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Pharm 2 Test 2 > Cardiac (Week 5) > Flashcards

Cardiac (Week 5) Flashcards

1
Q

Fibers that conduct electrical excitation very rapidly to all parts of the ventricles; causes synchronized ventricular contraction

A

His-Purkinje System

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2
Q

What are the two kinds of cardiac action potential?

A

Fast Potential

Slow Potential

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3
Q

Where do fast potentials occur in the His-Purkinje System?

A

In the atrial and ventricular muscle

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4
Q

What are the 5 phases of Fast Potentials?

A 
Phase 0
Phase 1
Phase 2
Phase 3
Phase 4
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5
Q

Rapid Depolarization due to influx of sodium ions. Sodium Channel blockers slow impulse conduction

A

Phase 0 of Fast Potentials

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6
Q

What phase has no relevance to antidysrhythmic drugs?

A

Phase 1

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7
Q

Prolong plateau, calcium enters cell; Beta blockers/Calcium Channel blockers reduce myocardial contractility

A

Phase 2

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8
Q

Rapid repolarization caused by potassium from the cell; Can be delayed by potassium channel blockers

A

Phase 3

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9
Q

Membrane potential may remain stable or membrane may undergo spontaneous depolarization

A

Phase 4

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10
Q

Where do the slow potentials occur?

A

In the cells of the SA and AV node

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11
Q

What are the phases of slow potentials?

A

Phase 0
Phase 2
Phase 3
Phase 4

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12
Q

Phase ___ is caused by slow influx of calcium

A

Phase 0

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13
Q

What causes dysrhythmias?

A

Disturbances of impulse formation

Disturbances of impulse conduction

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14
Q

What are the factors that can alter automaticity?

A 
Hypoxia
Electrolyte imbalance 
Cardiac surgery 
MI
Decreased Coronary blood flow
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15
Q

Name three sodium channel blockers

A

Quinidine
Lidocaine
Flecainide

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16
Q

What are the indications for Quinidine?

A

Active against Supraventricular and Ventricular rhythms, Atrial flutter, A Fib

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17
Q

What is the MOA of quinidine?

A

Slows impulse conduction in the atria, ventricles and His-Purkinje system

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18
Q

What are the adverse effects of Quinidine?

A 
Diarrhea
Cinchonism 
Cardiotoxicity 
Arterial embolism 
Hypotension
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19
Q

What are the nursing considerations for Quinidine?

A

Monitor for dysrhythmias

Report signs of embolism

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20
Q

What is the regular dosing for Quinidine?

A

200-400 mg

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21
Q

What is the regular dose for lidocaine (Xylocaine)?

A

1mg/kg

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22
Q

What are indications for Lidocaine (Xylocaine)?

A

Ventricular dysrhythmias

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23
Q

What is the MOA of lidocaine (Xylocaine)?

A

Slows conduction in the atria, ventricles, and His-Purkinhe system

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24
Q

What are the adverse effects of Lidocaine (Xylocaine)?

A

HIGH DOSES: drowsiness, confusion, and paresthesias

TOXIC DOSES: Seizure and Resp. Arrest

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25
Q

What are some nursing diagnoses for lidocaine (Xylocaine)?

A

Monitor blood pressure for signs of toxicity

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26
Q

What are the indications for Flecainide?

A

Maintenance therapy of AFib and A Flutters

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27
Q

What is the MOA of Flecainide?

A

Decreases cardiac conduction and increases ERP

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28
Q

What are some interactions for Flecainide?

A

Should not be combined with any drug that reduces myocardial contractility

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29
Q

What are the adverse effects of Flecainide?

A

Arrythmias
Dizziness
Chest Pain
Blurred Vision

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30
Q

What are some nursing considerations for Flecainide?

A

Monitor for worsening dysrhythmia or new ones

Should be reserved when other drugs have failed

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31
Q

Name a non-selective beta-adrenergic antagonist (Beta Blockers)

A

Propranolol (Inderal LA)

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32
Q

What are indications of Propranolol (Inderal LA)

A

Treatment of dysrhythmias

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33
Q

What are the adverse effects of propranolol (Inderal LA)?

A 
Heart Failure 
AV Block 
Sinus Arrest 
Hypotension 
Bronchospasm (asthma patients)
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34
Q

What kind of patient is contraindicated for propranolol?

A

Heart Blocks

HF

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35
Q

What are the 5 potassium channel blockers?

A 
Amiodarone 
Dronedarone 
Dofetilide 
Ibutilide 
Sotalol

**Each drug CANNOT be used interchangeably

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36
Q

What is the regular dose of Amiodarone (Corderone)?

A

800 mg-1600 mg for 1-3 weeks

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37
Q

What are the indications of Amiodorone (Corderone)?

A

Recurrent V Fib

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38
Q

What is the MOA of amiodarone (Corderone)?

A

Delays depolarization, reduced contractility

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39
Q

How long can the effects of Amiodarone last?

A

Effects can last from weeks to months after usage stopped

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40
Q

What are the Amiodarone adverse effects?

A 
Pulmonary toxicity 
Cardiotoxicity 
Thyroid toxicity 
Liver Toxicity 
Ophthalmic Effects 
Toxic in pregnancy and breastfeeding 
Dermatologic toxicity 
CNS
GI (NV)
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41
Q

Amiodarone levels can be increased by what?

A

Grapefruit juice

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42
Q

Severe dysrhythmias can occur with the use of diuretics with that drug?

A

Amiodarone

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43
Q

Initial treatment and prevention of V Fib

Slows down AV Conduction

A

IV Amiodarone

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44
Q

What kind of drug is Sotalol (Betapace)?

A

Beta blocker

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45
Q

What are the indications of Stall (Betapace)?

A

Life threatening Ventricular dysrhythmias
A Fib
A flutter

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46
Q

What is the MOA of Sotalol (Betapace)?

A

Delays depolarization

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47
Q

What are the adverse effects of Sotalol (Betapace)?

A

Torsades de pointes

48
Q

Name 2 calcium channel blockers

A

Verapamil (Calan)

Cardizem (Diltiazem)

49
Q

What is the regular dosages for Verapamil and Cardizem?

A

5-10 mg injected over 2-3 mins

Bolus 0.25 mg/kg

50
Q

What are the indications for Verapamil (Calan) and Cardizem (Diltiazem)?

A

A Fib
A Flutter
SVT termination

51
Q

What is the MOA of Verapamil and Cardizem?

A

Suppresses impulse conduction through the AV node

52
Q

What are interactions for Verapamil (Calan0 and Cardizem (Diltiazem)?

A

Elevated Digoxin levels
Higher risk of AV block
Beta blockers

53
Q

What are the adverse effects of Verapamil (Calan) and Cardizem (Diltiazem)?

A 
Bradycardia
AV Block
HF 
Hypotension 
Peripheral edema 
Constipation
Dizziness (Due to vasodilation)
Headache
Edema
54
Q

What do you want to monitor with CCB?

A

Vitals

ECG

55
Q

What kind of drug is adenosine (Adenocard)?

A

Antidysrhythmic

56
Q

What is the regular dosage for Adenosine (Adenocard)?

A

6 mg

57
Q

What is an indication for Adenosine (Adenocard)?

A

Termination of paroxysmal SVT

58
Q

What is the MOA of Adenosine (Adenocard)?

A

Suppresses calcium dependent action potentials in the SA and AV node

59
Q

What are interactions for Adenosine (Adenocard)?

A

Clients taking methylxanthines need larger doses of adenosine b/c methylxanthines block adenosine receptors

60
Q

What are the short lived adverse effects of Adenosine (Adenocard)?

A 
Bradycardia 
Dyspnea 
Hypotension 
Facial flushing
Chest discomfort
61
Q

What kind of drug is Digoxin (Lanoxin)?

A

Antidysrhythmic

62
Q

What is the regular dose for Digoxin

A

0.125 mg - 0.5 mg

63
Q

What are indications for Digoxin (Lanoxin)?

A

A-Fib
A-Flutter
SVT

64
Q

What is the MOA of Digoxin

A

Suppresses dysrhythmias by decreasing conduction through the AV node and decreasing automaticity in the SA node

65
Q

What are interactions for digoxin?

A

Concurrent diuretic use can lead to hypokalemia

66
Q

what are the adverse effects of digoxin?

A 
Dysrhythmias 
Anorexia
N/V
Abdominal discomfort 
Fatigue 
Visual disturbances
67
Q

What do ACE Inhibitors end in?

A

Pril

68
Q

What are ACE Inhibitors used for?

A

Hypertension
HF
Diabetic neuropathy
MI

69
Q

Name 4 ACE Inhibitors

A

Captopril (capoten)
Enalapril (vaster)
Lisinopril (Prinivil)
Ramipril (Altace)

70
Q

ACE Inhibitors block the production of what?

A

Angiotensin II

71
Q

ACE Inhibitors reduce the risk of cardiovascular mortality caused by what?

A

Hypertension

72
Q

How do ACE Inhibitors effect HF patients?

A

Reduces cardiac afterload
Lowers arteriole tone
Dilates blood vessels in kidneys
Suppresses Aldosterone

73
Q

How do ACE Inhibitors effect MI’s?

A

Reduces the risk of developing HF

74
Q

How does captopril effect Diabetic Neuropathy?

A

Slows progression by reducing Glomerular filtration pressure.

75
Q

What are drugs that interact with ACE Inhibitors?

A

Diuretics
Antihypertensive drugs
Lithium
NSAIDs

76
Q

What ACEI is approved for Diabetic retinopathy/

A

Enalopril

77
Q

What ACEI’s are approved for MI?

A

Captopril
Trandolopril
Lisinipril

78
Q

Name an ARB

A

Losartan

79
Q

What are indications for losartan?

A

Management of hypertension

Prevention of stroke

80
Q

What does Losartan bind too?

A

99% Protein bound

81
Q

What is the Maintenance dose for Losartan?

A

25-100mg a day

82
Q

What are the adverse effects of Losartan?

A

Diarrhea

Angioedema

83
Q

What are indications for Spironolactone?

A

Hypertension

HF

84
Q

What is the MOA of Spironolactone?

A

Blocks receptors for aldosterone

85
Q

What are the adverse effects of Spironolactone?

A 
Hyperkalemia 
Deepening of the voice 
Gynecomastia
Hirsutism 
Impotence 
Menstrual irregularities
86
Q

What is Verapamil used for?

A

Angina
Hypertension
Dysrhythmias

87
Q

What are the signs of Verapamil toxicity?

A

Hypotension

Cardiotoxicity

88
Q

What is Nifedipine used for?

A

Angina

Hypertension

89
Q

What is the MOA of nifedipine?

A

Blocks calcium channels in the VSM

Vasodilation

90
Q

What are the adverse effects of Nifedipine?

A 
Facial flushing
Dizziness
H/A
Peripheral edema
Gingival hyperplasia
91
Q

What are nursing considerations for Nifedipine?

A

Monitor Vitals

Monitor for reflex tachycardia (BB combined to prevent)

92
Q

Name 3 Vasodilators

A

Hydralazine
Minoxidil
Sodium Nitroprusside (Nitropress)

93
Q

What is Hydralazine used for?

A

Selective dilation of arterioles
Hypertension
Hypertensive crisis
HF

94
Q

What are the adverse effects of Hydralazine?

A 
Reflex tachycardia 
Increased blood volume
Headache 
Dizziness
Weakness 
Fatigue
95
Q

What drugs interact with Hydralazine?

A

Antihypertensive drugs

96
Q

What can hydralazine be combined with to manage sodium and water rentention and blood expansion?

A

BB and Diuretic

97
Q

What is Minoxidil used for?

A

Severe symptomatic hypertension

Hypertension associated with end-organ damage

98
Q

What drugs should Minoxidil be administered with?

A 
Beta blockers (Propranolol)
Diuretic (furosemide)
99
Q

What are the adverse effects of Minoxidil?

A

Reflect tachycardia
Sodium and water retention
Hypertrichosis (Excessive hair growth anywhere on the body)

100
Q

What drug is more intense than Hydralazine but causes more severe adverse reactions?

A

Minoxidil

101
Q

What is Sodium Nitroprusside used for?

A

Hypertensive emergencies

Controlled hypotension in surgery

102
Q

What is the MOA of Sodium Nitroprusside

A

Release nitric oxide

103
Q

What are the adverse effects of Sodium Nitroprusside?

A

Excessive hypotension
Cyanide poisoining
Thiocyanate toxicity

104
Q

What are nursing considerations for Sodium Nitroprusside?

A

Monitor Vitals
Diuretic administration
Do not mix any other meds

105
Q

What is Thiazide Diuretics used for?

A

HTN
HF
Diabetes Insipidus

106
Q

What is the MOA of Thiazide?

A

Promotes urine production

107
Q

Which diuretic keeps going regardless of the patients water percentage?

A

Loop Diuretic (Furosemide)

108
Q

What diuretic is contraindicated in pregnant women?

A

Potassium sparing diuretics (Spironolactone)

109
Q

Name four Inotropic drugs

A

Dopamine
Dobutamine
Digoxin
Milrinone

110
Q

What is dopamine used for?

A

Shock

Severe acute HF

111
Q

What does dopamine interact with?

A

MAOI’s
TCA’s
General anesthetics

112
Q

What are the adverse effectss of dopamine?

A

Tachycardia
Dysrhythmias
Anginal pain
Extravasation

113
Q

What is Dobutamine used for?

A

Short term treatment for HF

114
Q

What are the adverse effects of Dobutamine?

A

Tachycardia

MI

115
Q

What is Milrinone used for?

A

Short term therapy for severe HF

116
Q

What are the adverse effects of Milrinone?

A

Dysrhythmias

MI

117
Q

What are nursing considerations for Inotropic drugs?

A

Cardiac monitoring

Pharm 2 Test 2 (4 decks)

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