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Pharmacology Final > Cardio Drugs > Flashcards

Cardio Drugs Flashcards

1
Q

the stretch of the heart

A

preload

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2
Q

the squeeze of the heart muscle

A

afterload

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3
Q

When preload and afterload are decreased =

A

blood pressure decreases

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4
Q
  • assess how well the body is being perfused by blood carrying oxygen and nutrients
A

blood pressure

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5
Q

the mean (average) perfusion pressure across the entire cardiac cycle

A

Mean Arterial Pressure (MAP)

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6
Q

blood pressure and ___ help determine how well the body is perfusing

A

MAP

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7
Q

Blood pressure consistently over 140/90
Most common disease

A

hypertension

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8
Q

Diuretics
adrenergic drugs
Vasodilators
angiotensin-converting enzyme (ACE) inhibitors
angiotensin receptor blockers (ARBs)
calcium channel blockers (CCBs)
and direct renin inhibitors.

A

Risk factor for multiple diseases

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9
Q

most people have_________hypertension, and it means there is a cause that they are not aware of

A

essential

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10
Q

______ hypertension is due to a disease that is causing the high blood pressure

A

secondary

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11
Q

if person have 140/90 multiple times they will usually __________

A

start medication

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12
Q

Decreases Sympathetic response
2. Less norepinephrine released
Slower heart rate
Less force of contraction
Vasodilation
Less renin released
Equals less cardiac output (Blood pressure drops)

A

centrally acting alpha 2 adrernergics

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13
Q

works directly on the part of the brain that lowers blood pressure

renin is an enzyme that when decreased causes decreased bp

A

centrally acting alpha 2 adrenergics

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14
Q

What are the centrally acting adrenergics?

A

clonidine
methyldopa
guafacine (tenex)

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15
Q

Some Types of heart failure
Use with an MAOI
When Breastfeeding

A

contraindications with centrally acting adrenergics

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16
Q

Recent myocardial Infarction
Diabetes Mellitus
Peptic Ulcer
HX of stroke, asthma, COPD, diabetes mellitus, major depressive disorder, or chronic kidney disease.

A

cautions with centrally acting adrenergics

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17
Q

Reduce Hypertension (hTN)
Primary HTN
Manage symptoms of heart failure

A

indications for centrally acting adrenergics

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18
Q

bradycardia
Orthostatic hypotension/Dizziness
Drowsiness, sedation
Dry mouth
Rebound htn when discontinued

A

adverse effects of centrally acting adrenergics

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19
Q

Might be given twice a day

is often given at bed time instead bc it causes drowsiness

slows pulse

monitor “tilt” blood pressures –laying down, sitting up, and standing measure the bp in these positions

usually not the first choice medication to treat high bp

reflex tachycardia is also a symptom but is less common than bradycardia

A

notes/ adverse effects for centrally acting adrenergics

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20
Q

Fall and injury risks from hypotension, dizziness, lightheadedness
Routes include oral, epidural, and transdermal
usually administered BID in divided doses
May take larger dose at bedtime to decrease daytime sleepiness
Report heart rate less than 60 bpm to physician
avoid excessive alcohol use
Avoid abrupt discontinuation of medication

A

patient education for centrally acting adrenergics

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21
Q

hypertension does not make you feel bad, but it may give you a ________, a lot of people do not have any symptoms

A

headache

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22
Q

when is the best time to give clonidine (or the higher dose if BID?)

A

bedtime

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23
Q

CAAS (Clonidine/aldomet) cause what affect on the heart rate?

A

bradycardia

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24
Q

Fluid volume excess in joints, peripheral limbs, surrounding the cell

A

edema

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25
Q

excess fluid loss

A

dehydration

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26
Q

most edema is ?

A

peripheral (in the legs)

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27
Q

What is normal potassium levels?

A

3.5-5

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28
Q

Anything less than ___ is hypokalemia

A

3.5

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29
Q

anything over ____ is hyperkalemia

A

5

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30
Q

Hypotension
General Weakness & Fatigue
Muscle cramps
Constipation, N/V
Irritable, confused
Arrhythmias/tachycardia
Shallow respirations

A

s/s of hypokalemia

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31
Q

General Weakness
Muscle fatigue, twitches, cramps, up to paralysis
paresthesia
Abdominal cramps, distention, Nausea, Diarrhea
Irritable, anxious
Arrhythmias/hypotension

A

hyperkalemia

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32
Q

________ is pin and needle feelings in your hands and feet

A

paresthesia

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33
Q

if you are to the ______, there is a MAJOR problem with hyper and hypokalemia

A

arrhythmias,

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34
Q

if they have ______ they can have muscle twitches

A

hyperkalemia

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35
Q

both _____ and ____ cause GI issues

A

hyper and hypokalemia

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36
Q

Essential for nerve impulse conduction
Regulates acid/base balance

A

potassium

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37
Q

Give _______ for hyperkalemia

A

Kayexalate

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38
Q

What happen if the nurse gives potassium IV as a bolus dose?

A

its fatal!!!!!!!!

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39
Q

Give _________ for hyperkalemia can be given PO or enema, pulls potassium out into GI lumen and causes diarrhea

A

kayexalate

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40
Q

Give kayexalate for ______ can be given PO or enema, pulls potassium out into GI lumen and causes diarrhea

A

hyperkalemia

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41
Q

t/f: NEVER GIVE POTASSIUM IV BOLUS OR FAST IV PUSH

A

true

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42
Q

Dilute iv dose with saline
no more than 40 meq/l at a time
no faster than 10 meq/hr

A

admin instructions for potassium

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43
Q

GI related
Diarrhea
Nausea
Vomiting
Adverse-
GI bleeding
Ulceration
IV fluid- has to be mixed to a certain concentration to give safely
IV infusion causes discomfort

A

adverse effects of potassium

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44
Q

when given too fast, it causes cardiac arrest

IV infusion can discomfort [possible thrombophlebitis]

A

potassium

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45
Q

Complex syndrome that impairs cardiac functioning  decreased cardiac output

A

heart failure

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46
Q

Dyspnea
Fatigue
Fluid retention (peripheral edema)
Pulmonary edema (fluid lungs)
Reduced ability to exercise
Persistent cough or wheezingwith white or pink blood-tinged phlegm
Increased need to urinate at night
Swelling of abdomen (ascites)
Sudden weight gain from fluid retention
Lack of appetite/nausea

A

s/s of heart failure

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47
Q

occurs when your heart muscle doesn’t pump blood as well as it should. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently

A

congestive heart failure

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48
Q

What are the two medication classes used to treat heart failure?

A

cardiac glycosides
diuretics

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49
Q

what are the cardiac glycosides?

A

digoxin

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50
Q

what are the diuretics

A

Thiazide diuretics-hydrochlorothiazide (HCTZ)
Loop diuretics- furosemide
Potassium-sparing diuretics- spironolactone
Osmotic diuretics-Mannitol

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51
Q

calculation that determines how well the blood is filtered by the kidneys

A

glomerular filtration rate

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52
Q

measures the amount of the waste product creatinine

A

Serum creatinine/creatinine clearance

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53
Q

anytime you give a med that is going to pull fluid off you need to know the

A

GFR and Serum creatinine clearance level

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54
Q

Works on the nephron
Block na and h2o reabsorption
Cause Direct arteriolardilation  decreases peripheralvascular resistance
Reduces extracellular fluid volume, plasma volume, and cardiac output  decrease in BP

A

diuretics

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55
Q

What are the different diuretic classes?

A

loop diuretics
mannitol (osmotic diuretic class)
metolozone (thiazide-like diuretic class)
thiazides
potassium sparing diuretics

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56
Q

the osmotics you don’t need to know as much about them bc most of the time ______ is given in the ICU for increased intracranial pressure

A

mannitol

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57
Q

Dehydration
electrolyte imbalance
muscle cramps
dizziness

A

adverse effects of all diuretics

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58
Q

Blocks reabsorption of sodium, potassium, chloride
Water is lost
arterioles relax
Reduced peripheral vascular resistance (After load)

A

how thiazide diuretics work

59
Q

causes body to excrete fluids
______ is not a very powerful diuretic
is used as a first line for hypertension bc it pulls fluid off pretty easily without causing a lot of side effects

A

thiazide diuretics

60
Q

What are the thiazide diuretics?

A

hydrochlorothiazide
chlorothiazide
metolazone (is thiazide like)

61
Q

Hypertension
Mild to moderate Heart failure
Edema
Hepatic cirrhosis
Various others

A

indications for thiazide diuretics

62
Q

remember, thiazide diuretics are not ______

A

very potent

63
Q

if allergic to sulfonamides (Sulfa) (uncommon cross allergy)
Avoid if pregnant or breastfeeding
Avoid in patients who have anuria/Severe renal failure
High levels of creatinine in the blood (indicating poor kidney function)

A

contraindications for thiazide diuretics

64
Q

Hx of cardiovascular disease, DM, hypokalemia, hyperlipidemia, hypomagnesemia, and gout
taking digoxin, lithium, or antihypertensives
SIDE EFFECTS MORE PRONOUNCED IN THE ELDERLY

A

cautions with thiazide diuretics

65
Q

KIDNEYS HAVE TO FUNCTION FOR THIS DIURETIC TO WORK

A

thiazide diuretics

66
Q

Dehydration
Electrolyte disturbances
Reduction of potassium
Reduction of sodium, Chloride, and magnesium to a
lesser degree
Increase of Calcium, lipids (LDL), glucose

Others:
Headache, impotence, decreased libido
Dizziness from Orthostatic Hypotension

A

adverse reactions to thiazide diuretics

67
Q

patient who is diabetic may still take this drug, just know that it can increase their glucose levels so you need to monitor their blood sugar.

A

thiazide diuretics

68
Q

Report s/s of hypokalemia (potassium level is below 3.5)
anorexia, nausea, lethargy, muscle weakness, irritability, confusion, hypotension, shallow respirations, fast and thready pulse, decreased intestinal mobility, dysrhythmias

eat foods rich in potassium, potassium supplements if ordered

Take measures to avoid dehydration
Minimize alcohol and caffeine beverages (Replace fluids during exercise or hot weather
Avoid exposure to intense heat for prolonged periods
Take small frequent amounts of ice chips or clear liquids if vomiting
Replace fluids with fruit juice or bouillon if diarrhea occurs

If diabetic, check blood glucose periodically

A

education for thiazide diuretics

69
Q

often you don’t need to have a potassium supplement with ______diuretics, but you may need to increase your dietary intake of potassium

A

thiazide

70
Q

All given orally Except ______ can begiven iv
Avoid giving in evening, night time

A

administration for thiazide diuretics
chlorothiazide

71
Q

Creatinine clearance
Electrolytes
glomerular filtration rate (GFR)

A

monitor these labs for thiazide diuretics

72
Q

Vital signs
I & o, daily weight
Signs of dehydration
Prevent falls/injuries

A

assessments for thiazide diuretics

73
Q

GIVE IN THE MORNING SO THAT THEY PEE DURING THE DAY AND NOT AT NIGHT (IS ALSO A FALL RISK IF THEY TAKE IT AT NIGHT) [only exception is if they take it more than once a day]

A

thiazide diuretics (also for other diuretics too I think)

74
Q

Decrease in blood pressure to normal range
Decrease in edema
Increase in urine output (at least 30ml/hour)
Preserved bone integrity in postmenopausal women. **

A

indications that thiazide diuretic is working

75
Q

Are the most potent diuretics

A

loop diuretics

76
Q

not used for hypertension, mostly used for heart failure

A

loop diuretics

77
Q

What are the loop diuretics?

A

ethacrynic acid
torasemide
furosemide
azosemide
bumetanide

78
Q

_______ (is the most common) –can be used IV, causes sodium Chloride and water to leave, also caused potassium calcium and magnesium to leave as well which causes even more water to leave the body. Can cause ototoxicity (especially if given too rapidly IV).

A

FUROSEMIDE

79
Q

What is the strongest loop diuretic?

A

bumetanide

80
Q

hyponatremia
hypokalemia
hypomagnesemia
ototoxicity

A

adverse effects of loop diuretics

81
Q

Manage edema associated with heart failure, hepatic or renal disease
To control htn (not as often as the thiazide diuretics though)
Increase the excretion of calcium in someone with hypercalcemia
Rapid diuresis (works PO, very well IV)

A

loop diuretic indications

82
Q

NSAIDS- decrease diuretic therapy from loop diuretic
Digoxin (Lanoxin)- digoxin toxicity/Hypokalemia
Corticosteroids- further hypokalemia
Antidiabetic medications- decreased effectiveness of antidiabetics- increased blood glucose

A

loop diuretic interactions

83
Q

Useful if rapid diuresis (removal of fluid) needed
PO are usually effective in once a day dosing
Prolonged high doses can rarely cause ototoxicity (can be permanent)

A

loop diuretics

84
Q

What are the 5 best sources of potassium from foods?

A

dried apricots
white beans
leafy greens
potato
acorn squash
bananas

85
Q

t/f: patient on loop diuretics or thiazide diuretics need to increase their dietary intake of potassium?

A

true

86
Q

______ are often given with potassium supplement

A

loop diuretics

87
Q

Anuria (no urine)
severe electrolyte depletion or dehydration present

A

contraindications for loop diuretics

88
Q

Hx of cardiovascular, DM, and gout
If taking digoxin, lithium, ototoxic medications, NSAIDs, or antihypertensives

A

caution for loop diuretics

89
Q

Dehydration – leg pain?

Electrolyte disturbances :
hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypocalcemia, hyperuricemia*

Hypotension

Ototoxicity (specific to the loop diuretics)

Hyperglycemia

decrease in HDL (good)cholesterol levels, increase in LDL (bad) cholesterol levels

A

adverse reactions to loop diuretics

90
Q

electrolytes
lipids
renal labs
glucose

A

labs you need to monitor with loop diuretics

91
Q

Signs of dehydration
BP
kidney damage or hearing damage
Monitor I/O, weight

A

assessment for loop diuretics

92
Q

Give iv over 2 minutes- GO slow!
Prevent falls by planning ahead
Avoid licorice or licorice extract/Herb
If daily give diuretic in the am

A

administration for loop diuretics

93
Q

teach patient on potassium dietary potassium
teach to weight daily
they should measure blood pressure daily and keep a log
change position slowly

A

education for loop diuretics

94
Q

low potassium increases risk for _________

A

digoxin toxicity

95
Q

block aldosterone receptors (different meds, different ways)
Sodium and water are excreted, Potassium is Retained

A

potassium sparing diuretics

96
Q

Relatively weak compared to other diuretics:
Synergistic effect  use in conjunction with other diuretics
Counteract the adverse metabolic effects (electrolyte loss)

A

potassium sparing diuretics

97
Q

What are the potassium sparing diuretics?

A

spironolactone
triamterene

98
Q

Decrease potassium loss from other diuretics
Reduce Edema of multipleetiologies
children with heart failure
Heart failure
Hypertension (is not a first line for blood pressure)

A

indications for potassium sparing diuretics

99
Q

Hyperkalemia (potassium greater than 5 mEq/mL)
Taking potassium supplements
With another potassium sparing diuretic
Anuria, renal failure

A

contraindications for potassium sparing diuretics

100
Q

client with diabetes mellitus
Impaired hepatic function (avoid Triamterene)
Other electrolyte imbalances
metabolic acidosis

A

cautions for potassium sparing diuretics

101
Q

if the patient is only taking a potassium sparing diuretics, do they need to take a potassium supplement?

A

no, they do not need to take a K+ supplement

102
Q

make sure theyre not using a potassium salt substitute with this med unless theyre using a potassium sparing diuretic with a loop diuretic

A

potassium sparing diuretic

103
Q

Hyperkalemia

Increased urinary frequency

Triamterene specific:
Low folate  Kidney stones
Anemia
Colored urine

A

adverse reactions with potassium sparing diuretics

104
Q

What is this?

A

colored urine from triamterene (a potassium sparing diuretic)

105
Q

BP, daily I/O
Changes in LOC
slow/Continued diuresis
Fall risk and environment

A

assessment for potassium sparing diuretics

106
Q

What labs do you need to get for potassium sparing diuretics?

A

Glucose, BUN, CREATinine, and Hepatic funciton labs

107
Q

Caution salt substitutes and potassium rich foods
Give in morning or early afternoon
Avoid driving or activities requiring alertness

A

education for potassium sparing diuretics

108
Q

What is the osmotic diuretic?

A

mannitol

109
Q

How are the osmotic diuretics administered?

A

IV

110
Q

Often used to decrease cerebral edema and intracranial pressure related to head trauma
Intraocular pressure

A

indications for osmotic diuretics

111
Q

Pulmonary edema- loop diuretics would be used
Severe kidney disease
Intracranial bleeding (head trauma)

A

contraindications for osmotic diuretics

112
Q

causes increasing osmotic pressure in the kideys which causes water to not be reabsorbed as much
[can be given with other diuretics but not a whole lot]

does not cause a lot of loss of electrolytes

A

osmotic diuretics, mannitol is one

113
Q

Convulsions
Thrombophlebitis
Pulmonary congestion (fluid build up in the lungs)

A

adverse reactions to osmotic diuretics

114
Q

Crystals can form in low temperatures
cannot let it get cold
There are different concentrations of the medication/ double check dose with other nurse

A

nurse notes for osmotic diuretics

115
Q

One of the oldest groups of cardiac drugs

A

cardiac glycosides

116
Q

Treatment of heart failure, atrial fibrillation

A

cardiac glycosides

117
Q

History: first line drug for 200 years (heart failure)
Present: ______ is Only cardiac glycoside available in U.S.

A

Digoxin

118
Q

Increased force of heart’s contraction
Improves cardiac output
Decreases heart rate
Promotion of diuresis (due to improved blood circulation)

A

method of action for cardiac glycosides

119
Q

What are the cardiac glycosides?

A

digoxin, digitoxin

120
Q

heart failure
Dysrhythmias (atrial fibrillation, Atrial Flutter)

A

indications for cardiac glycosides

121
Q

heart blocks and other dysrhythmias

A

contraindication for cardiac glycosides

122
Q

Hypokalemia, Advanced heart failure, impaired kidney function

Licorice
St. john’s wort (herb used for depression)
Amiodarone, verapamil, quinidine
all Increase digoxin levels by 50%!!!

A

cautions for cardiac glycosides

123
Q

Cardiovascular
dysrhythmias, Bradycardia, tachycardia, hypotension

vision changes
green, purple, yellow colored vision,
halo vision
flickering lights

A

adverse effects of cardiac glycosides

124
Q

What is the therapeutic range of digoxin?

A

0.5-0.8 ng/mL or 0.5-2 ng/ml

125
Q

Signs can appear even at 1.75 ng/ml level
Decreased renal function, Low potassium, or low magnesium can contribute to toxicity

A

digoxin toxicity

126
Q

GI issues usually first effects
bradycardia, headache, dizziness, confusion, nausea, visual disturbances (sees halo), changes in normal heart rhythms

A

signs of digoxin toxicity

127
Q

Low ____ increases risk of digoxin toxcity

A

potassium

128
Q

hold next dose

Draw Labs
serum digoxin level, electrolytes
Administer potassium supplements if hypokalemic

Continuous cardiac monitoring
administer an anti-dysrhythmic medication (Phenytoin or Lidocaine), if needed
Administer atropine for bradycardia

For excessive overdose
activated charcoal, cholestyramine, or digoxin immune Fab (DIGIBIND)

A

protocol for digoxin toxicity

129
Q

__________________ therapy
Available only as 40mg vial, parenteral form
Antibody that inactivates free digoxin
Used in Severe cases only
Given IV over 30 minutes

A

Digoxin immune Fab

130
Q

loading dose will be larger than maintenance dose
Assessment apical pulse (rate and rhythm) before administration
Record findings
Notify the provider if heart rate is less than 60/min in an adult
Administer digoxin at the same time daily
Monitor digoxin levels and potassium levels periodically during treatment
If administering IV digoxin, infuse over at least 5 min, (10-15 min in clients who have pulmonary edema)

A

administration and nursing notes for digoxin

131
Q

When oxygen and nutrient supply is insufficient
heart muscle will ache = ______

A

angina pectoris

132
Q

Ischemic conditions -> heart shifts to ______ metabolism

A

anaerobic

133
Q

Anaerobic product is lactic acid ->accumulates
Lactic acid and other byproducts stimulate the pain receptors = _____

A

angina!

134
Q

Dilates blood vessels
Dose dependent
relaxation of smooth muscle cells in walls of vein/ arteries
Redistributes blood and oxygen to ischemic myocardial tissue
Reduce venous return  reduce preload  angina relieved

A

nitrates/nitrites method of action

135
Q

used to treat and prevent angina

A

nitrates/nitrites

136
Q

What are the nitrates/nitrites?

A

nitroglycerin
isosorbide mononitrate

137
Q

can take up to three doses with five minutes in between doses

A

nitrates/nitrites

138
Q

if it doesn’t resolve with ______ doses, you need to go to the hospital

A

three

139
Q

severe anemia – increases vasodilation
closed‑angle glaucoma and traumatic brain injury (TBI) - increases intracranial pressure
can be life threatening when taken with erectile dysfunction medications (within 24-48 hours of ntg administration)
sildenafil (Viagra), tadalafil (cialis), and vardenafil (Levitra)

A

contraindications for nitrates/nitrites

140
Q

Client taking antihypertensive medications
clients who have hyperthyroidism
Clients with kidney or liver dysfunction

A

cautions for nitrates/nitrites

141
Q

Vasodilation effects:
Headache
Orthostatic Hypotension (fall prevention needed)
Reflex Tachycardia if vasodilated too fast
Topical:
can cause contact dermatitis (not a true allergy)
Local burning or tingling sensation

Tolerance can occur quickly
Nitrate “vacation” needed

A

adverse effects of nitrates/nitrides

142
Q

First dose? Sit/Lie down for 15 mintues
Spray translingual spray against oral mucosa and do not inhale
Take long acting capsules on an empty stomach with 8 oz of water
Vitals prior to administration -Hold for SBP less than 90
Avoid use with erectile dysfunction medication (decrease bp)
Always have it accessible (Fast acting)
Replace sublingual tablets (Fast Acting)every 3 months and remove the cotton, store in original brown container in cool, dry place
need to replace every three months
Can swim or bathe with a NTG patch in place

Use rapid‑acting nitrate at the first indication of chest pain
Use prior to activity that is known to cause chest pain
Be medication free 8-12 hours a day
Remove the prior dose before a new dose is applied
easily forgotten when it’s a transdermal or topical med
Measure specific dose with applicator paper and spread over 2.5 to 3.5 inches of the paper
See next slide for example

A

nursing notes for nitrates/nitrides

143
Q

prn angina treatment: Take 1 dose q5 minutes x3
Rest- sit or lie down immediately
Take each dose 5 minutes apart
Need emergency help if not relieved after 3 doses
Take no more than 3 doses
Instruct client to report all attacks
Include details

A

patient education for nitrates/nitrides

Pharmacology Final (12 decks)

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