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PNUR 155 - Pharmacology > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

1
Q

positive iontropic drugs do what to the heart (cardiac glycosides)

A

increase the force of the muscle contraction
(used to treat heart muscle failure)
Ex: Digoxin

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2
Q

what are cardiac glycosides used for

A

commonly used in the treatment of heart failure and to control atrial fibrillation or flutter

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3
Q

cardiac glycoside mechanisms of action are

A
  • increase muscle contractility
  • change the electrical conduction properties of the heart
  • result in resudced heart rate and improved cardiac efficiency
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4
Q

what are the drug effects of cardiac glycosides

A

positive inotropic (modify the speed or contraction of muscle) effect: Increase in force and velocity of myocardial contraction (without an increase in oxygen consumption)

negative chrontropic (change the heart rate) effect: reduced heart rate

negative dromotropic (conduction speed in the AV node) effect: decreases the autmoatic response at SA node, decreases AV nodal conduction, and other effects

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5
Q

What are some of the drug effects that you would notice with cardiac glycosides

A
  • Increased stroke volume
  • Reduction in heart size during diastole
  • Decrease in venous blood pressure (BP) and vein engorgement
  • Increase in coronary circulation
  • Promotion of diuresis due to improved blood circulation
  • Palliation of exertional and paroxysmal nocturnal dyspnea, cough, and cyanosis
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6
Q

What would you use cardiac glycosides for

A

heart failure

atrial fibrillation/flutter

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7
Q

What are some of the contraindications of cardiac glycosides

A
  • know drug allergy
  • ventricular tachycardia
  • subaortic stenosis
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8
Q

When using the cardiac glycoside Digoxin, what do you need to monitor for

A

it has a very narrow therapeutic window

drug levels must be monitored

monitor low potassium levels this increases the toxicity of digoxin

monitor electrolyte levels

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9
Q

What are some of the side effects in the body that could occur from using the cardiac glycoside Digoxin

A

CV: dysrhythmias
CNS: headaches, fatigue, confusion
EENT:halo vision, flickering lights
GI: nausea, vomiting, diarrhea

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10
Q

What do you use to reverse Digoxin toxicity

A

Digibind

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11
Q

What are some predisposing factors that could put someone at risk for Digoxin toxicity

A
  • low potassium levels
  • having a pacemaker
  • excessive calcium
  • advanced age
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12
Q

As nurses what needs to be done prior to and during administration of positive inotropic drugs

A
  • assess history, allergies and contraindications
  • assess: bp, apical pulse (for 1 minute) if loer than 60 or greater than 120 hold dose and notify prescriber, heart and breath sounds, weight, I & O, ECG, labs
  • check dosage forms carefully, and follow instructions for giving
  • avoid giving digoxin with high-fibre foods (fibre binds with digitalis)
  • patients should report immediately a weight gain of 1 kg or more in 1 day or 2 kg or more in 1 week
  • monitor for therapeutic effects
    *Increased urinary output
    *Decreased edema, shortness
    of breath, dyspnea, crackles,
    fatigue
  • resolving of paroxysmal
    nocturnal dyspnea (severe
    SOB and coughing at night
    usually while sleeping)
  • improved peripheral pulses, skin
    colour, temperature
  • monitor for adverse effects
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13
Q

What are 2 primary forms of lipds in the blood

A

triglycerides and cholesterol

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14
Q

What is another name for HMG-CoA reductase inhibitors

A

Statins (antilipemics)

Ex. crestor, zocor,lipitor

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15
Q

What is the mechanism of action for statins

A

used to lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver

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16
Q

What are statins used for

A

hypercholesterolemia

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17
Q

What are the contraindications for using statins

A
  • know drug allergy
  • if you are pregnant
  • liver disease or elevated liver enzymes
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18
Q

As nurses what needs to be monitored or assessed prior to and during administration of statin drugs

A

Obtain baseline liver function studies

Patients on long-term therapy may need supplemental fat-soluble vitamins (A, D, K)

Monitor for adverse effects, including increased liver enzyme studies

Monitor for therapeutic effects

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19
Q

What are some of the adverse effects of statins

A

Mild, transient gastrointestinal (GI) disturbances

Rash

Headache

Myopathy (muscle pain), possibly leading to the serious condition rhabdomyolysis (breakdown of muscle fibers)

Elevations in liver enzymes or liver disease

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20
Q

What can statins have interactions with that may cause unwanted effects

A 
Oral anticoagulants
Oral antidiabetic drugs
erythromycin
insulin
Niacin
Grapefruit juice
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21
Q

When dealing with hypertension what drug categories are available to use
(there are 6)

A
  • adrenergics
  • ACE inhibitors
  • ARBs
  • calcium channel blockers
  • diuretics
  • vasodilators
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22
Q

What are the 5 subcategories of adrenergic drugs

A
  1. centrally and peripherally acting adrenergic neuron blockers
  2. centrally acting a2 receptor agonists
  3. peripherally acting a1 receptor blockers
  4. peripherally acting b receptor blockers both cardioselective and nonselective
  5. peripherally acting dual a1 and b receptor blockers
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23
Q

What is mechanism of action for centrally acting a2 receptor agonists (agonists stimulate a reaction)

A
  • reduces renin (protein in the kidneys that promotes the production of the protein angiotensin) activity in the kidneys
  • decreases norepinephrine production
  • results in decreased blood pressure
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24
Q

What is the mechanism of action for peripherally acting a1 blockers/antagonists (inhibitors)

A
  • blocks the a1 adrenergic receptors
  • includes doxazosin (Cardura) and prazosin (Minipress)
  • decreases blood pressure
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25
Q

What is the mechanism of action for the peripherally acting b blockers both cardioselective and nonselective

A
  • reduces bp by decreasing the heart rate through b1 receptor blockade
  • reduces secretion of renin
  • reduces peripheral vascular resistance
  • decreases bp
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26
Q

What is the mechanism of action of peripherally acting a1 and b receptors blockers

A
  • blocks the a1 adrenergic receptor
    • reduces heart rate (b receptor blockade)
    • vasodilation (a1 receptor blockade)
  • one drug is carvedilol
  • decreases bp
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27
Q

What are centrally acting a2 receptor agonists used for

A
  • hypertension

- glaucoma

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28
Q

What are peripherally acting a1 receptors agonists used for

A
  • hypertension
  • relief of benign prostatic hypertrophy
  • mgme of severe heart failure when used with glycosides and diuretics
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29
Q

What are some contraindications for adrenergics

A
  • drug allergy
  • acute heart failure
  • asthma
  • colitis
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30
Q

What are some of the most common side effects of adrenergic drugs

A
  • dry mouth
  • drowsiness
  • constipation
  • orthostatic hypotension
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31
Q

What are ACE inhibitors used for

A
  • heart failure

- hypertension

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32
Q

What is the mechanism of action for ACE inhibitors

A

*Renin–angiotensin–aldosterone system
-stops the angiotensin-converting enzyme
from converting angiotensin I to
angiotensin II
(FYI - angiotensin II is a vasoconstrictor)

*Aldosterone stimulates water and sodium resorption
-this increases blood volume, cardiac
preload increases and bp increases

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33
Q

What are ACE inhibitors indicated for

A

-hypertension
-heart failure
-to slow the progression of left ventricular
hypertrophy after an MI (cardioprotective)
-renal protective in pt’s with diabetes

(Note - drug of choice for diabetics and hypertensive patients with heart failure)

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34
Q

What is the suffix on the name of the drugs associated with ACE inhibitors

A

“prils”

Ex: captopril, enalapril,quinapril

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35
Q

What are some contraindications for ACE inhibitors

A 
drug allergy
lactating women
children
bilateral renal artery stenosis
hyperkalemia
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36
Q

What are some side effects of ACE inhibitors

A

fatigue
headache
dizziness
mood changes

(Note - first dose may have a hypotensive effect)

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37
Q

What are the possible drug to drug interactions that can occur with ACE inhibitors

A

NSAIDs can reduce the effectiveness of the antihypertensive effect

if taking lithium this could result in lithium toxicity

if taking potassium supplements and potassium sparing diuretics this may result in hyperkalemia

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38
Q

What is the main difference btween ACE inhibitors and ARBs

A

ARBs do not cause a dry cough like ACE inhibitors do

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39
Q

What is the mechanism of action for ARBs

A
  • allows angiotensin I to be converted to angiotensin II but blocks the receptors from receiving angiotensin II
  • blocks the vasoconstriction and the release of aldosterone
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40
Q

What is the suffix that ARB drug come with

A

“sartan”

Ex: losartan, valsartan

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41
Q

What are the indications for ARBs

A

-hypotension
-used as an adjunct for tx of heart failure
-used primarily in pt’s that can’t tolerate ACE
inhibitors

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42
Q

What are the contraindications for ARBs

A

drug allergy
pregnancy
lactation

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43
Q

What are some drug to drug interactions

A

phenobarbital

cimetidine

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44
Q

What are some adverse side effects of using ARBs

A
  • headaches
  • upper respiratory infections
  • dizziness
  • diarrhea
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45
Q

What is the mechanism of action for calcium channel blockers

A

they cause smooth muscle relaxation by blocking calcium from its receptors. This prevents muscle contractions from happening
which in turn decreases vacular resistance and bp

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46
Q

What would you used calcium channel blockers for

A
  • angina
  • hypertension
  • dysrhythmias
  • migraine headaches
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47
Q

What do diuretics do in regards to the heart

A
  • decrease preload
  • decrease cardiac output
  • decrease total peripheral resistance

(the overall effect is the workload of the heart is decrease and this in turn decreases bp)

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48
Q

Which diuretics are the most commonly prescribed for hypertension

A

thiazide diuretics

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49
Q

What is the mechanism of action for vasodilators

A
  • directly relax arteriolar and venous smooth muscle
  • decreased systemic vascular response,
  • decreased afterload
  • decreased peripheral vasodilation
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50
Q

What is the suffix that comes with the names of thiazide drugs

A

“ide”

Ex: hydralazine, sodium nitroprusside

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51
Q

What are vasodilator drugs indicated for

A

hypertension

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52
Q

What are some of the contraindications for vasodilators

A 
drug allergy
hypotension
head injury
MI
CAD
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53
Q

What are some of the side effects that vasodilators have

A 
dizziness
headache
anxiety
hypotension
bradycardia
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54
Q

As nurses what needs to be monitored or assessed prior to and during administration of vasodilator drugs
(there are 7, try to list 4)

A
  • obtain health history
  • head to toe physical

-assess for contraindications specific to
hypertensive drugs

-assess for conditions hat require caution when
using these drugs

  • monitor for adverse effects
  • monitor for therapeutic effect
  • monitor bp throughout therapy
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55
Q

What are diuretics

A

drugs that accelerate the rate of urine formation (they remove sodium and water)

they cause arteriole dilation reducing fluid volume, plasma volume and cardia output

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56
Q

What are the different types of diuretics

A

loop diuretics (furosemide or Lasix)

potassium-sparing diuretics (spironolactone)

thiazide and thiazide like diuretics
(hydrochlorothiazide and metolazone)

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57
Q

What is the mechanism of action with loop diuretics

A

they work directly on the loop of henle in the kidney to stop chloride and sodium reabsorption

increase kidney prostaglandins resulting in dilation of blood vessels and reduced peripheral vascular resistance

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58
Q

When a person takes this drug what will happen

A

-there is a decrease in fluid volume which can cause:
reduced bp
reduced pulmonary vascular resistance
reduced system vascular resistance
reduced left ventricular end-diastolic pressure

-potassium and sodium loss

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59
Q

What are loop diuretics used for

A
  • edema associated with heart failure
  • control of hypertension
  • hypercalcemia
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60
Q

What are some contraindications for loop diuretics

A
  • drug allergy
  • allergy to sulfonamide antibiotics
  • severe electrolyte loss
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61
Q

What are some of the adverse effects on the body when taking a loop diuretic

A 
CNS = dizziness, headache, tnnitus
GI = nausea, vomiting, diarrhea
HEMA = thrombocytopenia
META = hypokalemia, hyperglycemia
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62
Q

What is the mechanism of action for a potassium-sparing diuretic

A
  • work in collecting ducts and distal convoluted tubules
  • interfere with sodium–potassium exchange
  • block the resorption of sodium and water usually induced by aldosterone
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63
Q

What is a potassium-sparing diuretic used for

A
  • hypertension
  • certain causes of heart failure
  • hyperaldosteronism
64
Q

What are the contraindications for potassium-sparing diuretics

A
  • drug allergy
  • hyperkalemia
  • severe kidney failure or anuria
65
Q

What are some of the adverse effects on the body when taking potassium-sparing diuretics

A 
CNS = dizziness, headache
GI = cramps, nausea, vomiting
other = urinary frequency, weakness
66
Q

What are a couple of adverse effects of taking spironolactone specifically

A
  • amenorrhea

- irregular menses

67
Q

What are some drug to srug interactions for potassium-sparing diuretics

A

lithium
ACE inhibitors
potassium supplements

68
Q

What is the mechanism of action for thiazide and thiazide like diuretics

A

inhibit tubular resorption of sodium, chloride, and potassium ions

act primarily in the distal convoluted tubule

result in excretion of water, sodium, and chloride, and potassium to a lesser extent

dilate the arterioles by direct relaxation

69
Q

What are the effects of thiazide and thiazide like diuretics

A

lowered peripheral vascular resistance

depletion of sodium and water (and potassium)

70
Q

What indications ae thiazide and thiazide like diuretics used for

A

hypertension
edema
heart failure d/t diastolic dysfunction

71
Q

What are the contraindications for thiazide and thiazide like diuretics

A

drug allergy
anuria
severe kidney failure

72
Q

What are some of the adverse effects on the body when taking thiazide and thiazide like diuretics

A 
CNS = dizziness, headache
GI = anorexia, nausea
GU = impotence
INTEG = urticaria, photosensitivity
META = hypokalemia, hyperglycemia
73
Q

What are some of the nursing things that as a nurse needs to be done prior to and during therapy

A

-perform a physical exam

-assess baseline fluid volume
I & O, weight
vital signs
electrolyte values

  • assess for any contraindications
  • monitor for adverse effects
  • monitor for therapeutic effects
  • monitor potassium levels
74
Q

What are some teaching that nurses can give to patients regarding diuretic drugs
(there are several name 5)

A

-teach patients to maintain proper nutritional and fluid volume status

  • teach patients to eat more potassium-rich foods when taking any but the potassium-sparing drugs, like:
    - bananas, oranges, dates, raisins
  • patients taking diuretics and digitalis should be taught to monitor for digitalis toxicity
  • diabetics taking thiazide and/or loop diuretics need to monitor blood glucose
  • teach patients to change positions slowly to prevent orthostatic hypotension
  • encourage patients to return for follow-up visits and laboratory tests
  • instruct patients to take in the morning can cause sleeplessness if taken at night
75
Q

What are some teaching that nurses can give to patients regarding statin drugs

A

advise patients to take with meals to decrease GI upset

patient must be counselled concerning diet and nutrition on an ongoing basis

instruct on proper procedure for taking the medications

instruct patients to report persistent GI upset, constipation, abnormal or unusual bleeding, and yellow discoloration of the skin

76
Q

What are some teaching that nurses can give to patients regarding statin drugs

A

-educate pt about taking medication
appropriately

-advise pt never to double dose if a dose is
missed

-advise pt to talk to doctor before stopping
medication

-advise pt about exercising regularly

-advise pt about making positive lifestyle
changes

-medication should be taken with food so that
absorption is more effective

77
Q

What types of drugs (classifications) are used for angina

A

nitrates
calcium channel blockers
beta blockers

78
Q

What is the therapeutic objective for antianginals

A

increase blood flow to the ischemic heart

decrease oxygen demand (or both)

minimize frequency of the attacks

improve pt’s functional capacity

79
Q

What is the mechanism of action for nitrates

A

cause vasodilation d/t relaxation of smooth muscles

has a potent dilating effect on coronary arteries

vasodilation results in reduced myocardial oxygen demand

nitrates cause dilation of both large and small coronary vessels

nitrates alleviate coronary artery spasms

80
Q

What are nitrates used for

A

Rapid-acting forms:
-are used to treat acute anginal attacks

Long-acting forms:
-are used to prevent anginal episodes

81
Q

What are some of the contraindications of nitrates

A
  • drug allergy
  • severe anemia
  • hypotension
  • severe head injury
82
Q

What are some of the adverse effects of nitrates

A

headaches
tachycardia
postural hypotension

83
Q

What are some drug to drug interactions for nitrates

A

Can produce additive hypotensive effects when taken with:
alcohol
beta blockers
calcium channel blockers

84
Q

What are a couple of drug names that are indicated for angina
(drug names end “olol”

A

atenolol
metoprolol
propanolol

85
Q

What is the mechanism of action for beta blockers

A

b1-adrenergic receptors on the heart are blocked

  - decrease the heart rate, resulting in 
  - decreased oxygen demand 
  - decrease contractility

b-blockers block the harmful effects of catecholamines, thus improving the chances of survival after an MI

86
Q

What do you use beta blockers for

A

angina
antihypertensive
cardiac dysrhythmias
cardioprotective effects

87
Q

What adverse effects occur to the body systems using beta blockers

A 
CV = bradycardia, hypotension, heart failure
META = altered glucose and lipids
CNS = dizziness, drowsiness, fatigue
OTHER = wheezing, dyspnea
88
Q

What are some patient teaching that should be done by the nurse

A

monitor pulse rate daily and report any rate lower than 60 beats/min

Dizziness or fainting should also be reported

Constipation is a common problem, tell pt’s to drink plenty of fluids and eat high fiber foods

beta blockers should never be abruptly discontinued d/t risk of rebound hypertensive crisis

89
Q

What should be monitored by the nurse when a pt is on antianginals

A

monitor for adverse reactions (allergic reactions, heaache, dizziness)

monitor for therapeutic effect (relief from angina, decreased bp)

90
Q

What is a common side effect of calcium channel blockers that the patient should be advised of by the nurse

A

Constipation is a common problem; instruct patients to take in adequate fluids and eat high-fibre foods

91
Q

What is the common suffix used when dealing with calcium channel blocker medications

A

“ines”

92
Q

What is the mechanism of action for calcium channel blockers

A

cause coronary artery vasodilation

cause peripheral arterial vasodilation

decreasing systemic vascular resistance

reduce workload of the heart

93
Q

Why would you use calcium channel blockers

A

hypertension

angina

94
Q

What are some adverse effects of calcium channel blockers

A 
hypotension
palpitations
tachycardia
bradycardia
constipation
95
Q

Why should you not have grapefruit juice if you are taking calcium channel blockers

A

it reduces the metabolism of the medication

96
Q

What are soem teaching points that should be given to a patient on nitroglycerin

A
  • Instruct in proper technique and guidelines for taking sublingual (SL, transdermal etc) nitro for anginal pain
  • Instruct never to chew or swallow the SL form
  • Instruct that a burning sensation felt with SL forms indicates that the drug is still potent

Instruct patients to keep a fresh supply of nitroglycerin on hand; the drug loses its potency after about 3 months of the bottle having been opened

Instruct to keep meds away from moisture, light, heat, and cotton filler and to keep it in its original packaging

Monitor vital signs frequently during acute exacerbations of angina

A patient taking sublingual nitroglycerin who experiences chest pain should lie down to prevent or decrease dizziness and fainting that may occur due to hypotensionIf anginal pain occurs, the patient should:
*Stop activity and sit or lie down
*Take an SL tablet, and wait 5 minutes
*If no relief in 5 minutes, take a second
SL tablet
*If no relief in 5 minutes, take a third SL
tablet
*After three tablets, or 15 minutes, if no
relief of chest pain, call 911

Note: New recommendations are that if the patient is still having chest pain after 1 dose of sublingual nitroglycerin, he or she should immediately call 911

97
Q

What are anticoagulants

A

prevent clot formation

98
Q

What antiplatelet drugs

A

inhibit platelet aggregation

99
Q

What are thrombolytics

A

these drugs breakdown exsisting clots

100
Q

What are hemostatic (antifibrinolytic) drugs

A

these promote blood coagulation

101
Q

If a blood clot has already formed will an anticoagulant have any affect on it

A

No

102
Q

What is the mechanism of action for anticoagulants

A
  • work on different points of the clotting cascade
  • they do not destroy pre-exsisting clots
  • they are use to prevent clot formation
103
Q

By preventing clot formation what else are preventing from happening

A

stroke
MI
DVT
pulmonary embolism

104
Q

What are some contraindications for anticoagulants

A

drug allergy
acute bleeding
deficiency of plateletsin the blood
(thrombocytopenia)

(Note- warfarin is strongly contraindicated in pregnancy)

105
Q

What are some adverse effects when using anticoagulants

A 
bleeding risks
nausea
vomiting
abdominal cramps
thrombocytopenia (lack of platelets)
106
Q

How is heparin monitored (lab test)

A

activated partial thromboplastin times (aPTTs)

107
Q

What is heparins antidote if needed

A

protamine sulfate

108
Q

How is warfarin monitored (lab test)

A 
prothrombin time (PT) and,
International Normalized Ratio (INR)
109
Q

What is the antidote for warfarin

A

vitamin K

110
Q

What do antiplatelet drugs do

A

prevent platelet adhesion

111
Q

Which drugs are anti platelet drugs

A

aspirin (ASA)

clopidogrel (Plavix)

112
Q

What are the uses for anti platelet drugs

A

reduce risk of fatal and non fatal strokes

113
Q

What are some contraindications for using antiplatelet drugs

A

drug allergy
active bleeding
thrombocytopenia
traumatic injury

114
Q

What are some drug interactions with anti platelet drugs

A 
aspirin
NSAIDS
clopidogrel
    can cause an additive effect and increase 
    bleeding potential
115
Q

What as a nurse should be done when administering heparin

A

Ensure that subcutaneous doses are given subcutaneously, not intramuscularly

Subcut doses should be given in areas of deep subcutaneous fat, and sites should be rotated

Do not give subcutaneous doses within 5 cm of: the umbilicus, abdominal incisions, open wounds, scars, drainage tubes, stomas

Do not aspirate subcut injections or massage injection site, may cause hematoma formation

Anticoagulant effects are seen immediately

Laboratory values are done daily to monitor coagulation effects (aPTT)

Monitor for therapeutic effects

Monitor for signs of excessive bleeding

Monitor for adverse effects, increased bp
headache, hematoma formation, hemorrhage, shortness of breath, chills, fever

116
Q

What as a nurse should be done when administering warfarin

A

warfarin may be started while the patient is still on heparin until PT/INR levels indicate adequate anticoagulation

Full therapeutic effect takes several days

Monitor PT/INR regularly—keep follow-up appointments

Many herbal products have potential interactions—increased bleeding may occur
     Capsicum pepper
     Feverfew
     Garlic
     Ginger
     Gingko
     Ginseng

Monitor for therapeutic effects

Monitor for signs of excessive bleeding

Monitor for adverse effects, increased bp
headache, hematoma formation, hemorrhage, shortness of breath, chills, fever

117
Q

Episodic, reversible oxygen insufficiency is called

A

angina

118
Q

The main purpose of using antianginal drugs is to

A

dilate coronary arteries

119
Q

Beta blockers prevent the development of

A

myocardial ischemia and pain

120
Q

Nitroglycerine is admin. to decrease the heart’s ? and ? to the heart muscle

A

workload and increase blood supply

121
Q

Class ? antidysrhythmic drugs may be the least toxic. Also know as ?.

A

2 and beta blockers

122
Q

Which drug is a common beta blocker used as an antidysrhythmic?

A

propranolol

123
Q

Which Ca channel blocker acts principally on the AV node and slows conduction?

A

veramapril

124
Q

The best description of how antihypertensives work is that they: ? vessels to ? pressure.

A

vasodialate and reduce

125
Q

Which blood element has a protective property for heart disease?

A

HDL

126
Q

Antihyperlipidemia drugs work to ? cholesterol and triglycerides.

A

lower

127
Q

When administering spironolactone, the nurse monitors the client for ? (electrolyte imbalance).

A

hyperkalemia

128
Q

Clients on blood thinning medication should be monitored for internal bleeding, which may be indicated by what:

A

sudden decrease in bp
multiple red spots on skin
black tarry stools

129
Q

Common adverse effects of antidysthrythmic drugs include what:

A

dysrhythmias
lightheadedness
hypotension
weakness

130
Q

Prevents angina

A

nitroglycerin

131
Q

Has common a/e of hypotension

A

beta blockers

132
Q

Lower blood pressure

A

Ca channel blockers

133
Q

Have common a/e of headache

A

nitroglycerin and Ca channel blockers

134
Q

Cause vasodilation

A

Ca channel blockers

135
Q

Decrease HR

A

Ca channel blockers and beta blockers

136
Q

Treats angina

A

nitroglycerin
Ca Channel blocker
propranolol

137
Q

Prevents cell aggregation

A

antiplatelet

138
Q

Dissolves existing thrombi

A

thrombolytic

139
Q

Prevents formation of new thrombi

A

anticoagulant

140
Q

What is a dysrhythmia

A

any deviation from the normal rhythm of the heart

141
Q

What do antidysrhythmics do

A

use to treat and prevent disturbances in cardiac rhythm

142
Q

What is the Vaughn Williams Classification

A

system used to classify antidysrhythmic drugs

143
Q

What is in the mechanism of action in Class I antidysrhythmics

A

Membrane-stabilizing drugs

Fast sodium channel blockers

Divided into Ia, Ib, and Ic drugs, according to effects

144
Q

What is the class 1a classification of antidysrhythmic drugs

A

Ex: of a drug quinidine

-Block sodium (fast) channels
-Delay repolarization
-Increase the action potential duration (APD)
-Are used for atrial fibrillation, premature atrial
contractions, premature ventricular
contractions, ventricular tachycardia, Wolff–
Parkinson–White syndrome

145
Q

What is the class 1b classification of antidysrhythmic drugs

A

Ex of a drug phenytoin (Dilantin), lidocaine (Xylocaine)

-Block sodium channels
-Accelerate repolarization
-Increase or decrease the APD
-Are used for ventricular dysrhythmias only
Premature ventricular contractions,
ventricular tachycardia, ventricular fibrillation

146
Q

What is the class 1c classification of antidysrhythmic drugs

A

Ex of a drugpropafenone (Rythmol)

-Block sodium channels (more pronounced
effect)
-Have little effect on APD or repolarization
-Are used for severe ventricular dysrhythmias
-May be used in atrial fibrillation/flutter,

147
Q

What is in the mechanism of action in Class II antidysrhythmics

A

b-blockers: acebutolol, propranolol (Inderal)

  • Reduce or block sympathetic nervous system stimulation, thus reducing transmission of impulses in the heart’s conduction system
  • Act as general myocardial depressants for both supraventricular and ventricular dysrhythmias
  • Are also used as antianginal and antihypertensive drugs
148
Q

What is in the mechanism of action in Class III antidysrhythmics

A

Ex of a drug amiodarone

  • Increase APD
  • Prolong repolarization in phase 3
  • Used for dysrhythmias that are difficult to treat
149
Q

What is in the mechanism of action in Class IV antidysrhythmics

A

Ex of a drug verapamil

Calcium channel blockers
Inhibit slow-channel (calcium-dependent)
pathways
Depress phase 4 depolarization
Reduce AV node conduction
Are used for tachycardia; rate control for
atrial fibrillation and flutter

150
Q

There are two unclassified antidysrhythmics, what are they

A

digoxin and adenosine

151
Q

What does adenosine do

A

-Slows conduction through the AV node

-Is used to convert paroxysmal supraventricular
tachycardia to sinus rhythm

-Has a very short half-life—less than 10 seconds

-Is administered only as fast intravenous (IV)
push

152
Q

What can all antidysrhythmics do

A

cause dysrhythmias

153
Q

What are some adverse effects for antidysrhythmics

A

Hypersensitivity reactions
Nausea
Vomiting
Dizziness

154
Q

What should the nurse be assessing when giving antidysrhythmics

A

-thorough medical history

-baseline for bp, pulse, I & O and cardiac
rhythm

-labs indicating potassium level before
initiating therapy

Assess for contraindications

Assess for potential drug interactions

During therapy, monitor cardiac rhythm, heart rate, blood pressure, general well-being, skin colour, temperature, heart and lung sounds

Assess plasma drug levels as indicated

Monitor for toxic effects

Monitor for therapeutic response
         Decreased BP in hypertensive patients
         Decreased edema
         Decreased fatigue
         Regular pulse rate

Monitor for adverse effects

155
Q

What are some teaching points for antidysrhythmias

A

Instruct patients to take medications as scheduled and not to skip doses or double up for missed doses

Instruct patients regarding dosing schedules and adverse effects to report to physician

Instruct patients not to crush or chew any oral sustained-release preparations

Ensure that the patient knows to notify health care provider of any worsening of dysrhythmia or toxic effects
           Shortness of breath
           Edema	
           Dizziness
           Syncope

Patients taking b-blockers, digoxin, and other drugs should be taught how to take their own radial pulse for 1 full minute, and told to notify their physician if the pulse is less than 60 beats/min before taking the next dose of medication

PNUR 155 - Pharmacology (1 decks)

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