NCLEX-RN ATI COMPRHENSIVE

NCLEX-RN ATI COMPRHENSIVE

REVIEW PART 4A PHARMACOLOG Y

Medication concepts, IVs, and Cardiac Meds

IV infusion complications • Infiltration- IV fluid escapes into tissues- stop infusion, take catheter out, cold compress, elevate, insert catheter in opposite extremity • Extravasation- toxic drug leaks out of vein & onto skin causing a chemical reaction-stop infusion, discontinue, aspirate as much as possible, cold compress, document findings • Pheblitis- inflammation of vein- stop infusion/discontinue, remove IV, put heat on it, insert new IV in opposite extremity (thrombophlebitis same except involves clot) • Hematoma- leakage of blood from vessels- stop IV and apply pressure • Catheter embolus- piece of catheter breaks of and travels through circulatory system-immediately apply tourniquet, xray

• REMEMBER STOP IV AND NEW CATHETER IN OPPOSITE EXTREMITY

Central Venous Catheter Complications

• Pneumothorax- collapsed lung- Tx: oxygen and chest tube admin.

• Air Embolism- air enters vein/artery- Tx: left lateral trendelenberg position & give oxygen • Lumen Collection- • Bloodstream infection- maintain sterility, change entire infusion system, notify provider to obtain cultures and give antibiotics

PICC Line Complications • Catheter Occlusion- reposition arm/prevent any kinks, confirm blood return, flush catheter btw meds and give thrombolytics • Catheter Dislodges- assess blood return, check for discomfort in jaw/chest/ear (tell provider, may mean dislodged) • Pheblitis • Catheter Embolism • Infection- remember aseptic technique, dressings clean and dry, report immediate signs of infection

Total Parenteral Nutrition (TPN)- hypertonic solution • Verify Rx & with another nurse • Via infusion pump • Monitor WEIGHT DAILY • Monitor I&O, glucose Q4-6hr, signs of infection • Change dressing 48-72hrs

• Change IV tubing and fluid 24hrs • IF TPN NOT AVAILABLE GIVE DEXTROSE 10% IN WATER- to prevent hypoglycemia

Antidotes • Acetaminophen (causes liver damage)- acetylcysteine • Benzodiazepine- flumazenile • Cyanide poisoning- methylene blue • Digitalis-digoxin immune FAB • Heparin/Enoxaparin (low weight heparin)- protamine sulfate • Iron- defeoxamine • Lead- succimer • Magnesium Sulfate- calcium gluconate (too much mag leads to hyperactive DTR, same with too little calcium=muscle twitching, CNS twitching) • Narcotics- NALAXONE • Warfarin- Vitamin K (Phytonadione)

Therapeutic Drug Levels • Digoxin 0.8-2 • Gentamicin 5-10 • Lithium 0.4-1.4 • Mag sulfate 4-8

Common Drug Class Suffixes • Afil- erectile dysfunction • Ase- thrombolytic • Asone, solone- corticosteroid • Arin- anticoagulant • Azine- antiemetic • Caine- anesthetics • Cillin- penicillin • Cycline- antibiotic • Dine- antiulcer • Dipine- calcium channel blocker • Floxacin- antibiotic • Ide- oral hypoglycemic • Mycin- aminoglycoside • Olol- beta blockers • Pam/lam- benzodiazepam • Phylline- bronchodialator • Pram/ine- SSRIs • Prazole- proton pump inhibitor • Pril- ACE inhibitors • Statin- antilipemic • Tyline- tricyclic antidepressants • Vir- antiviral • Zine- antihistamine

CARDIOVASCULAR MEDICATIONS

• Antihypertensives • ACE inhibitors

• CCB

• Alpha adrenergic blockers • Centrally acting alpha agonist • Beta blockers • Vasodilators • Remember assess weight, vitals, hydration, BP, standing/sitting/laying down, renal function and coagulation. Take meds at same time everyday, don’t go in hotubs/saunas, DO NOT STOP ABRUPTLY, prevent orthostatic hypotension.

ACE & ARB • ACE end in -prils (captopril, enalapril, lisinopril) • ARB end in -sartan (losartan, valsartan) • Side effects- angioedema (give epinephrine), hypotension (with ACE- nonproductive cough)

• DO NOT TAKE IF PREGNANT

CCBs • Nifedipine, amlodipine • Verapamil, diltiazem (can also be used for arrhythmias)

• Contraindication: pt. with HF, heart block, bradycardia

• DO NOT TAKE WITH GRAPEFRUIT JUICE

• Side effects- constipation, reflex tachycardia (when BP lowers body tries to compensate by making you tachycardic), peripheral edema, toxicity

• GIVE IV INJECTION OVER 2-3 MINUTES AND DO NOT DISCONTINUE ABRUPTLY

Alpha Adrenergic Blockers • Prazosin, doxazosin (for doxazosin in specific DO NOT TAKE WITH NSAIDS) • Take these meds at bedtime due to hypotension and notify provider if taking an OTC drugs • Side effect- dizziness, fainting

Centrally Acting Alpha 2 Agonist • Prevent the brain from sending out signals to speed up the HR • Clonidine, Guanfacine, Methyldopa • Side effects due to CNS effects- dry mouth, drowsiness/sedation, rebound hypertension, black/sore tongue, leukopenia (monitor WBCs)

Beta Blockers

• OPPOSITE EFFECT OF FIGHT OR FLIGHT

• Olols • B1- metoprolol, atenolol • B2- propranolol, nadolol, labetalol • Contraindication- AV block, sinus bradycardia; B2 contraindication- asthma, bronchospasms, HF • Side effects- bradycardia, nasal stuffiness, AV block, bronchospasm

• HOLD MED IF SYSTOLIC BP IS LESS THAN 100 OR PULSE IS LESS THAN 60

Vasodilators • Nitroglycerin, enalaprilat, nitroprusside, hydralazine • Side effects- dizziness, headache, hypotension, cyanide toxicity • Precautions- pt. with hepatic/renal disease, older adults, electrolyte imbalance

Cardiac Glycoside • Increases the force of contraction and slows conduction • Digoxin

• Interactions: thiazide/loop diuretics- increase risk for hypokalemia

• Side effects- bradycardia, hypokalemia, digoxin toxicity • Digoxin toxicity- GI effects (N/V, abdominal pain, anorexia) and CNS effects (fatigue, weakness, diplopia, halos around the eyes, and blurred vision) • Therapeutic level 0.8-2 • ASSESS PULSE FOR ONE MINUTE; If less than 60 withold med and notify provider

Antianginal • Nitrates

• Come in: sublingual, transdermal patch, SR tablet, ointment

• Contraindication: head injury, taking erectile dysfunction med

• Side effects: headache, orthostatic hypotension, reflex tachycardia, tolerance • Sublingual- KEEP IN DARK CONTAINER, DO NOT SHAKE, REPLACE TABLET Q6MONTHS, WEAR MEDICAL ALERT ID. Can be used prophylactically 5-10 minutes before exercising • Patch- wear for 12-14hrs • Ointment- wear gloves. Do not massage or rub in. Apply to area with no hair