its definition. Mechanism of Action: Phosphodiesterase Inhibitors • Phosphodiesterase inhibitors (PDIs) have an added advantage in treating heart failure. These drugs cause a positive inotropic effect and what other effect? Self Check: Impact of Heart Failure Self Check: Last Use for Heart Failure • Which medication to treat heart failure is used after all other medications have been prescribed? Self Check: Dosing for Sacubitril/Valsartan • Use the drop down menus to fill in the missing information related to dosing of sacubitril/valsartan. Self Check: Safe Administration of Milrinone • While administering milrinone to a person with heart failure monitor, which clinical response to treatment is most important? Self Check: Pharmacokinetics for Ivabradine • Use the drop down menus to complete the pharmacokinetic information for ivabradine. Reflect: Heart Failure Medications Adverse Effects: milrinone • Which adverse cardiac conduction alteration is most likely to occur in a patient who is receiving intravenous milrinone? Effects of Medication for Heart Failure • Which effects do medications used to treat heart failure have on the heart and blood vessels? Select all that apply. Therapeutic Effects: milrinone • The nurse is administering an intravenous infusion of a phosphodiesterase inhibitor to a patient who has heart failure. The nurse will evaluate the patient for which therapeutic effects? Select all that apply. Therapeutic Effects: Beta Blockers • Which beneficial cardiovascular effects are anticipated when metoprolol is used to treat heart failure? Select all that apply. Outcomes of Heart Failure Therapy Holistic therapy provided to individuals with heart failure is aimed at decreasing the likelihood of which events? Select all that apply. Contraindications: sacubitril/valsartan • Administration of sacubitril/valsartan is contraindicated for use with individuals whose health history includes which conditions? Select all that apply. Medications for Heart Failure Match the medications to the classification in which each belongs. If you can’t see • Angiotensin Converting Enzyme (ACE) Inhibitors: • Angiotensin II Receptor Blockers (ARBs): • Beta Blockers: • Loop Diuretics: • Aldosterone Inhibitors: Population Specific Heart Failure Medication • Which heart failure medication was developed specifically for use by a specific ethnic group? Nursing Application: Heart Failure Medications Prepare: Nursing Application for Heart Failure Medications Medications for Heart Failure • These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the workload of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes: Priority Assessment: Heart Failure Medications • The nurse includes which parameters in ongoing focused assessment of patients receiving positive inotropic medication for heart failure? Select all that apply. Contraindication: milrinone • The nurse would question the use of milrinone in a patient with which condition? Self Check: Pre-Assessment Data for Heart Failure Medications • Select the data collected by the nurse prior to administering a dose of a prescribed medication to a patient with chronic heart failure. Self Check: Implementation of Heart Failure Medications Nursing Interventions for Heart Failure Drugs • You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking hydralazine and isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom? Treating Heart Failure • Select all the correct statements about educating the patient with heart failure. Self Check: Patient Teaching for Heart Failure Medications Patient Education for Heart Failure Medications • Which topics will the nurse include in discharge teaching for a patient newly diagnosed with heart failure taking valsartan/sacubitril? Select all that apply. Evaluating Patient Understanding • The nurse is providing diet education to a patient with a history of heart failure. Which statement made by the patient indicates they understood the diet teaching? Reflect: Nursing Application for Heart Failure Medications Patient Education • A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may not be adhering to their prescribed medication regimen? Safe Administration of Heart Failure Drugs • What priority assessment data will the nurse caring for a patient receiving nesiritide monitor? Evaluation of Risk for Heart Failure Exacerbation • Which patient living with heart failure is most at risk for exacerbation of the disease? Heart Failure Medications and Critical Adverse Effects • A stable patient prescribed valsartan/sacubitril to treat acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before positioning the patient on the bedside, which priority function will the nurse assess? Indications for Heart Failure Medications • The nurse is caring for a client who has heart failure and has a new prescription for sacubitril/valsartan. Which client information is most important to discuss with the health care provider before administration of the medication? Safety for Heart Failure Medications • A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid? Adverse Effects of Heart Failure Medications • A client with stable angina has a prescription for ranolazine 500 mg twice a day. Which client finding is most important for the nurse to discuss with the health care provider? Nursing Implications for Heart Failure Medications • The nurse is caring for a hospitalized client with heart failure who is receiving captopril and spironolactone. Which laboratory value will be most important to monitor? Antilipemics Prepare: Antilipemics Exogenous Lipids • Exogenous lipids originate outside of the body. Protein • Lipoprotein is a protein, synthesized in the liver, that contains varying amounts of triglycerides, cholesterol and phospholipids. Hypercholesterolemia • Hypercholesterolemia is a condition of high Low-density lipoprotein (LDL). Self-Check: Cholesterol Levels • Which factors are considered to support the use of pharmacotherapy to reduce low-density lipoprotein (LDL)? Select all that apply. Self-Check: Antilipemic Drugs • What drug decreases the rate of cholesterol production? Self-Check: Client Education on Antilipemic Drugs • Which statement by the client on long-term antilipemic therapy indicates the need for further education? Reflect: Antilipemics Side Effects: Antilipemics • What are issues that can occur with antilipidemics with long term use? Antilipemics Drugs • Which factors are assessed when antilipemics drugs are prescribed? Select all that apply. Hyperlipidemia • When referring to hyperlipidemia, what is phenotyping? Good Cholesterol • High-density lipoprotein (HDL) are considered good cholesterol. Fat Soluble Vitamins • Which of the following are fat soluble vitamins? Antilipemic Drugs Classes • What drug lowers low-density lipoprotein (LDL) by activating lipase to breakdown cholesterol? Antilipemic Drugs Classes • Niacin will lower plasma concentrations of all lipoproteins. Antilipemic Drugs Classes • Bile acid sequestrant prevents the resorption of the bile acids from the small intestine. Beta-Hydroxy Beta-methylglutaryl-Coenzyme A (HMG-CoA) Reductase Inhibitors (atorvastatin) Prepare: β-hydroxy β-methylglutaryl Coenzyme A Reductase Inhibitors • β-hydroxy β-methylglutaryl Coenzyme A (HMG-CoA) reductase inhibitors are metabolized by which enzyme? Adverse Effect • β-hydroxy β-methylglutaryl Coenzyme A Reductase inhibitors have an adverse effect of rhabdomyolysis. β-hydroxy β-methylglutaryl Coenzyme A Reductase Inhibitors • β-hydroxy β-methylglutaryl Coenzyme A (HMG-COA) reductase inhibitors are considered statins. Self-Check: β-hydroxy β-methylglutaryl Coenzyme A Reductase Inhibitors Statins The client was recently prescribed a statin medication. • The therapeutic effect of statin medications is a reduction in which value? • What high-priority lifestyle change should the nurse discuss with this client? Contraindications • What are the contraindications of β-hydroxy β-methylglutaryl Coenzyme A (HMG-CoA) reductase inhibitors? Self-Check: atorvastatin • What is the ideal time for a client to take atorvastatin? Cholesterol Drugs • What drug decreases cholesterol production by the liver? Reflect: β-hydroxy β-methylglutaryl Coenzyme A Reductase Inhibitors Atorvastatin • When atorvastatin is prescribed what laboratory values should be assessed? Select all that apply. Beta-Hydroxy Beta-methylglutaryl-Coenzyme A (HMG-CoA) Reductase Inhibitors • HMG-CoA reductase inhibitors raise High-density lipoprotein (HDL) levels. Use of β-hydroxy β-methylglutaryl Coenzyme A Reductase Inhibitors • What are issues that can occur with β-hydroxy β-methylglutaryl Coenzyme A (HMG-COA) reductase inhibitor use? Atorvastatin • A client called the clinic to report blood in the urine and muscle soreness three (3) months after starting atorvastatin. How should the nurse respond? Routes of Administration • Which of the following is the route of administration for atorvastatin? Patient Education • Which statement by the patient indicates a need for more education about atorvastatin? Effect of atorvastatin • What is the overall treatment goal for a client taking atorvastatin? Patient Teaching • A patient has been prescribed atorvastatin. Which of the following statements indicates that more teaching is needed? Nursing Application: Antilipemics Prepare: Nursing Application: Antilipemics Priority Assessment: Antilipemic Medications • Which priority assessments should be completed before administering antilipemic medications to a patient? Select all that apply. Side Effects: Antilipemics • A client has started taking niacin (nicotinic acid) as part of treatment for high cholesterol levels. After the first dose, he tells the nurse that he feels “hot” and that his face and neck are flushed. He says that he thinks he is having an allergic reaction. What is the nurse’s best response? Classification of Antilipemic Medications Place each antilipemic drug into the correct class. Self-Check: Pre-Assessment Data: Medications for Heart Failure Pre-Assessment: Medications for Cholesterol • Select the data collected by the nurse prior to administering the first dose of a prescribed antilipemic medication. Self-Check: Complications: Antilipemic Therapy • A patient taking an antilipemic for three months calls the health care provider’s office to report their abdomen is sore and their eyes appear to have a yellowish color this morning. The nurse asks about specific cues that may indicate which adverse effect of medications in this class? Self-Check: Medication Instruction: Antilipemics • The nurse is working with a patient who has elevated triglyceride levels despite dietary changes. The health care provider has ordered fenofibric acid daily. Which information should the nurse include in the teaching? Self-Check: Dietary Changes: cholestyramine • A client taking cholestyramine asks the nurse which foods should be restricted while taking this medication. Which foods does the nurse recommend? Select all that apply. Self-Check: Antilipemic Therapy • Evaluating Effectiveness of Antilipemic Therapy While providing care to a 68-year-old man taking gemfibrozil, the nurse determines that treatment has been effective base on which laboratory result? Reflect: Nursing Application: Antilipemics Contraindications: Atorvastatin • The nurse contacts the health care provider to question a new prescription for atorvastatin for a patient who is also taking which medication? Safe Administration: Antilipemics • The nurse providing patient education about cholestyramine will include which statements in the education? Select all that apply Antilipemic Medications and Pregnancy • A woman with known hyperlipidemia being treated with simvastatin is planning to start a family. Which lipid lowering agent does the nurse anticipate the health care provider prescribing? Indications for Use: Ezetimibe • The nurse is reviewing the home medication list for a client with identified hypercholesterolemia. The client reports taking ezetimibe daily. The nurse understands this medication is designed to reduce the client’s risk for which condition? Dosing Schedule: Simvastatin • The nurse determines a patient who was recently prescribed simvastatin determines that the patient understands the dosing schedule when they make which statement? Omega-3 Fatty Acids: Patient Education • The nurse is advising a patient whose triglyceride levels remain elevated despite three months of following a low-fat, low-cholesterol diet. The client is started on omega-3 acid ethyl esters. Which statements would the nurse include in the teaching? Select all that apply. Safety: Beta-Hydroxy Beta-methylglutaryl-Coenzyme A (HMG-CoA) Reductase Inhibitors • The nurse expects which laboratory studies will be ordered for a client who has been taking simvastatin for six (6) months? Select all that apply. Mechanism of Action of Antilipemic Drugs • Match the mechanism of action on the right to the antilipemic drug classification on the left.