A
What are two major adverse effects of loop diuretics?
1. hypokalemia
2. hearing loss
What is the antidote for hypermagnesemia?
IV calcium gluconate
What diuretic is contraindicated for patients with a sulfa drug allergy?
Thiazides (hydrochlorothiazide)
What cardiac medications have a grapefruit juice interaction?
Calcium Channel Blockers
Statins
What are the major adverse effects of ACE inhibitors?
1. angioedema
2. Chronic cough
3. hyperkalemia
4. hypotension
How is angioedema treated?
epinephrine
Which diuretic has endocrine effects including gynecomastia and hair growth?
spironolactone
In reviewing the medication records of the following group of clients, the nurse determines that which client would be at greatest risk for developing hyperkalemia?
A) Client receiving furosemide (Lasix)
B) Client receiving bumetanide (Bumex)
C) Client receiving spironolactone (Aldactone)
D) Client receiving hydrochlorothiazide (HCTZ)
C) Client receiving spironolactone (Aldactone)
Adlactone is K sparing. 1, 2 and 4 could result in hypokalemia
What is a major symptom of digoxin toxicity?
halos
Which diuretic can be used in neuro emergencies?
Osmotic (mannitol)
What is an appropriate digoxin serum level?
0.5-2.0
A patient taking digoxin for heart failure reports nausea, vision changes (yellow halos), and palpitations. Labs:
K⁺ = 3.0
Digoxin level = 1.4 ng/mL (therapeutic 0.8–2.0)
HR = 52 bpm
Which interpretation is MOST accurate?
A. Hypokalemia is increasing digoxin toxicity
B. The digoxin level is normal so symptoms are unrelated
C. This is expected as the heart failure worsens
D. The patient is dehydrated from diuretics
A. Hypokalemia is increasing digoxin toxicity
Digoxin toxicity occurs even at normal serum levels when potassium is low.
K⁺ < 3.5 → ↑ digoxin binding → fatal arrhythmias.
Bradycardia + halos + GI upset = classic toxicity.
When is heparin contraindicated?
eye, brain, or spinal cord surgery
What is a possible treatment for hyperkalemia?
IV insulin and glucose
what is the antidote for digoxin?
digibind
What serum potassium level is associated with cardiac arrest?
8-9 mEq/mL
What is the antidote for calcium channel blockers?
glucagon and calcium
Administering a beta-adrenergic antagonist (beta-blocker) to a patient who is receiving a calcium channel blocker may result in which of the following conditions?
a. Hypertension and bradycardia
b. Hypotension and bradycardia
c. Tachycardia and hypertension
d. Tachycardia and hypotension
b. Hypotension and bradycardia
A patient receiving high-dose IV furosemide for pulmonary edema suddenly reports ringing in the ears, dizziness, and extreme muscle weakness. Labs show:
K⁺ = 2.9
Na⁺ = 128
BP = 88/52
What is the MOST critical concern?
A. Severe hypokalemia and ototoxicity
B. Mild dehydration
C. Expected diuresis
D. Worsening heart failure
A. Severe hypokalemia and ototoxicity
Furosemide given too fast IV can cause permanent hearing loss AND dangerous electrolyte imbalances (especially K⁺ < 3.0) → ventricular dysrhythmias → sudden death.
A patient taking warfarin for atrial fibrillation has an INR of 1.4 at today’s clinic visit. The patient states they have not missed any doses. Which recent change is MOST likely responsible for the low INR?
A. Increasing intake of spinach and broccoli
B. Drinking a glass of wine each night
C. Beginning a new walking exercise program
D. Taking acetaminophen for headaches
A. Increasing intake of spinach and broccoli
Spinach, broccoli, kale, and other leafy greens are high in vitamin K, which lowers INR and reduces warfarin’s anticoagulant effect.
The other options do affect the body, but only vitamin K directly reverses warfarin’s action.
What is the antidote for heparin?
Protamine sulfate
What is the antidote for apixaban (eliquis) & rivaroxaban (xarelto)?
AndexXa
What is the antidote for dabigatran (Pradexa)
Praxbind
What is the antidote for Warfarin (Coumadin)?
Vitamin K
A patient taking atorvastatin reports new severe muscle pain and dark-colored urine. Which complication is most concerning?
A. Rhabdomyolysis
B. Dehydration
C. Tendonitis
D. Viral illness
A. Rhabdomyolysis
Statins can cause muscle breakdown (rhabdomyolysis) → releases myoglobin → kidney injury → dark tea-colored urine.
This is a medical emergency.