Cardio Drugs Flashcards
What number nerve is the vagus nerve?
10
What does the vagus nerve control?
parasympathetic nerves
WHen you bare down using valsalva maneuver what happens to the heart? What happens to BP?
slows down
drops
This is why postoperative patients pass out when trying to poop.
____ ____ is the amount pumped out of the ventricle with each beat. It is influenced by what three factors?
stroke volume
preload
afterload
contractility
When someone has congestive heart failure the heart beats (slower/faster)? Why?
faster, it is trying to accommodate the low stroke volume.
Body needs cardiac output. Let’s suppose a healthy person is pushing out 80mL at 100 bpm. If a person has CHF and is pushing only 50 mL, the heart has to practically double the speed of beats.
The blood sitting in your heart before it squeezes
preload
To decrease preload we use diuretic.
To increase preload we administer fluids (drinks, IVs, increase antidiuretic hormone)
______ is the resistance against which the heart has to beat. The higher the resistance , the harder the heart must contract to force the valves open and pump blood. BP is a measurement of this.
afterload
What causes a loss of elasticity/contractility of the heart?
- Too much preload
- chronic htn
- cardiac muscle damage
- heart failure (when ventricle doesn’t empty completely and the fluid backs up
___ ____ is caused by increased rate, volume and/or peripheral resistance. It is the force exerted against vessel wall.
blood pressure
The kidney gets “sad” when it doesn’t get enough oxygen, also known as decreased glomuler flow rate. When this happens it the kidneys release what?
renin; it also causes a release of eryhtropoietin
renin activates angiotensin system
angiotensin 2 causes what?
vasoconstriction
increased secretion of ADH
Increased retention of water
leading to increased blood pressure
What happens when angiotensin I is paired with ACE?
converts to angiotensin 2
What happens when angiotensin 2 makes its way to the adrenal glands?
converts to 3, releases aldosterone–>retains sodium w/water–> Blood volume and pressure increase along with increase of blood flow to the kidneys
_____ hypertension is a consequence of underlying disease
secondary
Blood pressure is regulated by which systems?
autonomic nervous system
Renal
Endocrine
What is a non modifiable risk factor?
genetics
You can modify your diet to reduce HTN, but you cannot modify your genetics.
what is essential hypertension?
HTN with no known cause
usually has no symptoms
What is epistaxis?
nosebleed
What are clinical manifestations of HTN?
Headache Visual Disturbances dizziness epistaxis chest pain
What are complications of HTN?
Heart failure (too much pressure + resistance = back up of RBCs leading to CHF)
Angina/MI (overworks heart)
renal failure (ruptures tubules)
CVA/TIA (increased pressure ruptures artery causing stroke or back up of cells cause ischemia)
Multiorgan failure
death
Treatment for HTN?
1st choice is always Diet exercise. If it fails we do D&E + med:
First med tried is diuretics. If that doesn’t work we add…
ACE ARBS Beta blocker Calcium channel blocker others
Common practice to have two anti-HTN med
What does aldosterone do ?
Retains sodium and water. Controls potassium level.
Diuretics we typically see?
Potassium sparing name?
Thiazide?
Loop/High Ceiling?
Potassium sparing name - Aldactone
Thiazide - hydrochlorothiazide (Dyazide)
Loop/High Ceiling - furosemide/Lasix
What is the risk of using thiazide or furosemide (Lasix)?
hypokalemia
What is standard range for potassium and sodium?
potassium 3.5-5
sodium 135-145
ACE inhibitors can be used for treatment of HTN (lowers volume), CHF (lowers volume), Left ventricular dysfunction following MI. What is the prototype?
ACE inhibitor= Capoten or Captoptil
Memory: Bust a cap in that ACE….
What is the number one side effect of ACE inhibitor?
Cough
The reason ARBS were invented…
ACE changes angiotensin 1 into 2 which causes vasoconstriction leading to increase in BP and blood flow to kidneys. What is the function of ACE inhibitors? Their indication?
Keep angiotensin 1 from becoming 2 by blocking the converting enzyme thereby preventing this system from increasing BP. Angiotensin cannot become three in the adrenal glands if it is never converted to 2 first, therefore less aldosterone will be released.
ACE inhibitor leads to a decrease in BP, aldosterone production and a small increase in serum potassium along with SOIDUM AND FLUID LOSS (less aldosterone holding onto sodium and water means less sodium and water).
What does ARB stand for ?
Angiotensin receptor blocker (blocks angiotensin 2)
How does an ARB work and what is the prototype?
DO NOT GIVE TO PREGNANT WOMEN!!!!
blocks the binding of angiotensin 2 in adrenal gland which prevents the release of aldosterone (remember aldosterone retains salt and water…) thereby decreases BP.
DO NOT GIVE TO PREGNANT WOMEN!!!!
Prototype is Lorsartan (Cozaar)
Memory lorsARRRRRtan (CozAArrrrr) sounds like ARB
How do calcium channel blockers work? What is the prototype?
Calcium Channel Blockers inhibit movement of calcium across the myocardial membranes and arterial muscle cells. Slows heart rate.
Lets discuss calcium and how it works:
To create muscle contraction, Na enters through fast channels, calcium enters through slow channels, potassium leaves (depolarization). So if we block calcium, we block muscle contraction which would decrease the HR thereby decreasing BP.
Side note: After contraction, repolarization takes place.
How does propranolol (Inderal) work?
leads to decrease in HR and strength of contraction as well as vasodilation.
Beta 1 = Heart ; when stimulated increases HR, when blocked slows HR. Beta 2 = Lungs; when stimulated leads to bronchodilation.
alpha 1 stimulation ______ vessels
alpha 2 _______ amount of epinephrine across nervous membrane.
constricts
decreases
If other drug therapies do not achieve desired reduction of blood pressure, we can give vasodilators which directly vasodilate. It is usually reserved for severe hypertension or hypertensive emergencies. What is our prototype?
Nitroprusside (Nitropress)
Relaxes smooth muscle of vessel wall, decreasing resistance and blood pressure.
IV Based, used in ICU
DIuretics cause what adverse effects?
Orthostatic Hypotension (when lowering BP with them, if we go ever so slightly too far, we go too low and then boom hypotension)…don’t stand abruptly
Hypokalemia (remember we always lose a lot of potassium with all diuretics EXCEPT potassium sparing diuretics.
Hyperglycemia
What is the best way to tell the amount of fluid daily?
weight
ACE Inhibitors work on the angiotensin system, which involves the kidneys. Therefore, we would NOT use this drug if someone has impaired _____ function
renal
nursing interventions
administer on an empty stomach
avoid sudden position change
inform patient to report cough
check protein in urine, if you see protein the kidneys are not functioning properly.
Monitor for potassium!! risk for hyperkalemia
Monitor sodium (135-145)
Why do ARBs have the side effect dizziness, syncope (fainting), headache and weakness?
They are used to lower BP. BP can become too low and cause these issues.
The antihypertensive medication is a calcium channel blocker called _______ (________) can cause peripheral edema, which is related to effects on cardiac output (Remember blocking calcium decreases muscle contraction).
Can also be used as antiarrhythmic. Effects ventricles.
diltiazem (Cardizem)
CArdizeM..CAlciuM
treatment of essential hypertension which means adversely it could cause hypotension
What two things do you ABSOLUTELY avoid when taking Cardizem, a calcium channel blocker?
- Digoxin
- Grapefruit Juice
Monitor liver enzymes
All ACE inhibitors end in ____?
IL
T or F: If you give a beta blocker to a patient with an issue like COPD, Asthma or similar, they will have an easier time breathing during exercise.
False!
They will have exercise intolerance!
Beta blockers will ______ your blood sugar. If you have low blood sugar, you won’t feel the sympathetic reaction of epinephrine of having low blood sugar.
raise
Propranolol (Inderal) can cause wheezing because? It may also cause…
it is a non selective beta blocker. This means it will effect both beta 1 (heart) and beta 2 (lungs).
Monitor lung sounds
Monitor blood sugar (like all beta blockers, hides hypoglycemia)
It may also cause bad dreams but will get better over time. Bad dreams/Insmonia
Hypotension/Bradycardia (used to treat HTN and Arrhythmia, when fixing if we go too far, it can cause too low, too slow).
In regard to HTN and antiHTN meds, what are the four most important things to teach the patient?
- Do not discontinue abruptly (leads to rebound hypertension
- Monitor BP at home
- Continue taking even when BP is normal
- Report side effects (Dr will adjust or change med)
A “P Wave” is when the _____ are activated
Atria
A “QRS Complex” is when the _____ are activated
Ventricles are activated
A “T Wave” is when the heart ______
Recovers
If the SA node does not function what do we use?
Pacemaker (or ICD implanatable cardioverter defibrillator
Electronic device that provides mechanical stimuli to the heart muscle.
Used to treat arrhythmias
Can be permanent (implant) or temporary (outside pads like an AED, detects and terminates life threatening tachycardia and fibrillation)
P-R interval reflects?
normal delay of conduction at the AV node.
What is an arrhythmia (also called dysrhythmia)?
involves a change in automaticity or conduction of heart cells. Changes result from varying factors: electrolyte imbalances, decreased oxygen delivery, structural damages, acidosis or waste product accumulation.
Types Bradycardia Tachycardia (sinus or ventricular) Premature ventricular contraction Ventricular tachycardia Atrial flutter/Atrial fibrillation Ventricular fibrillation asystole
5 phases of the AP of Cardiac Muscle Cell?
0 - cell reaches point of stimulation. Sodium gates open.
Phase 1 - sodium enters cell first
(Class 1 Antiarrhythmics works by blocking sodium channels - lidocaine [Xylocaine])
Phase 2 - calcium enters, potassium begins to leave
(Class 4 blocks calcium channels. diltizem [Cardizem])
Phase 3 - potassium flows out when sodium gates are shut
(Class 3 Antiarrhythmic blocks potassium channel, keeping potassium from leaving the cell, prolonging this phase: amiodarone [Cordarone])
4 - cell rests, then depolarization happens again
(Class 2 causes a depression of this phase. propanolol [Inderal])
Cardizem and Propranolol can be used as an anti________ and/or anti________.
antihypertensive or antiarrhythmic
Cardizem works on calcium for both issues.
Propranolol competitively blocks beta receptor sites for both issues.
Propranolol treats SVT (Supreventricular Tachycardia) and PVC (premature ventricular contraction); works on ventricles
Lidocaine is used to manage _____ fibrillation. Adverse effects?
ventricular
decreases depolarization (depolarization is a difference in charges between inside and outside of heart which causes the molecules to swap sides creating contraction. Without depolarization there is less contraction, therefore a slowing of the heart).
Adverse effects are hypotension and bradycardia. Remember we are slowing the contractions down, therefore slowing the beat.
Is patient on Digoxin?
Avoid alkaline drinks, acid or basic is better.
This drug blocks potassium from leaving the cell (during phase 3) and treats life threatening ventricular arrhythmias. It prolongs the action potential.
Amiodarone (Cordarone)
(aldactONE was potassium sparing diuretic. cardarONE/AmidodarONE works on potassium)
weakness, dizziness, digoxin
For long term stabilization of atrial fibrillation, use…
quinidine
For a long time, quinidine!
not prototype but she said important to remember….
Ischemic Stroke Video
https://www.youtube.com/watch?v=7FR1TsKLoDI
caused by clot or closed artery
Hemorrhagic Stroke
https://www.youtube.com/watch?v=bp1HRfpOUo0
https://www.youtube.com/watch?v=f9Ojq9f2qaM
clots, thrombi and antiplatelets
What is the difference between intrinsic and extrinsic pathways in regard to clotting?
Intrinsic pathway is activated in response to injury. Extrinisic is activated when blood leaks out of vessel and enters the tissue space.
How do anticoagulants work? What are the names of the meds we use?
DOUBLE CHECK MED!
they do not dissolve clots, they prevent formation of clots.
once you have a clot, your body should dissolve it.
heparin (liquid - subQ injection or IV)
Coumadin/warfarin (pill)
How do antiplatelets work? name of prototype?
interfere with platelet aggregation.
prototype is aspirin (oral)
Plavix is another one used (oral).
Ther is an option for low molecular weight heparin. It has fewer systemic effects. It is given to patients to prevent formation of clots (PE and DVT). Most commonly used drug is?
enoxaparin (Lovenox)
subQ injection
Injuries while taking anticoagulants can be very dangerous. We have reversal agents for them. What is the reversal agent for Heparin? Coumadin?
Heparin - Protamine sulphate
Coumadin - Vitamin K (this is why you cannot eat a lot of green lettuce like kale, spinach, etc.
Newer meds have less restrictions but no reversal agents. This means you would have to wait until it is out of your system before surgery or in emergency cases use transfusion of blood products (platelets)
Why must you avoid alcohol, aspirin, ginkgo, garlic and vitamin E (as well as fish oil) when taking anticoagulants?
Anticoagulants interact with these and cause bleeding. Each of them effect bleeding on their own. These are concerns prior to surgery even if they are not on anticoagulants. Need to stop them for at least ten days.
What does PTT stand for and what is it used for?
Partial thromboplastin time
It is used to monitor efficacy of heparin
You will see a number which means takes # times longer to clot than normal.(for a 2 it takes 2 x longer than normal)
Count to ten
H E P A R I N + P T T = 10 letters
C O U M A D I N + PT = 10 letters
What does PT stand for and what is it used for?
prothrombin time
INR = international ratio
What is the purpose of a tiny amount of aspirin (81mg) given to patients?
What is the main contraindication for aspirin?
prevention of strokes. given as a prophylactic
contraindication: severe liver impairment
Assess for and monitor for bruising or S/S of bleeding
(END OF CARDIO 1 PPT)
