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Pharmacology > Cardiac Drugs > Flashcards

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
Q

Nitroglycerin (nitrostat) route/dose

A

sublingual tablet q 5 min up to 3 doses; onset 1-3min; duration: 30-60 min

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26
Q

Nitroglycerin (nitrostat) caution

A

erectile dysfunction meds in last 24 hours
ex: sildenafil, because they both cause hypotension, that would be dangerous to ingest both.

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27
Q

Nitroglycerin (nitrostat) AE

A

hypotension (orthostatic), headache, dizziness, tachycardia, sweating

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28
Q

Nitroglycerin (nitrostat) nursing actions in acute care

A

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

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29
Q

Nitroglycerin (nitrostat) teaching

A

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).

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30
Q

Arrhythmias patho

A

changes to automaticity or conductivity of heart cells- change in HR
uncoordinated heart muscle contractions
altered movement of impulses

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31
Q

Afib Patho

A

dyssynchronous firing of atria, uncoordinated with ventricles. can be acute and chronic (phase in and out)
Slow HR: Metoprolol, diltiazem, amiodarone

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32
Q

tachycardias patho

A

v fib, v tach,
medical emergencies- control V arrhythmia, administer lidocaine

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33
Q

class 1 of antidysrhythmic drug

A

sodium channel blockers- fast conducting
lidocaine

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34
Q

class 2 of antidysrhythmic drug

A

beta-adrenergic blockers
metoprolol

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35
Q

class 3 of antidysrhythmic drug

A

potassium channel blockers
amiodarone

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36
Q

class 4 of antidysrhythmic drug

A

calcium channel blockers
diltiazem

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37
Q

common use of lidocaine

A

life threatening ventricular arrhythmias during MI or cardiac surgery

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38
Q

common use of metoprolol

A

atrial fibrillation/flutter, supraventricular and ventricular dysrh. hypertension

39
Q

common use of amiodarone

A

a fib/flutter
ventricular tachycardia or fibrillation

40
Q

common use of diltiazem

A

supraventricular tachycardias, afib/flutter, hypertension

41
Q

general considerations of antidysrhythmic drugs

A

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
Q

Lidocaine class

A

sodium channel blockers

43
Q

Lidocaine MoA

A

decreases depolarization, decreasing automaticity of the ventricular cells; increases ventricular fibrillation threshold.

44
Q

Lidocaine indication

A

treatment of life threatening ventricular arrhythmias during MI or cardiac surgery

45
Q

Lidocaine route

A

IV (topical lidocaine low systemic risk)

46
Q

Lidocaine IV onset, peak, duration

A

onset: immediate
peak: immediate
duration: IV 20 min

47
Q

Lidocaine AE

A

dizziness, headache, cardiac arrest, respiratory depression, anaphylaxis

48
Q

Lidocaine nursing consideration

A

have resuscitation equipment available

49
Q

Amiodarone class

A

potassium channel blockers

50
Q

Amiodarone MoA

A

blocks potassium channels, delays repolarization; slows HR

51
Q

Amiodarone indications

A

v-tach v fib; afib or flutter

52
Q

Amiodarone dose

A

maintenance: oral; acute IV push/infusion on tele floors/ICU/ACLS

53
Q

Amiodarone Drug-drug

A

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
Q

Amiodarone AE

A

GI effects (n/v/d), corneal micro-deposits (cause visual issues- photophobia, visual halos, dry eyes), fatigue, dizziness, photosensitivity

55
Q

Amiodarone black box

A

hepatotoxicity, pulmonary toxicity, pro-arrhythmias

56
Q

Amiodarone nursing considerations

A

no grapefruit juice, use barrier sun block; cardiac monitoring (IV), monitor electrolytes

57
Q

Beta blockers, calcium channel blockers, direct vasodilators, ace inhibitors, and ARBs affect what part of HTN

A

vasoconstriction and increase peripheral resistance

58
Q

ACE inhibitors, ARBs, diuretics affect what part of HTN

A

renal salt and water retention and increase blood volume

59
Q

ACE inhibitors block what part of RAAS system

A

conversion of angiotensin 1 to angiotensin 2

60
Q

ARBs block what part of RAAS system

A

with the adrenal gland cortex and aldosterone secretion.

61
Q

administration considerations for antihypertensive drugs (acute care)

A

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
Q

Lisinopril class

A

ACE inhibitor

63
Q

Lisinopril MoA

A

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
Q

Lisinopril route

A

oral

65
Q

Lisinopril contraindications/cautions

A

ACE inhibitor, ARBs, K+ sparing diuretics, NSAIDs (kidneys)

66
Q

Lisinopril AE

A

common-persistant dry cough, orthostatic hypotension, hyperkalemia, rare-angioedema (swelling of blood vessels that compromise airway)

67
Q

Lisinopril nursing considerations

A

monitor K+ and renal function

68
Q

ACE acronym for AE

A

Angioedema
Cough
Elevated potassium

69
Q

Losartan (Cozaar) class

A

angiotensin-receptor blocker ARB

70
Q

Losartan (Cozaar) MoA

A

blocks binding of angiotensin II to specific receptors in blood vessels and adrenal gland; used as alternate to ACE inhibitors
ONLY BP

71
Q

Losartan (Cozaar) route

A

oral

72
Q

Losartan (Cozaar) contraindications/cautions

A

ACE inhibitor, ARBs, K+ sparing diuretics, NSAIDs (kidneys)

73
Q

Losartan (Cozaar) AE

A

GI effects- n/v/d

74
Q

Nitroprusside (Nitropress) class

A

direct vasodilator- different route than nitroglycerin

75
Q

Nitroprusside (Nitropress) MoA

A

act directly on vascular smooth muscle (venous and arterial) to cause relaxation/vasodilation
ONLY BP

76
Q

Nitroprusside (Nitropress) route

A

maintenance: oral or transdermal
Acute HTN crisis: IV push

77
Q

Nitroprusside (Nitropress) caution

A

PVD, CAD, HF (weak heart and dilated vessels= poor perfusion), tachycardia, hypotension

78
Q

Nitroprusside (Nitropress) AE

A

hypotension, reflex tachycardia, bradycardia

79
Q

Diltiazem (cardizem) class

A

calcium channel blocker

80
Q

Diltiazem (cardizem) MoA

A

inhibits flow of calcium ions into myocardial cells and vascular smooth muscle; slows HR and lowers BP
BP and HR

81
Q

Diltiazem (cardizem) Indications

A

HTN, A fib, A flutter, supraventricular tachycardias

82
Q

Diltiazem (cardizem) route

A

maintenance: oral
acute: IV infusion

83
Q

Diltiazem (cardizem) caution

A

hypotension, acute MI, pulmonary congestion

84
Q

Diltiazem (cardizem) AE

A

hypotension, bradycardia/heart block, peripheral edema

85
Q

Diltiazem (cardizem) nursing considerations

A

teach patient to avoid grapefruit juice (increases levels)

86
Q

Metoprolol (Toprol) class

A

beta adrenergic blocker

87
Q

Metoprolol (Toprol) MoA

A

block beta 1 and beta 2 receptors of the SNS; slows HR and lowers BP
HR and BP

88
Q

Metoprolol (Toprol) indications

A

HTN, HF, MI, A fib, A flutter

89
Q

Metoprolol (Toprol) route

A

maintenance: oral
acute HTN or dysrhythmias: IV push

90
Q

Metoprolol (Toprol) drug-drug

A

beta agonist inhaler (albuterol)

91
Q

Metoprolol (Toprol) contraindications/cautions

A

bradycardia, hypotension, masks signs of hypoglycemia

92
Q

Metoprolol (Toprol) AE

A

bradycardia, hypotension, bronchospasm, pulmonary edema, weakness, fatigue, decreases exercise intolerance, alterations in blood glucose

93
Q

Metoprolol (Toprol) nursing considerations

A

monitor hypoglycemia closely in diabetes mellitus; immediate and extended release (XL, XR) prescribed

94
Q

Drug therapy across the life span: cardiac drugs

A

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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