Cardiovascular/Renal Flashcards
What is hyperlipidemia?
A condition in which there are high levels of fat (LIPIDS) particles in the blood
What is hypertension?
High blood pressure.
Elevated 120-129, less than 80
Stage 1 hypertension 130-139, less than 80
Stage 2 hypertension 140 or higher, over 90
Hypertensive crisis higher than 180/120
What is thrombi?
A blood clot formed in situ within the vascular system of the body and impeding blood flow.
What is atherosclerosis?
The buildup of plaque in the walls/inner lining of arteries.
Thickening or hardening of arteries
What is coronary artery disease?
Major blood vessels that supply the heart (coronary arteries) struggle to send enough blood, oxygen and nutrients to the heart muscle.
Cholesterol deposits (plaques) in the heart arteries and inflammation is usually the cause
What is a myocardial infarction (MI)?
Heart attack.
Occurs when a blood clot blocks blood flow to the heart
What is an arrhythmia/dysrhythmia?
An abnormal beating of the heart
What is a heart failure?
A chronic condition in which the heart doesn’t pump blood as well as it should
What is an inotrope?
A type of drug that can help your heart muscle CONTRACT with more or less power
What is a chronotrope?
A drug that can change the heart rate by affecting the electrical conduction system of a heart and nerves that influence it
What is a dromotrope?
Medication agent that affects the conduction “speed” in the AV node (Rhythm)
What is an (INR) international normalized ratio blood test for?
This blood test tells you how long it takes your blood to clot
often used to tell if warfarin treatment is effective
The nurse is preparing to administer metoprolol (beta 1 agonist). What finding would cause the nurse to HOLD the medication?
Heart rate under 60 bpm
Metoprolol is used to treat what issues?
High blood pressure
decreased chest pain due to poor blood flow
Early myocardial infarction intervention (HEART ATTACK)
What is the black box warning for metoprolol?
When discontinuing therapy, taper for 1-2 weeks, faster may cause chest pain or heart attack
What should your patient do when they’re taking a medication for their hypertension?
Monitor their pulse and blood pressure at home
Avoid caffeinated substances
Take the medication at the same time of day
Do not stop the medication up abruptly
Patients taking the (beta blocker) Metoprolol should have what assessments done by the NURSE?
Monitor heart rate and blood pressure
Do not administer, if heart rate is under 60 bpm
Monitor blood sugar in diabetic patients
What is the loop diuretic (furosemide)
used to treat?
Edema related to heart failure, and hypertension
The loop diuretic (Furosemide) inhibits the reabsorption of what electrolyte in the loop of Henle?
What is the loop of Henle?
Inhibits the absorption of Na, SODIUM
The loop of Henle is located in the nephron (kidney)
What are adverse reactions for LOOP Diuretics?
Nephrotoxicity and ototoxicity
What are side effects of LOOP Diuretics?
Hypotension and dehydration
Electrolyte imbalances
IMPORTANT: (potassium) imbalance can lead to (hypokalemia) which causes (cardiac dysrhythmias)
Patients with heart failure and edema should have what monitored each day by the nurse?
Monitor I&O
Monitor weight daily
(same time, same clothes, same scale)
Loop diuretics should include patient teaching about what topics?
Teach about kidney issues
Encourage high potassium foods and low sodium
Change positions slowly, due to orthostatic hypertension
Weight gain of 3 pounds overnight or 5 pounds in one week call your HCP
Take in the a.m.
Potassium sparing diuretics (spironolactone) have what adverse side effect?
Nephrotoxic
Potassium sparing diuretics can have what side effects?
Gynecomastia and hyperkalemia (HIGH potassium)
What should you teach clients that are taking potassium sparing diuretics?
Take in the morning, low sodium diet and caution with salt substitute
Salt substitutes are often potassium-based
Beta 1 antagonist and Beta 1 adrenergic blocker may cause biological males to have what dysfunction?
Erectile dysfunction 
Beta blockers can be selective or non-selective what does this mean?
Meaning they can block different beta sites, beta 1 &/or beta 2
Hint:
beta1: think 1 heart
beta2: think 2 lungs
What are the five “B’s” of beta blockers?
Bradycardia and heart blocks
Breathing problems = bad for asthma Pts
Bad for heart failure patient (in acute care)
Blood sugar masking (Masks signs and symptoms of hypoglycemia)
Blood pressure lowered
Beta blockers are used to treat what condition?
Hypertension, stable angina, chronic heart failure, dysrhythmias
Nitroglycerin’s or antianginal’s should not be taken with which type of meds?
Hint: med is for biological males
Erectile dysfunction meds
Nitroglycerin come in a few different types of forms. What are they?
Sublingual, mouth sprays, transdermal patches
What are expected signs and symptoms of nitroglycerin?
Headache, hypertension, hot flushed face
What are alarming signs after administering nitroglycerin’s?
Dizziness and lightheadedness
Why should nitroglycerin not be taken with erectile meds…what happens to the body?
The blood pressure drastically lowers and can cause death
What do nitroglycerin’s (antianginals) due to blood flow?
Increase blood flow
Digoxin is a cardiac glycoside and treats what types of conditions
Heart failure, dysrhythmias, atrial fibrillation, cardiogenic shock
What is the lab range for digoxin?
0.5 - 2.0
Above 2.0 is TOXIC
What are cardiac glycoside (digoxin) signs of toxicity?
Visual: blurred vision, yellow/green vision, halo effect around dark objects
GI: nausea, vomiting, and diarrhea
Neurological: headache, confusion, and drowsiness
What is the antidote for digoxin?
Digibind and digifab
Which medications should not be given if your heart rate is below 60 bpm?
Beta blockers like Metropol
Cardiac glycosides like digoxin
Warfarin is an anticoagulant. Is it used for long-term or short term therapy?
Long-term therapy
(Works slowly)
Do warfarin or heparin dissolve clots?
No, they do not dissolve clots.
Heparin: prevents clots and older clots from getting bigger in size
Warfarin: suppresses coagulation by interfering with vitamin K production to prevent clots
What is the antidote for warfarin (Coumadin)?
 Vitamin K or Aquamephyton
For warfarin and heparin. What should you teach the patient?
Bleeding precautions:
avoid NSAIDs, aspirin, antibiotics and alcohol
 Gently brush teeth with soft bristle toothbrush
Avoid contact sports
Remove throw rugs because they increased fall risk
Use electric razor
❤️Always wear medicalert ❤️
Warfarin therapy is given orally and heparin therapy is given IV or sub-cue. The infusion should be stopped if there is evidence of what?
Evidence of bleeding or bruising
Is warfarin safe for pregnancy?
Is heparin safe for pregnancy?
Warfarin is not safe in pregnancy
Heparin is safe in pregnancy
Heparin is used for what conditions?
(Hint: Heparin happens fast)
Treats angina, MI, DVT, and PE
Most hypertensives have what in common?
They should not be stopped abruptly. They should be taken at the same time of day. They may cause orthostatic hypotension.
What is the black box warning for beta blockers?
Taper 1 to 2 weeks to avoid angina or myocardial infarction
ACE inhibitors treat what conditions?
Hypertension, heart failure, and myocardial infarction’s
Are ACE inhibitors contraindicated in pregnant women?
YES, not for pregnant women
What should you monitor in patients taking ACE inhibitors?
BUN and creatinine levels
Angioedema: swelling of face
Dry cough
Elevated vitamin K+
Both heparin and warfarin should have blood levels of INR and aPTT measured frequently. Why?
 These blood tests show the therapeutic dosage window for each patient
Higher INR levels = higher bleeding risk
What foods are high in potassium?
Dairy products, dark leafy greens, dried fruits, beans, nuts, bananas, avocados
What are adverse effects for (metoprolol) beta blockers?
Worsening heart failure, hypertension, bradycardia
What are side effects of beta blockers?
Erectile dysfunction, fatigue, insomnia
Causes the heart muscle to squeeze or contract stronger
Positive inotropic action
Causes a heart to beat slower
Negative Chronotropic action
Slows down the impulses sent through the AV node
Negative dromotropic action
Therapeutic range for digoxin and antidote
0.5 - 2 ng/ml
Digibind
If your patient is experiencing digoxin toxicity, what would you do?
Hold further medication doses and notify MD
Antiplatelet medication (Clopedigrel or plavix) makes platelets slippery in your body.
What is the side effect or adverse reaction of this mechanism of action?
Increased risk of bleeding and bruising. Internal or external bleeding.
Plavix an (antiplatelet medication) has a black box warning that contraindicates use with what food?
Do not combine with grapefruit
When taking an antiplatelet, the nurse should monitor platelet levels. What is the platelet level range?
150,000 – 400,000
What medications are under the anticoagulant category?
Lovenox, heparin, warfarin, eliquis
Lovenox and heparin are often a bridge medication to long-term therapy treatment of ??
Warfarin
All four anticoagulant medication’s can cause bleeding. What should you educate your patient about?
Avoid NSAIDs or aspirin
No contact sports
Brush teeth with a soft bristle brush
Use an electric razor
Remove rugs or avoid fall risks
Monitor for signs of bleeding or bruising
What should the nurse monitor in patients that are taking heparin?
Monitor labs: APTT and PTT
Signs of hemorrhaging or bleeding
What is the antidote for heparin?
Protamine sulfate
Heparin is given subcutaneously where?
(In the abdomen) 2 inches away from the scars, bruising, etc.
What is the black box warning for heparin and Lovenox?
 Epidural or spinal hematomas
HMG COA reductase inhibitors
(-statins) are used to for what conditions?
Hyperlipidemia, strokes, MI
HMG COA reductase inhibitors
(-statins) has a black box warning, what is it?
Do not use in patients with liver disease
What are side effects of statin medication’s?
What labs do you monitor?
Liver dysfunction and increased liver labs
Monitor liver enzymes panel
Patients taking HMG COA reductase inhibitors (-statins) should be taught to monitor for signs of what?
These signs can lead to an adverse reaction called?
Monitor for signs of muscle pain and tea colored urine
Adverse reaction: myalgias aka pain
** Rhabdomyolysis **
HMG COA reductase inhibitors
(-statins)  patient education includes:
Not for pregnant or breast-feeding women
Avoid grapefruit juice or alcohol
Diabetic patients should monitor blood glucose levels because it can increase levels 
Did Digoxin mechanism of action?
Positive inotrope
Negative Chromotrope
negative dromotrope
What is the black box warning for digoxin?
 Heart rate and elderly
What should you teach patients taking digoxin?
Pulse rate monitoring and avoid potassium rich foods
Sildenafil (Viagra) should never be given with nitroglycerin, why?
Lowers blood pressure and may cause death
Priapism that last for more than four hours is serious, what should the patient do?
Seek medical attention at emergency room
What should be included on a teaching plan for calcium channel blockers?
Change position slowly, due to orthostatic, hypertension and side effects of medication
Aspirin prevents what?
Platelet aggregation
A patient on diuretic therapy complains of numbness, tingling and weakness.  What electrolyte lab value is more than likely abnormal?
 Potassium
What should a patient on calcium channel blockers avoid?
Grapefruit juice
Acronym for a patient education on statin drugs
** STAT **
S: sore muscles
T: toxic to liver (monitor ALT & AST)
A: avoid grapefruit and St. John wort
T: take at night
Angiotensin II receptor blockers (ARBs) have what 2 dangerous and deadly side effects?
Angioedema and hyperkalemia
ARBs patient education includes:
Orthostatic hypertension, avoid potassium foods/pills, including salt substitutes.
Do not suddenly stop medication because of rebound hypertension
Ace inhibitors are not great choices for African Americans. What is a better choice for antihypertensives?
Calcium channel blockers
