Synesthesia
What is a potential adverse effect we would watch for with all anticoagulants?
BLEEDING!!!!
What is a potential adverse effect we would watch for with all antidysrhythmics?
A DYSRHYTHMIA!!!!
What is the juice of evil for pretty much all of pharmacology?
GRAPEFRUIT JUICE!
It decreases medication effectiveness. This isn't new, but I saw it mentioned a lot. Like....A LOT a lot for some reason.
Describe the differences between systole and diastole
Systole is the phase when the heart muscles contract to pump blood out of the heart. (Think systole/squeeze. Heart squeezes when it pumps)
Where should a self administered dose of an indirect thrombin inhibitor be given?
Deltoid
Abdomen
Back of Arm
Abdomen
Heparin and enoxaparin (Lovenox) are indirect thrombin inhibitors. Self-administered doses of these meds should be given sub Q, and while the back of the arm is an appropriate sub Q site, that wouldn't be a safe place for someone to give themselves an injection. Deltoid is an IM site, leaving the abdomen as your last remaining option.
Common side effect of ASA overdose?
tinnitus/ototoxicity
T or F: If a patient fails lifestyle changes and they are put on an antilipidemic, we no longer need to ask if they are continuing their lifestyle modifications.
False
Patients should still maintain their lifestyle changes to avoid needing additional medications (and to further promote a healthy lifestyle), as dyslipidemia is also a cardiac risk. It would be the medical team's responsibility to ensure the patient is keeping up with those changes.
Name four lab values that may be obtained for patients taking a statin
ALT
AST
LDL
HDL
Total cholesterol
Triglycerides
Cholesterol to HDL ratio
CK (sometimes)
Of all the antidysrhythmics we discussed, which was the only one intended to treat bradydysrhythmias?
Atropine
The rest are used to treat tachydysrhythmias
What are gemfibrozil and fenofibrate used to treat?
Dyslipidemia/hyperlipidemia
Specifically they are fibrates that decrease triglycerides and increase HDL. No cute way to remember these meds so just wanted to call out what class they are as a reminder.
Your patient just started simvastatin, which complaint warrants immediate intervention?
Shortness of breath
Muscle pain
Tingling sensation in the hands
Excessive drowsiness
Muscle pain
Could be a precursor to rhabdomyolysis which can be fatal. The other complaints, while noteworthy and warrant investigation, don't pose the most immediate risk to the patient.
What is rhabdo? Painful breakdown of muscle fibers characterized by unexplained muscle pain. During rhabdomyolysis, contents of muscle cells spill into the systemic circulation causing potentially fatal acute renal failure. S/S of rhabdo include dark or red/brown urine and severe muscle pain
Which of the following would we not advise our patient on regarding warfarin use?
"It's important to eat lots of green leafy vegetables high in vitamin K to help the warfarin work more effectively"
"You will need to get regular blood tests to ensure the warfarin is in a safe range and working properly"
"Report any signs of bleeding, like red/brown urine or dark stool"
It's important to lots of green leady vegetables high in vitamin K to help the warfarin work more effectively
A balanced diet including green leafies is important, but vitamin K is the antidote for warfarin so a diet high in vitamin K would counteract the drug making in ineffective. The other options are appropriate to teach the patient.
What pt education would you give to someone who started taking a statin? Select all that apply:
Most patients are on multiple statins due to their low efficacy
Once started on this medication you may have to take it for the rest of your life
Maintain your lifestyle changes to avoid having to take other types of medications
Alcohol use won't affect your condition as long as you don't binge drink
Once started on this medication you may have to take it for the rest of your life
Maintain your lifestyle changes to avoid having to take other types of medications
Which of the following would not improve cardiac output?
Increasing afterload
Increasing inotropy
Increasing contractility
Increasing afterload
Afterload is the pressure your heart must pump against to get the blood out of the heart. Increasing this pressure would decrease cardiac output, not improve it. The question was asking which would not improve cardiac output, making this the correct answer.
Increasing the strength of the contraction (inotropy) and increasing the contractility would both improve cardiac output, making them incorrect answers here.
What three important things do we check before giving digoxin?
Hint: one is an RN Ax, two are labs
60 second apical pulse (hold if less than 60)
Dig level (If over 1.8ng/ml hold and call the doc. Recall has a very narrow therapeutic window and a long half-life, meaning toxicity, which can be fatal, is easy to achieve)
Potassium level (High K can decrease the effectiveness of the digoxin. Low K levels increase potential for toxicity which can be fatal. Tx is IV infusion of digoxin immune fab [Digibind], which contains antibodies specific for digoxin)
Which is the best descriptor of antilipidemic pharmacokinetics?
They work by causing the body to burn cholesterol more quickly
They work by preventing fatty build up in the vessels
They work by increasing cholesterol absorption so it doesn't build up
They work by lowering cholesterol in the body
They work by lowering cholesterol in the body
Direct Thrombin Inhibitors work by:
Dissolving preexisting clots
Binding with thrombin to prevent formation of new clots
Preventing platelet aggregation
Inhibiting vit K, which in turn suppresses the hepatic synthesis of coagulation factors
Binding with thrombin to prevent formation of new clots
Dissolving preexisting clots = thrombolytics
Preventing platelet aggregation = antiplatelets
Inhibiting vit K, which in turn suppresses the hepatic synthesis of coagulation factors = Vitamin K antagonists (warfarin)
Name four specific lifestyle changes that we would recommend to a patient prior to starting them on a statin for dyslipidemia.
Maintain weight at an optimal level (BMI 18.5–24.9)
Increase physical activity (work up to doing at least 30 min of moderate exercise 5x/wk or vigorous aerobic activity for 20 min 3x/wk. Should be monitored by doc to deter injuries)
Reduce dietary saturated fats, trans fats, and cholesterol
Increase soluble fiber in the diet such as that found in oat bran, apples, beans, and broccoli
Eat foods rich in omega-3 fatty acids (salmon, mackerel, herring, walnuts and flaxseeds)
Eliminate tobacco use
Minimize ETOH use
While reviewing the EKG after administration of adenosine, what would we expect to see that shows the medication worked as expected?
A temporary period of asystole followed by NSR / a conversion from a tachy rhythm to NSR / decreased HR.
Remember this is the medication that literally pauses the heart to break the cycle of the dangerously high rate it's in, slowing it down. The pause in the heart is seen as asystole on the EKG strip.
What are three critical things to monitor while administering milrinone?
This med is a phosphodiesterase inhibitor used for heart failure. RNs should monitor:
EKG
Electrolytes (especially potassium)
BP (monitoring for hypotension)
Urine output (helps tell us med is working, and is an indication of kidney health)
How long they've been on the med (should only be used for 2-3 days due to potential for serious toxicity)
Which coagulation medication has side effects of flu-like Sx, rash and pruritus?
alteplase
clopidogrel
Warfarin
clopidogrel
What lab test is used to monitor warfarin dosing?
PT/INR.
Teach patient that they will need regular monitoring for the duration they're on the med.
Which is a potential side effect of lidocaine when used for treatment of arrhythmias (select all that apply)?
Dry mouth
Altered LOC
Headache
Numbness/tingling
Altered LOC and numbness/tingling.
Sodium channel blockers are not often used to treat dysrhythmias d/t their CNS toxicity which can manifest as paresthesia, confusion, numbness, tingling, altered LOC
Aside from cardiac, what body system should be frequently checked for adverse reactions in patients taking amiodarone?
Respiratory system
"Amiodarone causes a pneumonia-like syndrome in the lungs. Because the pulmonary toxicity may be fatal, baseline and periodic assessment of lung function is essential" - textbook pg 416
What is the antidote for factor Xa inhibitors?
Vitamin K
Protamine Sulfate
Andexanet alfa
Andexanet alfa
Vitamin K is the antidote for warfarin
Protamine Sulfate is antidote for heparin