PHARMACOLOGY NCLEX QUESTIONS AND ANSWERS 2022 LATEST ACE Inhibitor Drugs - ANS-Captopril (Capoten), Enalapril (Vasotec), Enalaprilat (Vasotec IV), Fosinopril (Monopril), Lisinopril (Prinivil) AC... E Inhibitors/ARBs Use - ANS-Uses: Hypertension, HF, MI, diabetic neuropathy. Precautions/interactions: caution with diuretic therapy, monitor potassium levels. Side effects of ACE inhibitor/ARBs - ANS-Persistent non-productive cough with ACE. Angioedema (administer epinephrine), hypotension, should not be used in second and third trimester of pregnancy Captopril time to take - ANS-1 hour before meals Calcium channel blocker drugs - ANS-Nifedipine (Adalat, Procardia), verapamil (Calan), Diltiazem (Cardizem), Amlodipine (Norvasc) Ca++ channel blocker Use - ANS-Angina, hypertension. Verapamil and diltiazem used for a fib, atrial flutter, or SVT. Use cautiously with digoxin and beta blockers, contraindicated for those with HF, heart block, bradycardia. NO GRAPEFRUIT JUICE. IV injection over 2-3 minutes. Slowly taper if discontinuing Side effects of calcium channel blockers - ANS-Constipation, reflex tachycardia, peripheral edema, toxicity Alpha Adrenergic Blockers (Sympatholytics) - ANS-Selectively inhibit alpha, adrenergic receptors, resulting in peripheral arterial and venous dilation that lowers BP. Side effects: dizziness, fainting. Take at bed time to minimize effects of hypotension. Alpha Adrenergic Blockers Drugs - ANS-Prazosin (Minipress), Doxazosin mesylate (Cardura) Centrally Acting Alpha2 Agonists - ANS-Stimulate alpha-adrenergic receptors in the brain to reduce peripheral vascular resistance, heart rate, and systolic and diastolic blood pressure. Used for HTN, hypertensive crisis, severe cancer pain. Centrally Acting Alpha2 Agonist Drugs - ANS-Clonidine (Catapres), Guanfacine HCl (Tenex), Methyldopa (Aldomet) Centrally Acting Alpha2 Agonist Drug Precautions - ANS-Contraindicated with anticoagulant therapy, hepatic failure. Do not administer to clients taking MAOIs. Do not administer methyldopa through IV line with barbiturates or sulfonamides. Use cautiously in CVA, MI, DM, depression, or chronic renal failure. Do not use during lactation Centrally Acting Alpha2 Agonist Drug Side Effects - ANS-Dry mouth, drowsiness, sedation, rebound HTN, black or sore tongue, leukopenia Beta Adrenergic Blockers (Sympatholytics) - ANS-Inhibit stimulation of receptor sites, resulting in decreased cardiac excitability, cardiac output, myocardial oxygen demand, lower BP by decreasing release of renin by kidney. Hypertension, angina, tachydysrhythmias, HF, MI. Beta Adrenergic Blocker Medications (Cardioselective Beta1 meds) - ANSMetoprolol (Lopressor), atenolol (Tenormin), Metoprolol succinate (Toprol XL) Beta Adrenergic Blocker Medications (Nonselective beta1 and 2 meds) - ANSPropranolol (Inderal), Nadolol (Corgard), Labetalol (Normodyne) Beta Adrenergic Blocker Precautions - ANS-Contraindicated in clients who have AV block and sinus bradycardia, do not administer nonselective beta blockers to clients who have asthma, bronchospasm, HF, propranolol may mask effects of hypoglycemia in DM, do not administer labetalol in same IV line with furosemide. Do not administer if systolic less than 100 and pulse less than 60. Beta adrenergic blocker side effects - ANS-Bradycardia, nasal stuffiness, AV block, rebound myocardium excitation if stopped abruptly, bronchospasm Vasodilators - ANS-Direct vasodilation of arteries and veins resulting in rapid reduction of BP (decreased preload and afterload). Used for hypertensive emergencies. Precautions: clients who have hepatic or renal disease, older adults, electrolyte imbalances Vasodilator medications - ANS-Nitroglycerin (Nitrostat IV): Enalaprilat (Vasotec IV), Nitroprusside (Nipride), Hydralazine (Apresoline). Vasodilator Side Effects - ANS-Dizziness, headache, profound hypotension, cyanide toxicity, thiocyanate poisoning Nitroprusside Interventions - ANS-Should not be mixed with any medication, apply protective cover to container, discard unused fluid after 24 hour, provide continuous ECG and blood pressure monitoring Cardiac Glycosides - ANS-Used in the treatment of clients who have cardiac failure or ineffective pumping mechanism of the heart muscle. Increase the force and velocity of myocardial contractions to improve stroke volume and CO. Slow the conduction rate, allowing for increased ventricular filling. Used for HF, a fib Cardiac Glycoside Medication - ANS-Digoxin (Lanoxin, Lanoxicaps, Digitek) Digoxin Precautions/interactions - ANS-Thiazide or loop diuretics increase risk of hypokalemia and precipitate digoxin toxicity. ACE and ARBs increase risk of hyperkalemia. Verapamil (Calan) increases risk of toxicity Digoxin Toxicity - ANS-GI effects (anorexia, n/v, abdominal pain), CNS effects (fatigue, weakness, diplopia, blurred vision, yellow-green or white halos around objects) Digoxin interventions - ANS-Assess apical pulse for 1 min prior to administration. Notify HCP if HR less than 60 (adult), less than 70 (child), less than 90 (infant), monitor for signs of digoxin toxicity, hypokalemia, and hypomagnesemia, notify provider of any sudden increase in pulse rate that previously normal or low, maintain therapeutic level Management of Digoxin Toxicity - ANS-Discontinue digoxin and potassium-wasting medications, treat dysrhythmias with phenytoin (Dilantin) or lidocaine, treat bradycardia with atropine, for excess overdose, administer Digibind to prevent absorption Antianginal Medications - ANS-Organic nitrates, beta adrenergic-blocking agents, and calcium channel blockers to treat pain related to imbalances between myocardial oxygen supply and demand. Organic Nitrates - ANS-Relax peripheral vascular smooth muscles, resulting in dilation of arteries and veins, thus reducing venous blood return (reduced preload) to the heart, which leads to decreased oxygen demands on the heart. Increase myocardial oxygen supply by dilating large coronary arteries and redistributing blood flow. Organic Nitrates Meds - ANS-Nitrostat (sublingual), nitrolingual (translingual spray), nitro-bid (topical ointment), nitro-dur (transderm patch) Organic Nitrate Precautions/interactions - ANS-Contraindicated in clients with head injury, hypotensive risk with antihypertensive meds, erectile dysfunction meds may increase life-threatening hypotension Organic Nitrates side effects - ANS-Headache, orthostatic hypotension, reflex tachycardia, tolerance Organic Nitrate Interventions - ANS-Sublingual: give, wait 5 mins, give again, if not relief call 911, may take up to three doses. May be used prophylactically before exercise. Nitrobid (topical ointment) administration - ANS-Wear gloves, do not massage or rub area, apply to area without hair, cover area where patch is placed with clear plastic wrap and tape in place, gradually reduce over 4-6 weeks. Nitro-Dur (transderm patch) - ANS-Skin irritation may alter medication absorption, optimal locations for patch are upper chest or side, pelvis, inner/upper arm, rotate skin sites daily Antidysrhythmic Agents - ANS-Complex agents with multiple mechanisms of action. They are classified according to their effects on the electrical conduction system of the heart (class I, II, III, IV) Antidysrhythmic Medications - ANS-Adenosine, amiodarone, atropine Adenosine (Adenocard) - ANS-Antidysrhythmic agent. Slows conduction time through the AV node, interrupts AV node pathways to restore NSR. Converts supraventricular tachycardia (SVT) to sinus rhythm. Rapid IV (1-2 seconds) push, flush immediately with normal saline. Amiodarone (Cordarone) - ANS-Antidysrhythmic agent. Prolongs repolarization, relaxes smooth muscles, decreases vascular resistance. For ventricular fibrillation and unstable ventricular tachycardia. Incompatible with heparin, may be given in PO maintenance dose, monitor for respiratory complications. Atropine - ANS-Antidysrhythmic agent. Increases firing of the sinoatrial node (SA) and conduction through the atrioventricular node (AV) of the heart, opposes the action of the vagus nerve by blocking acetylcholine receptor sites. Used for bradycardia and known exposure to chemical nerve agent (AtroPEN). Antidysrhythmic agents precautions/interactions - ANS-Toxicity is a major concern due to additive effects, caution is needed when used with an AV block, caution is needed when using anticholinergic medications. Adenosine (Adenocard) side effects - ANS-Flushing, nausea, bronchospasm, prolonged asystole Amiodarone side effects - ANS-Bradycardia, cardiogenic shock, pulmonary disorders Atropine side efffects - ANS-When used for life-threatening emergency, has no contraindications. Monitor for dry mouth, blurred vision, photophobia, urinary retention, and constipation. Antilipemic Medications - ANS-Aid in lowering low-density lipoprotein (LDL) levels and increase high-density lipoprotein (HDL) levels. Therapy includes diet, exercise, and weight control. Uses: primary hypercholesterolemia, prevention of coronary events, and protection against MI and stroke in clients with diabetes. Should not be used with pregnancy and used with caution in renal dysfunction. Antilipemic Medication Side Effects - ANS-Muscle aches, hepatotoxicity, myopathy, rhabdomyolysis, peripheral neuropathy Antilipemic Nursing Interventions - ANS-Take medication in the eventing (when cholesterol synthesis increases), monitor liver and renal function laboratory profiles, low-fat/high-fiber diet, note dietary precautions with specific classes Antilipemic Drugs - ANS-Simvastatin (Zocor), Lovastatin (Mevacor), Pravastatin sodium (Pravachol), Rosuvastatin (Crestor), Fluvastatin (Lescol, Lescol XL) Antilipemic Medication Precaustions and interactions - ANS-- Prolonged bleeding in certain clientes also taking warfarin (coumadin). - Has multiple drug interactions: digoxin, warfarin, thyroid hormones, thiazide diuretics, phenobarbital, NSAIDs, tetracycline, beta-blocking agents, gemfibrozil, glipizide, glyburide, oral contraceptives, and phenytoin. - DO NOT ADMINISTER WITH GRAPEFRUIT JUICE. Cholesterol Absorption Inhibitor - ANS-Inhibits the absorption of cholesterol secreted in the bile and from food. Often used in combination with other antilipemic medications. Med: Ezetimibe (Zetia). Take 1 hour before or 4 hours after other antilipemics. Risk of liver damage increased when combined with statins. Inhalation Guidelines - ANS-Take beta2 agonist before the inhaled glucocorticoid to increase steroid absorption, examine mouth for irritation, and perform frequent oral care. 1. Remove the mouthpiece cap. 2. If appropriate, shake the container. 3. Stand up or sit upright, exhale deeply. 4. Place the mouthpiece between teeth and close lips tightly around the inhaler. 5. While breathing in, press down on the inhaler to activate and release the medication; continue breathing in slowly for several more seconds (slow, long, steady inhalation is better than quick short breaths) 6. Hold breath for 5-10 seconds 7. Breathe in/out normally. Beta2 adrenergic agonists - ANS-Promote bronchodilation by activating beta2 receptors in bronchial smooth muscle. Albuterol (proventil, ventolin); Formoterol (Foradil), salmeterol (Serevent); Terbutaline (Brethine) Beta2 Adrenergic Agonist Precautions/Interactions - ANS-Contraindicated for clients with tachydysrhythmias; caution: DM, hyperthyroidism, heart disease, hypertension, angina; beta blockers will reduce effects; MAOIs will increase effects. Beta2 Adrenergic Agonist Side Effects - ANS-Tachycardia, palpitations, tremors. Albuterol (Proventil, Ventolin) - ANS-Inhaled (short-acting), few minutes for onset. Used for acute bronchospasm. Formoterol (Foradil), salmeterol (Severent) - ANS-Inhaled (long-acting), onset is 15- 20 minutes and lasts 12 hours. Caution against using salmeterol more frequently than every 12 hours. Terbutaline (Brethine) - ANS-Oral (long-acting), long term control of asthma. Methylxanthines - ANS-Relaxation of bronchial smooth muscle, resulting in bronchodilation. Relief of bronchospasm and long-term control of asthma. Methylxanthines Drugs - ANS-Aminophylline (Truphylline), Theophylline (Theo-Dur, Theolair, Theo-42) Methylxanthine Precautions/Interactions - ANS-Contraindicated with active peptic ulcer disease. Caution: DM, hyperthyroidism, heart disease, HTN, angina. Do not mix parenteral form with other medications. Phenobarbital and phenytoin decrease theophylline levels. Caffeine, furosemide, cimetidine, fluoroquinolones, acetaminophen, and phenylbutazone falsely elevate therapeutic levels. Methylxanthine Side Effects - ANS-Irritability and restlessness, toxic effects (tachycardia, tachypnea, seizures Methylxanthine Nursing Interventions - ANS-Monitor therapeutic levels for aminophylline and theophylline, avoid caffeine intake, monitor for signs of toxicity, smoking will decrease effects, alcohol abuse will increase effects. Treatment of methylxanthine toxicity - ANS-Stop parenteral infusion, activated charcoal to decrease absorption in oral overdose, lidocaine for dysrhythmias, diazepam to control seizures. Inhaled anticholinergics - ANS-Muscarinic receptor blocker resulting in bronchodilation. Used to prevent bronchospasm, manage allergen or exerciseinduced asthma, or COPD. Maximum effects may take up to 2 weeks, shake inhaler well before administration, when using two different inhaled medications, wait 5 minutes between, if administered via nebulizer, use within 1 hour of reconstitution. Inhaled anticholinergic drugs - ANS-Ipratropium (Atrovent) and Tiotropium (Spiriva) Inhaled anticholinergic Precautions/Interactions - ANS-Contraindicated for clients with peanut allergy (contains soy lecithin), use extreme caution with narrow-angle glaucoma and BPH, do not use treatment of acute bronchospasms. Inhaled anticholinergic side effects - ANS-Dry mouth and eyes, urinary retention. Glucocorticoids - ANS-Prevent inflammatory response by suppression of airway mucus production, immune responses, and adrenal function. Short term uses: IV agents for status asthmaticus, oral for treatment of symptoms following an acute asthma attack. Long term uses: inhaled for prophylaxis of asthma and oral for treatment of chronic asthma. Glucocorticoids Oral Drugs - ANS-Prednisone (Deltasone), Prednisolone (Prelone), and betamethasone (Celestone). Glucocorticoids Inhalation Drugs - ANS-Beclomethasone dipropionate (QVAR), budesonide (pulmicort, flexhaler), fluticasone propionate (Advair, Flovent), and Triamcinolone acetonide (Azmacort) Glucocorticoid IV Drugs - ANS-Hydrocortisone sodium succinate (Solu-Cortef), Methylprednisolone sodium succinate (Solu-Medrol), Betamethasone sodium phosphate (Betnesol, Celestone Phosphate) Glucocorticoid Precautions/Interactions - ANS-Clients who have DM may require higher doses, never stop medication abruptly CONTINUES.... [Show More]
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