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Nursing Pharmacology > C6- Cardiovascular And Renal Medications PT 1 > Flashcards

C6- Cardiovascular And Renal Medications PT 1 Flashcards

1
Q

Inotropic definition (positive and negative medication effects)

A

The strength of contraction
- Positive drugs= stronger force
-Negative drugs = decreased force of contraction

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2
Q

Chronotropic definition definition (positive and negative medication effects)

A

Heart rate

Positive drugs- increased HR
Negative drugs- decreased HR

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3
Q

Dromotropic

A

The speed of electrical impulse

Positive drugs- faster conduction
Negative drugs - slower conduction

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4
Q

What is Preload?

A

Volume of blood in ventricles at end of diastole
-end diastolic pressure

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5
Q

Risk of preload increased in:

A

Hypervolemia

Regurgitation of cardiac valves

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6
Q

What is afterload?

A

The load against which a muscle exerts its force
- resistance left ventricle must overcome to circulate blood

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7
Q

Afterload increased in

A

Hypertension
Vasoconstriction

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8
Q

Increased afterload = increased cardiac __________

A

Cardiac workload

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9
Q

ABCD’s of Hypertension

A

A- Ace inhibitors & ARB’s
B- Beta blockers
C- calcium channel blockers
D- Diuretics

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10
Q

What percentage of the population is affected by hypertension?

A

45% of population

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11
Q

Hypertension prevalence in race:

A

Non-Hispanic black people

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12
Q

Hypertension Normal stage

A

<120/80mmHg

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13
Q

Ace Inhibitors Examles:

A

Lisinopril

** Common ending of “PRIL” **

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14
Q

Ace inhibitors Action and what it results in (what happens to the blood flow? What gets excreted? What is retained? Does it hinder progression in a disease?)

A

Blocking the production of Angiotensin II by blocking the conversion of angiotensin I to angiotensin II

Resulting in:
-Vasodilation
-Excretion of sodium and water (drops blood volume)
-Retention of K+
-Slows progression of diabetic neuropathy

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15
Q

Ace inhibitors not reccommended in people:

A

-Elderly
-African American populations

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16
Q

Advantages of Ace inhibitors:

A

Increase renal blood flow
Lack of aggravation with DM
Infrequent orthostatic hypotension
Lack of aggravation of pulmonary dx

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17
Q

Disadvantages of Ace Inhibitors

A

Cough (must D/C medication)
Angioedema (containdicated)
Hyerkalemia
Headache/dizziness
Orthostatic hypotension - infrequent
GI distress
Kidney function (caution w/ renal issues)
Salty/metallic taste
** Preg. Cat. D **

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18
Q

Ace Inhibitors Drug interactions

A

K+ sparing diuretics lead to hyperkalemia
Diuretics can impact kidneys and lead to hypotension
Alcohol
Beta blockers -enhance the hypotensive effects
NSAID’s- decrease effect of Ace Inhibitors risk

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19
Q

Angiotensin Receptor blockers are also referred to as:

A

ARBs

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20
Q

ARBs Action:

A

Blocks the action of Angiotensin II in the body

Results in:
-vasodilation
-Excretion of sodium and water
-retention of K=
-Resulting in lower blood pressure

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21
Q

ARBs Examples

A

Losartan

** Common ending “SARTAN” **

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22
Q

ARBs Side effects:

A

Angioedema (contrindicated)
Hyperkalemia
Headache
Orthostatic hypotension
GI distress
Kidney function -caution with renal issues
Salty/metallic taste
** PREG. CAT. D **

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23
Q

ARBs relax _____ ______ and lower _____ _____

A

Relax
-blood vessels

Lower
- blood pressure

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24
Q

Who should not use ACEs and ARBs? Specific diseases? conditions?

A

Pregnancy/breastfeeding CAT D.
DO NOT USE IF patient has renal artery stenosis

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25
Nursing teaching ACEs an ARBs
Do not use salt substitutes -contain k+ and ACE & ARB cause body to retain K+ Sit or lie down 2-4 hours after initial dose -risk of first-dose hypotension Rise slowly Avoid NSAIDs Don’t stop meds w/o consulting physician
26
ACE & ARB administration what time of day? Take with meals?
Taken one hour before meals on an empty stomach
27
Normal range for Potassium
3.5-5.5 mEq/L
28
Normal range for BUN (indicate renal function)
7-22 mg/dL
29
Normal labs for Creatinine
0.7-1.3 for men 0.6-1.1 for women
30
Beta 1- adrenergic receptors location
Located in heart and kidneys
31
Beta 1 adrenergic receptor stimulation causes: what happens to the heart productivity?
Increased heart rate (pos. chronotropic) Increase in strength of contraction (inotropic) Increases cardiac conduction (velocity and automaticity)
32
Beta 2 adrenergic receptor location
Lungs and liver
33
Beta 2 adrenergic receptor stimulation causes: (What happens with the blood vessels? What happens in the muscles? What happens with the liver (blood glucose)?
Vasoconstriction - more blood flow to muscles Tremor in skeletal muscle Glycogenolysis - (liver) increase glucose production for energy
34
Beta adrenergic blocking agents (BETA BLOCKERS) action: What do they inhibit? Which results in a decrease of?
Inhibit -cardiac response to sympathetic nerve stimulation by blocking beta receptors Decrease -hr and cardiac output -blood pressure -renin release
35
Beta 1 and 2 non selective blockers:
Propranolol (inderal)
36
Beta 1 cardio selective blocker
Metoprolol (lopressor)
37
Alpha 1 AND beta 1. Blocker
Carvedilol (Coreg) just for heart failure patients
38
Beta blockers (+/-): Chronotrope, inotrope, dromotrope
TRIPLE NEGATIVE
39
Beta adrenergic blocking agents uses:
HTN Heart failure Angina Arrhythmia Glaucoma Migraine HA Tremors
40
Beta blockers end in
OLOL
41
Beta blockers side effects
Bradycardia (60-90 rule) hypotension (orthostatic) heart failure (edema, dyspnea, crackles) Erectile dysfunction Depression
42
What class of drugs reduce the effect of beta blockers?
NSAIDS REDUCE EFFECT OF BETA BLOCKERS
43
Beta Adrenergic Blocking Agents interactions
Antihypertensive meds - additive B-adrenergic agonists Enzyme inducing agent - enhance metabolism
44
Beta Adrenergic Blocking Agents contraindicated in which conditions?
Asthma Bradycardia Hyperthyroid
45
Beta Adrenergic Blocking Agents Nursing implications (Hx of? Who should be weaned off of the med? What can reduce/reverse an overdose?)
-Check hx of resp condition- aggravates bronhoconstriction -Avoid abruptly discontinued in pts with CAD -Glucagon may reverse overdose -Check baseline of HR/BP 60/90 rule! *then call PCP
46
Calcium channel blockers Action? Where does the action take place?
Blocking of calcium channels in blood vessels leads to VASODILATION in the arterioles and arteries of the heart
47
Calcium Channel Blockers: blocking of calcium channels in the myocardium the SA node and AV node Decrease…?
Force of contraction HR Rate of conduction through the AV node
48
Calcium Channel Blockers example
Amlodipine Verapamil Diltiazem
49
Calcium Channel Blockers uses
HTN Angina Cardiac dysrhythmias Alternative to B-blocker *** FIRST CHOICE FOR AFRICAN AMERICANS ***
50
Calcium Channel Blockers contraindications
Heart block Hypotension Bradycardia - 60/90 Rule! Aortic stenosis Severe heart failure
51
Calcium Channel Blockers grapefruit juice restriction
Delays metabolism May result in toxicity
52
Calcium Channel Blockers side effects
Orthostatic hypotension Constipation Reflex tachycardia Bradycardia/dysrhythmias Peripheral edema Gingival hyperplasia/ hypertrophy *** PREG CAT C ***
53
Calcium Channel Blockers teaching
Change positions slowly Monitor edema Monitor blood pressure and hr
54
Calcium Channel Blockers interactions
Beta blockers Digoxin
55
Diuretics used to treat
Mild-moderate HTN Peripheral or pulmonary edema Heart failure or kidney disease
56
Diuretics action
Reduce blood volume through urinary excretion of water and electrolytes - electrolyte imbalances can occur -hypo/er-kalemia (K+) depends on type of diuretic
57
Loop diuretics examples
Furosemide (Lasix)
58
Effectiveness of loop diuretics/Furosemide
Decreased edema Increase in fine output Decrease in blood pressure Weight loss
59
Loop diuretics efficiency
MOST EFFICIENT Works well on clients with renal impairment Pulmonary edema caused by heart failure
60
Loop diuretics side effects
Electrolyte imbalance Hypotension (monitor BP, Rise slowly) Dehydration (monitor I/O, weight same time every day) Ototoxicity Hyperglycemia Hyperuricemia (gout)
61
normal potassium levels
3.5-5.5 * Panic above 6.2 and below 2.8 ***
62
Hypokalemia signs and symptoms
Palpitations Constipation Neben and tingling General weakness Fatigue Cramping in arm or leg
63
Teach patient about K+ rich foods such as:
Bananas Avocados Broccoli
64
Loop diuretics Nursing:
Avoid taking late in day (avoid nocturia) Infuse IV doses slowly ototoxicity Watch for s&s of low electrolytes (twitching cramping tremors) Encourage high potassium foods Urine <30ml/hr stop lasix and notify PCP
65
Loop diuretics interactions
Ototoxic (aminoglycosides, Vancomycin) Hypokalemia (digoxin) Lithium levels can rise NSAIDS Avoid in client with gout or diabetes Antihypertensives (additive)
66
Use caution administering loop diuretics if patient is allergic to?
Sulfa (sulfer)
67
Diuretic (thiazides) name
Hydrochlorothiazide (HCTZ)
68
Diuretic (thiazides) Hydrochlorothiazide action blocks what? Promotes?
Block reabsorbtion of NA and Chloride (prevent H2O reabsorption) Promote diauresis *** not as strong as lop diuretics ***
69
Diuretic (thiazides) Hydrochlorothiazide helps with what conditions
Mild to moderate hypertension * PRIMARY Edema Mild to moderate heart failure
70
Diuretic (thiazides) Hydrochlorothiazide side effects:
Dehydration Electrolyte imbalance Hyperglycemia Hyperuricemia- gout
71
Diuretic (thiazides) Hydrochlorothiazide administration guidelines (when?) (IF GI UPSET- what do you do?)
Take medication first thing in the morning If GI upset- take with food
72
Diuretic (thiazides) Hydrochlorothiazide Nursing (decrease? Increases what?)
Effective decrease in -BP -Edema Increases -urine output Not effective with limited renal function
73
Diuretic (thiazides) Hydrochlorothiazide use caution (allergy?)
Sulfonamide (sulfa)
74
Diuretic (thiazides) Hydrochlorothiazide interactions
Hypokalemia- digoxin Antihypertensive- added hypotensive Lithium levels may rise NSAIDS *** pregnant/breastfeeding ***
75
Diuretic Potassium-sparing (spironolactone):
Sipironolactone/Aldactone
76
Diuretic Potassium-sparing (spironolactone): action
Block action of aldosterone (NA+ and H2O retention) resulting in K+ retention and secretion of (NA+ and H2O)
77
Diuretic Potassium-sparing (spironolactone): used for
When Hypokalemia is a risk -mild HTN -Heart failure -combination therapy with K+ wasting drugs -block actions of aldosterone -acne
78
Diuretic Potassium-sparing (spironolactone): side effects
Hyperkalemia -cardiac monitoring of increased K+ -treat hyperkalemia with D/C of drug, restrict K+ in diet, inject insulin Endocrine -impotence (males) -irregular menstruation (females) -gynecomastia
79
Diuretic Potassium-sparing (spironolactone): interactions
ACE inhibitors increase risk of hyperkalemia K+ supplements
80
Diuretic teaching:
Reduce Na+ in. The diet Monitor electrolyte levels Avoid K+ and Na+ substitutes Use protection from sunlight Don’t drink alcohol or take other meds w/o DR approval Take with food decrease stomach upset Take med early in day to avoid interrupting sleep to go urinate

Nursing Pharmacology (11 decks)

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