PHARM 2 Pharmacology Final Exam Study Guide Complete

PHARM 2 Pharmacology Final Exam Study Guide Digoxin discharge teaching, what must a client know how to do? TAKE THEIR PULSE, 0.5-2.0 NORMAL THERAPEUTIC DOSE, HOLD MEDS IF PULSE IS UNDER 60, IF LEVEL IS NOT THERAPUETIC ADJUST THE DOSE. What is main thing you need to ‘assess’ while on digoxin? PULSE^^^ How to monitor and interpret labs for potassium wasting diuretics (HCTZ). Know Normal potassium ranges. 3.5-5.0 IS NORMAL Nursing interventions-should you give potassium wasting diuretic if K+ is out of range? NO! BECAUSE IT CAN CAUSE DISRHYTHMIAS OR HYPERKALEMIA. IF ITS TOO LOW IT CAN CAUSE DISRHYMIAS, TOO HIGH CAN CAUSE LETHAL DISRHYTHMIAS What are potassium rich foods? SPINACH, BANANAS, POTATOES, APRICOTS, WHITE BEANS CAUTION IF PATIENT GAINS 2 LBS IN 24 HOURS OR 5 LBS IN A WEEK. THIS INDICATES MEANS HEART FAILURE (EDEMA). HYDROCHLOROTHIAZIDE IS A POTASSIUM WASTING DIURETIC- MEANS YOUR LOSING MORE POTATSSIUM WHEN YOU’RE TAKING IT. IF POTASSSIUM IS LOW DON’T GIVE MEDS BECAUSE IT WILL MAKE IT LOWER. Actions of ACE inhibitors, think about chronotropic, inotropic etc. Why is it given and what are it’s effects on the heart? –(reduces workload by decreasing fluid volume) ACE INHIBITIOR IS A VASODILATOR. REDUCES WORK LOAD AND DECREASES FLUID VOLUME. OPENS BLOOD VESSELS SO BLOOD DOESNT HAVE TO WORK SO HARD TO PUSH THROUGH SYSTEM IT BLOCKS ANGIOTENSIN 2 AND CAUSES DIURESIS BECASUE IT BLOCKS ELDOSTERONE. IT DECREASESS FLUID VOLUME. what meds should you not take with grapefruit juice- calcium channel blockers should not be taken Client teaching with use of nitro and other vasodilators- IT’S NOT GIVEN SO THEY CAN CONTINUE TO DO THE ACTIVITY THEY RAE DOING. TYPICALLY GIVING FOR ANGINAL PAIN WHICH IS USUALY CAUSED BY ACTIVITY. DON’T HAVE PATIENT CONTINUE ACTIVTY, HAVE THEM REST. GIVE WHEN PATIENT IS SITTING AND HAVE THEM REST AFTER. GIVEN IN 3 DOSES BUT HAVE TO BE TAKEN 5 MINUTES APART, OTHERWISE BLOOD PRESSURE WILL DROP TOO DRAMATICALLY IF NOT 5 MINUTES APART (WANT BP TO DROP BUT NOT RAPIDLY). HAVE PATIENT SIT AND REST AFTERWORDS should they continue to perform a task causing pain? How much time should be between each dose of nitro? How do calcium channel blockers work in the heart, the rest of the body? What is it used for? And how does it work on the heart? (vasodilator- what does that mean?) by blocking the entry of calcium, calcium channel blockers reduce electrical conduction within the heart, decrease the force of contraction (work) of the muscle cells, and dilate arteries. Dilation of the arteries reduces blood pressure and thereby the effort the heart must exert to pump blood. When to hold beta blockers-what do they impact? HOLD ON PULSE UNDER 60, DON’T GIVE IF SYSTOLIC IS UNDER 100. THEY WORK BY LOWERING THE BLOOD PRESSURE BY BLOCKING EPINEPHRINE. HR, BP, should be checked before given what are the parameters to hold? Minipress for HTN teaching- what should patient do after taking it since it can cause lightheadedness CHANGE POSITIONS SLOWLY. WHEN GETTING UP, SIT UP BEFORE THEY STAND UP. When should we tell clients to take diuretics? Morning, afternoon, bedtime? TAKE IN THE MORNING. IF TWO DOSES, TAKE ONE IN AM AND ONE IN THE AFTERNOON. TAKE AS EARLY AS THEY GET UP. If taken too late in the afternoon it can disrupt sleep-pt will need to get up to pee. Taking them at night can also lead to falls Use of potassium as a supplement, when to give, when to hold NEVER CHEW IT. IT EFFECTS HEART SO GIVING TOO MUCH CAUSES LETHAL DISRHYTHMIAS. What is normal potassium ranges? Antidote for heparin =protamine sulfate THIS WILL BE ON TEST! Antidote for Coumadin= vit K GIVE WHEN COUMADIN IS OUT OF RANGE, ADN YOU CANNOT GIVE WITHOUT DOCTOR ORDERS. Importance of daily weights in monitoring heart failure Heart failure means more fluids on board, peripheral edema is a late sign, once that happens heart and lungs are already filling with fluid- weights are better indicator of excess fluid than peripheral edema for early diagnosis or worsening heart failure- suddenweight gain of more than 2 lbs in 24 hours (=a liter of extra fluid on board) heart failure pts. Fluid retention=heart failure, Should take it easy with light activity if patient is filling with fluid and its not working they need a higher dose Interactions of Coumadin and antibiotics, what happens to INR levels and what may we need to do? Spinach and herbs alter Coumadin effects, antibiotics alter effects RANGE IS 2-3.5 IS THERAPEUTIC FOR INR LEVEL TO ADJUST COUMADIN. LOWER DOSE OF COUMADIN IF IT EFFECTS INR LEVELS Side effects of ACE inhibitors **cough** **cough** KNOW THIS FOR TEST! When to hold digoxin (lanoxin), what are the side effects of digoxin, client complaints/ symptoms s/s=bradycardia, nausea, altered vision (yellow/green halos) IF LEVEL IS TOO HIGH GREATER THAN 2 IT EFFECTS THERAPEUTIC RANGE Remember salt substitutes are often made of potassium, which type of diuretic should you avoid. DON’T TAKE ALDACTONE WITH SALT SUBSTITUTE Salt substitutes contain potassium do not take with potassium sparing diuretics (Aldactone) potassium sparing = does not decrease levels of potassium potassium wasting=potassium is lost while taking them KNOW THESE! Side effects of cholesterol medications, impacts on muscles (think where they are metabolized) Know which medications these are (names of statins) KNOW LIPITOR IS A STATIN FOR TEST!!!! SIDE EFFECTS INCLUDE RHABDOMYOLYSIS (BAD FOR LIVER, CAUSES TREMORS, MUSCLE RIGITITY. ALL STATINS EFFECT LIVER SO MONITOR LIVER FUNCTION. STATINS INCREASE GOOD C