PHARMACOLOGY HESI REVIEW MEDICATION

PHARMACOLOGY HESI REVIEW MEDICATIONCardiac Drugs/Diuretics • Digoxin – positive inotrope (increases force of contraction); negative chronotrope (decreases heart rate). How do you assess for this? (Always take AP for a full minute!) • Client with long hx of daily digoxin and furosemide (Lasix) use; creates a high risk for dig toxicity (Lasix can cause hypokalemia, which can lead to dig toxicity) • Digoxin toxicity – know normal digoxin level (0.5 – 2 ng/mL); serum potassium (K+) level (3.5 to 5.0 mEq/L); low potassium or magnesium levels may increase risk for digoxin toxicity; S/S of dig toxicity include anorexia, bradycardia, headache, dizziness, confusion, nausea, and visual disturbances (blurred vision, yellow vision, and/or halo vision); hold digoxin if AP less than 60. • Labetalol (beta blocker) for HTN: Notify prescriber for low pulse rate and do not give med; SE is weight gain (fluid retention) – pulmonary assessment (which is…). Remember monitoring weight is one of the best indicators of fluid gain or loss – 1 kg (2.2 lb) = 1,000 mL fluid gain or loss in 24 hrs. • Nitroglycerin transdermal patch for treating chest pain (angina) – remove at night to allow 8 hours without patch (can produce tolerance in 24 hours); may use SL nitro when wearing patch if patient having chest pain • Why wear gloves when applying nitroglycerin paste or patch? (severe vasodilation, ↓BP, intense HA [may give acetaminophen for HA]) • Angina – for chest pain, if VS OK, leave nitro patch on and administer PRN SL nitro • Pt. in CCU/ICU on nitro drip; becomes hypotensive, decrease rate of nitro drip • Calcium channel blockers – dipine (like amlopidine) and verapamil (Calan) and diltiazem (Cardizem). – dipine affect vessels only (vasodilation). SE: dizziness, facial flushing, hypotension, edema. Verapamil (Calan) and diltiazem (Cardizem) also affect heart. Monitor BP, HR (↓). Constipation is SE. Avoid grapefruit juice. • Aliskiren (Tekturna) – (direct renin inhibitor for HTN); teach don’t take if pregnant (stop drug if become pregnant); don’t take with high fat meal. May increase K+, so don’t take with other drugs that ↑ K+. • Furosemide (Lasix) – loop diuretic; rapid acting; used for rapid diuresis in emergencies (pulmonary edema); may produce hypokalemia (assess for muscle cramps, muscle weakness). Hypotension, F/E abnormalities, dehydration. SE: dizziness, HA, tinnitus, N/V/D, ↓ K+, hyperglycemia, ototoxicity with aminoglycosides (-mycin drugs). • May need potassium supplement. Foods containing potassium: dried fruits, fish, leafy veggies, squash, beans, meats, nuts, bananas, potatoes, dairy products. • IV potassium (KCl) – assess overall condition of the veins. Use large vein, like antecubital (AC) vein when administering potassium. Venous access is important because IV potassium can irritate the vein. Have patient notify nurse immediately if burning at site. IV K+ extravasation can cause necrosis of tissues. Calculate and set the rate as ordered, know anticipated duration of therapy, know restrictions imposed by patient’s history. Don’t give IV push; infuse at a rate no greater than 20 mEq/hr; concentration no greater than 40 mEq/L. Always use infusion pump. Assess IV site every hour. • Antihypertensives and low potassium (K+); hypokalemia. Antihypertensive effects are more pronounced in the elderly. • Osmitrol (Mannitol) – osmotic diuretic; effectiveness determined by ↓ ICP. NOT used for peripheral edema; used to treat pt. with closed head injury; effective response is decreased ICP