CARDIAC_MEDS Flashcards
1
Q
We cut the connection to Aldosterone
(‘pril, ‘sartan, ‘actone ending drugs); What Lab should we watch for?
ACE / ARBS / SPIRONOLACTONE
A
–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
2
Q
Aldosterone
A
Adds Na+ H20 to the body,
Lets K+ out of body into potty
3
Q
How do we treat CHF?
[ DRBEDSS ]
education
A
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
4
Q
Heart Failure management medications?
A
diuretics, ACE Inhibitors, Low dose beta blockers
Furosemide(loop diuretic), Lisinopril (ACE inhibitor).
5
Q
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
A
ACE
ARB
- they inhibit or STOP the RAAS system, which the whole point of the RAAS system (which retains fluid.)
- Na/H20
- Potassium
6
Q
TYPES OF ACE INHIBITORS
A
Captopril
Enalapril
Lisinopril
7
Q
Instructions to include when taking Lisinopril? (ACE Inhibitor)
hint: its a sin to eat __-,___.
A
Limit your intake of foods such as avocados, apricots.
- you may notice a decrease in your ability to taste foods
8
Q
RAAS is blocked from adding Na+/h20 & letting K+ out
A
too much potassium now!
9
Q
TYPES OF ARBS
A
Losartan
Valsartan
Irbesartan
10
Q
ARBs
A
lower BP not HR
11
Q
Can we give an ACE/ARB if the patient has a HR of 60?
A
YES; ACE/ARBs don’t effect HR
12
Q
ACE/ARBs act by lowering the ____ not the _____
A
BP not HR
13
Q
ACE/ARBS Therapeutic Use
A
HTN, HF, MI, Diabetic neuropathy
14
Q
Precautions/Interactions_ACE/ARBs
A
- use with caution if the patient is taking a diuretic
- monitor potassium levels
15
Q
should you take captopril with/without food?
A
Without
16
Q
ACE inhibitors ‘pril___ P_____
A
Puff up the tongue (Angioedema)
17
Q
Avoid K+ rich foods when taking - ACE/ARBs
A
Banana, oranges, kidney beans, kale, swiss chard, collard greens, potato, dried apricot, avocado
BOSKCo PAD. — vitamin K —-AyyyCE lets go to the bosco pad
18
Q
you will have a persistent non-productive cough when taking ____
A
ACE Inhibitors (AyyyyCE stop coughing)
19
Q
Adverse effects of ACE Inhbitors?
A
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
20
Q
Precautions for patients taking ACEs
hint: AACE
A
Avoid pregnant pts
Angioedema (airway risk-tongue)
Cough
Elevated K+
21
Q
what trimester should pregnant women avoid taking an Ace/Arb?
A
2nd & 3rd trimester
22
Q
‘Sartan drugs like _____, will spare _____.
A
Losartan, Potassium
23
Q
Nursing interventions & Client Education: CAPTOPRIL
A
-Captopril should be taken 1 hour before meals
- Monitor BP
- Monitor for Angioedema & promptly administer EPINEPHRINE 0.5 mL of 1,000 solution SUBQ
24
Q
TYPES OF CALCIUM CHANNEL BLOCKERS
A
Nifedipine, Verapamil, Diltiazem, Amlodipine
25
what is a CCB
slows the movement of Calcium into the smooth muscle cells, resulting in arterial dilation and decreased BP
- Lowers BP & HR
26
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
27
Verapamil/ Diltiazem may be used for
A-fiib, A-flutter, SVT
28
C count HR & BP
C Change positions slowly
B bad headache
< 100BP sys, <60 HR
29
What VS needs to be assessed before giving a CCB?
Blood Pressure
risk of HYPOTENSION
* hold is systolic <100
30
Precautions/Interactions_CCB
CAUTION: clients taking digoxin/Beta blockers
- contraindicated for clients who have HF, Heart Block, Bradycardia
- DO NOT CONSUME Grapefruit juice (toxic)
31
Side/Adverse Effects_CCB
side effects= headache: vasodilation to brain ; hypotension - from relaxed heart & vessels
Constipation, Reflex Tachycardia, Peripheral Edema, Toxicity
32
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
33
Alpha-1 Adrenergic Blockers (Sympatholytics)
'zosin
[Prazosin, Doxazosin mesylate]
Inhibit Alpha-1 receptors
- Peripheral & Vasodilation
- Lowers BP
34
AAB [ 'zosin ] Therapeutic Use
Primary HTN
35
Doxazosin may be used in treatment of ?
BPH
36
Alpha-1_ Side/Adverse effects
( 'zosin ) Adrenergic blockers____ Block norepinephrine from tightening muscles in the heart walls.
Blood Pressure medication
Dizziness/Fainting
37
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
38
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
39
CA A-2 Agonists_Medications
'dine, cine, dopa ??
Clonidine, Guanfacine HCl, Methyldopa
40
CA A-2 Agonists_Therapeutic Use:
'dine, cine, dopa
Primary HTN
Hypertensive Crisis
Severe Cancer Pain
41
Centrally Acting A-2 Agonists_ ( 'dine, 'cine )__primary hypertension__may be used in COMBO with?
Diuretics; or other Anti-hypertensives
42
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
43
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)
44
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
45
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)
46
(Cardioselective) Beta-1 receptors are primarily in the _____ & _____
cardiac & renal tissues
47
Beta-2 receptors are found primary in the
Lungs, GI, Liver, Uterus, vascular smooth muscle, Skeletal muscle
48
Non-selective B1 & B2 meds: " beta blockers meds"
propanolol, labetalol, nadolol
49
Beta 1/2: Beta Adrenergic Blockers___Use
Primary HTN
Angina
Tachydysrhythmias, HF, MI
50
Beta Adrenergic Blockers__ contraindicated in patients with ____ ______, ______ _______.
Contraindicated in clients with (AV BLOCK, SINUS BRADYCARDIA)
51
DO NOT administer nonselective beta blockers to clients who have ____,____,______.
Asthma, Bronchospasms, HF
52
DO NOT administer labetalol in the same IV line as ________.
hint: 'ide
Furosemide
53
PROPANOLOL CAN MASK EFFECTS OF ______ IN CLIENTS WHO HAVE DM
HYPOGLYCEMIA
54
#1 treatment for HF?
"ide ending drugs
furosemide, Bemetanide
55
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)
56
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
57
Cardioselective B1 meds/ "beta blockers"
Metoprolol
Atenolol
Metoprolol succinate
58
Beta Blockers_side effects/adverse effects
Bradycardia
Nasal Stuffiness
AV Block
Rebound myocardium excitation if stopped abruptly
bronchospasm
59
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
60
Beta Blockers__EDUCATION
DO NOT d/c without consulting provider
DO NOT crush ERT
61
Vasodilators
direct vasodilation of arteries and veins in rapid reduction of blood pressure (decreases preload/afterload)
62
what are types of vasodilators?
hint: HENN
"the HENN is mad and vasodilating"
Hydralazine
Enalaprit
Nitroprusside
Nitroglycerin
63
Therapeutic Use of Vasodilators?
Hypertensive Emergencies
64
Precautions/Interactions of Vasodilators?
Clients who have hepatic or renal disease
Older Adults
Electrolyte imbalances
65
Side Effects of Vasodilators?
dizziness, Headache
66
Adverse effects of Vasodilators?
Profound Hypotension, Cyanide Toxicity, Thiocyanate poisoning
67
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
68
what type of medication is a cardiac glycoside? DIGOXIN
Used in treatment of clients who have cardiac failure or ineffective pumping of heart muscle
69
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
70
Therapeutic serum digoxin levels?
0.5-2 ng/mL.
>2 is toxic
71
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.
72
What type of medication would be considered a cardiac glycoside?
DIGOXIN
73
therapeutic use of DIGOXIN/Cardiac glycoside?
Heart Failure, Atrial Fibrillation
74
What precautions/interactions happen with a CG (Digoxin) and these meds? ____
Thiazide/loop diuretics
Calcium Channel Blockers ( dig tox)
- ephedra, licorice extract
75
A Thiazide Loop diuretic can increase the risk of?
ACE/ARBs Increase the risk of ?
Verapamil increases risk of__?
Hypokalemia
Hyperkalemia
Toxicity
76
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.
77
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)
78
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
79
early sign of Digoxin toxicity?
Vomiting (earliest sign)
Nausea, anorexia, vision changes (yellow-green halos)
80
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
81
how long should you asses the pulse prior/after administration of a CG (DIGOXIN)
Assess apical pulse for 1 min prior to administration
82
You would notify the provider if the HR is less than __ for adult.
< ___ for child
< ___ for Infant
60
70
90
83
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
84
To manage Digoxin Toxicity
Digoxin immune Fab
binds to digoxin, preventing from reaching the tissues; rapid onset, less than 1 min after infusion begins.
85
If the Patient has Digoxin Toxicity then we would D/C Digoxin & ___ ___ _____
POTASSIUM WASTING DIURETICS
86
digoxin : how would we treat dysthythmias?
Phenytoin (lidocaine)
87
how would we treat bradycardia?
Atropine
88
Digoxin overdose: what do you administer?
Digibind/DSFab
89
ANTIANGINAL MEDS
ANGINAL MEDS
90
What does an Organic Nitrate do?
relaxes peripheral vascular smooth muscles.
--Results in DILATION of Arteries/Veins.
--reduced preload=decreased 02 demand.
91
what types of meds are available for Nitrates?
Sublingual Tablet
Sustained-release tablet
Transdermal ointment
Transderm unit( patch)
92
Nitrates have a therapeutic use for
Acute angina attack
Prophylaxis of chronic stable/ variant angina
93
Nitrates are precautioned when?
- patient has a head injury
- If they're taking Antihypertensive medications=risk for hypotension
- If taking Erectile dysfunction meds ('afil)
94
Side/Adverse effects of NItrates?
Headache
Orthostatic Hypotension
Reflex Tachycardia
Tolerance
95
how would you administer NItrostat?
Sublingually
96
how many Nitrostat tabs can you take and time?
3 tabs 5 min apart
- if pain not relieved by first tablet call 911
97
Nitrolingual (spray) can be used up to _______ min before exercise
30
98
You would want to replace NTG tabs every _____ months.
6 months
99
Nitro-Bid is a ______ ________. Used for?
Topical ointment; increasing myocardial 02 demand on the heart
100
Nitro-Bid (topical ointment); apply to area without hair
Chest, Flank, Upper Arm
101
NItro-Bid: patch; Wear ____ for administration
GLOVES
102
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
103
Nitro-Dur is given in what form?
Transdermal Patch
104
Gradually reduce the dose and frequency of application of Nitro-Bid over ____ to ____ weeks
4-6 weeks
105
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
106
A side effect of Nitro-Dur?
Skin irritation
107
common side effects of anti-dysrhythmic medications?
Dizziness, Hypotension, Weakeness
108
Antidysrhythmic Agents
ANTIDYSRHYTHMIC
109
____ slows conduction time through the AV node, interrupts AC node pathways to restore NSR
ADENOSINE
110
Avoid giving Amiodarone to a patient with a LOW ____ & a ______
Heart RAte
PAcemaker
111
Amiodarone will to what to the Digoxin levels?
Decrease levels of Digoxin & Theophyloine, cyclosporin, carvedilol, phenytoin
112
Amiodarone will interact with Warfarin by doing what?
^ its effectiveness; so Higher risk for bleeding
113
Amiodarone has alot of _____ in the medication.
Iodine; watch levels
114
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)
115
Prolongs repolarization, relaxes smooth muscle, decreases vascular resistance
Amiodarone
116
With prolonged use of Amiodarone, what would you expect the skin to look like?
Bluish color
117
This can prolong QT Interval? why is it important?
AMiodarone
VFIB/TORSADDES DE POINTS
118
Amiodarone is a ____ _____ _____.
Potassium Channel Blocker
119
Amiodarone Route?
IV Infusion
PO tablet
120
Patients can take _____ chronically to help with arrhythmias
Amiodarone
121
Amiodarone is an _____ med
Antidysrhythmic
122
Increases the heart rate by counteracting the muscarine-like actions of Acetylcholine
Atropine
123
what are some precautions/interactions of Antidysrhythmic medications?
toxicity
Caution should be used when patient is taking an AV Block
Caution: Anticholinergic meds
124
_____ converts SVT to normal sinus rhythm.
ADENOSINE
125
SIDE EFFECTS OF ADENOSINE?
FLUSHING, NAUSEA, BRONCHOSPASMS, PROLONGED ASYSTOLE
126
Adenosine should be given IV ____, and then flushed immediately with ______
Push (1-2 seconds)
Normal Saline
127
V-Fib, Unstable Ventricular Tachycardia: Which Med should I give the patient?
Amiodarone
128
Side/Adverse effects of Amiodarone
Bradycardia, Cardiogenic Shock, Pulmonary Disorders
129
Amiodarone is incompatible with ______.
Heparin
130
A maintanence dose of Amiodarone can be given ____.
PO
131
You would monitor for _____ ______ when taking Amiodarone
Respiratory comlpications
132
Atropine is considered what category of medication?
Antidysrhythmic
133
what med is used for a patient who has, Bradycardia, exposure to chemical nerve agent and reducing secretions ?
ATROPINE
134
Side effects/Adverse effects of Atropine?
Life threatening EMERGENCY
135
What would you monitor for Atropine?
Dry mouth, blurred vision, photophobia, urinary retention, constipation
136
Antilipidemic MEDS
137
Antilipidemics action ?
lower low-density lipoproteins (LDL) levels and INCREASE HDL
138
Primary use for an Antilipidemic medication?
hypercholestrolemia
prevention of coronary events
Protection against MI/ Stroke in clients who have DM
139
can you take an Antilipidemic during pregnancy?
NO
140
if you have renal dysfunction, should you take an antilipidemic?
use with caution
141
Antilipidemic's can have what side effects?
Musle aches Hepatotoxicity, Rhabdomyolysis, Peripheral Neuropathy
142
'statins (Myopathy)
They get metabolized from the liver so you check teh LFT's PRIOR to administration
143
Education: When taking an Anti-lipidemic, you should take it at what time?
In the evening
144
You would want to monitor what labs when your patient is on an Anti-lipidemic?
Liver & Renal function lab profiles
145
what kind of diet should a patient who is taking Anti-lipidemic meds adhere to?
Low Fat/High-Fiber
146
what labs should you monitor when your patient is taking 'Statins?
LFT--risk of hepatic injur
147
Name some Statin Meds
Atorvastatin, simvastatin, lovastatin, fluvastatin
148
Statins can cause prolonged _____ in clients taking ______
Bleeding; Warfarin
149
Do NOT administer a STATIN with ______ ______.
Grapefruit Juice
150
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
151
When taking Exetimibe, when should you take it after taking another antilipemics?
2 hours before or 4 hours after other one.
152
there is a risk of Liver damage when combined Cholestrol Absorption Inhibitor is taken with a
Statin
153
With prolonged use of Amiodarone, what would you expect the skin to look like?
Bluish color
154
what trimester should pregnant women avoid taking an Ace/Arb?
2nd & 3rd trimester
155
AvoidPotassium (not vitamin K) rich foods when taking - ACE/ARBs
kidney beans, kale, swiss chard, collard greens, potato, dried apricot, avocado, Liver, Spinach, Brocoli
156
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.
157
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.
158
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,
159
Prednisone is a corticosteroid that causes _____ retention, thereby increasing fluid volume.
& lowers you _____ levels.
Sodium
-increasing fluid volume --> exacerbate HF Symptoms Potassium.
160
Steroids end in '______.
'Sone (Prednisone, hydrocortisone, dexamethasone)
161
Dobutamine helps ___ cardiac _____.
Increase
Contractility
- helps increase cardiac output in acute HF
- Short-term management
