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Nursing Pharmacology > C6- Cardiovascular And Renal Medications PT 2 > Flashcards

C6- Cardiovascular And Renal Medications PT 2 Flashcards

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1
Q

Left sided heart failure (CHF):
Pulmonary congestion (symptom)

A

Cough
Crackles
Wheezes
Blood tinged sputum
Tachypnea

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2
Q

Left sided heart failure (CHF): symptoms

A

Restlessness
Confusion
Orthopäde
Tachycardia
Exertional Dyspnea
Fatigue
Cyanosis

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3
Q

If the Left side of heart has issues: blood may travel where?

A

Blood may go into the lungs

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4
Q

Right sided heart failure (Cor Pulmonale) symptoms

A

Fatigue
Increased peripheral venous pressure
Enlarged liver & spleen
Distended jugular veins
Anorexia & complaint of GI distress
Swelling in hands and fingers
Dependent edema
Fluid collection in abdomen

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5
Q

Cardiac Glycosides- Digoxin: Action

A

Increase contraction force (+ inotrope)
Decrease HR (- chronotrope)
-low hr increases filling time
Decrease AV Node conductivity (- dromotrope)

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6
Q

Cardiac Glycosides- Digoxin: Narrow therapeutic range

A

0.5-2.0 ng/mL

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7
Q

Cardiac Glycosides- Digoxin daily dosing

A

125-500 mcg/day

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8
Q

Cardiac Glycosides- Digoxin therapeutics (what does it treat?

A

Heart failure
-increases force of contraction
Atrial fibrillation
-reduces heart rate
-prolongs refractory period in AV node

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9
Q

Cardiac Glycosides- Digoxin (what plant does digoxin naturally derive from?)

A

Foxgloves
-poisonous in large amounts

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10
Q

Cardiac Glycosides- Digoxin toxicity levels:

A

2.0 ng/mL or higher is toxic

GOAL LEVEL: 0.8- That’s great!

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11
Q

Cardiac Glycosides- Digoxin signs of toxicity

A

Bradycardia
Confusion & fatigue
Visual halos
Nausea
Anorexia

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12
Q

N/a

A
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13
Q

Cardiac Glycosides- Digoxin Teaching

A

Foods high in K+
Limit salt intake
Signs of toxicity
-bradycardia
-visual halos
- anorexia
-fatigue/weakness
-diarrhea

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14
Q

Cardiac Glycosides- Digoxin Nursing implications

A

Take apical pulse for 1 minute
-hold if less than 60 (adult)
Monitor K+ levels
Monitor daily weight, I/O, ECG

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15
Q

2 types of Drugs that lower K+

A

Thiazide or loop diuretics
Glucocorticoids (steroids)

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16
Q

Cardiac Glycosides- Digoxin reversal of overdose/toxicity

A

Digoxin immune fab

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17
Q

Treatment for Angina

A

Nitroglycerin

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18
Q

Causes of angina

A

Imbalance or deficit of O2 to the heart
-decreased supply
-increased demand

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19
Q

Angina treatment

A

Reduce myocardial O2 demand
Increase myocardial O2 supply

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20
Q

Factors affecting myocardial oxygen demand

A

Increase in:
-HR
-Blood volume (preload) - nitrates
-Blood pressure (after load) - nitrates
-Left ventricular muscle size
-muscle contraction

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21
Q

Rapid acting nitrates:

A

Nitroglycerin (NTG)
-used to treat acute angina attacks (RAPID)

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22
Q

Nitrate long acting:

A

Isosorbide
Nitroglycerin patch (transdermal)
-used to PREVENT angina attack
-blood pressure control

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23
Q

Nitrate/Nitroglycerin action

A

Cause smooth muscle relaxation in veins and arteries to dilate
- What does it decrease?
-blood return (preload)
-peripheral vascular resistance (afterload)
-What does it Increase?
- blood supply to heart muscle

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24
Q

Nitroglycerin used for

A

Symptomatic treatment of angina (stable & unstable)

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25
Q

Nitroglycerin IV form used for

A

BP control in hypertension
Treatment of heart failure
Heart pain
Pulmonary edema associated with acute MI
Hypertensive emergencies

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26
Q

Nitroglycerin forms

A

Sublingual - fast acting
IV - fast acting
Transdermal patch- maintenance

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27
Q

Teaching associated with oral capsules extended release isosorbide

A

Swallow whole
Do not crush or chew
Take in the AM every day
Do not take during acute attack

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28
Q

Teaching associated with nitroglycerin sublingual tablets

A

Do not eat or drink while tab dissolves
Under tongue
Give 1 tab every 5 minutes (only up to 3 tablets)
Kept in original glass bottle or proper carrying device
Store:
-room temp
-out of sun

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29
Q

Teaching associated with nitroglycerin trans-lingual spray

A

1-2 sprays with onset (wait 5 mins)
-up to 3 sprays
Do not allow to freeze
Do not shake container
Do not use near fire or while smoking

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30
Q

Teaching associated with nitroglycerin transdermal patches

A

Non-hairy area of application
Rotate site
Remove patch for 10-12 hours daily (off at night or in AM)
Apply same time every day
Shower with patch is okay
If it falls off replace with fresh

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31
Q

Nitroglycerin tolerance occurs in patients who

A

Take nitrates around the clock or long acting

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32
Q

Nitroglycerin tolerance prevented by

A

Allowing a regular nitrate-free period

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33
Q

Nitroglycerin IV administration

A

Dose 5mcg/min delivered through infusion pump with special tubing
Degrades plastic so must be in glass and have special tubing for administration

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34
Q

Nitrates/Nitroglycerin adverse effects

A

Headache (gets better with continued use)
Orthostatic hypotension (postural)
Dizziness
Reflex tachycardia
Tolerance development

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35
Q

Nitrates/Nitroglycerin drug interactions

A

Alcohol (hypotension)
Sildenafil (not within 24 hr)
Calcium channel blockers (orthostatic hypotension)

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36
Q

Nitrates/Nitroglycerin contraindications

A

Allergy to nitrates
Anemia
Head trauma
Cerebral hemorrhage
Pregnancy, lactation

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37
Q

Slidenafil originally developed to treat?

A

Hypertension and angina pectoris

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38
Q

Sildenafil clinical trial findings?

A

Little effect on angina
Noted it induces an erection in 30-60 minutes

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39
Q

Sildenafil approved use

A

ED

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40
Q

Sildenafil alternate use

A

Pulmonary hypertension

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41
Q

Sildenafil action

A

Vasodilation

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42
Q

Sildenafil Cautions?

A

Don’t use with other vasodilators (nitrates and antihypertensives)

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43
Q

Store nitrates in?

A

Cool dark place
Tightly closed container (original container)

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44
Q

Always keep nitroglycerin accessible

A

Carry container in jacket pocket or purse
NOT CLOSE TO BODY HEAT

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45
Q

Replace nitroglycerin tablets

A

Every 3 months

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46
Q

Remove the cotton from the medication container because

A

Nitroglycerin can be absorbed through the cotton

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47
Q

Nitroglycerin paste application guideline?

A

Do not spread with fingers
Use gloves or applicator

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48
Q

If 3 tablets taken 5 minutes apart does not relieve angina pain

A

Go to the ER

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49
Q

Anticoagulants prevent:

A

The formation of blood clots (venous)
Expansion of formed thrombus

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50
Q

Anti platelets prevent (cause)

A

Prevent clumping of platelets (aggregation)
Stents (arterial/venous)

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51
Q

N/A

A
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52
Q

Anticoagulants: (venous) examples

A

Heparin
Enoxaparin
Warfarin
Apixaban
Rivaroxaban

53
Q

Atiplatelet (Arterial): Examples

A

Aspirin
Clopidogrel

54
Q

Parenteral Anticoagulation drug names:

A

Heparin and Enoxaparin

55
Q

Parenteral anticoagulation action

A

Prevents clotting by inactivating thrombin formation. Inhibits fibrinogen conversion to fibrin.

  • prevents existing clot from getting bigger, does not break down clot. *
56
Q

Parenteral Anticoagulant therapeutic benefits/treatments

A

Prevents venous thrombosis
DVT treatment
Stroke/Acute MI treatment
DIC treatment

57
Q

Parenteral Anticoagulation pregnancy category?

A

C
-use caution during delivery
-does not cross placental barrier or breast milk

58
Q

How do you administer Heparin/Enoxaparin?

A

IV or SubQ
-no oral or IM administration

59
Q

How long is the onset (subQ) of Heparin/ Enoxaparin? What is the half life?

A

20-60 minutes

T 1/2- 90mins

60
Q

Antidote of Heparin/ Enoxaparin?

A

Protamine Sulfate

61
Q

Heparin/ Enoxaparin Partial Thromboplastin Time (PTT) normal? PTT therapeutic?

A

Normal: 11-15 seconds

Therapeutic: 60-80 seconds

62
Q

Heparin Side effects

A

Hemorrhage
Heparin induced thrombocytopenia (HIT)
-platelet count (monitor)
Hypersensitivity reactions
-small test dose prior to administration of full dose

63
Q

Nursing implications of heparin? What should you monitor?

A

Monitor for hemorrhage
Monitor labs (CBC- RBC & Platelets) (PTT/aPTT) (Guaiac blood in stool)
Implement bleeding precautions (R.A.N.D.I) (Protamine sulfate)

64
Q

The higher the number for PTT the slower it takes the patient to ______?

A

Clot

65
Q

Bleeding precautions- R.A.N.D.I

A

Razor (electric razor only)
Aspirin (NOOOO)
Needles (Small-gauge)
Decrease needle sticks
Injury (protect/avoid)

66
Q

Bleeding precautions- observe for

A

Blood in stool- rectal bleeding
Nosebleeds
Gingival bleeding
Bruising

67
Q

Warning signs of slow clotting:

A

Epistaxis - nosebleeds
Hematuria - blood in urine
Brusing
Dark stool- Melana
Coffee ground emesis

68
Q

Oral anticoagulant

A

Warfarin

69
Q

Oral anticoagulant warfarin action:

A

Antagonize VITAMIN K
Prevents synthesis of:
-clotting factors
-prothrombin

70
Q

Warfarin prevents?

A

Venous thrombosis
Atrial fibrillation thrombus formation
Prosthetic heart valve thrombus formation

71
Q

Warfarin pregnancy category?

A

X!!! DO NOT USE

72
Q

Contraindications with Warfarin?

A

Liver disease
Low platelets
Surgery

73
Q

Oral dosing onset?

A

Greater than 2 days

74
Q

Oral dosing peak?

A

1-3 days

75
Q

Duration of warfarin? Half life?

A

Duration 2.5-5 days

T 1/2 0.5-3 days

76
Q

Warfarin is ________ Protein bound!!!

A

HIGHLY PROTEIN BOUND-

77
Q

Antidote of warfarin?

A

Vitamin K

78
Q

Labs for warfarin productivity?

A

Prothrombin time (PTT)

International Normalized Ration (INR)

79
Q

International Normalized Ration (INR) Normal range? Therapeutic range?

A

0.8-1.2 (Normal)

1.5-3 (Therapeutic)

80
Q

Other major use of Warfarin???

A

RAT POISION

81
Q

What is a nursing teaching related to diet for warfarin?

A

Keep vitamin K intake consistent
-supply pt with list of foods high in vitamin K
(Not necessary to avoid totally, just keep a CONSISTENT intake)

82
Q

What is a nursing teaching related to interactions with warfarin?

A

Highly protein bound medication
OTC/Prescription medications
-(notify prescriber of all meds, OTC, and herbals)
Antibiotics

83
Q

What is a teaching associated with monitoring INR and warfarin?

A

Weekly INR
- need to schedule weekly INR lab draws

84
Q

What is a teaching associated with RANDI/Bleeding precautions and Warfarin?

A

Use a soft bristled tooth brush
Monitor for signs and symptoms of bleeding (trouble clotting)

85
Q

Foods high in vitamin K? REMEMBER VITAMIN K IS NOT POTASSIUM (K+)

A

Deep leafy greens
Kale
Spinach
Broccoli
Liver

86
Q

What is PT/INR used to measure?

A

Warfarin therapeutic effects

87
Q

Normal PT is

A

11-12.5 seconds (fibrin clot formation)

88
Q

Therapeutic PT levels

A

1.25-2.5 times control level
-not consistent across labs

89
Q

INR is calculated how?

A

By dividing the patient’s PT by a control (normal) PT

90
Q

Normal INR range

A

0.9-1.2

91
Q

Therapeutic INR level?

A

2-3

Prosthetic heart valves up to 3.5

92
Q

Most accurate way to measure therapeutic levels of warfarin?

A

INR levels

93
Q

What are the two factor 10a inhibitor names?

A

Apixaban

Rivaroxaban

94
Q

Apixaban half life?

A

12 hours

95
Q

Rivaroxaban half life?

A

5-9 hours

96
Q

Reversal of factor 10a oral anticoagulant?

A

Coagulation factor Xa (10a)

97
Q

Are there any dietary restrictions or monitoring associated with factor 10a inhibitors?

A

NOOOOOOOOOOOOOOOO BITCH

98
Q

Factor 10a inhibitor anticoagulation for which conditions?

A

Atrial fibrillation
DVT prevention
not approved for artificial heart valve a/c

99
Q

Anti platelet medication action?

A

Prevents platelets from clumping together by inhibiting enzymes and factors that normally lead to arterial clotting

100
Q

Anti platelets work in which part of the vascular system?

A

Arterioles and arteries

101
Q

Anti platelets are used to prevent?

A

Primarily - myocardial infarction (heart attack)
Prevention of another heart attack after one has occurred
Prevention of stroke
DVT prophylaxis
Post stent placement

102
Q

Anti platelet examples:

A

Aspirin (anti-aggregate)
Clopidogrel

103
Q

Do not use anti platelets if you are over _______ years old.

A

70

104
Q

Anti platelet side effects?

A

GI bleeding/ulcers
Hemorrhagic stroke
Prolonged bleeding

105
Q

Anti platelet interactions with other medications that enhance bleeding are?

A

Heparin
Warfarin
NSAIDs

106
Q

Anti platelet pregnancy category? Which trimester?

A

D (3rd trimester)

107
Q

Do not give anti platelets in thrombocytopenia? Platelets less than?

A

100,000

108
Q

Hold anti platelet 7 days prior to?

A

Surgery

109
Q

Blood lipoproteins

A

Triglycerides
-fats in blood
Total cholesterol
-overview of all subcat.
LDL (bad cholesterol)
HDL (good cholesterol)

110
Q

Triglyceride ideal level

A

<150

111
Q

Total cholesterol ideal level

A

<200

112
Q

LDL ideal level

A

<100

113
Q

HDL ideal level

A

> 40

114
Q

HMG-CoA reductase inhibitors end in?

A

STATIN

(Atorvastatin)

115
Q

Atorvastatin adverse effects

A

Gi upset
Hepatotoxicity
Muscle pain
Muscle breakdown (rhabdomyolysis)
Dark urine (rhabdomyolysis)
Cataracts

116
Q

Atorvastatin therapeutics

A

Reduce synthesis- increase elimination
Decrease LDL- Increase HDL
Stabilize plaque, reduce inflammation, thrombus
-3 weeks for therapeutic effect
MI/CAD

117
Q

Atorvastatin contraindications

A

Liver disease
Grapefruit juice

118
Q

Atorvastatin pregnancy category?

A

X

119
Q

Atorvastatin administration?

A

Take with evening meal or at bedtime

120
Q

Antiarrhythmic used for

A

Atrial and ventricular arrhythmias

121
Q

Antiarrhythmic drug name

A

Amiodarone

122
Q

Amiodarone half life

A

25-110 days

123
Q

Amiodarone adverse effects

A

Pulmonary toxicity (blue tinge in skin color)
Cardio toxicity
Blurred vision
Pregnancy category D

124
Q

What are some teaching & monitoring guidelines for Amiodarone?

A

Liver and thyroid functions
Cardiac rate & rhythm
Pulmonary function
AVOID GRAPEFRUIT JUICE

125
Q

Ferrous sulfate

A

Iron

126
Q

Ferrous sulfate used for

A

Anemia
-replaces iron stores

127
Q

Monitor what labs regarding ferrous sulfate?

A

Hemoglobin

128
Q

Iron side effect

A

Stain teeth (liquid)
Black/dark green stools
Constipation

Nursing Pharmacology (11 decks)

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