Cardiovascular meds Flashcards
Action of ACEs
block conversion of of angiotensin 1 to angiotensin 2
Action of ARBs
selectively block the binding of angiotensin 2 to AT1 receptors found in tissues
Therapeutic use of ACE/ARBs (4)
- HTN
- Heart failure
- MI
- Diabetic nephropathy
Side/adverse effects of ACE/ARBs (3)
- Persistent, non-productive cough
- Angioedema
- Hypotension
Calcium channel blocker action
Slows movement of calcium into smooth muscle cells causing arterial dilation and decreased blood pressure
Therapeutic uses for calcium channel blockers (2)
- Angina
- HTN
Precautions for ACE/ARBs
- Diuretic therapy
Precautions for calcium channel blockers (3)
- Use caution in patients taking digoxin and beta blockers
- Don’t use in patients with heart failure, heart blocks, bradycardia
- No grapefruit juice
Side/adverse effects for calcium channel blockers (4)
- Constipation
- Reflex tachycardia
- Peripheral edema
- Toxicity
Things to monitor while on ACE/ARBs (2)
- Potassium
- Blood pressure
Nursing interventions for calcium channel blockers (3)
- IV injection given over 2-3 minutes
- Slowly taper
- Monitor heart rate and bp
Alpha adrenergic blockers action
Selectively inhibits alpha1 adrenergic receptors causing dilation in peripheral arteries and veins and lowering bp
Alpha adrenergic blockers meds (2)
- Prazosin
- Doxazosin mesylate
Therapeutic use of alpha adrenergic blockers (2)
- Primary HTN
- Doxazosin used to treat BPH
Precautions for alpha adrenergic blockers (2)
- Increased risk for hypotension/syncope if taken with other antihypertensives, beta blockers, diuretics
- NSAIDS decrease effectiveness of Prazosin
Nursing interventions for alpha adrenergic blockers (2)
- Monitor heart rate/bp
- Take at bedtime to decrease effects of hypotension
Side/adverse effects of alpha adrenergic blockers (2)
- Dizziness
- Fainting
Centrally acting alpha2 agonists action
Stimulate alpha2 in brain reducing peripheral vascular resistance, heart rate, bp
Centrally acting alpha2 agonists meds (3)
- Clonidine
- Guanfacine HCL
- Methyldopa
Therapeutic use for centrally acting alpha2 agonists (3)
- Primary HTN
- Hypertensive crisis
- Severe cancer pain (epidural)
Precautions for centrally acting alpha2 agonists (4)
- Can’t be used with anticoagulants, hepatic failure, MAOIs
- Methyldopa can’t be given through the same IV as barbiturates, sulfonamides
- Use caution in CVA, MI, diabetes, major depression, chronic renal failure
- Don’t use if lactating
Side/adverse effects of centrally acting alpha2 agonists (5)
- Dry mouth
- Drowsiness/sedation that resolves over time
- Rebound HTN
- Black/sore tongue
- Leukopenia
Nursing interventions for centrally acting alpha2 agonists (4)
- Monitor for adverse CNS effects, CBC, heart rate, bp, weight gain, edema
- Watch for rebound HTN 48 hours after stopping
- Never skip a dose
- Take at bedtime to decrease hypotension
- Notify provider of involuntary, jerky movements, prolonged dizziness, rash, yellow skin
Beta blocker action
Blocks stimulation of receptor sites causing decreased cardiac excitability, cardiac output, myocardial oxygen demand, lowers bp by decreasing release of renin in kidneys
Therapeutic uses for beta blockers (5)
- Primary HTN
- Angina
- Tachydysrhythmias
- Heart failure
- MI
Precautions for beta blockers (4)
- Don’t give to patients with AV block, sinus bradycardia
- Don’t give non-selective beta blockers to patients with asthma, bronchospasm, heart failure
- Propranolol can mask symptoms of hypoglycemia in diabetic patients
- Don’t give labetalol in same IV as furosemide
Selective beta blocker meds (3)
- Metoprolol
- Metoprolol succinate
- Atenolol
Non-selective beta blocker meds (3)
- Propranolol
- Nadolol
- Labetalol
Side/adverse effects of beta blockers (5)
- Bradycardia
- Nasal stuffiness
- AV block
- Rebound myocardium excitation when stopped abruptly
- Bronchospasm
Nursing interventions for beta blockers (4)
- Administer 1-2 times daily
- Don’t stop without talking to provider
- Hold med if systolic bp <100 or pulse is <60
- Monitor diabetic patients for s/s of hypoglycemia
Vasodilators action
Direct vasodilation of arteries and veins causing rapid reduction of bp
Vasodilator meds (4)
- Nitroglycerin
- Enalaprilat
- Nitroprusside
- Hydralazine
Therapeutic uses of vasodilators
- Hypertensive emergencies
Precautions for vasodilators (3)
- Patients with hepatic/renal disease
- Older adults
- Electrolyte imbalances
Side/adverse effects of vasodilators (5)
- Dizziness
- Headache
- Profound hypotension
- Cyanide toxicity
- Thiocyanate poisoning
Nursing interventions for vasodilators (4)
- Nitroprusside can’t be mixed with any other medication
- Apply protective covering to container
- Throwout unused fluid after 24 hours
- Monitor continuous ECG/bp
Cardiac glycosides action (2)
- Increase force/velocity of myocardial contractions to improve stroke volume/cardiac output
- Slow conduction rate allowing for increased ventricular filling
Cardiac glycoside meds
Digoxin
Therapeutic uses of cardiac glycosides (2)
- Heart failure
- Afib
Precautions with cardiac glycosides (3)
- Thiazide/loop diuretics increase risk of hypokalemia and precipitate digoxin toxicity
- ACE/ARBs increase risk of hyperkalemia
- Verapamil increases risk of toxicity
GI effects of digoxin toxicity (4)
- Anorexia
- Nausea
- Vomiting
- Abdominal pain
CNS effects of digoxin toxicity (5)
- Fatigue
- Weakness
- Diplopia
- Blurred vision
- Yellow, green, white halos around objects
Nursing interventions for cardiac glycosides (5)
- Assess apical pulse for 1 minute before giving med
- Notify provider of heart rate less than 60 for adults, 70 for kids, 90 for babies
- Monitor for signs of toxicity, hypokalemia, hypomagnesemia
- Notify provider of sudden increase in pulse rate that was previously normal/low
- Maintain therapeutic level
Digoxin toxicity management (4)
- Stop med/potassium wasting meds
- Treat dysrhythmias with phenytoin/lidocaine
- Treat bradycardia with atropine
- Excess overdose give digoxin immune FAB to prevent absorption
Antianginal meds actions (2)
- Relax peripheral vascular smooth muscles causing dilation of arteries/veins and reducing venous blood return leading to decreased oxygen demands on the heart
- Increase myocardial oxygen supply by dilating large coronary arteries and redistributing blood flow
Antianginal meds therapeutic uses (2)
- Acute angina attack
- Prophylaxis for chronic stable/variant angina
Precautions for antianginal meds (3)
- Can’t be used in patients with head injuries
- Hypotensive risk with antihypertensive meds
- Not given to patients taking erectile dysfunction meds - causes life threatening hypotension
Side/adverse effects of antianginal meds (4)
- Headache
- Orthostatic hypotension
- Reflex tachycardia
- Tolerance
Nursing interventions for Nitrostat/Nitrolingual (7)
- Sublingual
- Rest for 5 minutes, not relieved after 1st tablet call 911, take a 2nd, wait 5 minutes and if not relieved take a 3rd
- Keep in original dark container
- Nitrolingual can be used for prophylaxis 5-10 minutes before exercising
- Don’t shake nitrolingual
- Replace NTG tablets every 6 months
- Wear medical alert id
Nitro-bid (topical) nursing interventions (5)
- Wear gloves when administering
- Don’t massage/rub area
- Apply to area without hair
- Cover area with clear plastic wrap and tape
- Gradually reduce dose/frequency over 4-6 weeks
Nitro dur (patch) nursing interventions (3)
- Skin irritation can alter medication absorption
- Apply to upper chest, side, pelvis, inner/upper arm
- Rotate sites and worn for 12-14 hours
Antidysrhythmic meds (3)
- Adenosine
- Amiodarone
- Atropine
Adenosine action
Slows conduction time through
AV node, interrupts AV node pathways to restore NSR
Amiodarone action
Prolongs repolarization, relaxes smooth muscle, decreases vascular resistance
Atropine action
Increases heart rate by counteracting the muscarine like actions of acetylcholine and other choline esters
Therapeutic uses of adenosine
Convert SVT to sinus rhythm
Side/adverse effects of adenosine (4)
- Flushing
- Nausea
- Bronchospasm
- Prolonged asystole
Nursing interventions for adenosine (2)
- Rapid IV push (1-2 seconds)
- Flush immediately after with normal saline
Therapeutic uses of amiodarone (2)
- Vfib
- Unstable ventricular tachycardia
Side/adverse effects of amiodarone (3)
- Bradycardia
- Cardiogenic shock
- Pulmonary disorders
Nursing interventions for amiodarone (3)
- Incompatible with heparin
- Can be given PO as maintenance dose
- Monitor for respiratory complications
Therapeutic uses of atropine (3)
- Bradycardia
- Known exposure to chemical nerve agent
- Reduce secretions
Side/adverse effects of atropine
None when used in emergencies
Nursing interventions for atropine
- Monitor for dry mouth, blurred vision, photophobia, urinary retention, constipation
Antilipemic meds action
Lowers LDL levels and increases HDL levels
Therapeutic uses of antilipemic meds (3)
- Primary hypercholesterolemia
- Prevent coronary events
- Protect against MI/stroke in diabetic patients
Precautions for antilipemic meds (2)
- Stopped during pregnancy
- Use caution in patients with renal dysfunction
Side/adverse effects of antilipemic meds (4)
- Muscle aches
- Hepatotoxicity
- Rhabdomyolysis
- Peripheral neuropathy
Nursing interventions for antilipemic meds (3)
- Take in evening
- Monitor liver/renal function lab profiles
- Low fat/high fiber diet
Statin meds action
Interferes with hepatic enzyme HMG-CoA to reduce formation of cholesterol precursors
Statin precautions (2)
- Prolonged bleeding in patients taking warfarin
- Interacts with digoxin, warfarin, thyroid hormones, thiazide diuretics, phenobarbital, NSAIDS, tetracycline, beta blockers, gemifibrozil, glipizide, glyburide, oral contraceptives, phenytoin
Nursing interventions for statins
- Don’t give with grapefruit juice
Cholesterol absorption inhibitor meds action
Blocks absorption of cholesterol secreted in bile and from food
Cholesterol absorption inhibitor med
- Ezetimibe
Nursing interventions for cholesterol absorption inhibitors (2)
- Take 2-4 hours after other antilipemics
- Liver damage increases when taken with statins
