Cardio System(Pharm) Flashcards
Nitroprusside(Nipride)
-Nitroprusside(Nipride)
Dopamine(Intropin)
-Dopamine(Intropin)
Epinephrine(Andrenalin)
-Epinephrine(Andrenalin)
Warfarin Na(Coumadin)
-Warfarin Na(Coumadin)
Amlodpine(Norvasc)
-Amlodpine(Norvasc)
Lisinopril(Prinivil)
-Lisinopril(Prinivil)
Captopril(Capoten)
-Captopril(Capoten)
Amiodarone Cl(Cordarone)
-Amiodarone Cl(Cordarone)
Ticlopidine(Ticlid)
-Ticlopidine(Ticlid)
Clopidogrel(Plavix)
-Clopidogrel(Plavix)
Simvastatin(Zocor)
-Simvastatin(Zocor)
Digoxin(Lanoxin)
- Digoxin(Lanoxin)
- cardiac glycoside
- cardiotonic
- po,im,iv
- loading dose(0.5-1.25 every 6-8hrs initially
- maintenance dose(0.125-0.25mg daily)
- 0.8-2.0ng theraputic dig level
Procainamide(Pronestyl)
-Procainamide(Pronestyl)
Lidocaine(Xylocaine)
-Lidocaine(Xylocaine)
Isosorbide(Isordil)
- Isosorbide(Isordil)
- NItrate drug
- coronary vasodilator
- po,chewable,sublingual
- sublingual-under tongue, dont drink,smoke,eat after
- taking on empty stomach
Propanolol(Inderal)
-Propanolol(Inderal)
Dilitiazem(Cardizem)
-Dilitiazem(Cardizem)
Nifedipine(Procardia)
-Nifedipine(Procardia)
Verapamil(Isoptin)
-Verapamil(Isoptin)
Methyldopa(Aldomet)
-Methyldopa(Aldomet)
Enoxaprin(Lovenox)
-Enoxaprin(Lovenox)
Cardiac Glycosides(Cardtiotonics) ACTION: DIGOXIN
action:
- act directly on the myocardium to slow down conduction and increase the force of myocardial contraction
- increase cardiac output through positive inotropic activity
- decrease conduction velocity through the SA/AV nodes
- result increase efficency and improved contraction of the heart muscle
Cardiac Glycosides(Cardtiotonics)
DIGOXIN
INDICATION:
indication:
- heart failure
- atrial fibrilation
- supraventricular tachycardia
Cardiac Glycosides(Cardtiotonics)
DIGOXIN(LANOXIN)
Route/Dose:
-po,im,iv
-digitalization: a series of doses given until the drug begins to exert full therapeutic effect
Dose:
-loading dose: 0.5-1.25mg every 6 to 8hrs initally
-maintainance dose: 0.125-0.25mg daily
-Theraputic dig level: 0.8-2.0ng
-over 2.0 is toxic
Cardiac Glycosides(Cardtiotonics)
DIGOXIN
Side effect:
Gi: early signs=N&V, anorexia,diarrhea
Neuro: headache,facial pain,apaty,drowsiness,disorientation,confusion,mental depression,delirium, convulsion
Visual: blurred,galo,diplopia,colored vision,yellow vision
Cardiac: bradycardia,tachycardia,extra systole,extra beats,atrial fibrilation and flutter
early signs of toxicity=nausea,vomitting, anorexia,diarrhea
later signs of toxicity=changes in mental status
Early signs of toxicity(Digoxin)
nausea,vomitting,anorexia,diarrhea
Later signs of toxicity(Digoxin)
changes in mental status
Factors that predispose patient to digoxin toxicity
- increase potassium
- decrease potassium
- decrease magnesium
- renal impairment
- recent mi and iv administration
- hypothyrodism-slows metabolism
Treatment of digoxin toxicity
1-withdraw drug(hold med)
2-treat the dysrrythmia with dilantin
3-atropine for bradycardia
antidote for digoxine is digibind not first line choice b/c drug is life threatening
Digoxin(Lanoxin) Nursing implication
- digoxin onset action 30min peak 2hrs, duration 2-6day
- i/o-weight-examine extremities for edema
- 2lbs per day or 5lbs per week must be recorded
- B/P-respiration-sputum ausculate lungs
- assess for jugular vein distention=fluid retention
- assess apical heart rate one full minute
- take same time each day
- oral preparation w/o regards to meals
- avoid antacid
- decrease k levels, increase k levels
- poorly absorbed IM
- periodic EKG-electrolytes/kidney function
Digoxin(positive outcomes)Cardiac Glycosides(Cardtiotonics)
- increase urine output
- decrease weight
- decreae edema
- decrease SOB
- decrease fatigue
Digoxin(interactions)Cardiac Glycosides(Cardtiotonics)
- antibiotics:macrolides,tetracycline
- antifungal: ketoconozole
- NSAIDs
- Benzodiazepine: xanax
- antiarrythmic-verapermil
- antacids-kapectate
- thyroid hormone
- antileptics
- oral aminoglycoside
- antitubercular-rifampin
- antineoplastic
Phosphodiesterase Inhibitors(Action)
Amirone
Primacor
- positive inotropic activity
- vasodilating properties
Phosphodiesterase Inhibitors(indication)
Amirone
Primacor
-short term management of heart failure when digioxin doesnt work
Phosphodiesterase Inhibitors(adverse reaction)
Amirone
Primacor
- n/v
- arrythmias
- sudden death
- not first line treatment
- hypotension
Phosphodiesterase Inhibitors(drugs)
amirone
primacor
amirone
primacor-20-30x stronger than amirone
Atrial Natriuretic peptide hormone(ANP)
Action
- inhibit the renin angiotension aldosterone system
- binds w/ smooth vascular muscle-cause vasodilation
- reduce intravascular fluid volume
Atrial Natriuretic peptide hormone(ANP)(Indication)
-CHF w/ dyspnea at rest
Atrial Natriuretic peptide hormone(side effect)
- hypotension
- decrease kidney function
- drop in Bp
Antiarrythmic drug
- used to teat abnormal electrical activity in the heart.
- act in different ways to diminish or obliterate arrhythmias
- antiarrhythmic agents are divided into four classes/groups based on their similarity of their action
Sodium Channel Blockers(CLass 1)
-blocks movement of sodium into myocardial cells
use:
-anesthetic like effect on myocardial cells
-ventricular tachy arrthymia
-used only in benefits outweigh the risk
-patient who are dying
Drug: Moriazine HCL(Ethnozine)
Quinidine(Class 1A)(ACTION)
origin: cinchonobark
action: membrane stablizing effect on myocardial cells to decrease excitability
Quinidine(Class 1A)(indication)
used for:
- atrial and ventricular arrythmia
- first line treatment for malaria
Quinidine(Class 1A)(adverse effect)
- cinchinism=effect cns=neurotoxicity=gi/neuro effect
- gi: n/v, anorexia,diarrhea
- cardiac: hypotension, vtach,vfib,embolism
- hypersensitivity: mild to severe
- bone marrow suppression
Quinidine(Class 1A)(interaction)
- anticoagulants: increase bleeding
- antacid: decrease absorbtion
- digoxin,betablock,ca chan bloc: increase cardiac depression
Quinidine(Class 1A)(Nursing implication)
- monitor apical pulse
- po w/meals
- avoid citrus
- shell in stool-sustained release
- iv test dose-supine position
- monitor k level
- monitor serum levels=2-6mcg
Quindine drugs
Disopyramide
action: decrease rate of absorption
adr: atropine like
contraindication: atropine like
use: ventricular arrhythmia
dose: q6 100-150mg
atropine: treat bradycardia
procainamide indication: first line drug of choice for vtach/vfib/pulselessness* route:po,parental dose:250-500mg adr: cross sensitivity w/ procaine gi irritation drowsiness dizziness joint pain, butterfly rash(lupus like symptoms) blood dyscaria
Lidocaine(Xylocaine)-Class 1B(action)
action:increase threshold of myocardial cells. decrease myocardial excitability
Lidocaine(Xylocaine)-Class 1B(indication)
- premature ventricular contraction post mi
- dose 100mg bolus,then 400mg in 500ml d5w infuse mg/kg/min
Lidocaine(Xylocaine)-Class 1B(adverse effects)
- neurological-dizzy,drowsy,confusion
- decrease heart rate
- resp depression
- gastrotoxic
Mexiletin-class 1b
po lidocaine
- all gastrotoxic
- all neuro toxic
- given po
phenytoin(dilatin)-class 1b-
antriarrythmic/hydantoin/anti-convulsant
-only to treat digoxin induced arrhythmia
Flecainidie-class 1C
action: decrease conduction in bundle of his and purkinjie fibers
indication: severe ventricular arrhythmia
route: po
Beta Blockers-class 2
1st/2nd generation
-2nd generation more cardia selective=decrease bronco spasm incidences/decrease risk of adverse effect
action: reduce sympathetic excitation in the heart by blocking cardiac cell response to epinephrine
indication/use:supraventricular arrhrythmia
Beta Blockers-class 2(drug)
- propranolol hcl(inderal)-
- 10mg 3x day TID
- every 8hrs evenly spaced around the clock
- treatment plan for migraine
- indication: hypertension,angina,migraine,panic attack/stage freight, treat
-metoprolol tartrate(lopressor)
Beta Blockers-class 2(side effect)
- gi: n/v
- resp: tachypnea, wheezing, dyspnea,broncospasm
- cardiac: hypotension(inhibit renin-angiotension),bradycardia,cardiac arrhythmia,angina,chf
- endocrine:hypoglycemia
- reproductive-impotence
- circulatory: Raynauds phenomenom=spasms in blood vessels effecting circulation
- neuro-fatigue
- skin: rash, purtitus
- mood: mental depression
- interaction: drugs that decrease b/p an pulse
- contraindication: COPD,PVD, heart disease and diabetes
Potassium Channel Blockers(action)
action: lengthen action potential of myocardial cells
Potassium Channel Blockers(Drugs)
-Bretylium Tosylate-causes severe hypotension
- Amiodarone HCL(cordarone)
- vasodilating properties,decrease hr
- decrease contractibility of left ventricle
- negative inotropic
- side effect-sandy eyes,discoloration of skin blue/gray,photosensitivity,hypotension,pulmonary toxicity
- Adenosine(Adenocard)
- natural chemical found in all cells
- aides in transfer of energy
- increase release of prostaglandins
- decrease platale aggrgation(bleeding)
- drug of choice for: SVT
-i/v protect from crystallization
Calcium Channel Blocker(class 4)(action)
- block ca uptake by myocardial cells
- decrease force of contraction
- decrease cardiac output
Calcium Channel Blocker(class 4)(side effect)
- same as beta blocker
- hepatoxicity
gi: n/v, PLUS SWOLLEN GUMS - resp: tachypnea, wheezing, dyspnea,broncospasm
- cardiac: hypotension(inhibit renin-angiotension),bradycardia,cardiac arrhythmia,angina,chf
- endocrine:hypoglycemia
- reproductive-impotence
- circulatory: Raynauds phenomenom=spasms in blood vessels effecting circulation
- neuro-fatigue
- skin: rash, purtitus
- mood: mental depression
- interaction: drugs that decrease b/p an pulse
- contraindication: COPD,PVD, heart disease and diabetes
Calcium Channel Blocker(class 4)(indication)
-use to treat (atypical)angina,hypotension,tachy-arrythmia
Calcium Channel Blocker(class 4)(drugs)
Amlodipine(norvasc)-
Diltiazem HCL(cardizem)-
Nifedipine(Procardia)-
Verapamil(Calan)-used for SVT-AFIB
Anticholinergic
-bradycardia
-prodysrhythmic effect of antiarrhythmic drug
drug used: atropine/anti-cholinergic
ADE: mad as hatter, red as a beat, blind as a bat, dry as bone
-elevated temp, confusion,blurry vision, flushed skin
Antianginal/vasodilators
types: 1)peripheral2)coronary
a. nitrates b.beta blockers c.calcium channel blocker
peripheral vaso dilators(action)
- relax the smooth muscle layer of atrerial blood vessels
- block alpha adrenegic receptors and stimulate beta adrenegic receptors
- dilate vascular bed in the femoral blood vessels
- inhibit platelet aggregation=risk for bleeding
peripheral vaso dilators(indication)
-intermittent claudication,PVD,Raynauds disease or burgers disease
peripheral vaso dilators(side effects)
- lowbp=hypotension
- every vasodilater has ability to drop bp
- flushing,tingling,dizziness,nervousness,postual hypotention, tachycardia, gi irritation, orthostatic hypotension
peripheral vaso dilators(interaction)
-betablockers-also hypertensive so cause greater hypertensive effect
peripheral vaso dilators(nursing implication)
- change in position slowly
- stop smoking b/c contricts vessels
- decrease cholesterol intake
- decrease caffeine intake=vaso contrictor
- caution pt with bleeding tendencies
- footcare: assess peripheral circulation: color,temp,pulses,edema,pain,foster circulation,pedal pulse cap refill in toes
- exercise to promote circulation
Coronary vaso dilator
indication: angina pectoris
action: opens coronary blood vessels, decrease cardiac workload, decrease cardiac oxygen consumption,increase risk for edema
Nitrate(coronary vasodilator)(Drug)
isosorbide dinitrate(isordil)-po, chewable,sublingual
- taken on empty stomach
- 1 before - 2hrs after
Nitroglycerin(Sublingual)
ac. attack of angina pectoris
- take at 5min interval, if no relief call md and go back to hospital
- dose: 0.4mg
- pain disappear in 1-3 min
- throbbin headache indicates potency
- burning sensation under tongue=potency/freshness of drug
- drop BP, hypotension
Nitroglycerin(lingual spray)
- 60-200meter dose
- indication-ac attack,hypertension
Nitroglycerin(patch)
-comes off at sleep to decrease tolerance
Nitroglycerin(IV)
-emergency treatment for high bp,vhf,post mi, and hypertension during cardiac surgery
Nitroglycein side effect/coranary vasodilator
3 H’s
Headache,Hypotension,Increarse heart rate
Nitroglycein(interaction)
- tobacco,cold,atropine
- viagra(vaso dilator causes futher dilation)
