Cardiovascular Part 2 Flashcards
Medication Administration
Thiazide Diuretics - hydrochlorothiazide
Available orally alone and in fixed-dose combination with multiple other drugs, such as potassium-sparing diuretics, ACE Inhibitors, ARBs, beta blockers, and other hypertensive drugs
Chlorothiazide is available in IV form
Give with food to minimize GI effects
Give last dose of day by 3pm to prevent nocturia and sleep loss
Client Education
Thiazide Diuretics - hydrochlorothiazide
Eat foods rich in potassium (if indicated) such as citrus fruits, potatoes, bananas
Report signs of electrolyte imbalance, such as confusion, muscle twitching, weakness, irregular pulse, nausea, and others
Clients who have diabetes mellitus need to carefully monitor blood glucose levels and notify provider for persistent hyperglycemia
Be aware that this effect may occur; usually without symptoms
Clients with history of gout need to report symptom onset to provider
Interactions
Thiazide Diuretics - hydrochlorothiazide
Lithium toxicity may occur
Increased risk of digoxin toxicity with potassium or magnesium deficiency
Corticosteroids and amphotericin B increase risk for hypokalemia
Decreased absorption with cholestyramine (Questran) or colestipol (Colestid)
NSAIDs can reduce effectiveness
Therapeutic Use
Loop Diuretics - furosemide
Treats pulmonary edema in HF
Treats edema caused by renal, hepatic, or cardiac failure not affected by other diuretics
Treats hypertension not controlled by other diuretics
Adverse Effects
Loop Diuretics - furosemide
Electrolyte imbalance: hyponatremia, hypochloremia, severe fluid loss (dehydration), and hypokalemia
Hypotension
Ototoxicity (all loop diuretics, can be temporary or permanent)
Hyperglycemia (especially in clients who have diabetes mellitus)
Increased uric acid levels (hyperuricemia) with possible gouty arthritis in susceptible clients
Interactions
Loop Diuretics - furosemide
Digoxin toxicity is a high risk with hypokalemia
Other diuretics increase the diuretic effect
NSAIDs can decrease diuretic effect
Lithium toxicity can occur
Amphotericin B can corticosteroids increase risk for hypokalemia
Other ototoxic drugs (e.g. aminoglycoside antibiotics) increase risk for ototoxicity
Adverse Effects
Potassium-Sparing Diuretics - spironolactone
Hyperkalemia
Menstrual irregularities, abnormal hair growth (e.g. on face) and deepening of voice may occur in women; gynecomastia (growth of breast tissue) and impotence may occur in men
Interactions
Potassium-Sparing Diuretics - spironolactone
Counteracts adverse effect (hypokalemia) of loop and thiazide diuretics (may be the desired effect).
ACE inhibitors, ARBs, direct renin blockers, potassium supplements, salt substitutes increase risk of hyperkalemia.
Increased risk of hypotension can occur with concurrent ingestion of alcohol, nitrates or other antihypertensives.
Adverse Effects
Inotropic Agents Cardiac Glycosides - digoxin
Cardiac dysrhythmias, especially likely with digoxin toxicity
Any dysrhythmia may occur, with AV block being most common
GI symptoms – early signs of toxicity - Nausea, vomiting, anorexia
CNS symptoms
Fatigue, visual disturbances, such as yellow vision and blurred vision
Increased mortality in women
Nursing Interventions
Inotropic Agents Cardiac Glycosides - digoxin
Erythromycin and some other antibiotics increase digoxin levels.
Other antidysrhythmic (verapamil, quinidine, amiodarone, flecainide) increase digoxin levels; decrease digoxin dosage for concurrent administration.
Diuretics increase the risk of digoxin toxicity by decreasing potassium levels.
Herbal ginseng increases risk of digoxin toxicity; St John’s wort decreases digoxin levels
Evaluation of Medication Effectiveness
Inotropic Agents Cardiac Glycosides - digoxin
Improvement in heart failure (ability to perform activities of daily living, improved breath sounds, and absence of edema)
Absence of cardiac dysrhythmias
Adverse Effects
Inotropic/Sympathomimetic - dobutamine
Tachycardia, cardiac dysrhythmias, and possible angina pain
Nursing Interventions
Inotropic/Sympathomimetic - dobutamine
Monitor ECG rhythm and vital signs continuously during infusion
Treat cardiac dysrhythmias as needed and prepare to decrease or
discontinue dobutamine for tachydysrhythmias
Adverse Effects
Inotropic/Phosphodiesterase Inhibitors - milrinone
Hypokalemia
Cardiac dysrhythmias, hypotension
Anginal chest pain
Nursing Interventions
Inotropic/Phosphodiesterase Inhibitors - milrinone
Correct fluid deficits and hypokalemia before beginning infusion.
Monitor potassium levels and correct hypokalemia as needed during infusion.
Monitor vital signs and ECG rhythm continuously during infusion.
Decrease dosage for dysrhythmias or blood pressure failing below prescribed parameters.
Monitor for chest pain during infusion.
Therapeutic Use
Class 1A Sodium Channel Blockers - quinidine
Broad-spectrum antidysrythmics treat atrial fibrillation, and supraventricular and ventricular tachycardias
Quinidine used more for long-term treatment while procainamide is used only for short-term treatment due to severe adverse effects
Adverse Effects
Class 1A Sodium Channel Blockers - quinidine
severe with oral administration than IV), widen the QRS complex and prolongs QT interval, ventricular dysrhythmias occur due to toxicity; oral or IV therapy (QRS too wide or QT interval too long), arterial embolism (caused by dislodging small clots) if treating atrial fibrillation, speed shock with too rapid IV infusion (flushing, headache, irregular heart rate, severe hypotension, loss of consciousness, cardiac arrest), quinidine- cinchonism (tinnitus, visual disturbances, headache, N, V), procainamide (system lupus erythematosus- like syndrome (SLE) seen in70% of clients after 1 year of oral therapy), blood dyscrasis (procainamide with continued used).
Client Education
Class 1A Sodium Channel Blockers - quinidine
Take with food if GI symptoms occur
Report GI symptoms to provider (especially severe diarrhea)
Teach client to monitor pulse rate and report changes from prescribed
parameters; keep record of pulse rate
Report dizziness, syncope to provider
Avoid hazardous activities, such as driving, if hypotension occurs
Do not change prescribed dose or dosage intervals; take at fixed times
daily
Be aware that monitoring of blood, ECG occurs
Report sudden chest pain, dyspnea to provider; call 911 for severe
symptoms
Be aware of the reasons for use of the IV infusion pump, vital sign
equipment, and cardiac monitors
Report flushing, headache or feeling of faintness to staff immediately
Report symptoms of cinchonism to provider
Report onset of fever, fatigue, and joint pain to provider
Report fatigue, weakness, easy bruising or infection to provider
Adverse Effects
Class 1B Sodium Channel Blockers - lidocaine
CNS effects- toxicity- confusion, drowsiness, restlessness, paresthesia, muscle twitching or tremors, seizures, respiratory arrest
Hypotension, bradycardia, heart block with high doses
Nursing Interventions
Class 1B Sodium Channel Blockers - lidocaine
Monitor for CNS effects; hold dose and notify provider
Monitor vital signs and cardiac rhythm
Expected Pharmacological Action
Class 1C Sodium Channel Blockers - felcainide
Blocks sodium channel in the heart, slowing the upstroke of the cardiac action potential
This slows conduction of the electrical impulse within the heart
Client Education
Class 1C Sodium Channel Blockers - felcainide
Report any visual changes to provider
Have regular ophthalmic examinations
Report shortness of breath, edema to provider
Instruct on temporary use of Holter monitor if necessary
Adverse Effects
Class II Beta Blockers - propranolol
Bradycardia due to blockade of beta1 receptors; may lead to reduced cardiac output, heart failure, rebound excitation causing angina pain or MI with sudden withdrawal of beta blockers in client with CHD
Peripheral arterial insufficiency (similar to Raynaud’s disease), CNS effects (confusion, fatigue, drowsiness)
Client Education
Class II Beta Blockers - propranolol
Check pulse rate daily before taking drug and report to provider for pulse slower than 60beats/min (or prearranged parameter)
Report shortness of breath, peripheral edema, night cough to provider
Do not stop taking this drug abruptly; talk to the provider
Report increase in angina or new onset of chest pain to provider
Report sensations of cold, numbness in hands or feet
Protect extremities from severe cold
Report CNS effects to provider
Avoid hazardous activities such as driving until effects are known
