C6- Cardiovascular And Renal Medications PT 1 Flashcards
Inotropic definition (positive and negative medication effects)
The strength of contraction
- Positive drugs= stronger force
-Negative drugs = decreased force of contraction
Chronotropic definition definition (positive and negative medication effects)
Heart rate
Positive drugs- increased HR
Negative drugs- decreased HR
Dromotropic
The speed of electrical impulse
Positive drugs- faster conduction
Negative drugs - slower conduction
What is Preload?
Volume of blood in ventricles at end of diastole
-end diastolic pressure
Risk of preload increased in:
Hypervolemia
Regurgitation of cardiac valves
What is afterload?
The load against which a muscle exerts its force
- resistance left ventricle must overcome to circulate blood
Afterload increased in
Hypertension
Vasoconstriction
Increased afterload = increased cardiac __________
Cardiac workload
ABCD’s of Hypertension
A- Ace inhibitors & ARB’s
B- Beta blockers
C- calcium channel blockers
D- Diuretics
What percentage of the population is affected by hypertension?
45% of population
Hypertension prevalence in race:
Non-Hispanic black people
Hypertension Normal stage
<120/80mmHg
Ace Inhibitors Examles:
Lisinopril
** Common ending of “PRIL” **
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?)
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
Ace inhibitors not reccommended in people:
-Elderly
-African American populations
Advantages of Ace inhibitors:
Increase renal blood flow
Lack of aggravation with DM
Infrequent orthostatic hypotension
Lack of aggravation of pulmonary dx
Disadvantages of Ace Inhibitors
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 **
Ace Inhibitors Drug interactions
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
Angiotensin Receptor blockers are also referred to as:
ARBs
ARBs Action:
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
ARBs Examples
Losartan
** Common ending “SARTAN” **
ARBs Side effects:
Angioedema (contrindicated)
Hyperkalemia
Headache
Orthostatic hypotension
GI distress
Kidney function -caution with renal issues
Salty/metallic taste
** PREG. CAT. D **
ARBs relax _____ ______ and lower _____ _____
Relax
-blood vessels
Lower
- blood pressure
Who should not use ACEs and ARBs? Specific diseases? conditions?
Pregnancy/breastfeeding CAT D.
DO NOT USE IF patient has renal artery stenosis
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
ACE & ARB administration what time of day? Take with meals?
Taken one hour before meals on an empty stomach
Normal range for Potassium
3.5-5.5 mEq/L
Normal range for BUN (indicate renal function)
7-22 mg/dL
Normal labs for Creatinine
0.7-1.3 for men
0.6-1.1 for women
Beta 1- adrenergic receptors location
Located in heart and kidneys
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)
Beta 2 adrenergic receptor location
Lungs and liver
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
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
Beta 1 and 2 non selective blockers:
Propranolol (inderal)
Beta 1 cardio selective blocker
Metoprolol (lopressor)
Alpha 1 AND beta 1. Blocker
Carvedilol (Coreg) just for heart failure patients
Beta blockers (+/-): Chronotrope, inotrope, dromotrope
TRIPLE NEGATIVE
Beta adrenergic blocking agents uses:
HTN
Heart failure
Angina
Arrhythmia
Glaucoma
Migraine HA
Tremors
Beta blockers end in
OLOL
Beta blockers side effects
Bradycardia (60-90 rule)
hypotension (orthostatic)
heart failure (edema, dyspnea, crackles)
Erectile dysfunction
Depression
What class of drugs reduce the effect of beta blockers?
NSAIDS REDUCE EFFECT OF BETA BLOCKERS
Beta Adrenergic Blocking Agents interactions
Antihypertensive meds - additive
B-adrenergic agonists
Enzyme inducing agent - enhance metabolism
Beta Adrenergic Blocking Agents contraindicated in which conditions?
Asthma
Bradycardia
Hyperthyroid
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
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
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
Calcium Channel Blockers example
Amlodipine
Verapamil
Diltiazem
Calcium Channel Blockers uses
HTN
Angina
Cardiac dysrhythmias
Alternative to B-blocker
** FIRST CHOICE FOR AFRICAN AMERICANS **
Calcium Channel Blockers contraindications
Heart block
Hypotension
Bradycardia - 60/90 Rule!
Aortic stenosis
Severe heart failure
Calcium Channel Blockers grapefruit juice restriction
Delays metabolism
May result in toxicity
Calcium Channel Blockers side effects
Orthostatic hypotension
Constipation
Reflex tachycardia
Bradycardia/dysrhythmias
Peripheral edema
Gingival hyperplasia/ hypertrophy
** PREG CAT C **
Calcium Channel Blockers teaching
Change positions slowly
Monitor edema
Monitor blood pressure and hr
Calcium Channel Blockers interactions
Beta blockers
Digoxin
Diuretics used to treat
Mild-moderate HTN
Peripheral or pulmonary edema
Heart failure or kidney disease
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
Loop diuretics examples
Furosemide (Lasix)
Effectiveness of loop diuretics/Furosemide
Decreased edema
Increase in fine output
Decrease in blood pressure
Weight loss
Loop diuretics efficiency
MOST EFFICIENT
Works well on clients with renal impairment
Pulmonary edema caused by heart failure
Loop diuretics side effects
Electrolyte imbalance
Hypotension (monitor BP, Rise slowly)
Dehydration (monitor I/O, weight same time every day)
Ototoxicity
Hyperglycemia
Hyperuricemia (gout)
normal potassium levels
3.5-5.5
- Panic above 6.2 and below 2.8 ***
Hypokalemia signs and symptoms
Palpitations
Constipation
Neben and tingling
General weakness
Fatigue
Cramping in arm or leg
Teach patient about K+ rich foods such as:
Bananas
Avocados
Broccoli
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
Loop diuretics interactions
Ototoxic (aminoglycosides, Vancomycin)
Hypokalemia (digoxin)
Lithium levels can rise
NSAIDS
Avoid in client with gout or diabetes
Antihypertensives (additive)
Use caution administering loop diuretics if patient is allergic to?
Sulfa (sulfer)
Diuretic (thiazides) name
Hydrochlorothiazide (HCTZ)
Diuretic (thiazides) Hydrochlorothiazide action blocks what? Promotes?
Block reabsorbtion of NA and Chloride (prevent H2O reabsorption)
Promote diauresis
** not as strong as lop diuretics **
Diuretic (thiazides) Hydrochlorothiazide helps with what conditions
Mild to moderate hypertension * PRIMARY
Edema
Mild to moderate heart failure
Diuretic (thiazides) Hydrochlorothiazide side effects:
Dehydration
Electrolyte imbalance
Hyperglycemia
Hyperuricemia- gout
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
Diuretic (thiazides) Hydrochlorothiazide Nursing (decrease? Increases what?)
Effective decrease in
-BP
-Edema
Increases
-urine output
Not effective with limited renal function
Diuretic (thiazides) Hydrochlorothiazide use caution (allergy?)
Sulfonamide (sulfa)
Diuretic (thiazides) Hydrochlorothiazide interactions
Hypokalemia- digoxin
Antihypertensive- added hypotensive
Lithium levels may rise
NSAIDS
** pregnant/breastfeeding **
Diuretic Potassium-sparing (spironolactone):
Sipironolactone/Aldactone
Diuretic Potassium-sparing (spironolactone): action
Block action of aldosterone (NA+ and H2O retention) resulting in K+ retention and secretion of (NA+ and H2O)
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
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
Diuretic Potassium-sparing (spironolactone): interactions
ACE inhibitors increase risk of hyperkalemia
K+ supplements
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
