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Challenges > Cardiovascular System Drugs: antianginal, Antihypertensive, Diuretic Medications > Flashcards

Cardiovascular System Drugs: antianginal, Antihypertensive, Diuretic Medications Flashcards

1
Q

Kidneys:

Highly vascular
Bean shaped
Right kidney is ______ than left kidney
Produces ______ (hormone that influences water and sodium balance)
Composed of nephrons that are responsible for concentrating urine
Nephrons decrease _______ and cannot be replaced
Receive about 20-25% of bloodflow from the heart or 1100 ml/min
Blood enters through ________

A

lower, aldosterone,

as we age,

renal artery

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2
Q

Normal Filtrate from kidneys:

________________
________________
________________
Contains urea
Contains uric acid
Red blood cells, albumin, and globulin are too large to pass through a healthy glomerular membrane.

A

Is basically protein free
Contains electrolytes
Contains creatinine

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3
Q

Normal Filtrate from kidneys:

Is basically protein free
Contains electrolytes
Contains creatinine
________________
________________
________________

A

Contains urea
Contains uric acid
Red blood cells, albumin, and globulin are too large to pass through a healthy glomerular membrane.

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4
Q

Require a map of at least ___to create the pressure gradient that aids in glomerular filtration

A

60

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5
Q

Glomerular filtrate rate (GFR) should be _____

A

80-125.

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6
Q

__________: hormones that promote reabsorption

A

Aldosterone and ADH

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7
Q

Aldosterone: promotes excretion of _______

A

potassium

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8
Q

if patient has less than ___ mL/ hour urine output –something is going on (less than_____ mL/kg/hr is bad)

A

30

0.5

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9
Q

if theyre peeing too much –they might be _____________________________

A

wasting electrolytes or hormones

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10
Q

How do kidneys help maintain acid base balance?

A
  1. reabsorbing filtered bicarbonate
  2. producing new bicarbonate
  3. excreting smaller amounts of H+ ions buffered by phosphates and ammonia
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11
Q

When in acidosis: The kidney assists with ammonia production and excretes ___________

A

hydrogen ions.

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12
Q

when is renin released?

A

low bp (low map) or low sodium

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13
Q

What does angiotensin do?

A

vasoconstricts and also stiumulates the production of aldosterone. aldosterone increases sodium and water reabsorption.

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14
Q

what does aldosterone do? what is it triggered by?

A

aldosterone promotes reabsorption of water and sodium in the kidneys. aldosterone release is triggered by antiogensin II

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15
Q

just gave patient 100 mg of Lasix and you have an inverted t wave WHAT DO YOU SUSPECT IS GOING ON AND WHAT IS CAUSING IT?

A

–low potassium —– side effect of the medication

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16
Q

Renal dysfunction in acutely ill patients

2/3 of critically ill patients experience some kind of renal dysfunction

When AKI progresses to Chronic Renal Failure, it is is associated with an increase in __________________________________

A

morbidity, mortality, and a decreased quality of life

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17
Q

A sudden decline in kidney function that causes disturbances in fluid, electrolyte and acid base balances because of a loss in small solute clearance and decreased GFR

A

AKI

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18
Q

What are the primary features of AKI?

A
  1. Azotemia: increase in BUN and Creatinine
  2. Oliguria: urine output less than 0.5 ml/kg/hr
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19
Q

what is the most common cause of AKI?

A

sepsis

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20
Q

high heart rate is common with ________. typically don’t want to give them ________ bc it further tachycardia.

A

sepsis, dopamine

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21
Q

interrupted delivery of blood for ultrafiltration

A

pre renal AKI (sepsis is a pre renal issue)

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22
Q

processing of ultrafiltrate by tubular secretion and reabsorption is impacted (renal tubular injury)

A

intra renal

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23
Q

excretion of kidney waste products through the ureters, bladder and urethra (bilateral obstruction to urine flow)

A

post renal

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24
Q

What are some pre renal AKI causes?

intravascular volume depletion -hemorrhage/trauma, surgery, diuretics, volume shifts, burns

vasodilation - sepsis, anaphylaxis, medications (antihypertensives), anesthesia

decreased cardiac output -heart failure, MI, cardiogenic shock, dysrhythmias, PE, ventilation, cardiac tamponade

meds that impair filtration and autoregulation -ace inhibitors, prostaglandin inhibition during renal hypoperfusion, norepinephrine, ergotamine, hypocalemia

A
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25
Q

Intrarenal Causes of aki: Glomerular, vascular or hematological problems:

Glomerulonephritis
Vasculitis
Malignant Hypertension
__________
Hemolytic uremic syndrome
Disseminated intravascular coagulation
Scleroderma
Bacterial endocarditis
__________________
Thrombosis of renal artery or vein

A

Systemic Lupus Erythematosus,

Hypertension of pregnancy

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26
Q

Intrarenal causes of AKI: tubular problems

Ischemia
Causes of pre-renal azotemia
Hypotension/Hypovolemia
OB Hemorrhage, placental abruption, placental previa
Meds See box 16.5 on page 412: Sole
Contrast dye or Blood transfusion reaction that results in hemoglobinuria
Tumor lysis syndrome
Rhabdomyolysis
Pre-existing renal impairment
________________
________________
Severe Heart Failure
___________ is the leading cause of AKI in the hospitalized patient. *

A

Diabetes
Hypertension

Contrast dye

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27
Q

what is the leading cause of AKI in the hospitalized patient?

A

contrast dye

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28
Q

__________ and _______ will help prevent contrast dye from damaging kidneys

A

acetylcysteine, fluids

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29
Q

What are two common nephrotoxic medications?

A

NSAIDS, toradol

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30
Q

Post renal causes of aki: Any Obstruction after the kidneys:

Benign prostatic hypertrophy
________
Renal Stones / Renal Crystals
Tumors
Postoperative edema
Medications
Tricyclic antidepressants
Ganglionic blocking agents
___________________
Ligation of ureter during surgery
Hydronephrosis

A

Blood clots, Foley catheter obstruction

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31
Q

Urine output tells us?

A

Is our BP enough to perfuse the kidneys? -are we getting at least 0.5 ml/kg/hr? if so, our map is probably at least 60

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32
Q

Patients my _________ as the lungs attempt to compensate for __________ which often accompanies AKI.

A

hyperventilate, metabolic acidosis

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33
Q

________: blood test (green top or gold top) that is ASSOCIATED with kidney function, but is _____ reliable on it’s own.

A

BUN, NOT

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34
Q

What tube and what panel does BUN come on ?

A

green, cmp

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35
Q

BUN can be elevated from:

A

-Dehydration
-High protein diet
-Starvation
-GI Bleeding

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36
Q

___________________ is more important: Normal is 10:1 up to 20:1

A

BUN/Creatinine Ratio

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37
Q

What is the normal BuN/Creatinine Ratio?

A

Normal is 10:1 up to 20:1

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38
Q

Caring for patients with aki: Wishlist

________________
________________
________________
Electrolytes normal
No peripheral edema

A

Body weight WNL for patient
Clear lung sounds
Normal hemodynamics (pressures)

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39
Q

Caring for patients with aki: Wishlist

Body weight WNL for patient
Clear lung sounds
Normal hemodynamics (pressures)
________________
________________

A

Electrolytes normal
No peripheral edema

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40
Q

Caring for patients with aki: to do list

___________________________________
________________________________
Hourly I/O
___________________________
Monitor for increased respirations, heart rate, or worsening of lung sounds (crackles)
Assess BP response to fluid
Monitor cardiac rhythm
__________________________________________
Assess for SS of uremia (confusion/bleeding)
Provide specific patient safety needs

A

Weight patients every day at the same time,

Report weight gain greater than 0.5-1 kg in 1 day (Sole, 2021)

Report new onset of urine output less than 0.5 ml/kg/hr

Monitor electrolytes, specifically potassium
increase bc its not getting peed of, cardiac dysrhythmias, peaked t wave

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41
Q

if you have ________ weight gain in 1 day you should be concerned

A

1 kg

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42
Q

if theyre having crackes, what do you think is happening?

A

fluid excretion is not happening properly.

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43
Q

Fluid intake should be based of what formula for AKI patient?

A

min: (Patient’s urine output + 600)

max: (patient urine output + 600+ 1000 ml per day)

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44
Q

How much sodium should AKI patient have per day?

A

0.5-1g per day

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45
Q

How much potassium should AKI patients have?

A

20-50 meq per day

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46
Q

How much calcium should AKI patient have per day?

A

800-1200 mg per day

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47
Q

On dialysis, patients should get:
________________________

A

Multivitamins
Folic Acid
Iron Supplements

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48
Q

How much protein should a patient experiencing AKI have per day?

A

at least 0.8g/kg

not really sure on the cap

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49
Q

What are s/s of fluid volume overload?

A

edema, crackles in lungs, JVD and other signs of right sided heart failure

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50
Q

how is FVO managed?

A

diet: restrict salt and water

diuretics

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51
Q

diuretics:

Increase urine output
Eliminate fluids
Eliminate urinary solutes
Decrease reabsorption of sodium in the renal tubules
Can result in hypovolemia if large urine loss is caused
Hypovolemia is usually treated with ____________

A

0.45% Saline

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52
Q

What are the loop diuretics?

A

furosemide, metanide, toresmide

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53
Q

how do loop diuretics work?

A

loop of henle

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54
Q

What are the major complications of loop diuretics? what rate can they be pushed at?

A

hypokalemia
hearing damage if pushed too fast

20mg/min

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55
Q

High Ceiling Loop Diuretics Complications/Side effects:

  1. Dehydration: ____________________________________
    _____
  2. LOW: _____________________________________
  3. High: ________________________________
A

Low blood volume, low blood pressure, higher heart rate, decreased temperature regulation

Sodium, Chloride, blood pressure, potassium, calcium, magnesium, good cholesterol

Glucose, uric acid (gout), cholesterol

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56
Q

What is your potassium normal lab value range?

A

3.5-5

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57
Q

What is your normal sodium range?

A

135-145

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58
Q

What is your normal calcium range?

A

9-10.5

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59
Q

What is the normal magnesium range?

A

1.3-2.1

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60
Q

Hypokalemia:

________________
________________
________________
________________
Hypoactive bowel sounds & constipation
nausea/vomiting
St segment depression
Inverted T wave

A

Weakness
Hyporeflexia (poor reflexes)
Thready pulse (slow or rapid & irregular)
Orthostatic hypotension

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61
Q

Hypokalemia:

Weakness
Hyporeflexia (poor reflexes)
Thready pulse (slow or rapid & irregular)
Orthostatic hypotension
________________
________________
________________
________________

A

Hypoactive bowel sounds & constipation
nausea/vomiting
St segment depression
Inverted T wave

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62
Q

What are the four major issues you need to monitor for with loop diuretic regarding electrolytes?

A

hyponatremia, hypomagnesemia, hypokalemia, hypocalcemia

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63
Q

Hyponatremia s/s:

A

lethargy, seizures, confusion, coma, nausea, vomiting, headaches, usually results from water overload, treat with fluid restriction

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64
Q

Hypomagnesemia s/s:

A

potential for bradycardia and heart blocks, lethargy, coma, hypotension, hypoventilation, weak-to-absent deep tendon reflexes, nausea, vomiting

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65
Q

Hypokalemia s/s:

A

potential for heart blocks, asystole, ventricular fibrillation, muscle weakness, diarrhea, abdominal cramps

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66
Q

Hypocalcemia: s/s:

A

potential for seizures, muscle cramps, laryngospasm, stridor, tetany, heart blocks, cardiac arrest

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67
Q

Loop diuretics:

Safety in coordination with dizziness and neurological problems related to ____________ OR blood pressure ___________

A

electrolyte imbalances, (FALL RISK)

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68
Q

loop diuretic education:

Monitor your bp
Change positions slowly (orthostatic hypotension)
If dizzy, consider reclining
Avoid use with other _____________________________
Notify physician of tinnitus
Monitor heart rate & rhythm and electrolytes
Encourage consuming ___________________ like

A

ear damaging meds (gentamycin/other abx)

high potassium foods (like fish, avocados, orange juice, spinach, potatoes, beans, bananas, spinach)

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69
Q

What are four manifestations of hypokalemia?

A

n/v
fatigue
leg cramps
general weakness

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70
Q

What are contraindications for loop diuretics?

A

pregnancy

anuria -no urine output

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71
Q

use loop diuretics cautiously with:

A

heart disease, diabetes, dehydration, electrolyte depletion, gout (uric acid is increased), digoxin, lithium, ototoxic meds, NSAIDS and other antihypertensives

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72
Q

To Do before/during loop diuretic administration:

Baseline ______
_____ consistently
Monitor BP & I&O
Give in ________
Administer Lasix no faster than ______
Do not give loop diuretic if ______
Potassium may need replaced prior to giving medicine. Never push potassium.

A

vitals/labs

Weigh

AM (nocturia)

20mg/min!!!

K<3.5

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73
Q

are we having improvement in edema? are we having improvement in lung crackles? if yes then the Lasix ______

A

are helping

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74
Q

Loop diuretics:

Decrease in _________
Decrease in peripheral edema
Weight loss
Decrease in _____
Increase in __________
Decreased ___________

A

pulmonary edema

BP

urine output (initially)

calcium level (off label use)

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75
Q

What are the thiazide drugs?

A

hydrochlorothiazide

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76
Q

What is the drug of choice for essential hypertension?

A

hydrochlorothiazide

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77
Q

thiazides:

____________ is the only medication in this class to be given IV.

A

Chlorothiazide

78
Q

Blocks reabsorption of sodium and chloride at the distal convoluted tubule (renal system), and prevents reabsorption of water

A

thiazides

79
Q

What are thiazides used for?

A

in mild to moderate heart failure, liver, & kidney disease

80
Q

Can be prescribed for blood pressure control alone or with other meds like Lisinopril

A

thiazides

81
Q

Reduce urine production for those with diabetes insipidus

A

thiazides

82
Q

What are the risks and intterventions with thiazides?

A

they are mostly the same as loop diuretics.

83
Q

what are the potassium sparing diuretics?

A

spironolactone

84
Q

how do potassium sparing diuretics work?

A

block action of aldosterone

85
Q

What is the result of potassium sparing diuretics?

A

potassium retention
secretion of sodium and water (little to no K goes in the toilet)

86
Q

What are potassium sparing diuretics used to treat?

A

Treats hypertension and edema
Given for heart failure

87
Q

how are potassium sparing diuretics administered and how long do they take to work?

A

PO, 12-24 hour potetntially

88
Q

Potassium Sparing Diuretics: Complications

_______________________________________________________________
Endocrine problems
Drowsiness
__________________
Cardiac rhythm problems

A

HYPERkalemia: Elevated T wave, muscle weakness, diarrhea, chest pain, palpitations

Metabolic acidosis

89
Q

________ is only seen in potassium sparing diuretics

A

hyperkalemia

90
Q

What are the ways to lower potassium?

A

kayexalate -works slow

insulin and D5 -works fast

sodium bicarb -moves K to intracellular fluid

albuterol -moves it into the cell

calcium gluconate protects the heart -doesnt lower the K, same for calcium chloride

91
Q

__________________________________________________ aren’t shifting the potassium, theyre just protecting the heart

A

calcium gluconate and calcium chloride

92
Q

Which diuretics affect the endocrine system?

A

potassium sparing -spironolactone

93
Q

_____________: controlling body temperature, thirst, hunger, and other homeostatic systems, and involved in sleep and emotional activity. this could potentially be affected by?

A

Hypothalamus, K sparing diuretics

94
Q

________________: Despite its small size, the gland influences nearly every part of your body. The hormones it produces help regulate important functions, such as growth, blood pressure and reproduction. this could potentially be affected by?

A

Pituitary Gland, K sparing diuretics

95
Q

your patient states they are taking spironolactone and are taking their blood pressure more seriously and have started exercising regularly and making their diet healthier by decreasing their sodium intake and have event started using a salt substitute. what should you do as the nurse?

A

tell them to stop taking the salt substitute as it contains potassium which can build up and cause dysrhythmias.

96
Q

What foods should someone taking potassium sparing diuretics avoid?

A

oranges, bananas, dates, potatoes

97
Q

What is a weird affect of triamterene? what kind of diuretic is it?

A

K sparing, it can cause blue pee

98
Q

potassium sparing diruetics work by? which is a ?

A

blocking aldosterone which is a hormone —-side effects can largely be hormonal issues

99
Q

What are the osmotic diuretics?

A

mannitol

100
Q

what are osomotic diuretics used for and how must they be administered?

A

used to reduce ICP and intraocular pressure. have to be given with an in line filter

101
Q

What medication can have crystals and what should be done about it?

A

mannitol (osmotic diuretic).

you should warm it (not in the microwave) and then cool it to body temperature before administering

102
Q

what do you do with left over mannitol?

A

discard it

103
Q

Reduces production of angiotensin II by blocking the conversion of I to II and increasing bradykinin

A

ace inhibitors

104
Q

What do ace inhibitors cause?

A

vasodilation, sodium and water excretion, potassium retention

105
Q

your patient taking catopril recently came to the clinic and report a cough, what should you do?

A

immediately stop the medication (ACE inhibitor)

106
Q

ACE inhibitor cough:

Can be caused by excessive _________build up in the lungs which triggers a cough. Bradykinin can also stimulate prostaglandins, leading to _____________________________

A

bradykinin

inflammation in the respiratory system

107
Q

the only treatment for ACE induced cough is to ?

A

stop the medication. Antiotensin Ii receptor blocker may be used as well

108
Q

ACE inhibitors:

HYPERkalemia: -monitor levels, -avoid salt substitutes that have K in them,-monitor for numbness-monitor for tingling or paresthesias in hands and feet
___________________: -report to provider

A

Rash & altered taste

109
Q

What is a medical emergency that is a potential complication of ACE inhibitors?

A

angioedema

110
Q

your patient has an itchy raised rash, swelling around the eye, swelling of the lips, and reports they recently started taking lisonopril. What do you suspect? what is your immediate nursing intervention?

A

angioedema, ephinephrine (sub q)

111
Q

what med is given for angioedema and what route?

A

epinephrine, sub q. STOP THE ACE INHIBITOR

112
Q

What is a hemophilic condition related to ACE inhibitors?

A

neutropenia.

113
Q

ACE inhibitors:

Neutropenia: -Monitor WBC every ____________________________________
-Is reversible if found early-Instruct clients to notify provider if they have signs of ___________________________

A

2 weeks for 3 months and then periodically.

infection, immediately

114
Q

What are angiotensin II receptor blockers?

A

losartan

115
Q

What do angiotensin II receptor blockers do?

A

block angiotensin II in the body, cause vasodilation, cause excretion of sodium and water

116
Q

_______________ block the formation of angiotensin II

_____________ the action of angiotensin II

A

ACE inhibitors

ARBs block

117
Q

for angiotensin receptor blockers (ARBS) what do you need to know?

A

Administer without regard to meals
Review renal function tests
Blocks vasoconstriction effect of renin-angiotensin system
Salt substitutions should not be used.

118
Q

What are complications associated with ARBS?

A

Angioedema (!!!!!) THIS is an emergency (!!!!!)
Fetal Injury
Hypotension
Dizziness/lightheadedness

119
Q

what are contraindications for ARBS?

A

Pregnancy
Renal stenosis or single kidney
USE CAUTIOUSLY in clients who experienced ANGIOEDEMA WITH ACE INHIBITORS

120
Q

What are the aldosterone antagonists?

A

eplerenone and spironolactone

121
Q

How do aldosterone antagonists work?

A

Reduce blood volume by blocking aldosterone receptors in the kidney, promoting excretion of sodium and water and retention of potassium

122
Q

spironolactone is?

A

potassium sparing diuretic and an aldosterone antagonists

123
Q

What are aldosterone antagonists used to treat and what do they do to blood volume?

A

decrease blood volume, can treat high bp and hear failure. Also can treat premenstrual syndrome, polycystic ovary syndrome, and even acne.

124
Q

potassium imbalances with aldosterone antagonists can cause?

A

tingly hands or feet

125
Q

What should patients taking aldosterone antagonists avoid?

A

grapefruit juice

126
Q

What are the calcium channel blockers?

A

nifedipine, verapamil, diltiazem/cardizem, ALSO THINGS THAT END IN -PINE

127
Q

how do calcium channel blockers work?

A

block calcium channels in vessels vessels to lead to vasodilation of vascular smooth muscle (peripheral arteries and arteries of the heart)

128
Q

What are calcium channel blockers used to treat?

A

high bp

129
Q

first line of defense against high bp is? second?

A

beta blocker, calcium channel

130
Q

nifedipine is affects?

A

angina pectoris and hypertension

131
Q

amlodipine affects?

A

angina pectoris and hypertension

132
Q

nicardipine affects?

A

angina pectoris and hypertension

133
Q

felodipine affects?

A

hypertension

134
Q

verapamil affects?

A

angina pectoris and hypertension and cardiac dysrhythmias

135
Q

diltiazem/cardizem affects?

A

angina pectoris and hypertension and cardiac dysrhythmias

136
Q

Can be used for angina or blood pressure control
Can cause reflex tachycardia, acute toxicity, orthostatic hypotension & peripheral edema
For problems with this drug, provide __________________

A

symptomatic treatment and treat what you see. this drug is nifedipine

137
Q

if patient taking nifedipine and they have reflexive tachycardia what do you do?

A

Administer a beta blocker

138
Q

nifedipine:

For toxicity,_______________ may be indicated (PO overdose)

A

gastric lavage

139
Q

nifedipine:

For toxicity, powerful _____________________________ may counteract negative effects. have ____ equipment

A

vasoconstrictors and fluid boluses

cardioversion/pacer

140
Q

Diltiazem/Cardizem***

Cardizem/Diltiazem is given frequently in the critical care setting, via IV/IVP. Bolus dose: _____________________. if bolus works, follow with a _____________________. Monitor rhythm and patient condition throughout.

A

0.25mg/kg over FIVE minutes. drip at 5mg/hr.

141
Q

What is diltiazem/cardizem often given for?

A

Afib RVR

142
Q

Diltiazem & Verapamil Complications:

________________
________________
________________
Dysrhythmias(Prolonged QT-can lead to death)
Acute Toxicity(Treat rhythm and vitals, have resuscitation equipment nearby)

A

Orthostatic hypotension and peripheral edema(teach how to manage symptoms & consider diuretic)
Constipation (teach to increase fiber and water)
Suppression of cardiac function(monitor & notify provider of slow pulse/activity intolerance)

143
Q

Diltiazem & Verapamil Complications:

Orthostatic hypotension and peripheral edema(teach how to manage symptoms & consider diuretic)
Constipation (teach to increase fiber and water)
Suppression of cardiac function(monitor & notify provider of slow pulse/activity intolerance)
____________________
______________________

A

Dysrhythmias(Prolonged QT-can lead to death)
Acute Toxicity(Treat rhythm and vitals, have resuscitation equipment nearby)

144
Q

What do beta blockers decrease?

A

heart rate and blood pressure, cardiac output as well

145
Q

what are beta blockers used to treat?

A

BP, chest pain, fast dysrhythmias, heart failure, heart attack

146
Q

DO NOT GIVE BETA 2s to PATIENTS WHO HAVE ____________

A

ASTHMA

147
Q

These beta blockers are cardio selective

A

metoprolol
atenolol
emsolol

148
Q

these beta blockers are non selective and affect both the hear and lungs

A

propanolol
nadolol
cardvedilol
labetalol

149
Q

beta blockers:

Don’t give if heart rate ____
Have diabetic patients check their __________ frequently. This drug can mask tachycardia, a sign of low glucose
This medication can mask tachycardia, a sign of infection and many other things. When looking at vitals, please consider that this medication may impact your results. Look at the ______ picture of the client.

A

<50

blood sugar

WHOLE

150
Q

beta blockers can mask ______

A

tachycardia (s/s infection, low bp etc)

151
Q

Beta 1 Blockade: Metoprolol and

Can cause _________
Don’t give if HR ______ (good advice for ALL meds that slow the HR)
Use cautiously with ______
For drips, start low
Watch for worsening heart failure: SHOB, edema, weight gain, fatigue)-notify physician as appropriate

A

hypoglycemia

<50

heart failure

152
Q

what med do you not give to patients with asthma?

A

propanolol

153
Q

This drug inhibits glycogenesis, so diabetic patients are at risk for hypoglycemia

A

propanolol, all beta blockers as well though

154
Q

dont panick until your bp is ____ or more

A

180 systolic -hypertensive crisis

155
Q

what are hypertensive crisis medications?

A

Nitroglycerin (vasodilator)
Nicardipine (CCB)
Cevidipine (CCB)
Enalaprilat (ACE)
Esmolol (BAB)

drugs will vasodilate rapidly decreasing preload and afterload

156
Q

hypertensive crisis indicates that you may have decreased blood flow to the

A

kidneys

157
Q

Hypertensive Crisis Meds

Give ____
Watch for side effects like excessive ________ (this WILL occur if you give meds too rapidly)
Monitor _________________continuously*
Use your drip chart
Ask when you don’t know

A

slow

HYPOtension

vitals and rhythm

158
Q

hypertensive crisis meds:

COMPLICATIONS: -Excessive hypotension-
___________________________
Bradycardia, tachycardia, other ECG Changes

A

Cyanide poisoning thiocyanate toxicity

159
Q

___________: Inability of the heart to meet the circulatory needs of the whole body.

A

Heart failure

160
Q

_____________: Decreased cardiac output, altered heart rate, altered stroke volume, altered ______ altered ______
Heart failure can be LEFT or RIGHT

A

Heart failure

preload,

afterload

161
Q

inotropic effect is what?

A

the force of the contraction

162
Q

chronotropic effect is what?

A

the rate

163
Q

digoxin has what affect on ionotropic and chronotropic effect?

A

postiive inotropic -increases force

negative chronotropic -decreases the heart rate

164
Q

digoxin:

Positive inotropic effect: increased force of myocardial contraction-improves _____ & ______
-makes the heart a more effective pump

A

stroke volume, cardiac output

165
Q

digoxin:

Negative chronotropic effect: decreases the heart rate
-slows the______ rate
-decreases the heart rate to give ventricles more filling time, which results in increased _________________________________

A

SA node. stroke volume (SV) and cardiac output (CO)

166
Q

your patients hear rate is 52 and they have a scheduled dose of digoxin. What do you do?

A

do not give the drug. cutoff for digoxin is 60 bpm

167
Q

Digoxin coplications:

A

dyshrythmias
hypokalemia

168
Q

you need to monitor what with digoxin

A

therapeutic levels
rate
anorexia, n/v, abdominal pain

169
Q

Can cause fatigue, weakness, vision changes (blurred vision, yellow-green or white halos around objects)

A

digoxin

170
Q

What is the therapeutic range for digoxin?

A

0.5 - 2

171
Q

encourage patient taking digoxin to eat what?

A

high potassium foods

172
Q

What are contraindications with digoxin?

A

pregnancy
Disturbances in ventricular rhythms: ventricular fibrillation, ventricular tachycardia, second degree block and third degree block

173
Q

What are cautions with digoxin?

A

hypokalemia, advanced heart failure and impaired kidney function

174
Q

What are toxicity s/s with digoxin?

A

fatigue, weakness, vision changes, halos, GI effects

175
Q

digoxin:

Administer IVP over a minimum of _______. If your patient has pulmonary edema give over ______
Excessive toxicity is treated with charcoal, cholestyramine, or ____________________

A

5 minutes, 10-15 minutes,

digoxin immune fab

176
Q

digoxin:

Teach patients that they should take care to get the dose every single time in a timely manner, but THEY SHOULD __________________________________________________________________. EVERY PATIENT NEEDS TO KNOW THIS.

A

NOT DOUBLE UP ON DOSES IF THEY MISS A DOSE

177
Q

Alpha 1 Receptors (adrenergic agonist):

VASOCONSTRICT
_________________
Increase heart rate
Increase myocardial __________
Increase heart rate
Activate kidneys to release _____

Alpha 1 = 1 heart = affect the heart

A

Mydriasis (dilate the pupil)
contractility
renin

178
Q

Epinephrine:
________
used for _______, and increase _______

A

beta 1
anaphylaxis, bp

179
Q

do not give ___epi unless they’ve coded

A

iv

180
Q

dopamine:

IN LOW DOSES this will produce renal blood vessel ______. This is called the “renal dose”.
Used for ________________________________________
Affects _____________________________
Used for shock and heart failure

A

dilation.

heart rate*** and blood pressure

shock, heart failure, acute kidney injury

181
Q

dobutamine:

Increases ______
Increases _________ and ___________
Increases rate of conduction through AV node

A

heart rate, contractility and cardiac output,

182
Q

dobutamine is used mostly and reserved mostly for?

A

hear failure patients

183
Q

angina:

Managed with organic _____________________________________________ and ranolazine

A

nitrates, beta blockers, calcium channel blockers

184
Q

those with CHRONIC STABLE angina should concurrently take an _______________________________________________________________________ to prevent myocardial infarction and death

A

antiplatelet agent (aspirin or clopidogrel), a cholesterol lowering agent and an ACE inhibitor

185
Q

nitroglycerin:

Is a vasodilator that dilates veins and decrease venous return, reducing ______ and decreasing oxygen demand
In vasospastic or Prinzmetal’s angina, this drug reduces coronary artery spasms, increasing o2 supply.
Treats acute angina
Can be taken prophylactically

Comes in capsules, tabs, spray, ointment, patches and IV.

A

PREload

186
Q

What are complications of nitroglycerin?

A

headache
hypotension
reflex tachycardia
tolerance

187
Q

what are contraindications with nitro?

A

Pregnancy
Severe anemia
Closed-angle glaucoma
Traumatic head injury (increases ICP)
Use caution when taking other anti-hypertensive drugs, having hyperthyroidism, or kidney/liver dysfunction

188
Q

what can you absolutely not take nitroglycerin with?

A

erectile dysfunction meds

189
Q

Administering Nitro & Teaching patients:

GET ECG if acute
Ask if the patient has already had nitro
Know how long these drugs take to work
Sublingual: RAPID, IV: Rapid, Spray: rapid
Start at ______ and titrate up to desired response. (typo in book)

A

5 mcg/min

190
Q

how long does it take nitro to work?

A

less than 5 minutes

191
Q

Can you push IV potassium?

A

no

192
Q

What is one med you can never IV push?

A

potassium

Challenges (6 decks)

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