Cardiovascular + BP Flashcards
Which drug will help reduce preload?
Furosemide, lisinopril
Which drug will increase after load?
Metoprolol, lisinopril
What drug increases contractility?
Digoxin
Drug card:
Digoxin
Goal: slower but more powerful heart
MAIN DRUG FOR HF
*drug-drug: Amiodarone and other antidysrhythmic drugs
What are CM of digoxin toxicity?
— bradycardia
— headache
— dizziness
— confusion
— nausea/vomiting
— visual disturbances
CARDIAC ARREST IS POSSIBLE
What is the reversal agent for digoxin toxicity?
Digoxin immune fab
Review of Patho:
CAD
— atherosclerosis narrows coronary arteries
Risk for plaque rupture with unstable plaque
Decreases blood flow
Higher risk for MI - tissue death
Review of Patho:
Stable and unstable angina:
Stable:
— increased O2 demand
— relieved with rest and nitroglycerin
— chest pain with exertion
Unstable:
— chest pain at rest
— unrelieved with nitroglycerin
— possible MI
Drug card:
Nitroglycerin
What are important things to monitor and teach with nitroglycerin?
Monitor:
— BP after admin
— high fall risk
Teach:
— administer 1 dose q5 min up to 3 doses
— must be stored in a dry, dark place; glass container
— refill when expired
Review of Patho:
Arrhythmias:
Afib:
Dyssynchronous firing of atria; uncoordinated with ventricles
Medications:
Metoprolol
Diltiazem
Amiodarone
Medication to control ventricular arrhythmias
Lidocaine
All antidysrhythmics have which general adverse effects?
Bradycardia
Heart blocks
Arrhythmias
Hypotension
Drug-drug interactions with antidysrhythmics:
Use of other antidysrhythmics
Antihypertensives - risk for hypotension
Drug card:
Lidocaine
Drug card:
Amiodarone
Antihypertensives:
Important administration considerations?
TAKE BP PRIOR TO ADMIN!
All can cause hypotension
— if dosed once daily, give in the AM
Do not abruptly discontinue; do not alter extended release tabs
How long do you need to give an Antihypertensive through IV push?
Minimum of 2 minutes
*tele monitor
When do you need to evaluate your patient after giving an antihypertensive?
IV push + oral:
IV push: 5-10 minutes
Oral: 1 hr
Drug card:
Lisinopril
What is the ACE acronym for adverse effects?
A = angioedema
C = cough
E = elevated potassium
Drug card:
Losartan
Drug card:
Nitroprusside
Drug card:
Diltiazem
Drug card:
Metoprolol
Antihypertensives:
Assessments
— focus on CV, resp, and neuro assessments
— assess cardiac rhythm
— always assess HR and BP prior to admin
What labs do you need to assess with your patient on antihypertensives?
Electrolytes
Kidney + liver function
What are BP parameters?
HIGH BP: systolic above 180; diastolic above 110
LOW BP: systolic below 90; diastolic below 60
*do not give hypertensives with low BP
CALL MD
Heart rate parameters for antihypertensives:
Hold if HR below 60
What are interventions for antiarrhythmic drugs?
— monitor cardiac rhythm with admin of IV agent
— ensure emergency life support equipment readily available
Antiarrhythmic education:
Medication: dosing, timing, AE
— do not abruptly discontinue medication
— how to assess pulse, BP, and s/s of bradycardia and hypotension
— need for follow-up and monitoring
What are interventions with antihypertensives?
— monitor for situation may lead to decrease fluid volume
— reduce risk for falls
What do you need to educate your client when taking antihypertensives?
Lifestyle change: weight loss, stop smoking, decrease alcohol/salt intake
— medication: dosing, timing, AE
— do not abruptly discontinue
— how to assess pulse, BP, and s/s of bradycardia or hypotension
— need for follow-up and monitoring
What are the goals for patients on antihypertensives? What do you need to assess?
BP goal for most clients: systolic below 140 and diastolic below 90
*multiple hypertensives may be needed for this goal
HR goal for afib: HR <110
CAUTION: drug-drug interaction with multiple meds that slow HR
AE:
— bradycardia
— hypotension
What are drug considerations with children, adults, pregnant women, and older adults?
Children:
Safety of meds not widely studied
Adults:
Drug-drug interactions, co-morbidities, appropriate education
Pregnancy:
Many meds are category D; risk vs benefit
Older adults:
More susceptible for hypotension, bradycardia, toxic effects due to underlying disease that interfere with metabolism and excretion
*high fall risk
