N220 Pharmacology Study Guide

Exam 3

1) Know the difference between a beta and alpha adrenergic drugs.

● Alpha Adrenergic Drugs
○ Predominant response is vasoconstriction and CNS stimulation
○ Alpha 1
■ Receptors located on the postsynaptic effector cells
■ The tissue, muscle, or organ that the nerve stimulates
○ Alpha 2
■ Receptors located on the presynaptic nerve terminals
■ Control the release of neurotransmitters
● Beta Adrenergic Drugs
○ Response is bronchial, gastrointestinal, uterine smooth muscle relaxation
○ Glycogenolysis
○ Cardiac Stimulation
○ Beta 1
■ Heart
○ Beta 2
■ Smooth muscle fibers of bronchioles, arterioles, visceral organs

2) Know about epinephrine.

● Lab Work (Route, Onset of Action, Peak Plasma Concentration, Elimination
Half-life, Duration of Action)
○ Subcut, 5-10 minutes, 20 minutes, variable, unknown
○ IV, less than 2 min, Rapid, Less than 5 min, 5-30 min
● Acts directly on both the alpha and beta adrenergic receptors of tissues innervated
by the SNS
● Considered prototypical non selective adrenergic agonist
● Used in emergency situations and is one of the primary vasoactive drugs used in
many advanced cardiac life support protocols
● Low doses
○ stimulates mostly beta 1 adrenergic receptors, increasing the force of
contraction and heart rate.
○ Used to treat acute asthma and anaphylactic shock because of significant
bronchodilatory effects (Beta 2 in lungs)
● High Doses(IV Drip)
○ stimulated mostly alpha receptors causing vasoconstriction which elevates
blood pressure

● For IV two strengths

○ 1:1000 (1mg/ml)
 ○ 1:10000 (.1mg/ml)f=

3) Know the effects of beta 1 and 2 and alpha 1 drugs.

● Beta 1
○ Heart
○ Cardiac Stimulation
● Beta 2
○ Bronchodilation
● Alpha Drugs
○ Vasoconstriction of blood vessels

4) Be able to recognize beta blocker drugs and know the nursing

considerations.
● List of Beta Blockers
○ Carvedilol-Coreg, Coreg CR
○ Labetalol-Normodyne, Trandate
○ Nadolol-Corgard
○ Penbutolol-Levatol
○ Pindolol-Visken
○ Propranolol-Inderal
○ Sotalol-Betapace
○ Timolol-Blocadren, Timoptic
● Nursing Considerations(Indications)
○ Angina(Chest pain)
○ MI(Myocardial Infarction-heart attack)
○ Cardiac Dysrythmias(irregular heart rhythms)
○ Hypertension(high blood pressure)
○ Heart Failure(heart does not pump as well as it should)

5) Know about the client teaching for alpha and beta agonist and antagonist.
● Agonists (Adrenergic Drugs)
○ Medications are to be used only as prescribed with regard to amount,
timing and spacing of doses
○ Advise patient to immediately report any complaints of chest pain,
palpitations, headaches, or seizures
○ Lung disease patients need to avoid anything that may exacerbate their
respiratory system. Example: Smoking
○ Salmeterol
■ Not to be used for relief of acute symptoms
■ 1 puff twice daily 12 hours apart
■ recheck orders and directions

○ If another type of inhaler is used (Such as corticosteroids)

 ■ Use bronchodilator first with a 5 minute waiting period prior to
taking the second drug
○ Ophthalmic forms
■ Expiration Date
■ Clear Solution
■ Do not allow eyedropper to touch eye
■ conjunctival sac not onto the cornea
○ Oral midodrine
■ As prescribed
■ Usually ordered to be given with forcing fluids before the patient
gets out of bed in the morning.
■ In the morning because that is when patients with orthostatic
intolerance are usually more symptomatic.
■ Avoid taking this med after 6 pm if possible to prevent insomnia
and possible supine hypertension
● Antagonists
○ Avoid caffeine
○ medical alert bracelet or necklace identifying the specific medical
diagnoses provide list of all medication
○ Encourage intake of water to minimize dry mouth
○ Alpha Blockers
■ Change positions slowly to prevent postural hypotension or
syncope
○ Tamsulosin
■ Caution with elderly and while driving
■ Benign prostatic hyperplasia BPH
■ inform all health care providers including dentist
■ Especially before surgery
○ Things to avoid to avoid vasodilation
■ Alcohol
■ excessive exercise
■ exposure to hot climates
■ saunas, hot tubs, heated showers or baths
○ Contact prescriber if patient has
■ Dizziness
■ Fainting
■ Lightheadedness
■ systolic blood pressure is lower than 100 mm hg
■ pulse rate lower than 60 beats per min
■ increase of 2 pounds in 24 hours 5 pounds in 1 week
○ Must be weaned off slowly could lead to rebound hypertension or chest
pain

6) Know everything about bethanechol chloride.

● Lab Values: Route, Onset of Action, Peak, Half-life, Duration
○ PO/Injection, 30-90 minutes, less than 30 minutes, unknown, 1-6 hours
● Used in the treatment of
○ acute postoperative and postpartum nonobstructive urinary retention
○ management of urinary retention associated with neurogenic atony(loss of
strength) of the bladder
○ prevent and treat bladder dysfunction induced by phenothiazine and
tricyclic antidepressants
○ treatment of postoperative GI atony
○ gastric retention
○ chronic refractory heartburn
○ diagnostic testing for infantile cystic fibrosis
● Contraindications
○ known drug allergy
○ hyperthyroidism
○ peptic ulcer
○ active bronchial asthma
○ cardiac disease or coronary artery disease
○ epilepsy
○ parkinsonism
○ patients whome strength or integrity of GI tract or bladder wall is
questionable
● Adverse effects
○ syncope
○ hypotension with reflex tachycardia
○ headache
○ seizure
○ GI upset
○ asthmatic attacks
● Drug interactions
○ Acetylcholinesterase inhibitors

7) Know teaching instructions for anticholinergic meds

● Taken exactly as prescribed
● Careful with exercise because sweating
● Sensitivity to light associated with meds
● give drug same time each day per the prescriber’s order
● give the medication with adequate fluid intake 6 to 8 glasses of water
● Atropine and Glycopyrrolate commonly combined with opioids and mixed in the
same syringe
● If blocking drug is given via ophthalmic route apply light pressure with a tissue to
the inner canthus of the eye for approximately 30 to 60 seconds
● Oxybutynin
○ Taken as directed 1 hour before or 2 hours after meals
● Tolterodine
○ must be taken as directed and with food
● Transdermal forms
○ are to be applied to skin only after previous dosage form removed and area
gently cleansed of residual medication
○ transdermal patches may be applied to dry non hairy non irritated area
○ rotation of transdermal sites is recommended to decrease skin irritation
● Adverse effects
○ Constipation and inability to sweat

8) Know everything about digoxin and digoxin toxicity (including dietary , drug
administration, drug interactions, antidote, etc.)
● Digoxin
○ Indications
■ Systolic heart failure
■ Atrial fibrillation
○ Contraindications
■ Known drug allergy
■ second or third degree heart block
■ Atrial fibrillation
■ Ventricular tachycardia or fibrillation
■ heart failure from diastolic dysfunction
■ subaortic stenosis(obstruction of left ventricle below the aortic
valve)
○ Adverse Effects
■ Cardiovascular
● Bradycardia
● Tachycardia
● Hypotension
■ Central Nervous
● Headache
● Fatigue
● Confusion
● Convulsions
■ Eye
● Colored vision (green yellow purple)
● Halo vision
■ Gastrointestinal
● Anorexia
● Nausea
● Vomiting
● Diarrhea

○ Management
■ Between 0.5 to 2 ng/ml
 ■ Low potassium magnesium levels may increase potential for
digoxin toxicity
■ 20% taking digoxin exhibit toxicity
■ decrease renal function is a common cause of toxicity
○ Predisposing Conditions
■ Use of cardiac pacemaker
● toxicity at lower dosages
■ Hypokalemia
● risk of dysrhythmias increase
● more susceptible to digitalis toxicity
■ Hypercalcemia
● higher risk of sinus bradycardia
● dysrhythmias
● heart block
■ Atrioventricular block
● worsen with increasing levels or digitalis
■ Dysrhythmias
● May occur that did not exist before digitalis
■ Hyperthyroidism, respiratory, or renal disease
● patients with any of these disorders require lower dosages
because they cause delayed renal drug excretion
■ Advanced age
● decreased renal function, diminished drug excretion,
decreased body mass. Lower dose is needed
● polypharmacy also may lead to toxicity
■ Ventricular fibrillation
● ventricular rate may increase with use
○ Step by Step Management to toxicity
■ 1 discontinue administration of drug
■ 2 begin continuous ECG monitoring for cardiac dysrhythmias;
administer any appropriate antidysrhythmic drugs as ordered
■ 3 determine serum digoxin and electrolyte levels
■ 4 administer potassium supplements for hypokalemia if indicated,
as ordered
■ 5 institute supportive therapy for gastrointestinal symptoms
(nausea, vomiting diarrhea)
■ 6 Administer digoxin antidote (digoxin immune fab) if indicated,
as ordered

○ Antidote
■ Route, Onset of Action, Peak, Half Life, Duration of Action
● IV, immediate, immediate, 14-20 hours, days to weeks
■ Digoxin immune Fab
 ● antibody that recognizes digoxin as an antigen and forms
and antigen antibody complex with the drug
● Only in parental form as 40 mg vial
● All subsequent measurements of digoxin will be elevated
for days to weeks, so you look for signs and symptoms not
digoxin levels
● When to use
○ Hyperkalemia (Serum potassium level higher than 5
mEq/L) in a patient with digoxin toxicity
○ Life threatening cardiac dysrhythmias, sustained
ventricular tachycardia or fibrillation, and severe
sinus bradycardia or heart block unresponsive to
atropine treatment or cardiac pacing
○ life-threatening digoxin overdose: more than 10 mg
in adults, more than 4 mg in children
○ Interactions
■ Important interactions
● Amiodarone, quinidine, and verapamil
○ can increase digoxin levels by 50%
● When large amounts of bran are ingested
○ absorption of oral digoxin may be decreased
● Ginseng
○ Increase Digoxin level
● Hawthorn
○ Potentiate the effects of digoxin
● Licorice
○ may increase the risk of cardiac toxicity due to
potassium loss
● St. John’s Wort
○ may reduce digoxin levels
● Lowering potassium and magnesium
○ predispose to digoxin toxicity
■ Antidysrhythmics, calcium(parental)
● Mechanism-increase cardiac irritability
● Result-Increased digoxin toxicity
■ Cholestyramine, colestipol, sucralfate
● Mechanism-decrease oral absorption
● Result-Reduced therapeutic effect
■ Beta blockers, Calcium channel blockers
● Mechanism-Block Beta1 receptors in the heart
● Result-Enhanced bradycardic effect of digoxin
■ Quinidine
● Mechanism-Block calcium channels in the myocardium
● Result-Enhanced bradycardic and negative inotropic effects
of digoxin
 ■ Verapamil, amiodarone, dronedarone, cyclosporine, azole
antifungals
● Mechanism-Decrease clearance
● Result-Digoxin levels increased by 50%, digoxin dose
should be reduced by 50%
■
○ Normal therapeutic drug levels
■ between 0.5 and 2 ng/ml
■ >2 ng/ml used for the treatment of atrial fibrillation
○ Route, Onset of action, peak, half life, duration
■ PO, 1-2 hours, 2-8 hours, 35-48 hours, 3-4 days
■ IV, 5-30 minutes, 1-4 hours, 35-48 hours, 3-4 days

9) Know about nitroglycerin teaching, administration

● For any dosage form
○ Administer while seated to avoid falls from drug induced hypotension
○ Monitor for chest pains
○ Rate on pain scale 1-10
○ Measure blood pressure and pulse rate
○ Check for headaches, dizziness, lightheadedness
○ Supine position dose
■ blood pressure 10 mm hg rise
■ heart rate 10 beats/min
○ Contact prescriber
■ systolic blood pressure of 90 mm hg or less
■ pulse rate of 60 beats/min or less
■ pulse rate greater than 100 beats/min
● Oral dosage
○ Before meals with 6 oz of water
○ Extended release not to be crushed
○ Acetaminophen may be given if there is a drug related headache
● Sublingual
○ Under tongue and not swallow until drug absorbed
○ Metered dose aerosol sprays are applied onto or under the tongue
○ patient must keep nitrates in their original package or container
○ exposure to light plastic cotton filler and moisture avoid it

● Ointment
○ Use proper dosing paper
○ Apply onto clean dry hairless skin of upper arms or body
○ Avoid below knees and elbows
○ Do not apply ointment with fingers unless glove is worn to avoid contact
with the skin
 ○ Tongue depressor may be used
● Transdermal forms
○ Apply patches to a clean residue-free hairless area
○ if cardioversion or use of an automated electrical defibrillator is required
■ remove transdermal patch to avoid burning of the skin and damage
to defibrillator paddles
○ New patch
■ remove old patch
■ clean skin
■ dispose of bad patches
■ flush down the toilet
● IV Form
○ Emergencies situations only
○ Close automatic monitoring of blood pressure and pulse
○ Constant ECG monitoring
○ Dangers of IV form
■ lead to sudden and severe
● Hypotension
● cardiovascular collapse
● shock
○ Always check for incompatibilities and proper diluent
○ intravenous solutions through an infusion pump as ordered

10) Know about calcium channel blockers ( nursing interventions)

● no sudden withdrawal
○ can lead to
■ rebound hypertension
■ worsening of tissue ischemia
● Weight needs to be measured daily
● Constantly monitor the patient for edema and shortness of breath
● Patient to move and change positions slowly to prevent syncope
● constipation may be prevented by increasing fluids and fiber
● Contact prescriber if
○ palpitations, dizziness, nausea, dypsnea
● IV
○ requires use of an infusion pump and careful monitoring

11) Know about lidocaine

● Lidocaine(xylocaine)
○ most effective drugs for the treatment of ventricular dysrhythmias
○ only administered intravenously because of long first-pass effect
○ because of its extensive hepatic metabolism, dosage reduction of 50% for
patients with liver failure or cirrhosis
 ○ Effects on the conduction system of the heart by making it difficult for the
ventricles to develop dysrhythmia raising the ventricular fibrillation
threshold
○ Blocks sodium channels
○ Adverse effects
■ CNS toxic effects
● Twitching
● Convulsions
● Confusion
● Respiratory depression or arrest
■ Cardiovascular effects
● Hypotension
● bradycardia
● dysrhythmia
○ Contraindications
■ Hypersensitivity
■ Severe SA or AV intraventricular block
■ Stokes-Adams syndrome
■ Wolff-Parkinson-White syndrome
○ Parenteral form for intramuscular or intravenous administration
○ Implementation notes
■ Clear solution labeled
● Cardiac
● Not cardiac
■ Parenteral solutions only stale for 24 hours
■ Used as anesthetic
■ Combined with epinephrine sometimes
● Used in surgery repairing wounds
● must be applied topically
● never intravenously
● Where/when it is used
○ cardiac step-down unit
○ telemetry unit
○ intensive care setting

12) Know the effects of nesiritide

● Nesiritide(Natrecor)
○ Synthetic version of human B-type natriuretic peptide
○ BNP
■ substance secreted from the ventricles of the heart in response to
changes in pressure that occur when heart failure develops
■ in the blood increases when heart failure symptoms worsen
○ Atrial natriuretic peptide affects vascular permeability
○ Vascular permeability
 ■ refers to the ability of plasma to flow between blood vessels and
their surrounding tissues
■ one way for the body to regulate blood pressure
○ Vasodilator for arteries and veins
○ Effects of Nesiritide
■ Diuresis(urinary fluid loss)
■ Natriuresis(urinary sodium loss
■ Vasodilation
■ Indirect increase in cardiac output
■ Suppression of neurohormonal systems such as renin angiotensin
system
○ Used for/in
■ Intensive care setting
■ Treat severe life threatening heart failure
■ Combination with other cardiostimulatory medications
■ No longer recommended to be used as first line drug for heart
failure

13) Know about nitrates

● Used for
○ Prophylaxis
○ Treatment for angina
○ Cardiac problems
● Rapid and long acting
○ Amyl nitrite-rapid acting
○ Nitroglycerin- Rapid and long acting
○ Isosorbide dinitrate- rapid and long acting
○ Isosorbide mononitrate- primarily long acting
● Dilate blood vessels

● Contraindications
○ known drug allergy
○ Anemia
○ Closed angle glaucoma
○ Hypotension
○ Severe head injury
○ Do not use with Erectile dysfunction drugs
■ Sildenafil-viagra
■ tadalafil-cialis
 ■ vardenafil-levitra
● Adverse effects
○ Headache-most common and diminishes soon after start of therapy
○ tachycardia
○ postural hypotension
○ reflex tachycardia- vasodilation occurs too rapidly so heart rate increases
■ Baroreceptors falsely sense that there has been a dramatic loss of
blood volume and try to create homeostasis
● Interactions
○ alcohol
○ beta blockers
○ calcium channel blockers
○ phenothiazines
○ erectile dysfunction drugs

14) Know about thiazide diuretics (contraindications, teaching

instructions, interactions, administration
● Taken by mouth
● Primary site of action-Distal Convoluted tubule
● Inhibits resorption of
○ Sodium
○ Potassium
○ Chloride
● Results in osmotic water loss
● Relaxation of arterioles
● Reduces peripheral vascular resistance
● Very effective for the treatment of heart failure and hypertension
● Used for (indications)
○ edema
○ Hypercalciuria
○ Diabetes insipidus
○ hypertension
● Adjunct drugs for (Indications)
○ Management of heart failure
○ hepatic cirrhosis
● Heart failure due to diastolic dysfunction (Indication)

● Contraindications
○ Drug allergy
○ Hepatic coma (Metolazone)
○ Anuria
○ Severe Renal Failure
● Adverse effects
○ reduced potassium levels
○ Elevate levels of
■ calcium
 ■ lipids
■ glucose
■ uric acid
○ Common effects
■ dizziness
■ vertigo
○ Important effects
■ headaches
■ impotence
■ decreased libido
○ Uncommon other effects
■ GI disturbances
■ skin rashes
■ photosensitivity
■ thrombocytopenia
■ pancreatitis
■ cholecystitis
○ Interactions
■ corticosteroids-Additive effect-hypokalemia
■ diazoxide-
■ digitalis-hypokalemia-increased digoxin toxicity
■ oral hypoglycemics
■ Licorice leads to hypokalemia(low levels of potassium)

15) Know about potassium –sparing diuretics (client teaching)

● Potassium is reabsorbed not excreted
● signs and symptoms of hyperkalemia
○ nausea
○ vomiting
○ diarrhea
○ muscle weakness
○ mental confusion
○ hypotension
● Emphasize the importance of being cautious with
○ hot climates
○ excessive sweating
○ fever
○ use of saunas or hot tubs
● Any sign or symptom of hyperkalemia must be reported immediately

16) Know effectiveness of lab values associated with taking triamterene

● Triamterene(dyrenium)
○ PO, 50-100g bid, not exceed 300 mg/day
● Pregnancy D category drug
● Indications
○ Edema
○ Hypertension
○ heart failure
○ ascites(Ascites is the build-up of fluid in the space between the lining of the
abdomen and abdominal organs.)

17) Know furosemide and aminoglycoside interaction

● Aminoglycoside
○ Vancomycin
■ Additive effect-Increased neurotoxicity, especially ototoxicity

18) Know furosemide and steroid interaction

● Corticosteroid
○ Digoxin
■ Hypokalemia-additive hypokalemia, increased digoxin toxicity

19) Know the effects of alcohol and antihypertensives

● Increased CNS depression

20) Know laboratory values of Losartan potassium

● Losartan(Cozaar)
○ Pregnancy category C, D
○ Angiotensin II Receptor Blocker
○ Adult
■ PO: 25-100 mg single dose or divided bid
○ indications
■ Heart failure
■ Hypotension

21) Know s/e of Minipress

● Headache, drowsiness, tiredness, weakness, blurred vision, nausea,
vomiting,diarrhea, or constipation may occur as your body adjusts to the
medication. If any of these effects persist or worsen, tell doctor or pharmacist
promptly.
● Lightheadedness or dizziness upon standing may also occur, especially after the
first dose and shortly after taking a dose of the drug during the first week of
treatment.
22) Know effect of beta blocker and digitalis
● Beta blocker
○ Effects on the heart
■ beta receptors are blocked
■ negative inotropic effect- reduced myocardial contractility
■ Negative chronotropic effect- reduced heart rate
● Digitalis(Digoxin)
○ Effects on the heart
■ Positive inotropic effect(Increased myocardial contractility
■ Negative chronotropic effect- reduced heart rate
■ Negative dromotropic effect
● Decreased automaticity at the SA node
● Decreased AV nodal conduction
● Reduced conductivity at the bundle of his
● Prolongation of the atrial and ventricular refractory periods
■ Increase in stroke volume
■ Reduction in heart size during diastole
■ Decrease in venous blood pressure and vein engorgement
■ increase in coronary circulation
■ promotion of tissue perfusion and diuresis as a result of improved
blood circulation
■ decrease in exertional and paroxysmal nocturnal dyspnea, cough
and cyanosis
■ improved symptom, quality of life and exercise tolerance, but no
apparent reduction in mortality

23) Know about nitroprusside preparation

● Sodium Nitroprusside-Nitropress
● Intensive care setting for severe hypertensive emergencies
● IV
● Contraindications
○ heart failure, hypersensitivity
○ known inadequate cerebral perfusion

● Lab Values
○ 0.3-0.5 mcg/kg/min. Max of 10 mcg/kg/min

24) Know everything about heparin (patient effects, patient teaching, lab
values, antidote, drug interactions)
● Drug Effect
○ Antithrombotic drug
■ work to prevent formation of a clot or thrombus
● Indications
○ Risk of blood clots
● Contraindications
○ known drug allergy
● Adverse effects
 ○ Bleeding
○ Heparin induced thrombocytopenia
● Lab Values
○ aPTT
■ 25-35 sec normal control values
■ 45 70 sec therapeutic values
○ Preg cat C
○ Pediatric
■ IV: 50 units/kg, than 12-25 units/kg/hr, increase by 2-4 units/kg/hr
q6-8h prn
○ Adult
■ Subcut: 5000 units q8-12 hr for prophylaxis
■ IV infusion: 20000-40000 units/day usually given as 80 unit/kg
bolus then 18 units/kg/hr
■ aPTT determines maintenance dosage
● Antidote
○ IV injection of protamine sulfate
■ 1 mg reverses 100 units of heparin
● Drug interactions
○ Enzyme inhibition of metabolism
○ Displacement of the drug from inactive protein-binding sites
○ Decrease in vitamin k Absorption or synthesis by the bacterial flora of the
large intestines
○ Altercation in the platelet count or activity
○ Heparin interactions all lead to increased bleeding risk
■ Aspirin other NSAIDs-Decreased platelet activity
■ Warfarin, heparin, thrombolytics- additive
■ Rifampin- Increased effects
■ herbal therapies
● Garlic
● Ginkgo
● Kava

25) Know everything about warfarin (side effects, patient teaching,

dietary restrictions, lab values, antidote, drug interactions)
● Drug Effects
○ Similar to heparin
● Lab Values
○ Preg cat X
○ International normalized ratio determines maintenance dose, usually 1-10
mg/day orally
○ 2.5 to 3.5 INR
● Dietary restrictions
○ Careful with foods that are high in vitamin k
 ■ Leafy green vegetables
● Kale
● Spinach
● Collard Greens
■ May still eat them but need to be consistent with them
● Antidote
○ Discontinue
○ Vitamin K1 (Phytonadione)
● Drug Interactions (all increase anticoagulant effect except herbals they increase
bleeding risk)
○ Displacement from inactive protein binding sites
■ Acetaminophen
■ Amiodarone
■ Bumetanide
■ Furosemide
○ Decreased platelet activity
■ Aspirin other NSAIDS
■ Broad spectrum antibiotics
○ Enzyme induction
■ Barbiturates
■ Carbamazepine
■ Rifampin
■ Phenytoin
○ Enzyme inhibition
■ Amiodarone
■ Cimetidine
■ Ciprofloxacin
■ Erythromycin
■ ketoconazole
■ metronidazole
■ omeprazole
■ sulfonamides
■ macrolides
■ HMG-COA reductase inhibitors (Statins)

○ Impaired Warfarin absorption

■ Cholestyramine
■ Sucralfate
○ Unknown; case reports of increased international normalized ratios
■ Dong quai
■ Garlic
■ Ginkgo
■ St. John’s Wort

26) Know normal and abnormal serum cholesterol levels

● Normal Cholesterol Levels
 ○ Less than or equal to 200 mg/dl
● Abnormal is around 300 mg/dl

27) Know everything about statin drugs (lovastatin, atorvastatin,

simvastatin
● Statin Drugs
○ Teaching tips
■ When taking
● best taken with mels or 6 oz of water
● monitor liver and renal function laboratory studies every 3-
6 months
● care of interactions (grapefruit)
■ Report to prescriber if
● muscle soreness
● change in color of urine
● fever
● nausea
● vomiting
● malaise
○ Drug Effects/mechanisms
■ Lower blood cholesterol by decreasing rate of cholesterol
production
■ inhibit HMG-CoA reductase
○ Indications
■ First line drug therapy for
● Hypercholesterolemia
○ especially elevated levels of LDL cholesterol
○ most common and dangerous form of dyslipidemia
○ Contraindications
■ Drug allergy
■ Pregnancy
■ liver disease
■ elevation of liver enzyme levels
○ Adverse Effects
■ Fairly uncommon
■ Most common problems
● Gi disturbances
● Rash
● Headache
■ Important adverse effects
● myopathy
○ Muscle Pain
○ May progress into a serious condition known as
Rhabdomyolysis
■ Breakdown of muscle protein accompanied
by myoglobinuria
 ● Urinary elimination of the muscle
protein myoglobin
○ Interactions
■ Inhibit Warfarin metabolism-Increased risk bleeding
● Warfarin
■ Inhibit Statin metabolism-Increased risk myopathy
● Erythromycin
● Azole antifungals
● Quinidine
● Verapamil
● Amiodarone
● grapefruit juice
● HIV and hepatitis C protease inhibitors
● Cyclosporine
● Clarithromycin
● Diltiazem
● Amlodipine
■ Potentiation-Increased risk of myopathy
● Gemfibrozil

○ Atorvastatin
■ Lipitor
● lower total cholesterol
● Lower LDL cholesterol level
● Lower triglyceride level
● Raise good cholesterol HDL
● Can be dosed any time of day
● Pregnancy X drug
● 10-80 mg a day
● Usually given at night
○ Simvastatin
■ Zocor
● Lower total cholesterol
● Lower LDL cholesterol
● Lower Triglyceride level
● Raise good cholesterol HDL
● 5-40 mg a day
● Pregnancy X
 ● 80 mg restriction
● Do not use with list
○ itraconazole
○ ketoconazole
○ posaconazole
○ erythromycin
○ clarithromycin
○ telithromycin
○ HIV protease inhibitors
○ nefazodone
○ femfibrozil
○ cyclosporine
○ danazol
● Special interactions
○ Verapamil and diltiazem
■ do not exceed 10 mg
○ Amiodarone, amlodipine, and ranolazine
■ Do not exceed 20 mg
○ Lovastatin
■ Mevacor

28) Know laboratory values and drug interactions associated with statin
drugs
● Statin drug interactions ^^^^^^^^^^^^^^^^^^^^^

● Lab Values
○ Atorvastatin - Lipitor X
■ 10-80 mg/day
○ Simvastatin - Zocor X
■ 5-40 mg/day

29) Know symptoms associated with vasodilators

● Symptoms
○ Diazoxide
■ dizziness
■ headache
■ orthostatic hypotension
■ dysrhythmias
■ sodium and water retention
■ nausea
■ vomiting
■ hyperglycemia
○ Hydralazine
 ■ dizziness
■ headache
■ anxiety
■ tachycardia
■ edema
■ dyspnea
■ nausea
■ vomiting
■ diarrhea
■ hepatitis
■ systemic lupus erythematosus
■ vitamin b deficiency
■ rash
○ Minoxidil
■ T-wave electrocardiographic changes
■ pericardial effusion or tamponade
■ angina
■ breast tenderness
■ rash
■ thrombocytopenia
○ sodium nitroprusside
■ bradycardia
■ decreased platelet aggregation
■ rash
■ hypothyroidism
■ hypotension
■ methemoglobinemia
■ cyanide toxicity

30) Know how to administer cholestyramine

● Bile Sequestrants
○ Warn patients not to take bile acid sequestrants at the same time as other
drugs because of reduced absorption
○ other drugs must be taken at least 1 hour before or 4 to 6 hours after the
bile sequestrant
● Cholestyramine
○ Taken before meals or with meals
○ Never be given with PKU because it contains aspartame

31) Know what solutions are lipids, crystalloids, colloid or blood product
● Lipids or it could mean fat solutions pg 860
○ Two forms
■ Triglycerides
■ Cholesterols
○ Fat solutions
■ Vitamin
 ● A
● D
● E
● K
● Crystalloids
○ Natural Saline NS-Sodium Chloride
■ 154-NA 154-CL
○ Hypertonic Saline
■ 513-NA 513-CL
○ Lactated Ringer’s Solution
■ 130-Na 190-CL 4-K 3-Ca 28-Lactate
○ D5W 5 % Dextrose in water
■ 1-K
● Colloids most are 154-Na 154-Cl
○ Dextran 70
○ Dextran 40
○ Hetastarch
○ 5% albumin
○ 25% albumin
● Blood Product
○ Cryoprecipitate
○ Fresh Frozen Plasma-FFP
○ Packed red blood cells- PRBC’s
○ Plasma Protein Fraction- PPF
○ Whole Blood

32) Know the normal levels of sodium, potassium

● Potassium normal level
○ 150 mEq/L inside
○ 3.5 to 5 mEq/L outside
● Sodium normal level
○ 135 to 145 mEq/ outside

33) Know potassium (drug interactions , administration, intervention

● Interactions
○ Concurrent use of potassium sparing diuretics and ACE inhibitors can
produce hyperkalemic state
○ Concurrent use of non-potassium-sparing diuretics, amphotericin B, and
mineralocorticoids can produce hypokalemic state

34) Know s/s of hypo/hyperkalemia

● Signs and symptoms
○ Hypokalemia
■ Anorexia
■ Lethargy
 ■ Hypotension
■ Mental confusion
■ Muscle weakness
■ Nausea
■ Cardiac Dysrhythmias
■ Neuropathy
■ Paralytic Ileus
■ Secondary Alkalosis
○ Hyperkalemia
■ muscle weakness
■ paresthesia
■ paralysis
■ cardiac rhythm irregularities
■ Ventricular fibrillation
■ Cardiac arrest

35) Know s/s of hypocalcemia

● Neuromuscular irritability
● Muscle cramps
● confusion
● Heart dysrhythmia

36) Know how to administer Kayexalate

● Sodium Polystyrene Sulfonate
○ Orally
■ Elevate the head of patients ed to prevent aspiration
■ do not give with antacids or laxatives
■ each does as a suspension for improved palatability
○ Never give kayexalate with sorbitol
■ colonic intestinal necrosis
○ Rectal
■ Retention enema is used
■ Expect more than one dose
SELECT ALL THAT APPLY

37) Know adrenergic effects

● Alpha 1
○ Relaxation of GI smooth muscle
○ contraction of uterus and bladder
○ male ejaculation
○ contraction of pupillary muscles of the eye
● Alpha 2
○ reverses sympathetic activity
● Beta 1
 ○ Increase in force of contraction- positive inotropic effect
○ increase in heart rate-positive chronotropic effect
○ an increase in conduction of cardiac electrical nerve impulses through
atrioventricular node-positive dromotropic effect
○ causes an increase in renin secretion
● Beta 2
○ relaxation of bronchi and uterus
○ increased glycogenolysis(glucose release) from the liver

38) Know s/s of digoxin toxicity

● Bradycardia
● headache
● dizziness
● confusion
● nausea
● visual disturbances-blurred vision or yellow vision
● heart block
● atrial tachycardia with block
● ventricular dysrhythmias

39) Know client teaching for antihypertensives

● Do not abruptly stop taking them leads to rebound hypertension
● Take as ordered
● Adherence to dietary restrictions
● avoid smoking
● excessive alcohol intake
● excessive exercise
● hot climates
● saunas
● hot tubs
● hot environment
● heat ay precipitate vasodilation lead to worsening of hypotension
● report to the prescriber with weight gain of 2 pounds over 24 hours
● report to preserver with weight gain of 5 pounds over in 1 week
● inform all health care providers of antihypertensive regimen
● careful changing positions
● eye exams every 6 months
● saliva substitutes
● sexual dysfunction may happen
● may lead to depression

40) Know client teaching for atorvastatin

● can be taken anytime
● Bedtime dosing provides peak drug levels in a time frame that correlates better
● Evening meals or at bedtime
● Advise health care providers about antilipemics
● educate patients exercise is to be done in moderation and usually with supervision
● Diet that has vegetables fruit and bran