Editing Pharmacology – RN Flashcards (section)

== Cardiovascular and Hemodynamic ==

;Digoxin: therapeutic range, precipitating electrolyte abnormality, toxicity signs, and antidote?
:Range 0.5 to 2.0 ng/mL overall, with 0.5 to 0.9 ng/mL targeted in heart failure. Hypokalemia potentiates toxicity and is common with concurrent loop diuretics; hypercalcemia and hypomagnesemia also increase risk. Toxicity presents as anorexia, nausea, vomiting, fatigue, visual disturbance including yellow-green halos, bradycardia, and dysrhythmias. Antidote is digoxin immune Fab.

;Why must nitrates never be given with a phosphodiesterase-5 inhibitor?
:Combined vasodilation causes profound, refractory hypotension and cardiovascular collapse. Avoid nitrates within about 24 hours of sildenafil or vardenafil and about 48 hours of tadalafil.

;What is the nursing priority when a vasopressor such as norepinephrine extravasates?
:Stop the infusion, disconnect the tubing while leaving the catheter in place to aspirate residual drug, notify the provider, and infiltrate the area with phentolamine as ordered to reverse local vasoconstriction and prevent necrosis.

;Two major toxicities unique to sodium nitroprusside?
:Cyanide and thiocyanate accumulation with prolonged or high-dose infusion, and light sensitivity requiring the container to be protected from light. Monitor for metabolic acidosis and altered mental status.

;Most serious long-term adverse effect of amiodarone?
:Pulmonary toxicity progressing to fibrosis. Also thyroid dysfunction in both directions, hepatotoxicity, corneal microdeposits, blue-gray skin discoloration, and QT prolongation.