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Cardiac Drugs Flashcards

1
Q

medications for arrhythmias

A

lidocaine, metoprolol, amiodarone, diltiazem

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2
Q

medications for HF

A

digoxin, metoprolol, lisinopril, furosemide

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3
Q

medications for HTN

A

hydrochlorothiazide, lisinopril, losartan, metoprolol, diltiazem, nitroprusside

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4
Q

medications for angina

A

nitroglycerin, diltiazem, metoprolol

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5
Q

HF patho

A

heart does no adequately pump blood (systolic) or fill with blood (diastolic). Inability to meet metabolic (oxygen) demands of the body. Right ventricular failure, left ventricular failure, congestive failure.

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6
Q

Preload in terms of medications

A

increased preload causes increased workload on heart- venous return filling the heart.
reduce preload: furosemide

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7
Q

After-load in terms of medications

A

increased after-load increases workload on the heart- resistance the heart has to go through to pump
reduce after load (vascular resistance): metoprolol, lisinopril.

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8
Q

Contractility in terms of medications

A

heart enlarges, but weakens, resulting in poor contraction (decreased contraction force).
Increase contractility: digoxin (lanoxin) “digoxin digs deeper for deeper contraction”

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9
Q

Digoxin (lanoxin) class

A

cardiac glycoside

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10
Q

Digoxin (lanoxin) MoA

A

increase force of contraction, increasing cardiac output and renal perfusion; slows HR (goal: slower but more powerful heart)

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11
Q

Digoxin (lanoxin) indication

A

heart failure

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12
Q

Digoxin (lanoxin) routes

A

oral, IV (IV push over at least 5 minutes with tele monitor)

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13
Q

Digoxin (lanoxin) drug-drug

A

MANY! Amiodarone and other anti-dysrhythmic drugs (not going to double dose on meds that cause bradycardia)

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14
Q

Digoxin (lanoxin) caution

A

heart block (type of bradycardia) or decreased renal function

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15
Q

Digoxin (lanoxin) AE

A

GI effects, visual disturbances (green/yellow halo), arrhythmias (Bradycardia)

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16
Q

Digoxin (lanoxin) nursing considerations

A

take apical pulse 1 full min prior to admin. Hold if HR less than 60- notify provider; use same brand consistently- varied bioavailability
toxicity rare but serious- monitor blood levels q 3 months

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17
Q

Digoxin (lanoxin) toxicity manifestations

A

bradycardia, headache, dizziness, confusion, n/v, visual disturbances (green and yellow halo is not indicative).

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18
Q

Digoxin (lanoxin) reversal agent

A

digoxin immune fab (creates antigen-antibody immunes complexes with drug-inactivates)

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19
Q

CAD patho

A

atherosclerosis narrows coronary arteries (stable and unstable plaques that could result in rupture), decreased blood flow (decreased oxygen), myocardial infarction (tissue death)

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20
Q

stable angina patho

A

chest pain with exertion (increased metabolic needs), increased O2 demand of heart, relieved with rest and nitroglycerin

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21
Q

unstable angina patho

A

chest pain at rest, unrelieved with nitroglycerin, possible myocardial infarction

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22
Q

Nitroglycerin (nitrostat) class

A

antianginal agents

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23
Q

Nitroglycerin (nitrostat) MoA

A

relaxes vascular smooth muscle; dilates coronary arteries to increase blood flow.

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24
Q

Nitroglycerin (nitrostat) indication

A

acute angina

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25
Nitroglycerin (nitrostat) route/dose
sublingual tablet q 5 min up to 3 doses; onset 1-3min; duration: 30-60 min
26
Nitroglycerin (nitrostat) caution
erectile dysfunction meds in last 24 hours ex: sildenafil, because they both cause hypotension, that would be dangerous to ingest both.
27
Nitroglycerin (nitrostat) AE
hypotension (orthostatic), headache, dizziness, tachycardia, sweating
28
Nitroglycerin (nitrostat) nursing actions in acute care
may administer 1 dose every 5 min up to 3 doses- if no relief after 2nd dose, assume MI and call rapid response. monitor blood pressure after administration high fall risk
29
Nitroglycerin (nitrostat) teaching
administration as above (after 2nd dose call 911), med must be stored in a dry, dark place- keep in dark glass container, refill medication when it expires (wont work as well as it should and is light sensitive).
30
Arrhythmias patho
changes to automaticity or conductivity of heart cells- change in HR uncoordinated heart muscle contractions altered movement of impulses
31
Afib Patho
dyssynchronous firing of atria, uncoordinated with ventricles. can be acute and chronic (phase in and out) Slow HR: Metoprolol, diltiazem, amiodarone
32
tachycardias patho
v fib, v tach, medical emergencies- control V arrhythmia, administer lidocaine
33
class 1 of antidysrhythmic drug
sodium channel blockers- fast conducting lidocaine
34
class 2 of antidysrhythmic drug
beta-adrenergic blockers metoprolol
35
class 3 of antidysrhythmic drug
potassium channel blockers amiodarone
36
class 4 of antidysrhythmic drug
calcium channel blockers diltiazem
37
common use of lidocaine
life threatening ventricular arrhythmias during MI or cardiac surgery
38
common use of metoprolol
atrial fibrillation/flutter, supraventricular and ventricular dysrh. hypertension
39
common use of amiodarone
a fib/flutter ventricular tachycardia or fibrillation
40
common use of diltiazem
supraventricular tachycardias, afib/flutter, hypertension
41
general considerations of antidysrhythmic drugs
all have potential AE: bradycardia, heart blocks, arrhythmias, and hypotension. Greater risk with IV administration (Cardiac monitor and BP monitor) drug/drug: antidysrhythmic drugs, antihypertensives contraindications: bradycardia, hypotension, heart block
42
Lidocaine class
sodium channel blockers
43
Lidocaine MoA
decreases depolarization, decreasing automaticity of the ventricular cells; increases ventricular fibrillation threshold.
44
Lidocaine indication
treatment of life threatening ventricular arrhythmias during MI or cardiac surgery
45
Lidocaine route
IV (topical lidocaine low systemic risk)
46
Lidocaine IV onset, peak, duration
onset: immediate peak: immediate duration: IV 20 min
47
Lidocaine AE
dizziness, headache, cardiac arrest, respiratory depression, anaphylaxis
48
Lidocaine nursing consideration
have resuscitation equipment available
49
Amiodarone class
potassium channel blockers
50
Amiodarone MoA
blocks potassium channels, delays repolarization; slows HR
51
Amiodarone indications
v-tach v fib; afib or flutter
52
Amiodarone dose
maintenance: oral; acute IV push/infusion on tele floors/ICU/ACLS
53
Amiodarone Drug-drug
many! increase digoxin levels (up yo 50-70% loading dose); decrease metabolism of warfarin requiring lower doses (50% increase in INR); decreases dose of either drug by 50%
54
Amiodarone AE
GI effects (n/v/d), corneal micro-deposits (cause visual issues- photophobia, visual halos, dry eyes), fatigue, dizziness, photosensitivity
55
Amiodarone black box
hepatotoxicity, pulmonary toxicity, pro-arrhythmias
56
Amiodarone nursing considerations
no grapefruit juice, use barrier sun block; cardiac monitoring (IV), monitor electrolytes
57
Beta blockers, calcium channel blockers, direct vasodilators, ace inhibitors, and ARBs affect what part of HTN
vasoconstriction and increase peripheral resistance
58
ACE inhibitors, ARBs, diuretics affect what part of HTN
renal salt and water retention and increase blood volume
59
ACE inhibitors block what part of RAAS system
conversion of angiotensin 1 to angiotensin 2
60
ARBs block what part of RAAS system
with the adrenal gland cortex and aldosterone secretion.
61
administration considerations for antihypertensive drugs (acute care)
Take BP prior to admin if dosed once daily, give in the AM- do not split, crush or chew ER tablets do not abruptly discontinue, especially adrenergic blocking agents (reflex HTN) IV push meds- minimum of 2 min/tele monitor PRN medications require evaluation- IVP recheck BP in 5-10 min, PO recheck BP in 1 hour
62
Lisinopril class
ACE inhibitor
63
Lisinopril MoA
blocks ACE, the enzyme responsible for converting angiotensin 1 to angiotensin 2 in the lungs, decreases vascular resistance, prevents aldosterone secretion, prevents breakdown of bradykinin (potent vasoconstrictor) ONLY BP
64
Lisinopril route
oral
65
Lisinopril contraindications/cautions
ACE inhibitor, ARBs, K+ sparing diuretics, NSAIDs (kidneys)
66
Lisinopril AE
common-persistant dry cough, orthostatic hypotension, hyperkalemia, rare-angioedema (swelling of blood vessels that compromise airway)
67
Lisinopril nursing considerations
monitor K+ and renal function
68
ACE acronym for AE
Angioedema Cough Elevated potassium
69
Losartan (Cozaar) class
angiotensin-receptor blocker ARB
70
Losartan (Cozaar) MoA
blocks binding of angiotensin II to specific receptors in blood vessels and adrenal gland; used as alternate to ACE inhibitors ONLY BP
71
Losartan (Cozaar) route
oral
72
Losartan (Cozaar) contraindications/cautions
ACE inhibitor, ARBs, K+ sparing diuretics, NSAIDs (kidneys)
73
Losartan (Cozaar) AE
GI effects- n/v/d
74
Nitroprusside (Nitropress) class
direct vasodilator- different route than nitroglycerin
75
Nitroprusside (Nitropress) MoA
act directly on vascular smooth muscle (venous and arterial) to cause relaxation/vasodilation ONLY BP
76
Nitroprusside (Nitropress) route
maintenance: oral or transdermal Acute HTN crisis: IV push
77
Nitroprusside (Nitropress) caution
PVD, CAD, HF (weak heart and dilated vessels= poor perfusion), tachycardia, hypotension
78
Nitroprusside (Nitropress) AE
hypotension, reflex tachycardia, bradycardia
79
Diltiazem (cardizem) class
calcium channel blocker
80
Diltiazem (cardizem) MoA
inhibits flow of calcium ions into myocardial cells and vascular smooth muscle; slows HR and lowers BP BP and HR
81
Diltiazem (cardizem) Indications
HTN, A fib, A flutter, supraventricular tachycardias
82
Diltiazem (cardizem) route
maintenance: oral acute: IV infusion
83
Diltiazem (cardizem) caution
hypotension, acute MI, pulmonary congestion
84
Diltiazem (cardizem) AE
hypotension, bradycardia/heart block, peripheral edema
85
Diltiazem (cardizem) nursing considerations
teach patient to avoid grapefruit juice (increases levels)
86
Metoprolol (Toprol) class
beta adrenergic blocker
87
Metoprolol (Toprol) MoA
block beta 1 and beta 2 receptors of the SNS; slows HR and lowers BP HR and BP
88
Metoprolol (Toprol) indications
HTN, HF, MI, A fib, A flutter
89
Metoprolol (Toprol) route
maintenance: oral acute HTN or dysrhythmias: IV push
90
Metoprolol (Toprol) drug-drug
beta agonist inhaler (albuterol)
91
Metoprolol (Toprol) contraindications/cautions
bradycardia, hypotension, masks signs of hypoglycemia
92
Metoprolol (Toprol) AE
bradycardia, hypotension, bronchospasm, pulmonary edema, weakness, fatigue, decreases exercise intolerance, alterations in blood glucose
93
Metoprolol (Toprol) nursing considerations
monitor hypoglycemia closely in diabetes mellitus; immediate and extended release (XL, XR) prescribed
94
Drug therapy across the life span: cardiac drugs
children: safety and efficacy of meds not widely studied adults: consider drug-drug interactions, co-morbidities; appropriate education pregnancy: many meds are pregnancy category D (risk v benefit) Older adults: more susceptible to AE of hypotension, bradycardia, toxic effects due to underlying disease that may interfere with metabolism and excretion. high fall risk

Pharmacology (6 decks)

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