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What is the initial treatment for mild hypertension?
lifestyle changes, then if BP doesn't normalize add diuretic or beta-blocker
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What are the two meds (either may be used) for initial treatment of moderate hypertension?
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What med is used for severe hypertension?
nipride is used for very severe hypertension
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What major side effect is caused by all meds that lower bp? What are patients taught to do to lessen this side effect?
- dizziness from orthostatic hypotension,
- arise slowly from lying to standing
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Atenolol (tenormin) is what type of adrenergic inhibitor?
Beta-Blocker
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What are three side effects of beta blockers: propranolol (Inderal) & nadalol (corgard)?
bradycardia, depression, impaired glucose control in diabetics, impotence
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What type antihypertensive is verapamil (calan)?
calcium channel blocker
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what type antihypertensive is lisinopril (zestril)
ace inhibitor
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What side effect should a patient taking corgard report if it occurs?
bradycardia
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What foods are high in potassium that the patient taking a loop diuretic or thiazide diuretic should eat?
bananas, citrus juice, meat, nuts
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What two drugs are combined in Aldactozide? What are their actions?
thiazide & potassium sparing (HTCZ & Aldactone)
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Describe the hair growth when taking minoxidil (Lonitin).
excessive hair growth
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What happens to B/P when the patient takes enalapril (vasotec), an ACE inhibitor, and is losing fluid through vomiting?
more pronounced decrease in bp
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How repidly does sodium nitroprusside (nopride) lower bp?
immediate, given IV, BP begins to lower within 5 minutes
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How long will a patient have to take prescribed antihypertensive meds?
for lifetime, because antihypertensive meds control bp, not cure disorder
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list four activity (adl) precautions for anyone taking antihypertensive meds.
arise slowly from tying to standing to accomodate, avoid sudden strenuous exercise, hot baths, & motionless/dependent legs.
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What is the action on LDL of a bile acid sequestrant?
reduces LDL
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What is a side effect of simvastatin (zocor)?
breakdown of skeletal muscle tissue leading to kidney failure
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What is the action of Niacin?
depresses synthesis of LDL's & increases level of HDL's
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What is a side effect of nicotinic acid (niacin)?
sensitivity, flushing, & itching
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How is the effectiveness of NTG evaluated?
absence of chest pain
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What is the correct procedure for taking NTG sublingually?
rest supine, head elevated, tab under tongue at 1st sign of chest discomfort, don't swallow until completely dissolved, may repeat total of 3 doses at 5 min intervals
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Nitroglycerin should be taken with the patient in what position? Why?
supine, it makes BP drop
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How should a nitroglycerin patch be applied? (Focus on correct site & rotate sites).
dry hairless area away from monitoring and defibrilation sites, rotate application sites
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State the steps to correctly use nitroglycerin aerosol.
1-2 sprays sublingual (don't shake, hold upright, close mouth around mouthpiece, activate spray, don't swallow for 1-2 minutes.
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Identify three long acting nitroglycerin medications.
tabs = peritrate, cardilate, isordil
also nitrol patch (24 hour dosage)
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How should NTG be stored? How long is it good? How can the patient tell if it is good?
- store in dry tight capped dark glass container
- new prescription Q5 months
- fresh when burning sensation under tongue
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Why does the patient with angina receive a beta blocker like propranolol (inderal)?
decreases O2 requirement of myocardium
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How frequently can NTG tablets be taken? When should the patient go to the Emergency Facility?
3 doses at 5 min intervals, if no relief after 3rd dose, call ems & go to ED
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What is the action of quinidine?
oral anti-arrhythmia agent
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What drug is given for bradycardia following an MI, heart attack?
atropine 0.5 mg IV
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Positive inotropic means what?
slows HR & increases force of myocardial contraction
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How do digoxin and beta blockers effect pulse rate?
they decrease it
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What must the adult pulse rate be to administer digoxin?
60 or greater
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What heart arrhythmia indicates digoxin toxicity?
- bigeminy dysrhythmia
- (alternating regular beat & irregular beat)
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What is the therapeutic serum digoxin level?
0.5 to 2.0 nanograms
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What is the action of a loop diuretic?
increas excess fluid pulled from serum into urine filtrate
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What time of day should diuretic meds be taken?
Internet says last dose no later than 4pm
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How should a patient monitor fluid loss or gain when taking furosemide (lasix)
weigh at same time daily and report 2lbs weight gain & swelling in ankles and feet
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What effect does heparin or enoxaparin (lovenox) or warfarin (coumadin) or dabigatran (pradaxa) have on a blood clot?
prevents further development on an existing thrombus and prevent emobilization
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What are the therapeutic levels of PT and PTT for a patient receiving an anticoagulant?
Normal PTT = 30-40sec, Therapeutic = 2-2.5 x normal = 75-80 sec
Normal PT = 11-12.5 sec, Therapeutic = 1.25 - 2.5 x normal = 18-24 sec
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How will spontaneous bleeding, a side effect of anticoagulants, be seen?
- black stools, blood in stools, urine
- (more likely when on 2 anticoagulants)
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What is the antidote to warfarin (coumadin)?
To Heparin?
- Coumadin = vit K
- Heparin = protamine sulfate
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What bleeding precautins should a patient on anticoagulants take?
See Book
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What med is prescribed for iron deficiency anemia?
ferrous sulfate (Feosol)
liquid iron?
Iron Dextran Injection?
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How should liquid iron be taken?
through straw to prevent teeth staining
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What effect does vitamin B12 have on red blood cell formation?
necessary for red blood cell maturation
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What med is prescribed for pernicious anemia? How is it given? how often?
- vitamin B12 (cyanocobalamin)
- IM
- daily for a week then monthly for life
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The malnourished or alcoholic/substance abuse patient needs what med to promote red blood cell development?
- folic acid deficient
- needs Folvite 1 mg oral daily
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What is the action of epoetin?
How is it given?
How often?
- Sub Q
- 3x weekly
- stimulates RBC production when myelosuppression has occurred
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