CARDIAC_MEDS Flashcards
We cut the connection to Aldosterone
(‘pril, ‘sartan, ‘actone ending drugs); What Lab should we watch for?
ACE / ARBS / SPIRONOLACTONE
–we don’t add water to the body and lose water in the potty
–now we have too much K+
all these drugs lead to HIGH POTASSUM
Aldosterone
Adds Na+ H20 to the body,
Lets K+ out of body into potty
How do we treat CHF?
[ DRBEDSS ]
education
D-diet ( LOW sodium & Fluid- 2L +2g/day)
R- Risk for Falls
B- BP & BNP (should not be increasing)
E- elevate legs(with pillows )high fowlers
D- daily weights (3 -5 lbs/day) worsening
S- sex (2 flights of stairs w/no SOB
S- stocking- ted hose
Heart Failure management medications?
diuretics, ACE Inhibitors, Low dose beta blockers
Furosemide(loop diuretic), Lisinopril (ACE inhibitor).
The whole point of ACE/ARBs is to lower the blood pressure (NOT HR)
First choice would be an ______
Second choice _______
Aldosterone is blocked from Adding ________ IN
Letting _______ OUT
ACE
ARB
- they inhibit or STOP the RAAS system, which the whole point of the RAAS system (which retains fluid.)
- Na/H20
- Potassium
TYPES OF ACE INHIBITORS
Captopril
Enalapril
Lisinopril
Instructions to include when taking Lisinopril? (ACE Inhibitor)
hint: its a sin to eat __-,___.
Limit your intake of foods such as avocados, apricots.
- you may notice a decrease in your ability to taste foods
RAAS is blocked from adding Na+/h20 & letting K+ out
too much potassium now!
TYPES OF ARBS
Losartan
Valsartan
Irbesartan
ARBs
lower BP not HR
Can we give an ACE/ARB if the patient has a HR of 60?
YES; ACE/ARBs don’t effect HR
ACE/ARBs act by lowering the ____ not the _____
BP not HR
ACE/ARBS Therapeutic Use
HTN, HF, MI, Diabetic neuropathy
Precautions/Interactions_ACE/ARBs
- use with caution if the patient is taking a diuretic
- monitor potassium levels
should you take captopril with/without food?
Without
ACE inhibitors ‘pril___ P_____
Puff up the tongue (Angioedema)
Avoid K+ rich foods when taking - ACE/ARBs
Banana, oranges, kidney beans, kale, swiss chard, collard greens, potato, dried apricot, avocado
BOSKCo PAD. — vitamin K —-AyyyCE lets go to the bosco pad
you will have a persistent non-productive cough when taking ____
ACE Inhibitors (AyyyyCE stop coughing)
Adverse effects of ACE Inhbitors?
CV: OH, Syncope, Tachyardia, Hypotension, Chest pain
CNS: dizziness, fatigue, headache, weakness
GI: abdominal pain, diarrhea, N/V
GU: ED, Impaired renal fxn, proteinuria
DER: rashes, hyperkalemia, angioededma
RESP: Upper resp infections, cough
Heme: Neutropenia
Precautions for patients taking ACEs
hint: AACE
Avoid pregnant pts
Angioedema (airway risk-tongue)
Cough
Elevated K+
what trimester should pregnant women avoid taking an Ace/Arb?
2nd & 3rd trimester
‘Sartan drugs like _____, will spare _____.
Losartan, Potassium
Nursing interventions & Client Education: CAPTOPRIL
-Captopril should be taken 1 hour before meals
- Monitor BP
- Monitor for Angioedema & promptly administer EPINEPHRINE 0.5 mL of 1,000 solution SUBQ
TYPES OF CALCIUM CHANNEL BLOCKERS
Nifedipine, Verapamil, Diltiazem, Amlodipine
what is a CCB
slows the movement of Calcium into the smooth muscle cells, resulting in arterial dilation and decreased BP
- Lowers BP & HR
CCB Therapeutic use
Angina, HTN
A: Antihypertensives
AA: Anti-angina’s - relax heart to use less 02 to make angina go away
AAA: Anti-artial arrhythmia – atrial flutter, A-fib, premature atrial contractions / NEVER VENTRICULAR
YES SUPRA-VENTRICULAR TACHY
Verapamil/ Diltiazem may be used for
A-fiib, A-flutter, SVT
C count HR & BP
C Change positions slowly
B bad headache
< 100BP sys, <60 HR
What VS needs to be assessed before giving a CCB?
Blood Pressure
risk of HYPOTENSION
* hold is systolic <100
Precautions/Interactions_CCB
CAUTION: clients taking digoxin/Beta blockers
- contraindicated for clients who have HF, Heart Block, Bradycardia
- DO NOT CONSUME Grapefruit juice (toxic)
Side/Adverse Effects_CCB
side effects= headache: vasodilation to brain ; hypotension - from relaxed heart & vessels
Constipation, Reflex Tachycardia, Peripheral Edema, Toxicity
Nursing Interventions/ Client Education_CCB
DO NOT CRUSH/CHEW
administer IV injection over 2-3 min
Slowly taper dose if d/c
Monitor HR and BP
Alpha-1 Adrenergic Blockers (Sympatholytics)
‘zosin
[Prazosin, Doxazosin mesylate]
Inhibit Alpha-1 receptors
- Peripheral & Vasodilation
- Lowers BP
AAB [ ‘zosin ] Therapeutic Use
Primary HTN
Doxazosin may be used in treatment of ?
BPH
Alpha-1_ Side/Adverse effects
( ‘zosin ) Adrenergic blockers____ Block norepinephrine from tightening muscles in the heart walls.
Blood Pressure medication
Dizziness/Fainting
Alpha-1 adrenergic blockers_ Interventions/Client Education
[ ‘zosin ]
Monitor HR, BP
Take medication at Bedtime to minimize effects of Hypotension
Advise to notify HCP immed. about adverse reactions
consult before taking OTC meds
Centrally Acting Alpha2 Agonists
Stimulate alpha-2 receptors in the brain to reduce peripheral vascular resistance, HR, Systolic/Diastolic pressure
-Sedative/Antihypertensive
drug: Treat High BP
CA A-2 Agonists_Medications
‘dine, cine, dopa ??
Clonidine, Guanfacine HCl, Methyldopa
CA A-2 Agonists_Therapeutic Use:
‘dine, cine, dopa
Primary HTN
Hypertensive Crisis
Severe Cancer Pain
Centrally Acting A-2 Agonists_ ( ‘dine, ‘cine )__primary hypertension__may be used in COMBO with?
Diuretics; or other Anti-hypertensives
Ca A-2 Agonists_ Precautions/Interactions
CAA2 (T)
- dont aminister with _____
- dont administer with ____ through IV line
- Contraindicted with ______ ________ = _____ _____.
- Use cautiosuly in _____, ____, ____, ____, ____,
- Breastfeeding woman shouldn’t use during _______
- Contraindicated with anticoagulant therapy= Hepatic Failure
- DONT administer with MAOIs
- DONT administer with Methyldopa through IV line with Barbiturates or sulfonamides-
- Use CAUTIOUSLY in CVA, MI, DIABETES, MAJOR DEPRESSION, CHRONIC RENAL FAILURE
- DO NOT USE DURING LACTATION
CA- A2 Agonists_ side/adverse effects
4 things: CAT
- dry mouth, drowsiness/sedation (resolves over time)
- Rebound HTN
- Black or sore tongue
- Leukopenia (not enough disease fighting leukocytes in the blood)
CA-A2 Agonists_ Interventions/Client Education
hint: brainstem/spinal cord; CATS have a good flexible ____
Monitor closely for _____
Monitor CNS effects
Monitor CBC, HR, BP
Assess weight gain/edema
Monitor closely for rebound HTN when med is d/c 48 hr
Instruct never to skip a dose
Take at bedtime to minimize effects of hypotension
Notify HCP of any involuntary jerly movements, prolonged dizziness, rash, yellowing of skin
Beta Blockers (sympatholytics)
Inhibit stimulation of the receptor sites, resulting in decreased cardiac excitability, cardiac output, myocardial oxygen demand; lowers blood pressure (decreases the release of Renin in the kidney)
(Cardioselective) Beta-1 receptors are primarily in the _____ & _____
cardiac & renal tissues
Beta-2 receptors are found primary in the
Lungs, GI, Liver, Uterus, vascular smooth muscle, Skeletal muscle
Non-selective B1 & B2 meds: “ beta blockers meds”
propanolol, labetalol, nadolol
Beta 1/2: Beta Adrenergic Blockers___Use
Primary HTN
Angina
Tachydysrhythmias, HF, MI
Beta Adrenergic Blockers__ contraindicated in patients with ____ ______, ______ _______.
Contraindicated in clients with (AV BLOCK, SINUS BRADYCARDIA)
DO NOT administer nonselective beta blockers to clients who have ____,____,______.
Asthma, Bronchospasms, HF
DO NOT administer labetalol in the same IV line as ________.
hint: ‘ide
Furosemide
PROPANOLOL CAN MASK EFFECTS OF ______ IN CLIENTS WHO HAVE DM
HYPOGLYCEMIA
1 treatment for HF?
“ide ending drugs
furosemide, Bemetanide
Treatment for Worsening HF? ‘HOPE’
H: HOB 45*
O: Oxygen
P: Push Furosemide + Morphine
E: ending all Na+ FLuids (no drinking extra fluid & Stoping IV Fluid)
How do we know in worsening HF if the Treatment is successful?
clearer lung sounds with Decreased HR
- Always question any order that wants to give fluids
Cardioselective B1 meds/ “beta blockers”
Metoprolol
Atenolol
Metoprolol succinate
Beta Blockers_side effects/adverse effects
Bradycardia
Nasal Stuffiness
AV Block
Rebound myocardium excitation if stopped abruptly
bronchospasm
Beta Blockers__NURSING INTERVENTIONS
- Administer 1-2x daily as prescribed
- HOLD med & notify HCP if Systolic BP is less than 100 or pulse if < 60
- Monitor clients who have DM for indications of hypoglycemia
Beta Blockers__EDUCATION
DO NOT d/c without consulting provider
DO NOT crush ERT
Vasodilators
direct vasodilation of arteries and veins in rapid reduction of blood pressure (decreases preload/afterload)
what are types of vasodilators?
hint: HENN
“the HENN is mad and vasodilating”
Hydralazine
Enalaprit
Nitroprusside
Nitroglycerin
Therapeutic Use of Vasodilators?
Hypertensive Emergencies
Precautions/Interactions of Vasodilators?
Clients who have hepatic or renal disease
Older Adults
Electrolyte imbalances
Side Effects of Vasodilators?
dizziness, Headache
Adverse effects of Vasodilators?
Profound Hypotension, Cyanide Toxicity, Thiocyanate poisoning
Nursing Interventions/ Education for Vasodilators?
Nitroprusside CANNOT be mixed with any medication
Apply protective cover to container
Discard unused fluid after 24 hours
Provide continuous ECG and blood pressure monitoring
what type of medication is a cardiac glycoside? DIGOXIN
Used in treatment of clients who have cardiac failure or ineffective pumping of heart muscle
the ACTION of a Cardiac Glycoside? DIGOXIN
Increases the force & velocity of myocardial contractions to improve stroke volume and cardiac output
- Slows the conduction rate, allow for increased ventricular filling
Therapeutic serum digoxin levels?
0.5-2 ng/mL.
>2 is toxic
discharge teaching for Digoxin?
Administer one hour before or two hours after meals
Call the doctor if the child starts eating poorly or vomiting
Administer the same time each day, pref in the morning before breakfast.
NEVER ADMINISTER WITH FOOD
DO NOT administer a dose if it was vomited up.
What type of medication would be considered a cardiac glycoside?
DIGOXIN
therapeutic use of DIGOXIN/Cardiac glycoside?
Heart Failure, Atrial Fibrillation
What precautions/interactions happen with a CG (Digoxin) and these meds? ____
Thiazide/loop diuretics
Calcium Channel Blockers ( dig tox)
- ephedra, licorice extract
A Thiazide Loop diuretic can increase the risk of?
ACE/ARBs Increase the risk of ?
Verapamil increases risk of__?
Hypokalemia
Hyperkalemia
Toxicity
the Infant has a HR of 85. Should i give the Digoxin? why?
Pulse is less than 90 bpm.
- hold the med and check in an hour.
types of Loop Diuretics and they do what with ____ ____ levels?
Bumetanide, Furosemide, Ethacrynic acid
- They give rid of Na/K+
-Their purpose is to block Chloride & sodium reabsorption.
- dilate the blood vessels of the kidneys, lungs, renal, pulmonary & SVR)
The desired outcome for a Loop Diuretic is ?
- reduction of blood pressure
- reduction of pulmonary vascular resistance
- reduction of systemic vascular resistance
- reduction of central venous pressure
- reduction of left ventricular end diastolic pressure
early sign of Digoxin toxicity?
Vomiting (earliest sign)
Nausea, anorexia, vision changes (yellow-green halos)
Side effects/Adverse of DIGOXIN TOXICITY (CG)
Gi effects: anorexia, nausea, vomiting, abdominal pain
CNS: effects (fatigue, weakness, diplopia, Blurred vision, yellow green or white halos around objects
how long should you asses the pulse prior/after administration of a CG (DIGOXIN)
Assess apical pulse for 1 min prior to administration
You would notify the provider if the HR is less than __ for adult.
< ___ for child
< ___ for Infant
60
70
90
Monitor for signs of Digoxin Toxicity, what labs are fucked up? and what does it lead too?
** DIGOXIN DOESN’T WASTE POTASSIUM
HYPOKALEMIA, HYPERCALCEMIA, HYPOMAGNESEMIA
To manage Digoxin Toxicity
Digoxin immune Fab
binds to digoxin, preventing from reaching the tissues; rapid onset, less than 1 min after infusion begins.
If the Patient has Digoxin Toxicity then we would D/C Digoxin & ___ ___ _____
POTASSIUM WASTING DIURETICS
digoxin : how would we treat dysthythmias?
Phenytoin (lidocaine)
how would we treat bradycardia?
Atropine
Digoxin overdose: what do you administer?
Digibind/DSFab
ANTIANGINAL MEDS
ANGINAL MEDS
What does an Organic Nitrate do?
relaxes peripheral vascular smooth muscles.
–Results in DILATION of Arteries/Veins.
–reduced preload=decreased 02 demand.
what types of meds are available for Nitrates?
Sublingual Tablet
Sustained-release tablet
Transdermal ointment
Transderm unit( patch)
Nitrates have a therapeutic use for
Acute angina attack
Prophylaxis of chronic stable/ variant angina
Nitrates are precautioned when?
- patient has a head injury
- If they’re taking Antihypertensive medications=risk for hypotension
- If taking Erectile dysfunction meds (‘afil)
Side/Adverse effects of NItrates?
Headache
Orthostatic Hypotension
Reflex Tachycardia
Tolerance
how would you administer NItrostat?
Sublingually
how many Nitrostat tabs can you take and time?
3 tabs 5 min apart
- if pain not relieved by first tablet call 911
Nitrolingual (spray) can be used up to _______ min before exercise
30
You would want to replace NTG tabs every _____ months.
6 months
Nitro-Bid is a ______ ________. Used for?
Topical ointment; increasing myocardial 02 demand on the heart
Nitro-Bid (topical ointment); apply to area without hair
Chest, Flank, Upper Arm
NItro-Bid: patch; Wear ____ for administration
GLOVES
NItro-Bid: Topical Ointment;
how to cover?
Tape the paper into place BUT do not cover it with gauze. Use clear plastic wrap and tape in place
Nitro-Dur is given in what form?
Transdermal Patch
Gradually reduce the dose and frequency of application of Nitro-Bid over ____ to ____ weeks
4-6 weeks
For a Nitroglycerin Patch, how long is it usually work for? and what do you make sure you need to do?
12-14 hours; rotate skin sites
A side effect of Nitro-Dur?
Skin irritation
common side effects of anti-dysrhythmic medications?
Dizziness, Hypotension, Weakeness
Antidysrhythmic Agents
ANTIDYSRHYTHMIC
____ slows conduction time through the AV node, interrupts AC node pathways to restore NSR
ADENOSINE
Avoid giving Amiodarone to a patient with a LOW ____ & a ______
Heart RAte
PAcemaker
Amiodarone will to what to the Digoxin levels?
Decrease levels of Digoxin & Theophyloine, cyclosporin, carvedilol, phenytoin
Amiodarone will interact with Warfarin by doing what?
^ its effectiveness; so Higher risk for bleeding
Amiodarone has alot of _____ in the medication.
Iodine; watch levels
Common Side effects of Amiodarone?
Eyes: Corneal microdeposits
GI: N/V, Constipation, Anorexia
Neurological: Ataxia, Involuntary movements, Peripheral neuropathy, Dizzy, Fatigue
Cardiovasc: Hypotension, Bradycardia {prolonged QT interval/HF/Worsening Arrhythmias}
Dermatologic: Photosensitivity {Toxic Epidermal Necrolysis}
Endocrine: Hypo/hyper thyroidism
Pulmonyar; {ARDS, CF)
Prolongs repolarization, relaxes smooth muscle, decreases vascular resistance
Amiodarone
With prolonged use of Amiodarone, what would you expect the skin to look like?
Bluish color
This can prolong QT Interval? why is it important?
AMiodarone
VFIB/TORSADDES DE POINTS
Amiodarone is a ____ _____ _____.
Potassium Channel Blocker
Amiodarone Route?
IV Infusion
PO tablet
Patients can take _____ chronically to help with arrhythmias
Amiodarone
Amiodarone is an _____ med
Antidysrhythmic
Increases the heart rate by counteracting the muscarine-like actions of Acetylcholine
Atropine
what are some precautions/interactions of Antidysrhythmic medications?
toxicity
Caution should be used when patient is taking an AV Block
Caution: Anticholinergic meds
_____ converts SVT to normal sinus rhythm.
ADENOSINE
SIDE EFFECTS OF ADENOSINE?
FLUSHING, NAUSEA, BRONCHOSPASMS, PROLONGED ASYSTOLE
Adenosine should be given IV ____, and then flushed immediately with ______
Push (1-2 seconds)
Normal Saline
V-Fib, Unstable Ventricular Tachycardia: Which Med should I give the patient?
Amiodarone
Side/Adverse effects of Amiodarone
Bradycardia, Cardiogenic Shock, Pulmonary Disorders
Amiodarone is incompatible with ______.
Heparin
A maintanence dose of Amiodarone can be given ____.
PO
You would monitor for _____ ______ when taking Amiodarone
Respiratory comlpications
Atropine is considered what category of medication?
Antidysrhythmic
what med is used for a patient who has, Bradycardia, exposure to chemical nerve agent and reducing secretions ?
ATROPINE
Side effects/Adverse effects of Atropine?
Life threatening EMERGENCY
What would you monitor for Atropine?
Dry mouth, blurred vision, photophobia, urinary retention, constipation
Antilipidemic MEDS
Antilipidemics action ?
lower low-density lipoproteins (LDL) levels and INCREASE HDL
Primary use for an Antilipidemic medication?
hypercholestrolemia
prevention of coronary events
Protection against MI/ Stroke in clients who have DM
can you take an Antilipidemic during pregnancy?
NO
if you have renal dysfunction, should you take an antilipidemic?
use with caution
Antilipidemic’s can have what side effects?
Musle aches Hepatotoxicity, Rhabdomyolysis, Peripheral Neuropathy
‘statins (Myopathy)
They get metabolized from the liver so you check teh LFT’s PRIOR to administration
Education: When taking an Anti-lipidemic, you should take it at what time?
In the evening
You would want to monitor what labs when your patient is on an Anti-lipidemic?
Liver & Renal function lab profiles
what kind of diet should a patient who is taking Anti-lipidemic meds adhere to?
Low Fat/High-Fiber
what labs should you monitor when your patient is taking ‘Statins?
LFT–risk of hepatic injur
Name some Statin Meds
Atorvastatin, simvastatin, lovastatin, fluvastatin
Statins can cause prolonged _____ in clients taking ______
Bleeding; Warfarin
Do NOT administer a STATIN with ______ ______.
Grapefruit Juice
Name a Cholesterol Absorption Inhibitor & what it does? & used in combination with?
Ezetimibe
- Inhibits absorption of cholesterol secreted in the bile and from food.
- Antilipemic medications
When taking Exetimibe, when should you take it after taking another antilipemics?
2 hours before or 4 hours after other one.
there is a risk of Liver damage when combined Cholestrol Absorption Inhibitor is taken with a
Statin
With prolonged use of Amiodarone, what would you expect the skin to look like?
Bluish color
what trimester should pregnant women avoid taking an Ace/Arb?
2nd & 3rd trimester
AvoidPotassium (not vitamin K) rich foods when taking - ACE/ARBs
kidney beans, kale, swiss chard, collard greens, potato, dried apricot, avocado, Liver, Spinach, Brocoli
when taking an ACE inhibitor, what lab should you monitor?
Creatinine
creatinine is the waste production of the muscles wear and tear. When Creatinine is high it means it’s not getting excreted by the kidneys. It can be a poor sign of kidney function.
What medications cause high creatinine levels?
cimetidine, trimethoprim, corticosteroids, pyrimethamine, phenacemide, salicylates and active vitamin D metabolites, have been reported to increase plasma creatinine without influencing its glomerular filtration.
the nurse is caring for a client who has an acute myocardial infarction. the nurse should anticipate an immediate prescription for ????
ASPIRIN
325 MG chewable aspirin,
Prednisone is a corticosteroid that causes _____ retention, thereby increasing fluid volume.
& lowers you _____ levels.
Sodium
-increasing fluid volume –> exacerbate HF Symptoms Potassium.
Steroids end in ‘______.
‘Sone (Prednisone, hydrocortisone, dexamethasone)
Dobutamine helps ___ cardiac _____.
Increase
Contractility
- helps increase cardiac output in acute HF
- Short-term management
