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Nursing Pharm - Cardiac, Infection, GI

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olanjones's version from 2016-08-01 15:55

Heart Failure

Question Answer
ACE-inhibitors are considered first-line/drug of choice in treatment of heart failure, how do they work? Slow progression of HF by decreasing BP, increasing CO, also dilate veins reducing pulmonary congestion & peripheral edema
What is the effect of diuretic (also first-line tx) on the treatment of heart failure?Reduce fluid overload & decrease BP, decreasing peripheral edema & pulmonary congestion which increases CO
What is the effect of beta-adrenergic antagonists on the heart in treatment of heart failure?Slow HR & decrease BP, decreasing cardiac workload; in some cases can actually cause reverse modeling of the heart
How do vasodilators help to treat heart failure?By relaxing BV & decreasing BP, creating less workload on heart
Cardiac glycosides were once drugs of choice for HF, but are now limited to late stage, what is the prototype?digoxin (Lanoxin) - treatment does not change mortality but does relieve s/s of HF
Why is digitalization used to determine correct dosing of digoxin?to prevent AE, has a very narrow therapeutic window (always be looking for s/s of toxicity - anorexia, N&V, diarrhea, visual disturbances; sudden cardiac death is most dangerous)
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Dysrhythmias

Question Answer
Dysrhythmias are caused by defective electrical impulse conduction in heart (action potential), how are they treated?Pharmocotherapy only if clear benefit patient outcome; Nonpharm tx includes cardioversion, defibrillation, ablation, pacemakers, & ICD (all generally more successful than meds)
What is the goal of pharmacotherapy in treatment of dysrhythmias?To terminate existing dysrhythmias or prevent them to reduce risk of sudden death (often work by 1. blocking flow through ion channels 2. altering autonomic activity)
SE associated with amiodarone/Cordarone (prototype - Potassium channel blocker) include dyspnea, fatigue, palpitations, hemoptysis; what is the most serious AE?potentially fatal pulmonary toxicity (s/s: dyspnea, cough, fatigue, pleuritic pain, fever)
What are class I antidysrhythmic drugs?Sodium Channel blockers- procainamide, phenytoin, flecainide
What are class II antidysrhythmic drugs?Beta-blockers- propranolol, metoprolol, atenolol
What are class III antidysrhythmic drugs?Potassium Channel blockers- amiodarone, sotalol, ibutilide
What are class IV antidysrhythmic drugs?Calcium Channel blockers- verapamil, diltiazem
What are class IV antidysrhythmic drugs?Variable mechanism drugs (includes Cardiac glycocides- digoxin)
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Anti-Infectives

Question Answer
How are bacteria classified?By Gram stain (positive/negative), Shape (bacilli, cocci, spirilla), O2 use (aerobic/anaerobic)
What host factors are taken into consideration when treating infection/choosing drug?Defenses (immune system status), Location of infection (some area harder to reach with drugs), Allergy hx, Age, Pregnancy/Lactation, Genetics
The most common AE of PCN use is allergic reaction, why might the PCP also avoid using cephalosporins in a pt allergic to PCN?Risk of cross-sensitivity
PenicillinsKill by disrupting cell wall. Widely distributed to body tissues (only small amount to CSF), most are rapidly excreted by kidneys, have short half-lives.
GI complaints are common with cephalosporins, why should else should be considered during treatment?Some interact with vit K, some produce disulfiram-like reaction to ETOH
CarbapenemsBroad spectrum alternative to PCN, low incidence of AE
Tetracyclines are one of broadest spectrum of any abx class, what limits their use? Resistance makes them drug of choice for only a few diseases. Tooth discoloration can occur in children <8, or in prenatal/infants if taken by pregnant/lactating women
Tetracyclines should be taken on empty stomach (gastric distress is common d/t often kill normal GI flora) What might diarrhea indicate?Toxicity (pseudomembranous colitis by C. diff). Superinfections by candida albicans are also common
MacrolidesSafe & well tolerated alternative to PCN for many gram+ infections, inhibit bacterial protein synthesis. Resistant strains are becoming more common. Are metabolized and concentrated in the liver.
Aminoglycosides carry a potential for oxotoxicity & nephrotoxicity, why should monitoring for these conditions continue after tx is d/c'd?It is excreted almost entirely by kidneys but tight tissue binding prolongs excretion – up to 20 days after D/C [postantibiotic effect].
Fluoroquinolones are good for outpatient therapy because they are well absorbed orally, what limits their use?Although initally well tolerated & few AE but over time, >50% have been D/Cd by FDA for safety concerns (potential for toxicity in many systems)
Sulfonamides are the traditional drug of choice for UTI, what may limit their use?Hypersensitivity, Blood abnormalities (agranulocytosis, aplastic anemia, other dyscrasias), May cause crystalluria in renal impairment (blockage), Readily crosses placenta
What is the advantage of treating UTIs with urinary antiseptics?Treats tissue locally without systemic toxicity
Why are first-line and second-line mycobacterial drugs used together?First-line drugs are safer & more effective, Second-line are used when resistance to first-line develops.
Why is amphotericin B (Fungizone) usually reserved only for systemic fungal infections?SE can be fatal (convulsions/seizures, increased or decreased urination, irregular heartbeat, muscle cramps or pain)
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Peptic Ulcer Disease & GERD

Question Answer
PUD is often caused by H. pylori infection (present in 50% of population), what are complications of PUD?Bleeding, perforation, penetration, scarring, & obstruction
What are symptoms of a duodenal ulcer?Gnawing, burning upper abd pain 1-3 hours following a meal, typically worse when stomach is empty, relieved with food, may awaken pat at night (can heal spontaneously but predisposed to future ulceration)
What are symptoms of a gastric ulcer?Often relieved by food but can be exacerbated by eating, anorexia, wt loss, vomiting more commonly seen, some erosions could be cancerous - should have f/u (are less common than duodenal)
What is Zollinger-Ellsion Syndrome?A possible be hidden cause of PUD - caused by a gastrin secreting tumor; ulcers are persistent hard to treat, slow to heal
What are s/s of GERD?Heartburn, dyspepsia, dysphagia, chest pain, nausea, belching (worsen after large meals, exercise, or in recumbent position), chronic cough, wheezing, bronchitis, sore throat, hoarseness
What substances may worsen GERD?caffeine, ETOH, citrus, tomatoes, carbonation, onions, spicy food, smoking, pregnancy, obesity, many meds (H. pylori is not associated with GERD)
How do PPIs work? By blocking gastric acid secretion. They are drugs of choice for PUD & GERD.
The SE of PPIs include HA, nausea, diarrhea, rash, abd pain, what should be reported to PCP? Severe abd pain, bloody emesis or stools, Report worsening or unresolved symptoms
H2-receptor antagonists may cause dizziness and confusion, why?They cross BBB (less likely with ranitidine - does not cross)
Why should patients being monitored for B12 and iron deficiency?They need acidic environment for absorption
Why should antacids be taken either 1 hour prior to of 2 hours after other meds?They can affect absorption of MANY oral drugs
Why are antacids sometimes combined with magnesium?To help decrease constipation (antacids should not be used in persons with possible bowel obstruction)
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GI & Bowel Conditions

Question Answer
What is the purpose of laxatives?promote evacuation of the bowel or defecation
How do stimulant laxatives work?stimulate peristalsis (rapid acting, more likely to cause diarrhea, often used as bowel prep)
How do stool softener laxatives work?fat & water are absorbed into stool, used to prevent - not treat
How do saline/osmotic laxatives work?pull water into fecal mass, typically used as bowel prep
What is the most effective way to treat diarrhea?identify and treat the underlying cause - NEVER use anti-diarrheal meds in cases of poisoning or infection induced diarrhea
How do bismuth compounds work?bind and absorb toxins
How does pysillium work?absorbs fluid and adds bulk
How does lactobacillis work?restores normal flora
How is IBS usually managed?dietary management & lifestyle changes: reduce stress; restrict caffeine, wheat, lactose-based products, beans, cabbage, peas; eval drugs that could be contributing (May tx w/ antidepressants & antianxiety drugs, meds for symptomatic tx, to regulate intestinal motility)
What type of N&V do antiemetics treat?simple N&V, motion sickness (antacids, Benadryl, peppermint, ginger)
What type of N&V do anticholinergics & antihistamines treat?simple N&V, motion sickness, 20-60 minutes for effect, may cause drowsiness (scopolamine, Dramamine, meclizine)
When are benzodiazepines often used to treat N&V?To decrease anxiety of anticipated N&V from chemo (lorazepam)
What are cannabinoids not used as often to treat N&V?They are not as effective (Marinol, nabilone)
What type of drugs are widely prescribed for chemo-induced N&V?serotonin antagonists (dolasetron, Zofran, palonosetron)
What is acute pancreatitis often associated with?gallstones in women, ETOH in men - typically resolves in a few days
How is acute pancreatitis usually treated?bedrest, fasting, hydration, pain meds, PPIs, H2 receptor antagonists, antispasmodics
What is chronic pancreatitis often associated with?70-80% assoc with ETOH, may cause occlusion of pancreatic duct requiring enzyme supplementation - Steatorrhea occurs late in disease
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