Study Guide for Pharmotherapeutics Final Exam Spring 2019
The chapters/items we will be focusing on are:
Cardiac medications- antihypertensive drugs
ACE inhibitors- side effects/adverse effects of lisinopril,
● A- angioedema
● C- cough
● E- elevated potassium (hyperkalemia)
● Orthostatic hypotension
● Rash and dysgeusia (altered taste)- usually with captopril
● Leukopenia (sore throat indicates infection)- captopril
Beta-blockers- i.e. metoprolol; vital signs to monitor; adverse effects
● Metoprolol (Beta adrenergic blocker)
○ Adverse Effects:
- Bradycardia
- Monitor pulse. If below 60/min, hold medication and notify the
provider.
- Decreased cardiac output
- AV block
- Obtain a baseline ECG and monitor
- Orthostatic Hypotension
- Rebound myocardium excitation
● Propranolol (Beta Blocker)
○ Special adverse effect:
- Bronchoconstriction
- DO NOT GIVE TO CLIENTS WITH ASTHMA
- Monitor Blood glucose levels
- Monitor ECG and blood pressure (monitor for a drop in BP)
- Monitor clients closely if taking a CCB and a beta-blocker concurrently.
- Take apical pulse prior to giving Metoprolol
What vital sign should the nurse be alert of before administering metoprolol?
- BP of 80/60
Calcium channel blockers- Nifedipine, Amlodipine- monitor for blood pressure; side
effects/adverse effects
● Nifedipine, Verapamil, Diltiazem, Amlodipine
○ Complications:
■ Reflex Tachycardia (special to Nifedipine)
● Monitor client for increased heart rate
● Acute toxicity- resulting in hypotension, bradycardia, AV block and
ventricular tachydysrhythmias
, ○ Monitor vital signs and ECG
● Orthostatic hypotension
● Peripheral edema
● Constipation (primarily verapamil)
● Suppression of cardiac function, Bradycardia, heart failure
● Dysrhythmias QRS complex is widened and QT interval is prolonged
Diuretics- Furosemide- electrolyte imbalance to monitor (hypokalemia); Spinorolactone-
side effects hyperkalemia; drug interactions and electrolyte levels like potassium,
sodium; contraindication of mannitol;
● Furosemide (High-ceiling loop diuretic)
○ Complications:
■ Dehydration, hyponatremia, hypochloremia (below 96 mEq/L)
■ Hypotension
● Monitor BP
■ Ototoxicity
■ Hypokalemia
● K+ less than 3.5
● Teach clients to consume high-potassium foods
■ Other adverse effects:
● Hyperglycemia, hyperuricemia, hypocalcemia, hypomagnesemia,
decrease in HDL cholesterol levels, increase in LDL cholesterol
levels
● Nursing considerations:
○ Assess/monitor for manifestations of dehydration: dry mouth, increased
thirst, minimal urine output, and weight loss
○ Monitor electrolytes
■ Potassium (K+ 3.5-5)
○ Report urine output less than 30 mL/hr
○ Monitor blood glucose, uric acid, calcium, magnesium, and lipid levels
○ Monitor digoxin levels (normal 0.5-2.0 ng/mL)
● MONITOR POTASSIUM- HYPOKALEMIA
● Mannitol
○ This medication is contraindicated in clients who have active intracranial bleed,
anuria, severe pulmonary edema, severe dehydration, and renal failure
○ Use extreme caution in clients who have heart failure, are pregnant or
breastfeeding, renal insufficiency, and electrolyte imbalances
○ Adverse effect- bibasilar crackles
● Spironolactone
○ Complications:
■ Hyperkalemia, hyponatremia
● Monitor serum potassium and sodium levels periodically.
● Normal potassium is 3.5-5.0 mEq/L
● Signs of hyperkalemia → paresthesia, tingling of the hands
, and feet, flu-like symptoms: fatigue, headache, diarrhea,
abdominal pain, cough
■ Endocrine effects
● Deepened voice, impotence (males)
● Irregularities of menstrual cycle (females)
■ Drowsiness, metabolic acidosis
○ MONITOR Potassium and Sodium
Which of the following diuretics can cause hypokalemia except:
- Aldactone (potassium sparing diuretic)
Cardiac glycosides_ DIGOXIN- therapeutic levels; signs of adverse reactions and nursing
action; vital signs to monitor; interaction with grapefruit and other drugs
● Complications:
○ Bradycardia
○ Hypotension
○ Toxicity
● Optimal therapeutic level is 0.5- 2.0 ng/mL
○ Monitor for Digoxin toxicity- anorexia, nausea, vomiting, visual disturbances,
dysrhythmias
● Nursing Considerations:
○ Monitor apical heart rate. Hold dose for heart rate less than 60/min
○ Monitor digoxin level (0.5-2.0)
○ Monitor potassium level. Hypokalemia increases risk for toxicity; keep potassium
level between 3.5-5.0 mEq/L
● Contraindications/Precautions:
○ Pregnancy Risk Cat. C
○ Contraindicated in clients who have ventricular tachycardia or ventricular
fibrillation not caused by heart failure
○ Use cautiously in clients who have AV block, bradycardia, kidney disease,
hypothyroidism, and cardiomyopathy
● Interactions:
○ Amiodarone, quinidine, verapamil, diltiazem, propafenone, and flecainide are
antidysrhythmics increase digoxin levels.
■ NURSING CONSIDERATIONS: Monitor for medication level and for
toxicity. Reduce medication dosage if needed.
○ Corticosteroids, diuretics, thiazides, and amphotericin B can cause decreased
potassium level.
■ Monitor potassium and monitor medication levels for toxicity
○ Antacids and metoclopramide can decrease digoxin absorption
Study your laboratory values, i.e. Potassium, sodium, magnesium, BUN, creatinine, AST,
ALT, PT/INR and aPTT, platelet levels
The chapters/items we will be focusing on are:
Cardiac medications- antihypertensive drugs
ACE inhibitors- side effects/adverse effects of lisinopril,
● A- angioedema
● C- cough
● E- elevated potassium (hyperkalemia)
● Orthostatic hypotension
● Rash and dysgeusia (altered taste)- usually with captopril
● Leukopenia (sore throat indicates infection)- captopril
Beta-blockers- i.e. metoprolol; vital signs to monitor; adverse effects
● Metoprolol (Beta adrenergic blocker)
○ Adverse Effects:
- Bradycardia
- Monitor pulse. If below 60/min, hold medication and notify the
provider.
- Decreased cardiac output
- AV block
- Obtain a baseline ECG and monitor
- Orthostatic Hypotension
- Rebound myocardium excitation
● Propranolol (Beta Blocker)
○ Special adverse effect:
- Bronchoconstriction
- DO NOT GIVE TO CLIENTS WITH ASTHMA
- Monitor Blood glucose levels
- Monitor ECG and blood pressure (monitor for a drop in BP)
- Monitor clients closely if taking a CCB and a beta-blocker concurrently.
- Take apical pulse prior to giving Metoprolol
What vital sign should the nurse be alert of before administering metoprolol?
- BP of 80/60
Calcium channel blockers- Nifedipine, Amlodipine- monitor for blood pressure; side
effects/adverse effects
● Nifedipine, Verapamil, Diltiazem, Amlodipine
○ Complications:
■ Reflex Tachycardia (special to Nifedipine)
● Monitor client for increased heart rate
● Acute toxicity- resulting in hypotension, bradycardia, AV block and
ventricular tachydysrhythmias
, ○ Monitor vital signs and ECG
● Orthostatic hypotension
● Peripheral edema
● Constipation (primarily verapamil)
● Suppression of cardiac function, Bradycardia, heart failure
● Dysrhythmias QRS complex is widened and QT interval is prolonged
Diuretics- Furosemide- electrolyte imbalance to monitor (hypokalemia); Spinorolactone-
side effects hyperkalemia; drug interactions and electrolyte levels like potassium,
sodium; contraindication of mannitol;
● Furosemide (High-ceiling loop diuretic)
○ Complications:
■ Dehydration, hyponatremia, hypochloremia (below 96 mEq/L)
■ Hypotension
● Monitor BP
■ Ototoxicity
■ Hypokalemia
● K+ less than 3.5
● Teach clients to consume high-potassium foods
■ Other adverse effects:
● Hyperglycemia, hyperuricemia, hypocalcemia, hypomagnesemia,
decrease in HDL cholesterol levels, increase in LDL cholesterol
levels
● Nursing considerations:
○ Assess/monitor for manifestations of dehydration: dry mouth, increased
thirst, minimal urine output, and weight loss
○ Monitor electrolytes
■ Potassium (K+ 3.5-5)
○ Report urine output less than 30 mL/hr
○ Monitor blood glucose, uric acid, calcium, magnesium, and lipid levels
○ Monitor digoxin levels (normal 0.5-2.0 ng/mL)
● MONITOR POTASSIUM- HYPOKALEMIA
● Mannitol
○ This medication is contraindicated in clients who have active intracranial bleed,
anuria, severe pulmonary edema, severe dehydration, and renal failure
○ Use extreme caution in clients who have heart failure, are pregnant or
breastfeeding, renal insufficiency, and electrolyte imbalances
○ Adverse effect- bibasilar crackles
● Spironolactone
○ Complications:
■ Hyperkalemia, hyponatremia
● Monitor serum potassium and sodium levels periodically.
● Normal potassium is 3.5-5.0 mEq/L
● Signs of hyperkalemia → paresthesia, tingling of the hands
, and feet, flu-like symptoms: fatigue, headache, diarrhea,
abdominal pain, cough
■ Endocrine effects
● Deepened voice, impotence (males)
● Irregularities of menstrual cycle (females)
■ Drowsiness, metabolic acidosis
○ MONITOR Potassium and Sodium
Which of the following diuretics can cause hypokalemia except:
- Aldactone (potassium sparing diuretic)
Cardiac glycosides_ DIGOXIN- therapeutic levels; signs of adverse reactions and nursing
action; vital signs to monitor; interaction with grapefruit and other drugs
● Complications:
○ Bradycardia
○ Hypotension
○ Toxicity
● Optimal therapeutic level is 0.5- 2.0 ng/mL
○ Monitor for Digoxin toxicity- anorexia, nausea, vomiting, visual disturbances,
dysrhythmias
● Nursing Considerations:
○ Monitor apical heart rate. Hold dose for heart rate less than 60/min
○ Monitor digoxin level (0.5-2.0)
○ Monitor potassium level. Hypokalemia increases risk for toxicity; keep potassium
level between 3.5-5.0 mEq/L
● Contraindications/Precautions:
○ Pregnancy Risk Cat. C
○ Contraindicated in clients who have ventricular tachycardia or ventricular
fibrillation not caused by heart failure
○ Use cautiously in clients who have AV block, bradycardia, kidney disease,
hypothyroidism, and cardiomyopathy
● Interactions:
○ Amiodarone, quinidine, verapamil, diltiazem, propafenone, and flecainide are
antidysrhythmics increase digoxin levels.
■ NURSING CONSIDERATIONS: Monitor for medication level and for
toxicity. Reduce medication dosage if needed.
○ Corticosteroids, diuretics, thiazides, and amphotericin B can cause decreased
potassium level.
■ Monitor potassium and monitor medication levels for toxicity
○ Antacids and metoclopramide can decrease digoxin absorption
Study your laboratory values, i.e. Potassium, sodium, magnesium, BUN, creatinine, AST,
ALT, PT/INR and aPTT, platelet levels
