Med-Surg/Pharm HESI Review: Things to review on your own: anticholinergics and their effects on the body systems (Cant

t see, cant pee, cant spit, cant shit!) -atropine (bradycardia-IV push to raise HR, can also be used to dry secretions before surgery) -decrease gastric secretions to help prevent vomiting -dilate pupils -iprotropium (relaxes smooth muscle in lungs and opens airways) -causes urinary retention -slows bowel function, may cause constipation Cholinergic -constricts pupils -increases salivary secretions -increases gastric secretions -constricts airways -decrease HR -urecoline (relieves bladder retention) -increases stools (diarrhea) glaucoma normal levels for serum cholesterol fundamental skills and principles

*A miotic is a drug that causes the pupil to constrict, true or false? True! -ex. pilocarpine, given for glaucoma -have cholinergic effects and may be used to

Drugs affecting the EYE -atropine in anticholinergic that causes pupil dilation (diltation) and cycloplegia (ex. isoptoatropine) -use cautiously in pts with glaucoma, b/c can be absorbed in general circulation

*Allergy ?: -pt is allergic to bananas and avocados-may also be allergic to LATEX! -may also be allergic to chestnuts, papaya

Valve Disease-see pg 1345 -name the heart valves in order and tell which structures/chambers they serve: -enters thru superior vena cava into right atrium to tricuspid valve to right ventricle to pulmonary valve to pulmonary artery to lungs to left atrium to mitral valve to left ventricle to aortic valve to aorta 1. tricuspid: RA to RV 2. 3. 4.

*Your pt with tricuspid stenosis will have JVD and hepatomegaly, true or false? -Truestenotic valve does not open properly and prevents forward flow. Can cause JVD, decreased CO, and increased right atrial pressure. EKG shows tall tented P waves.

*Pt with tricuspid stenosis will not benefit from furosemide therapy, true or false? -FalseWILL benefit with diuretics like furosemide (Lasix) and antiarrhythmicss like digoxin (Lanoxin). *Digoxin will help improve CO and control a-fib if present. Take apical for one full min and do not give if below 60bpm. Hypokalemia contributes to dig toxicity. -S/S dig toxicity-c/o visual disturbances (halos, colors), anorexia, N/V, dramatic change in HR and rhythm

*Pts surgeons says there is a possibility that he may require blood or blood products during surgery. Can the pt donate his own blood? -Yesbut must donate several months before. Disadv: May also cause pt to be anemic during surgery. Costs of processing *Mrs. Heart has valve replacement surgery to have her tricuspid valve replacement with a mechanical valve. Will she require anticoagulation therapy afterwards? -Yes, mechanical valves are most durable, but blood tends to clot on them making anticoagulation necessary.

*What type of incision do you anticipate for her valve replacement? -midsternal, *Mrs. Hearts oral temp is now 105 degrees in PACU, what do you suspect? -malignant hyperthermia d/t to anesthesia rx.; may be genetic, more common w/volatile anesthesics and neuromuscular blocking agents *What are priority interventions for Mrs. Heart? -need to wake pt! -administer drugs: dantrolene sodium-causes muscle relaxation, but also hepatotoxic; may also receive procainamide for dysrhythmias, may trigger Lupus

Pt with DM type II, orders are sliding scale insulin and glucoscans including one at 3am *Why does he need 3am blood sugar? Somogyi phenomenon -normal blood sugars at bedtime and hypoglycemia at 2-3am \ with rebound hyperglycemia at 7am -what drug would be given to treat hypoglycemia? If awake and can swallow-give 15 g of fastacting simple carbohydrates such as 8 oz juice, or milk PO -if not awake or cant swallow, give glucagon *How is Somogyi phenomenon usu. treated? -by increasing the bed time snack or decreasing the HS insulin *What classes of drugs will this pt receive? -antidiabetic -insulins and oral hypoglycemic What are some different types of insulins he may receive for sliding scale coverage? -short acting (Regular, onset of action approx 30 min, give 30min-1hr before meal, usu. given Q4H) -rapid acting (Lispro, administer 15 min before meals) -intermediate acting (NPH, it is cloudy bc of protein, usu. given twice per day; Humulin N, Novolin N) -long acting (Lantus, glargine, lasts approx 24 hrs)

*can mix a clear with a cloudy, draw up clear insulin before cloudy!! (27 G, 3/8) R.N. (regular then NPH) *What insulins may be given IV? ONLY short acting (regular) *What are the classes of the oral hypoglycemic for a type II diabetic? -sulfonylureas; promote insulin secretion by the pancreas -1st generations-Diabinese (chlorpropamide) -2nd generation (glizapride)

*Is metformin a sulfonylurea? Noit is a bi Hypoglycemia <60mg/dL

*New drug for diabetes is Bydureon -once weekly

Pts BP is 150/94, dx w/HTN. -normal BP 120/80 -why does it develop in a diabetic? -narrowing of the vessels *What is the DASH diet? -dietary approaches to stop HTN-low cholesterol, low sodium, diet rich in fruits and veggies; wt loss with BMI 18-25, smoking cessation *Pt is now experiencing coupling PVCs greater than 6/min, what would you anticipate giving? -Lidocaine HCl IVP and followed by IV drip. 1-4mg/min *What else does he need? -oxygen -reposition to sitting or High Fowlers -cardiac monitoring and frequent VS

Antihypertensives: Diuretics -What other diuretics could you order for the above pt? - Potassium sparing: aldactone; aldosterone antagonists, -Thiazide diuretics: hydrochlorothiazide -cheapest and most effective -may cause dehydration or hyperglycemia -Beta-blockers (lols) -metoprolols -take apical pulse and BP before administering -Calcium channel blocker -promote dilation of arterioles -diltiazim (Cardizem) -nifedipine (Procardia)-may cause reflex tachycardia *What type of antihypertensive drug ends with sartan? -angiotensin II receptor antagonists (ARBs) -Angiotensin converting enzyme (ACE) inhibitors -Captopril -may cause hyperkalemia *What s/s would you expect to see with hyperkalemia? -EKG-narrow, peaked T wave; widening of QRS -acidosis, irritability, diarrhea -what order would you anticipate? Kayexalate

*MAP=[(DPx2)+SP]/3 -normal range is approx. 65-100

Acute myocardial infarction: -BP is 109/62, pulse is weak and thread, pt is pale and diaphoreticwhat would you administer? -Nitroglycerin SL q 5 min x 3. (0.4 mg??) -nitrates, vasodilators

*What labs would you order? -troponin (rises w/in 3 hrs of infarction), -CK-MB, -LDH peaks 48-72 hrs after MI -myoglobin-level rises w/in 1 hr after cell death and peaks 4-6 hrs -WBC 10000-20000 cells/mm3 up to 1 week -what would EKG reveal? ST segment elevation, T wave inversion, abnormal Q wave, U wave present

*Pt develops a-fibadminister what? -Digoxin IVP followed by daily maintenance dose. -therapeutic range 0.7-2.0 ng/ml

*LEFT sided heart failure only, S/S? -crackles and SOB PULMONARY SYMPTOMS!!

PHARM: *Depressed client is taking fluoxetine and also takes Imitrex for migraine HA. -What class of drug is fluoxetine (Prozac)? SSRI, antidepressant -What life threatening symptom may occur? serotonin syndrome -can occur with SSRIs and Imitrex -What are s/s of serotonin syndrome? -agitation, confusion, hallucinations, fever, ataxia, over active reflexes, tachycardia

TX of serotonin syndrome -benzodiazepines, IVFs, discontinue drug causing syndrome Zyprexa (Olanzepine) -what is drug class? atypical antipsychotic -take at same time each day Iron supplements -ferrous sulfate is most common -administer w/food bc upsetting to stomach and with source of vit C to increase absorption -CBC to evaluate effectiveness Inhalation drugs -bronchodilators (albuterol; indications: SOB, decreased SpO2, wheezing) -anticholinergic/bronchodilators (Duoneb or Spiriva) -nonsystemic corticosteroids (Advair) hold 10 sec. between each inhalation and rinse mouth afterwards Mevacor -lovastatin -can cause rhabdomyolysis; condition that results in breakdown of skeletal muscle tissue and pigment and which can lead to acute tubular necrosis