Cardiovascular system drugs Flashcards by Angelina Franco

Normal Blood pressure

SBP: < 120
DBP: <80

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Elevated blood pressure

SBP: 120-129
DBP: <80

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Prehypertension (Stage I)

SBP: 130-139
DBP: 80-89

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Hypertension (Stage II)

SBP: > 140
DBP: >90

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Hypertensive Crisis

SBP: >180
DBP: >120

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Diuretic types

Loop: Furosemide, bumetanide
Potassium-sparing: spironolactone
Thiazide: Hydrochlorothiazide

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Furosemide adverse effects

Electrolyte imbalance: hyponatremia, hypokalemia, hypochloremia
Ototoxicity: hearing (tinnitus) or balance problems
Hypotension
Hyperglycemia
Hyperuricemia is (Increased uric acid levels) w/ possible gouty arthritis

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Hydrochlorothiazide therapeutic use

Used with other drugs, treat heart failure
Treats cirrhosis of the liver and renal failure
Treats hypertension

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Hydrochlorothiazide (HCTZ) adverse effects

Electrolyte imbalance: Hypokalemia, hypochloremia, hyponatremia
Hyperglycemia (especially in diabetic patients)
Hyperuricemia (along with gouty arthritis)

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Spironolactone adverse effects

Hyperkalemia (because of decreased excretion of potassium)
Menestral irregularities: abnormal hair growth, deepening of the voice, gynecomastia (growth of breast tissue)

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Atenolol adverse drug effects

Bradycardia (due to blockade of Beta 1)
Heart failure: shortness of breath, edema, coughing at night
Rebound excitation causing angina pain or MI w/ Sudden withdrawal of beta blocker in client with CHD

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Carvedilol adverse effects

-Dizziness, hypotension
-Bradycardia due to blockage of Beta 1 receptor (lead to reduced cardiac output)
-Postural hypotension
-Exacerbation of asthma (airways are swollen and inflamed)

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Angiotensin-converting Enzyme (ACE) inhibitors examples

Captopril
Benazepril
Lisinopril
Enalapril

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Captopril adverse effects

Severe hypotension following first dose (most likely in clients taking diuretics, w/ high BP)
Dry nonproductive cough due to increase in bradykinin
Rash & report of metallic taste in mouth
Angioedema (swelling of mouth, throat)
Hyperkalemia
Neutropenia (decrease in WBC with increase of infection)

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Angiotensin II Receptor Blockers

Losartan
Valsartan

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Losartan adverse reactions

Angioedema (occurs less than ACE)
Headache, hypotension, dizziness, insomnia
Fetal injury

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Atorvastatin adverse reactions

Myopathy: pain in muscle, which can progress to rhabdomyolysis: breakdown of muscle protein caused by kidney damage
Hepatotoxicity: anorexia, nausea, vomiting, jaundice

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Digoxin adverse effects

Cardio toxicity leading to bradycardia
Hypokalemia increases toxicity
Manifestations of toxicity
- Vincent Van Gough (colored vision, halo vision, flickering lights
- anorexia, nausea, vomiting, diarrhea

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Heparin adverse effects

Bleeding and heparin toxicity
- petechiae, ecchymosis
-bleeding mucous membrane or gum
-Hematuria
-Melena

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Heparin antidote

Protamine sulfate

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Anti-platelet examples

Aspirin (ASA)
Clopidogrel

Anti-platelet adverse effects (ASA, Clopidogrel)

Prolonged bleeding time, thrombocytopenia
Tinnitus, hearing loss (ASA)
Nausea, vomiting, dyspepsia (indigestion)
GI bleed

Warfarin adverse effects

Bleeding and warfarin toxicity or overdose
Any bleeding —> stop drug immediately

Warfarin antidote

Vitamin K

Enoxaparin

Low-molecular weight heparin (LMWH) Injectable only Prefilled syringes (do not expel air bubble) Usually given after surgery

Manifestations of heart failure

Shortness of breath Tachypnea, tachycardia Edema of legs, ankle, and feet

ACE inhibitors client teaching

Take on an empty stomach, or 1 hr before meals for adequate absorption Notify HCP if cough develops Refrain from potassium supplements Report palpitations, muscle twitching, weakness Report dry cough, rash or, metallic taste in mouth

ACE inhibitors and ARBs client teaching

Change positions slowly Impotence is expected (erectile dysfunction) Monitor serum potassium and liver and kidney function Avoid potassium and potassium containing salt substitutes

ARB client teaching

Stop immediately if angioedema develops

Beta-adrenergic examples

Cardio selective Noncardioselective Alpha & beta (noncardio selective)

Cardioselective

Atenolol Metoprolol

Noncardioselective

Propranolol

Alpha & Beta noncardioselective

Carvedilol Labetalol

ACE drug action

Inhibit RAAS -produce vasodilation -Inhibit aldosterone secretion

Normal INR (International normalized ratio)

1.1 or below (what everyone’s level should be)

Therapeutic INR

2-3x of the normal (Because we want a longer bleeding time)

Normal PT (prothrombin time)

11-12.5 seconds

Therapeutic PT

1.5-2x of normal

Warfarin Nursing implications

Assess the laboratory values -platelets -pt, aPTT, INR Assess for history of abnormal bleeding conditions, baseline vital signs, medication history and allergies

Normal platelet count

150,000-400,000 per UL

Heparin Implications

Assess the laboratory values Platelets PT, aPTT, INR History of abnormal bleeding, baseline vital signs, laboratory studies, medication history and allergies VERIFY IV HEPARIN WITH ANOTHER NURSE — USE INFUSION PUMP FOR CONTINUOUS INTRAVENOUS ADMINISTRATION DO NOT MASSAGE INJECTION SITE TO PREVENT HEMATOMA ROTATE SUBCUTANEOUS INJECTION

Hydrochlorothiazide interventions

A client is at risk for hypokalemia if they are also taking digoxin (digitalis drug) Potassium supplements may be added to drug regimen Giving this drug with corticosteroids increases risk for hypoglycemia

Hydrochlorothiazide administration

Give with food to minimize GI effect Give by 3 pm to prevent nocturia and sleep loss

Which diuretic drug is likely to be used initially for antihypertensive therapy A. Loop diuretics B. Osmotic diuretics C. Thiazide diuretics D. Potassium-sparing diuretics

C. Thiazide diuretics Explanation: considered first-line drugs in the treatment of hypertension.

Signs of potassium deficiency

Muscle weakness, anorexia, lethargy, hypotension, and confusion.

Beta Blockers

Are given to patients after they have suffered an MI because of their cardio protective properties. Ex: reduction of HR, decreased contractile force and a lesser impulse conduction

Non cardio selective beta blocker (Carvedilol) contraindications

May precipitate bronchoconstriction, and or increased airway resistance making any pre-existing respiratory conditions such as asthma worse. Severe unstable heart failure Cardiogenic shock Lactation/pregnancy

Which beta blockers are used for the treatment of heart failure?

Carvedilol and metoprolol

Furosemide (loop diuretic) interaction

Digoxin toxicity Antihypertensives (can have additive hypotension effect) Lithium NSAIDs (decrease blood flow to the kidneys, reduces diuretic effect)

Normal Potassium level

3.6-5.2 mEQ/L If level drops below 3.5 mEQ/L, monitor the ECG and notify provider because client might require a potassium supplement