CHF / Antianginals / Antidysrhythmic Flashcards
drug classes affecting blood vessels (3)
- ACEi
- ARB
- CCB
emergency medicine for HF (2)
- dopamine
2. dobutamine
what is HF
- weak heart unable to pump (systolic HF)
OR
- stiff heart unable to relax and fill (diastolic HF)
HF results in (2)
- low CO
2. congestion - blood backing up in the area that feeds into the failing chamber
CHF & HF cure
- prevented and managed, NOT cured
- goal is to decrease the workload of the heart = decrease HR and BP, reducing preload and afterload
diuresis drugs effects
decreases BP and edema (symptom management, dyspnea, pulmonary edema)
sympatholytics drugs effects
- vasodilate = decrease BP
- decrease HR = decrease workload
- alpha2 agonist
- beta-blockers
drugs affecting blood vessels
- vasodilate = decrease BP
- alpha1 blocker
- ACEi
- ARB
- CCB
CHF drugs
- diuretics - thiazides, thiazide-like, loop, K-sparing
- sympatholytics
- Alpha-2 agonist
- Beta-blockers - drugs affecting blood vessels
- ACEi, ARB, CCB - digoxin
- milrinone
- Emergency Medicine for HF
- dopamine
- dobutamine - Other emergency medications
- vasopressin
- Antidysrhythmics
- atropine
- NTG
cardiac glycoside - digoxin MOA and therapeutic effects
- positive inotrope
- –> increase force and CO, better perfusion
- negative chronotrope
- –> decrease HR, lower workload
- negative dromotrope
- –> decrease conduction, less excitability
cardiac glycoside - digoxin route
IV/PO
cardiac glycoside - digoxin indication
HF and dysrhythmia
cardiac glycoside - digoxin toxicity
- monitor for bradycardia and hold for HR less than 60
- yellow halos around objects, blurred, diplopia, dysrhythmias
- narrow therapeutic window
- hypokalemia
cardiac glycoside - digoxin nursing
- monitor K level = low K = dig toxicity
- K wasting diuretics = dig toxicity
- K sparing diuretics, ACE, ARB = increase K = decrease effect of digoxin
- educate: checking HR, toxicity, s/s, avoid sildenafil
phosphodiesterase inhibitor - milrinone indication
- for 48-72 hour to manage acute exacerbation of HF
- end-stage HF unresponsive to other medications
phosphodiesterase inhibitor - milrinone route
IV gtt
phosphodiesterase inhibitor - milrinone MOA and therapeutic effects
- positive inotrope = increases force = increases CO
- anteriodilator = decreased BP = decreased cardiac workload
phosphodiesterase inhibitor - milrinone side effects
- dysrhythmia
- low BP
emergency medicine for HF, hypotension, shock - dopamine MOA and therapeutic effects
- nonspecific adrenergic = increase HR and vasoconstriction
emergency medicine for HF, hypotension, shock - dopamine side effects
MANY
- like tachydysrhythmias, MI, N/V, AKI
- for IV = extravasation
emergency medicine for HF, hypotension, shock - dopamine route
IV gtt, via pump in central IV line
alpha 1 blocker drug way to know
- osin
- sosin
emergency medicine for HF, hypotension, shock - dopamine nursing
- needs titration, hemodynamic monitoring (MAP, PP) and cardiac rhythm monitoring
- tapering dose before stopping
emergency medicine for HF, hypotension, shock - dobutamine MOA and therapeutic effects
beta1 agonist =
- positive inotrope = increases force
- positive chronotrope = increases HR
emergency medicine for HF, hypotension, shock - dobutamine route
IV gtt via pump in peripheral IV
emergency medicine for HF, hypotension, shock - dobutamine nursing
- taper dose before stopping
- needs titration, hemodynamic monitoring (MAP, PP) and cardiac rhythm monitoring
emergency medicine for HF, hypotension, shock - dobutamine adverse effects
- MI
- tachycardia
- tremors
what are our emergency medicines (6)
- dopamine and dobutamine
- vasopressin for shock and cardiopulmonary resuscitation
- antidysrhythmic drugs
- epinephrine IV for shock and cardiac arrest
- atropine for bradycardia
- nitroglycerin for angina
medicine for acute angina emergency (4)
- Morphine
- Oxygen
- Nitroglycerin (SL)
- Aspirin (aka ASA)
MONA!!
medicine for preventing angina recurrence (3)
- PO nitrates
- beta-blockers (-lol)
- CCBs (-dipine)
what is angina and 3 causes
chest pain associated with coronary artery disease (CAD)
- coronary occlusion (CAD)
- poor perfusion of myocardium
- oxygen supply-demand mismatch
antianginal drug goal for acute angina emergency
correcting oxygen supply and demand mismatch
antianginal drug, preventing recurrence - nitrates MOA
- coronary artery dilation = increase oxygen supply
- systemic vasodilation = decrease BP = decrease workload of the heart = decrease oxygen demand
antianginal drug, preventing recurrence - beta-blockers MOA
- decrease HR and BP = decrease workload of the heart = decrease oxygen demand
antianginal drug, preventing recurrence - CCBs MOA
(vasculature-specific -dipine)
- coronary artery dilation = increases oxygen supply
- systemic vasodilation = decrease BP = decrease workload of the heart = decrease oxygen demand
antianginal drug, preventing recurrence - nitrates routes
- SL
- IV gtt
- topical ointment/transdermal patch
- PO
antianginal drug, preventing recurrence - nitrates side effects
- low BP
- dizziness
- faintness
- HA
- tachycardia
- FALL
antianginal drug, preventing recurrence - nitrates nursing (3) and nursing for angina at home
- monitor for SE
- cardiac monitoring and VS
= obtaining ECG and labs should not delay NTG administration - educate when having angina at home=
1. stop activity, lie down, rest = keep them calm!
2. take NTG SL, chew an aspirin
3. call 911 if pain is not resolved with first NTG and 5 min of rest and take the second SL
4. avoid taking more than 3 SL
antianginal drug, preventing recurrence - nitrates contraindications (2)
- glaucoma
2. traumatic brain injury
antianginal - nitroglycerin SL nursing
- give 0.4 mg q5min
- monitor BP/HR before and Q5 min w/ SL dose
- SL tablets must be kept in their own dark glass container up to 6 mo after opening or until expiration date if not opened
- spray lasts up to 2 years
- take SL dose prophylactically before strenuous activity (stairs)
antianginal - nitroglycerin SL side effect (1)
causes severe throbbing headache
“when you forget your nitro brew, you get a headache”
antianginal - isosorbide mononitrate & isosorbide dinitrate PO nursing
- taper, do NOT stop abruptly
- educate pt to keep a log of angina (freq, intensity, duration, location, quality)
- do NOT crush or chew
“Iso swallow only”
antianginal - nitropaste topical ointment nursing
- can cause tolerance = have 8-12 hours nitrate free periods per day
- do NOT cut the patch
- apply to hairless area of chest, back or abdomen
- rotate side to avoid skin irritation; wipe off the old ointment when replacing
- avoid touching the ointment
antianginal - nitroglycerin IV indication (2)
- acute severe angina
- HF
antianginal - nitroglycerin IV nursing
- continuous infusion gtt
- special tubing from a glass vial
- FALL risk
antianginal - beta-blocker drugs
-lol ‘s!!
propanolol, metoprolol, atenolol, carvedilol, labetalol
antianginal - beta-blocker indication
- angina/MI
- dysrhythmia
- HTN
- HF
antianginal - beta-blocker MOA
- decrease BP (preload and afterload) = decreases workload and oxygen demand by
- decrease HR (negative chronotrope) = decrease oxygen demand
- decrease excitability (negative dromotrope) = decrease dysrhythmia
antianginal - CCBs indication
- HTN
- HF
- angina
describe dysrhythmia
- damaged electrical system of the heart
- harmless to lethal
- high risk for thromboembolism = hence AC for all dysrhythmia
s/s:
- dizziness, weakness
- decrease activity tolerance
- SOB, fainting
- palpitation, skipped beat
- cardiac arrest
dysrhythmia drugs work on
- anticoagulation for all dysrhythmias
- blocking electrolyte channels (Na, K, Ca)
- sympatholytic for suppressing autonomic nervous system and reducing HR
- negative chronotrope
- negative dromotrope
Some Block Potassium Channel
dysrhythmia class I - sodium channel blocker drugs (3 main ones)
- procainamide*
- flecainide*
- lidocaine
- quinidine
- phenytoin
- propafenone
dysrhythmia class II - beta blocker drugs
- propranolol
- esmolol
- acebutolol
dysrhythmia class III - potassium channel blocker drugs
- amiodarone
2. sotalol
dysrhythmia class IV - calcium channel blocker drugs (nonspecific)
- verapamil
2. diltiazem
dysrhythmia other drugs
- adenosine
- digoxin
- magnesium
- atropine (indication: symptomatic bradycardia, anticholinergic)
dysrhythmia drug side effects
- dysrhythmia*
- bradycardia*
- hypotension*
- dizziness
- syncope = FALL risk
- fatigue
- edema
- impotence
dysrhythmia drugs: procainamide, flecainide side effects
- anticholinergic = bear!
- lupus s/s
- low blood cells (monitor CBC)
- dysrhythmia (monitor cardiac rhythm, VS)
- paresthesia, seizure (precautions)
dysrhythmia drugs: amiodarone, sotalol nursing
- monitor HF, pulmonary edema (dyspnea, crackles breath sound, edema)
- monitor for brady-dysrhythmia (monitor cardiac rhythm, low HR, low BP)
- photophobia may progress to loss of vision
dysrhythmia drugs: diltiazem, verapamil indication
tachy-dysrhythmias
dysrhythmia drugs: diltiazem, verapamil side effects and nursing
- call the provider and hold for HR less than 60 or SBP less than 90
- peripheral edema = monitor daily weight and I/O
- decrease BP = FALL
- decrease BP = monitor renal panel and I/O
- ventricular dysrhythmia
all dysrhythmia drugs nursing
- cardiac rhythm must always be monitored
- anticoagulation is always part of the plan of care
- continuous IV infusion eventually switched to PO
- IV push always slow (2-3 minutes)
BUT adenosine has half-life of less than 10 seconds to push it very fast and flush it quickly with NS
educate:
- keep a log of VS, side effects at home and report to cardiologist, encourage adherence
- avoid grapefruit juice, caffeine, ETOH, tobacco
