💊- Cardiac Drugs Test Flashcards
Negative chronotropic action
Decreases ❤️ rate
Positive inotropic action
Increases myocardial contraction stroke volume
Negative dromotropic action
Decreases conduction of heart cells
What is the therapeutic serum level for digoxin
0.8 - 2 ng/mL
Patients taking digoxin and a diuretic should consume foods rich in what
Potassium or take potassium supplements to avoid hypokalemia and digitalis toxicity
How do vasodilators work to correct HF
Decrease venous blood return to the heart resulting in a decrease in cardiac filling , ventricular stretching (preload) and oxygen demand on the heart
Spironolactone
Aldactone
A potassium-sparing diuretic , that blocks the production of aldosterone
Angina
A condition of acute cardiac pain caused by inadequate blood flow to the myocardium due to either plaque occlusions within or spasms of the coronary arteries
Decreased blood flow- decreased oxygen-pain
Anginal pain is frequently described as
Tight pressure, dull or sharp pain, often in the center of chest, back, neck and left arm
Classic (stable) angina
Occurs with predictable stress or exertion
Unstable angina
Occurs frequently with progressive severity unrelated to activity; unpredictable regarding stress/exertion and intensity
Variant (vasospastic) angina
Occurs during rest
What steps should be taken to treat classic angina pectoris
- Nitrate
- Nitrate plus beta-blocker
- Nitrate plus beta-blocker plus calcium blocker
- Coronary artery bypass graft
What steps should be taken to treat variant angina pectoris
- Nitrates or Ca channel blockers
- Nitrates plus Ca channel blocker
- Coronary artery bypass graft
Beta blockers are NOT effective and may aggravate which type of angina
Variant (vasospastic) angina pectoris
How do nitrates work
Produce vasodilation in arteries and veins , increasing blood flow reducing myocardial ischemia but can cause hypotension
What are the 3 types of antianginal drugs
Beta blockers
Calcium channel blockers
Nitrates
What is your next course of action after 5 minutes if pain is not subsided when a sublingual (SL) nitroglycerin tablet is taken
Call 911
Monitor closely for what signs when taking nitroglycerin
Hypotension , dizziness , syncope , headache and reflex tachycardia (if given too fast)
How does nitroglycerin work
Acts directly on the smooth muscle of blood vessels causing relaxation and dilation
Decreased preload, afterload and myocardial oxygen demand
Do NOT give nitroglycerin in the presence of what
Hypotension
How does digoxin work
Increase myocardial contraction, which increases cardiac output and improves circulation and tissue perfusion
Decrease conduction through the av node, the heart rate decreases
List 10 signs of digoxin toxicity
Nausea , anorexia , bradycardia , blurry vision, yellow halo’s , diplopia , drowsiness , confusion , heart block and dysrhythmias
What is the antidote for digoxin toxicity
Digibind
What are some teaching implications for digoxin administration
- Pulse rate
- Early signs of toxicity (nausea and anorexia)
- symptoms of bradycardia
- medication compliance
- serum level monitoring
A patient should have a ❤️ rate of atleast what before the administration of digoxin
60 bpm
How do beta blockers work
Block the action of catecholamines (epinephrine and norepinephrine) thereby decreasing heart rate, BP and contractility
Beta blockers should NOT be given in the presence of
Heart block and bradycardia
Monitor closely for what when beta blockers are administered
Bradycardia, hypotension, orthostatic hypotension, heart block, cough, rebound hypertension
Drugs like viagra and cialis shouldn’t be mixed with what type of medications
Antianginals - nitrates, beta blockers and Ca channel blockers
Due to life threatening hypotension
Verapamil
Calan
Ca channel blocker
Diltiazem
Cardizem
Ca channel blocker with coronary and peripheral effects
How do Ca channel blockers work
Relaxing coronary artery spasm, relaxing peripheral arterioles and decreasing cardiac oxygen demand
Decreases contractility, afterload, peripheral resistance and reduces workload
Nonselective beta blockers
Block beta 1 and beta 2
Selective (cardiac) beta blockers
Block beta 1
Class I: sodium channel blockers
Slow the rate of impulse conduction through the heart
What is lidocaine used for
Premature ventricular contraction
Give two examples of class I: sodium channel blockers
Slow the rate of impulse conduction through the heart
Ex: procanamide and quinidine
Give an example of a class II: beta blocker
Decrease conduction velocity, automaticity and recovery time (refractory period)
Propranolol and esmolol
Give an example of a class III: drug that prolongs repolarization
Used in emergency treatment of ventricular dysrhythmias
Ex: amiodarone
Antidysrhythmic drugs should NOT be given in the presence of
2nd or 3rd degree heart block or bradycardia
True or false: antidysrhythmics shouldnt be stopped abruptly and should be tapered slowly
True
What is a normal blood pressure range
Less than 120 / less than 80
What is the prehypertension range
120 - 139 / 80 - 89
What is the stage I htn range
140 - 159 / 90 - 99
What is the stage II htn range
Greater than 160 / greater than 100
Which antihypertensive drugs do/don’t work the best in African Americans
Do: alpha 1 and ca channel blockers
Don’t: beta blockers and ace inhibitors (unless with diuretic)
Which antihypertensive drugs don’t work the best in Asian Americans
Sensitive to beta blockers
Name 2 nonselective beta blockers
Blocks beta 1 and beta 2
Propranolol (inderal)
Carvedilol (coreg)
List 2 selective (cardiac) beta blockers
Block beta 1
Atenolol (tenormin) Metoprolol tartrate (lopressor)
Beta blockers can cause an increase of what
Blood sugar
Alpha 1 blockers are useful in treating hypertension in patients with lipid abnormalities , what is something important to note in relation to that
They are highly protein bound and should not be taken with anticoagulants
They can cause orthostatic hypotension & erectile disfunction, reduce LDL while increasing HDL
Nonselective alpha blockers are more effective for
Acute hypertension
Selective alpha blockers are more useful for
Long-term essential hypertension
How do alpha 2 agonists work
Reduce vascular resistance and decrease vasodilation
Ex: clonidine, methyldopa, guanfacine
How do alpha 1 blockers work
Block alpha 1 causing vasodilation and decrease BP - also used to treat benign prostatic hypertrophy
Ex: doxazosin, prazosin, terazosin
How do alpha 1-beta 1 blockers work
Cause vasodilation, decrease resistance to blood flow. Decrease BP , ❤️ rate and contractility
*shouldnt be given to patients with asthma in large doses due to increased airway resistance
ACE inhibitors typically end in
-pril
ARB’s typically end in
-sartin
Ca channel blockers typically end in
-ipine
Beta blockers typically end in
-lol
Alpha blockers typically end in
-zosin
How do ACE inhibitors work
ACE inhibitors block ACE (angiotensin-converting enzyme) inhibiting angiotensin II formation and blocks the release of aldosterone
Aldosterone
Adrenal hormone that Promotes Na retention K excretion causing increases BP
Can ACE inhibitors be combined with diuretics
Yes , but not K sparing diurects due to risk of hyperkalemia
Ex: spironolactone (aldactone) or salt substitutes that contain K
What are some side effects of ACE inhibitor administration
Cough !
N/v/d , increase K , headache, dizziness, fatigue
Angioedma may occur due to hypersensitivity and is more prevalent in blacks
Preload
Load or tension on the cardiac muscle just prior to contraction
Stretching the 💞 muscle
Afterload
Pressure in the aorta that must be overcome for blood to be ejected from the left side of the heart during systole
^ BP = ^ afterload
Thiazide diuretics should be used with caution with digoxin why
Because thiazides can cause hypokalemia which enhances the action of digoxin , and digitalis toxicity can occur
Also induce hypercalcemia which enhances digoxin and possible digitalis toxicity
List 4 signs and symptoms of digitalis toxicity
Bradycardia
Nausea
Vomiting
Visual changes
Loop diuretics
Decrease reabsorption of Na and Cl along the renal tubule, particularly the loop of henle
Water , Na , K , Ca and Mg are lost
Highly protein bound
Ex: furosemide (lasix) and bumetamide (bumex)
Thiazides
Inhibit the reabsorption of Na and Cl in the distal convoluted tubule
Water , Na , K , Mg , Cl are EXCRETED .. Ca is RETAINED
not used in patients with renal dysfunction
Ex: hydrochlorothiazide (hydrodiuril, hctz)
Potassium sparing
Prevent the reabsorption of Na in the distal convoluted tubule and collecting duct
Water and Na are EXCRETED .. K is RETAINED
Should not be given with ACEI’s , ARB’s or those with poor renal function
Ex: spironolactone (aldactone)
List 7 side effects of diuretics
Frequent urination , hypotension , dehydration , electrolyte imbalance , digitalis toxicity , hyperglycemia and hyperuricemia
Carbonic anhydrase inhibitors
Work by acidifying the blood. Inhibit carbonic anhydrase which decreases the production of aqueous humor, reducing intraocular pressure
Used to treat open-angle glaucoma
Ex: acetazamide (diamox)
Diamox is used with what type of patient
Acetazolamide a carbonic anhydrase inhibitor diuretic
Is used in patients with metabolic alkalosis who need a diuretic
Osmotic diuretics
Increases the osmolarity of filtrate , in the proximal ruble and loop of henle increasing water excretion
Used to treat increased intracranial and intraocular pressure and to maintain irons output during surgery
Ex: mannitol
List 4 nursing implications for diuretic administration
- monitor I&O, weight, fluid retention, BP
- monitor electrolytes and Uric acid
- fall prevention
- monitor glucose levels
Hemostatsis
Is the slowing or stopping of blood flow
Coagulation
The process of blood clotting
Thrombus
Blood clot that is stationary
Embolus
A blood clot that is traveling in the bloodstream
Anticoagulant
An agent that inhibits the formation of blood clots ; doesn’t dissolve already formed clots
Antiplatelets
Prevent clot formation in arteries through inhibition of platelet aggregation
Thrombolytic
Drugs that dissolve clogs already formed
“Clot buster”
Heparin
- prevent thrombus formation or prevent a thrombus from growing larger
- interferes with fibrin formation
Monitor closely for: thrombocytopenia, bleeding and hypotension
What is the antidote for heparin overdose
Protamine sulfate
Warfarin sodium
Coumadin
Highly protein bound with a narrow therapeutic range
-works by inhibiting hepatic synthesis of vitamin k
What is the antidote for Coumadin overdose
Vitamin K or fresh frozen plasma if acute bleeding
What are the INR levels for Coumadin
Normal: less than 1.3-2
Therapeutic Coumadin range: 2.0-3.0
Higher risk therapeutic range: 3-3.5
(For mechanical 💕 valve or recurrent systemic emboli)
What should the nurse monitor for while administering Coumadin
Petechiae, ecchymosis, tarry stools and hematemesis
Hematemesis
Bloody vomit
Antiplatelet agents
Used to prevent thrombus in the arteries by suppressing platelet aggregation
Ex: aspirin, plavix
Clopidogril
Plavix
Is frequently used after 💕 attack or strobe to prevent a second event
-highly protein bound
Patient teaching for anticoagulants and antiplatelets
- don’t give in the presence of active bleeding
- don’t give with NSAIDS
- assess for bruising
- monitor lab work
- stop oral anticoagulants 7 days before surgery
-use soft toothbrush, electric razors etc
Thrombolytics
Promotes the fibrinolytic mechanism (convert plasminogen to plasmin, which destroys the fibrin in the blood clot)
Monitor for: blood counts, bleeding, hypotension, tachycardia and allergic reactions
Ex: streptokinase, tPA, alteplase
Thrombolytics must be administered within what time frame
4 hours of a 💕 attack and 3 hours of a stroke
High density lipoproteins
‘Good cholesterol’
They pick up cholesterol in blood and transports it to liver
HMG CoA reductase inhibitors
(Statins)
-inhibit the enzyme HMG CoA reductase in cholesterol biosynthesis in the liver
⤵️ ldl, triglycerides, vldl
⤴️ hdl
Ex: atorvastin, simvastatin, prevastatin
List some side/adverse effects of statins
Gi upset, liver damage, rhabdomyolysis and may rise the rise of diabetes in women
Monitor for: liver enzyme levels, creatinine kinase levels and get an annual eye exam because cataracts may form
Fibrates
- decrease triglycerides more than increase hdl or reducing ldl
- take BEFORE meals, don’t mix with anticoagulants
Ex: fenofibrate, gemfibrozil
Gemfibrozil
lopid
Used to reduce type IV hyperlipdemia
-highly protein bound
Cholesterol absorption inhibitor
-blocks cholesterol absorption in small intestine, take WITH meals
Ex: ezetimibe (zetia)
Bile-acid sequestrants
- bind bile acids in the small intestine, preventing their return to the liver, bound cholesterol is excreted in the stool
- decreases ldl
- take BEFORE meals, may cause constipation
Ex: cholestyramine (questran)
Nicotinic acid
Niaspan
Take WITH food
Many side effects including significant vasodilation, flushing and gi distress
-reduces vldl and ldl
Lifestyle changes to correct hyperlipidemia
Diet , exercise
Reduce dietary saturated fat to 7% of total caloric intake
Reduce cholesterol intake to less than 200 mg/day
Increase intake of whole grains, vegetables and fruits so that total dietary fiber is 10-25 mg/day
DONT SMOKE
