Cardiac Drugs (42) Flashcards
Cardiac Functions:
____ –> contraction
Chronotropic –> ____
____ –> electrical impulses
inotropic… heart rate… dromotropic..
Cardiac glycosides:
____ & similar drugs –> ____ plant (digitalis)
Digoxin… Foxglove
Congestive Heart Failure (CHF) –> ____ can’t pump entire amount of blood received, which causes cardiac ____.
ventricles… distention.
CHF heart adapts leads to ____.
Decrease of renal blood flow, which leads to ____ and ____ retention.
hypertrophy…Na+ & water.
CHF Signs and Symptoms: Weight \_\_\_\_ Edema SOB Pulmonary \_\_\_\_
gain… congestion
Cardiac glycosides give a ____ inotropic action, which ____ force of heart contraction –> will ____ mechanical efficiency which will ____ size of heart.
positive…increases… increase… decreases
Positive inotropic action of cardiac glycosides –> it increases ____ to kidneys, which will have a ____ effect and relieve ____ retention
blood flow… diuretic… Na+ & water
Negative chronotropic action of cardiac glycosides –> slows heart rate (Tx: CHF, ____)
arrhythmias…
Stay with the ____ brand when choosing the drug of choice for cardiac effects.
same
Digitoxin - rarely prescribed but has a very long half-life.
Digoxin (Lanoxin) - commonly used
DO NOT ____ THE TWO.
CONFUSE
Digitalization - bring ____ levels up to therapeutic levels
serum
Dosage of Digoxin/Digitoxin:
Digitalization - p.o. 0.5 - 1mg in 2 divided doses.
Maintenance - p.o. 0.125 - 0.5 mg/day
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What are the therapeutic blood levels 0.8 - 2mg
Low therapeutic index - very low to toxic levels so monitor clients.
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S/S Drug toxicity of Digoxin/Digitoxin:
GI distress (n/v, diarrhea, abd pain)
Euro effects (visual disturbances, restless, ____)
Cardiac effects: ____
HA…Bradycardia
Predisposing factors to toxicity:
Hypokalemia
____ impairment
IV drug administration
renal…
Antidote for severe intoxication:
Digoxin ____ - binds with digoxin and forms complex molecules that are then excreted in the ____.
immune fab… urine.
milrinone lactate (Primacor) gives a \_\_\_\_ inotropic effect on heart and direct relaxant effect on vascular smooth muscle which leads to \_\_\_\_ (helps increase \_\_\_\_)
positive….vasodilation
milrinone lactate is for ____ management and those who do not respond well to other meds.
short-term
Miltrinone only give through ____ –> 0.375 - 0.75 mcg/kg/min
IV
Check apical pulse for one minute before administering Digoxin/Digitoxin and do not give if pulse rate is less than ____ bpm.
60…
Monitor serum digoxin levels:
normal range –> ____ mg/mL
toxic –> ____ mg/mL
0.8 - 2… greater than 2
Monitor serum potassium levels (Normal range: ____)
Report ____.
3.5 - 5.3 mEq/L… hypokalemia
Instruct client how to check pulse rate when taking Digoxin/Digitoxin.
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Report side effects to health care provider:
Low ____
n/v, ____, ____ disturbances
pulse rate… HA… visual
Encourage foods high in ____ (BANANAS)
potassium
Antianginal drugs destroy the plaque that builds up in lumens of blood vessels which leads to ____.
atherosclerosis
In the coronary arteries, there is less blood flow to the heart muscle so ischemia leads to angina pectoris (chest pain).
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3 Types of Antianginal drugs:
Nitrates
Beta-blockers
Calcium channel blockers
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Nitroglycerin (NTG) most important drug in symptomatic relief of ____.
angina.
NTG SL(Sub Lingual): Most common route \_\_\_\_, predictable action Onset \_\_\_\_ min For acute \_\_\_\_ attack
Rapid… 1-3… anginal
Example of NTG SL:
Nitrostat - ____ sensation –> tabs still potent
burning.
Nitroglycerin Ointment:
Applied over 6x6 inch area of skin
Cover with plastic ____.
wrap
NTG transdermal patch:
____ sites
Worn ____ hrs/day
“Patch-Off” period of ____ hours which helps prevent tolerance.
rotate… 12-14… 8-12
NTG - Side Effects:
HA - most common - take ____ for relief
Hypotension, dizziness, ____
Taper off transdermal patch to prevent ____ effect.
acetaminophen… weakness… rebound
When taking NTG:
ID card
Avoid ____
SL NTG: ____ of attack.
tobacco… 1st sign
Take SL NTG if chest pain occurs… If pain is not better or has worsened 5 minutes after first dose, call ____.
911.
Sit or lie down when taking NTG products for 1st time to prevent ____.
Fresh supply of SL NTG tabs every ____ months and store away from ____.
hypotension… 3… heat.
Avoid direct contact with the topical preparations when administering NTG. Rotate ____ sites to prevent skin ____. Avoid where the fibrillation paddles may be displaced or ____ areas.
patch… irritation… hairy.
IV NTG is only administered in ____.
Do not mix NTG with ____.
glass bottles… other drugs.
Beta adrenergic blockers decrease effect of ____ n.s. by blocking Epi and Norepi which will decrease ____ and ____.
sympathetic… HR… BP.
Beta Adrenergic Blockers decrease ____ and myocardial ____ –> decreased need for oxygen consumption which will decrease ____ pain. Do not ____ abruptly.
HR… contractility… anginal… d/c
Nonselective beta adrenergic blockers :
propranolol (INderal)
nadolol (Corgard)
These will decrease ____ and ____ but cause ____.
HR… BP… bronchoconstriction.
Selective Beta blockers (cardiac):
atenolol (Tenormin)
metoprolol (Lopressor) - decreases ____ and ____, avoids ____, also drug group of choice for ____.
HR… BP… bronchoconstriction… angina.
When giving Beta blockers, monitor vital signs closely in early stages of therapy.
Taper off drug slowly to prevent ____.
rebound effect.
Calcium Channel Blockers - relax coronary artery spasm and ____ arterioles which will ____ oxygen demand, which will ____ cardiac contractility, which will ____ decrease workload of heart.
peripheral… decrease… decrease… decrease
Calcium Channel Blockers Examples: verapamil (Calan) nifedipine (Procardia) diltiazem (Cardizem) Frequently given with other \_\_\_\_ drugs.
antianginal.
S/S of Calcium Channel Blockers:
HA, ____, dizziness, ____.
hypotension… flushing
Heart rhythm controlled by primary pacemaker ____ node.
SA
Cardiac dysrhythmia is a spontaneous electrical discharge anywhere. Also, any deviation from normal rate pattern is considered dysrhythmia.
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Cardioversion - externally induce electrical impulses through artificial ____ or drug therapy.
pacemakers
Antidysrhythmic drugs diminish/obliterate rhythm problems and depress myocardial ____ and ____.
excitability… contractility.
Antidysrhythmic drugs decrease conduction velocity in cardiac tissue, suppress spontaneous ____, and block ____ stimulation of heart.
depolarization… adrenergic.
Most antidysrhythmic drugs are administered through IV until heart converts to ____ sinus rhythm –> ____ maintenance doses after.
normal… oral
4 classes of antidysrhythmic drugs:
- ____ Channel Blockers
- ____ Blockers
- Drugs that prolong ____.
- ____ Channel Blockers.
Sodium… Beta… repolarization…. Calcium
Sodium channel blocker example:
procainamide (Pronestyl) depresses myocardial ____ by slowing down ____ of cardiac tissue.
excitability… conductivity.
Sodium channel blocker example:
lidocaine (Xylocaine) for acute ____ dysrhythmias
ventricular
procainamide (Pronestyl) and lidocaine (Xylocaine) Side Effects:
high doses: bradycardia, ____.
less serious: dizziness, ____.
Local anesthetic activity
hypotension… light-headedness
Be sure client is not sensitive to similar local ____.
anesthetics.
Sodium channel blockers examples: flecainide (Tambocor) propafenone HCL (Rhythmol)
Tx: life-threatening ____ dysrhythmias.
ventricular.
Class IV (Calcium Channel Blockers): verapamil (Calan) blocks calcium influx which decreases \_\_\_\_ and \_\_\_\_ and treats \_\_\_\_, angina, and \_\_\_\_.
excitability… contractility… dysrhythmias… hypotension.
Monitor ____ for decreased ____ and ____ for abnormal patterns.
vital signs… BP… ECG
Avoid alcohol, caffeine, and tobacco when on antidysrhythmics.
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