cardio/ renal drugs specific Flashcards
What is amiodrarone
(not the class)
Potassium channel blockers
Classification of amiodarone
Antiarrythmic
amiodarone MOA
prolongs repolarization by blocking potassium channels in cardiac cells
when is amidarone indicated
Indicated only for the treatment of life-threatening recurrent ventricular dysrhythmias when unresponsive to other treatments
what happens when you take amidarone
Usually hospitalized during initiation for close monitoring
Monitor BP & HR for profound hypotension and bradycardia
What should you avoid/ consider w/ AMIODARONE
Black Box warning: Fatal toxicities (pulmonary, arrhythmia exacerbation, liver, heart block)
Avoid grapefruit juice
Classification of Dilitazem
Antiarryhtmic
what does dilitazem do
Calcium channel blockers
- blocks calcium during depolarization
what might patients expieinece using dilitazem
and what should you check
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)
what to avoid with dilitazem
Use caution with otc/herbal medications d/t interactions
Avoid grapefruit juice
classification of adenosine
antiarryhmics
adenosine use
moa
emergent use,
slows conduction
svt–Supraventricular tachycardia
Patients may experience with adenosine
and what to check for
Prolonged asystole/absence of pulse (monitor w/ EKG)
Palpitations (monitor pulse for 1 minute)
hypotension (assess for orthostatic hypotension, monitor bp, advise slow positional changes)
Bronchospasms/shortness of breath (assess airway/lung sounds, monitor for severe sob)
Facial flushing (update PCP with presence, maintain skin integrity)
Loss of consciousness (assess loC)
Dizziness (teach on slow positional changes)
clarification of digoxin
antiarrythmics
what is digoxin
not the class
Cardiac glycosides
what does digoxin do
inhibits na/k pump to raise CO/ lower HR
Patients may experience with digoxin
Digoxin toxicity (n/v, fatigue, halos/blurring, bradycardia)
—Make sure to monitor digoxin levels (0.8-2.0 therapeutic)
Bradycardia (assess apical pulse x 1 minute – hold <60bpm)
What at risk for with digoxin
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!!!
medication considerations with digoxin
antidote
Use extreme caution with other medications that decrease potassium (fureosemide)
Antidote: digibind
classification of nitroglycerin
vasodilator
what does nitroglycerin treat
treats angina caused by atherosclerosis (chronic pain) or MI (acute pain)
Patients may experience with nitroglycerin
Hypotension / dizziness (monitor BP after each dose, advise slow positional changes, sit down!!!)
Headache (d/t vasodilation – increased blood flow)
Sweating (may make you feel like you’re going to pass out)
n/v
what does nitroglycerin come in
comes In sl, xr tabs, creams, patches, or iv (wear gloves when applying the patch)
nitroglycerin considerations
don’t give/keep
Keep the bottle out of sunlight / away from heat (decomposes)
Do not give with sildenafil!!! (can cause severe hypotension leading to mi/cardiac death)
furosemide classifications
loop diuretic
Furosemide MOA
prevents reabsorption of na/cl in loop of kidneys
Furosemide uses to treat
Used to treat edema, heart failure & hypertension (removes fluid – potassium wasting diuretic!!!
Patients may experience with furosemide
and what to monitor
Dehydration (rehydrate w/ electrolytes)
Hypotension / dizziness (monitor BP, advise slow positional changes)
Hypokalemia (monitor kidney function, replace potassium)
Considerations with furosemide
what monitor/when take
may need to adjust dose if causing harm to kidneys
Monitor weight (3# in day / 5# in a week) – contact pcp
Do not readjust dose independently if weight gain occurs
Administer IV furosemide Slowly (can cause ototoxicity)
Take early in the morning to prevent nocturia
classification of Hydrochlorothiazide
thiazide diuretics
Hydrochlorothiazide Moa
– promotes excretion of sodium & water
Hydrochlorothiazide use
Used to manage hypertension and edema
Hydrochlorothiazide
Patients may experience:
Electrolyte depletion (rehydrate w/ electrolytes)
Hypotension / dizziness (monitor BP, slow positional changes)
Photosensitivity (use sunscreen)
Renal impairment (monitor kidney function)
Hydrochlorothiazide considerations
Thiazide diuretics are not effective for immediate diuresis
Take at the same time each day
Monitor weight
spironolactone classification
potassium sparing diuretics
spironolactone moa
promotes excretion of sodium & water but retains potassium
spironolactone use
Used to manage hypertension and edema in HF
spironolactone
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
Spironolactone considerations
may need to adjust dose if causing harm to kidneys
Take at the same time each day
clonidine – classification
alpha 2 agonist
clonidine moa + do
stimulates alpha-adrenergic receptors = vasodilation & decreased BP
clondine use
Used to manage hypertension and adhd
Clondine considerations
Monitor heart rate and blood pressure
Do not stop abruptly d/t rebound hypertension
Avoid alcohol and other cns depressants
Patients may experience:
clondine
Hypotension (monitor BP, advise slow positional
Changes)
Dry mouth / dry eyes (rehydrate / keep moist)
metoprolol classification
beta 1 antagonist
metoprolol – moa
blocks beta-1 receptors = decreased BP & heart rate
what is metoprolol used for
Used to manage hypertension, chest pain & tachycardia
Patients may experience with metoprolol
bradycardia (monitor apical pulse & hold <60bpm)
Shortness of breath d/t bronchoconstriction (caution with breathing diagnosis)
Hypotension (monitor bp & use slow positional changes)
Metoprolol considerations
Monitor vital signs (heart rate, blood pressure, respiratory rate)
Do not stop abruptly d/t rebound hypertension
Do not crush extended-release formulas
metoprolol can mask what
Can mask hypoglycemia (monitor blood sugars if diabetic)
causes Confusion, dizziness, sweating (cool and clammy – eat some candy)
classification of captopril
ace inhibitor
captopril MOA
blocks conversion of angiotensin I to angiotensin ii
what does captopril used for and what does it do
Used to manage hypertension & heart failure
= decreased BP
what might patients experience with captopril
Dry, non-productive cough (contact pcp, medication will be stopped/changed)
Hyperkalemia (monitor kidney function, limit potassium)
Hypotension (monitor bp & use slow positional changes)
Angioedema
nursing considerations for captopril
limit
Limit all:
salt substitutes & Potassium rich foods (bananas, potatoes, oranges),
medications that increase potassium
Angioedema (go to ER!!!!) Concern for AIRWAY!!!
losartan classification
angiotensin ll receptor blocker
losartan moa
– blocks angiotensin ii = decreased BP
losartan use
Used to manage hypertension & prevent nephropathy (kidney deterioration)
what pt experience with losartan and what might nursing considerations
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
classification of hydralazine
vasodilator
hydralazine used for/moa
relaxes blood vessels to treat hypertension
what patients experience with hydralazine
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
what are you monitoring for with hydralazine
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
classification of atorovasatin
HMG-COA reductase inhibitor
atorvastatin – moa
blocks the enzyme that makes cholesterol
what is atorvastatin used for
Used to treat high cholesterol (hyperlipidemia)
Assess liver function
Patients may experience with atorvastatin –
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)
what to consider with atorvastatin –
Avoid taking with grapefruit juice
May take 2 weeks to reach therapeutic levels
classification of ezetimibe
cholesterol absorption inhibitor
ezetimibe moa
blocks cholesterol absorption
ezetimibe used for
Used to treat high cholesterol (hyperlipidemia)
Patients may experience:
with ezetimibe
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)
what to consider with ezetimibe
Avoid taking with grapefruit juice
Take as prescribed
classification of heparin
anticoagulant
heparin moa
heparin – inhibits clot formation
heparin used for
Used to prevent clots
what might patients expirience with heparin
sudden vital changes (internal bleeding)
Low BP & High HR
Bleeding (teach bleeding precautions
bleeding precautions
Use caution with knives, use soft toothbrush, use electric razor, monitor for blood in stool/urine, IM injections
medications consideration for heparin
antidote
Monitor ptt with iv use to ensure therapeutic range
High-alert medication
Avoid medications containing aspirin or nsaids
Antidote: protamine sulfate
classification of enoxaparin
anticoagulant
LMW
what does enoxaparin do
Used to prevent blood clots
advantages of enoxaparin
NO labs
what might patentees expiernce with enoxaparin
Bleeding (teach bleeding precautions)
Risk for heparin-induced thrombocytopenia (HIT) – low plt
What medications to avoid with enoxaparin and how to inject
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
classification of warfarin
anticoagulant
warfarin moa
inhibits synthesis of vitamin-k clotting factors
warfarin used for
Used to prevent clots/dvt, used for a. fib, stroke prevention
pt expirence with warfarin
Bleeding (teach bleeding precautions) – do not give w/ excessive bleeding!!!
what to avoid with warfarin and the antidote
Avoid :
-grapefruit juice
-high contact sports
-medications containing aspirin or nsaids
Antidote: vitamin k
Foods w/ Vitamin K (kale, spinach, turnips, broccoli, dark leafy greens, some vegetables)
what to monitor for with warfarin and typical onset
Monitor pt/inr to ensure therapeutic range (2.0 – 3.0)
Onset takes 2 – 7 days (may overlap w/ other treatments)
classification for Aspirin & Clopidogrel
anti platelet
Aspirin & Clopidogrel Moa
inhibits platelet activation and aggregation
Aspirin & Clopidogrel use
Used to reduce risk of Myocardial infarction (MI) & Stroke
Aspirin & Clopidogrel
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
Aspirin & Clopidogrel considerations
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)
Avoid medications containing nsaids
Overdose is irreversible
sildenafil classification
pde 5 inhibitor
sildenafil moa/ use
relaxes smooth muscles (heart) increasing blood flow (causing vasodilation)
sildenafil – 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)
sildenafil black box
Do not give with other nitroglycerin!!!!! (can cause severe hypotension leading to mi/cardiac death)
