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Pharmacology > 💊- Cardiac Drugs Test > Flashcards

💊- Cardiac Drugs Test Flashcards

1
Q

Negative chronotropic action

A

Decreases ❤️ rate

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2
Q

Negative dromotropic action

A

Decreases conduction of heart cells

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3
Q

What is the therapeutic serum level for digoxin

A

0.8 - 2 ng/mL

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4
Q

Patients taking digoxin and a diuretic should consume foods rich in what

A

Potassium or take potassium supplements to avoid hypokalemia and digitalis toxicity

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5
Q

How do vasodilators work to correct HF

A

Decrease venous blood return to the heart resulting in a decrease in cardiac filling , ventricular stretching (preload) and oxygen demand on the heart

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6
Q

Spironolactone

A

Aldactone

A potassium-sparing diuretic , that blocks the production of aldosterone

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7
Q

Angina

A

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

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8
Q

Anginal pain is frequently described as

A

Tight pressure, dull or sharp pain, often in the center of chest, back, neck and left arm

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9
Q

Classic (stable) angina

A

Occurs with predictable stress or exertion

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10
Q

Unstable angina

A

Occurs frequently with progressive severity unrelated to activity; unpredictable regarding stress/exertion and intensity

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11
Q

Variant (vasospastic) angina

A

Occurs during rest

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12
Q

What steps should be taken to treat classic angina pectoris

A
  1. Nitrate
  2. Nitrate plus beta-blocker
  3. Nitrate plus beta-blocker plus calcium blocker
  4. Coronary artery bypass graft
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13
Q

What steps should be taken to treat variant angina pectoris

A
  1. Nitrates or Ca channel blockers
  2. Nitrates plus Ca channel blocker
  3. Coronary artery bypass graft
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14
Q

Beta blockers are NOT effective and may aggravate which type of angina

A

Variant (vasospastic) angina pectoris

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15
Q

How do nitrates work

A

Produce vasodilation in arteries and veins , increasing blood flow reducing myocardial ischemia but can cause hypotension

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16
Q

What are the 3 types of antianginal drugs

A

Beta blockers

Calcium channel blockers

Nitrates

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17
Q

What is your next course of action after 5 minutes if pain is not subsided when a sublingual (SL) nitroglycerin tablet is taken

A

Call 911

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18
Q

Monitor closely for what signs when taking nitroglycerin

A

Hypotension , dizziness , syncope , headache and reflex tachycardia (if given too fast)

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19
Q

How does nitroglycerin work

A

Acts directly on the smooth muscle of blood vessels causing relaxation and dilation

Decreased preload, afterload and myocardial oxygen demand

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20
Q

Do NOT give nitroglycerin in the presence of what

A

Hypotension

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21
Q

How does digoxin work

A

Increase myocardial contraction, which increases cardiac output and improves circulation and tissue perfusion

Decrease conduction through the av node, the heart rate decreases

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22
Q

List 10 signs of digoxin toxicity

A

Nausea , anorexia , bradycardia , blurry vision, yellow halo’s , diplopia , drowsiness , confusion , heart block and dysrhythmias

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23
Q

What is the antidote for digoxin toxicity

A

Digibind

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24
Q

What are some teaching implications for digoxin administration

A
  • Pulse rate
  • Early signs of toxicity (nausea and anorexia)
  • symptoms of bradycardia
  • medication compliance
  • serum level monitoring
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25
Q

A patient should have a ❤️ rate of atleast what before the administration of digoxin

A

60 bpm

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26
Q

How do beta blockers work

A

Block the action of catecholamines (epinephrine and norepinephrine) thereby decreasing heart rate, BP and contractility

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27
Q

Beta blockers should NOT be given in the presence of

A

Heart block and bradycardia

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28
Q

Monitor closely for what when beta blockers are administered

A

Bradycardia, hypotension, orthostatic hypotension, heart block, cough, rebound hypertension

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29
Q

Drugs like viagra and cialis shouldn’t be mixed with what type of medications

A

Antianginals - nitrates, beta blockers and Ca channel blockers

Due to life threatening hypotension

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30
Q

Verapamil

A

Calan

Ca channel blocker

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31
Q

Diltiazem

A

Cardizem

Ca channel blocker with coronary and peripheral effects

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32
Q

How do Ca channel blockers work

A

Relaxing coronary artery spasm, relaxing peripheral arterioles and decreasing cardiac oxygen demand

Decreases contractility, afterload, peripheral resistance and reduces workload

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33
Q

Nonselective beta blockers

A

Block beta 1 and beta 2

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34
Q

Selective (cardiac) beta blockers

A

Block beta 1

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35
Q

Class I: sodium channel blockers

A

Slow the rate of impulse conduction through the heart

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36
Q

What is lidocaine used for

A

Premature ventricular contraction

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37
Q

Give two examples of class I: sodium channel blockers

A

Slow the rate of impulse conduction through the heart

Ex: procanamide and quinidine

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38
Q

Give an example of a class II: beta blocker

A

Decrease conduction velocity, automaticity and recovery time (refractory period)

Propranolol and esmolol

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39
Q

Give an example of a class III: drug that prolongs repolarization

A

Used in emergency treatment of ventricular dysrhythmias

Ex: amiodarone

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40
Q

Antidysrhythmic drugs should NOT be given in the presence of

A

2nd or 3rd degree heart block or bradycardia

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41
Q

True or false: antidysrhythmics shouldnt be stopped abruptly and should be tapered slowly

A

True

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42
Q

What is a normal blood pressure range

A

Less than 120 / less than 80

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43
Q

What is the prehypertension range

A

120 - 139 / 80 - 89

44
Q

What is the stage I htn range

A

140 - 159 / 90 - 99

45
Q

What is the stage II htn range

A

Greater than 160 / greater than 100

46
Q

Which antihypertensive drugs do/don’t work the best in African Americans

A

Do: alpha 1 and ca channel blockers

Don’t: beta blockers and ace inhibitors (unless with diuretic)

47
Q

Which antihypertensive drugs don’t work the best in Asian Americans

A

Sensitive to beta blockers

48
Q

Name 2 nonselective beta blockers

A

Blocks beta 1 and beta 2

Propranolol (inderal)
Carvedilol (coreg)

49
Q

List 2 selective (cardiac) beta blockers

A

Block beta 1

Atenolol (tenormin) 
Metoprolol tartrate (lopressor)
50
Q

Beta blockers can cause an increase of what

A

Blood sugar

51
Q

Alpha 1 blockers are useful in treating hypertension in patients with lipid abnormalities , what is something important to note in relation to that

A

They are highly protein bound and should not be taken with anticoagulants

They can cause orthostatic hypotension & erectile disfunction, reduce LDL while increasing HDL

52
Q

Nonselective alpha blockers are more effective for

A

Acute hypertension

53
Q

Selective alpha blockers are more useful for

A

Long-term essential hypertension

54
Q

How do alpha 2 agonists work

A

Reduce vascular resistance and decrease vasodilation

Ex: clonidine, methyldopa, guanfacine

55
Q

How do alpha 1 blockers work

A

Block alpha 1 causing vasodilation and decrease BP - also used to treat benign prostatic hypertrophy

Ex: doxazosin, prazosin, terazosin

56
Q

How do alpha 1-beta 1 blockers work

A

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

57
Q

ACE inhibitors typically end in

A

-pril

58
Q

ARB’s typically end in

A

-sartin

59
Q

Ca channel blockers typically end in

A

-ipine

60
Q

Beta blockers typically end in

A

-lol

61
Q

Alpha blockers typically end in

A

-zosin

62
Q

How do ACE inhibitors work

A

ACE inhibitors block ACE (angiotensin-converting enzyme) inhibiting angiotensin II formation and blocks the release of aldosterone

63
Q

Aldosterone

A

Adrenal hormone that Promotes Na retention K excretion causing increases BP

64
Q

Can ACE inhibitors be combined with diuretics

A

Yes , but not K sparing diurects due to risk of hyperkalemia

Ex: spironolactone (aldactone) or salt substitutes that contain K

65
Q

What are some side effects of ACE inhibitor administration

A

Cough !

N/v/d , increase K , headache, dizziness, fatigue

Angioedma may occur due to hypersensitivity and is more prevalent in blacks

66
Q

Preload

A

Load or tension on the cardiac muscle just prior to contraction

Stretching the 💞 muscle

67
Q

Afterload

A

Pressure in the aorta that must be overcome for blood to be ejected from the left side of the heart during systole

^ BP = ^ afterload

68
Q

Thiazide diuretics should be used with caution with digoxin why

A

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

69
Q

List 4 signs and symptoms of digitalis toxicity

A

Bradycardia

Nausea

Vomiting

Visual changes

70
Q

Loop diuretics

A

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)

71
Q

Thiazides

A

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)

72
Q

Potassium sparing

A

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)

73
Q

List 7 side effects of diuretics

A

Frequent urination , hypotension , dehydration , electrolyte imbalance , digitalis toxicity , hyperglycemia and hyperuricemia

74
Q

Carbonic anhydrase inhibitors

A

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)

75
Q

Diamox is used with what type of patient

A

Acetazolamide a carbonic anhydrase inhibitor diuretic

Is used in patients with metabolic alkalosis who need a diuretic

76
Q

Osmotic diuretics

A

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

77
Q

List 4 nursing implications for diuretic administration

A
  • monitor I&O, weight, fluid retention, BP
  • monitor electrolytes and Uric acid
  • fall prevention
  • monitor glucose levels
78
Q

Hemostatsis

A

Is the slowing or stopping of blood flow

79
Q

Coagulation

A

The process of blood clotting

80
Q

Thrombus

A

Blood clot that is stationary

81
Q

Embolus

A

A blood clot that is traveling in the bloodstream

82
Q

Anticoagulant

A

An agent that inhibits the formation of blood clots ; doesn’t dissolve already formed clots

83
Q

Antiplatelets

A

Prevent clot formation in arteries through inhibition of platelet aggregation

84
Q

Thrombolytic

A

Drugs that dissolve clogs already formed

“Clot buster”

85
Q

Heparin

A
  • prevent thrombus formation or prevent a thrombus from growing larger
  • interferes with fibrin formation

Monitor closely for: thrombocytopenia, bleeding and hypotension

86
Q

What is the antidote for heparin overdose

A

Protamine sulfate

87
Q

Warfarin sodium

A

Coumadin

Highly protein bound with a narrow therapeutic range

-works by inhibiting hepatic synthesis of vitamin k

88
Q

What is the antidote for Coumadin overdose

A

Vitamin K or fresh frozen plasma if acute bleeding

89
Q

What are the INR levels for Coumadin

A

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)

90
Q

What should the nurse monitor for while administering Coumadin

A

Petechiae, ecchymosis, tarry stools and hematemesis

91
Q

Hematemesis

A

Bloody vomit

92
Q

Antiplatelet agents

A

Used to prevent thrombus in the arteries by suppressing platelet aggregation

Ex: aspirin, plavix

93
Q

Clopidogril

A

Plavix

Is frequently used after 💕 attack or strobe to prevent a second event

-highly protein bound

94
Q

Patient teaching for anticoagulants and antiplatelets

A
  • 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

95
Q

Thrombolytics

A

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

96
Q

Thrombolytics must be administered within what time frame

A

4 hours of a 💕 attack and 3 hours of a stroke

97
Q

High density lipoproteins

A

‘Good cholesterol’

They pick up cholesterol in blood and transports it to liver

98
Q

HMG CoA reductase inhibitors

A

(Statins)

-inhibit the enzyme HMG CoA reductase in cholesterol biosynthesis in the liver

⤵️ ldl, triglycerides, vldl
⤴️ hdl

Ex: atorvastin, simvastatin, prevastatin

99
Q

List some side/adverse effects of statins

A

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

100
Q

Fibrates

A
  • decrease triglycerides more than increase hdl or reducing ldl
  • take BEFORE meals, don’t mix with anticoagulants

Ex: fenofibrate, gemfibrozil

101
Q

Gemfibrozil

A

lopid

Used to reduce type IV hyperlipdemia

-highly protein bound

102
Q

Cholesterol absorption inhibitor

A

-blocks cholesterol absorption in small intestine, take WITH meals

Ex: ezetimibe (zetia)

103
Q

Bile-acid sequestrants

A
  • 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)

104
Q

Nicotinic acid

A

Niaspan

Take WITH food

Many side effects including significant vasodilation, flushing and gi distress

-reduces vldl and ldl

105
Q

Lifestyle changes to correct hyperlipidemia

A

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

106
Q

Positive inotropic action

A

Increases myocardial contraction stroke volume

Pharmacology (8 decks)

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