Cardiovascular System Flashcards
ACE inhibitors prototype and other drug names
captopril (Capoten), lisinopril, enalopril, ramipril
ACE inhibitors EPA
block enzyme that converts angiotensin I to angiotensin II thereby decreasing vasoconstriction and aldosterone (reducing retention of sodium and water), leading to vasodilation and retention of K+
ACE inhibitors adminitstration
PO
ACE inhibitors therapeutic use
treatment of HTN and heart failure
ACE inhibitors ADRs
orthostatic hypotension, dry non productive cough, hyperkalemia, angioedema, taste distortions, rash
ACE inhibitors contraindications and interactions
Pregnancy - teratogenic
Breastfeeding
Liver disease w/elevated liver enzymes
Avoid NSAIDs
ACE inhibitors RN intervention and client education
Avoid salt substitutes
Monitor BP before, during, and after
Educate patient regarding possibility of chronic, dry, unproductive cough
Monitor K+ due to potential for hyperkalemia
Potassium levels - 3.5-5
ARBs prototype and other drug name
losartan (Cozaar), valsartan (Diovan), and irbesartan (Avapro)
ARBs EPA
blocks vasoconstricting and aldosterone-secreting effects of angiotensin II. Increases renal blood flow. Vasodilation and retention of K+
ARBs administration
PO
ARBs therapeutic use
treatment of HTN; stroke prevention (losartan only); diabetic neuropathy (Losartan and Irbesartan); heart failure (vasartan)
ARBs ADRs
angioedema, dizziness, hypotension, headache, insomnia
ARBs contraindications and interactions
Pregnancy /breast feeding - teratogenic
Children <6
NSAIDs increase risk for renal complications
ARBs RN intervention and client education
Monitor BP before, during, after
Monitor K+ due to potential for hyperkalemia (much less risk than w/ACE)
Monitor for angioedema
aldosterone antagonists prototype and other drug names
eplerenone (Inspra)
Others: spironolactone (Aldactone)
aldosterone antagonists EPA
blocks aldosterone receptors thereby blocking effects of aldosterone - excretion of Na+, water and retention of K+
aldosterone antagonists administration
PO can take up to 4 weeks
aldosterone antagonists therapeutic uses
HTN and symptoms of heart failure following MI
aldosterone antagonists ADRs
hyperkalemia (very common)
aldosterone antagonists contraindications and interactions
Avoid medications that can raise potassium such as ACE inhibitors, potassium sparing diuretics
Do not take if serum K+ levels are >/=5.0 mEq/L
Avoid if breastfeeding
Use caution in children
NSAIDs may decrease effects
If client is also taking lithium, aldosterone MAY cause lithium toxicity
aldosterone antagonists RN intervention and client education
Monitor BP
Monitor for s/sx of hyperkalemia:
- Palpitations, muscle twitching, weakness, paresthesia in extremities, diarrhea
- Slow irregular heart rate
Periodic blood levels:
- Potassium (K+)
- BUN and serum creatinine
Avoid salt substitutes
direct renin inhibitors prototype
aliksiren (Tekturna)
direct renin inhibitors EPA
binds with renin thereby inhibiting activation of angiotensin I - vasodilation and urinary excretion of sodium and water
direct renin inhibitors administration
PO 1 hour before meals. Do not admin w/ fatty foods (decreases absorption). 2 weeks to reach therapeutic effect
direct renin inhibitors therapeutic use
HTN
direct renin inhibitors ADRs
diarrhea, dyspepsia, abdominal pain; low incidence of hyperkalemia, but still possible; angioedema; dry nonproductive cough similar to ACE but not as common
direct renin inhibitors contraindications and interactions
Pregnancy and lactation
Hyperkalemia (K+ > 5.0 mEq/L)
<18 year old
ACE inhibitors and ARBs
Increases blood levels of atorvastatin (Lipitor)
direct renin inhibitors RN interventions and client education
Monitor BP
Monitor for s/sx of hyperkalemia:
- Palpitations, muscle twitching, weakness, paresthesia in extremities, diarrhea
- Slow irregular heart rate
Periodic blood levels:
- Potassium (K+)
- BUN and serum creatinine
Avoid salt substitutes
Calcium channel blockers (CCB) prototype and other drug names
nifedipine (Adalat) or (Procardia)
Others: amlodipine (Norvasc), verapamil (Calan), diltiazem (Cardizem)
CCB EPA
block calcium channels in vascular smooth muscle cells of peripheral arteries - vasodilation and decreased BP
CCB administration
PO (IR or ER)
CCB therapeutic use
HTN; stable angina
CCB ADRs
reflex tachycardia, angina: vasodilatory effects: headache, dizziness, facial flushing, peripheral edema and arrhythmias. Gingival hyperplasia
CCB contraindications and interactions
Avoid in children
2nd and 3rd degree heart block
Many drug interactions (anti seizure meds)
Grapefruit juice increases blood levels
CCB RN interventions and client education
Monitor BP and heart rate. HOLD for SBP <90
Instruct client to periodically measure HR and BP
Risk for falls
Monitor for peripheral edema (diuretic)
Regular dental checkups
Avoid grapefruit juice and grapefruit
alpha 1 blockers prototype and other drug names
Prototype: doxazosin (Cardura)
Others: prazosin (Minipress)
alpha 1 blockers EPA
block alpha1 receptors - venous and arteriolar dilation
alpha 1 blockers administration
PO at bedtime
alpha 1 blockers therapeutic use
HTN and benign prostatic hypertrophy (BPH)
alpha 1 blockers ADRs
orthostatic hypotension; reflex tachycardia, headache, dizziness
alpha 1 blockers contraindications and interaction
Avoid in children
Liver disease
CONTRAINDICATED in sildenafil (Viagra)
alpha 1 blockers RN intervention and client education
Carefully monitor BP when changing positions
Risk for falls secondary to orthostatic changes
Raise slowly from sitting to standing
beta blockers prototype and other drug names
atenolol (Tenformin)
Others: metoprolol (Lopressor), carvedilol (Coreg)
beta blockers EPA
block beta1 receptors - dec in HR and contractility - cardiac output and suppresses reflex tachycardia. Block beta 1 in kidney - blocks renin release
beta blockers administration
PO (IR and ER) and IV
beta blockers therapeutic use
HTN, angina, dysrhythmias, MI, heart failure
beta blockers ADRs
bradycardia, heart failure, rebound excitation with sudden withdrawal
beta blockers contraindications and interactions
Bradycardia
1st degree heart block
Heart failure
Children <6
Asthma or COPD
May inc effects of oral hypoglycemia agents
beta blockers RN intervention and client education
Carefully monitor BP and HR
HOLD for SBP < 90 and HR < 60
Do not stop abruptly
Monitor for s/sx of heart failure: SOB, edema, coughing at night while orthopneic
direct acting vasodilators prototype
hydralizine
direct acting vasodilators EPA
acts directly on arterioles to relax smooth muscle leading to vasodilation. stimulates SNS, affecting heart rate
direct acting vasodilators administration
PO and IV
direct acting vasodilators therapeutic use
mod - severe HTN, hypertensive crisis
direct acting vasodilators ADRs
reflex tachycardia, dizziness, fluid retention
direct acting vasodilators RN intervention and client education
Monitor BP prior to, during, and after administration
Do not stop abruptly
cardiac glycoside prototype
digoxin (Lanoxin)
cardiac glycoside therapeutic use
management of mild to moderate heart failure in adults and children. The drug is also used to control the ventricular response rate in adults with chronic arterial fibrillation
cardiac glycoside administration
PO and IV
cardiac glycoside EPA
positive inotropic effect that improves the contractility and pumping ability of the heart. Increases the force of myocardial contractility by inhibiting NA, K, ATPase (increased calcium = increased contraction)
cardiac glycoside ADRs
digoxin toxicity. Very narrow therapeutic window! cardiac dysrhythmias
cardiac glycoside RN intervention and client education
MANY med and herbal interactions
- Administer 1 hr prior to an antacid
Cardiac assessment - hold for a pulse <60 bpm
- Teach client how to check pulse
IV - SLOW IV push (at least 5 minutes)
Monitoring of serum drug levels
Educate client on s/sx of toxicity
Take at same time everyday and do not skip a dose - do not double dose
cardiac glycoside contraindications and interactions
Clients w/ ventricular dysrhythmias, AV block, severe heart disease
Infants, children, and older adults = higher risk for toxicity
Sympathomimetics prototype
dobutamine
sympathomimetics therapeutic use
SEVERE heart failure - short term
sympathomimetics administration
IV only!
sympathomimetics EPA
beta-1 adrenergic agonist = increased inotropy = increased cardiac output
sympathomimetics ADRs
tachycardia, dysrhythmias, possibly anginal pain
sympathomimetics RN intervention and client education
Cardiac monitoring (telemetry, ECG)
Continuous vital signs
Monitor urine output
sympathomimetics contraindications and indications
MAOIs and TCAs, general anesthesia
phosphodiesterase inhibitor prototype
Milrinone
phosphodiesterase inhibitor therapeutic use
short term management of acute to severe heart failure patients, in patients not responsive to digoxin, diuretics and vasodilators. Bridge therapy or longer term for palliation of symptoms
phosphodiesterase inhibitor administration
IV only!
phosphodiesterase inhibitor EPA
blocks PDE3 - enzyme that breaks down cyclic AMP = positive inotropic effect
phosphodiesterase inhibitor ADRs
ventricular dysrhythmias. Hypotension, hypokalemia, anginal chest pain
phosphodiesterase inhibitor RN intervention and client education
Continuous monitoring of BP, HR, and cardiac rhythm
Monitoring of electrolytes - K+
Monitor for chest pain
phosphodiesterase inhibitor contraindications and interactions
Caution: aortic/pulmonary valve issues, acute MI
Also renal impairment, history of arrhythmias, electrolyte imbalances, abnormal digoxin levels
loop diuretics prototype and other drug names
furosemide (lasix)
Others: bumetanide (Bumex) and torsemide (Demadex)
loop diuretics administration
PO and IV
loop diuretics therapeutic use
diuretic of choice when rapid effects are required (pulmoary edema), and when renal function is impaired - HF, HTN, pulmonary edema, renal and liver disease
loop diuretics EPA
inhibits sodium and chloride reabsorption in the loop of Henle
loop diuretics ADRs
hypokalemia, hyponatremia, hypochloremia, fluid volume deficit (dehydration), hypotension - orthostatic hypotension. Hyperglycemia and hyperuricemia. OTOTOXICITY!
loop diuretics RN intervention and client education
Must administer IV dose slowly! 1-2 min per 20 mg
Monitor daily weights
Monitor I/Os
Monitor electrolytes - especially K+!!
- Hypokalemia = risk of dysrhythmias
Take BP before and after
Monitor renal function (CRE, BUN, GFR)
Educate client to report hearing loss, tinnitus, vertigo
Digoxin can increase risk of hypokalemia!
loop diuretics contraindications and interactions
Caution w/electrolyte imbalances, dehydration
Caution w/ other ototoxic meds!
May increase lithium toxicity
thiazide diuretics prototype and other drugs
hydrochlorothiazide (Microzide)
Other: chlorothiazide (Diuril)
thiazide diuretics therapeutic use
mild to moderate HTN, edema d/t HF. Long term management of HF and HTN
Only works if the kidneys are making urine!
thiazide diuretics administration
PO, chlorothiazide is IV
thiazide diuretics EPA
inhibits reabsorption of sodium, water, chloride and bicarbonate in the distal convoluted tubal
thiazide diuretics ADRs
electrolyte imbalances (hyponatermia, hypokalemia, hypochloremia), hyperglycemia, hyperuricemia
thiazide diuretics RN intervention and client education
Give w/ food - ideally last dose before 1500
Monitor BP
Daily weights
Monitor I/O
Monitor electrolytes (K+) - watch for s/sx of imbalances
- Muscle twitching/weakness, irregular pulse, nausea
Monitor renal function (CRE, BUN, GFR)
thiazide diuretics contraindications and interactions
Renal decompensation or anuria
With lithium, risk for lithium toxicity
potassium sparing diuretics prototype
spironolactone (Aldactone)
potassium sparing diuretics therapeutic use
HF, ascites (liver fx), HTN
In pt’s with HF and inadequate renal function the addition of spironolactone allows for smaller doses of loop diuretics and minimizes potassium loss
potassium sparing diuretics administration
PO with food to increase absorption
potassium sparing diuretics EPA
aldosterone antagonist - aldosterone has sodium retaining properties - decreased potassium excretion
potassium sparing diuretics ADRs
common = dizziness, HA, abdominal cramping and diarrhea. Hyperkalemia. Can cause effects on the androgen receptors (deepening of voice, gynecomastia, menstrual irregularity, and testicular atrophy)
potassium sparing diuretics RN intervention and client education
Monitor BP, I/Os, daily weights
Monitor for hyperkalemia
- Cardiac dysrhythmias
- Report: palpitations, irregular pulse
- Avoid K+ supplements/food. Salt substitutes
Lots of drug and herbal interactions
Educate client on endocrine effects
potassium sparing diuretics contraindications and interactions
Teratogenic
Increased risk of hyperkalemia w/ ACE, ARB
HGM-CoA Reductase Inhibitors *Antilipemic?Statins Prototype and other drug names
atorvastatin (Lipitor)
Other drugs: simvastatin (Zocor), lovastatin (Mevacor), and rosuvastatin (Crestor)
statins EPA
Raise HDL and lower LDL and total cholesterol by inhibiting HMG CoA reductase, an enzyme that synthesizes cholesterol in the liver
statins therapeutic use
used to treat high cholesterol and prevent vascular disease
statins administration
PO, take in evening (the body makes cholesterol at night)
statins ADRs
Myopathy (which can progress to rhabdomyolysis) and hepatotoxocity
statins contraindications and interactions
Teratogenic
Current liver disease
ETOH use and disorder
Interacts with grapefruit juice and high risk of ADRs
Warfarin + statin + increased risk of bleeding
statins RN intervention and client education
Report muscle pain to provider
Report abdomibnal pain, jaundice, and fatigue to provider
May need periodic liver function testing
fibrates prototype and other drug names
gemfibrozil (Lopid)
Others: fenofibrate (TriCor)
fibrates EPA
increases oxidation of fatty acids in liver and tissues, thus decreasing production of triglycerides
fibrates therapeutic uses
most effective for reducing serum triglycerides, increasing HDLs too
fibrates administration
PO
fibrates ADRs
GI effects (N/D/abdominal pain), hepatotoxicity, gallstones, and myopathy
fibrates contraindications and interactions
Avoid in someone with gall bladder disease
Liver disease
Severe renal impairment
Warfarin + fibrate = increased risk of bleeding
Risk of myopathy increases with concurrent use of statins
fibrates RN intervention and client education
Recommended to take with food
Report muscle pain to provider
Report abdominal pain, jaundice, and fatigue to provider
May need periodic liver function testing
nitrates *antianginals prototype
Nitroglycerin
nitrates EPA
converts to nitric oxide, potent vasodilator; relaxes smooth muscle in blood vessel walls. Relieve angina pain by venous dilation, coronary artery dilation, and arteriole dilation
nitrates therapeutic use
management/treatment of acute chest pain caused by myocardial ischemia
nitrates administration
PO (SL, tablets, translingual spray), transdermal, topical ointment, IV
nitrates ADRs
HA, hypotension, dizziness, bradycardia, syncope
nitrates contraindications and interactions
Severe anemia
Hypotension
Hypovolemia
Use caution in renal impairment
AVOID phosphodiesterase enzyme inhibitors… sidenafil (Viagra) - Can produce LIFE THREATENING hypotension!!!
nitrates RN interventions and client education
Educate client on how to take nitroglycerin at home for angina attack: Stop activity - lie or sit down, Put one SL tablet under tongue and let it dissolve, wait/rest 5 min. If pain unrelieved, place 2nd tablet under tongue
wait/rest another 5 minutes, if pain unrelieved, take 3rd tablet under tongue. If after 3 doses, pain is unresolved, seek medical attention immediately!!!
DO NOT take more than 3 tablets!!!
Spray substitutes for 1 SL tablet
In hospital or providers office-same protocol as above but would obtain an EKG first and then VS before each dose of nitro - Hold if systolic BP <90 and HR <60
Store SL nitro tablets out of sunlight and once open, use within ~4 months
Wear gloves when applying transdermal patches and topical ointment
Class IB sodium channel blockers prototype
lidocaine
Class IB sodium channel blockers EPA
blocks Na+ channels therebny shortening the repolarization phase of the cardiac cycle… decreases the rate of contractions of the heart
class IB sodium channel blockers therapeutic use
treats serious ventricular dysrhythmias associated with MI, cardiac cath, and cardiac surgery
class IB sodium channel blockers administration
only given IV in hospital setting
class IB sodium channel blockers ADRs
hypotension, bradycardia, other dysrhythmias, and anxiety
class IB sodium channel blockers contraindications and interactions
Untreated bradycardia or heart block
Pregnancy and lactation
class IB sodium channel blockers RN intervention and client education
Continuous monitor of cardiac rhythm and vital signs
Avoid OTC cold med, asthma remedies and appetite suppressants that could aggravate irregular heartbeats
class IC sodium channel blockers prototype
flecainide (Tambocor)
class IC sodium channel blockers EPA
Blocks Na+ channel to slow conduction velocity and the refractory period
class IC sodium channel blockers therapeutic use
treat atrial flutter or artrial fibrillation
class IC sodium channel blockers administration
PO
class IC sodium channel blockers ADRs
worsening heart failure, widens QRS complex, potential for other dysrhythmias to occur
BLACK BOX WARNING: can cause fatal arrhythmias and death in patients with recent MI
class IC sodium channel blockers contraindications and interactions
Heart blocks
Heart failure
class IC sodium channel blockers RN intervention and client education
Clients must be in hospital setting when therapy begins to monitor heart continuously
Cardiac monitoring and VS before each dose
Avoid OTC cold med… asthma remedies and appetite suppressants that could aggravate irregular heartbeats
class II beta-adrenergic blockers prototype
propranolol (Inderal LA)
class II beta-adrenergic blockers EPA and other info
Discussed during HTN/CAD lecture
Slows down the heart rate
class III potassium channel blockers prototype
amiodarone
class III potassium channel blockers EPA
blocks K+ channels in turn slowing repolarization and prolonging the refractory period to slow down the heart rate
class III potassium channel blockers therapeutic use
treats various life-threatening ventricular and/or arterial tachy-dysrhythmias
class III potassium channel blockers administration
PO and IV
class III potassium channel blockers ADRs
fatal dysrhythmias and hypotension
BLACK BOX WARNING: long term use of amiodarone can cause fatal pulmonary toxicity
class III potassium channel blockers contraindications and interactions
Heart block
Heart failure
teratogenic
class III potassium channel blockers RN interventions and client education
Cardiac rhythm monitoring and VS before each dose
Take with food
Do not drink with grapefruit juice
IV route can be very harmful to small veins… need to watch!
Avoid OTC cold med, asthma remedies and appetite suppressants that could aggravate irregular heartbeats]increases the effects of beta-blockers, oral anticoagulants, digoxin and phenytoin
class IV calcium channel blockers prototype and other drug names
diltiazem (Cardizem)
Others: verapamil (calan)
class IV calcium channel blockers EPA
Blocks the Ca2+ channels, causing a slower conduction through the SA and AV nodes, slowing down the heart rate
class IV calcium channel blockers therapeutic use
used to treat atrial tachycardias
class IV calcium channel blockers adminsitration
PO or IV
class IV calcium channel blockers ADRs
dizziness, bradycardia, and heart block
class IV calcium channel blockers contraindications and interactions
Heart block
Heart failure
class IV calcium channel blockers RN interventions and client education
Cardiac rhythm monitoring and vital signs before each dose
Avoid OTC cold med, asthma remedies and appetite suppressants that could aggravate irregular heartbeats
Unclassified Antidysrhythmic Drugs
Adenosine
- Treats SVT
- Acts like a calcium channel blocker
- Only given in IV
- Vert short health life so must be given FAST through IV
Magnesium
- Treats torsades de pointe
- Mg2+ is the gatekeeper for Ca2+ being allowed into the cells. With low Mg2+ the gate is open and Ca2+ will flood the cell causing contraction and an irritable cardiac cell leading to dysrhythmias
- Given IV in acute setting and PO outpatient
