Cardiac 1 Flashcards
ADRs of Diuretics general
Dehydration
Hypovolemia
Hypotension
Acid-base imbalances
Electrolyte level imbalances
Sleep Disturbances (take diuretics in the am)
Classes of Diuretics
Loop (Furosemide)
Thiazide (Hydrochlorothiazide)
Potassium sparing (Spironolactone, Triamterene)
Osmotic (Mannitol) (not used for HTN)
Loop diuretics
Furosemide (lasix) - inhibits reabsorption of Na+ and Cl- in ascending loop of Henle - LARGE UOP
-indicated for emergent/urgent diuretic needs - edema r/t liver cirrhosis, HF, renal disease, fluid overload - indicated for HTN when thiazides not enough or need for rapid mobilization,
can be used with low gfr
-Potassium wasting
ADRs: hyponatremia, hypokalemia, ototoxicity, hyperglycemia, hyperuricemia (esp in gout pts)
-Use in pregnancy if necessary
Interactions: antihypertensive (additive effect), ototoxic drugs (aminoglycosides abx), NSAIDs blunt diuretic effect, digoxin toxicity (hypokalemia increases drug toxicity of digoxin), lithium (inc risk of lithium toxicity esp if low Na+)
positive interaction: K+ sparing drugs counteract loss of K+
s/s hypokalemia
arrhythmias, fatigue, weakness, confusion, drowsiness, flaccid paralysis, extreme thirst, thready pulse, GI disturbances, N/V, ileus
education for furosemide + thiazides
-Recognize Hyponatremia, hypochloremia, dehydration
-postural hypotension
-hypokalemia - dietary counseling, eat foods rich in potassium or supplement, recognize s/s
-hyperglycemia in pts with DM
-signs of gout - swollen, tender joints
- ototoxicity - alert to changes in hearing and balance
- NSAIDs - blunt effect, don’t take, use other analgesics
- daily weights
-monitor BP
-assess skin
- time of admin (avoid late dosing)
Diuretics - Thiazides
Thiazides - early distal convoluted tubule
action dependent on adequate GFR
indicated for mild/mod HTN, edema from HF, cirrhosis, renal failure
protection for postmenopausal osteoporosis - promotes tubular reabsorption of Ca+
*paradoxical antidiuretic effect in diabetes insipidus
ADRs:
Hyponatremia, hypochloremia, dehydration, hypokalemia, hyperglycemia, hyperuricemia
Caution in: renal disease (GFR), gout pts, unstable diabetes, hyperlipidemia, pregnancy and lactation
Potassium -sparing Diuretics
Aldosterone antagonist - spironolactone
Nonaldosertone antagonist-
triamterene, amiloride
Prototype K sparing Diuretic
Spironolactone- blocks the action of aldosterone in distal tubule - promotes Na+/water excretion
weak diuretic
indicated to counteract loss of K+ caused by thiazides/loop diuretics
indications: HTN, edema, HF
other - hyperaldosteronism, hormonal acne in women, PCOS, prevention/treatment of hypokalemia
ADRs - same as other diuretics
hyperkalemia (constipation, weakness, cramping, hypoactive reflexes, ecg changes)
steroid derivative - can lead to gynecomastia, menstrual irregularities, impotence, hirsutism, voice changes
potassium sparing interactions/contraindications
contraindications: hyperkalemia, anuria, AKI, hypersensitivity
drug-drug:
agents that increase K+ - ACEi, ARB, transplant drugs
NSAIDS, digoxin
hypotension w/ ETOH, antiHTN, nitrates
education: no supplement K+ - salt substitutes, monitor K+
osmotic diuretic
mannitol - stays in nephron and creates osmotic force
indicated for ICP, reduce intraocular pressure (glaucoma)
-prevention of acute renal failure - will pull water into kidneys
-toxic OD, GU irritation
ADR: edema - extreme caution in heart disease, HF, Pulmonary congestion (can leave vascular system in all capillaries except in brain), headache, N/V, F&E imbalances, GI: dry mouth, polyuria, weakness
rash, vision disturbances,
rebound ICP inc.
contraindications: inc serum osmolarity, renal/cardiac dysfunction, active IC bleeding, pulmonary edema
nursing implications: monitor VS, UOP, s/s dehydration, fluid overload, neuro status, intraocular pressure, check renal function - do not give if high osmo. (>310), IV line filter (crystalizes at low temps), effects last 6-8 hrs, use indwelling catheter - must have accurate i&o
other: crystallizes in low temps -
beta blockers (beta1) 4 useful actions for HTN
- dec HR, conduction, contractility
- suppress reflex tachycardia (r/t vasodilators also used as antiHTN)
- inhibits renin release
- decreases PVR (moa unknown)
more effective in white people
beta blockers - indications and ADRs
HTN
MI- prevent 2nd occurrence - cardioprotective
Angina goal HR 50-60, exertion 100
cardiac dysrhythmias
HF* caution
hyperthyroidism
migraine prophylaxis
anxiety/stage fright
pheochromocytoma (tumor on adrenal - oversecretion of epi)
glaucoma
ADRs: bradycardia, decreased AV conduction - avoid in HB,
exacerbation of HF - pulmonary edema, asthma, heart blocks, slow heart
bronchoconstriction in nonselective
mask s/s of hypoglycemia (elevated HR)
can antagonize hypoglycemia (inhibits glycogenolysis in 1st gen)
rebound tachycardia
mask
fatigue, drowsiness, depression, sexual dysfunction, impotence
insomnia, bizarre dreams
mask hypothyroidism
mask hypoglycemia in DM
beta blockers education
do not stop abruptly (beta blockers rarely held)
teach early signs of HF: SOB, cough PM, edema in extremities
Avoid OTCs - decongestants pseudophedrine, phenylephrine
check HR - <50 may meet hold parameter
BP, orthostatic hypotension
assess - signs of depression, fatigue, sexual dysfunction
diabetics: warn s/s hypoglycemia
Doxazosin, Prazosin, Terazosin
apha1 antagonists
- second line in HTN
arteriole and vein constriction blocking - promotes vasodilation of arterioles and veins –> decreased BP
indications: HTN & BPH
ADRs:
-orthostatic hypotension (!1ST DOSE!)
-reflex tachycardia
-nasal congestion
-sexual dysfunction
-sodium/fluid retension - edema
-Weakness, GI sx, HA, syncope, SOB
education:
-first dose hypotensive rxn - avoid postural changes - fainting and falls
-effects may take 4-6 wks
-may relax bladder sphincter
-extravasation with IV!
Alpha/Beta Blockers
Carvedilol, Lebetalol
blocks alpha 1 and beta receptors
- dilates arterioles and veins
- reduces heart rate and contractility
-suppresses renin release
ADRs
orthostatic hypotension
bradycardia
AV HB
bronchoconstriction
mask the signs of hypoglycemia
