Cardiovascular Module 2 Flashcards
Cardiotonics are also called what
Cardiac glycosides or initropics
What are some indications of cardiotonics
Heart failure Atrial fibrillation Atrial flutter Supra ventricular tachycardia
Digitalization
A series of doses given until the drug begins to extent full therapeutic effect
Digoxin can be given in what route
Po IM IV
What is the drug action of digoxin
Increase cardiac output through positive inotropic activity Enhance movement of calcium into myocardial cells Decrease conduction velocity through the SA and AV nodes
The drug action of digoxin results in what
Increase efficiency and improved contraction of the heart muscle
Loading dose of digoxin
0.5 to 1.25 mg every 6 to 8 hours initially
Maintenance dose of digoxin
0.125 to 0.25 mg daily
What is an early sign of digoxin toxicity
GI signs that include N & V anorexia and diarrhea
Other signs of digoxin toxicity
CNS- Headache facial pain apathy drowsiness disorientation confusion mental depression delirium convulsion VISUAL- blurred vision halo diplopia colored vision yellow vision CARDIAC- bradycardia tachycardia atrial fibrillation/ flutter extra systole coupled beats
Factors that predispose patients to digoxin toxicity
Hyperkalemia / hypoHypercalcemia Hypomagnesmia Renal impairment Recent MI, and IV administration
How does hypothyroidism effect digoxin
It slows digoxin metabolism
How do you treat digoxin toxicity
Withdraw drug Treat dysrhythmia Give atropine for bradycardiaAnd give antidote
What is the digoxin antidote
Digibind (digoxin immune fab)
What does digibind do?
It treats digoxin as an antigen
Serum digoxin levels (therapeutic range)
0.8-2 ng/ ml
What is the onset peak and duration for digoxin
30min Peak 2hr Duration 2-6 days
What are some nursing implications for digoxin
Intake and output -weight -examine extremities for edema Assess jugular vein distinction Assess apical heart rate for one full minute Take same time each day Oral preparation without regards to meals Avoid antacid - kaopectate Increase and decreased K levels Poorly absorbed IM Periodic EKG electrolytes liver and kidney function
Digoxin Positive outcomes
Increase urinatiob Decrease weight edema sob fatigue
Drugs that increase digoxin levels
Antibiotics Antifungals NSAIDs Benzodiazepines Antiarrhythmics
Drugs that decrease digoxin levels
Antacid Thyroid hormone Antilipemics Oral amino glycosideAnti tubercular Antineoplastic
Phsphodiesterase inhibitors
ACTION Positive inotropic activity Vasodilation properties INDICATION OF PHOSPHODIESTERASE INHIBITORS short term management of HF when digoxin doesn’t work ADVERSE REACTIONS OF PHOSPHODIESTERASE INHIBITORS N&V arrhythmia sudden death PHOSPHODIESTERASE INHIBITORS DRUGS Amirone Primacor
Atrial natriuretic peptide hormone ANP
Inhibit the renin angiotensin aldosterone system
Anti-Arrhythmics
Indication – cardiac arrhythmias
Atrial arrhythmias
Ventricular arrhythmias
Class I Na Channel Blockers Class II Beta Blockers Class III K Channel Blockers Class IV Ca Channel Blockers
Cardiac Arrhythmias
Supraventricular tachycardia Atrial fibrillation Atrial flutter Premature ventricular contractions Ventricular tachycardia Ventricular fibrillation
Class I
Na Channel Blockers
Sodium Channel Blockers
Moricizine Hcl (Ethmozine)
Blocks movement of sodium into
myocardial cells
Indication - Ventricular tachyarrhythmia
Used only if benefits outweigh risk
ADR
Neurotoxic - paresthesia, nervousness,
insomnia, dizziness, headache, blurred vision
Muscle pain, fatigue
Hypotension
N&V, diarrhea, and dry mouth
Class I-A
Quinidine (Quinidex, Quinalute,
Quinora, Cardioquin)
Origin - Cinchona bark
Action - Membrane stabilizing effect on
myocardial cells to ↓ excitability
Quinidine - Side Effects
GI: N&V, anorexia, diarrhea Cardiac: Hypotension, V tach, V fib, embolism Hypersensitivity: Mild - severe Hepatoxicity Bone marrow suppression Cinchonism
Quinidine - Interactions
Anticoagulant: ↑ bleeding
Antacid: ↓ absorption of med
Digoxin, beta blockers, Ca channel
blockers: ↑ cardiac depression
Quinidine – Nursing Implications
Take apical pulse PO with meals Avoid citrus Sustained release: shell in stool IV: test dose - supine position Monitor K level Maintain serum levels: 2 - 6 mcg/ml
Procainamide
Procainamide (Pronestyl, Procanabid)
Indication
First line drug: V tach, V fib and pulselessness
Route – PO, parenteral
Procainamide
ADR Cross sensitivity with procaine GI irritation Drowsiness, dizziness joint pains, butter-fly rash blood dyscrasias Nsg Long acting forms: shell in stool
Dysopryamide (Norpace)
Action: ↓ rate of depolarization
ADR: Atropine like
Contraindications: Atropine like
Lidocaine (Xylocaine)
Action:↑ threshold of myocardial cells
Indication: PVC post MI
Dose: 100 mg bolus, then 400 mg in 500
ml D5W infuse mg/kg/min
Lidocaine - Side Effects
Neurological dizziness, drowsiness, confusion, hallucination, euphoria, blurred vision, tinnitus, convulsions Decrease heart rate Respiratory depression
Class I-B
Other drugs
Mexiletine (Mexitil) - PO lidocaine
Phenytoin (Dilantin)
All are gastrotoxic
All are neurotoxic
given PO
Class I-C
Action - decrease conduction in Bundle of
His and Purkinje Fiber
Indication: severe ventricular arrhythmia
Route - PO
Drugs -
Flecainide (Tambocor)
Propafenone (Rythmol)
Class II – Beta Blockers
1st and 2nd generations
2nd generation more cardio selective
Action: reduce sympathetic excitation in
the heart
Blocks cardiac cell response to epinephrine
Blocks beta receptors
Indication: Supraventricular arrhythmias
Beta Blockers
Drugs Propranolol (Inderal) Acebutolol (Sectral) Esmolol (Brevibloc) Sotalol (Betapace) Nadolol (Corgard) Atenolol (Tenormin) Timolol Maleate (Blocarden) Metoprolol (Lopressor, Toprol) Bisoprolol (Ziac) Carteolol (Cartrol) Betaxalol (Kerlone) Penbutolol (Levatol) Pindolol (Visken) Nebivolol (Bystolic)
Beta Blockers - Side Effects
GI: N&V diarrhea Resp: Tachypnea, wheezing, dyspnea and bronchospasm Cardiac: Hypotension, bradycardia, cardiac arrhythmia, angina, CHF Endocrine: Hypoglycemia Reproductive: Impotence Circulatory: Raynaunds phenomena Neuro: Fatigue, sedation, dizziness, vertigo, headache, visual disturbance, insomnia, confusion and hallucination Skin: Rash, pruritus Mood: Mental depression Interaction: Drugs that decrease B/P and pulse Contraindication: COPD, PVD, heart disease and diabetes
Class III
Potassium channel blockers
Action - Lengthen action potential of myocardial cells Indication - Vent arrhythmias Drugs Bretylium Tosylate (Bretylol) Dofetilide (Tikosyn) Amiodarone (Cordarone) Adenosine (Adenocard)
Class III
Drug
Amiodarone (Cordarone)
Vasodilating properties, decreases HR,
decreases contractility of left ventricles
First line drug: V tach, V fib and
pulselessness
Routes: PO or IV
Class III - Side Effects
Sand eyes Photosensitivity, blue gray discoloration to skin N&V, anorexia Hypotension Pulmonary toxicity
Adenosine (Adenocard)
Natural chemical found in all cells Aides energy transfer ↑ prostaglandin release ↓ Platelet aggregation ↓ HR Indication: drug of choice - SVT
Class IV - Ca channel blockers
Action: Block Ca uptake by myocardial
cells
ADR: Same as beta blockers ADR also include: GI: constipation, swollen gums Endocrine: fever, chills, sweating Circulatory: peripheral edema Hepatotoxocity Interactions – Beta blockers, Digoxin, antiarrhythmics
Class IV - Ca Channel Blockers Drugs
Verapamil (Calan, Isoptin) Dilitiazem (Cardizem) Nimodipine (Nimotop) Amlodipine (Norvasc) Bepridil (Vascor) Felodipine (Plendil) Isradipine (Dyna - Circ) Nicardipine (Cardene) Nefedipine (Procardia) Nisoldipine (Sular)
Anti Cholinergic
Indication – Bradycardia
Prodysrhythmic effect of antiarrhythmic drugs
Drug: Atropine
Nursing Care - anti-arrhythmics
Monitor apical heart rate Patient education – pulse rate Assess B/P before each dose Know med parameters for holding drugs PO: take with full glass of water IV administration bed rest cardiac monitoring continuous B/P Continuous O2 sat Use infusion pump CPR equipment must be available Monitor Electrolytes Liver and kidney function Intake & output Space drugs at equal intervals Monitor for cardiac suppression
Patient Education
Take own pulse Dry mouth: sips of water or gum Change position slowly Report weight gains of more than 2 lbs per day Don’t omit or change dose Don’t use OTC meds Avoid alcohol and smoking Avoid hazardous task Wear or carry medic alert
Procainamide
Pronestyl
It is a sodium channel blocker which blocks open sodium channels and prolongs the cardiac action potential (outward potassium (K+) currents may be blocked). This results in slowed conduction, and ultimately the decreased rate of rise of the action potential, which may result in widening of QRS on electrocardiogram
This drug is used for both supraventricular and ventricular arrhythmias. For example, it can be used to convert new-onset atrial fibrillation, though it is suboptimal for this purpose.[4] It can also be used to treat Wolff-Parkinson-White syndrome by prolonging the refractory period of the accessory pathway
Propranolol
Inderal
Beta blocker
Treats high blood pressure, angina (chest pain), irregular heartbeat, migraine headaches, tremors, and lowers the risk of repeated heart attacks. This medicine is a beta blocker.
Lidocaine
Xylocaine
Antiarrhythmic drugs
Causes numbness or loss of feeling in an area of your body. Given before and during surgery, childbirth, or dental work. Also treats emergency heart rhythm problems.
Diltiazem
Cardiezm
Calcium channel blocker
Used alone or together with other medicines to treat high blood pressure and chest pain (angina). Lowering blood pressure reduces the risk of strokes and heart attacks. This medicine is a calcium channel blocker.
Digoxin
Lanoxin
Cardiac glycoside
Treats certain heart rhythm problems (atrial fibrillation). Also used to treat heart failure, usually in combination with a diuretic (water pill) and an angiotensin-converting enzyme (ACE) inhibitor. This medicine is also called digitalis.
Amlodipine
Norvasc
Calcium channel blocker,
Treats high blood pressure or chest pain (angina). A lower blood pressure will reduce the risk of stroke and heart attack. This medicine is a calcium channel blocker.
