Pharm

PHARMACOLOGY II – EXAM II: QUICK NOTES/GROUP DISCUSSION

Medication Prefixes & Suffixes

  • Recommendation: Make flashcards for prefixes and suffixes to aid memory retention.
Blood Pressure Medications
  • ACE Inhibitors (-pril):
    • Examples: captopril, quinapril.
    • Mechanism: Relax blood vessels, thereby decreasing workload on the heart.
  • Beta Blockers (-lol):
    • Examples: atenolol, propranolol, metoprolol.
    • Mechanism: Reduce blood pressure by slowing heart rate & reducing myocardial contractility.
  • Calcium Channel Blockers (-dipine/-zem):
    • Examples: amlodipine, nifedipine, diltiazem (Cardizem).
    • Mechanism: Relax blood vessels, increasing blood supply and oxygen to the heart.
  • Angiotensin Blockers (-sartan):
    • Examples: losartan, valsartan.
    • Mechanism: Inhibit blood vessel constriction.
  • Potassium-sparing Diuretics (-actone):
    • Examples: aldactone, spironolactone.
    • Mechanism: Increase fluid passed out by kidneys while retaining potassium.
  • Thiazide Diuretics (-thiazide):
    • Example: hydrochlorothiazide.
    • Mechanism: Used for treating blood pressure.
Cardiovascular Medications
  • Anticoagulant (-parin):
    • Examples: enoxaparin, heparin.
    • Mechanism: Prevent blood coagulation or prolong clotting time.
  • Antilipidemic (-statin):
    • Examples: atorvastatin, simvastatin.
    • Mechanism: Reduce LDL cholesterol and cardiovascular disease risk.
  • Thrombolytic (-ase):
    • Example: streptokinase.
    • Mechanism: Breaks down unwanted blood clots.

Airway – Breathing – Circulation (ABCs)

  • Emphasis on first checking:
    • Airway: Always takes priority.
    • Breathing: Second in priority.
    • Circulation: Last in priority.
  • Safety First: Maintain a safe environment and prevent injury.
Orthostatic Hypotension (Safety & Education)
  • Problem Overview:
    • Antihypertensive medications can cause sudden drops in blood pressure when changing positions, increasing fall risk.
  • Key Interventions (The "Dangle" Rule):
    1. Dangle First: Instruct the patient to sit on the edge of the bed for 1-2 minutes before standing.
    2. Slow Transitions: Move in stages: Lying → Sitting → Standing.
    3. Environmental Safety: Ensure a steady surface to hold onto.
  • Patient Education (Signs to Watch):
    • Subjective Symptoms: Teach to recognize light-headedness, dizziness, blurred vision, or "seeing spots."
    • Immediate Action: If symptoms occur, the patient should sit or lie back down to prevent syncope.

Assessment Quick Notes

  • Initial Assessment Importance: Identify the root cause, especially in emergencies.
  • Primary Focus: Rapid assessment to identify life-threatening problems.
  • Vital Signs Assessment:
    • Apical Heart Rate & Blood Pressure: Check before administering cardiac medications.
    • Assessing vital signs and labs is a priority for cardiac medications.
Medication Administration/Timing
  1. Safety First: Follow facility policies.
  2. Timing Window: Generally, ±60 minutes of scheduled time.
  3. Clinical Judgement: Administer based on patient assessment rather than strictly by the clock.
IV Reaction Protocol
  • Signs of Reaction: Respiratory distress (dyspnea/wheezing), pruritus (itching), nausea, hives.
  1. Immediate Actions:
    • Stop infusion immediately.
    • Keep vein open with normal saline using new tubing.
    • Notify provider.

Myocardial Infarction (MI) & Stroke Quick Notes

  • Time-Sensitive: “Time is tissue/brain/muscle.” Suspect MI or stroke and act immediately.
  • Symptoms Overview:
    • MI/Stroke Symptoms: Act quickly; don’t wait to call 911.
  • Acute MI/Stroke Protocol:
    • Activate EMS/911.
  • For stroke assessment use B.E.F.A.S.T.:
    • B: Balance issues
    • E: Eyes (vision issues)
    • F: Face drooping
    • A: Arm weakness
    • S: Speech difficulties
    • T: Time to call 911.
  • MI Specifics: Chest pain assessment is critical. Immediate Aspirin Admin: 160-325 mg can limit infarct size and mortality.
Myocardial Infarction (MI) in Women
  • Clinical Pearl: Women may present with atypical manifestations mimicking GI distress or exhaustion.
    • Symptoms include vague upper-body sensations (heaviness, burning) and respiratory distress.
    • Maintain a high suspicion for cardiac issues; prioritize diagnostic ECG.
Angina Overview
  • Definition: Chest pain caused by myocardial ischemia from narrowed coronary arteries.
  • Assessment Findings:
    • Classic Symptoms: Substernal chest pressure or heaviness.
    • Anginal Equivalents: Dyspnea, fatigue, pain radiating to jaw/neck/arm (common in women/diabetics).
  • Stable Angina: Triggered by exertion, relieved by rest/nitroglycerin.
  • Unstable Angina: Occurs at rest, unpredictable, may not respond to nitroglycerin (medical emergency).

Nitroglycerin (Nitrostat, Nitro-Dur) Quick Notes

General Mechanism
  • Class: Potent fast-acting vasodilator.
  • Effects: Improves blood flow, increases myocardial oxygen supply, reduces cardiac workload.
  • Monitoring Needs: Watch for hypotension.
Administration & Nursing Care
  1. Sublingual (SL) Tablets (Acute Relief):
    • Positioning: Advise the patient to sit or lie down before taking to prevent dizziness/syncope.
    • Instructions: .1 tablet under the tongue, can take 1 every 5 minutes for up to 15 minutes. Do not exceed 3 tablets within 15 minutes; seek medical attention if no relief.
  2. Topical / Transdermal:
    • Ointment: Measure on dose paper; typically starting dose ½ inch applied twice a day.
    • Patch: Rotate sites and avoid application on hairy or broken skin.
Expected Side Effects
  • Common Effects: Tingling/burning under tongue, flushing, dizziness, pounding headache (due to cerebral vasodilation).
  • Storage: Keep in original dark glass bottle away from light/heat.

Safety & Contraindications for Nitroglycerin

  • Interaction: Do not mix with PDE-5 inhibitors (e.g., sildenafil) as it may cause lethal hypotension.
  • Contraindication: Do not administer if systolic BP < 90 mmHg.

Stroke (CVA) Definition

  • Condition: Life-threatening due to impaired cerebral blood flow; results in cellular hypoxia and irreversible brain tissue death.
  • Ischemic Stroke (87% of cases): Arterial occlusion causing decreased oxygen delivery.
    • Thrombotic: Clot forms at narrowed artery site.
    • Embolic: Clot travels and lodges in cerebral vessel.
Hemorrhagic Stroke
  • Mechanism: Rupture of blood vessel causing intracranial bleeding and increased ICP.
    • Intracerebral: Rupture within brain tissue.
    • Subarachnoid: Bleeding between pia mater and arachnoid membrane, presents as “worst headache of my life.”
Treatment for Stroke
  • Ischemic stroke:
    • Treatment with thrombolytic drugs within a 3-4.5 hour window is critical.
    • Thrombectomy within 24 hours if no significant brain damage.
  • Hemorrhagic Stroke:
    • Manage blood pressure and reverse anticoagulants; restrict pressure inside the skull.
Thrombolytic Therapy Overview
  • Definition: Medications that dissolve blood clots, need to be administered promptly to avoid bleeding complications.
  • tPA (tissue plasminogen activator): Converts plasminogen into plasmin to help restore blood flow post-stroke.
Nursing Actions for Thrombolytics
  1. Rule Out Hemorrhage: CT or MRI prior to administration.
  2. Vitals & Labs: Blood pressure must be < 185/110 mmHg, check blood glucose.
  3. Monitoring: Frequent neuro checks for consciousness level; watch for bleeding signs.

Antiplatelet Medications

  • Examples: Aspirin, clopidogrel (Plavix).
  • Mechanism: Prevent platelets from aggregating.
  • Usage: Long-term prevention of TIA, Ischemic Stroke, and MI.
Key Nursing Assessments for Antiplatelets
  • Monitor for signs of bleeding (bruising, epistaxis, and hematuria).
  • Aspirin Toxicity: Report Tinnitus.
  • Contraindications: Active bleeding, and avoid in pediatrics with viral infections due to Reye’s syndrome.

Anticoagulants (“Blood Thinners”)

General Notes
  • Function: Prevent clot formation or growth.
Warfarin (Coumadin)
  • Indications: Long-term prevention in A-fib, DVT, PE, prosthetic heart valves.
  • Monitoring: PT/INR for therapeutic levels (2.0-3.0; or 2.5-3.5).
  • Dietary Education: Consistent Vitamin K intake.
Heparin
  • Administration: IV infusion or subcutaneous injection, monitor aPTT levels.
  • Risk: Heparin-Induced Thrombocytopenia (notify if platelets drop > 50%).
Enoxaparin (Lovenox)
  • Function: Treat or prevent blood clots, injected subcutaneously, and does not require routine lab monitoring.
Factor Xa Inhibitors (DOACs)
  • Examples: Rivaroxaban (Xarelto), Apixaban (Eliquis).
  • Usage: Prevent clots in A-fib without routine INR monitoring; high risk if spinal/epidural punctured.

Universal Bleeding Precautions for Anticoagulants

  • Signs & Symptoms of Bleeding: Report black tarry stools, hematuria, epistaxis.
  • Patient Safety Measures: Use an electric razor and soft-bristled toothbrush; avoid NSAIDs and aspirin unless prescribed.

Digoxin (Lanoxin): Cardiac Glycoside Quick Notes

  • Origin: Derived from foxglove plant (Digitalis purpurea).
  • Mechanism: Positive inotrope (↑ squeeze), negative chronotrope (↓ heart rate).
  • Indications: Heart failure and atrial fibrillation.
Nursing Assessments for Digoxin
  • The 60-Second Rule: Assess apical pulse for 1 full minute before administering.
  • Hold dose if: HR <60 bpm (adult), <70 bpm (child), or <90 bpm (infant).
  • Therapeutic Range: Narrow range (0.5-2.0 ng/mL). Levels >2.0 indicate toxicity.
  • Potassium Check: Hypokalemia increases toxicity risk.
Digoxin Toxicity Management
  • Signs Include: GI upset, confusion, visual disturbances, and arrhythmias.
  • Management: Notify provider, may administer antidote Digibind if severe.
Patient Education for Digoxin
  • Monitor Pulse: Report if below recommended levels.
  • Diet: Promote potassium-rich foods, particularly with potassium-wasting diuretics.

Hyperlipidemia Overview

  • Pathophysiology: High LDL levels lead to atherosclerosis, increasing MI/stroke risk.
  • Goals: Keep LDL
Lifestyle Modifications
  • Dietary Changes: Low-saturated fat and low-cholesterol foods.
  • Weight Management: Maintain healthy BMI (18.5-24.9).
  • Habits: Smoking cessation to improve vessel health.
Statins (HMG-CoA Reductase Inhibitors)
  • Examples: Atorvastatin, Simvastatin, Rosuvastatin.
  • Mechanism: Inhibit cholesterol synthesis in the liver.
  • Administer Timing: Bedtime to coincide with peak liver cholesterol synthesis.
  • Monitor for: Hepatotoxicity and myopathy.
Bile Acid Sequestrants
  • Example: Cholestyramine.
  • Mechanism: Binds bile acids in the gut, depleting cholesterol storage.
  • Administration: Timing of other medications important to avoid interactions.
Niacin (Vitamin B3)
  • Mechanism: Reduces LDL production.
  • Common Side Effect: Flushing can be mitigated with pre-medication.

Beta-Blockers Overview

  • Examples: Atenolol, Metoprolol, Propranolol.
  • Primary Uses: Hypertension, angina, CHF, arrhythmias.
  • Mechanism: Block beta receptors to lower heart demand.
  • Antidote: Epinephrine, glucagon.
Nursing Considerations for Beta-Blockers
  • Check Vitals: Monitor HR and BP prior to administration; hold if HR <60 bpm or BP <90-100 mmHg.
  • Safety: Watch for symptoms of hypotension.
  • Education on Discontinuation: Never stop abruptly to avoid rebound symptoms.
Expected versus Adverse Effects
  • Expected Effects: Mild fatigue, decreased exercise tolerance.
  • Adverse Effects: Report signs of bronchoconstriction, severe hypotension, or worsening CHF.

Diuretics Overview

  • Types: Potassium-wasting vs. potassium-sparing diuretics.
  • Goal: Reduce fluid volume to treat conditions like heart failure and hypertension.
Potassium-Wasting Diuretics
  • Examples: Furosemide (Lasix), thiazides.
  • Monitoring Priority: Watch for hypokalemia and encourage potassium-rich diets.
Potassium-Sparing Diuretics
  • Example: Spironolactone.
  • Monitoring Priority: Watch for hyperkalemia, avoid potassium intake.

IV Potassium Administration & Safety

  • Oral: Administer with food/water, do not crush.
  • IV: Ensure safe infusion rates; significant caution needed with rapid delivery.

Fluid Volume Excess Management

  • Definition: Excessive retention of water/sodium in extracellular fluid.
  • Assessment Techniques: Focus on cardiovascular, respiratory, and integumentary evaluations.
  • Nursing Interventions: Daily weights, positioning, fluid/sodium restrictions.
IV Infusion Protocol
  1. If dyspnea or allergic reaction during an infusion, immediately stop the infusion and assess the patient.

Alternative/Integrative Cardiac Care

  • Garlic (Allium sativum): Used for lowering cholesterol and blood pressure but can increase bleeding risks.
  • Safety Precautions: Patients should discontinue garlic supplements before surgeries to prevent excessive bleeding risk.

Medication Calculations & Abbreviations

  • Common Medication Abbreviations:
    • q.d.: once a day
    • b.i.d.: twice a day
    • t.i.d.: three times a day
    • q.i.d.: four times a day
    • PRN: as needed.
  • Defining Abbrev. for Time/Volume:
    • 1 kg = 2.2 lbs
    • 30 mL = 1 oz
  • Dosage Calculation Formula: ext{Dose Ordered} imes rac{ ext{Quantity}}{ ext{Dose on Hand}} = ext{Amount to administer}
    • Example: Administering 50 mg with a stock of 20 mg/10 mL:
      50 mg imes rac{10 mL}{20 mg} = 25 mL