cardio meds Flashcards
what is mild HTN BP
140-149/90-99
FIRST LINE tx for most HTN
thiazide
thiazide MOA
Lower plasma volume by dec Na resorption at distal convuluted tubule by inhibiting Na/Cl transporter
Diuretics MOA
remove excess water and Na; dec amt of fluid flowing through blood vessels to reduce pressure on vessel walls
first line medications list tx for htn
thiazide, ccb, ace/arbs
thiazide and calcium
increase Ca reabsorption and lower urinary Ca excretion(good for kidney stones)
Electrolyte effect of thiazide
hypokalemic metabolic alkalosis, hyponatremia, decreased Mg;
HYPER(G-L-U-C): glycemina, lipidemia, uricemia, calcemia)
FIRST LINE tx for mild HTN
Diuretics
Contraindications to thiazides(5)
HypoTN, Sulfur allergy, gout, renal failure, hypokalemina, careful in diabetics
loop MOA
act on ascending loop of henle inhibiting Na/K++/Cl transporter
where is most of the Na reabsorbed
loop of henle
Electrolyte effect of Loops
hyperuricemia, decrease K++, Mg, Ca
good and bad side of using Loops
Powerful but short acting
Good med for acute pulm edema with renal failure
loop
SE of loops
ototoxicity but it is reversible
2 MOA of K++ sparing diuretics
Block Na exchange sites; and aldosterone antagonists which prevent specific proteins from being created that are part of the Na K++ exchange pump
when to use K++ sparing diuretics
SECOND line with another med for acute pulm edema or CHF
Electrolyte effect of K++ sparing diuretics
hyperuricemia and dec Mg
FIRST line treatment as monotherapy or with thiazides, ACE/ARB for HTN regardless of age or race
CCB
CCB MOA
Block Ca channels in blood vessels and cardiac muscle; this prevents Ca from entering the cells reducing muscle contractility–leading to vasodilation and decreased cardiac contractility
What reduces AV node conduction therefore HR; and also reduces aldosterone production
CCB
Dihydropyridine
CCB(Nifedipine and Amlodipine)
Dihydropyridine MOA
Peripheral Vasodilation w/out affecting HR or rate control.
Danger of Dihydropyridines
Reflex Tachycardia
Danger of Nifedipine
Reduce ventricular contractility, worsening angina, avoid in HF
Nondihydropyridines
Diltiazem and Verapamil
3 uses for CCB
HTN, angina, Arrhythmia(supraventricular tachyarrhythmias)
CCB less effective on cardiac tissue
dihydropyridines(amlodipine and nifedipine), it works more on the peripheral system
SE of CCB
HA, peripheral edema, leg edema, bradycardia(due to AV node)
which CCB can cause AV block and worsening heart failure
NonDihydropyridines(diltiazem and verapamil)
which CCB causes flushing and which ones cause constipation
nifedipine. diltiazam and verapamil
SE of K++ sparing diuretics
hypokalemia, gynecomastia, sexual dysfunction
hydralazine MOA and SE
causes release of nitric oxide and increases HR
lupus like syndrome, pericarditis
inotropes
MOA and meds
increase cardiac output by increasing contractility and it also increases BP.
-dobutamine, dopamine, epi
chronotropes MOA and meds
alter HR.
- positive: adrenaline
- neg: digoxin
avoid what in WPW
adenosine
meds to reduce mortality in CHF
BB with ACE
ACE MOA and pts to use in
help relax blood vessels by preventing formation of angiotensin(narrows vessels);inhibit bradykinin degradation and stimulate synthesis of vasodilating prostaglandins. good for DM, kidney pt, young white folk
ACE SE
angiodema, rash, leukopenia, HYPERkalemia
ARB SE
leukopenia, rash, HYPERkalemia
Avoid in cocaine users
BB
What worsens claudication
BB
Tx for HTN urgency
ACE, BB, Clonidine
Tx for HTN emergency
Nitroprusside, Nicardipine, Labetolol
avoid what in renal dysfunction patients
ACE
B1
increase C.O. by raising HR by increasing impulse conduction, increases renin secretion
B2
relax smooth muscle(including bronchials), increases renin secretion
3 things BB do
- reduce HR
- reduce contractility
- decrease renin production and this lowers plasma volume
when to use BB(4)
HTN, angina, CHF, Post MI to prevent another MI
BB SE (8)
bronchospasm, bradycardia, CHF exacerbation, impotence, fatigue, depression, N/V, hypoglycemia
Alpha blockers do what
prevent sympathetic vasoconstriction
SE of alpha blockers
postural hypoTN
What does angiotensin II do?
vasoconstriction and stimulates aldosterone secretion causing kidneys to reabsorb more Na and water
adenosine
slows conduction time through AV node, interrupts reentry pathways
digoxin
direct action on cardiac muscle and indirect action of CV system
Life threatening V tach or V fib
flecainide,propafenone (Na channel blocker)
how do nitrates work
venodilation to decrease preload and O2. also coronary artery dilation to increase blood flow.
dig toxicity (sx, test, tx)
Sx: N/V, confusion, arrhythmia, abd pain, weakness
test: order serum digoxin, serum K++, renal function, EKG(ST seg depression)
tx: digoxin antibody fragments and may activated charcoal
common arrthymia with dig toxicity
premature ventricular contractions; nothing specific
med for Afib with low EF
digoxin; slows rate
which heart failure is digoxin for
systolic! improves EF
med for chronic Afib with concurrent CHF
digoxin
contraindications to digoxin
Vfib and heart block
statin
lower HDL and TG; inc LFT, myositis, warfarin potentiation
fibrates (lipoprotein lipase stimulators) effect and SE
dec Tg and inc HDL; cholelithiasis, myositis, inc LFT, GI upset
cholesterol absorption inhibitors(Ezetimibe) effect and SE
dec LDL; diarrhea, abd pain, maybe angiodema
niacin effect and SE
inc HDL, dec LDL; flushing that be prevented with aspirin, paraesthesias, pruritis, inc LFT, GI pain
bile acid resins(cholestyramine, colestipol, colesevelam) effect and SE
dec LDL; myalgias, constipation, LFT abn, GI upset; can dec absorption of other drugs in small intestine
CAD tx
statin, BB, aspirin right away
BB 3 functions and se
Dec Bp, co, hr
Se: avoid in acute HF pts, BS, breathing issues
BB 3 functions and se
Dec Bp, co, hr
Se: avoid in acute HF pts, BS, breathing issues
Ace se
Angioedema, low K++
Ace and aldosterone
Let’s body not hold onto water and sodium
Ccb
Think Calcium “CONTRAcTS”
Relaxes blood vessels to bring more oxygen to the heart and decrease workload
Cardiac glycoside
Help heart pump more effectively
Digoxin (lanoxin)
Uses calcium and sodium in cells to contract, improves circulation and decrease edema in body
Digoxin on HR…
Use on who
Avoid in who
Decease hr and bp
Increase cardiac function and blood flow
Use for htn, cardiac arrhythmias (afib), HRT FAILURE
Avoid in MI and v fib
Safe digoxin level
SE 4
Toxicity SE/causes
0.5-2
Dizzy, gi upset, worsening edema, rash (allergy or toxicity)
Toxicity: vision changes, confusion, dizziness, N/V, bradycardia, fatigue
Low k++, bad kidneys, elderly (low gfr)
Diuretics used in what 4 cases
Htn, hrt failure, edema, CKD
Loops suffix
Moa /location
K++
Nide and mide
Inhibits reabsorption of sodium and chloride in proximal/distal tubules, loop of henle
K wasting
How to take potassium PO
IV
With a full glass of water in a meal to prevent G.I. upset 
Infusion pump and diluted if doing IV 
How do you administer for furosemide 
IV, slowly to prevent ototoxicity 
Moa thiazide
Inhibit reabsorption of sodium and chloride on the acending loop of Henley  and early distal tubule
K++ wasting must monitor
Avoid in gout pts and sulfa allergys
What med can cause hyperuricemis?
Thiazide
What to avoid if your patient has a sulfa allergy 
Thiazide
What 2 meds block aldosterone
Ace and spirinolactone
Foods high in k++
Green, leafy vegetables, tomatoes, raw carrots, orange juice, bananas, lemon, and limes
Salt substitutes 
Osmotic, diuretic mode of action
Increase the thickness of the filtrate =
So that water cannot be re-absorbed into the bloodstream 
Osmotic, diuretic name and uses
Mannitol
Used to decrease swelling and pressure. Treat cerebral edema and decrease intraocular pressure. 
Three nursing considerations for the osmotic mannitol
Only given IV
Solution may crystallize so check it prior
Perform neural assessments
