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Pharm II Study Guide exam 2
Pharmacology II (NUR 354)
Arizona College of Nursing
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Exam 2 Study Guide
MI
o Pathophysiology Clot or plaque obstructing blood flow Necrosis occurs if ischemia continues=MI
o Reteplase (retavase) Education/instruction BP and HR, medical Hx Don’t shake this med, roll it! Bleeding at IV is common, dysrhythmias Cannot be combined with Heparin. Do not give if hx of stroke, recent surgical procedure, or active bleeding Route IV bolus only! Fast acting, 20min, can give second bolus 30min after if the first one did not work Classification Thrombolytic, Dissolves blood clots Angina o Pathophysiology Narrowing of coronary artery, resulting in lock of O2 to heart o S/S chest pain may radiate to neck, jaw or shoulders, fatigue, weakness, SOB, pallor, diaphoresis (excessive sweating) Stable angina Happens at rest Unstable angina Happen when your exercising/activity and can stop during no activity Silent ischemia Happen during activity Can be asymptomatic o Nitroglycerin (Nitrostat)- vasodilator Patient assessment/findings Monitor BP and hold if drops below 90/ Patient/family education/instructions If angina not relieved or worse in 5min, call 911! Topical (called Nitro Paste) or sublingual, make sure nurse wears gloves or will get a HA, apply every 24hr Contraindications No to pt with hypersensitivity to nitroglycerin No to pt taking phosphodiesterase (PDE) inhibitors or erectile dysfunction (ED) drugs preexisting hypotension, intracranial pressure, or head trauma Adverse effects/common SE
Exam 2 Study Guide
Headache-most common, hypotension, dizzy, increased HR Expected outcome Stops angina (chest) pain in 2-4min short acting, typically 5min can perform activities without chest pain lowers BP Route(s) of administration Topical (called Nitro Paste) or sublingual, make sure nurse wears gloves or will get a HA, apply every 24hr Should be given up to 3x, sublingual, 5min apart If someone having chest pain give them this (fast acting), then call 911 o Na channel blocker Pharmacological action o PCIs (Percutaneous Coronary Intervention) AHA recommends that a PCI be performed within 90min after hospital arrival for MI o Priority actions RAAS o Hormones involved Aldosterone, renin, angiotensin o How it works ACE converts angiotensin I to angiotensin II Blocks ACE and inhibits vasoconstriction which decreases bloop pressure When BP low kidneys release renin Renin splits into angiotenin I Angio I converts to ACE in lungs, then angio II Angio II release aldosterone, kidneys retain Na and excrete K, which decrease BP o Organs involved Kidneys, lungs, liver Hypertension – o Pathophysiology of Cardiac output= volume of blood pumped per min Stroke volume= amount of blood pumped through a ventricle in one contraction Peripheral resistance=friction in arteries as blood flows threw it ANS is responsible for regulating at the baso motor center, and baro receptors sense that pressure of blood o Assessment findings AHA guidelines Normal: less than 120/ Elevated: 120-129/80- lifestyle changes Stage 1: 130-139/80-89-lifestyle and one medication Stage 2: greater than 140/90-two meds and one diuretics, lifestyle change
Exam 2 Study Guide
Do not take with potassium sparing diuretics, increases lithium blood levels Report any irregular heart rhythms and chest pain Assess infusion site if given IV Will know if drug is working if cap refill is less than 3 seconds
o Beta blockers- Metoprolol (Lopressor) – HTN and HF Beta 1 Selective Pharmacological action/Pathophysiology Reduces release of renin which lowers angiotensin II, causes vasodilation, and excretes Na and H Decreases cardiac workload and lowers BP Combined with an ACE/ARB Adverse effects Bradycardia, bronchoconstriction, HPO, sexual dysfunction, insomnia Bs=Bradycardia (60 or less hold), Bronchospasms, Blood pressure lowered (hold if less than 120/80, hypotension), Bad for HF pt-worsen crackles o If pt in hypotension use vasopressor drug to help o Ca channel blockers- Nifedipine (Procardia) Used HTN and angina Pharmacological action(s) Works on HR and BP (others are usually just BP) Nifedipine blocks calcium ONLY in the arteries and causes dilation Expected outcome Increase cardiac output, lowers BP Assessment specifics Hepatoxicity, MI, HF, confusion, mood swing o Alpha 1 blocker- Doxazosin (Cardura) Patient education/instructions/understanding NOT a 1st line drug for HTN, used in combination with a diuretic Some pt my have serious orthostatic HPO, do not stop abruptly or first dose phenomenon Off label treatment used in men for BPH o Direct vasodilators- Hydralazine fast acting, used in emergency situations Action Vasodilation by direct relaxation of smooth muscle Expected outcome Lower BP, forces heat to work harder, Na/H20 retained Patient education/instructions/understanding Monitored by nurse, VS constantly monitored, potassium, electrolytes Route IV
Exam 2 Study Guide
Pediatric administration/AE Reflex tachycardia, HA, palpation, Lupus, and sodium and fluid retention
Diuretics/Renal, table 24 chart- look at what diseases diuretics are treated for o How and where each class flows through the kidneys (actions of each class) 24. Thiazide-act on (DCT) DISTAL CONVOLUTED TUBES, block absorption NA, Cl, H20, excrete K Loop-act on ASCENDING NEPHRON LOOP, block reabsorption of Na, Cl, H20, excrete K Potassium sparing-act on LATE DCT AND COLLECTING DUCTS, block reabsorption Na and reduce secretion of K o CKD (Chronic Kidney Disease) Patient education/instructions/understanding Low Na diet low K food, slow to move-hypotension, protein restriction, take in morning not at night Unsuccessful treatment would include: weight gain, lung signs wet/gasping, oliguria – no urine output, less than 400mL in a day Reduce water intake, not consume K and Na, o Diseases that would be prescribed these drugs o Thiazide- Hydrochlorithiade (Microzide) - treats cirrhosis, HTN, edema, HF How they work/action Blocks NA and H20, and excretes K Contraindications/interactions Digoxin and lithium toxicity, NSAID, reduce effectiveness of anticoagulant and insulin Decrease blood volume!! Gout! Assessment/labs Monitor K and Na o Loop- Furosemide (Lasix) NUMBER ONE DRUG FOR WORSENING HF How they work/action Ascending nephron loop Blocks reabsorption of Na, Cl, H20, excretes K Patient education/instructions/understanding Admin slowly! Eat potassium Assessment/reassessment/labs Assess in 2hr to see if drug is effective when given orally, unless it’s given push IV then assesses back in minutes. If it doesn’t say IV then assume that it is given orally Expected outcome Lower edema, BP, calcium level
Pharm II Study Guide exam 2
Course: Pharmacology II (NUR 354)
University: Arizona College of Nursing
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