Cardiovascular II Flashcards
1
Q
classes of CV II drugs
A
- cardiac glycosides
- adrenergic agonists
- organic nitrates
- antidysrhythmics
- antilipemics
2
Q
HF
A
heart failure
3
Q
heart failure types
A
- systolic
- diastolic
- right-sided
- left-sided
4
Q
systolic phase
A
when blood is pumped out of heart
5
Q
diastolic phase
A
when blood fills heart
6
Q
heart failure
A
demand for blood is unmet by heart’s effort
7
Q
S/Sx of left-sided HF
A
- dyspnea
- paroxysmal nocturnal
- exertional
- orthopnea
- ↑ pulmonary capillary wedge pressure
- pulmonary congestion
- restlessness
- confusion
- orthopnea
- tachycardia
- fatigue
- cyanosis
8
Q
S/Sx of right-sided HF
A
- fatigue
- ↑ peripheral venous pressure
- ascites
- enlarged liver, spleen
- may be 2/2 chronic pulmonary issues
- JVD
- anorexia
- c/o GI distress
- wt gain
- dependent edema
9
Q
S/Sx of pulmonary congestion
A
- cough
- crackles
- wheezes
- blood-tinged sputum (frothy)
- tachypnea
10
Q
One of the most common causes of pulmonary HTN is _______ _______ ______.
A
left-sided heart failure
11
Q
Pts with long-standing ____ or ____ are at risk for left-sided HF.
A
- HTN
- CAD
12
Q
Pulmonary HTN can exacerbate dz in what vital organ?
A
liver
13
Q
systolic HF
A
- heart doesn’t pump blood with enough force
- muscle is weaker
- less blood ejected
14
Q
diastolic HF
A
- heart doesn’t fill as much
- thickened, stiff muscles
- less blood ejected
15
Q
SV x HR =
A
CO
16
Q
SV
A
stroke volume
17
Q
CO
A
cardiac output
18
Q
average SV
A
70-80 mL/beat
19
Q
average CO
A
5,500 mL/min
20
Q
average HR
A
70 bpm
21
Q
cardiac output
A
volume of blood pumped from each ventricle per minute
22
Q
preload
A
volume of blood in ventricles at end of diastole
23
Q
afterload
A
resistance left ventricle must overcome to circulate blood
24
Q
drugs for HF
A
- first-line
- diuretics that inhibit the RAAS
- beta blockers
- if uncontrolled, cardiac glycosides
25
RAAS
renin-angiotensin-aldosterone system
26
cardiac glycoside prototype
digoxin
27
cardiac glycosides use
* second-line Tx for
* HF
* dysrhythmias (a-fib)
28
inotropy
force of muscle ctx
29
+ inotropic effect
* ↑ force of myocardial contraction
* improves SV
30
chronotropy
affecting a time or rate, as in HR
31
– chronotropic effect
* ↓ HR
* slows rates of SA node depolarization and impulses through heart's conduction system
32
+inotropy + –chronotropy =
more time for ventricles to fill → ↑ SV and CO
33
digoxin complications
* dysrhythmias caused by interference with electrical conduction in myocardium
* cardiotoxicity
34
cardiotoxicity of digoxin
→ bradycardia
35
conditions that ↑ risk of digoxin-induced dysrhythmias
* hypokalemia
* ↑ serum digoxin levels
* heart dz
* **older age**
36
digoxin toxicity
* GI effects (**usually first sign**)
* anorexia
* N&V
* abd pain
* CNS effects
* fatigue
* weakness
* vision changes
* diplopia
* blurred vision
* yellow-green or white halos
37
therapeutic digoxin level
0.5-2.0 ng/mL
38
serum K+ level
3.5-5.0 mEq/L
39
Digoxin dosage is based on what two factors?
* serum levels
* client response
40
IV digoxin administration
* infuse over at least 5 min
* monitor for dysrhythmias
41
What do you check before given digoxin?
HR and rhythm
42
Before giving digoxin, check and document what?
HR and rhythm
43
HRs to notify provider of before giving digoxin
* \< 60 bpm in adult
* \< 70 bpm in children
* \< 90 bpm in infants
44
What supplement may be prescribed with digoxin, and what other drug may accompany it?
* K+
* diuretic
45
baseline/periodic labs for digoxin
* digoxin level
* serum K+
46
digoxin pt ed
* take as prescribed
* take at same time daily
* missed dose: **do not double next dose**
* avoid OTC meds
* notify provider of toxicity Sx
* fatigue
* weakness
* vision changes
* GI effects
* eat **high-K+ foods**
* green leafies
* bananas
* potatoes
* report Sx of hypokalemia
* N&V
* general weakness
* **monitor pulse rate**, report changes before taking
* irregular rate with early or extra beats
* HR \< 60 bpm or \> 100 bpm
47
digoxin contraindications and precautions
* Pregnancy: C
* contra: disturbances in ventricular rhythm
* v-fibv
* v-tach
* second- and third-degree heart block
* caution
* hypokalemia
* partial AV block
* advanced HF
* renal insufficiency
48
digoxin + thiazide or loop diuretic =
* possible hypokalemia
* ↑ risk of dysrhythmias
49
digoxin + ACE inhibitors or ARBs =
↑ risk of hyperkalemia → ↓ effects of digoxin
50
digoxin + sympathomimetics =
* complement inotropic action, ↑ rate and force of heart muscle contraction
* May be beneficial, but also may ↑ risk of tachydysrhythmias
* monitor ECG
* instruct pt to measure HR, report palpitations
51
digoxin + quinidine =
* ↑ risk of digoxin toxicity
* avoid concurrent use
52
digoxin + verapamil =
* ↑ plasma levels of digoxin
* interventions
* ↓ digoxin dose
* usually avoided b/c verapamil’s cardiosuppression can counteract digoxin
53
digoxin + antacids =
* ↓ absorption of digoxin
* can ↓ its effectiveness
* pt: talk to provider before taking
54
digoxin toxicity management
* **stop immediately**
* digoxin
* K+-wasting meds
* **monitor K+ levels**
* disrhythmias: phenytoin or lidocaine
* bradycardia: atropine
* excessive overdose, admin one of the following
* activated charcoal
* cholestyramine
* **Digibind**
55
catecholamines
hormones produced by adrenal glands
56
commonly known/used catecholamines
* epinephrine (adrenaline)
* norepinephrine (noradrenaline)
* dopamine (intropin)
57
fxns of catecholamines
* neurotransmitters
* hormones that regulate physiological fxn
58
adrenergic agonists (catecholamines)
* epinephrine
* dopamine
* dobutamine
* isoproterenol
* norepinephrine
* other
* albuterol
* terbutaline
* ephedrine
59
catecholamine receptors
* Alpha1
* Beta1
* Beta2
* dopamine
60
alpha1 adrenergic receptor locations and action
* arterioles of skin, viscera, mucous membranes
* veins
* vasoconstriction
61
Beta1 adrenergic receptor locations and actions
* heart
* ↑ HR
* ↑ contractility
* ↑ rate of conduction through AV node
* kidney
* release of renin
62
Beta2-adrenergic receptors locations and action
* vasodilation: arterioles of heart, lungs, skeletal muscles
* bronchodilation
* relaxation: uterine smooth muscle
* glycogenolysis: liver
* contraction: skeletal muscle
63
activation of dopamine receptors causes
dilation of renal blood vessels
64
Epinephrine activates what 3 types of receptors?
* alpha 1
* beta 1
* beta 2
65
Dopamine activates what receptors?
* low dose: dopamine receptors
* moderate dose
* dopamine
* beta 1
* high dose
* dopamine
* beta 1
* alpha 1
66
Dobutamine activates what receptors?
beta 1
67
uses for dopamine
* **shock**: vasoconstriction → ↑ systolic BP
* HF
68
uses for epinephrine
* slower absorption of local anesthetics
* manage superficial bleeding
* ↓ congestion of nasal mucosa
* ↑ BP
* Tx of AV block and **cardiac arrest**
* asthma
69
use for dobutamine
Tx of HF
70
AE of epinephrine
* alpha 1 activation → vasoconstriction → **hypertensive crisis**
* beta 1 activation
* → **dysrhythmias**
* ↑ workload of heart and O2 demand → angina
71
AE of dopamine
* beta 1 activation
* → **dysrhythmias**
* ↑ workload of heart and O2 demand → angina
* necrosis from extravasation @ high doses
72
AE of dobutamine
↑ HR
73
interventions for epinephrine-induced vasoconstriction
* continuous cardiac monitoring
* report VS changes to provider
74
interventions for possible dysrhythmias from epinephrine
* continuous cardiac monitoring
* Monitor closely for
* dysrhythmias
* change in HR
* CP
* Notify provider and treat per protocol
75
interventions for possible dysrhythmias with dopamine admin
* continuous cardiac monitoring
* monitor closely for
* dysrhythmias
* change in HR
* CP
* notify provider and treat per protocol
76
interventions for possible necrosis at dopamine IV site
* monitor IV site carefully
* infuse through central line if possible
* D/C infusion at first sign of irritation
77
interventions for dobutamine AE
* continuous cardiac monitoring
* report VS changes to provider
78
catecholamines contraindications
* pregnancy risk category
* epinephrine and dopamine: C
* dobutamine: B
* tachydysrhythmias
* ventricluar fibrillation
79
catecholamines precautions
* hyperthyroidism
* angina
* Hx of MI
* HTN
* DM
80
pinephrine + MAOIs =
* prolonged epinephrine effect
* avoid concurrent use
81
TCAs + epinephrine =
* blocked epinephrine uptake → prolonged and intensified effects
* ↓ dose of epinephrine
82
general anesthetics + epinephrine =
* dysrhythmias
* continuous ECG
* notify provider of
* CP
* dysrhythmias
* ↑ HR
83
epinephrine + alpha blockers =
* counteracted
* epinephrine antidote: **phentolamine**
84
