LOVE AND OTHER DRUGS

DIGOXIN FOR HEART FAILURE!

DRUG CLASS AND MECHANISM:•  DIGOXIN INCREASES THE STRENGTH AND VIGOR OF HEART CONTRACTIONS,

AND IS USEFUL IN THE TREATMENT OF HEART FAILURE. IT IS EXTRACTED FROM THE LEAVES OF A PLANT CALLED DIGITALIS LANATA. DIGOXIN INCREASES THE FORCE OF CONTRACTION OF THE MUSCLE OF THE HEART BY INHIBITING THE ACTIVITY OF AN ENZYME (ATPASE) THAT CONTROLS MOVEMENT OF CALCIUM, SODIUM ANDPOTASSIUM INTO HEART MUSCLE. CALCIUM CONTROLS THE FORCE OF CONTRACTION. INHIBITING ATPASE INCREASES CALCIUM IN HEART MUSCLE AND THEREFORE INCREASES THE FORCE OF HEART CONTRACTIONS

DRUG CLASS AND MECHANISM:• . DIGOXIN ALSO SLOWS ELECTRICAL CONDUCTION BETWEEN THE ATRIA AND

THE VENTRICLES OF THE HEART AND IS USEFUL IN TREATING ABNORMALLY RAPID ATRIAL RHYTHMS SUCH AS ATRIAL FIBRILLATION, ATRIAL FLUTTER, AND ATRIAL TACHYCARDIA. (ABNORMALLY RAPID ATRIAL RHYTHMS CAN BE CAUSED BY HEART ATTACKS, EXCESSIVE THYROID HORMONES, ALCOHOLISM, INFECTIONS, AND MANY OTHER CONDITIONS.) DURING RAPID ATRIAL RHYTHMS, ELECTRICAL SIGNALS FROM THE ATRIA CAUSE RAPID CONTRACTIONS OF THE VENTRICLES.

DRUG CLASS AND MECHANISM:• RAPID VENTRICULAR CONTRACTIONS ARE INEFFICIENT IN PUMPING BLOOD

CONTAINING OXYGEN AND NUTRIENTS TO THE BODY, CAUSING SYMPTOMS OF WEAKNESS, SHORTNESS OF BREATH, DIZZINESS, AND EVEN CHEST PAIN. DIGOXIN ALLEVIATES THESE SYMPTOMS BY BLOCKING THE ELECTRICAL CONDUCTION BETWEEN THE ATRIA AND VENTRICLES, THUS SLOWING VENTRICULAR CONTRACTIONS. THE FDA APPROVED DIGOXIN IN 1975

• PRESCRIBED FOR: DIGOXIN IS USED FOR MILD TO MODERATE CONGESTIVE HEART FAILURE AND FOR TREATING AN ABNORMAL HEART RHYTHM CALLED ATRIAL FIBRILLATION.

DOSING: 

•  DIGOXIN MAY BE TAKEN WITH OR WITHOUT FOOD. DIGOXIN IS PRIMARILY ELIMINATED BY THE KIDNEYS; THEREFORE, THE DOSE OF DIGOXIN SHOULD BE REDUCED IN PATIENTS WITH KIDNEY DYSFUNCTION. DIGOXIN BLOOD LEVELS ARE USED FOR ADJUSTING DOSES IN ORDER TO AVOID TOXICITY. THE USUAL STARTING DOSE IS 0.0625-0.25 MG DAILY DEPENDING ON AGE AND KIDNEY FUNCTION. THE DOSE MAY BE INCREASED EVERY TWO WEEKS TO ACHIEVE THE DESIRED RESPONSE.

• DRUG INTERACTIONS: DRUGS SUCH AS VERAPAMIL (CALAN, VERELAN, VERELAN PM, ISOPTIN, ISOPTIN SR, COVERA-HS), QUINIDINE (QUINAGLUTE, QUINIDE),AMIODARONE (CORDARONE), INDOMETHACIN (INDOCIN, INDOCIN-SR), ALPRAZOLAM(XANAX, XANAX XR, NIRAVAM), SPIRONOLACTONE (ALDACTONE), AND ITRACONAZOLE(SPORANOX) CAN INCREASE DIGOXIN LEVELS AND THE RISK OF TOXICITY. THE CO-ADMINISTRATION OF DIGOXIN AND BETA-BLOCKERS [FOR EXAMPLE PROPRANOLOL(INDERAL, INDERAL LA) OR CALCIUM CHANNEL BLOCKERS (FOR EXAMPLE, VERAPAMIL), WHICH ALSO REDUCES HEART RATE, CAN CAUSE SERIOUS SLOWING OF THE HEART RATE

• HTTP://WWW.MEDICINENET.COM/HEART_DISEASE_QUIZ/QUIZ.HTM

• GG’S BLOOD PRESSURE IS 145/90. ACCORDING TO THE GUIDELINES FOR DETERMINING HYPERTENSION, STAGE OF HER BP IS:

• NORMAL

• PREHYPERTENSION

• STAGE 1 HYPERTENSION

• STAGE 2 HYPERTENSION

• THE FIRST-LINE DRUG FOR TREATING GG’S BLOOD PRESSURE MIGHT BE:

• DIURETICS

• ALPHA BLOCKERS

• ACE INHIBITORS

• ALPHA/BETA BLOCKERS

• SIX MONTHS LATER, GG’S BLOOD PRESSURE WAS 168/86. HER HYPERTENSION WOULD BE CLASSIFIED AS:

• STAGE 1

• STAGE 1 ISH

• STAGE 2

• STAGE 2 ISH

• THE GROUP(S) OF ANTIHYPERTENSIVE DRUGS THAT ARE LESS EFFECTIVE IN AFRICAN-AMERICAN CLIENTS IS/ARE:

• DIURETICS

• CALCIUM-CHANNEL BLOCKERS AND VASODILATORS

• BETA BLOCKERS AND ACE INHIBITORS

• ALPHA BLOCKERS

• THE MOST FREQUENT DIURETIC THAT IS COMBINED WITH AN ANTI-HYPERTENSIVE DRUG IS:

• CHLORTHALIDONE

• HYDROCHLOROTHIAZIDE

• BENDROFLUMETHIAZIDE

• POTASSIUM-SPARING DIURETIC

• THE PREFERRED BETA BLOCKER CATEGORY FOR TREATING HYPERTENSION IS:

• BETA1 BLOCKER

• BETA2 BLOCKER

• BETA1 AND BETA2 BLOCKER

• BETA2 AND BETA3 BLOCKER

• A COMMON SIDE EFFECT OF ACE INHIBITOR

• NAUSEA AND VOMITING

• DIZZINESS AND HEADACHE

• UPSET STOMACH

• CONSTANT IRRITATED COUGH

• ANGIOTENSIN II RECEPTOR BLOCKERS(ARBS) ACT BY:

• INHIBITING ANGIOTENSIN-CONVERTING ENZYME

• BLOCKING ANGIOTENSIN II FROM AT1 RECEPTORS

• PREVENTING THE RELEASE OF ANGIOTENSIN I

• PROMOTING THE RELEASE OF ALDOSTERONE

• JR HAS A SERUM CHOLESTEROL LEVEL OF 265 MG/DL, TRIGLYCERIDES 235MG/DL, AND LDL 180MG/DL. THESE SERUM LEVELS INDICATE:

• HYPOLIPIDEMIA

• NORMOLIPIDEMIA

• HYPERLIPIDEMIA

• ALIPIDEMIA

• THE CLIENTS CHOLESTEROL LEVEL SHOULD BE:

• 150 TO 200 MG/DL

• 200 TO 225 MG/DL

• 225 TO 250 MG/DL

• GREATER THAN 250 MG/DL

• DEMI’S HIGH DENSITY LIPOPROTEIN IS 60MG/DL. THIS IS:

• LOWER THAN THE DESIRED LEVEL OF HDL

• DESIRED LEVEL OF HDL

• HIGH THAN THE DESIRED LEVEL FOR HDL

• VERY LOW HDL LEVEL THAN DESIRED

• THE LABORATORY TESTS ORDERED TO DETERMINE THE PRESENCE OF AMINO ACID THAT CAN CONTRIBUTE TO CARDIOVASCULAR DISEASE OR STROKE IS

• ANTIDIURETIC HORMONE

• HOMOCYSTEINE

• CERULOPLASMIN

• CRYOGLOBULIN

• WHICH SERUM LEVELS SHOULD BE MONITORED WHEN THE CLIENT IS TAKING A STATIN DRUG?

• BLOOD UREA NITROGEN

• COMPLETE BLOOD COUNT

• CARDIAC ENZYMES

• LIVER ENZYMES

• WHAT SEVERE SKELETAL MUSCLE ADVERSE REACTION COULD OCCUR WHILE TAKING STATINS?

• MYASTHENIA GRAVIS

• RHABDOMYOLYSIS

• DYSKINESIA

• AGRANULOCYTOSIS

• A CLIENT IS DIAGNOSED WITH PERIPHERAL ARTERIAL DISEASE (PAD). HE IS PRESCRIBED ISOXUPRINE HCL. THE ACTION OF ISOXUPRINE HCL IS TO:

• RELAX THE ARTERIAL WALLS WITHIN THE SKELETAL MUSCLES

• INCREASE TISSUE OXYGEN IN THE VESSELS

• INCREASE THE RIGID ARTERIOSCLEROTIC BLOOD VESSELS

• INCREASE INTERMITTENT CLAUDICATION

• CLIENT IS DIAGNOSED WITH PEPTIC ULCER DISEASE. THE NURSE REALIZES THAT PREDISPOSING FACTORS FOR THIS CONDITION INCLUDE:

• HELICOBACTER PYLORI

• HYPOSECRETION OF PEPSIN

• DECREASE HYDROCHLORIC ACID

• DECREASED NUMBER OF PARIETAL CELLS

• WHEN A CLIENT IS GIVEN SUCRALFATE (CARAFATE), THE NURSE KNOWS THAT ITS MODE OF ACTION IS TO:

• NEUTRALIZE GASTRIC ACIDITY

• INHIBIT GASTRIC SECRETION BY INHIBITING HISTAMINE 2 RECEPTORS IN PARIETAL CELLS

• SUPPRESS GASTRIC ACID SECRETION BY INHIBITING THE HYDROGEN/ POTASSIUM ATPASE ENZYME

• COMBINE WITH PROTEIN TO FORM A VISCOUS SUBSTANCE THAT FORMS A PROTECTIVE COVERING OF ULCER

• THE TEACHING FOR CLIENT TAKING RANITIDINE INCLUDES:

• DRUG-INDUCED IMPOTENCE IS IRREVERSIBLE

• ADMINISTER DRUG 30 MEALS BEFORE MEALS

• SEPARATE FROM AN ANTACID BY AT LEAST ONE HOUR

• ALWAYS ADMINISTER WITH A MAGNESIUM HYDROXIDE

• A CLIENT IS TAKING FAMOTIDINE TO INHIBIT GASTRIC ACID SECRETIONS. THE SIDE EFFECTS OF FAMOTIDINE MAY INCLUDE:

• DIARRHEA

• DIZZINESS

• DRY MOUTH

• BLURRED VISION

• KRISHA HAS A HEART FAILURE AND IS PRESCRIBED LASIX. WHAT TYPE OF DIURETIC IS FUROSEMIDE (LASIX)

• THIAZIDE DIURETIC

• OSMOTIC DIURETIC

• HIGH-CEILING (LOOP) DIURETIC

• POTASSIUM-SPARING DIURETIC

• WHAT TYPE OF ELECTROLYTE IMBALANCE COULD OCCUR WHEN TAKING FUROSEMIDE?

• HYPOKALEMIA

• HYPERKALEMIA

• HYPOGLYCAEMIA

• HYPERMAGNESEMIA

• WHY WOULD A DIURETIC COMBINATION SUCH AS TRIAMTERENE AND HYDROCHOLOROTHIAZIDE BE PRESCRIBED?

• TO DECREASE SERUM POTASSIUM LEVEL

• TO INCREASE SERUM POTASSIUM LEVEL

• TO DECREASE THE GLUCOSE LEVEL

• TO INCREASE THE GLUCOSE LEVEL

• THALIA IS TAKING HYDROCHLOROTHIAZIDE 50MG/DAILY AND DIGOXIN 0.25MG DAILY. WHAT TYPE OF ELECTROLYTE IMBALANCE CAN OCCUR?

• HYPOCALCEMIA

• HYPOKALEMIA

• HYPERKALEMIA

• HYPERMAGNESEMIA

• THALIA’S ELECTROLYTE IMBALANCE WOULD BE BECAUSE OF:

• HIGH DOSE OF DIGOXIN

• DIGOXIN TAKEN DAILY

• HYDROCHLOROTHIAZIDE

• LOW DOSE OF HYDROCHLOROTHIAZIDE

• MR HAS DIABETES MELLITUS AND IS TAKING HYDROCHLOROTHIAZIDE, 50MG. CONCERNING THE HYDROCHLOROTHIAZIDE, CLIENT TEACHING SHOULD INCLUDE MONITORING:

• HAEMOGLOBIN AND HAEMATOCRIT

• SERUM BLOOD UREA NITROGEN (BUN)

• BLOOD GASES

• SERUM GLUCOSE (SUGAR) LEVELS

• MRS. DEMI JONAS TAKES DIGOXIN 0.25MG PER DAY. WHAT IS THE SERUM THERAPEUTIC RANGE FOR DIGOXIN?

• 0.1 TO 1.5NG/ML

• 0.5 TO 2.0NG/ML

• 1.0 TO 2.5NG/ML

• 2.0 TO 4.0NG/ML

• YOU ARE ASSESSING MRS. LOVATO FOR POSSIBLE DIGITALIS TOXICITY. SIGN AND SYMPTOMS OF DIGITALIS TOXICITY INCLUDE:

• FAST PULSE RATE OF 100 BPM

• PULSE OF 72 WITH AN IRREGULAR RATE

• PULSE GREATER THAN 60BPM AND IRREGULAR RATE

• PULSE BELOW 60 BPM

• SELENA GOMEZ, A PATIENT WITH RIGHT-SIDED HEART FAILURE IS TAKING LOOP DIURETICS, FUROSEMIDE (LASIX) 40 MG TABLET. WHAT DO YOU THINK IS THE REASON WHY SHE IS TAKING DIURETICS?

•  

• FOR FEVER AND DIARRHEA

• FOR FEVER, ASTHMA AND DIARRHEA

• FOR EDEMA AND HYPERTENSION

• FOR INCREASED INTRA-CRANIAL PRESSURE AND CEREBRAL EDEMA

•  

• THE NURSE PROVIDES NUTRITIONAL TEACHING FOR A CLIENT RECEIVING LEVODOPA. THE CLIENT SHOULD BE ENCOURAGED TO:

• LOWER THE INTAKE OF SIMPLE CARBOHYDRATES

• INCREASE VITAMIN B6 INTAKE

• AVOID FOODS SUCH AS HAM, SWEET POTATOES AND OATMEAL

• DECREASE INTAKE OF DAILY PRODUCTS

• WHEN A CLIENT FIRST TAKES NITRATE, A COMMON SYMPTOM THAT OFTEN OCCURS IS:

• NAUSEA AND VOMITING

• HEADACHES

• STOMACH CRAMPS

• IRREGULAR PULSE RATE

• YOU ARE ASSESSING MRS. LOVATO FOR POSSIBLE DIGITALIS TOXICITY. SIGN AND SYMPTOMS OF DIGITALIS TOXICITY INCLUDE:

• FAST PULSE RATE OF 100 BPM

• PULSE OF 72 WITH AN IRREGULAR RATE

• PULSE GREATER THAN 60BPM AND IRREGULAR RATE

• PULSE BELOW 60 BPM

• WHEN A CLIENT FIRST TAKES NITRATE, A COMMON SYMPTOM THAT OFTEN OCCURS IS:

• NAUSEA AND VOMITING

• HEADACHES

• STOMACH CRAMPS

• IRREGULAR PULSE RATE

• NORMAL VALUES FOR MAGNESIUM

• 1.8-3.7MG/DL

• 1.2-3.7MG/DL

• 1.8-2.7MG/DL

• ALL OF THE ABOVE EXCEPT C

• NORMAL VALUES FOR SODIUM

• 125-135MG/DL

• 135-145MG/DL

• 135-155MG/DL

• ALL OF THE ABOVE EXCEPT C

• NORMAL VALUES FOR POTASSIUM

• 3.5-5.5MEQ/ML

• 4-5MEQ/ML

• 3.5-5.0MEQ/ML

• ALL OF THE ABOVE

• NORMAL VALUES FOR CALCIUM

• 8-10MG/DL

• 9-15MG/DL

• 12-20MG/DL

• 15-20MG/DL

• D5LRS 1LITER, TO CONSUME FOR 24. DROP FACTOR IS 20.

• 10-11GTTS/MIN

• 13-14GTTS/MIN

• 41-42GTTS/MIN

• ALL OF THE ABOVE EXCEPT C

• D5LRS 1LITER, TO CONSUME FOR 24. DROP FACTOR IS 15.

• 10-11GTTS/MIN

• 13-14GTTS/MIN

• 41-42GTTS/MIN

• ALL OF THE ABOVE EXCEPT C

• NA LEVEL OF 137MG/DL

• HYPERNATREMIA

• HYPONATREMIA

• ABNORMAL

• NORMAL

• K LEVEL OF2.5 MEQ/ML

• HYPOKALEMIA

• HYPERKALEMIA

• ABNORMAL

• NORMAL

• MG LEVEL OF 1.1 MG/DL

• HYPOMAGNESEMIA

• HYPERMAGNESEMIA

• ABNORMAL

• NORMAL

• MRS. LOVATO IS ALSO TAKING DIURETIC THAT DECREASES HER POTASSIUM LEVEL. A LOW POTASSIUM LEVEL (HYPOKALEMIA) COULD HAVE WHAT EFFECT ON DIGOXIN.

• INCREASES THE SERUM DIGOXIN SENSITIVITY LEVEL

• DECREASES SERUM DIGOXIN LEVEL

• DOES NOT HAVE ANY EFFECT ON THE SERUM DIGOXIN SENSITIVITY LEVEL

• CAUSES A LOW AVERAGE SERUM DIGOXIN SENSITIVITY LEVEL

• BETA-BLOCKERS ARE EFFECTIVE AS ANTI-ANGINALS BECAUSE THEY:

• INCREASE OXYGEN TO SYSTEMIC CIRCULATION

• MAINTAIN HEART RATE AND BLOOD PRESSURE

• DECREASE HEART RATE AND DECREASE MYOCARDIAL CONTRACTION

• DECREASE HEART RATE AND INCREASE MYOCARDIAL CONTRACTION

• WHAT INSTRUCTION SHOULD THE CLIENT RECEIVE WHEN DISCONTINUING A BETA BLOCKER?

• THE BETA-BLOCKER SHOULD BE ABRUPTLY STOPPED WHEN ANOTHER CARDIAC DRUG S PRESCRIBED

• THE BETA-BLOCKER SHOULD NOT BE ABRUPTLY STOPPED; THE DOSE SHOULD BE TAPERED DOWN

• THE BETA-BLOCKER SHOULD BE MAINTAINED WHILE TAKING ANOTHER ANTI-ANGINAL DRUG

• HALF THE BETA-BLOCKER DOSE SHOULD BE TAKEN FOR THE NEXT SEVERAL WEEKS

• THE BETA-BLOCKER ACETABULOL (SECTRAL) IS PRESCRIBED TO DYSRHYTHMIAS. THE PRIMARY PURPOSE OF THE DRUG IS TO:

• INCREASE THE BETA1 AND BETA2 RECEPTORS IN THE CARDIAC TISSUES

• INCREASE THE FLOW OF OXYGEN TO THE CARDIAC TISSUES

• BLOCK THE BETA 1 ADRENERGIC RECEPTORS IN THE CARDIAC TISSUES

• BLOCK THE BETA 2 ADRENERGIC RECEPTORS IN THE CARDIAC TISSUES

• A CLIENT IS SUFFERING FROM FEVER. WHAT MEDICATION SHOULD YOU ADMINISTER?

• ACETAMINOPHEN (TYLENOL)

• CLOPIDOGREL (PLAVIX)

• FUROSEMIDE (LASIX)

• PREDNISONE

• A CLIENT IN ER COMPLAINED FROM CHEST PAIN. HIS MEDICATION IS NITROSTAT, WHAT DO YOU CALL IN MEDICAL TERMS IS THAT CHEST PAIN?

• VAGINA

• ANGINA PECTORIS

• PECTORIS PRECTORIS

• ALL OF THE ABOVE EXCEPT A