cardiovascular medications

Question 1

what is a diuretic?

Answer 1

-it removes excess fluid from the body via the urinary system
-before administering: check BP, Electrolytes, weight, edema, urinary output

Question 2

Hydrochlorothiazide

Answer 2

Class: Thiazide Diuretics
MOA: blocks reabsorption of sodium and chloride in the kidneys which promotes diuresis
Indication: hypertension, moderate heart failure, liver/kidney disease
Route: PO
Adverse: Dehydration, hyponatremia, hypokalemia
Contraindictions: CV disease, hypokalemia, hyperlipidemia, digoxin, lithium, antihypertensives
Action: assess for signs of dehydration, monitor weight, K+, NA+, output, monitor BP, take in the morning, encourage high pottasium food food, monitor BP
Eval: decrease BP, decrease in edema, increase in urine output

Question 3

Furosemide

Answer 3

Class: Loop Diuretics
indications: Hypertention, Pulmonary edema
MOA: blocks reabsorption of sodium and chloride and that prevents reabsorption of water
Route: PO,IV
adverse effects: decrease in all electrolytes, dehydration
contraindications: pregnancy, anuria, ototoxic medication
action: baseline BP, weight, electrolyte level,edema, I&O, monitor EKG if K+ drops below 3.5, get up slowly
Eval: decrease in pulmonary and peripheal edema, weight loss, decreased BP, increase in urine output

Question 4

Spironolactone

Answer 4

Class: potassium-sparing diuretics
indication: used with other diuretics, hypokalemia
MOA: blocks aldosterone causing a loss of sodium
Route: PO
Adverse:kidney stones, hyperkalemia, Hyponatremia
contraindications: Hyperkalemia, aspirin, amiloride, or triamterene
Action: Avoid salt
Eval: pottasium is normal, weightloss, decreased BP and edema

Question 5

Digoxin

Answer 5

Class: Cardiac Glycosides
Indications: 2nd line medication, treats A-FiB, Heart Failure
MOA: decreases heart rate and improves stroke volume and cardiac output
Route: PO, IV
adverse: CARDIOTOXICITY, GI, CNS- yellow halos
contraindications: pregnancy C, hypkalemia, AV block, impaired kidney function, hypokalemia
Action: check pulse rate/rhythm, evaluate amount of digoxin in the blood if toxicity in suspected, monitor K+ levels
Eval: control of heart failure, absence of cardiac dysrythmias
Antidotes: activated charcoal, cholestyramine, digoxin immune Fab

Question 6

Sacubitril/Valsartan

Answer 6

Class: ANRI
Indication: Class II-IV HF, Reduced EF
MOA: Inhibits the renin angiotensin- aldosterone system.
Route: PO
Adverse: angioedema, hyperkalemia, hypotension, cough, dizziness, renal failure.
Contraindications: Pregnancy, Lactation, concurrent use with ACE inhibitors or ARBs, potassium-sparing diuretics, NSAIDS, or lithium; diabetic taking aliskiren.
Action: Monitor renal function and K+, and signs of worsening HF

Question 7

what should a nurse do after administering medications for heart failure?

Answer 7

BP, HR(if indicated)
Labs(electrolytes, renal function)(Digoxin levels if indicated)
Ongoing weight measurements
Extent of edema
Any respiratory issues
Current rate of urinary output

Question 8

Captopril

Answer 8

Class: Angiotensin- Converting Enzyme Inhibitors
Indication: HTN, HF, MI, diabetic and non-diabetic nephropathy
Mechanism of Action: reduces conversion of angiotensin I to angiotensin II, causing vasodilation, excretion of sodium and water with retention of potassium
Route: PO
Adverse Reactions: Orthostatic hypotension, cough, hyperkalemia, rash, dysgeusia, angioedema, neutropenia,
Contraindications: Pregnancy category risk D during second and third trimesters. Contraindicated in history of allergy and/or case of angioedema, bilateral renal artery stenosis, kidney impairment.
Interactions: Potassium supplements, potassium sparing diuretics, lithium, NSAID’s
Action: monitor BP before and after 2hrs, signs of angioedema, WBC, and K+, change positions slowly

Question 9

Losartan

Answer 9

Class: Angiotensin II Receptor Blockers
Indication: HTN, HF, stroke prevention, delay progression of diabetic nephropathy, slow the development of diabetic retinopathy.
Mechanism of Action: blocks the action of angiotensin II, which leads to vasodilation and excretion of sodium and water.
Route: PO
Adverse Reactions: Angioedema, fetal injury, hypotension, dizziness, Lightheadedness
Contraindications: Pregnancy risk category D, bilateral renal stenosis, history of angioedema
Action: monitor for angioedema, BP can be taken with or without food

Question 10

Aliskiren

Answer 10

Class: Direct Renin Inhibitors
Indication: Relieves hypertension when used alone or with other antihypertensives.
Mechanism of Action: Binds with renin, inhibits angiotensin I, and decreases angiotensin II and aldosterone.
Route: PO
Adverse Reactions: Angioedema, rash, cough, hyperkalemia, diarrhea, hypotension
Contraindications: Caution with pregnancy, asthma, and other respiratory disorders, history of angioedema, DM, renal stenosis, hypotension, kidney or liver disease. Concurrent use with furosemide, atorvastatin, ketoconazole, caution with use with other antihypertensives, high-fat foods, and potassium-sparing/potentiating agents.
Action: monitor BP, no High Fat foods, monitore for hyperkalemia, NO SALT SUBSTITUTES OR K+ SUPPLEMENTS

Question 11

Verapamil

Answer 11

Class: calcium channel blocker
Indications: Angina Pectoris, HTN, Cardiac Dysrhythmias(A. Fib, A. Flutter, SVT)
MOA: decreases the force of contraction which decreases the heart rate
Side effects/adverse effects: Orthostatic hypotension, peripheral edema, constipation, suppression of cardiac function(Bradycardia and heart failure), Dysrhythmias(Wide QRS and Prolonged QT), acute toxicity (Hypotension, bradycardia, AV block, and ventricular tachydysrhythmias).
Contraindications: Pregnancy, Lactation, hypotension, heart block, digoxin toxicity, severe heart failure, kidney and/or liver impairment, heart failure, GERD. Existing use of digoxin, beta-blockers, NO GRAPEFRUIT JUICE!
Action: monitor BP, edema, weight, HR
CURE: Gastric Lavage