Cardiovascular System Drugs: antianginal, Antihypertensive, Diuretic Medications Flashcards by Glen McCormick

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 ________

lower, aldosterone,

as we age,

renal artery

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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.

Is basically protein free
Contains electrolytes
Contains creatinine

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Normal Filtrate from kidneys:

Is basically protein free
Contains electrolytes
Contains creatinine
________________
________________
________________

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

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Glomerular filtrate rate (GFR) should be _____

80-125.

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__________: hormones that promote reabsorption

Aldosterone and ADH

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Aldosterone: promotes excretion of _______

potassium

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

0.5

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if theyre peeing too much –they might be _____________________________

wasting electrolytes or hormones

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How do kidneys help maintain acid base balance?

reabsorbing filtered bicarbonate
producing new bicarbonate
excreting smaller amounts of H+ ions buffered by phosphates and ammonia

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

hydrogen ions.

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when is renin released?

low bp (low map) or low sodium

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What does angiotensin do?

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

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what does aldosterone do? what is it triggered by?

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

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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?

–low potassium —– side effect of the medication

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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 __________________________________

morbidity, mortality, and a decreased quality of life

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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

AKI

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What are the primary features of AKI?

Azotemia: increase in BUN and Creatinine
Oliguria: urine output less than 0.5 ml/kg/hr

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what is the most common cause of AKI?

sepsis

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

sepsis, dopamine

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interrupted delivery of blood for ultrafiltration

pre renal AKI (sepsis is a pre renal issue)

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

intra renal

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

post renal

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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

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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

Systemic Lupus Erythematosus, Hypertension of pregnancy

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. *

Diabetes Hypertension Contrast dye

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

contrast dye

__________ and _______ will help prevent contrast dye from damaging kidneys

acetylcysteine, fluids

What are two common nephrotoxic medications?

NSAIDS, toradol

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

Blood clots, Foley catheter obstruction

Urine output tells us?

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

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

hyperventilate, metabolic acidosis

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

BUN, NOT

What tube and what panel does BUN come on ?

green, cmp

BUN can be elevated from:

-Dehydration -High protein diet -Starvation -GI Bleeding

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

BUN/Creatinine Ratio

What is the normal BuN/Creatinine Ratio?

Normal is 10:1 up to 20:1

Caring for patients with aki: Wishlist ________________ ________________ ________________ Electrolytes normal No peripheral edema

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

Caring for patients with aki: Wishlist Body weight WNL for patient Clear lung sounds Normal hemodynamics (pressures) ________________ ________________

Electrolytes normal No peripheral edema

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

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

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

1 kg

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

fluid excretion is not happening properly.

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

min: (Patient’s urine output + 600) max: (patient urine output + 600+ 1000 ml per day)

How much sodium should AKI patient have per day?

0.5-1g per day

How much potassium should AKI patients have?

20-50 meq per day

How much calcium should AKI patient have per day?

800-1200 mg per day

On dialysis, patients should get: ________________________

Multivitamins Folic Acid Iron Supplements

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

at least 0.8g/kg not really sure on the cap

What are s/s of fluid volume overload?

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

how is FVO managed?

diet: restrict salt and water diuretics

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 ____________

0.45% Saline

What are the loop diuretics?

furosemide, metanide, toresmide

how do loop diuretics work?

loop of henle

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

hypokalemia hearing damage if pushed too fast 20mg/min

High Ceiling Loop Diuretics Complications/Side effects: 1. Dehydration: ____________________________________ _____ 2. LOW: _____________________________________ 3. High: ________________________________

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

What is your potassium normal lab value range?

3.5-5

What is your normal sodium range?

135-145

What is your normal calcium range?

9-10.5

What is the normal magnesium range?

1.3-2.1

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

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

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

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

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

hyponatremia, hypomagnesemia, hypokalemia, hypocalcemia

Hyponatremia s/s:

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

Hypomagnesemia s/s:

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

Hypokalemia s/s:

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

Hypocalcemia: s/s:

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

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

electrolyte imbalances, (FALL RISK)

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

ear damaging meds (gentamycin/other abx) high potassium foods (like fish, avocados, orange juice, spinach, potatoes, beans, bananas, spinach)

What are four manifestations of hypokalemia?

n/v fatigue leg cramps general weakness

What are contraindications for loop diuretics?

pregnancy anuria -no urine output

use loop diuretics cautiously with:

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

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.

vitals/labs Weigh AM (nocturia) 20mg/min!!! K<3.5

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

are helping

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

pulmonary edema BP urine output (initially) calcium level (off label use)

What are the thiazide drugs?

hydrochlorothiazide

What is the drug of choice for essential hypertension?

hydrochlorothiazide

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

Chlorothiazide

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

thiazides

What are thiazides used for?

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

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

thiazides

Reduce urine production for those with diabetes insipidus

thiazides

What are the risks and intterventions with thiazides?

they are mostly the same as loop diuretics.

what are the potassium sparing diuretics?

spironolactone

how do potassium sparing diuretics work?

block action of aldosterone

What is the result of potassium sparing diuretics?

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

What are potassium sparing diuretics used to treat?

Treats hypertension and edema Given for heart failure

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

PO, 12-24 hour potetntially

Potassium Sparing Diuretics: Complications _______________________________________________________________ Endocrine problems Drowsiness __________________ Cardiac rhythm problems

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

________ is only seen in potassium sparing diuretics

hyperkalemia

What are the ways to lower potassium?

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

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

calcium gluconate and calcium chloride

Which diuretics affect the endocrine system?

potassium sparing -spironolactone

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

Hypothalamus, K sparing diuretics

________________: 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?

Pituitary Gland, K sparing diuretics

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?

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

What foods should someone taking potassium sparing diuretics avoid?

oranges, bananas, dates, potatoes

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

K sparing, it can cause blue pee

potassium sparing diruetics work by? which is a ?

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

What are the osmotic diuretics?

mannitol

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

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

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

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

what do you do with left over mannitol?

discard it

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

ace inhibitors

What do ace inhibitors cause?

vasodilation, sodium and water excretion, potassium retention

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

immediately stop the medication (ACE inhibitor)

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

bradykinin inflammation in the respiratory system

the only treatment for ACE induced cough is to ?

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

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

Rash & altered taste

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

angioedema

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?

angioedema, ephinephrine (sub q)

what med is given for angioedema and what route?

epinephrine, sub q. STOP THE ACE INHIBITOR

What is a hemophilic condition related to ACE inhibitors?

neutropenia.

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

2 weeks for 3 months and then periodically. infection, immediately

What are angiotensin II receptor blockers?

losartan

What do angiotensin II receptor blockers do?

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

_______________ block the formation of angiotensin II _____________ the action of angiotensin II

ACE inhibitors ARBs block

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

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

What are complications associated with ARBS?

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

what are contraindications for ARBS?

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

What are the aldosterone antagonists?

eplerenone and spironolactone

How do aldosterone antagonists work?

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

spironolactone is?

potassium sparing diuretic and an aldosterone antagonists

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

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

potassium imbalances with aldosterone antagonists can cause?

tingly hands or feet

What should patients taking aldosterone antagonists avoid?

grapefruit juice

What are the calcium channel blockers?

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

how do calcium channel blockers work?

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

What are calcium channel blockers used to treat?

high bp

first line of defense against high bp is? second?

beta blocker, calcium channel

nifedipine is affects?

angina pectoris and hypertension

amlodipine affects?

angina pectoris and hypertension

nicardipine affects?

angina pectoris and hypertension

felodipine affects?

hypertension

verapamil affects?

angina pectoris and hypertension and cardiac dysrhythmias

diltiazem/cardizem affects?

angina pectoris and hypertension and cardiac dysrhythmias

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 __________________

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

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

Administer a beta blocker

nifedipine: For toxicity,_______________ may be indicated (PO overdose)

gastric lavage

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

vasoconstrictors and fluid boluses cardioversion/pacer

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.

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

What is diltiazem/cardizem often given for?

Afib RVR

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

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)

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) ____________________ ______________________

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

What do beta blockers decrease?

heart rate and blood pressure, cardiac output as well

what are beta blockers used to treat?

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

DO NOT GIVE BETA 2s to PATIENTS WHO HAVE ____________

ASTHMA

These beta blockers are cardio selective

metoprolol atenolol emsolol

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

propanolol nadolol cardvedilol labetalol

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.

<50 blood sugar WHOLE

beta blockers can mask ______

tachycardia (s/s infection, low bp etc)

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

hypoglycemia <50 heart failure

what med do you not give to patients with asthma?

propanolol

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

propanolol, all beta blockers as well though

dont panick until your bp is ____ or more

180 systolic -hypertensive crisis

what are hypertensive crisis medications?

Nitroglycerin (vasodilator) Nicardipine (CCB) Cevidipine (CCB) Enalaprilat (ACE) Esmolol (BAB) drugs will vasodilate rapidly decreasing preload and afterload

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

kidneys

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

slow HYPOtension vitals and rhythm

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

Cyanide poisoning thiocyanate toxicity

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

Heart failure

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

Heart failure preload, afterload

inotropic effect is what?

the force of the contraction

chronotropic effect is what?

the rate

digoxin has what affect on ionotropic and chronotropic effect?

postiive inotropic -increases force negative chronotropic -decreases the heart rate

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

stroke volume, cardiac output

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 _________________________________

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

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

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

Digoxin coplications:

dyshrythmias hypokalemia

you need to monitor what with digoxin

therapeutic levels rate anorexia, n/v, abdominal pain

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

digoxin

What is the therapeutic range for digoxin?

0.5 - 2

encourage patient taking digoxin to eat what?

high potassium foods

What are contraindications with digoxin?

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

What are cautions with digoxin?

hypokalemia, advanced heart failure and impaired kidney function

What are toxicity s/s with digoxin?

fatigue, weakness, vision changes, halos, GI effects

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

5 minutes, 10-15 minutes, digoxin immune fab

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.

NOT DOUBLE UP ON DOSES IF THEY MISS A DOSE

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

Mydriasis (dilate the pupil) contractility renin

Epinephrine: ________ used for _______, and increase _______

beta 1 anaphylaxis, bp

do not give ___epi unless they’ve coded

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

dilation. heart rate*** and blood pressure shock, heart failure, acute kidney injury

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

heart rate, contractility and cardiac output,

dobutamine is used mostly and reserved mostly for?

hear failure patients

angina: Managed with organic _____________________________________________ and ranolazine

nitrates, beta blockers, calcium channel blockers

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

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

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.

PREload

What are complications of nitroglycerin?

headache hypotension reflex tachycardia tolerance

what are contraindications with nitro?

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

what can you absolutely not take nitroglycerin with?

erectile dysfunction meds

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)

5 mcg/min

how long does it take nitro to work?

less than 5 minutes

Can you push IV potassium?

What is one med you can never IV push?

potassium