cardio/renal drugs general drug cards Flashcards
antiarrythmics
amiodarone
Potassium channel blockers
- prolongs repolarization by blocking potassium channels in cardiac cells
Indicated only for the treatment of life-threatening recurrent ventricular dysrhythmias when unresponsive to other treatments
Usually hospitalized during initiation for close monitoring
Monitor BP & HR for profound hypotension and bradycardia
Black Box warning: Fatal toxicities (pulmonary, arrhythmia exacerbation, liver, heart block)
Avoid grapefruit juice
antiarrythmic
Diltiazem
Calcium channel blockers
- blocks calcium during depolarization
Patients may experience:
Bradycardia (assess hr) – Check VItals
Edema (assess lung sounds/presence of edema)
hypotension (assess for orthostatic hypotension, advise slow positional changes)
Headache (assess bp to ensure med is working/provide analgesic)
Dizziness (D/t hypotension – Slow positional changes)
Use caution with otc/herbal medications d/t interactions
Avoid grapefruit juice
antiarrhytmics
adenosine
emergent use, slows conudtions
prolonged absence of pulse
palpitations-moniter pulse 1 min
hypotension-BP
bronchospams-lung sounds, monitor SOB
facial flushing-skin integrity
loc-assess
dizziness-slow positional changes
Antiarrythmics
Cardiac glycosides
Digoxin
inhibits na/k pump
raises co lowers hr
digoxin toxicity- fatigue, blurring,brady cardia
risk for toxicity d/t hypokalemia (monitor potassium level (3.5-5.0)
Increased risk w/ renal impairment – can’t excrete properly so becomes toxic!!!
Use extreme caution with other medications that decrease potassium
Antidote: digibind
vasodilators
Nitroglycerin
drug
use
experience
come in
considerations
treats angina caused by atherosclerosis (chronic pain) or MI (acute pain
–Hypotension / dizziness
–Headache (d/t vasodilation – increased blood flow)
–Sweating
–n/v
comes In sl, xr tabs, creams, patches, or iv (wear gloves when applying the patch
Keep the bottle out of sunlight / away from heat (decomposes)
Do not give with sildenafil!!! (can cause severe hypotension leading to mi/cardiac death)
*Loop diuretics
drug
use
expirence
monitor
administer
furosemide
prevents reabsorption of na/cl in loop of kidneys
Used to treat edema, heart failure & hypertension (potassium wasting
dehydration, hypotension, hypokalemia,
moniter weight
administer iv slowly
take early in morning
thiazide diuretics
Thiazide
Used to manage hypertension and edema
diuretics are not effective for immediate diuresis
Patients may experience:
Electrolyte depletion (rehydrate w/ electrolytes)
Hypotension / dizziness (monitor BP, slow positional changes)
Photosensitivity (use sunscreen)
Renal impairment (monitor kidney function)
Take at the same time each day
Monitor weight
*Potassium-sparing diuretics
spironolactone
– promotes excretion of sodium & water but retains potassium
Used to manage hypertension and edema in HF
Patients may experience:
Hyperkalemia (monitor kidney function, limit potassium)
Salt substitutes & Potassium rich foods (bananas, potatoes, oranges)
Hypotension / dizziness (monitor BP, advise slow positional Changes)
Dehydration (rehydrate)
may need to adjust dose if causing harm to kidneys
Take at the same time each day
Alpha-2 agonist
clonidine
– stimulates alpha-adrenergic receptors = vasodilation & decreased BP
Used to manage hypertension and adhd
Monitor heart rate and blood pressure
Do not stop abruptly d/t rebound hypertension
Patients may experience:
Hypotension (monitor BP, advise slow positional
Changes)
Dry mouth / dry eyes (rehydrate / keep moist)
Avoid alcohol and other cns depressants
*beta-1 antagonist
metoprolol
– blocks beta-1 receptors = decreased BP & heart rate
Used to manage hypertension, chest pain & tachycardia
Monitor vital signs (heart rate, blood pressure, respiratory rate)
Do not stop abruptly d/t rebound hypertension
Patients may experience:
bradycardia (monitor apical pulse & hold <60bpm)
Shortness of breath d/t bronchoconstriction (caution with breathing diagnosis)
Hypotension (monitor bp & use slow positional changes)
Sx of hypotension: dizziness, sweating, confusion, Feeling sick (assess what they are feeling), Fainting / weakness
Cold sensitivity (offer warm blankets)
Do not crush extended-release formulas
Can mask hypoglycemia (monitor blood sugars if diabetic)
Confusion, dizziness, sweating (cool and clammy – eat some candy)
*AcE inhibitors
captopril
– blocks conversion of angiotensin I to angiotensin ii = decreased BP
Used to manage hypertension & heart failure
Patients may experience:
Dry, non-productive cough (contact pcp, medication will be stopped/changed)
Hyperkalemia (monitor kidney function, limit potassium)
Salt substitutes & Potassium rich foods (bananas, potatoes, oranges), medications that increase potassium
Hypotension (monitor bp & use slow positional changes)
Angioedema (go to ER!!!!) Concern for AIRWAY!!!
*Angiotensin ii receptor blockers (ARBS)
losartan
– blocks angiotensin ii = decreased BP
Used to manage hypertension & prevent nephropathy (kidney deterioration)
Patients may experience:
Hypotension (monitor bp & use slow positional changes)
Angioedema (go to ER!!!!) – more likely if used w/ an ace
Increased risk for infection (good hygiene/skin integrity, monitor for s/s of infection)
Hyperkalemia (monitor kidney function, limit potassium)
Salt substitutes & Potassium rich foods (bananas, potatoes, oranges), medications that increase potassium
vasodilators
hydralazine
– relaxes blood vessels to treat hypertension
Patients may experience:
Hypotension / dizziness (monitor BP, advise slow positional changes, sit down!!!)
Headache (d/t vasodilation – increased blood flow)
Palpitations / angina
Tremors, numbness, tingling
n/v/d
Monitor for infection, increased risk for developing systemic lupus erythematosus (SLE) – immune system attacks its own tissues (fatigue, joint pain, butterfly rash)
Consult pcp if 2 or more doses are missed
Monitor weight and assess for fluid retention
Hmg-cOA reductase inhibitors
atorvastatin
– blocks the enzyme that makes cholesterol
Used to treat high cholesterol (hyperlipidemia)
Assess liver function
Patients may experience:
n/V
Dyspepsia (avoid acidic/spicy foods)
Increased glucose (monitor sugars with diabetics)
Rhabdomyolysis (skeletal muscle breakdown)
Muscle pain, tenderness, weakness (contact PCP)
Myalgia (muscle pain)
Avoid taking with grapefruit juice
May take 2 weeks to reach therapeutic levels
Cholesterol absorption inhibitors
ezetimibe
– blocks cholesterol absorption
Used to treat high cholesterol (hyperlipidemia)
Patients may experience:
diarrhea
Upper respiratory infections (teach pulmonary hygiene)
Hepatic impairment (monitor liver function labs)
Rhabdomyolysis (skeletal muscle breakdown)
Muscle pain, tenderness, weakness (contact PCP)
arthralgia (joint stiffness)
Avoid taking with grapefruit juice
Take as prescribed
Anticoagulants
heparin
– inhibits clot formation
Used to prevent clots
Monitor ptt with iv use to ensure therapeutic range
Patients may experience:
Monitor for sudden vital changes (internal bleeding)
Low BP & High HR
Bleeding
stop heparin drip
Give reversal agent
Check ptt
High-alert medication
Avoid medications containing aspirin or nsaids
Antidote: protamine sulfate
Anticoagulants
Enoxaparin
(LMW Heparin) – prevents dvts
Used to prevent blood clots
Advantage: no labs!
Patients may experience:
Bleeding
monitor for blood in stool/urine
Risk for heparin-induced thrombocytopenia (HIT) – low plt
Avoid medications containing aspirin or nsaids
Injection
“love handles” of abdomen – 2” away from belly button
Given subcutaneous (bunch skin)
Do not massage
Do not express air
Anticoagulants
warfarin
– inhibits synthesis of vitamin-k clotting factors
Used to prevent clots/dvt, used for a. fib, stroke prevention
Monitor pt/inr to ensure therapeutic range (2.0 – 3.0)
Onset takes 2 – 7 days (may overlap w/ other treatments)
Patients may experience:
Bleeding (teach bleeding precautions) – do not give w/ excessive bleeding!!!
Use caution with knives, use soft toothbrush, use electric razor, monitor for blood in stool/urine
Avoid grapefruit juice
Avoid high contact sports
Avoid medications containing aspirin or nsaids
Antidote: vitamin k
Foods w/ Vitamin K (kale, spinach, turnips, broccoli, dark leafy greens, some vegetables)
Antiplatelets
Aspirin & Clopidogrel
– inhibits platelet activation and aggregation
Used to reduce risk of Myocardial infarction (MI) & Stroke
duration is 7-10 (life of a platelet)
Must stop taking several days prior to surgery d/t bleeding risk
Concurrent use (ASA & Clopidogrel) increases bleeding in elderly
Contraindicated in children <12 with flu-like symptoms (reye’s syndrome)
Patients may experience:
Bleeding (teach bleeding precautions) – do not give w/ excessive bleeding!!!
Use caution with knives, use soft toothbrush, use electric razor, monitor for blood in stool/urine
Report tinnitus, unusual bleeding/bruising/blood in stool
Avoid medications containing nsaids
Overdose is irreversible
*Pde-5 inhibitor (phosphodiesterase)
sildenafil
– relaxes smooth muscles (heart) increasing blood flow (causing vasodilation)
Patients may experience:
Hypotension / dizziness (monitor BP, advise slow positional changes, sit down!!!)
Headache (d/t vasodilation – increased blood flow)
flushing (may make you feel like you’re going to pass out)
Vaso-occlusive crisis (occlusion of blood vessel)
Priapism (go to er if lasts >4 hours)
Do not give with other nitroglycerin!!!!! (can cause severe hypotension leading to mi/cardiac death
