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Pharmacology Test 4 > Cardiac Drugs > Flashcards

Cardiac Drugs Flashcards

1
Q

adenosine: class

A
  • antidysrhythmic
  • naturally occurring nucleotide
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2
Q

adenosine: MOA

A
  • decreases automaticity of SA node and slows conduction thru AV node
  • inhibits cyclic AMP induced calcium influx, so suppresses calcium dependent action potentials in the SA and AV nodes
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3
Q

adenosine: Indication

A
  • termination of paroxysmal SVT–more emergent use
    • including Wolff Parkinson White Syndrome
  • test drug during stress test in cardiac cath lab
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4
Q

adenosine: SE

A
  • dyspnea (from bronchoconstriction)
  • hypoTN
  • facial flushing (from vasodilation)
  • chest comfort (from stimulation of pain receptors in the heart)
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5
Q

adenosine: ADRs

A
  • sinus bradycardia
  • seizures
  • stroke
  • MI
  • ventricular tachycardia
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6
Q

adenosine: nursing implications

A
  • ADRs/SEs are minimal and last less than 1 minute b/c the drug is cleared rapidly from the blood
  • asthma pts taking certain meds (ie. theophylline) need a larger dose of adenosine b/c those meds block adenosine Rs and even then the adenosine may not work
  • short half life (<10 sec), so must give by IV bolus
  • watch for orthostatic hypoTN and bronchospasm in asthmatics
  • 6 second flat line
  • hold arm above pt when administer
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7
Q

digoxin: class

A
  • antidysrhythmic
  • cardiac glycoside
  • inotropic
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8
Q

digoxin: MOA

A
  • positive inotropic actions: their ability to inc myocardial contractile force
    • can inc CO
    • works by inhibiting Na/K ATPase, so inhibits the uptake of K into the cell which inhibits Na moving out, so w/ each action potential, intracellular K declines, Na inc, and Ca inc, so promotes Ca accumulation in myocytes
  • dec conduction thru AV node by:
    • direct depressant effect on AV node
    • acting on CNS to inc parasympathetic impulses to AV node
  • dec automaticity of SA node by :
    • inc parasympathetic traffic to node
    • dec sympathetic traffic
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9
Q

digoxin: indications

A
  • HF
  • control of dysrhythmias
    • SVT
  • atrial fibrillation/flutter: can slow ventricular rate by reducing atrial impulses thru AV node
  • ineffective against ventricular dysrhythmias
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10
Q

digoxin: SEs

A
  • GI disturbances: anorexia, nausea, vomiting, discomfort
  • CNS: fatigue, visual disturbances
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11
Q

digoxin: ADRs

A
  • cardiotoxicity: dysrhythmias
    • risk inc by hypokalemia which can result from concurrent therapy with diuretics (thiazides and loop diuretics)
    • risk inc by presence of heart dz
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12
Q

digoxin: nursing implications

A
  • watch K+ levels especially in pts taking thiazide or loop diuretics
    • must be w/in normal ranges: 3.5-5.0 mEq/L
    • need to monitor these–digoxin toxicity
  • narrow therapeutic range, so need to keep range b/w 0.5-0.8 ng/mL
    • ​half life is 36-48 hours
  • make sure pts don’t double up on doses to compensate for missed dose
  • limit salt intake to 1500 mg/day
  • pts should avoid excess fluid
  • if drink alcohol, consume no more than 1 drink/day
  • help pts establish appropriate regular, mild exercise
  • teach pt to monitor pulse
    • HR must be over 60 bpm before administration
  • teach pt to monitor for signs of hypokalemia (muscle weakness)–inform doctor
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13
Q

verapamil: class

A
  • antidysrhythmic
  • nondihydropyridine calcium channel blocker (class IV)
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14
Q

verapamil: MOA

A
  • slowing of SA nodal automaticity
  • delay of AV nodal conduction
  • reduction of myocardial contractility
  • blockade of peripheral arterioles which causes dilation and reduces arterial pressure
  • blockade of arteries and arterioles which inc coronary perfusion
  • vasodilation
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15
Q

verapamil: indications

A
  • atrial fibrillation w/ RVR or flutter
    • b/c slow ventricular rate
  • AV nodal reentrant circuit
    • so terminates SVT–more long term than adenosine
  • essential HTN
  • angina pectoris
  • NOT effective against ventricular dysrhythmias
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16
Q

verapamil: SEs

A
  • vasodilation–>hypoTN and peripheral edema, facial flushing, headache, dizziness
  • constipation
17
Q

verapamil: ADRs

A
  • bradycardia
  • AV block
  • heart failure
  • can exacerbate heart dysfunctions
18
Q

verapamil: nursing implications

A
  • contraindications: severe hypoTN, sick sinus syndrome, 2nd/3rd degree AV heart block
  • check BP, pulse, liver & kidney fcn before starting
  • can inc risk of digoxin toxicity–so watch K+ levels
  • if combine with beta blocker, it will inc risk of bradycardia, AV block, HF
  • can be given PO or IV, but PO undergoes extensive metabolism on first pass thru liver
  • do NOT consume grapefruit juice
  • monitor BP
  • inform pts about signs of cardiac effects and edema
  • tell pts that constipation can be minimized by inc fluids and fiber
19
Q

diltizem: class

A
  • antidysrhythmic
  • nondihydropyridine calcium channel blocker (class IV)
20
Q

diltizem: MOA

A
  • blocks Ca channel blockers in the heart and blood vessels
  • slowing of SA nodal automaticity
  • delay of AV nodal conduction
  • reduction of myocardial contractility
  • blockade of peripheral arterioles which causes dilation and reduces arterial pressure
  • blockade of arteries and arterioles which inc coronary perfusion
  • vasodilation
21
Q

diltizem: indications

A
  • atrial fibrillation w/ RVR or flutter
    • b/c slow ventricular rate
  • AV nodal reentrant circuit
    • so terminates SVT
  • essential HTN
  • angina pectoris
  • NOT effective against ventricular dysrhythmias
22
Q

diltizem: SEs

A
  • vasodilation–>hypoTN and peripheral edema, facial flushing, headache, dizziness
  • constipation, but LESS than verapamil
  • chronic eczematous rash in older adults
23
Q

diltizem: ADRs

A
  • bradycardia
  • AV block
  • heart failure
  • can exacerbate heart dysfunctions
24
Q

diltizem: nursing implications

A
  • contraindications: severe hypoTN, sick sinus syndrome, 2nd/3rd degree AV heart block
  • check BP, pulse, liver & kidney fcn before starting
  • need to watch pts that are receiving diltizem with digoxin or a beta blocker
  • can be given PO or IV, but PO undergoes extensive metabolism on first pass thru liver
  • do NOT consume grapefruit juice
  • monitor BP–b/c this drug will dec BP
  • inform pts about signs of cardiac effects and edema
  • tell pts that constipation can be minimized by inc fluids and fiber
25
Q

amiodarone: class

A
  • antidysrhythmic
  • potassium channel blocker (class III)
26
Q

amiodarone: MOA (PO)

A
  • delays repolarization so prolongs action potential and ERP
    • effects may be due to blockage of potassium channels
  • reduced automaticity of SA node
  • reduced contractility
  • reduced conduction velocity of AV node, ventricles, His Purkinje fibers
  • promote dilation in coronary and peripheral blood vessels
27
Q

amiodarone: SE (PO)

A
  • dyspnea
  • cough
  • corneal microdeposits
  • photosensitivity
  • CNS effects: ataxia, dizziness, tremor, hallucinations, mood alterations
  • GI disturbances: nausea, vomiting, anorexia
28
Q

amiodarone: ADRs (PO)

A
  • lung damage (biggest concern)
    • hypersensitivity pneumonitis
    • interstitial/alveolar pneumonitis
    • pulmonary fibrosis
  • paradoxical inc in dysrhythmic activity
  • sinus bradycardia
  • AV block
  • HF
  • hypo/hyperthyroidism
  • liver injury: malaise, dark urine, fatigue, jaundice
  • optic neuropathy
  • neuritis
29
Q

amiodarone: nursing implications (PO)

A
  • contraindicated for pts w/ severe sinus node dysfunction, 2nd/3rd degree heart block, pregnant women, preexisting HF
  • very toxic so only give to pts who haven’t responded to safer drugs
  • toxicity can continue for weeks or months after withdrawal, so patient must be given medication guide
  • baseline chest x ray and pulmonary fcn
    • monitor throughout therapy
  • baseline thyroid fcn
    • monitor throughout therapy
  • baseline liver fcn
    • monitor throughout therapy
  • do not give to pregnant women or women who are breast feeding b/c lipid soluble (so crosses placenta and enters breast milk)
  • avoid sunlamps, wear sunscreen
  • do NOT consume grapefruit juice, b/c can cause toxicity
  • report any signs of changes in visual acuity
30
Q

amiodarone: indications (IV)

A
  • tx and prophylaxis of recurrent ventricular fibrillation
  • hemodynamically unstable ventricular tachycardia
  • unapproved uses:
    • atrial fibrillation
    • AV nodal reentrant tachycardia
    • shock resistant ventricular fibrillation
31
Q

dronedarone: Indications

A
  • atrial flutter, fibrillation
  • also give to pts in sinus rhythm with a history of paroxysmal or persistent afib
32
Q

dronedarone: MOA

A
  • blocks cardiac potassium channels so delays repolarization
  • can block Na channels, beta adrenergic receptors, and calcium channels
33
Q

dronedarone: class

A
  • antidysrythmic
  • potassium channel blocker (class III)
34
Q

dronedarone: SE

A
  • diarrhea
  • weakness
  • nausea
  • skin rxns
    • sensitivity to light’
  • abdominal pain
35
Q

dronedarone: nursing implications

A
  • teach pts signs of liver toxicity: anorexia, nausea, vomiting, malaise, fatigue, itching, jaundice, dark urine
  • cannot use in pregnancy b/c proven teratogen
    • category X
  • do NOT consume grapefruit juice

Pharmacology Test 4 (10 decks)

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