Classifications of Medications II

Flashcards covering the pharmacology of cardiovascular, respiratory, gastrointestinal, hematologic, endocrine, and urinary system medications.

What is the primary action of cardiotonic medications?

They stimulate or strengthen the heart's pumping action.

What nursing action must be performed before administering a cardiotonic, and under what condition should it be withheld?

The apical pulse must be counted for $1$ full minute before administration; withhold the medication if the heart rate is below $60$ beats per minute or if irregularities in heart rhythm are present.

What are the inotropic and chronotropic effects of Digoxin?

Digoxin strengthens the force of ventricular contractions (positive inotropic effect) and slows the heart rate while increasing cardiac output (negative chronotropic effect).

What are the common symptoms of Digoxin toxicity?

Nausea, vomiting, headache, premature ventricular contractions, diarrhea, confusion, drowsiness, vision blurring, and visual disturbances.

What is the primary use and mechanism of Quinidine Sulfate (Quinidine)?

It is used to treat atrial arrhythmias by regulating the number of times the atria contract in a given period.

How does Verapamil Hydrochloride (Calan, Isoptin, Verelan) work to treat cardiac arrhythmias?

It is a calcium channel blocker that slows the electrical conduction rate of the AV node, resulting in a slower heart rate and decreased cardiac workload.

What is the clinical indication for Hydrochloride (Xylocaine)?

It is administered IV or IM to treat life-threatening ventricular arrhythmias following an MI (heart attack) and should be used only in intensive care settings.

What are the indications and administration requirements for Norepinephrine bitartrate (Levophed, Levarterenol)?

It is used to raise and sustain blood pressure in acute states of hypotension and in cardiac arrest; it is administered IV and only given in an ICU.

What is the pregnancy category and mechanism of Metaraminol bitartrate (Aramine)?

It is a pregnancy category D agent that indirectly affects the release of norepinephrine to raise or maintain blood pressure.

What are the therapeutic actions and primary indications of Nitrates?

Nitrates dilate blood vessels and increase blood flow to affected tissue, treating and preventing acute episodes of angina pectoris (heart pain).

What route of administration, onset, and duration of action characterize Amyl Nitrate?

It is administered by inhalation, has an immediate effect, and lasts approximately $3\text{--}5\,\text{mins}$.

What instructions and contraindications apply to Nitroglycerin administration?

Tablets should not be crushed or chewed, sustained-release forms must be given with water, and translingual spray should not be inhaled; it is contraindicated in clients with recent MI, severe asthma, angle-closure glaucoma, severe anemia, increased intracranial pressure, or hypotension.

Why is Prazosin HCL (Minipress) often prescribed with a diuretic?

Because it tends to cause fluid retention while reducing peripheral vascular resistance to lower blood pressure.

Where are Beta 1 and Beta 2 receptors primarily located?

Beta 1 receptors are primarily located in the myocardium of the heart, while Beta 2 receptors are located in the bronchial tree in the smooth muscles of blood vessels.

Why should non-selective beta blockers (such as Propranolol, Nadolol, and Timolol) not be given to clients with bronchial asthma?

Because blocking Beta 2 receptors causes bronchoconstriction in the bronchial tree.

What common suffix identifies Angiotensin-Converting Enzyme (ACE) Inhibitors, and how do they work?

They end in -pril and reduce peripheral vascular resistance in hypertensive clients by blocking the activation of angiotensin.

What advantage do Angiotensin 2 Receptor Blockers (ARBs, ending in -sartan) have over ACE inhibitors?

They have a similar blood-pressure lowering effect but produce fewer side effects such as coughing.

When is Clonidine (Catapres) indicated for hypertensive management?

It is used in hypertensive crises when blood pressure is over $180/120\,\text{mmHg}$.

What are the daily iron intake requirements for adult males compared to premenopausal and pregnant women?

Adult males require only $15\,\text{mg}$ daily, whereas premenopausal and pregnant women require four times as much.

What nursing instructions apply to the administration of oral liquid iron preparations (Ferrous sulfate and Ferrous fumarate)?

Clients should use a straw so the liquid does not stain their teeth and are encouraged to drink orange juice to maintain iron levels.

How should Iron Dextran (DexFerrum) be administered parenterally, and what happens if it is injected superficially?

It must be administered deep into muscle using the Z-track method; superficial administration can discolor the skin.

What is the clinical indication for Folic acid administration during pregnancy?

It is administered to prevent neural tube defects such as spina bifida.

What stomach-secreted substance is required for Vitamin B12 absorption, and what condition develops if it is absent?

Intrinsic factor is required; lacking it causes the client to develop pernicious anemia.

What is the primary physiologic role of Vitamin K in coagulation?

Vitamin K is necessary for the formation of prothrombin.

What laboratory test is used to monitor Heparin therapy, and what is its specific antidote?

Heparin is monitored using Prothrombin time (PT) (or PTT as noted in lab tests), and its antidote is protamine sulfate.

What laboratory tests are used to monitor Warfarin Sodium (Coumadin), and what is its antidote?

Warfarin is monitored using Partial thromboplastin time (PTT) and International normalized ratio (INR); its antidote is Vitamin K.

What nursing precautions must be taken when administering subcutaneous Heparin in the abdominal region?

Apply an ice pack to the area $10\text{--}15\,\text{min}$ before injection, do not aspirate during administration, and do not massage the injection site.

Under what condition is Whole Blood transfusion primarily indicated?

It is primarily indicated when there is rapid loss of both red blood cells and plasma, such as during a massive hemorrhage.

Why should individuals with asthma avoid taking antihistamines?

Because the drying actions of antihistamines may dry their respiratory tract.

What is the maximum recommended duration of use for OTC/prescription corticosteroid nasal sprays before considering immunotherapy?

They must not be used for more than $10\,\text{days}$.

What are the common adverse effects associated with bronchodilators?

Tremors, nervousness, tachycardia, palpitations, and dizziness.

How should Fluticasone (Flovent) be scheduled relative to bronchodilators?

It should be used $5\,\text{min}$ after using a bronchodilator.

What are the indications for the respiratory stimulants Naloxone and Doxapram?

Naloxone reverses respiratory depression; Doxapram is used for respiratory depression in the immediate postoperative recovery period and to treat acute respiratory failure associated with COPD.

Why is the use of nasal decongestants limited to no longer than 3 days' duration?

To avoid rebound congestion, where the client becomes congested again.

Why is oral decongestant Pseudoephedrine (Sudafed) contraindicated in hypertensive clients?

It can raise blood pressure due to its vasoconstrictive properties.

How do Histamine antagonists (-tidine) and Proton pump inhibitors (-prazole) differ in inhibiting stomach acid?

Histamine antagonists inhibit gastric secretions mediated by histamine, whereas proton pump inhibitors inhibit gastric acid secretion at its final stage.

Why do current rescue guidelines advise against the routine use of emetics?

Because vomiting may cause additional damage by subjecting the throat to the poison a second time; activated charcoal or gastric lavage is preferred.

How does Metoclopramide (Reglan) act as an antiemetic, and what serious adverse effects can it cause?

It increases gastric motility and gastric emptying (acting as a GI stimulant); it carries the possibility of Parkinson-like dyskinesias and akathisia.

How do fecal softeners (e.g., docusate sodium) relieve constipation?

They act like a detergent, permitting water and fatty material to mix with fecal contents so stools become moist, bulky, and easier to expel.

What is the primary action of Loop Diuretics (e.g., Furosemide, Bumetanide) and what electrolyte supplement is required?

They inhibit the reabsorption of sodium and chloride in the loop of Henle; clients require supplemental potassium due to potassium wasting.

What is the primary therapeutic indication for the osmotic diuretic Mannitol?

It pulls water into the urine to decrease fluid in tissues and reduce intracranial pressure due to edema.

What notable adverse effect on urine color is caused by Phenazopyridine (Pyridium)?

It turns the urine reddish orange.

What are the major physiological functions of Progesterone during pregnancy?

It prepares the lining of the uterus for implantation, suppresses ovulation, and reduces the irritability of uterine muscle to prevent labor or spontaneous abortion.

How do 5-Alpha reductase inhibitors (e.g., Finasteride, Dutasteride) benefit clients with BPH?

They help shrink the prostate and prevent additional growth of benign prostatic hyperplasia.

What are the major contraindications and defining duration of priapism associated with PDE5 inhibitors (e.g., Sildenafil)?

They should not be used with nitrates or in individuals with heart conditions (CAD); priapism is defined as an erection lasting more than $3\text{--}4\,\text{hours}$.