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Pharm HESI Study Guide 3_14_ 10_ 7 30 pm CST

Pharm HESI Study Guide 3_14_ 10_ 7 30 pm CST - Converting...

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Converting micro drops into drops= a micro drop is 1/ one millionth of a drop Or 0.000001 Or (1/1,000,000) all math converting problems are fill in the blank….no multiple guess Converting mcg into mg= 1,000 mcg (micrograms) is equal to 1 mg (milligram); 1,000 mg = 1 gram Know about Calcium channel blockers= a. Calcium Channel Blockers (main use dysrhythmias/angina) i. Lower Calcium within the cell which creates smooth muscle relaxation, creating vasodilatation and lowering ii. Prototype: Calan (verapamil) 1. MOA – decrease peripheral resistance (dilate arterioles); decrease cardiac workload and oxygen consumption; decreasing B/P 2. Contraindications/cautions – allergy, heart block, sick sinus syndrome, pregnancy/lactation; hepatic/renal dysfunction 3. Adverse effects – dizziness, H/A, fatigue; nausea; hypotension, bradycardia, peripheral edema 4. Interactions – increase in serum levels of cyclosporine if taken with Cardizem 5. Nursing diagnoses a. Decreased cardiac output r/t hypotension b. Risk for injury r/t CNS/CV effects c. Ineffective tissue perfusion r/t hypotension /change in cardiac output d. Deficient knowledge: (medication effects) r/t lack of understanding 6. Nursing Actions a. Assess foe allergy, other medications, medical conditions b. Monitor V/S c. Comfort for adverse effects d. Safety measures e. Client teaching I. Calcium channel blockers a. First class: slow HR, dilate vessels, increase blood flow to heart; problem constipation especially in older clients i. Calan (verapamil): block calcium primarily coronary vessels & AV node; increase blood flow to heart, decrease impulses through AV node; use decrease workload of heart slow heart rate (HTN, angina, atrial fib) b. Second class: slow heart rate, dilate blood vessels, less constipation i. Cardizem (diltiazem): dilates calcium channels on coronary & peripheral vessels; uses atrial fib, HTN, angina, vasospasm
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c. Third class: Not “de plane”, but “dipines”: block peripheral vascular calcium channels; potent vasodilator; use HTN; SE fluid into feet, feet swollen i. Norvasc (amlodipine) ii. Procardia (nifedipine) iii. Cardene (nicardipine) iv. Sular (nisoldipine) v. Plendil (felodipine) vi. Dynacirc (isradipine) vii. CADUET (amlodipine + atrovastatin) viii. Case study: 93 yo male with severely edematous feet; HCTZ given with no effect; Motrin (ibuprofen) given for pain of edema, worse edema; taking Plendil (felodipine) for HTN, eating grapefruit or drinking grapefruit juice each day with breakfast; What is wrong??? 1. Ibuprofen close front door of kidney; vasoconstrict renal artery, block vasodilating prostaglandins, fluid retention 2. Grapefruit juice increase bioavailability of felodipine & increases toxicity 3. What to do? Say no to grapefruit; yes to medication ix. Uses of “dipines”: hypertension, vasospasm (Prinzmetal’s angina, Raynaud’s phenomenon, cocaine/meth-induced vasospasms) 1. FYI: ureteral spasms in clients with small renal stones, try slow release nifedipine 30 mg qd x 5-7 days 2. “Male contraceptive”: infertility in couples; husband on calcium channel blockers; stop & wives got pregnant a.
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