Pharm Notes Exam 2

Pharm Notes Exam 2 - Pharm Study Guide Exam II Treatment of...

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Pharm Study Guide – Exam II Treatment of Heart Failure Vasodilators (ACE inhibitors) – block angiotensin o Side effects – hypotension, hyperkalemia, cough o Contraindications – pregnancy Diuretics – lower BP: increase water and Na excretion Types 1. Thiazides (duiril) - decreases Na reabsorption in loop of Henle and parts of distal tubules, KCl and some bicarbonate also excreted 2. Potent or Loop (lasix, edecrin) – most potent, more prone to severe dehydration thrombus, increase Na and water excretion by inhibiting Na reabsorption 3. Potassium-sparing or aldosterone antagonists (aldactone, edecrin) – causes excretion of Na, bicarbonate, and Ca but conserves K+, spironolactone blocks action of aldosterone in distal tubules 4. Osmotic (mannitol) – increase osmotic pressure of glomerular filtrate which inhibits water and electrolyte reabsorption, affects proximal tubule and descending loop of Henle, used to prevent acute renal failure and to treat increased ICP 5. Carbonic anhydrase inhibitors (acetazolamide, methazolamide) – blocks action of carbonic anhydrase which promotes bicarbonate reabsorption increased bicarbonate, Na, and water excretion, used to lower IOP and to treat seizure activity Symptoms – malaise, muscle weakness or paralysis, behavior changes, GI complaints, calf cramping Major side effects – hypokalemia, hypochloremia, hyponatremia, GI distress, hyperglycemia, dry mouth Nursing considerations 1. Observe for side effects, especially electrolyte abnormalities 2. Daily weight (gain of 2lbs in one day or slow, persistent weight gain) 3. Skin care for edema 4. Potassium replacement 5. Routine follow up Hypokalemia Objective data – serum K+ levels, 12-lead EKG (sagging of ST segment, depression of T wave, development of U wave) Hyponatremia Symptoms – fatigue, weakness, cramping, nausea, bloating, dizziness, etc. Inotropic agents o Cardiac glycosides – digitalis preparations Actions – increase movement of Ca into cell, positive inotropic (increases myocardial contractibility), negative chronotropic (slows heart rate), negative dromotropic (delays conduction) Side effects – arrhythmias, hypotension, nausea, anorexia, diarrhea, behavior changes, abnormal vision Predisposing factors to digitalis toxicity – decreased K, increased Ca, pathologic conditions, quinidine and digitalis interaction (prolongs half-life of digitalis) increased toxicity, slower body function Never give with Ca very low HR Digitalis preparations serum levels – narrow margin of safety Digoxin o Therapeutic serum levels: 0.5-2.0 ng/ml o Toxic serum levels: >2.0 ng/ml *Take apical pulse before one full minute before giving: if <60 or >100 or irregular, withhold and notify Dr. Spironolactone – K-sparing diuretic, blocks aldosterone receptors
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Pharm Notes Exam 2 - Pharm Study Guide Exam II Treatment of...

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