HTN/CHF
What is Digoxin?
Use?
What should you monitor prior to administration?
SE?
Signs of Toxicity?
Therapeutic Level?
What relationship does digoxin and potassium possess?
What is the antidote?
As for Digibind, What would be an appropriate goal to evaluate effectiveness?
Digoxin is a cardio glycoside
Used for heart failure
Prior to administration, need to assess digoxin level, potassium, and apical heart rate. At what point would you hold the medication according to heart rate?
Side Effects-
Signs of toxicity-
early: nausea, vomiting, confusion (elderly)
late: green/yellow halos, visual disturbances
Therapeutic level 0.5-1.5
Dig and Potassium are inverse and bind to similar receptors. Therefore, a patient with a low potassium would be more likely to be dig toxic, and this applies in the opposite manner as well.
Digibind is the antidote
Gone for Digibind: Decrease in s/s of toxicity
What medication should be used for Premature Ventricular Contractions (aka PVCs)?
Lidocaine- used to treat ventricular dysrhythmias only. It works by decreasing the myocardial excitability in the ventricles.
What is niacin?
SE?
Instructions?
Used to lower their lipid levels
Niacin can cause flushing, pruritus, and GI distress.
Take NSAID (Aspirin) thirty minutes prior to dose to prevent flushing. Take with meals.
What is warfarin (Coumadin)?
What is a therapeutic INR level for a patient on Coumadin?
Meds that increase efficiency of Coumadin? What would you see with this?
Meds that decrease efficiency of Coumadin? What does you see with this?
How long does it take for this med to work?
Anticoagulant
Therapeutic 2-3 (sometimes 2.5-3.5)
See slide in powerpoint for examples of meds that will increase or decrease efficacy. (One of these medications is Zetia.)
You will see bleeding with an increase.
You will see clothing with a decrease.
3-5 days; may need heparin in the mean time.
What is nesiritide (Natracor)?
vasodilator of arteries and vein
used for severe heart failure; iv drip
Contraindications: dysrhtymia, insomnia, headache, and renal dysfunction
SE: diuresis, natriuresis (sodium loss), and vasodilitation
What is nitroprusside (Nipride)?
What should the nurse monitor?
What are some nursing considerations or interventions?
Potent vasodilator
IV only; given in the ICU
Requires close monitoring of the BP as the patient can experience severe hypotension.
Ideally, patient should not be on this medication for longer than 10 minutes, at which time the nurse should contact the provider. The reason is that it predisposes an individual to cyanide toxicity. What are the signs and symptoms of this? nausea, abdominal pain, confusion, stupor
What is an example of a beta blocker?
How do these meds work?
What is the suffix for these meds?
Potential side effects?
What should you monitor prior to adminstration?
Indications for this medication?
Metoprolol, Labatelol (-lol)
Work by stamping down the SNS, which results in ramping up the PNS. Therefore, signs and symptoms reflect this.... decrease heart rate, decrease blood pressure (as a result of heart rate reduction), potential for bronchial constriction in the beta 2 (can not give to asthmatic patients for this reason), and decrease blood glucose levels.
Prior to administration, be sure that you check an apical heart rate and blood pressure. Hold for apical heart rate less than 60 or systolic less than 100.
HTN, CHF, and Angina
What are -statin medications?
Who are they contraindicated for?
What labs should you monitor?
When should they take them?
Complications?
Lipid lowering agent (HMG-CoA reductase inhibitors)
Liver disease is a contraindication
Liver Failure
Take at night time.
Rhabdomyolysis
How do you give a Lovenox injection?
- Don't aspirate
-Rotate injection sites
-Perform hand hygiene prior
Sustained release meds should not be _____
crushed or chewed.
They must be taken whole.
What medication should be avoided with potent vasodilators? How do you identify these?
Phosodiasterase Inhibitors
-afil
Vasodilators
-Isosorbide Mononitrate, nitro, hydralazine, nitropresside
*A combination of these medications that lead to deadly hypotension.
What is sublingual nitro use?
Instruction for nitro patch?
one tab sublingual every 5 minutes x 3 doses pro chest pain
Keep the nitro in the original bottle. Dark glass with a metal cap with no cotton filler. Instruct clients that a burning sensation felt with sublingual forms indicate that drug still potent.
Remove your nitro patch at bedtime (8 hours) and replace in the morning.
What is albumin?
What does it do?
Who could this be used for?
Colloid
Increase colloid oncotic pressure-move fluid into the intravascular space
shock, burns
What is Heparin?
What lab to you monitor?
Antidote
Anticoagulant- working in the clotting cascade
PTT
Protamine Sulfate
Know the normal levels for PTT
What is epoetin?
Why is it given?
What should be taken with this to increase effeteness?
Increase RBCS
Chronic Renal Failure
Iron- ineffective without iron
What are examples of loop diuretics?
What are examples of potassium sparing diuretics?
What are examples of thiazide diuretics?
What is adjunct therapy?
Electrolyte levels
Lasix (furosemide)
Spirolactone
HCTZ
Combination therapy- spironolactone could be added as heart failure progresses
Need to know what electrolytes are lost/gained with each
What is adenosine?
Adenosine is medication used as "pharmacological cardio version" for the treatment of PSVT (paroxysmal supra ventricular tachycardia) or also know as SVT. When this medication is administered, the nurse must push this medication rapidly and follow up with a 10 ml flush. Shortly after administration, the patient will experience a few second of aystole. The goal is to restore the patient to normal sinus rhythm.
Blood transfusion- review process
What solution do you prime the IV line with?
What assessments should be made?
What are other blood products?
Normal saline
Prior to infusion and during infusion: BP,HR, and Temp
Fluid volume overload- JVD, dyspnea, apical heart rate elevated, wheezing
FFP- clotting factors
RBC
Platelets
Whole Blood
What are antiplatelet medications?
Plavix, Brilinta, Effient, Pletal
Prevent platelet adhesion at the side of blood vessel injury
Who is predisposed to iron deficiency anemia?
Treatment?
Teaching?
Potential complications for IV iron
Pregnant women, women during menstrual cycle
Iron supplements
Black stools
drink liquid from straw to prevent yellow tooth discoloration
IV iron dextran- anaphylactic risk
What are ace inhibitors/arbs?
How do they work?
SE?
HTN, HF
Prevent conversion of angiotensin 1 to angiotensin 2, which is a potent vasoconstriction and promote aldosterone secretion (Therefore, inhibition of this will result in VASODILATION and inhibition of aldosterone secretion. This results in diuresis and decrease blood volume.)
Side Effects
-Hyperkalemia- signs and symptoms?
-Dry nonproductive Cough- with ace inhibitors/ not with arbs
What are calcium channel blockers?
Examples?
SE?
Cause smooth muscle relaxation by blocking the binding of calcium to the receptors. When calcium binds to these receptors, it causes the smooth muscle in the vessels to contract (vasoconstriction).
Card, -mil, -pine
SE: reflex tachycardia, decrease heart rate
Monitor heart rate prior to adminstration
Teaching- avoid grapefruit juice as this could increase efficacy
Isotonic
Hypertonic
Hypotonic
How do these fluids work? What is happening to the cell?
Isotonic- give to patient dehydration related to nausea and vomiting
Hypertonic- low sodium/cerebral edema
Hypotonic-high sodium
What is pernicious anemia?
Med?
When the gastric mucosa can't produce intrinsic factor leading to an inability for vitamin B12 to be absorbed.
cycancobalamin (vit b12)
-oral or IM (also intranasal)
-once remission, give once per month
What is folic acid?
Food sources?
Medical issues due to deficit?
Water soluble B complex vitamin
Spinach, dried beans, peas, oranges, green veggies
Neural Tube defects in unborn children