Pharmacology Hesi 2023 with complete solution

Digoxin (Lanoxin) - positive inotrope (increases force of contraction); negative chronotrope (decreases heart rate). How do you assess for this? Always take apical pulse for one full minute Client with a long hx of daily digoxin and fourosemide (Lasix) use; creates a high risk for dig toxicity because Lasix can cause hypokalemia, which can lead to dig toxicity What can happen when Digoxin is taken with Dronedarone (Multaq), which is another anti-dysrhythmic drug)? Digoxin can increase in the blood level and further increase the effects What is the normal digoxin level? 0.5-2 ng/mL Normal serum potassium level is 3.5-5.0 mEq/L Low potassium or magnesium levels may increase risk for Digoxin toxicity What are the signs and symptoms for digoxin toxcitiy? anorexia, bradycardia, headache, dizziness, confusion, nausea, and visual disturbances such as blurred, yellow, or halo vision. When should you hold off on giving digoxin drug therapy? if apical pulse is less than 60 What effects do Calcium channel blockers (-dipine; amlodipine (Norvasc), nifedipine (Procardia) cause produce vasodialation and reflex tachycardia (lowers BP but increases HR) Verapamil and diltiazam produce vasodialation and cardiosuppresssion (lowers BP and Lowers heart rate) Beta blockers have the drug ending -OLOL such as atenolol, propanolol, esmolol, ect.) Beta 1 blocks receptors in the heart Beta 2 blocks receptors in the lungs Beta blockers can be non selective so be aware of any respiratory conditions such as asthma, emphysema COPD, ect. A nurse should always check _____ and _____ before giving a beta blocker AP and BP do not give if HR is below 60 never stop abruptly Why do you never stop taking a Beta BLocker abruptly Must taper because angina or MI can orccur When would a nurse hold HTN medication Labetalol? A patient with a low pulse rate. Side effect of Labetalol (beta blocker) is weight gain / fluid retention montioring weight is one of the best indicators of loss/gain 1kg is equivalent to 1,000 mL It is important to assess _____ when taking a beta blocker such as Labetalol pulmonary is it OK to give nitroglycerin to a patient who is hypertensive? Yes If an ICU patient on a nirto drip becomes hypotensive what immediate action should the nurse take? titrate (decrease the rate) of the nitro drip. This drug is used for a rapid diuresis in emergencies to decrease pulmonary edema Furosemide (Lasix) a loop diuretic Furosemide (Lasix) can cause hypokalemia When taking furosemide (Lasix) a nurse should assess for what signs of hypokalemia? muscle cramps and muscle weakness Hypotension F/E abnormalities dehydration Side effects with aminoglycosides (-mycin drugs) dizziness head ache tinnitus N/V/D low potassium hyperglycemia ototoxicity Foods containing potassium dried fruits, fish, leafy veggies, squash, beans, meats, nuts, bananas, potatoes, dairy products It is important to use a large vein, such as AC (antecubital when administering __________ because it can irritate the vein potassium It is important to notify the nurse immediately is burning at the IV site when giving potassium because this can result in necrosis of the tissue Can potassium be given in a fast IV push? NO, always diluted at a rate of 10 mEq/hr for peripheral 20 mEq/hr for central line Requires an infusion pump IV site should be assessed every hour Which antihypertensives will raise potassium? ACEs (-pril) ARBs (-sartan) and other renin inhibitors Which antihypertensives will lower potassium? loop diuretics such as furosemide (-ide) and thiazides such as hydrochlorthiazide This drug can be administered via NG tube or as an enema to reduce severe serum potassium levels when life threatening values are seen Sodium polystyrene sulfonate (Kayexalate) To correct severe hyperkalemia administration of dextrose and insulin, sodium bicarbonate, and calcium gluconate or chloride are often required followed by oral or rectal use of Kayexalate or even hemodialysis to eliminate the extra potassium in the body What are some potassium sparing diuretics that inhibit sodium and water reabsorption? Spionolactone (Aldactone), amiloride (Midamore), triamterene (Dyrenium) What is important when teaching patients to take diuretics? Take in the AM avoid salt substitutes ACEs and ARBs are often taken with other thiazide diuretics to treat... Edema, hypertension, and heart failure When taking an atorcastatin (Lipitor) the _____should increase whereas the ______ and total cholesterol should decrease. HDL increases LDL decreases An important patient teaching on diet when taking statin medications is eating a diet low in animal fats and high in fiber Checking for muscle pain and monitoring _____ should be done when a patient is taking Crestor (rosuvastatin) LFTs (LIver Function Tests) CK (Creatine Kinase) ______ are agents that reduce intraocular pressure by increasing the outflow of fluids from the eye, and are usually used to reverse angle closure glaucoma or prevent angle closure in eyes with narrow chamber angles Miotics (see Cholinergic drugs) _____ are agents used to produce dilation of pupils for eye exams and ocular surgery Mydriatics Decongestants and bronchodialators have ______ effects such as ___, ____, and ___. sympathomimetic (adrenergic) effects are increased heart rate nervousness insomnia Decongestants and bronchodialators should be taken during the ______ take during the day not at night Bronchodialators that stimulate B2 receptors if taken at a high enough dosage can ________ selectivity and also stimulate ______ so it is important to monitor ______ loose selectivity B1 receptors monitor cardiac When a patient is being discharged on warfarin (Coumadin) it is important to teach a patient about ways to avoid _____ and they should use _____. avoid bleeding risks soft toothbrush, electric razor, do not go without shoes Should patients on warfarin (Coumadin) should never make changes in ______. Diet maintain vitamin K foods (greens, spinach, mustard greens, swiss chard) in diet and do not decrease or increase it Warfarin (Coumadin patients should have _____ and ____ monitored routinely. PT - Prothrombin time INR - International normalized ratio _______ is a low molecular weight heparin for DVT prophylaxis and is only given _____. Enoxaparin (Lovenox) is given SQ (Subcutaneously) _____ produces platelet inihibition and vasodilation which is used to treat intermittent claudicagtion and ischemic pain. Pentoxifylline (Trental) Heparin sodium for injection is not the same as ________ solution and is not interchangeable. Hep-lock concentrations of hep lock solution is either 10 units/mL whereas heparin for injection is 10,000 units/mL, 20,000 units/mL, or 50,000 units/mL Heparin is a high alert medication and requires another nurse to double check dosage. A major side effect of heparin is bleeding