Cardiac 2
Name a Potassium-Sparing Diuretic
Spironolactone
Triamterene
After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states:
1) I can still use my salt substitute if I want to.
2) I need to take the drug on an empty stomach.
3) I need to make sure I don't eat too many high-potassium foods.
4) I should take the medicine around dinnertime for the best effect.
I need to make sure I don't eat too many high-potassium foods.
Why are the others wrong?
What is the primary organ that processes and affects the metabolism of medications?
The liver
What is the most common antidiabetic medication and what are some of the SE?
Concerend for lactic acidosis especially with impaired kidney or liver function- decreased appetite, nausea, diarrhea, decreased B12 & Folate. Not hypoglycemia.
Because hydralazine can cause a rapid drop in blood pressure, the nurse must monitor for Reflex _______________, which is why the patient is also taking a Beta-blocker.
Tachycardia
The provider adds Hydralazine to Mr. Henderson’s regimen. Based on the "Principles of Therapy" for direct vasodilators, why is it critical that the patient is already taking a Beta-blocker?
A. To prevent the "Lupus-like" syndrome associated with Hydralazine.
B. To blunt the reflex tachycardia caused by rapid vasodilation.
C. To increase the renal excretion of Hydralazine.
D. To prevent the dry cough often caused by vasodilators.
Hydralazine causes rapid arterial dilation, which triggers the baroreceptor reflex. The body attempts to compensate for the drop in BP by increasing the heart rate (Reflex Tachycardia). A Beta-blocker is required to maintain a stable heart rate and prevent increased myocardial oxygen demand.
What diet education would the nurse need to give the patient taking Furosemide (Lasix)- 2 things
↑ Potassium foods and ↓ NA foods
What is Pharmokinetics?
ADME- absorption, distribution, metabolism and excretion
What medication is given to treat hypothyroid and what is important education to provide patients about it?
Levothyroxine and give daily on an empty stomach- ↓ absorption with food and medications.
Direct vasodilators can cause the kidneys to retain sodium and water; therefore, the nurse should assess the patient for peripheral _______________ and monitor daily _______________.
Edema; Weights
The patient is taking both Furosemide (Lasix) and Spironolactone. What is the primary "Principle of Therapy" for combining these two specific diuretics?
A. To provide a synergistic effect while maintaining potassium balance.
B. To prevent the ototoxicity (ear damage) associated with Lasix.
C. To ensure the patient excretes sodium while retaining excess fluid.
D. To protect the liver from the metabolic byproducts of Spironolactone.
Furosemide is a loop diuretic that causes significant potassium loss (hypokalemia). Spironolactone is a potassium-sparing diuretic. By using them together, the nurse achieves a greater diuretic effect (synergy), while Spironolactone helps "offset" the potassium loss caused by Lasix.
Which drug acts as an osmotic diuretic, and what types of patients are they commonly used to treat?
Mannitol and treats increase ICP
What is the primary organ that excretes the majority of medications? What is the 2nd most common mechanism?
Kidney
Feces- through the GI
What information should the nurse provide to the patient diagnosed with type 1 diabetes who is prescribed Lispro?
Give the med subQ, no sooner than 15 min before meals- rapid insulin. Check BS before administering and hold if too low per Dr. parameters. <70
A rare but serious adverse effect of Hydralazine that the nurse must teach the patient to report is a "butterfly" rash or joint pain, known as Drug-Induced _______________
Lupus
If the provider decided to swap Spironolactone for Triamterene, which laboratory value must the nurse monitor most closely to ensure patient safety?
A. Serum Sodium
B. Serum Potassium
C. Serum Magnesium
D. Hemoglobin and Hematocrit
Both Triamterene and Spironolactone are Potassium-Sparing diuretics. The greatest risk with these drugs is Hyperkalemia (Potassium > 5.0 mEq/L), which can lead to fatal cardiac arrhythmias.
What are common things to monitor for with a patient taking statins?
Liver enzymes, creatinine and muscle pain
Define pharmacodynamics
The action that the drug has on body cells
A patient receives 25 units of NPH insulin at 7 AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?
Late afternoon- 8-12 hrs for peak
Mr. Henderson has transitioned to IV Nitroglycerin for a hypertensive crisis. Nitroglycerin primarily dilates the veins, which reduces _______________
Preload
A patient with angina is experiencing chest pain and has taken two doses of sublingual nitroglycerin five minutes apart. Which assessment finding by the nurse requires immediate intervention and notification of the healthcare provider?
A. The patient reports a "strong, throbbing" headache after the first dose.
B. The patient states, "I feel a stinging or tingling sensation under my tongue."
C. The patient becomes cool, clammy, and reports feeling "extremely faint."
D. The patient’s heart rate increases from 82 bpm to 94 bpm.
C is correct- Feeling "extremely faint," especially when combined with cool, clammy skin, is a sign of profound hypotension and potential shock. This indicates that vasodilation has decreased blood pressure sufficiently that brain perfusion is compromised. The nurse should immediately assess the patient's blood pressure, place the patient in the supine position or Trendelenburg, and notify the provider.
A throbbing headache is a common, expected side effect of cerebral blood vessel dilation. A stinging or tingling sensation under the tongue indicates that the medication is chemically active and potent. A mild increase in heart rate is a normal compensatory response (reflex tachycardia) to vasodilation and reduced blood pressure. An increase of 12 bpm is not an emergency in this context.
Name 2 different types of Calcium channel blockers? Name 3 side effects?
pines- nifedipine, amlodipine, etc and Diltiazem and Verapamil.
Ginigval hyperplasia, hypotension, many drug interactions, edema, flushing and dizziness
Prescription practices for controlled substances are monitored by which agency?
Drug Enforcement Agency
How is insulin given- meaning time of day with Sulfonyureas and what is the acronym for this?
BIDS- Bedtime insulin and daytime sulfonyureas
Meaning give the insulin at night and Sulfonyureas in the morning to balance the additive hypoglycemic effects
A very common and expected side effect of Nitroglycerin therapy is a _______________, which can be treated with acetaminophen.
Headache