311 Exam 2 Flashcards
What class of antidysrhythmic drugs are prescribed for atrial flutter and fibrillation?
Class 2 beta-adrenergic antagonists
What class of antidysrhythmic drugs are prescribed for severe atrial and ventricular dysrhythmias?
Class 3 potassium channel blockers
What class of antidysrhythmic drugs are prescribed for paroxysmal supraventricular tachycardia?
Class 4 calcium channel blockers
What antidysrhythmic drugs are prescribed for severe ventricular dysthymias?
Lidocaine and flecainide
Using a calcium channel blocker at the same time as digoxin may cause what?
A partial or complete heart block , heart failure, or dysrhythmias
The antidysrhythmic drug Amiidarone (Pacerone) carries what black box warning
It can cause pneumonia like syndrome in lungs which can be fatal and requires a baseline and periodic lung function assessment
This is a potassium channel blocker
What is Dofetilde (Tikosyn) used to treat
It terminates atrial flutter and fibrillation
What waveform would indicate ischemia of the myocardium?
Flat T wave
A prolonged PR interval may indicate what?
Heart block
What is a dysrhythmia that originates in the atria referred to as?
Supraventricular
A rapid rate of >140 and a narrow QRS indicates..
Supraventricular tachycardia (SVT)
Amiodarone (Pacerone)
-what class drug?
Potassium channel blocker
St. John wort decreases the effectiveness of what potassium channel blocker?
Amiodarone (Pacerone)
Grapefruit juice may increase toxicity of what antidysrhythmic drug?
Amiodarone (Pacerone). Potassium channel blocker
What are side effects of Amiodarone?
Pulmonary toxicity
Hypotension
When a patient is taking Amiodarone (Pacerone) what lab test should be monitored if they are also taking Coumadin
TSH. Pacerone block’s warfarin metabolism
What class of drug is Diltiazem (Cardizem) and what are the side effects?
calcium channel blocker
HA, Dizziness, Hypotension
what does the drug Adenosine (Adenocard) do? (Miscellaneous antidysrhythmic)
Terminates serious atrial tachycardia
Rapid IV administration
Primary factors affecting BP
Blood volume
Peripheral resistance/diameter of vessels
Cardiac output (CO)
Stroke volume (SV)
Heart rate
BP of 130-139/80-89 is what
HTN stage 1
normal BP
less than 120/ less than 80
Potassium sparing diuretics
Most commonly used: and the
Side effects.
spironolactone:
hyperkalemia, dehydration
Loop diuretics
Most commonly used: and the
Side effects.
furosemide :
hypokalemia, dehydration
Chlorthalidone is what type of drug and has what side effects?
Thiazide diuretics
Side effects: hypokalemia, dehydration, hypotension, hyponatremia
what is the primary homeostatic mechanisms controlling blood pressure and fluid balance in the body
Renin-angiotensin-aldosterone system (RAAS).
Renin converts angiotensin to angiotensin I (start of increasing BP)
ACE and ARBs mechanism of action
act on the RAAS to decrease blood pressure
ARB- LoSARtan, good way to remember arb meds is they have SAR in their name. SAR sounds like ARB
ACE- Enalapril, good way to remember ACE meds is they have PRIL in their name. ACE-pril
Losartan (Cozaar):
is what drug with what side effects?
Side effects (Common with ARBs)
Angioedema
Hyperkalemia
Renal failure
If overdose, administer Normal saline
Enalapril (Vasotec):
is what drug with what side effects?
Ace inhibitor
Side effects (Common with ACE inhibitors)
Fetal toxicity
Elevated kalemia (hyperkalemia)
Angioedema
Renal failure
Sodium channel blockers treat what kind of dysrhythmia
A-fib. Premature atrial contraction. PVCs. Vent Tachy
All potassium channel blockers can produce what fatal condition
Torsades de pointes.
Which antidysrhythmic drug can result in malignant hypothermia as an adverse effect
Lidocaine
Which antidysrhythmic drug may induce lupus like symptoms as an adverse effect
Procainamide. (Sodium channel blocker)
What patient condition’s are contraindicated for receiving Procainamide
Complete AV block
severe HF
Blood dycrasias
Myasthenia gravis
What medication slows down heart rate and decreases conduction velocity through av node
Beta adrenergic antagonists.
Beta blockers can affect lungs potentially causing bronchospasms. T/f
T
Which antidysrhythmic drug is considered both a beta blocker and a potassium channel blocker.
Sotalol
Which antidysrhythmic drug is approved to treat a-fib or flutter but is contraindicated for serious HF
Dronedarone.
Which antidysrhythmic drug blocks warfarin, requiring lower doses of the anticoagulant
Amiodarone
What antidysrhythmic drugs primary indication is a specific dysrhythmia know. As Paroxysmal supraventricular tachycardia (psvt)
Adenosine
Calcium channel blockers are used for what conditions
Angina pectoris
HTN (not usually monotherapy)
Dysrhythmias
Selective and non selective calcium channel blocker differences
Selective act on vessels only
Non selective act on vessels and heart.
What kind of medication is Verapamil. (Calan SR)
CCB
Effects both HR and BP
Some herbals interact
What kind of drug is Diltiazem (Cardizem) and it’s main side effect
CCB
HA
What kind of drug is Nifedipine (procardia XL) and it’s side effects
CCB
Hypotension
HA
Dizzy
Peripheral edema (common with CCB)
*Grapefruit juice might enhance absorption
What kind of drug is clevidipine (cleviprex)
And what is it Used for?
How is it used
CCB
To tx serious, life threatening HTN
Has a short half life
Iv route only. Continuous BP monitoring
Propranolol had hypoglycemic effects and can mask symptoms of hypoglycemia
T
(Make this card backwards somehow)
What do alpha adrenergic antagonists do and give an example
Block sympathetic receptors in arterioles causing vessels to dilate
Doxazosin (cardura).
What are the side effects of doxazosin (cardura)
Hypotension, Dyspnea, SOB
(It dilates arteries and veins)
T or f
Women have a higher mortality rate than men when it comes to HF
T
2 most important factors for cardiac output
Preload :ventricles filling
After load: pressure aorta needs to overcome for blood to be ejected
What is cardiac remodeling
Over time the changes in size and shape and structure of myocardial cells occurs with hypertrophy (thickening and hardening of left ventricle working harder)
What do adrenergic blockers do to treat HF
Decrease cardiac workload by decreasing HR and BP
(Carvdilol)
Used in stages b and c
What do vasodilators do to treat HF.
Dilate vessels reducing preload
(Hydralazine)
Used in stage c
What do phosphodiesterase inhibitors do to treat HF
Increase CO by increasing myocardial contraction
(milrinone)
Used in stage d
What do aces and arbs do to treat HF
Increase CO by lowering BP and decrease blood volume.
Used in stage b, c
What do cardiac glycosides do to treat HF
Increase CO by increasing myocardial contraction
What do diuretics do to tx HF
Increase CO by decreasing fluid volume and BP
What type of drug is digoxin and how is it used
Cardiac glycoside
Increases Cardiac contractility.
Suppresses SA mode and slows conduction through AV node.
Used in HF for rhythm and rate control.
Digoxin side effects and warnings
Nausea and vomiting and anorexia
Do not stop abruptly
Do not take ginseng
What type of drug is Milrinone (Primacor) how is it used and side effects
Phosphodiesterase inhibitor
Iv only
Side effects: ventricular arrhythmia: continuous ECG monitoring needed.
CAD is a fatty plaque build up in arteries that starts early in life and leads to what
MI (heart attack)
What is angina pectoris
Acute chest pain caused by insufficient oxygen supply
If improves with rest it is -stable
If does not improve with rest - unstable
What occur when a coronary artery become completely occluded
Myocardial infarction
How long does it take for cardiac tissue to die if blood flow is not restored
20 minutes
How do organic nitrates work
Relax arterial and smooth muscle and dilate veins to reduce preload.
You should cover the nitrate IV bottle to reduce the degradation of nitrates with light exposure. T/F
T
Max dose of nitroglycerin is what and how often
3 tab max
1 tab every 3-5 minutes
Sublingual nitroglycerin dose should terminate chest pain how fast
2-4 minutes. If not resolved after 5 minutes call EMS it could indicate MI
What drugs are used for angina when beta blockers have been unsuccessful
CCBs
Shock occurs when tissues are not receiving adequate blood flow and can lead to what
Tissue death and organ failure. It is a
Medical emergency
Nursing interventions for shock.
Chest compressions, airway, breathing
Immediately connect to cardiac monitor, pulse ox and oxygen
Restore fluid volume/composition and maintain adequate BP.
What is carcinogenic shock
Failure of heart to pump sufficient blood to tissues
What is hypovolemic shock
Loss of blood volume
What is neurogenic shock
Vasodilation due to overstimulation of the parasympathetic nervous system or under stimulation of the sympathetic nervous system.
What is septic shock
Multiple organ dysfunction as a result of pathogenic organisms in the blood. Often a precursor to acute respiratory distress syndrome and DIC
What drugs are used for shock
Fluid replacement
Albumin- protein to increase BP
Dopamine-given via continuous IV; monitor for dysrhythmia. Monitoring urine output assesses renal and cardiac fx
Norepinephrine- do not abruptly discontinue; continuously monitor BP
What is important to monitor for patients with shock being treated with dopamine
Monitor for Dysrhythmias
Monitor urinate output
Patient presents with low blood pressure, rapid HR, weak threads pulse. They have rapid shallow breathing, are pale cool and clammy and are saying they are thirsty.
What is the most likely condition they are experiencing
Shock
2 pharmacotherapeutic goal for shock
Maintain adequate blood pressure and restore normal fluid volume.
Depletion of more than how much blood volume would indicate a need for while blood treatment
More than 30%
Colloids are proteins or large molecules that stay suspended in the blood.
What blood product colloids are used for shock
Human serum albumin and plasma protein fraction.
IV Vasoconstrictors are only used when
When IV fluid therapy has failed to raise blood pressure.
These are critical care meds.
Dopamine is considered both a…(type of drug)
Vasoconstrictor and an inotropic drug.
If a patient is in acute shock and is also experiencing hypotension due to blood volume deficits- why would you or wouldn’t you administer norepinephrine?
It can cause additional vasoconstriction. So do not administer
Use of maois along with norepinephrine can cause what
Can lead to acute hypertensive crisi.
What are inotropic drugs
Reverse cardiac symptoms of shock by increasing myocardial contraction
Ex: digoxin, dobutamine, dopamine.
A client is experiencing a hypertensive emergency. Which type of medication should the nurse anticipate administering concurrently with a direct vasodilator to help prevent reflex tachycardia?
Beta adrenergic blocker
What medication dilates the coronary arteries resulting in better blood supply to the myocardium and reducing ischemia?
Calcium channel blockers
Ace inhibitors prevent the breakdown of bradykinins. What adverse effect should the nurse recognize is due to this build up.
Angioedema. (Swelling of mouth, lips, and tongue.) a cough is also a symptom.
