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Cardiac Flashcards

1
Q

angina

A
  • episodes of chest pain - can progress to MI
  • myocardial oxygen supply vs demand
  • atherosclerotic plaque in coronary arteries
  • angina, variant angina (spasms of coronary artery - at rest) and unstable angina (comes from advanced CAD)
  • signs of angina with women are different - fatigue, SOB
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2
Q

nitroglycerin (NTG) (Nitro-BID, Nitrostat, Nitro-dur)

isosobide (Isobid, Isordil, Imdur)

A

(nitrates)

  • relaxes smooth muscle in blood vessels, vasodilate
  • decreases preload (amt/volume dumped in right atrium and stretch in right atrium)
    (—and afterload is the resistance felt when the heart tries to pump blood out of left ventricle)
  • fight line defense in prevention and treatment
  • use: acute attacks, chronic angina
  • adverse: HA, hypotension, dizziness, N/v, flushing, tachycardia

nitroglycerine

  • po sublingual
  • topical gel (in hospital)
  • sprays underneath tongue
  • patches - 24 hours
  • IV

isordil - long term
imdur - immediate and sustained release (commonly used)

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3
Q

nitrates

A
  • sl, po, IV
  • interactions: alcohol, beta blockers and erectile dysfunction drugs
  • may take 3 NTG pills, 5 mins apart, if no relief call EMS
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4
Q

Nursing Implications for nitrates

A
  • assess pain, monitor BP/HR
  • wear gloves with ointment, patches
  • patches: on for 12 hours, off for 12 hours
  • SL tabs must fizzle or burn
  • sit/lie down
  • spray NTG - on or under tongue
  • avoid smoking
  • pills must be stored in original container
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5
Q

atenolol (Tenormin)

metoprolol (Lopressor)

A

(beta blockers)

  • block beta 1 and/or 2
  • use: angina, MI, HTN, dysrhythmias
  • used for chronic stable angina - not attack
  • drugs given to all patients post MI unless strongly contraindicated
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6
Q

agents to lower lipids

A
  • abnormally elevated serum lipid and triglycerides
  • total serum cholesterol < 200 mg/dl
  • –LDL > 100
  • –HDL high > 60, Low < 40
  • –triglycerides < 150
  • high cholesterol linked to arteriosclerosis, HTN, CAD, PVD, and MI
  • first line treatment = diet and exercise
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7
Q

colestipol (Colestid)

cholestyramine (Questran)

A

(bile acid sequestrants)

  • inhibit or increase excretion of bile acid in GI tract
  • adverse: constipation, bloating, flatulence, nausea
  • precautions: patients with bile obstructive disease

Nursing:

  • monitor serum cholesterol
  • take before meals
  • high fiber foods
  • power mixed with foods/fluid
  • watch for bleeding
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8
Q

atorvastatin (Lipitor)

simvastatin (Zocor)

A

(HMG-CoA reductase inhibitors)

  • blocks synthesis of cholesterol in liver
  • may increase or maintain HDL
  • adverse: constipation, abdominal distention, belching
  • caution: liver failure
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9
Q

Nursing Implications for HMG-CoA reductase inhibitors

A
  • give at night
  • watch serum levels
  • do not become pregnant
  • monitor liver function tests
  • change diet, exercise
  • restrict alcohol and stop smoking
  • report muscle pain
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10
Q

gemfibrozil (Lopid)

A

(fibric acid derivative)

  • reduce plasma triglycerides in increasing enzyme lipoprotein lipase
  • short term use
  • use with patients with hyperlipidemia who fail diet
  • adverse: abd pain, diarrhea, fatigue, HA
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11
Q

Nursing Implications for fibric acid derivatives

A

Contraindicated - renal/liver/gall bladder disease

Nursing:

  • monitor triglyceride levels and liver function tests
  • monitor for signs of gall stones
  • need extra fiber and fluid
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12
Q

ezetimbe (Zetia)

A

(cholesterol absorption inhibitors)

  • acts in small intestine
  • Zetia used for people who are intolerant to other therapies
  • –sometimes also used in conjunction with statins
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13
Q

Heart failure symptoms

A 
dyspnea
fatigue
ankle edema
JVD
pulmonary edema
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14
Q

lisinopril (Prinivil, Zestril)

capatopil (Capoten)

A

(angiotensin-converting enzyme [ACE] inhibitors)

  • inhibits the conversion of angiotensin I to angiotensin II
  • use: heart failure, HTN
  • adverse: severe hypotension, renal tubular damage, cough
  • caution: renal disorder, do not take if pregnant
  • ACE inhibitor is a cardioprotective drug - ventricular remodeling after MI
  • common for diabetics
  • protective of kidneys when there’s no renal failure - otherwise it’s more detrimental
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15
Q

Adverse and Nursing Implications for ACE inhibitors

A

Adverse:
- angioedema - strong vascular reaction involving inflammed submucosal tissue

Nursing:

  • monitor K
  • monitor BP, weight, I&O
  • risk of rebound hypertension with abrupt stop
  • watch NSAIDs w ace inhibitors
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16
Q

losartan (Cozaar)

valsartan (Diovan)

A

(angiotensin II receptor blockers [ARBS])

  • complete with angiotensin II for tissue binding sites
  • use: HTN, heart failure
  • adverse: severe hypotension, less cough
  • caution: liver failure, do not take if pregnant
  • nursing: monitor BP, weight
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17
Q

nesiritide (Natrecor)

A

(B-type natriuretic peptides)

  • increase cardiac output, stroke volume and contractility without significantly altering HR or BP
  • use: acute heart failure
  • given IV
  • adverse: severe hypotension, dysrhythmias.
  • monitor BNP (brain natriuretic peptide), gives in ICU only

BNP - shows how hard the heart is working - higher the #, the harder its working

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18
Q

milrinone (Primacor)

inamrinone (Inocor)

A

(phosphodiesterase inhibitor)

  • inhibit action phosphodiesterase enzyme
  • use: short term treatment acute heart failure
  • adverse: severe hypotension, thrombocytopenia (inamrinone), dysrhytmia (milrinone)
  • ICU care only, use only after other treatments fail
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19
Q

digoxin (Lanoxin)

A

(cardia glycocides)

  • positive inotrope: slow rate, increase force of contractions, increase cardiac output
  • use: heart failure, tachyarrhythmias
  • adverse: bradycardia, heart block
  • –toxicity: anorexia, upset stomach, hypokalemia, vision changes (yellow/green vision)
  • contraindications: heart block, bradycardia
  • digoxin is no longer the 1st line treatment - too many side effects and incompatibilities
  • –watch therapeutic blood levels
  • –pateints already on digoxin, will stay on it, but new patients will not be put on digoxin
20
Q

Toxicity and Nursing Implications for digoxin

A

Toxicity:

  • blood level (0.5-2.0ng/mL)
  • elderly, impaired renal function, electrolyte imbalances
  • digoxin exclusively excreted via kidneys
  • digoxin immune Fab (Digibind) - used for digoxin toxicity but its not for everyone

Nursing:

  • start with loading doses and followed by maintenance dose
  • hold for HR < 60
21
Q

Other drugs for heart failure

A

Diuretics

  • loop diuretics for fluid overload
  • K+ sparing for heart failure progress

hydralazine/isosorbide (BiDil) - used to treat the african amercian pop

22
Q

dysrhythmias

A
  • disturbances in electrical conduction
  • benign or life threatening
  • –sinus, atrial, nodal
  • –ventricular and heart block - life threatening
  • uses classification system: I, II, III, IV
23
Q

Class 1A

quinidine (Quinidex)
procainamide (Pronestyl)
disopryramide (Norpace)

A
  • Na+ channel blockers
  • membrane stabilizing drugs
  • use: supraventricular/ventricular arrythmias
  • adverse: blood disorders and lupus like syndome (Pronestyl), tinnitus (quinidine), diarrhea, N/V, hypotension, dizziness, dysrhythmias
  • contraindicated: kidney/liver disorders
  • nursing: take APR, BP, many drug interactions, take on time schedule
24
Q

Class 1B

lidocaine (Xylocaine)

A
  • decreases automaticity in ventricles
  • use: serious ventricular dysrhytmias
  • adverse: bradycardia, heart block, hypotension, confusion
  • precautions: pregnancy, elderly, acute MI
  • nursing: lidocaine IV only, monitor rate/rhythm/ BP, safety
25
Q

Class 1C

propafenone (Rythmol)
flecainide (Tambocor)

A
  • decrease conduction to ventricles
  • use: life-threatening ventricular arrythmias
  • adverse: dysrhythmias, dizzines, fatigue
  • caution: heart failure, liver disease, K+ imbalances
  • Nursing: monitor serum K+, rate, rhythm
26
Q

Class II

propranolol (Inderal)
esmolol (Brevibloc)
sotalol (Betapace)

A
  • beta blockers

- use: treatment of supraventricular tachycardia

27
Q

Class III

amiodarone (Cordarone)

A
  • prolong duration of the action potential, slow repolarization, prolong refractory period in atria and ventricles
  • use: ventriculr dysrhytmias
  • adverse: hypotension, N/V, visual disturbances
  • precautions: liver or pulmonary diseases
  • nursing: monitor for HR, dysrhythmias, BP, thyroid function
28
Q

Class IV

verapamil (Calan)
diltiazem (Cardiazem)

A
  • calcium channel blockers, slow inward flow of calcium
  • use: prevent/control supraventricular arrythmias, HTN
  • adverse: nausea, leg cramps, hypotension, bradycardia, heart block
  • precautions: pregnancy, heart block, hypotenstion, elderly
  • nursing: monitor BP/HR, give with food
29
Q

Unclassified

adenosine (Adenocard)

A
  • slows conduction time through the AV node
  • use: conversion of PSVT (proximal supraventricular tachycardia) to sinus rhythm
  • used after failure of other treatments
  • 10 sec half life, given fast IV push
  • causes asystole for period of seconds
30
Q

Hypertension

A
  • diagnosed SBP > 140 and/or DBP > 80
  • need lifestyle changes to prevent CAD
  • thiazide diuretics - first line treatment
  • patients with HTN will need 2 or more meds
31
Q

types of anti-hypertensives

A
  • ace inhibitors
  • arbs
  • beta blockers
  • diuretics
  • vasodilators
  • calcium channel blockers
32
Q

diuretics

A
  • first line treatment for HTN
  • used as monotherapy or in combo with HTN
  • decrease plasma and ECF volumes, decrease preload
  • give in AM!
  • types: loop, K+ sparing, thiazide
33
Q

furosemide (Lasix)

A

(loop diurectic) - very potent

  • increase water excretion by blocking reabsorption of Na+ and Cl- in loop of Henle
  • decrease preload
  • used when patients are in fluid overload
  • use: pulmonary edema, edema, HTN
  • adverse: *hypokalemia, dehydration, lower BP, ototoxic (hearing)
  • nursing:
  • –monitor weight daily, electrolytes (K), BP, I&O
  • –decrease effectiveness with NSAIDs
  • –prolonged use of high doses - hearing loss
  • –po or IV
34
Q

spironolactone (Aldactone)

A

(potassium sparing diuretic)

  • causes loss of Na+ in urine, inhibit aldosterone
  • relatively weak diuretic
  • use: heart failure, HTN, edema, ascites (liver failure)
  • adverse: hyperkalemia
  • nursing:
  • –monitor K+, I&O, and weight
  • –po only
35
Q

hydrochlorothiazide (Hydrodiuril)

A

(thiazide diuretic)

  • decrease reabsorption of Na+, water, Cl- and HCO3 in distal convulated tubules
  • use: hypertension, heart failure
  • advers: electrolyte imbalance, dehydration
  • nursing:
  • –monitor BP, weight, electrolytes, I&O
  • –photosensitive
  • –not for use with renal failure
  • – po only
36
Q

hydralazine (Apresoline)

nitroprusside (Nipride)

A

(vasodilators)

  • cause direct vasodilation
  • use: severe HTN emergencies
  • advers: tachycardia
  • given IV in ICU to produce controlled hypotension
  • cyanide is a metabolite of drug - prolonged use can cause cyanide poisoning
  • Apresoline
  • –given IV or po, less commonly used
  • –given in combo with isosorbide (BiDil)
37
Q

amlodipine (Norvasc)

diltiazem (Cardizem)

A

(calcium channel blockers)

  • causes smooth muscle relaxation by blocking calcium
  • use: HTN, Reynaud’s subarachnoid hemorrhage
  • adverse: hypotension, tachycardia
  • may be given in combination
  • po, SR, IV
38
Q

drugs that affect blood coagulation

A
  • anticoagulants
  • antiplatelets
  • thrombolytics
  • most dangerous drugs used to today
  • commonly associated with adverse drug reactions
39
Q 
Aspirin
clopidogrel (Plavix)
A

(anti-platelet drugs)

  • decrease platelet aggregation
  • use: prevent MI, CVA, improve graft patency (stent)
  • nursing: monitor bleeding, safety
40
Q

heparin
enoxaparin (Lovenox)
fondaparinux (Arixtra)

A

(anti-coagulants)

  • interfere with coagulation cascade
  • use: thrombotic disorders, prevent clot extension and formation
  • caution: bleeding disorders, ulcers, pregnancy
41
Q

Heprain

A

anticogulant

  • subQ or IV push or infusion (DVT/ after MI)
  • monitor PTT for infusions
  • antidote - protamine sulfate
  • used for central line flushes
  • start with loading dose then continuous drip
  • short half life
  • patients coming in for surgery (who were on Coumadin) can be put on a heparin drip
42
Q

enoxaparin/fondaparinux

A

anti-coagulants

enoxaparin

  • no lab work needed
  • subQ only
  • can be given at home

fondaparinux

  • prophylaxis for DVT for hip fracture surgery, knee replacement surgery, or abdominal surgery
  • subQ
43
Q

warfarin (Coumadin)

A

anticoagulant

  • interferes with vit K dependent clotting
  • given po
  • 3-5 days for effect
  • monitor PT or INR (international normalized ratio) - 1.5-2.5x control
  • dosage adjusted daily until therapeutic
  • vit k antidote for too much coumadin
  • many drug interactions
  • watch K intake - green leafy veggies
44
Q

alteplase (Activase)

A

thrombolytics

  • dissolve clots, reestablish blood flow, prevent or limit tissue damage
  • use: acute MI, stroke, PE
  • adverse: bleeding
  • precaution: pregnancy or delivery within 10 days, bleeding
  • decrease use of thrombolytics for MI due to advances in PTCAs
45
Q

Nursing Implications of thrombolytics

A
  • given immediately following symptoms
  • check bleeding every 15 min during first hour, every 30 mins for next hour and then every 4 hours
  • oral temps only
  • check pulse every hour
  • maintain bed rest
  • avoid trauma

Pharmacology (7 decks)

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