Antihypertensive
Prior to administering a beta blocker, what is the most important health history to confirm?
PMHX of Asthma/COPD
What antihistamines are considered non-sedative?
Second generation antihistamines:
Loratadine (Claritin)
Fexofenadine (Allegra)
Cetirizine (Zyrtec)
Name at least 4 drug classes that are used for management of Dyslipidemia.
•Hydroxymethylglutaryl–Coenzyme A (HMG–CoA) Reductase Inhibitors (or Statins)
•Bile Acid Sequestrants (Cholestyramine)
•Niacin (Vitamin B3, Nicotinic Acid)
•Fibric Acid Derivatives/Fibrates (Gemfibrozil)
•Cholesterol Absorption Inhibitor (Zetia)
What are anticoagulants?
Name 4 anticoagulants.
Medications that inhibit the coagulation of blood. They do not lyse (break) the clots.
Heparin, Enoxaparin, Warfarin, Rivaroxaban
All antidysrhythmics can cause what?
Dysrhythmia
In regard to CCBs, what nursing education should be provided to the client? Please name 3 common CCBs.
"Common side effect is Constipation, so you need to increase fiber and fluid intake."
"You need to contact your HCP if you have dizziness."
"Do not take with Grapefruit Juice."
Amlodipine, Verapamil, Nifedipine, Diltiazem
What are Antitussives supposed to do and what are the 2 types?
Antitussives suppress the cough reflex (They stop nonproductive cough).
2 types: Opioid & Nonopioid Antitussives
Which lab value(s) is a contraindication for administering Atorvastatin? Select all that apply.
A. AST: 10
B. BUN: 50
C. ALT: 250
D. Creatinine: 5.63
E. K+: 4.8
B. BUN: 50
C. ALT: 250
D. Creatinine: 5.63
What labs need to be checked when giving Heparin and Warfarin?
What are the therapeutic levels?
Heparin: aPTT & INR (aPTT: 60-80 sec)
Warfarin: PT & INR (INR:2-3)
What is the priority nursing intervention when administering Verapamil IV to a client with SVT?
What drug class is this?
Monitoring for Hypotension
CCB
Which drug class is Doxazosin?
What are the common side effects?
When should Doxazosin be taken and why?
Alpha-1 Blocker
First-dose Hypotension & First-dose Syncope.
Taken before bed or at night due to the risk of first-dose hypotension & first-dose syncope.
A client is prescribed Diphenhydramine for allergies.
What are the Side effects?
What nursing instructions should be provided?
SE: dry eyes, dry mouth, urinary retention, constipation, dizziness.
"The medication can cause dry mouth, so you can suck on sugar-free hard candy."
How does Niacin work?
What are the common side effects?
What can we do to prevent these side effects?
Increases activity of lipase, which breaks down lipids.
Common side effects: Flushing, Pruritus, GI distress
Prevention: Small doses of Aspirin or a NSAID may be taken 30 minutes before Niacin to minimize cutaneous flushing.
A client has been prescribed Warfarin for A. Fib. What nursing education should be provided? Provide at least 5.
Increased risk for bleeding.
Keep green, leafy vegetables consistent and low.
Shave with an electric razor.
Use a soft bristle toothbrush.
PT & INR will need to be monitored regularly.
Do not take any other anticoagulants or NSAIDs; use Acetaminophen for pain.
ETOH, cranberries, garlic, ginger, and ginkgo biloba can increase effects. St. John's wort will decrease effects.
Which medication is one of the most effective antidysrhythmic drugs for controlling ventricular dysrhythmias.
What should the RN educate to the client?
Amiodarone
Educate client about adverse effects: visual halos, photophobia, dry eyes, pulmonary toxicity.
LIMIT OR AVOID CAFFEINE.
Please explain which suffix is used to distinguish beta blockers from other antihypertensives. When should this medication be held? What nursing education should be given?
Suffix: "-lol"
-olol: Selective and Nonselective beta blockers
-alol or -ilol: Nonselective adrenergic blockers
Should be held if HR is below 60 and systolic BP is below 100.
Educate on taking HR and BP prior to taking medication, reposition slowly, may cause impotence!
A client CC is having a constant runny nose. The provider prescribes a Decongestant for it.
Name a possible decongestant.
How should it be administered?
What types of clients should not take Adrenergic Decongestants?
Phenylephrine
Administer nasal spray into each nostril for no more than 3 days - Can cause Rebound Congestion. Sprays do not last as long as Systemic medications.
Clients with HTN or possible HTN should not take Adrenergic Decongestants (Sympathomimetics).
A 55-year-old female has been newly prescribed Simvastatin 10mg PO qHS 2 weeks ago. She contacts the RN and asks if her LDL is better now since she has been experiencing muscle cramps. How should the RN respond?
It can take up to 4 weeks for the medication to work. If you are experiencing any muscle cramps, you need to come back to office due to risk of rhabdomyolysis.
What is unstable angina? Which medication should be given if this occurs? Explain the protocol when taking this medication.
A condition where the heart does not get enough blood flow and oxygen. It is considered "unstable" when the chest pain does not go away.
Drug of Choice: Nitroglycerin (sublingual route)
1. Take 1st dose at the onset of chest pain.
2. Call 911 if one tablet does not relieve pain after 5 minutes, and then take 2nd dose.
3. After another 5 mins, take 3rd and LAST dose.
What is Milrinone used for?
How should it be administered?
Used for severe HF or Dysrhythmia.
Should be administered IV and in a separate line.
Which drug class is usually the first to be prescribed to client with new onset of HTN?
What are common adverse effects of this class?
What should the RN educate to the client on?
ACE Inhibitors: medications ending in "-pril". Examples: Lisinopril, Captopril
Common Adverse Effects: Dry cough, Hyperkalemia, Angioedema.
Educate - Not to take an Antitussive. And, not to use salt substitutes.
Please explain which medication would be given during an ACUTE Asthma attack.
What is given for maintenance treatment?
What are the common side effects of Albuterol?
Acute: Albuterol (Short-acting beta-2 agonist)
Maintenace: Ipratropium, Montelukast, Theophylline.
Side effects of Albuterol: TREMORS & ANXIETY.
A 67-year-old client has just been prescribed Cholestyramine. Explain how this medication works, when it should be taken, and common side effects.
MOA: Prevents resorption of bile acids from small intestine resulting in lipids not entering the bloodstream.
Should be taken 1 hour after or 4 to 6 hours before other medications.
SE: Nausea, bloating, constipation
Explain how Nitroglycerin works, how to administer Nitroglycerin patch, and what nursing education should be provided.
MOA: Causes vasodilation by relaxation of vascular smooth muscles.
Patch should be placed in a hairless area and rotate sites.
Client needs to remember to remove old patch before placing a new one & clean old sites.
Patch should be removed for 8-12 hrs daily due to the risk of tolerance.
A client has been hospitalized for CHF and the RN is about to give him his morning medications. These include the following: Digoxin and Torsemide.
What S&S would prompt the RN to not give these medications?
What should the RN do?
Headache, blurred vision, seeing yellowish halo, bradycardia, hypotension, N/V/D, Loss of appetite, and Decreased LOC.
The RN should check Digoxin and Potassium levels, and also check APICAL pulse.