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what side effect of atorvastatin (Lipitor) should pt. notify MD for?
*atorvastatin (Lipitor) is an antihyperlipidemic drug (HMG-CoA reductase inhibitor)
rhabdomyolysis: rare condition in which muscle damage results in the release of muscle cell contents into the blood; results in muscle pain; an acute sometimes fatal disease where the products of skeletal muscle destruction accumulate in renal tubules --> ARF
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how do you know if simvastatin (Zocor) is working?
*simvastatin (Zocor) is an antihyperlipidemic drug (HMG-CoA reductase inhibitor)
- total cholesterol level is under 200
- *simvastatin (Zocor): inhibit the manufacture of cholesterol/promote breakdown of cholesterol; lowers blood levels of cholesterol, LDL's & serum triglycerides; used to tx hyperlipidemia
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desirable levels for total cholesterol & HDL (high density lipoproteins)?
*high density lipoproteins: elevation decreases risk of heart disease, brings cholesterol from peripheral cells to the liver for metabolism & excretion
- total cholesterol: < than 200 mg/dL
- HDL: < than 40 mg/dL is low, level should be > than 60 mg/dL
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bile acid resins (sequestrants) are not given w/ what type of juice?
*bile acid resins (sequestrants): [antihyperlipidemic drug] bind bile in the intestinal tract preventing absorption, causing the liver to use cholesterol to make more bile, this lowers serum cholesterol
*ex: cholestyramine (Questran, Prevalite), colestipol (Colestid), colesevelam (Welchol)
grapefruit juice
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another name for niacin (Nicotinic Acid, Niaspan)?
*niacin (Nicotinic Acid, Niaspan): antihyperlipidemic drug
vitamin b9
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what med. is given w/ niacin (Nicotinic Acid, Niaspan), how much & why?
325 mg of ASA (acetylsalicylic acid aspirin) to reduce flushing & itching taken 30 min. prior to niacin (Nicotinic Acid, Niaspan)
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what type of drug is gemfibrozil (Lopid) & what is it given for?
*gemfibrozil (Lopid): increases the excretion of cholesterol in the feces & decreases the production of triglycerides by the liver lowering serum lipid levels
gemfibrozil (Lopid): antihyperlipidemic drug (fibric acid derivative) given to tx pt. w/ very high serum triglyceride levels that are at risk for abd pain & pancreatitis & who do not experience a response to dietary modifications
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what type of drug is HCTZ, hydrochlorthiazide (Hydrodiuril)?
- (thiazide) diuretic: [antihypertensive drug] increases the excretion of sodium w/ water passively following (blocks reabsorption of Na & Cl in the tubules)
- *check potassium levels
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what type of drug is furosemide (Lasix)?
- (loop) diuretic: antihypertensive drug
- *check potassium levels
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what type of drug is lisinopril (Zestril)?
angiotensin-converting enzyme inhibitor (ACE-inhibitor): [antihypertensive drug] slows the conversion of angiotensin 1 to 2; angiotensin 2 is the body's most powerful vasocostrictor, also stimulates secretion of Aldosterone whice causes sodium reabsorption
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what should you be concerned about for a pt. taking furosemide (Lasix) or lisinopril (Zestril)?
dehydration, hypokalemia, electrolyte imbalance & hypotension
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what s/s would a pt. taking furosemide (Lasix) exhibit if their potassium level is low?
dysrrhythmias, muscle cramps & twitching
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nursing intervention prior to giving B/P or cardio med?
take B/P & apical pulse for 1 min.
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what type of drug is metoprolol (Lopressor) & what is it used for?
- beta-adrenergic blocker: antihypertensive drug
- used for MI & HTN, stable angina, arrythmias, migraine headaches, HF & glaucoma
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what VS is taken before administering furosemide (Lasix)/lisinopril (Zestril)?
- B/P
- *hold med. if systolic pressure is below 100 or 110
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why is grapefruit juice not given w/ furosemide (Lasix) or lisinopril (Zestril)?
- too acidic & deactivates med*grapefruit juice interferes w/ the liver's ability to rid the body of calcium channel blockers
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pt. teaching regarding B/P med.?
when any antihypertensive drug is given, postural (dizziness & light headedness occuring when individual rises suddenly from lying/sitting position)/orthostatic (occurs when individual has been standing in 1 place for a long time) hypotension can occur; rise slowly from a lying/sitting position & avoid standing for long periods of time; *take in a safe place at home
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what type of drug is bumetanide (Bumex)?
- loop diuretic: antihypertensive drug
- *monitor potassium levels
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how do you apply a patch med.?
- cleanse & pat dry skin, use gloves (to avoid coming in contact w/ ointment) to apply patch in a hairless area
- *B/P & pulse must be taken prior to topical drug (nitrate) administration (don't give if pulse is > than 100 or < than 60 & if B/P is too low)
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what type of drug is valsartan (Diovan)?
angiotensin 2 receptor blocker: antihypertensive drug
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what does sublingual mean?
under the tongue
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why do you get a headache w/ nitrate?
*nitrate: antianginal drug
nitrate causes vasodilation: increases the lumen of the artery/arteriole & increases the amt. of blood flowing through the vessels; increases blood flow resulting in an increase in O2 supply to surrounding tissues
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pt. teaching regarding nitrate administration?
- med. can be taken up to 3 doses, 5 min. apart
- *if not effective, might be an MI
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is nitroglycerin long/short-acting?
short-acting nitrate
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is isosorbide (Isordil) long/short-acting, what is it used for & when is it taken?
*isosorbide (Isordil): antianginal drug
long-acting nitrate used for stable angina taken daily at the same time
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which side effect of isosorbide (Isordil) should the pt. notify MD for in order to change dosage?
- headache (may be severe & persistent)
- dizziness, weakness
- restlessness
- hypotension
- flushing (capillary dilation)
- rash
- reflex tachycardia (bradycardia)
- tolerance
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therapeutic level for pt. taking heparin?
*heparin: anticoagulant drug
1.5-2.5 times the control
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which labs are done prior to administering heparin?
PTT & INR
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which labs are done for warfarin (Coumadin)?
*warfarin (Coumadin): anticoagulant drug
PT & INR
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what type of drug is enoxaparin (Lovenox) & what is it used for?
- low-molecular weight heparin (LMWH's): anticoagulant drug
- used in pt. at risk for DVT (ex: any kind of bone (hip) surgery)
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what is the antidote for heparin?
protamine sulfate
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what is the antidote for warfarin (Coumadin)?
vitamin K (AquaMEPHYTON)
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what should a pt. taking heparin do if their gums begin to bleed?
notify MD (labs needed)
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s/s of heparin overdose?
bleeding
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heparin dosage & route?
5,000-10,000 units vian injection (SQ/IV)
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legal rule for heparin administration?
checked by 2 lincensed nurses
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administration route for warfarin (Coumadin)?
- P.O.
- *heparin cannot be absorbed orally
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tar-colored stool for pt. taking warfarin (Coumadin) indicates?
GI bleeding
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what type of drug is dalteparin (Fragmin) & in which route is it given?
LMWH: anticoagulant drug given SQ/IV
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"clot buster" drugs?
- thrombolytic drugs:
- alteplase (Activase)
- reteplase (Retavase)
- streptokinase (Streptase)
- tenecteplase (TNKase)
- urokinase (Abbokinase)
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too much streptokinase (Streptase) can cause what?
bleeding
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action of streptokinase (Streptase)?
- used to dissolve blood clots that have already formed w/in the walls of a blood vessel
- re-open blood vessels after they become occluded
- break down fibrin clots by convertin plasminogen to plasmin
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another name for bloody nose?
epistaxis
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what type of drug is clopidogral (Plavix)?
adenosine diphosphate (ADP) receptor blocker (antagonist): antiplatelet drug
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what is digitalization?
a series of (digoxin) doses are given until therapeutic effect is exerted
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antidote for digoxin overdose?
- atropine sulfate
- *life threatening toxicity is tx w/ digoxin immune fab (Digibind)
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brand name for digoxin?
Lanoxin
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nursing intervention done prior to giving digoxin (Lanoxin)?
- take apical pulse for 1 min. (hold drug for AP < than 60 or > than 100)
- *dig level (0.5-2 ng/mL)
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what type of drug is digoxin (Lanoxin)?
cardiotonic drug
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what is telemtry?
heart monitor
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what type of drug is amiodarone (Cordarone)?
class III potassium channel blocker: antiarrythmia drug
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which type of arrythmia is worse: atrial/ventricular?
ventricular
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what is a PVC arrythmia?
premature ventricular contractions: beat originating in ventricles instead of SA node
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what type of drug is lidocaine (Xylocaine)?
- "membrane stabilizer"
- *class IB: antiarrythmia drug
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action of filgastrim (Neupogen)?
*filgastrim (Neupogen): colony stimulating factor [immunostimulant drug]
glycoproteins that act on the hematopoietic (blood forming) cells to stimulate proliferation, differentation & maturation of WBC's
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what is erythropoietin?
RBC's in the bone marrow
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erythropoietin is not given when what VS is elevated?
B/P
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what type of drug is epoetin alfa (Epogen, Procrit), which route is it given & what is it given for?
- hematopoietic: immunostimulant drug
- given SQ/IV to tx anemias (of chron's disease) associated w/ CKD, chemotherapy, Zidovudine (AZT) therapy for HIV, postsurgical blood replacement
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what type of drug is darbepoetin alfa (Aranesp)?
erythropoiesis stimulating proteins (hormone): immunostimulant drug
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pt. teaching for taking erythropoiesis stimulating hormone?
- contraindicated for pt. w/ htn
- taken daily at the same time to maintain hormone level
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iron supplements are taken w/ what kind of juice?
orange juice
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what should you consume more when taking iron supplements?
fiber & fluids
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iron supplements can turn your stool into what color?
greenish/tarry stool
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what type of disease can develop w/ folic acid & iron deficiency?
autoimmune diseases: chron's disease, colitis, lupus
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s/s of b12 deficiency/pernicious anemia?
beefy red tongue & paresthesia
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