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Pharmacology N322 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Nitrate NI

A

• AE: HA (primary), hypotension, reflex tachycardia, tolerance
• Teach Nitro Protocol for Administration**
o Can have systolic drop of 40.
o Always check BP and Pulse.
o Wait 5 minutes, still having chest pain-check BP and pulse again before giving more.
o If take one at home want to call provider and let them know.
o Light sensitive—needs to be stored in cool, dry, dark place, expires in 6 months.
• Contraindicated w/ phosphodiesterase Type 5 inhibitors (Viagra)— will cause massive hypotension and possible death.
• Monitor for drug tolerance—make sure they don’t take it for anxiety. Patch on in the morning and off at night. 12hours off.
• Wear gloves! Absorbed through skin.
• Can be IV, SL (sublingual), short or long acting tablet, topical patch/creams
• ST depression, ST elevation, new BBB give nitro. Maybe tombstone T’s
a. Looks like they may be having a heart attack.

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2
Q

Class 2 Beta blockers

A

Metoprolol

BP, HR, bronchoconstriction

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3
Q

Mannitol NI

A

Edema except in brain.
hold when Na >160
only given IV and ICU setting. ICP>20

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4
Q

Sympatholytics

A

Alpha 1 Adrenergic Blockers

Beta Adrenergic Blockers
(B1-heart, B2 lungs)

Adrenergic neuron Blockers

Centrally Acting Alpha 2 Agonists

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5
Q

Negative inotropes

A

Decrease contractility

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6
Q

Alpha/Beta blockers

A

-ilol, -alol

Carvedilol, labetalol

dizziness, bradycardia, hypotension

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7
Q

Loop diuretics SE

A

Same as thiazide plus:

Ototoxicity and nephrotoxicity

NSAID and ACE increase nephrotoxicity

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8
Q

Na channel IA blockers use

A

Quinidine-AF, Aflutter, Vt

Procainamide-VT

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9
Q

Adenosine use

A

SVT

first dose is 6mg given fast, can repeat if needed

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10
Q

Aldosterone antagonists

nursing implications

A

Hyperkalemia-hold if K hits 5. Kayexalate to reverse (poop out K)

renal impairment: BUN and Cr

CYP3A4: grapefruit, macrolides, HIV meds

Lithium toxicity

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11
Q

Thiazide labs

A

BUN, Cr, GFR

ineffective if GFR <20

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12
Q

Cardiac dysrhythmia Drugs and class

A 
Class 1: Sodium channel blockers
Class 2: Beta Blockers
Class3: K channel blockers
Class 4: Ca channel blockers
Class 5:  Adenosine, atropine, epinephrine
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13
Q

Diuretics

A

Thiazide diuretics, loop diuretics, Potassium sparing diuretics, osmotic diuretics,

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14
Q

Positive chronotrope

A

Increases HR

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15
Q

Clonidine NI

A

drowsiness, dry mouth, euphoric and hallucinogenic effects at high doses

Must be tapered or experience withdrawal symptoms

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16
Q

ACE inhibitors

A

-pril

Angioedema, Cough, hyperkalemia, major side effects

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17
Q

Non-DHP use

A

Angina: Verapamil but don’t usually give.

Cardiac dysrhythmias: Verapamil and diltiazem

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18
Q

Direct Acting Vasodilators

A

Hyrdalazine–arterial vasodilation

Nitroprusside: venous and arterial dilation (more for HTN emergencies

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19
Q

Class 1 sodium channel blockers

A

A: Quinidine(Heart block and thrombocytopenia, Procainamide 1:08
 IB: Lidocaine(confusion and drowsy, need drip slowed down, don’t stop it), Mexitil
 IC: flecainide (Tambocor)(worsening heart failure, sob, weakness); propafenone (Rythmol)(neutropenia)
 IA: Lidocaine most widely used in ICU
 1C: home use.
 Torsaudes possible side effect of all of them.

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20
Q

Direct Renin Inhibitors

A

Aliskiren

Cough and Hyperkalemia

Rarely prescribed, affects all aspects of RAAS

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21
Q

Centrally acting alpha 2 agonists

A

Clonidine

Severe HTN, severe pain, ADHD

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22
Q

digoxin NI

A

• AE or early toxicity: Anexoria, nausea, CNS effects-visual changes: discolorations or halos, arrhythmias.
Hold if HR less than 60.

If low potassium will cause dig toxicity
If too much K, likely dig blocking, lots of K floating around.

• Teach about toxicity and symptoms
• Dig Toxicity risks: K, CR/BUN, concurrent use with amiodarone, verapamil, or quinidine
• Watch with any drug causing hypokalemia (cardiac toxicity d/t K loss) –diuretics
• Therapeutic level: 0.5-2.0 ng/mL
• Given orally or IV, sometimes w/ IV loading doses then switch to oral
 Antidote: digoxin immune fab, (digibind)
 Give it and then treat symptoms.

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23
Q

Carvedilol use

A

HF: have CHF if on this drug

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24
Q

K sparing

A

Spironolactone

Hyperkalemia

Steroid effect:
dysmenorrhea, facial hair growth, gynecomastia, impotence.

Don’t use with severe renal failure, hyperkalemia and pregnancy

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25
Q

Thiazide diuretics

A

Hydrochlorothiazide (HCTZ)

HTN, CHF, liver ascites

Hyponatremia, hypokalemia, hyperglycemia, hyperuricemia

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26
Q

Direct Acting Vasodilators use

A

HTN

Hydralazine often used for African American pts with heart failure. Also common for use in end stage renal disease.

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27
Q

Negative chronotropes

A

Decreases HR

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28
Q

Statin NI

A

myopathy, Rhabdo, liver toxicity

29
Q

sympathomimetics

A

dobutamine, dopamine, vasopressors

dobutmaine: HF
dopamine: Hypotension, HF, bradycardia

30
Q

Antilipemic

A

HMG-CoA reductase inhibitors, Statins

Lower LDL (high cholesterol)

Atorvastatin higher likelihood of decreasing triglycerides.

Can reduce CVA in high risk patients

31
Q

Labetalol use

A

HTN: hypertensive crisis

32
Q

What meds are all positive chronotropes?

A

Anticholinergics

33
Q

Nitrates

A

Prevent or treat angina

works on smooth muscle to promote vasodilation, decreases pre and afterload, less 02 demand

34
Q

Na channel blockers IC

A

Flecainide, propafenone-SVT, AF, VT

35
Q

Calcium channel blockers Nursing implications

A
  • Hypotension: Monitor vitals
  • Peripheral Edema: of feet and legs, thought that these increase capillary permeability.
  • Tachycardia: from sudden improvement in BP
  • Bradycardia: common with non DHP; do no give in AV block
  • IR (Immediate)vs CR (controlled release): watch for facial flushing, dizziness
  • Gingival hyperplasia.
36
Q

Fibrates

A

Gemfibrozil

Reduce triglycerides, less effective for LDL, HDL

Warfarin can cause higher levels of the the anticoagulant–Monitor INR

37
Q

Alpha 1 Adrenergic Blockers

A

-zosin

Rarely used for BP

use: HTN and BPH

implications:
Ortho hypo, HA, nasal congestion.

Don’t give with sildenafil: extreme hypotension

38
Q

beta blockers

A

Metoprolol: SVT, AF, AFlutter, ST

39
Q

Calcium channel blockers

2 types

A

Non-DHP
Verapamil, Diltiazem

DHP
Amlodipine (-dipines)

40
Q

Dopamine therapeutic use

A

 Stimulates Dopaminergic, Beta1 and Alpha1 receptors, but effects vary by dose. Positive Inotrope and Chronotropic Effects
 Low dose: dilate vessels in heart, brain, kidneys, mesentery (dopaminergic activity)
o Maybe kidney failure trying to improve perfusion to kidney
 Higher dose: contractility and CO (beta 1 activity)
o Positive inotrope and chronotrope
 Highest dose: vasoconstriction (alpha 1 activity)
o BP in the crapper
o Sepsis 3L fluid then give. Gotta fill the tank
o Won’t use if patient is tachycardic.

41
Q

First drug to treat HTN

A

HCTZ

42
Q

dopamine NI

A
  • AE: HR, arrhythmias, angina
  • Don’t give with dehydration
  • Monitor BP, HR, UO-should see increased urine because of increased perfusion.
  • Monitor EKG
  • All given IV and titrated to desired effect. Peaks 10-15 mins after starting
43
Q

digoxin therapeutic use

A
  • Rate control w/ atrial arrhythmias

* Symptom management with HF

44
Q

Epinephrine use

A

Asystole (also use dopamine), Afib, PEA rhythms

45
Q

Statin Labs

A

CPK, LFT (baseline and periodic), cholesterol, liver and kidney

CYP3A4-no grapefruit, macrolides, antifungal

46
Q

Class 3: K channel blockers

A

Channel Blockers
 amiodarone (Cordarone)(VFIB, VTACH, AFIB, Aflutter)(given after epinephrine

 amiodarone:SE pulmonary fibrosis (check PFTs), never goes away, may get worse. Sign of toxicity. Can cause blue grey skin. Look like a smurf, doesn’t generally go away

 Amiodarone can increase blood levels of several drugs including digoxin, phenytoin, diltiazem, warfarin, and statins. Increases chance of dig toxicity.

	sotalol (Betapace): special properties of both beta blocker and potassium channel blocker
o	actually a class 2 and 3

All can cause: All cause prolonged QT

47
Q

Cardiac glycosides

A

Positive inotrope, negative chronotrope.

Digoxin

Sits on Na/k pump so K can’t enter, pushes Ca++ out.
K and dig fight for same pump. If low K, digoxin will hog them all and become dig toxic.
Lots of K floating around so can cause hyperkalemia.

48
Q

Loop Diuretics

A

Most Potent

Furosemide

Renal, cardiac, liver failure. pulmonary edema

HTN

49
Q

DHP

A

Antihypertensive

50
Q

Positive inotropes

A

Meds that increase contractility

51
Q

Vasopressors

A

Nor Epi: raise blood pressure in shock states

52
Q

Coated med

A

extended release, can’t crush

53
Q

Antianginal

A

Nitrates

beta-blockers and Calcium channel blockers (non-DHP): used to help with symptoms (tachycardia)

54
Q

Na Channel blockers IB

A

lidocaine- VF, VT

55
Q

Phosphodiesterase inhibitors

A

Milrinone

Positive inotrope

CHF

SE: dysrhythmia, hypotension, hypokalemia.

IV only, must be on tele

56
Q

ACE nursing implications

A

Hypotension-take pm if orthostatic hypotension

Dry cough from bradykinin (stop med)

Contraindicated for pts with renal failure also for dehydration

NSAIDs decrease effectiveness*

Pregnancy D, shouldn’t take while breastfeeding.

Should only be on one RAAS drug

57
Q

Beta Adrenergic Blockers

A

-olol

HTN, angina, dysrhythmias

Can precipitate and treat HF

58
Q

RAAS suppressants

A

ACE inhibitors, angiotensin receptor blockers (ARBS), Aldosterone Antagonists (K+ sparing diuretics), Direct renin Inhibitors, Ca+ channel blockers.

59
Q

Atropine use

A

Bradycardia

.5 first dose, repeat every 3-5 mins, max of 3 mg

60
Q

Ca channel blockers

A

diltiazem, verapamil: Afib, Aflutter

61
Q 
Aldosterone Antagonists
(potassium sparing diuretics)
A

Spironolactone, HCTZ

Blocks aldosterone, (essentially testosterone as well)

SE: Ed, impotence, loss of libido, feminizing features.

62
Q

Beta adrenergic Blockers

A

Bronchoconstriction–caution asthma and COPD

Bradycardia and Hypotension***

hypoglycemia

63
Q

Loop diurteics labs

A

BUN, Cr, all electrolytes, especially Na and K

64
Q

K channel blockers

A

Amiodarone, sotalol: Vfib, Vtach, Aflutter

65
Q

Torsades treatment

A

Mg

66
Q

Direct Acting Vasodilators

A

Increase HR and plapitations, SLE (lupus) syndrome

Abrupt stop can cause severe HTN

67
Q

Angiotensin Receptor Blockers (ARBS)

A

-sartan

Less protective than ACE

Similar side effects as ACE but no cough, angioedema is less common

monitoring and teaching same as ACE

68
Q

Osmotic Diuretics

A

Mannitol (only drug approved in US)

Cerebral or ocular edema:
decrease ICP and IOP

rarely used for kidney protection in acute renal episode

not used for HTN

69
Q

digoxin antidote

A

Digibind (digoxin immune fab)

Pharmacology N322 (11 decks)

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