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NUR 2407 Pharm Exam 3 Study Guide
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NUR 2407 Pharm Exam 3 Study Guide
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Pharm Exam 3 Study Guide – PLEASE STUDY HARD!!!!!!!Cardiac
1. Digoxin – client teaching, side/adverse effects, normal Digoxin levels and s/s of
Digoxin toxicity
digoxin (Lenoxin)
For A-fib and CHF – Slows and strengthens the heart.
Hold for HR<60
Can be PO or IV (IV must be administered slowly – over 5 minutes).
Narrow therapeutic window 0.5 – 2.0 ng/mL
digoxin immune Fab (Digibind) is the antidote.
Side/Adverse Effects:
N/V, loss of appetite, GI symptoms, malaise
S/S Dig toxicity:
Visual illusions (white, green/yellow halos around objects, confusion, delirium,
PVC’s, cardiac dysrhythmias.
Client Teaching:
Report HA, Visual Disturbances, seeing Halos.
How to take pulse and to hold medication is <60.
2. Potassium levels, considerations and precautions related to levels, and when taking
with HCTZ or potassium supplements
Normal K+ = 3.5-5.2mEq/L Critical <2.5mEq/
Hypokalemia <3.5 mEq/L Hyperkalemia >5.2mEq/L
S/S – Hypokalemia S/S - Hyperkalemia
Cardiac Dysrhythmias, twitching, Muscle weakness, lethargy,
Fatigue, paresthesia, dyspnea, anorexia, dysrhythmias.
Cramping, diarrhea.
Considerations/Precautions:
Hold medication if level is too low.
Contraindicated with other thiazides or sulfonamides, anuria.
When taking with HCTZ or K+ supplements:
Monitor K+ levels (K+ loss is the main concern.)
Pt. needs to increase K+ intake for prevention of hypokalemia and dysrhythmias.
Foods HIGH in K+:
Dark leafy greens (Spinach, Kale, etc), Potatoes with skins, Tomatoes, Dried
Apricots, Avocados, Bananas, Mushrooms, Orange/Grapefruit juice, beets,
K+ based salt substitutes Strawberries Avoid alcohol, increases risk of OrthoHypo
3. ACE Inhibitor: lisinopril (Zestril)-client teaching All end in -pril
, Use: Decrease workload of the heart, decrease BP. Often used in concurrence with
thiazide diuretics.
Adverse Effects: Hypotension, orthohypo, Persistent dry cough, angioedema,
Hyperkalemia in diabetics, renal failure and with potassium-sparing diuretics.
Client Teaching:
Monitor BP following first dose.
Report dry, non-productive cough is continued for long period.
Report decreased taste, intake, or weight loss.
Report sore throat or other infections to MD.
Report angioedema, rash, orthostatic hypotension.
Do NOT use alcohol.
NSAIDS decrease efficiency.
Avoid foods high in K+ or K+ supplements.
4. Calcium channel blockers (nifedipine) – client teaching
Use: Controls HTN and angina. Dilates coronary arteries, decreases HR, BP.
Adverse Effects: HA (due to Vasodilation), constipation, peripheral edema,
rebound Hypotension.
Client Teaching:
Avoid grapefruit juice (increases concentration of meds in blood).
Avoid Calcium based Antacids (decreases effects of CCBs).
Avoid caffeine, aspirin, St. John’s Wort, laxatives.
Educate pt on how to properly take pulse, notify MD <50pbm.
Change positions slowly.
Maintain good oral hygiene to prevent gingival hyperplasia.
Report any angina.
Wear sunscreen when outside,
5. Nitroglycerin – client teaching, side/adverse effects, contraindications
, Use: Reduce angina. Short acting for acute, long acting for severe recurrent
episodes.
Side/Adverse Effects:
Dizziness, HA (dilation of cerebral vessels), Hypotension, Reflex Tachycardia,
flushing, blurred vision
Contraindications:
Do not give to pt with hypotension, high intracranial pressure, head trauma, or
taking ED medications due to synergistic effect.
Client Teaching:
Only take 1 SL q 5 min b/c of rapidly dropping BP – up to 3!! Sit down and rest.
If not effective, call EMS.
Change positions slowly.
Do not drink alcohol while taking this med.
HA is normal side effect.
Keep meds in original dark container due to deactivation and avoid exposure to
air or moisture.
Transdermal patches should be removed at night (6-12 hours) to prevent
tolerance.
Avoid aspirin and antihistamines.
6. Beta-blockers atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL) – nursing
considerations, side effects
Use: Decreases HR and BP.
Treats heart failure and dysrhythmia due to HTN and angina.
Side/Adverse Effects: Based on inhibition of fight-or-flight response
Decreased HR.
Hypotension
Bronchoconstriction
fatigue and activity intolerance as HR is less responsive with exertion
insomnia
ED
Pulmonary edema
mental status changes
increased liver enzymes
drug induced lupus syndrome
Nursing Considerations:
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