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Felder > Cardiovascular Module 2 > Flashcards

Cardiovascular Module 2 Flashcards

1
Q

Cardiotonics are also called what

A

Cardiac glycosides or initropics

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2
Q

What are some indications of cardiotonics

A

Heart failure Atrial fibrillation Atrial flutter Supra ventricular tachycardia

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3
Q

Digitalization

A

A series of doses given until the drug begins to extent full therapeutic effect

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4
Q

Digoxin can be given in what route

A

Po IM IV

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5
Q

What is the drug action of digoxin

A

Increase cardiac output through positive inotropic activity Enhance movement of calcium into myocardial cells Decrease conduction velocity through the SA and AV nodes

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6
Q

The drug action of digoxin results in what

A

Increase efficiency and improved contraction of the heart muscle

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7
Q

Loading dose of digoxin

A

0.5 to 1.25 mg every 6 to 8 hours initially

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8
Q

Maintenance dose of digoxin

A

0.125 to 0.25 mg daily

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9
Q

What is an early sign of digoxin toxicity

A

GI signs that include N & V anorexia and diarrhea

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10
Q

Other signs of digoxin toxicity

A

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

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11
Q

Factors that predispose patients to digoxin toxicity

A

Hyperkalemia / hypoHypercalcemia Hypomagnesmia Renal impairment Recent MI, and IV administration

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12
Q

How does hypothyroidism effect digoxin

A

It slows digoxin metabolism

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13
Q

How do you treat digoxin toxicity

A

Withdraw drug Treat dysrhythmia Give atropine for bradycardiaAnd give antidote

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14
Q

What is the digoxin antidote

A

Digibind (digoxin immune fab)

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15
Q

What does digibind do?

A

It treats digoxin as an antigen

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16
Q

Serum digoxin levels (therapeutic range)

A

0.8-2 ng/ ml

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17
Q

What is the onset peak and duration for digoxin

A

30min Peak 2hr Duration 2-6 days

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18
Q

What are some nursing implications for digoxin

A

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

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19
Q

Digoxin Positive outcomes

A

Increase urinatiob Decrease weight edema sob fatigue

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20
Q

Drugs that increase digoxin levels

A

Antibiotics Antifungals NSAIDs Benzodiazepines Antiarrhythmics

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21
Q

Drugs that decrease digoxin levels

A

Antacid Thyroid hormone Antilipemics Oral amino glycosideAnti tubercular Antineoplastic

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22
Q

Phsphodiesterase inhibitors

A

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

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23
Q

Atrial natriuretic peptide hormone ANP

A

Inhibit the renin angiotensin aldosterone system

24
Q

Anti-Arrhythmics

A

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
25
Q

Cardiac Arrhythmias

A 
Supraventricular tachycardia 
 Atrial fibrillation 
 Atrial flutter 
 Premature ventricular contractions 
 Ventricular tachycardia 
 Ventricular fibrillation
26
Q

Class I

Na Channel Blockers

A

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

27
Q

Class I-A

A

 Quinidine (Quinidex, Quinalute,
Quinora, Cardioquin)

 Origin - Cinchona bark

 Action - Membrane stabilizing effect on
myocardial cells to ↓ excitability

28
Q

Quinidine - Side Effects

A 
GI: N&V, anorexia, diarrhea 
 Cardiac: Hypotension, V tach, V fib, 
embolism 
 Hypersensitivity: Mild - severe 
 Hepatoxicity 
 Bone marrow suppression 
 Cinchonism
29
Q

Quinidine - Interactions

A

 Anticoagulant: ↑ bleeding

 Antacid: ↓ absorption of med

 Digoxin, beta blockers, Ca channel
blockers: ↑ cardiac depression

30
Q

Quinidine – Nursing Implications

A 
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
31
Q

Procainamide

A

 Procainamide (Pronestyl, Procanabid)

 Indication
 First line drug: V tach, V fib and pulselessness

 Route – PO, parenteral

32
Q

Procainamide

A 
ADR 
 Cross sensitivity with procaine 
 GI irritation 
 Drowsiness, dizziness 
 joint pains, butter-fly rash 
 blood dyscrasias 
 Nsg 
 Long acting forms: shell in stool
33
Q

Dysopryamide (Norpace)

A

Action: ↓ rate of depolarization
 ADR: Atropine like
 Contraindications: Atropine like

34
Q

Lidocaine (Xylocaine)

A

Action:↑ threshold of myocardial cells
 Indication: PVC post MI
 Dose: 100 mg bolus, then 400 mg in 500
ml D5W infuse mg/kg/min

35
Q

Lidocaine - Side Effects

A 
Neurological 
 dizziness, drowsiness, confusion, 
hallucination, euphoria, blurred vision, 
tinnitus, convulsions 
 Decrease heart rate 
 Respiratory depression
36
Q

Class I-B

A

Other drugs
 Mexiletine (Mexitil) - PO lidocaine
 Phenytoin (Dilantin)

 All are gastrotoxic
 All are neurotoxic
 given PO

37
Q

Class I-C

A

Action - decrease conduction in Bundle of
His and Purkinje Fiber
 Indication: severe ventricular arrhythmia
 Route - PO
 Drugs -
 Flecainide (Tambocor)
 Propafenone (Rythmol)

38
Q

Class II – Beta Blockers

A

 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

39
Q

Beta Blockers

A 
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)
40
Q

Beta Blockers - Side Effects

A 
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
41
Q

Class III

Potassium channel blockers

A 
 Action - Lengthen action potential of 
myocardial cells 
 Indication - Vent arrhythmias 
 Drugs 
 Bretylium Tosylate (Bretylol) 
 Dofetilide (Tikosyn) 
 Amiodarone (Cordarone) 
 Adenosine (Adenocard)
42
Q

Class III

A

 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

43
Q

Class III - Side Effects

A 
 Sand eyes 
 Photosensitivity, blue gray discoloration 
to skin 
 N&V, anorexia 
 Hypotension 
 Pulmonary toxicity
44
Q

 Adenosine (Adenocard)

A 
 Natural chemical found in all cells 
 Aides energy transfer 
 ↑ prostaglandin release 
 ↓ Platelet aggregation 
 ↓ HR 
 Indication: drug of choice - SVT
45
Q

Class IV - Ca channel blockers

A

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
46
Q

Class IV - Ca Channel Blockers Drugs

A 
 Verapamil (Calan, Isoptin) 
 Dilitiazem (Cardizem) 
 Nimodipine (Nimotop) 
 Amlodipine (Norvasc) 
 Bepridil (Vascor) 
 Felodipine (Plendil) 
 Isradipine (Dyna - Circ) 
 Nicardipine (Cardene) 
 Nefedipine (Procardia) 
 Nisoldipine (Sular)
47
Q

Anti Cholinergic

A

Indication – Bradycardia
 Prodysrhythmic effect of antiarrhythmic drugs

 Drug: Atropine

48
Q

Nursing Care - anti-arrhythmics

A 
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
49
Q

Patient Education

A 
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
50
Q

Procainamide

A

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

51
Q

Propranolol

A

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.

52
Q

Lidocaine

A

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.

53
Q

Diltiazem

A

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.

54
Q

Digoxin

A

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.

55
Q

Amlodipine

A

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.

Felder (9 decks)

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