BNPH700 Cardiac Flashcards

1
Q

MOA and ADR’s for cardiac glycocides (Digoxin)

A

MOA - inhibits the Na/K pump which increases intracellular Na+ and therefore Ca2+ resulting in reduced cardiac workload with increased cardiac output
ADRs - Anorexia and GI upset. Visual disturbances, confusion, drowsiness, dysrhythmias

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2
Q

Nursing care for digoxin

A

Check apical pulse for rate and rhythm prior to admin.
Monitor K+ levels as hypokalaemia can cause digoxin toxicity

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3
Q

What are risk factors, signs and symptoms and antidote for digoxin toxicity

A

Risk factors - dehydration, hypokalaemia, renal failure.
S&S - Dysrhythmias, nausea and vomiting, confusion and visual disturbances.
Antidote - digibind

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4
Q

MOA for Nitrates (GTN)

A

MOA - Binds to nitrate receptors in vascular smooth muscle resulting in vasodilation and venodilation which increases coronary perfusion and increases O2 delivery to heart.

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5
Q

ADR’s for GTN

A

Postural hypotension
Dizziness
Fainting
Headache
Nausea/vomiting
Agitation
Dry mouth
Blurred vision
Facial flushing

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6
Q

What is the angina action plan?

A

If experiencing angina symptoms stop and rest, tell someone and take 1 puff of GTN
If after 5 more minutes symptoms are still present take 1 more puff.
If after 5 more minutes symptoms are still present call an ambulance.

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7
Q

ACE inhibitors (-pril) MOA

A

Block the ACE enzyme responsible for converting angiotensin 1 to angiotensin 2 which decreases vascular tone and results in less secretion of aldosterone thereby increasing Na+ and H2O excretion which decreases blood volume and BP.

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8
Q

Indications for use of ACE inhibitors

A

Hypertension, heart failure, left ventricular dysfunction following MI

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9
Q

ADR’s of ACE inhibitors

A

Hypotension, headaches, dizziness, fatigue, nausea, hyperkalaemia, renal impairment.
Cough

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10
Q

Nursing considerations for ACE inhibitors

A

Avoid when pregnant
Do not take with NSAIDS or diuretics
Monitor K+ levels
Monitor BP
Monitor renal function

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11
Q

Indications for use of diuretics

A

Heart failure, hypertension

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12
Q

Three classes of diuretics?

A

Loop
Potassium sparing
Thiazides

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13
Q

MOA of diuretics

A

Decrease Na+ reabsorption at different nephron sites thereby increasing urinary loss of Na+ and H20 which decreases fluid retention.

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14
Q

Common ADR’s of diuretics

A

Dehydration & electrolyte imbalance, dizziness, postural hypotension

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15
Q

How are potassium sparing diuretics different?

A

Loop and thiazide diuretics also result in K+ loss and can lead to hypokalemia. Potassium sparing diuretics result in less K+ being lost so can have the opposite effect

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16
Q

Nursing considerations for diuretics

A

Monitor weight.
Fluid balance chart
Take in the morning to prevent nocturia
monitor for side effects

17
Q

Indications for beta adrenoreceptor antagonists (betablockers -lol)

A

Angina, arrhythmias, hypertension, heart failure, post MI.

18
Q

What are the two types of Betablockers?

A

Selective - target beta 1 receptors (Heart) eg metoprolol
non-selective - target B1 and B2 (heart + lungs) eg propanolol.

19
Q

MOA of betablockers

A

Beta blockers are antagonists so they bind to beta receptors and block the sympathetic response.

20
Q

ADR’s of betablockers

A

Bradycardia, dizziness, hypotension, arrythmias, bronchoconstriction, fatigue, insomnia, depression, nightmares

21
Q

Nursing considerations for betablockers

A

-Caution with abrupt cessation - can cause tachycardia and hypertension
-Caution with resp conditions for non-selective - can cause bronchoconstriction
-Caution with diabetes as can mask a low and inhibit SNS response.
- Monitor BP, HR and resp symptoms

22
Q

Indications for use of HMG-CoA inhibitors (Statins) Simvastatin

A

Risk of CVD
Prevention of atherosclerosis

23
Q

MOA of statins

A

Inhibits synthesis of cholesterol in the liver by inhibiting the HMG-CoA reductase enzyme - resulting in lower LDL levels.

24
Q

ADR’s for statins

A

GI upset incl stomach cramps
Headaches
Sleep disturbances
Must report muscle pain or weakness due to rare but serious risk of myopathy/rhabdomyolysis.

25
Q

Nursing considerations for statins

A

Avoid grapefruit, st johns wort & anything else that may inhibit drug metabolism - increased risk of myopathy/rhabdo
Take at night
Reduce cholesterol and alcohol
Discuss smoking cessation

26
Q

Indication for use of antiplatelets (Aspirin)

A

Prevention of arterial thrombosis

27
Q

MOA of Aspirin

A

Inhibits the cyclooxygenase enzyme (COX1) causing a decrease in synthesis of thromboxane A2 which inhibits platelet aggregation and vasoconstriction. Aspirin binds to the platelet for the life of the platelet

28
Q

ADR’s of Aspirin

A

Bruising, bleeding, GI upset, GI bleeding

29
Q

Nursing considerations for Aspirin

A

Not for use in children
Caution for older people r/t decreased renal and hepatic function
Avoid in people with haemorrhagic, coagulation, respiratory conditions or recent trauma/surgery.
Do not take with OTC NSAIDS
Monitor for signs of GI bleeds, SOB/Bronchoconstriction

30
Q

Indications for anticoagulant Warfarin

A

Prevention of existing clots, DVT, PE, chronic AF

31
Q

MOA of Warfarin

A

Inhibits the synthesis of Vitamin K dependent clotting factors. (antidote vit K).

32
Q

ADR’s of Warfarin

A

Bleeding
Chest pain
GI Upset
Dizziness, headache, visual disturbances
Dyspnoea

33
Q

Nursing considerations for Warfarin

A

Not for use in people with haemorrhagic conditions, alcoholism, elderly, pregnancy.
Require regular INR tests and adjustments as narrow therapeutic range.
Monitor closely for signs of bleeding.
Take at same time daily, do not stop taking, do not double dose.
Avoid vit K rich foods.

34
Q

anticoagulant Heparin & Clexane LMWH) indications for use

A

Prevention and treatment of venous thrombi, formation of clots in IV, dialysis. Used acutely.

35
Q

MOA of Heparin & Clexane

A

Inhibits clotting factors resulting in inhibition of thrombin and prevention of fibrin clot formation.

36
Q

Nursing considerations for Heparin & Clexane

A

Not for use in people with haemorrahgic conditions.
Not recommended in pregnancy
Heparin requires regular aPTT monitoring.
Alternate injection sites to prevent bruising & Lipohypertrophy.
Avoid OTC NSAIDS
Monitor for signs of bleeding.

37
Q

ADR’s for Heparin & clexane

A

Bleeding & bruising
Lipohypertrophy (lump of fatty tissue at sight of repeated injections)
Thrombocytopenia (rare)

38
Q

Thrombolytics MOA & key information

A

MOA - Activates plasminogen to form plasmin, an enzyme that digests or dissolves fibrin clots.
Key info: Only used in highly monitored situations.
ADR of bleeding.

39
Q

What medications should not be used in conjunction with NSAIDS

A

ACE inhibitors
Clexane
Heparin
Aspirin