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

C6- Cardiovascular And Renal Medications PT 2 Flashcards

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
Nitroglycerin IV form used for
BP control in hypertension Treatment of heart failure Heart pain Pulmonary edema associated with acute MI Hypertensive emergencies
26
Nitroglycerin forms
Sublingual - fast acting IV - fast acting Transdermal patch- maintenance
27
Teaching associated with oral capsules extended release isosorbide
Swallow whole Do not crush or chew Take in the AM every day Do not take during acute attack
28
Teaching associated with nitroglycerin sublingual tablets
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
29
Teaching associated with nitroglycerin trans-lingual spray
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
30
Teaching associated with nitroglycerin transdermal patches
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
31
Nitroglycerin tolerance occurs in patients who
Take nitrates around the clock or long acting
32
Nitroglycerin tolerance prevented by
Allowing a regular nitrate-free period
33
Nitroglycerin IV administration
Dose 5mcg/min delivered through infusion pump with special tubing Degrades plastic so must be in glass and have special tubing for administration
34
Nitrates/Nitroglycerin adverse effects
Headache (gets better with continued use) Orthostatic hypotension (postural) Dizziness Reflex tachycardia Tolerance development
35
Nitrates/Nitroglycerin drug interactions
Alcohol (hypotension) Sildenafil (not within 24 hr) Calcium channel blockers (orthostatic hypotension)
36
Nitrates/Nitroglycerin contraindications
Allergy to nitrates Anemia Head trauma Cerebral hemorrhage Pregnancy, lactation
37
Slidenafil originally developed to treat?
Hypertension and angina pectoris
38
Sildenafil clinical trial findings?
Little effect on angina Noted it induces an erection in 30-60 minutes
39
Sildenafil approved use
ED
40
Sildenafil alternate use
Pulmonary hypertension
41
Sildenafil action
Vasodilation
42
Sildenafil Cautions?
Don’t use with other vasodilators (nitrates and antihypertensives)
43
Store nitrates in?
Cool dark place Tightly closed container (original container)
44
Always keep nitroglycerin accessible
Carry container in jacket pocket or purse NOT CLOSE TO BODY HEAT
45
Replace nitroglycerin tablets
Every 3 months
46
Remove the cotton from the medication container because
Nitroglycerin can be absorbed through the cotton
47
Nitroglycerin paste application guideline?
Do not spread with fingers Use gloves or applicator
48
If 3 tablets taken 5 minutes apart does not relieve angina pain
Go to the ER
49
Anticoagulants prevent:
The formation of blood clots (venous) Expansion of formed thrombus
50
Anti platelets prevent (cause)
Prevent clumping of platelets (aggregation) Stents (arterial/venous)
51
N/A
52
Anticoagulants: (venous) examples
Heparin Enoxaparin Warfarin Apixaban Rivaroxaban
53
Atiplatelet (Arterial): Examples
Aspirin Clopidogrel
54
Parenteral Anticoagulation drug names:
Heparin and Enoxaparin
55
Parenteral anticoagulation action
Prevents clotting by inactivating thrombin formation. Inhibits fibrinogen conversion to fibrin. * prevents existing clot from getting bigger, does not break down clot. *
56
Parenteral Anticoagulant therapeutic benefits/treatments
Prevents venous thrombosis DVT treatment Stroke/Acute MI treatment DIC treatment
57
Parenteral Anticoagulation pregnancy category?
C -use caution during delivery -does not cross placental barrier or breast milk
58
How do you administer Heparin/Enoxaparin?
IV or SubQ -no oral or IM administration
59
How long is the onset (subQ) of Heparin/ Enoxaparin? What is the half life?
20-60 minutes T 1/2- 90mins
60
Antidote of Heparin/ Enoxaparin?
Protamine Sulfate
61
Heparin/ Enoxaparin Partial Thromboplastin Time (PTT) normal? PTT therapeutic?
Normal: 11-15 seconds Therapeutic: 60-80 seconds
62
Heparin Side effects
Hemorrhage Heparin induced thrombocytopenia (HIT) -platelet count (monitor) Hypersensitivity reactions -small test dose prior to administration of full dose
63
Nursing implications of heparin? What should you monitor?
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
The higher the number for PTT the slower it takes the patient to ______?
Clot
65
Bleeding precautions- R.A.N.D.I
Razor (electric razor only) Aspirin (NOOOO) Needles (Small-gauge) Decrease needle sticks Injury (protect/avoid)
66
Bleeding precautions- observe for
Blood in stool- rectal bleeding Nosebleeds Gingival bleeding Bruising
67
Warning signs of slow clotting:
Epistaxis - nosebleeds Hematuria - blood in urine Brusing Dark stool- Melana Coffee ground emesis
68
Oral anticoagulant
Warfarin
69
Oral anticoagulant warfarin action:
Antagonize VITAMIN K Prevents synthesis of: -clotting factors -prothrombin
70
Warfarin prevents?
Venous thrombosis Atrial fibrillation thrombus formation Prosthetic heart valve thrombus formation
71
Warfarin pregnancy category?
X!!! DO NOT USE
72
Contraindications with Warfarin?
Liver disease Low platelets Surgery
73
Oral dosing onset?
Greater than 2 days
74
Oral dosing peak?
1-3 days
75
Duration of warfarin? Half life?
Duration 2.5-5 days T 1/2 0.5-3 days
76
Warfarin is ________ Protein bound!!!
HIGHLY PROTEIN BOUND-
77
Antidote of warfarin?
Vitamin K
78
Labs for warfarin productivity?
Prothrombin time (PTT) International Normalized Ration (INR)
79
International Normalized Ration (INR) Normal range? Therapeutic range?
0.8-1.2 (Normal) 1.5-3 (Therapeutic)
80
Other major use of Warfarin???
RAT POISION
81
What is a nursing teaching related to diet for warfarin?
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
What is a nursing teaching related to interactions with warfarin?
Highly protein bound medication OTC/Prescription medications -(notify prescriber of all meds, OTC, and herbals) Antibiotics
83
What is a teaching associated with monitoring INR and warfarin?
Weekly INR - need to schedule weekly INR lab draws
84
What is a teaching associated with RANDI/Bleeding precautions and Warfarin?
Use a soft bristled tooth brush Monitor for signs and symptoms of bleeding (trouble clotting)
85
Foods high in vitamin K? ****REMEMBER VITAMIN K IS NOT POTASSIUM (K+)****
Deep leafy greens Kale Spinach Broccoli Liver
86
What is PT/INR used to measure?
Warfarin therapeutic effects
87
Normal PT is
11-12.5 seconds (fibrin clot formation)
88
Therapeutic PT levels
1.25-2.5 times control level -not consistent across labs
89
INR is calculated how?
By dividing the patient’s PT by a control (normal) PT
90
Normal INR range
0.9-1.2
91
Therapeutic INR level?
2-3 Prosthetic heart valves up to 3.5
92
Most accurate way to measure therapeutic levels of warfarin?
INR levels
93
What are the two factor 10a inhibitor names?
Apixaban Rivaroxaban
94
Apixaban half life?
12 hours
95
Rivaroxaban half life?
5-9 hours
96
Reversal of factor 10a oral anticoagulant?
Coagulation factor Xa (10a)
97
Are there any dietary restrictions or monitoring associated with factor 10a inhibitors?
NOOOOOOOOOOOOOOOO BITCH
98
Factor 10a inhibitor anticoagulation for which conditions?
Atrial fibrillation DVT prevention ****not approved for artificial heart valve a/c****
99
Anti platelet medication action?
Prevents platelets from clumping together by inhibiting enzymes and factors that normally lead to arterial clotting
100
Anti platelets work in which part of the vascular system?
Arterioles and arteries
101
Anti platelets are used to prevent?
Primarily - myocardial infarction (heart attack) Prevention of another heart attack after one has occurred Prevention of stroke DVT prophylaxis Post stent placement
102
Anti platelet examples:
Aspirin (anti-aggregate) Clopidogrel
103
Do not use anti platelets if you are over _______ years old.
70
104
Anti platelet side effects?
GI bleeding/ulcers Hemorrhagic stroke Prolonged bleeding
105
Anti platelet interactions with other medications that enhance bleeding are?
Heparin Warfarin NSAIDs
106
Anti platelet pregnancy category? Which trimester?
D (3rd trimester)
107
Do not give anti platelets in thrombocytopenia? Platelets less than?
100,000
108
Hold anti platelet 7 days prior to?
Surgery
109
Blood lipoproteins
Triglycerides -fats in blood Total cholesterol -overview of all subcat. LDL (bad cholesterol) HDL (good cholesterol)
110
Triglyceride ideal level
<150
111
Total cholesterol ideal level
<200
112
LDL ideal level
<100
113
HDL ideal level
>40
114
HMG-CoA reductase inhibitors end in?
STATIN (Atorvastatin)
115
Atorvastatin adverse effects
Gi upset Hepatotoxicity Muscle pain Muscle breakdown (rhabdomyolysis) Dark urine (rhabdomyolysis) Cataracts
116
Atorvastatin therapeutics
Reduce synthesis- increase elimination Decrease LDL- Increase HDL Stabilize plaque, reduce inflammation, thrombus -3 weeks for therapeutic effect MI/CAD
117
Atorvastatin contraindications
Liver disease Grapefruit juice
118
Atorvastatin pregnancy category?
X
119
Atorvastatin administration?
Take with evening meal or at bedtime
120
Antiarrhythmic used for
Atrial and ventricular arrhythmias
121
Antiarrhythmic drug name
Amiodarone
122
Amiodarone half life
25-110 days
123
Amiodarone adverse effects
Pulmonary toxicity (blue tinge in skin color) Cardio toxicity Blurred vision Pregnancy category D
124
What are some teaching & monitoring guidelines for Amiodarone?
Liver and thyroid functions Cardiac rate & rhythm Pulmonary function AVOID GRAPEFRUIT JUICE
125
Ferrous sulfate
Iron
126
Ferrous sulfate used for
Anemia -replaces iron stores
127
Monitor what labs regarding ferrous sulfate?
Hemoglobin
128
Iron side effect
Stain teeth (liquid) Black/dark green stools Constipation

Nursing Pharmacology (11 decks)

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