Cardiovascular + BP

Question 1

Which drug will help reduce preload?

Answer 1

Furosemide, lisinopril

Question 2

Which drug will increase after load?

Answer 2

Metoprolol, lisinopril

Question 3

What drug increases contractility?

Answer 3

Digoxin

Question 4

Drug card:
Digoxin

Answer 4

Goal: slower but more powerful heart
MAIN DRUG FOR HF

*drug-drug: Amiodarone and other antidysrhythmic drugs

Question 5

What are CM of digoxin toxicity?

Answer 5

— bradycardia
— headache
— dizziness
— confusion
— nausea/vomiting
— visual disturbances

CARDIAC ARREST IS POSSIBLE

Question 6

What is the reversal agent for digoxin toxicity?

Answer 6

Digoxin immune fab

Question 7

Review of Patho:
CAD

Answer 7

— atherosclerosis narrows coronary arteries
Risk for plaque rupture with unstable plaque
Decreases blood flow
Higher risk for MI - tissue death

Question 8

Review of Patho:
Stable and unstable angina:

Answer 8

Stable:
— increased O2 demand
— relieved with rest and nitroglycerin
— chest pain with exertion

Unstable:
— chest pain at rest
— unrelieved with nitroglycerin
— possible MI

Question 9

Drug card:
Nitroglycerin

Answer 9

Question 10

What are important things to monitor and teach with nitroglycerin?

Answer 10

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

Question 11

Review of Patho:
Arrhythmias:

Answer 11

Afib:
Dyssynchronous firing of atria; uncoordinated with ventricles

Medications:
Metoprolol
Diltiazem
Amiodarone

Question 12

Medication to control ventricular arrhythmias

Answer 12

Lidocaine

Question 13

Question 14

All antidysrhythmics have which general adverse effects?

Answer 14

Bradycardia
Heart blocks
Arrhythmias
Hypotension

Question 15

Drug-drug interactions with antidysrhythmics:

Answer 15

Use of other antidysrhythmics
Antihypertensives - risk for hypotension

Question 16

Drug card:
Lidocaine

Answer 16

Question 17

Drug card:
Amiodarone

Answer 17

Question 18

Question 19

Question 20

Question 21

Antihypertensives:
Important administration considerations?

Answer 21

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

Question 22

How long do you need to give an Antihypertensive through IV push?

Answer 22

Minimum of 2 minutes
*tele monitor

Question 23

When do you need to evaluate your patient after giving an antihypertensive?
IV push + oral:

Answer 23

IV push: 5-10 minutes
Oral: 1 hr

Question 24

Drug card:
Lisinopril

Answer 24

Question 25

What is the ACE acronym for adverse effects?

Answer 25

A = angioedema
C = cough
E = elevated potassium

Question 26

Drug card:
Losartan

Answer 26

Question 27

Drug card:
Nitroprusside

Answer 27

Question 28

Drug card:
Diltiazem

Answer 28

Question 29

Drug card:
Metoprolol

Answer 29

Question 30

Antihypertensives:
Assessments

Answer 30

— focus on CV, resp, and neuro assessments
— assess cardiac rhythm
— always assess HR and BP prior to admin

Question 31

What labs do you need to assess with your patient on antihypertensives?

Answer 31

Electrolytes
Kidney + liver function

Question 32

What are BP parameters?

Answer 32

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

Question 33

Heart rate parameters for antihypertensives:

Answer 33

Hold if HR below 60

Question 34

What are interventions for antiarrhythmic drugs?

Answer 34

— monitor cardiac rhythm with admin of IV agent
— ensure emergency life support equipment readily available

Question 35

Antiarrhythmic education:

Answer 35

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

Question 36

What are interventions with antihypertensives?

Answer 36

— monitor for situation may lead to decrease fluid volume
— reduce risk for falls

Question 37

What do you need to educate your client when taking antihypertensives?

Answer 37

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

Question 38

What are the goals for patients on antihypertensives? What do you need to assess?

Answer 38

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

Question 39

What are drug considerations with children, adults, pregnant women, and older adults?

Answer 39

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