Cardiac Meds Flashcards
1
Q
When do pt need diuretics?
A
When they require a reduced fluid circulation
2
Q
Are diuretics often given by themselves?
A
No they are usually given with antihypertensive meds
3
Q
Which diuretics have risk for hypokalemia?
A
Loop diuretics, thiazide and related diuretics
Because they make potassium excreted in urine
4
Q
Loop diuretics ex?
A
Furosemide (Lasix)
5
Q
Thiazide and related diuretics ex?
A
Hydrochlorothiazide
6
Q
Furosemide class?
A
Loop diuretics
7
Q
Hydrochlorothiazide class?
A
Thiazide and related diuretics
8
Q
What do potassium-sparing diuretics do?
A
Reduce secretion of K from kidney
9
Q
Potassium-sparing diuretics ex?
A
Spironolactone
10
Q
Spironolactone class?
A
Potassium-sparing diuretics
11
Q
What do loop diuretics do?
A
Inhibit Na and Cl
12
Q
What is the first drug in tx for new onset of hypertension?
A
Hydrochlorothiazide
13
Q
What do you need to make sure to do before giving diuretics?
A
Get electrolytes under control!
14
Q
What does osmotic diuretics do?
A
Osmotic means water
Prevents reabsorption of water, increase urine, increase Na and Cl absorption
15
Q
Osmotic diuretics ex?
A
Mannitol
16
Q
Mannitol class
A
Osmotic diuretics
17
Q
what are pt taking thiazide diuretics at risk for? (Not hypokalemia)
A
Gout attacks b/c it increase urate in body
18
Q
Which diuretics can cause hypokalemia?
A
Loop diuretics and thiazide diuretics
19
Q
Which diuretics can cause hyperkalemia?
A
Potassium-sparing diuretics
20
Q
What hormone affect can spironolactone cause in males?
A
Gynecomastia b/c it blocks male sex hormone
21
Q
Can you take diuretics with food/milk?
A
Yes
22
Q
When should you take diuretics?
A
Early in the morning!
23
Q
Can pt reduce fluid intake while on diuretics to reduce the need to urinate?
A
No!
24
Q
Relations between cholesterol, triglycerides, and lipoproteins?
A
Cholesterol and triglycerides are not soluble in water, so need lipoproteins to help eliminate
25
What is LDL?
Low density lipoprotein
Harmful b/c it transports cholesterol to peripheral cells but discard the rest into bloodstream, causing atherosclerosis
26
What is HDL?
High density lipoprotein
Better b/c it takes cholesterol from peripheral cells to the liver to metabolize and excrete
Lower risk for atherosclerosis
27
What level of cholesterol and triglycerides is considered hyperlipidemia?
Cholesterol > 240
Triglycerides > 150
28
What do the statins help treat?
Hyperlipidemia
Prevent MI, stroke, and atherosclerosis
29
What do the statins do?
Inhibit manufacture and promotes breakdown of cholesterol
30
What is one serious adverse reaction of statins?
Leg pain/cramping and muscle ache/weakness
Because of rhabdomyolysis (breakdown of muscle and tissue)!
31
What kind of pt cannot take statins?
Diabetic b/c statins raise blood glucose
32
What do bile acid resins do?
Binds to bile acid, forms insoluble substance that cannot be absorbed in GI system, so you can poop it out
33
What are bile acid resins used for?
Hyperlipidemia
Gallstone when surgery is not recommended
34
Bile acid resins ex?
colestipol
35
colestipol class?
Bile acid resins
36
What are fabric acid derivatives (fibrates) used for?
Very high serum triglyceride levels
Reduce LDLs, cholesterol, and triglycerides
37
Fibric acid derivatives ex?
gemfibrozil
38
gemfibrozil class?
Fibric acid derivatives
39
When should pt take statins?
In the evening or at bedtime
40
What diet should pt have when taking statins?
Low fat/saturated fat
41
Can you drink grapefruit juice when taking statins?
No!
42
When should pt take bile acid resins?
Before meals
43
what is DASH diet?
Used for hypertensive pt
Low saturated fat and cholesterol
Rich in fruits, vegetables, and low-fat dairy food
Whole grain, poultry, fish, and nuts
Reduce fats, red meats, sweets, and sugared beverage
44
What do beta blockers do?
Decrease hr and bp
45
Centrally acting antiadrenergic drugs ex?
Clonidine
46
Peripherally acting antiadrenergic drugs ex?
Doxazosin
47
Calcium channel blockers ex?
Amlodipine, diltiazem
48
ACE inhibitors ex?
Lisinopril
49
Clonidine class?
Centrally acting antiadrenergic
50
Doxazosin class?
Peripherally acting antiadrenergic
51
Amlodipine class?
Calcium channel blocker
52
Diltiazem class?
Calcium channel blocker
53
Lisinopril class?
ACE inhibitors
54
What do you need to check before giving antihypertensive drugs?
bp and hr
55
What is one expected finding on pt who are taking ACE inhibitors?
Dry, nonproductive cough
56
What do calcium channel blockers do?
Relax and open vessels
57
How do calcium channel blockers work?
They block the calcium ions to reduce contraction of heart and smooth muscle, relax and open vessels
Cardiac and smooth muscle contraction rely on calcium!
58
How to discontinue beta blockers?
Taper off
59
What is a severe side effect of antihypertensive drugs?
Rhabdo
60
What do antianginal drugs do?
Relieve chest pain, decrease pressure by dilating coronary arteries, increase blood supply to myocardium
61
How do beta-blockers help with angina?
Reduce hr and contractility, and decrease O2 demand
62
How do calcium channel blockers help with angina?
Reduce the calcium available for transmission of nerve impulse, increase O2 to heart, decrease workload
63
What do nitroglycerin do?
Dilate blood vessels, increase flow, decrease bp
64
How should pt take nitrate?
3 dose max with 5 min apart
65
What to do when 3 dose of nitrates doesn't relieve chest pain?
Call 911 immediately
66
What is one common side effect of antianginal meds?
Hypotension
67
What data do you need to collect before administering antianginal meds?
bp and pulse
68
What respiratory disorders is beta blockers contraindicated in?
Asthma and emphysema
69
What should you do after applying topical nitro ointment?
Measure the inches of ointment that is being applied for dosage documentation
70
What are anticoagulants used for?
Prevent blood clot
Usually used prophylactically for high risk pt
71
Do anticoagulants have affect on existing clots?
No, but it can prevent future clots
72
What are anticoagulants also called?
Blood thinners
But they don't thin the blood, just prevents clots
73
Warfarin class
Anticoagulant
74
How long does it take for warfarin to take effect?
1.5-3 days
75
Dalteparin (Fragmin) class
Anticoagulant
Low molecular weight heparin
76
Enoxaparin (Lovenox) class
Anticoagulant
Low molecular weight heparin
77
Apixaban (Eliquis) class
Anticoagulant
78
What should you do if pt have an order for anticoagulants but they have thrombocytopenia?
Call the provider b/c pt is already lacking clotting factors (platelets)
79
Is heparin given orally?
No
80
Why is heparin not given orally?
Because they will get inactivated by gastric acid
81
What is the antidote for heparin?
Protamine sulfate
82
What precaution should pt taking anticoagulants be on?
Bleeding precaution
83
What do antiplatelet drugs do?
Decrease ability of platelets to stick together
84
Difference between anticoagulants and antiplatelets?
Anticoagulants are for veins
Antiplatelets are for arteries
85
What labs do you need for warfarin?
PT and INR
86
If pt is taking warfarin, what should the normal range of PT and INR be?
PT: 11-13.5
INR: 2-3
87
What is a PT blood test?
Prothrombin Time
See how long does it take blood to clot
Norm: 11-13.5 sec
88
What is INR?
International Normalized Ratio
Test done with Prothombin Time for pt who are on warfarin
Norm: 2-3
Doctors use this to determine the right dose for pt
89
What lab do pt need if they are on heparin?
aPTT
90
What is aPTT?
Activated Partial Thromboplastin Time
See how long does it take for blood to clot after a substance is added to activate the clotting process
91
What is the normal aPTT value for pt that are on heparin?
60-80 sec
92
What is the normal value of aPTT for pt that are not on heparin?
30-40 sec
93
What risk do thrombolytic drugs increase?
Bleeding
94
What do thrombolytics do to the body?
Breaks down ALL the clots, not only the abnormal ones
95
Alteplase recombinant (Activase) class
Thrombolytics
96
Telecteplase (TNKase) class
Thrombolytics
97
What foods do pt need to be aware of when taking blood thinners?
Foods high in Vitamin K b/c counteracts with the effects of blood thinners
Ex: leafy green vegetables, beans, broccoli, cabbage, cauliflower, cheese, fish, and yogurt
98
What are pt at risk for during the first 3 months of tx if they are on anticoagulants/antiplatelets/thrombolytics?
Infection!
99
How long before surgery should you stop taking aspirin?
7 days prior
100
What herbs do pt need to avoid while taking blood thinners?
Garlic, ginger, and ginkgo b/c higher risk for bleeding
101
What are cardiotonics?
强心剂
Increase heart muscle contraction
Increase blood flow
And hr decreases with stronger contraction to allow heart chambers to be filled with blood for contraction
102
What do antiarrhythmics do?
Get heart back on regular rhythm
103
Digoxin (Lanoxin) class
Cardiotonics
104
Ivabradine (Corlanor) class
Cardiotonics
105
Adverse reactions for cardiotonics
Visual disturbance: blurring, yellow halo
Digitalis toxicity: digoxin
106
What is digoxin's narrow therapeutic range?
0.8-2 mg
107
What do beta-blockers do when used as antiarrhythmic agents?
Decrease excitability of heart, release renin to decrease hr and bp
108
Amiodarone (Nexterone) class
Potassium channel blockers
Antiarrhythmic agents
109
How do potassium channel blockers (amiodarone) work?
Binds with potassium ions to slow down overactive electric signals in the heart
110
Verapamil (Calan) class
Calcium channel blockers
Antiarrhythmic agents
111
How do calcium channel blockers work?
Dilate coronary and peripheral artery, decrease the force of cardiac contraction
112
Severe side effects of calcium channel blockers?
Hepatotoxicity, MI, HF
113
What is a common action of antiarrhyhmic agents?
Vasodilation
114
What are some side effects of antiarrhythmic agents due to vasodilation?
Hypotension
Lightheadedness
Bradycardia
115
What should pt monitor before taking antiarrhythmic agents?
Heart rate
Hold med if hr is irregular
(<60/>100)
116
What food do pt need to eat while taking digoxin?
Foods high in potassium
117
What can indicate digoxin toxicity?
Yellow halo visual disturbance
118
What drugs do pt need to avoid while taking antiarrhythmic agents?
Antacids!
And nonprescription cough/cold/allergy/antidiarrheal/diet drugs
119
Why does digoxin need potassium?
Because they bind to the same place on sodium-potassium pump, so if potassium is low, digoxin binds more freely and that increases the risk of digoxin toxicity
