cardiac medications Flashcards
s/s of dig toxicity
nausea, vommiting, anorexia, bradycardia, visual disturbances, cardiac dysrythmias, yellow and green halos
pt on digoxin should do what?
take pulse daily, do not take if HR less than 60
normal serum dig
0.8-2.0
monitor potassium for (when taking dig)
hypokalemia
can lead to toxicity
do not give dig with ??
antacids, makes drug ineffective
antidote for dig toxicity
digoxin immuno fab
hypokalemia and dig
hypokalemia increases effects of drugs and can lead to toxicity
first time someone takes nitro what should you do?
have them laying when they take it then test for orthostatic hypotension
do not apply nitro patches or ointment where?
near pacemaker or ICD
withdrawal symptoms of ca channel blockers and beta blockers
reflex tachycardia
pain
common se of nitroglycerin
HA pt can take tylenol for HA
what do beta blockers do?
decrease HR and myocardial contractility
calcium channel blockers action
relax coronary artery spasm, relaxes coronary artery spasms, and relaxes peripheral arteries, decreases contractility in turn decreases oxygen demands
decrease afterload, decrease peripheral resistance, reduces workload of the heart
Nitro SL tablets may have
stinging or biting feel
sodium channel blockers
decreases sodium influx into cardiac cellls, which decreases the likelyhood of ectopic foci
when administering antidysrythmics what should be done?
IV push or bolus, monitor for hypotension, compare baseline ecg to ecg after drugs are administered
adverse effects of antidysrhythmics
dizziness, fainting, nausea, vomiting
tell patient on antidysrhythmics to avoid
alcohol, caffeine, tobacco
what lab results to monitor with beta blockers?
BUN creatnine GFR AST LDH
what can beta blockers cause in a trauma situation?
hypoglycemia
side effects/ adverse effects of beta blockers
dizziness, slow hr, changes in bp, palpitations, orthostatic hypotension, confusion, GI upset, constipation
monitor what with alpha-adrenergic receptor blockers?
urine output, less than 600 daily than contraindicated with renal damage
sudden marked decreased in bp and increased hr
daily wts, can lead to edema
how long does it take for AA receptor blockers to work?
up to 4 weeks
side effects of AA blockers
dizziness, lightheadness, drowsiness, impotence, edema (fluid retention is an issue),
African americans should take
AA blockers and Ca channel blockers, beta blockers are not typically effective
asian patients are more susceptible to what?
effects of propanolol
side effects of ACE inhibitors
angioedema, cough, dysgeusia, weakness, hyperkalemia, renal impairment
nis for ACE inhibitors
BUN, creatnine, urine protein, bruising, petichae, bleeding
Teaching: avoid salt substitutes with K in them
rise slowly cause you can have orthostatic hypotension
how to take and record bp
report any occurrences of bleeding
report dizziness longer than a week
take with out food to increase absorption
food taste may diminish during first month of therapy
Hyperkalemia is possible
african americans will not respond to an ace inhibitor unless
it is taken with a diuretic
contraindications of warfarin
blood dyscrasia, peptic ulcers, cvas, hemophilia, severe hypertension
therapeutic PT/INR
PT 1.25-2.5
INR 2-3
prosthetic heart valves- INR up to 3.5
nursing assessment for a patient on heparin or warfarin
epistaxsis, hematuria, petechia, purpura, occult blood in stools
antidotes for heparin and warfarin
heparin- protamine sulfate
Warfarin- Vit K
fresh frozen plasma
teaching patients about warfarin and heparin
electric razor, PT and INR done regularly, medic alert card, do not smoke, if they do smoke may need to increase warfarin dosage, avoid herbal therapy, avoid large amounts of green leafy veggies, legumes, soybean,
increases effects- fish oils, green tea, chamomile, st johns wort, garlic, ginger, ETOH decreases effectiveness
aspirin cannot be taken with
warfarin, suggest acetaminophen
contraindications of thrombolytics
injury/head injury, CVA, hypertension, active bleeding, severe hypertension, anticoagulant therapy, report NSAIDS or aspirin
nursing assessment of a patient on thrombolytics
decreased bp, increased hr
observe for signs of bleeding in mouth or rectum, hemorrhage, aminocaproic acid can be given as an intervention to stop bleeding
monitoring vs/reactions of a pt on thrombolytics
q15 1st hr q30 for next 8hrs
s/s of allergic reactions
ecg for evidence of reperfusion, dysrythmias
avoid venipuncture (and arterial sticks)
side effects of thrombolytics
lightheadness, dizziness, palpitations, nausea, puritis, urticaria
desired cholesterol levels
150-200
high risk cholesterol levels
greater than 240
desired triglycerides
40-150
high risk triglycerides
190
LDL levels
100-160
HDL levels
low risk: greater than 60
high risk: less than 35
side effects of statins
GI disturbances, head aches, muscle cramps, fatigue
labs with statins
monitor liver enzymes
what else needs to be monitored for with statins?
eye exam, can cause cataracts
muscle cramping/weakness can be a sign of rhabdomylosis
may take how long for statins to work?
up to a couple months
people with what should not take gemfibrozil
diabetes on anticoagulants (watch themselves for bleeding)
side effects of niacin
vasodilatation- dizziness, fainting, flush (decreases w time)
do not stop taking a statin
abruptly, can cause MI
report to er if
muscle weakness
fever
tea like urine
use of peripheral vasodilators
increase blood flow to an area, PVD
reassess blood slow to an area after dosage
nursing interventions for peripheral vasodilators
monitor for orthostatic hypotension and tachycardia
may take 1.5-3.0 months to work
use with aspirin to prevent platelet aggregation
side effects of cilostazol
flushing, h/a, dizziness
alcohol can potentiate this
