Summary Eastern Florida State College; NURC1143/ NURC 1143 Exam 3 Complete Study Guide ALL ANSWERS 100% FALL-2021 GUARANTEED GRADEA+

Medication administration-Eye ◆ Mydriatics (apraclonidine/Iopidine) - Dilate the pupil • Reduces IOP 23-39% by stimulating alpha2 & beta2 receptors • Prevents ocular vasoconstriction-reduces ocular bp as well as aqueous humor formation • Used to inhibit perioperative IOP increases rather than treat glaucoma • Burning, eye pain, lacrimation, rare systemic effects: HTN, tachycardia, extrasystoles ◆ Miotics (acetylcholine, pilocarpine)- Constrict the pupil ◆ Cycloplegics (atropine, cyclopentolate) -Paralyze the ciliary body; Have mydriatic properties • Cycloplegia: paralysis of accommodation ◆ Nursing implications • Assess patient’s history including meds • Assess baseline vitals, visual acuity & do physical assessment of eye & surrounding structures • Assess for contraindications to specific drugs • Avoid touching eye w/tip of dropper; Apply ointments as a thin layer in the conjunctival sac • Pressure may be applied to inner canthus for 1 minute to reduce systemic absorption of drug Cholinergic Drugs ◆ Mimic the parasympathetic NS neurotransmitter acetylcholine; Also called miotics, cholinergics ◆ Direct-acting - Acetylcholine (Miochol-E) - Used to produce miosis during ophthalmic surgery ◆ Indirect-acting drugs-Echothiophate (Phospholine iodide) • Cause pupillary constriction (miosis), which leads to reduced IOP caused by increased outflow of aqueous humor • Indications: open-angle glaucoma, angle-closure glaucoma, convergent strabismus (cross-eye), ophthalmologic exams • Adverse effects - Most limited to local effects; If sufficient amounts enter the bloodstream, systemic effect may occur (most likely w/indirect-acting agents): o Hypotension, bradycardia/tachycardia, Headache, NVD, abdominal cramps, asthma attacks Chapter 58: Otic Drugs Medication Administration EAR (2 Q) 1. (Adult) Pull pinna up and back; (Child less than 3) Pull pinna down and back. 2. Allow time for eardrops to flow down into canal. 2. Have the patient lie on side opposite to ear infection for about 5 minutes after instilling. 2. A small cotton ball may be gently placed into ear canal to keep drug in, do not force cotton into ear canal 2. Gently massage tragus of ear to encourage flow of medication. Chapter 57: Opthalmic Drugs - Glaucoma (2 Q) • Glaucoma: elevated pressure w/in eye from obstruction of outflow of aqueous humor. Pressure against the retina destroys neurons, leading to impaired vision & eventual blindness. Inhibition of normal flow. Results in increased intraocular pressure (IOP). Damages optic nerve. o Pressure against the retina destroys neurons, leading to impaired vision & eventual blindness. ▪ Angle closure glaucoma can cause rapid vision loss, less common; Open-angle glaucoma chronic, more common ▪ Also characterized by underlying cause-Primary, Secondary, Congenital Chapter 57: Opthalmic Drugs - Cholinergic (1 Q) • Cholinergic Drugs (miotics) are used to treat glaucoma. o Cholinergic drugs mimic the effect of acetylcholine (neurotransmitter). o Direct-acting and indirect-acting drugs o Cause pupillary constriction (miosis), which leads to reduced IOP caused by increased outflow of aqueous humor • MEDS TO KNOW o Pilocarpine: direct-acting cholinergic. Miotic for chronic open-angle & angle- closure glaucoma. ▪ (Ocusert Pilo-20): applied once weekly by the patient o Timolol: differs slightly from other ophthalmic beta blockers in that it reduces IOP by increasing the outflow of aqueous humor as well as decreases its formation. ▪ It does NOT affect pupil size, accommodation, or night vision o Latanoprost: naturally occurring prostaglandin. Converted by hydrolysis (w/ water from ocular fluids) to prostaglandin F2-alpha, which in turn reduces IOP. ▪ Most drugs allow for single daily dosing because of effects lasting for 20 to 24 hours. ▪ In some persons with hazel, green, or blue/brown eyes, eye color will change permanently to brown. Color change occurs even if the medication is stopped. Chapter 58: Otic Drugs - Otitis Media (1Q) • Common disease of infancy & early childhood; Often preceded by upper respiratory tract infection. • Trauma to tympanic membrane can cause otitis media in adults. • Symptoms - pain, fever, malaise, pressure, sensation of fullness in the ears, or hearing loss. • If untreated, tinnitus, nausea, vertigo, or mastoiditis may occur. • Hearing deficits and hearing loss may result if prompt therapy is not started. Chapter 56: Dermatologic Drugs Medication Dermatologic (5Q) • Bacterial, fungal, and viral drugs. • Oil based medications make them stickier than creams and better for smaller areas. • Creams are water based and are better for larger surfaces; Gels enhance penetration of active ingredient. • Lotions are like creams but are lighter; Powder promotes drying of area where applied • MEDS TO KNOW o Mupirocin: (Topical/ intranasal antibacterial). Used topically for Staph & Strep impetigo ▪ Applied topically tid & intranasally bid to treat MRSA. o Silver sulfadiazine: (Topical anti-infective). To prevent/treat infection for 2nd & 3rd degree burns. ▪ Adverse effects= pain, burning, itching. Do not use in patients who are allergic to sulfonamide drugs. o Clotrimazole: (topical antifungal) used to treat oropharyngeal candidiasis (thrush) & dermatophytosis (athlete’s foot). o Lindane: (topical scabicide & pediculicide) used for scabies, lice, nits. For those intolerant to or who do not respond to other agents. Topical; Does not prevent from getting lice/mites. o Isotretinoin: (antiacne) Oral product. Treats severe resistant cystic acne. Inhibits sebaceous gland activity & has anti-skin hardening & anti- inflammatory effects. Pregnancy category X drugs. Female patients must be counseled & agree not to become pregnant during use Chapter 24: Heart Failure - Action, Nursing Implications and Antidotes for Digoxin (3Q) o Digoxin: indicated for the treatment of heart failure, atrial fib & flutter. Oral and injectable. o Contraindicated-known hypersensitivity & w/ vent. tachycardia & fibrillation. o Normal therapeutic drug levels are b/w 0.5 and 2ng/mL o Levels higher than 2ng/mL are used for the treatment of atrial fibrillation. o Because of Digoxin’s long half-life, a loading “digitalizing” dose is often given to bring serum levels of the drug up to desirable therapeutic level more quickly. o Asses apical pulse for 1 minute before giving product/ If pulse is less than 60 in adult or 90 in infant call prescriber. Monitor ECG continuously during parenteral loading dose. Monitor I and O’s, daily weight, check for edema. Monitor for increase/decrease in potassium. o Low potassium can increase chance for digoxin toxicity. • Antidote: Digoxin immune Fab (Digifab). For reversal of life-threatening cardiotoxic effects. Only in parenteral form. Chapter 24: Heart Failure - Milrinone Adverse Effects (1Q) • Adverse Effects: (inotropic, vasodiolator); Cardiac dysrhythmias, headache, hypokalemia, tremor, thrombocytopenia, and elevated liver enzyme levels. Chapter 24: Heart Failure - Drugs of Choice for Early Treatment of Heart Failure (1Q) • Focus on reducing effects of the renin-angiotensin-aldosterone system & sympathetic nervous system o ACE inhibitors (lisinopril, enalapril, captopril, and others) o ARBs (valsartan, candesartan, losartan, and others) o Certain beta-blockers (metoprolol, a cardioselective beta-blocker; carvedilol, a nonspecific beta-blocker) o Loop diuretics (furosemide) used to reduce the symptoms of HF secondary to fluid overload. o Aldosterone inhibitors (spironolactone, eplerenone) are added as the HF progresses. o Only after these drugs are used is digoxin added. o Dobutamine: positive inotropic drug o Hydralazine/isosorbide dinitrate (BiDil) was 1st drug approved specifically for use in the African-American population. ▪ WATCH THIS Chapter 25: Antidysrhythmic Drugs - Adenosine (Adenocard) (1Q) • Adenosine (Adenocard) o Slows electrical conduction time thru AV node; indicated for the conversion of PSVT (Paroxysmal supraventricular tachycardia) to sinus rhythm. o It is useful when the PSVT has failed to respond to verapamil or if patient has coexisting conditions such as heart failure, hypotension, or left ventricular dysfunction that limit use of verapamil. o Very short half-life—less than 10 seconds; Only administered as fast intravenous (IV) push o May cause asystole for a few seconds Chapter 25: Antidysrhythmic Drugs - Cardizem (1Q) • Diltiazem (Cardizem) o Temporary control of a rapid ventricular response in pts w/ AFib or flutter & PSVT o Very effective for treatment of angina pectoris from coronary insufficiency & hypertension o Contraindications: hypersensitivity, acute myocardial infarction, pulmonary congestion, Wolff-Parkinson-White syndrome, severe hypotension, cardiogenic shock, sick sinus syndrome, or second- or third-degree AV block Chapter 25: Antidysrhythmic Drugs - Adverse Effects (1Q) • Antidysrhythmics: Adverse Effects; ALL antidysrhythmics can cause dysrhythmias! o Hypersensitivity reactions, Nausea, vomiting, and diarrhea, Dizziness, Headache and blurred vision, Prolongation of the QT interval Chapter 25: Antidysrhythmic Drugs - Admiodarone (Cordarone) (1Q) • Amiodarone (Cordarone, Pacerone); Class III Antiarrhythmic o Markedly prolongs the action potential duration & effective refractory period in all cardiac tissues o Blocks both alpha- & beta-adrenergic receptors of the sympathetic nervous system ▪ Uses: one of the most effective antidysrhythmic drugs for controlling supraventricular and ventricular dysrhythmias ▪ Indications: management of sustained ventricular tachycardia, ventricular fibrillation, and nonsustained ventricular tachycardia ▪ Drug of choice for ventricular dysrhythmias according to the Advanced Cardiac Life Support guidelines ▪ Adverse effects: corneal microdeposits (may cause visual halos), photophobia, dry eyes, photosensitivity; pulmonary toxicity ▪ Drug interactions: digoxin and warfarin; Contraindications: hypersensitivity, severe sinus bradycardia or second- or third-degree heart block Chapter 28: Diuretic Drug Spironolactone (1Q) • Spironolactone (Aldactone): potassium-sparing diuretic & aldosterone antagonist- reduces symptoms of HF o Hyperaldosteronism; Hypertension; Reversing potassium loss caused by potassium-losing drugs o Certain cases of HF: prevention of remodeling ▪ Adverse effects - Gynecomastia, amenorrhea, irregular menses, postmenopausal bleeding, Dizziness, headache, cramps, NVD, frequent urination, weakness & hyperkalemia (high K+) ▪ Interactions: Lithium, ACE inhibitors, Potassium supplements, NSAIDs Chapter 28: Diuretic Drug Nursing Implications (2Q) Nursing Implications • Perform a thorough patient history & physical examination. • Assess baseline fluid volume status, Is & Os, serum electrolytes, weight & vital signs (esp. postural BP) • Assess for disorders that may contraindicate/necessitate cautious use of these drugs. • Instruct patients to take the med in the morning if possible to avoid interference w/ sleep patterns. • Monitor serum potassium levels during therapy • Teach patients to maintain proper nutritional and fluid volume status. • Teach patients to eat more potassium-rich foods when taking any, but the potassium-sparing drugs. o Foods high in potassium include bananas, oranges, dates, apricots, raisins, broccoli, green beans, potatoes, meats, fish, and legumes. • Patients taking diuretics w/ a digitalis preparation should be taught to monitor for digitalis toxicity. • Patients w/ diabetes mellitus who are taking thiazide or loop diuretics should be told to monitor blood glucose & watch for elevated levels. • Teach patients to change positions slowly & rise slowly after sitting/lying to prevent dizziness & fainting= orthostatic hypotension. • Encourage patients to keep a log of their daily weight. • Patients ill w/ NVD should notify their primary care providers-fluid and electrolyte imbalances can result. • S&S of hypokalemia include muscle weakness, constipation, irregular pulse rate & lethargy. • Instruct patients to notify their primary care providers immediately if they experience rapid heart rates or syncope (reflects hypotension or fluid loss). • Excessive consumption of licorice can lead to additive hypokalemia in patients taking thiazides. • Monitor for adverse effects: o Metabolic alkalosis, drowsiness, lethargy, hypokalemia, tachycardia, hypotension, leg cramps, restlessness, decreased mental alertness • Monitor for hyperkalemia with potassium-sparing diuretics. • Monitor for therapeutic effects: Reduction of edema; Reduction of fluid volume overload; Improvement in manifestations of HF; Reduction of hypertension; Return to normal intraocular pressures Chapter 28: Diuretic Drug Mannitol (Osmitrol) (1Q) • Most used osmotic diuretic; Intravenous (IV) infusion only w/ filter - May crystallize in bag/tubes when exposed to low temperatures ▪ Indications: Treatment of patients in early, oliguric phase of acute renal failure (ARF) (IRF) o Acute renal failure CAN be reversed o To promote excretion of toxic substances; To reduce intracranial pressure; Treatment of cerebral edema (Mannitol) ▪ Adverse Effects: Convulsions, Thrombophlebitis, Pulmonary congestion Chapter 29: Fluids and Electrolytes - Blood Products (1Q) • Blood Products: Indications o Cryoprecipitate and plasma protein factors ▪ Management of acute bleeding (greater than 50% slow blood loss or 20% acutely) o Fresh-frozen plasma (FFP)-Increase clotting factor levels in patients with demonstrated deficiency o Packed red blood cells (PRBCs) -To increase oxygen-carrying capacity in patients w/ anemia, in patients w/ substantial hemoglobin deficits, & in patients who have lost up to 25% of their total blood volume o Whole blood ▪ Same as for PRBCs except that whole blood is more beneficial in cases of extreme (greater than 25%) loss of blood volume because whole blood also contains plasma ▪ Contains plasma proteins, which help draw fluid back into blood vessels from surrounding tissues Chapter 29: Fluids and Electrolytes - Nursing Considerations for Potassium Administration (1Q) • Nursing Implications o Assess baseline fluid volume, electrolyte status & vital signs. o Assess skin, mucous membranes, daily weights, and input and output. o Before giving potassium, assess electrocardiogram. o Assess for contraindications to therapy & transfusion history. o Establish venous access as needed. o Monitor serum electrolyte levels, infusion rate, appearance of fluid/solution & infusion site. o Observe for infiltration and other complications of IV therapy. ▪ Parenteral infusions of potassium must be monitored closely. ▪ IV potassium must not be given at a rate faster than 10 mEq/hr to patients who are not on cardiac monitors. For critically ill patients on cardiac monitors, rates of 20 mEq/hr or more may be used. ▪ NEVER give as an IV bolus or undiluted ▪ Oral forms of potassium ▪ Must be diluted in water or fruit juice to minimize GI distress or irritation ▪ Monitor for complaints of nausea, vomiting, GI pain, and GI bleeding Chapter 22: Antihypertensive Drugs - Nursing Implications (2Q) • Nursing Implications o Before beginning therapy, obtain a thorough health history & head-to-toe physical exam. o Assess for contraindications to specific antihypertensive drugs & conditions that require cautious use of these drugs. o Instruct patients to check w/ their physicians for instructions on what to do if a dose is missed; patients should never double up on doses if a dose is missed o Monitor BP during therapy; instruct patients to keep a journal of regular BP checks. o Instruct patients that these drugs should not be stopped abruptly because this may cause a rebound hypertensive crisis and perhaps lead to stroke. o Oral forms should be given with meals so that absorption is more gradual and effective. o Administer IV forms with extreme caution and use an IV pump. o Remind patients that medication is only part of therapy. Encourage patients to watch their diet, stress level, weight, and alcohol intake. o Instruct patients to avoid smoking and eating foods high in sodium. Encourage supervised exercise. o Teach patients to change positions slowly to avoid syncope from postural hypotension. o Instruct patients to report unusual shortness of breath; difficulty breathing; swelling of the feet, ankles, face, or around the eyes; weight gain or loss; chest pain; palpitations; and excessive fatigue. o Male patients who take these drugs may not be aware that impotence is an expected effect, and this may influence compliance with drug therapy. o Hot tubs, showers, or baths; hot weather; prolonged sitting or standing; physical exercise; and alcohol ingestion may aggravate low BP, leading to fainting and injury; patients should sit or lie down until symptoms subside. o Patients should not take any other medications, including OTCs, w/o approval of their DR. o Weight loss, Stress management, Supervised exercise, Dietary measures o Monitor for adverse effects (dizziness, orthostatic hypotension, fatigue) and for toxic effects. o Monitor for therapeutic effects. Chapter 22: Antihypertensive Drugs - ACE Inhibitors Indications (Captopril and Lisinopril) (1Q) • Indications o Hypertension and HF (either alone or in combination with diuretics or other drugs) o Slow progression of left ventricular hypertrophy after myocardial infarction (MI)(cardioprotective) o Renal protective effects in patients w/ diabetes o Captopril and lisinopril are NOT prodrugs & can be used if patient has liver dysfunction, unlike other ACE inhibitors that are prodrugs o Prodrugs are inactive in their administered form & must be metabolized in the liver to an active form so as to be effective. Chapter 22: Antihypertensive Drugs - ACE Inhibitors Adverse Effects (2Q) • ACE Inhibitors: Adverse Effects: Fatigue, Dizziness, Headache, Mood changes, Impaired taste, Possible hyperkalemia, Dry, nonproductive cough, which reverses when therapy is stopped o Angioedema: rare but potentially fatal; Note: First-dose hypotensive effect may occur. Chapter 23: Antiangina; Drugs - Nursing Implications for Nitoglycerin/ Contradincations for CCBs (3Q) • Nitrates: long been the mainstay for prophylaxis & Tx for angina & other cardiac problems. Today there are several chemical derivatives of the early precursors, all of which are organic nitrate esters -available in a wide variety of preparations, including sublingual & oral tablets; capsules; ointments; patches; a translingual spray & IV solutions.