Nursing Pharmacology

82 flashcards by MentisLibrary

Drug classes from the bedside angle: what to assess before the dose, what to monitor after it, what to teach the patient, and when to hold and call. Built around the questions that actually get asked on the floor and on the exam.

What is assessed before administering digoxin?
The apical pulse counted for a full minute, and the drug is withheld and the provider notified if it is below 60 in an adult
Why does potassium matter so much in patients taking digoxin?
Low potassium increases digoxin binding at its site of action, so toxicity can occur even at a normal drug level
What is taught to a patient starting an ACE inhibitor?
A persistent dry cough is common and should be reported, and dizziness on standing is expected early
Why is angioedema an emergency in a patient on an ACE inhibitor?
Swelling of the lips, tongue and larynx can obstruct the airway within minutes
What is assessed before giving a beta blocker?
Heart rate and blood pressure, with the dose typically withheld for a heart rate below 60 or hypotension per parameters
Why are beta blockers a concern in diabetes?
They mask the adrenergic warning signs of hypoglycemia such as tremor and palpitations, leaving sweating as the main clue
What teaching accompanies calcium channel blockers?
Report ankle swelling, rise slowly, and avoid grapefruit juice with the agents affected by it
What is monitored in a patient receiving a loop diuretic?
Potassium, sodium, magnesium, kidney function, daily weight, blood pressure and hearing
Why is daily weight the most reliable fluid status measure?
One kilogram of weight change corresponds to about one liter of fluid, and it is more sensitive than intake and output records
What teaching accompanies a thiazide diuretic?
Take it in the morning, expect increased urination, and report muscle cramps or weakness that suggest low potassium
What is the main risk of spironolactone?
Hyperkalemia, which is amplified when it is combined with an ACE inhibitor, an ARB or potassium supplements
What is taught to a patient using sublingual nitroglycerin?
Sit or lie down before taking it, since it can cause sudden dizziness, and follow the prescribed repeat and emergency call interval
What is monitored in a patient taking a statin?
Liver enzymes at baseline and as indicated, plus any new muscle pain, tenderness or weakness
What laboratory value guides warfarin therapy?
The INR, with a typical therapeutic target of 2.0-3.0 for most indications
What is the antidote for warfarin, and what is the antidote for heparin?
Vitamin K for warfarin, and protamine sulfate for heparin
What laboratory value monitors unfractionated heparin?
The activated partial thromboplastin time, typically targeted at 1.5-2.5 times the control value
Why is the platelet count monitored during heparin therapy?
To detect heparin induced thrombocytopenia, an immune reaction that paradoxically causes clotting
How is subcutaneous heparin or enoxaparin injected?
Into the abdominal fat at least two inches from the umbilicus, without aspirating and without massaging the site
What is different about monitoring direct oral anticoagulants?
They do not require routine INR monitoring, which is one of their main practical advantages over warfarin
What teaching applies to a patient on daily low dose aspirin?
Take it with food, report black or tarry stools, and remember that it affects platelets for about a week after the last dose
Which insulin is the only one that can be given intravenously?
Regular insulin
In what order are regular and NPH insulin drawn into one syringe?
Air into NPH, air into regular, draw up regular, then draw up NPH, so the clear is drawn before the cloudy
What are the signs of hypoglycemia?
Shakiness, sweating, tachycardia, hunger, irritability, confusion, and eventually seizure and loss of consciousness
Why is metformin held before an iodinated contrast study?
Because contrast induced kidney impairment can allow metformin to accumulate and increase lactic acidosis risk
What is the key teaching for a patient starting an SGLT2 inhibitor?
Maintain fluid intake, practice good genital hygiene, and report signs of urinary or genital infection
What is the most common early side effect of GLP-1 receptor agonists?
Nausea, which usually improves as the dose is increased gradually
How is levothyroxine taken?
On an empty stomach in the morning, with water, and separated from calcium, iron and antacids by several hours
What signs suggest a patient is receiving too much thyroid hormone?
Tachycardia, palpitations, weight loss, heat intolerance, tremor and insomnia
What teaching accompanies long term corticosteroid therapy?
Never stop abruptly, take it with food, monitor glucose, and report signs of infection because inflammation may be masked
Why must corticosteroids be tapered rather than stopped?
Exogenous steroids suppress the adrenal axis, and abrupt withdrawal can precipitate adrenal insufficiency