Cardiac meds Flashcards
right side HF symptom
peripheral edema
left side HF symptoms
SOB , dyspnea
cardiac glycosides examples
- Rapid acting Digitalis- Digoxin (Lanoxin)
- Phosphodiesterase inhibitors= milrinone lactate
digoxin antidote
immune fab (Digibind)
cardiac glycosides use and ind
- cause cardiac muscle to contract
- Used to treat HF, atrial fibrillation, and atrial flutter
dig toxicity SS
- anorexia
- blurred vision, or other vision changes
- diarrhea- cardiac dysrhythmias, HA
- N&V
- Bradycardia P≤60BPM- auscultate HR apical for full minute
Cardiac glycosides CA
-HR≤ 60 hold med
therapeutic digoxin levels
- Therapeutic dig blood
0. 2 - 2.0 ng/ml
dig + diuretics=
risk for hypokalemia
antianginals
- nitrates
- beta blockers
- calcium channel
blockers
-treat chest pain
nitrate action
generalized vasodilation- emergency
-short & long acting
nitrate SEs
- HA-expected
- AD: HoTN, bradycardia
short acting SL
-0.4 mg tablet dissolved under tong
nitrate transdermal patch
- lasts 24 hours but takes 30 -60 min for effects
- Nitro-Bid-only effective for 6-8 hours -needs to be applied 3-4 times a day-rotate topical sites
nitrate PT
- do not stop abruptly -taper dose over weeks to avoid rebound angina and reflex tachycardia- may also make HF worse
beta blocker antianginal effect
effects of the SNS by blocking catecholamine(s)= HR and BP
antianginal nursing process
- obtain baseline VS-apical pulse
- watch for bradycardia pulse < 60
- watch for HoTN < 100/60
- position PT lying down or sitting when taking nitrate med for 1st time
Antidysrhythmics
NI
-Baseline BP -Pulse and EKG results- always know BP and P before giving any cardiac medication
Antidysrhythmics PT
-advise PT to avoid alcohol (HoTN), caffeine ( decrease catecholamine levels), and tobacco (promotes vasoconstriction)
Antidysrhythmics sodium channel blockers action
-controls PVC and treats ventricular dysrhythmias
Antidysrhythmics beta blockers
- decrease contraction velocity, automatically, and recovery time of heart contraction.
Indications: treat angina & HTN, treat ventricular issues
diuretics nursing process
- obtain drug, herbal, medical history
- assess VS, serum electrolytes, weight, and UO for baseline levels
thiazide ex.
- Chlorothiazide (Diuril)
- Hydrochloro-thiazide (HCTZ)-may be combined with other CV meds
thiazide contraind.
PT with renal failure risk of oliguria
oliguria
abnormally low amounts of urine
Loop (High ceiling Diuretics)
-furosemide (Lasix)
-bumetanide (Bumex)
(never combine other loop diruretics)
Loop action/Ind
- Na and H2O are lost with potassium, Mg, Ca.
- effective on HF
Loop NI
- very potent and quick acting- risk of SE
- K+-wasting medications- foods on K+
Loop SE
- hypokalemia
- OH
- hypovolemia
- ototoxicity in higher doses
- dig+loop= dig toxicity can result
osmotic diuretics ex and use
Mannitol- potent osmotic K+-wasting Dtc
- used in ICP and IOP emergency situation - acute
osmotic diuretics ind
-used to prevent acute kidney failure (oliguria), decrease intra-cranial pressure (ICP), and decrease intraocular pressure (IOP) in glaucoma
carbonic anhydrase caution and ind
- Prolonged use may result in metabolic acidosis
- Indication: used to treat open-angle (chronic) glaucoma only
potassium sparing diuretics
- spironolactone (Aldactone)- HR more regular/ help with chronic HF
- triameterine (Dyrenium)-useful in the treatment of HF, edema, or cirrhosis
- amiloride (Midamor)- antihypertensive
potassium sparing diuretics action
promote Na and H2O excretion with K+ retention
normal urinary output
Normal UO should be 30 ml per hour (30mlX24)= 720 ml per day
potassium sparing diuretics SE
- Hyperkalemia- be careful when giving to PTs with poor renal function as kidney excretes 80-90% of K+
diuretic action as antihypertensives
- thiazide - treat mild HTN
- loop diuretic- used in PT with renal insufficiency because they do not prevent blood flow
CA and PT for all antihypertensives
Critical Assessments: BP ≤ 100/60 and pulse ≤ 60
-impotence is expected- counsel male clients to talk to their physician
antihypertensives beta blockers
Used in BP-Continuous use results in decreased vascular resistance and decreased blood pressure as blood vessels do not have to work as hard. decreased HR, contractibility, and renin release
beta blockers caution
- do not stop abruptly- may cause rebound hypertension, reflex tachycardia, angina
report these symptoms to doc
- Weight gain of more than 2 pounds in 1 day or 5 lbs within 1 week
- Edema of the feet or ankles
- SOB
- Excessive fatigue or weakness
Syncope or dizziness
alpha adrenergics ex.
- Doxazosin (Cardura)- Used for HTN & BPH
- Prazosin (Minipress)- used for HTN & PTSD
Terazosin (Hytrin) -used for HTN & BPH
alpha adrenergics use
- blockage of alpha receptors result in vasodilation and decrease BP
- help maintain the renal blood flow
- useful in PT with HTN and abnormality
alpha adrenergics SE
- OH, dizziness, syncope which may occur with first dose
- nasal congestion
Angiotensin-Converting Enzyme (ACE) inhibitors action
decrease systemic vascular resistance (afterload), vasodilation-> decrease BP
Angiotensin-Converting Enzyme (ACE) inhibitors SE
- dry, nonproductive cough, which reverses when therapy is stopped
- when given first-dose hypotensive and hyperkalemia may occur
Angiotensin II receptor Blockers use
-do not cause the chronic dry cough that is present with ACE inhibitors
anticoagulant SE AD
- risk of bleeding with dosage- localized or systemic
- can also platelets causing thrombocytopenia
anticoagulant PT
-importance of regular lab testing long term- 4-6 wks
measures to prevent bruising, bleeding, or tissue injury
avoid foods high on Vit K (tomatoes, dark leafy green vegetables)
heparin action
turn off coagulation pathway and prevent clot formation
heparin toxicity antidote
Effects reversed by protamine sulfate - binds to medication
heparin CA
aPTT, platelets
heparin NI
-ensure that SC doses are given SC, not IM- 45 degree angle
Warfarin action
inhibits vit K synthesis by bacteria in intestinal tract-> inhibits clotting factors
warfarin route
oral only
warfarin therapeutic levels
Warf Therapeutic levels 2-3.5
antidote for warfarin
Vitamin K
warfarin NI
- may be started while the PT is taking heparin until PT-INR levels indicate adequate anticoagulation
- full therapeutic effect take several days
- monitor PT-INR regularly
