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Pharm Exam 3 > CHF / Antianginals / Antidysrhythmic > Flashcards

CHF / Antianginals / Antidysrhythmic Flashcards

1
Q

drug classes affecting blood vessels (3)

A
  1. ACEi
  2. ARB
  3. CCB
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2
Q

emergency medicine for HF (2)

A
  1. dopamine

2. dobutamine

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3
Q

what is HF

A
  • weak heart unable to pump (systolic HF)

OR

  • stiff heart unable to relax and fill (diastolic HF)
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4
Q

HF results in (2)

A
  1. low CO

2. congestion - blood backing up in the area that feeds into the failing chamber

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5
Q

CHF & HF cure

A
  • prevented and managed, NOT cured

- goal is to decrease the workload of the heart = decrease HR and BP, reducing preload and afterload

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6
Q

diuresis drugs effects

A

decreases BP and edema (symptom management, dyspnea, pulmonary edema)

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7
Q

sympatholytics drugs effects

A
  • vasodilate = decrease BP
  • decrease HR = decrease workload
    • alpha2 agonist
    • beta-blockers
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8
Q

drugs affecting blood vessels

A
  • vasodilate = decrease BP
  • alpha1 blocker
  • ACEi
  • ARB
  • CCB
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9
Q

CHF drugs

A
  1. diuretics - thiazides, thiazide-like, loop, K-sparing
  2. sympatholytics
    - Alpha-2 agonist
    - Beta-blockers
  3. drugs affecting blood vessels
    - ACEi, ARB, CCB
  4. digoxin
  5. milrinone
  6. Emergency Medicine for HF
    - dopamine
    - dobutamine
  7. Other emergency medications
    - vasopressin
    - Antidysrhythmics
    - atropine
    - NTG
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10
Q

cardiac glycoside - digoxin MOA and therapeutic effects

A
  • positive inotrope
  • –> increase force and CO, better perfusion
  • negative chronotrope
  • –> decrease HR, lower workload
  • negative dromotrope
  • –> decrease conduction, less excitability
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11
Q

cardiac glycoside - digoxin route

A

IV/PO

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12
Q

cardiac glycoside - digoxin indication

A

HF and dysrhythmia

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13
Q

cardiac glycoside - digoxin toxicity

A
  • monitor for bradycardia and hold for HR less than 60
  • yellow halos around objects, blurred, diplopia, dysrhythmias
  • narrow therapeutic window
  • hypokalemia
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14
Q

cardiac glycoside - digoxin nursing

A
  • 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
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15
Q

phosphodiesterase inhibitor - milrinone indication

A
  • for 48-72 hour to manage acute exacerbation of HF

- end-stage HF unresponsive to other medications

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16
Q

phosphodiesterase inhibitor - milrinone route

A

IV gtt

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17
Q

phosphodiesterase inhibitor - milrinone MOA and therapeutic effects

A
  • positive inotrope = increases force = increases CO

- anteriodilator = decreased BP = decreased cardiac workload

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18
Q

phosphodiesterase inhibitor - milrinone side effects

A
  • dysrhythmia

- low BP

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19
Q

emergency medicine for HF, hypotension, shock - dopamine MOA and therapeutic effects

A
  • nonspecific adrenergic = increase HR and vasoconstriction
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20
Q

emergency medicine for HF, hypotension, shock - dopamine side effects

A

MANY

  • like tachydysrhythmias, MI, N/V, AKI
  • for IV = extravasation
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21
Q

emergency medicine for HF, hypotension, shock - dopamine route

A

IV gtt, via pump in central IV line

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22
Q

alpha 1 blocker drug way to know

A
  • osin

- sosin

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23
Q

emergency medicine for HF, hypotension, shock - dopamine nursing

A
  • needs titration, hemodynamic monitoring (MAP, PP) and cardiac rhythm monitoring
  • tapering dose before stopping
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24
Q

emergency medicine for HF, hypotension, shock - dobutamine MOA and therapeutic effects

A

beta1 agonist =

  • positive inotrope = increases force
  • positive chronotrope = increases HR
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25
Q

emergency medicine for HF, hypotension, shock - dobutamine route

A

IV gtt via pump in peripheral IV

26
Q

emergency medicine for HF, hypotension, shock - dobutamine nursing

A
  • taper dose before stopping

- needs titration, hemodynamic monitoring (MAP, PP) and cardiac rhythm monitoring

27
Q

emergency medicine for HF, hypotension, shock - dobutamine adverse effects

A
  • MI
  • tachycardia
  • tremors
28
Q

what are our emergency medicines (6)

A
  1. dopamine and dobutamine
  2. vasopressin for shock and cardiopulmonary resuscitation
  3. antidysrhythmic drugs
  4. epinephrine IV for shock and cardiac arrest
  5. atropine for bradycardia
  6. nitroglycerin for angina
29
Q

medicine for acute angina emergency (4)

A
  1. Morphine
  2. Oxygen
  3. Nitroglycerin (SL)
  4. Aspirin (aka ASA)

MONA!!

30
Q

medicine for preventing angina recurrence (3)

A
  1. PO nitrates
  2. beta-blockers (-lol)
  3. CCBs (-dipine)
31
Q

what is angina and 3 causes

A

chest pain associated with coronary artery disease (CAD)

  1. coronary occlusion (CAD)
  2. poor perfusion of myocardium
  3. oxygen supply-demand mismatch
32
Q

antianginal drug goal for acute angina emergency

A

correcting oxygen supply and demand mismatch

33
Q

antianginal drug, preventing recurrence - nitrates MOA

A
  • coronary artery dilation = increase oxygen supply

- systemic vasodilation = decrease BP = decrease workload of the heart = decrease oxygen demand

34
Q

antianginal drug, preventing recurrence - beta-blockers MOA

A
  • decrease HR and BP = decrease workload of the heart = decrease oxygen demand
35
Q

antianginal drug, preventing recurrence - CCBs MOA

A

(vasculature-specific -dipine)

  • coronary artery dilation = increases oxygen supply
  • systemic vasodilation = decrease BP = decrease workload of the heart = decrease oxygen demand
36
Q

antianginal drug, preventing recurrence - nitrates routes

A
  1. SL
  2. IV gtt
  3. topical ointment/transdermal patch
  4. PO
37
Q

antianginal drug, preventing recurrence - nitrates side effects

A
  • low BP
  • dizziness
  • faintness
  • HA
  • tachycardia
  • FALL
38
Q

antianginal drug, preventing recurrence - nitrates nursing (3) and nursing for angina at home

A
  • 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
39
Q

antianginal drug, preventing recurrence - nitrates contraindications (2)

A
  1. glaucoma

2. traumatic brain injury

40
Q

antianginal - nitroglycerin SL nursing

A
  • 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)
41
Q

antianginal - nitroglycerin SL side effect (1)

A

causes severe throbbing headache

“when you forget your nitro brew, you get a headache”

42
Q

antianginal - isosorbide mononitrate & isosorbide dinitrate PO nursing

A
  • 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”

43
Q

antianginal - nitropaste topical ointment nursing

A
  • 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
44
Q

antianginal - nitroglycerin IV indication (2)

A
  • acute severe angina

- HF

45
Q

antianginal - nitroglycerin IV nursing

A
  • continuous infusion gtt
  • special tubing from a glass vial
  • FALL risk
46
Q

antianginal - beta-blocker drugs

A

-lol ‘s!!

propanolol, metoprolol, atenolol, carvedilol, labetalol

47
Q

antianginal - beta-blocker indication

A
  • angina/MI
  • dysrhythmia
  • HTN
  • HF
48
Q

antianginal - beta-blocker MOA

A
  • decrease BP (preload and afterload) = decreases workload and oxygen demand by
  • decrease HR (negative chronotrope) = decrease oxygen demand
  • decrease excitability (negative dromotrope) = decrease dysrhythmia
49
Q

antianginal - CCBs indication

A
  • HTN
  • HF
  • angina
50
Q

describe dysrhythmia

A
  • 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
51
Q

dysrhythmia drugs work on

A
  1. anticoagulation for all dysrhythmias
  2. blocking electrolyte channels (Na, K, Ca)
  3. sympatholytic for suppressing autonomic nervous system and reducing HR
    - negative chronotrope
    - negative dromotrope

Some Block Potassium Channel

52
Q

dysrhythmia class I - sodium channel blocker drugs (3 main ones)

A
  1. procainamide*
  2. flecainide*
  3. lidocaine
  4. quinidine
  5. phenytoin
  6. propafenone
53
Q

dysrhythmia class II - beta blocker drugs

A
  1. propranolol
  2. esmolol
  3. acebutolol
54
Q

dysrhythmia class III - potassium channel blocker drugs

A
  1. amiodarone

2. sotalol

55
Q

dysrhythmia class IV - calcium channel blocker drugs (nonspecific)

A
  1. verapamil

2. diltiazem

56
Q

dysrhythmia other drugs

A
  1. adenosine
  2. digoxin
  3. magnesium
  4. atropine (indication: symptomatic bradycardia, anticholinergic)
57
Q

dysrhythmia drug side effects

A
  1. dysrhythmia*
  2. bradycardia*
  3. hypotension*
  4. dizziness
  5. syncope = FALL risk
  6. fatigue
  7. edema
  8. impotence
58
Q

dysrhythmia drugs: procainamide, flecainide side effects

A
  • anticholinergic = bear!
  • lupus s/s
  • low blood cells (monitor CBC)
  • dysrhythmia (monitor cardiac rhythm, VS)
  • paresthesia, seizure (precautions)
59
Q

dysrhythmia drugs: amiodarone, sotalol nursing

A
  • 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
60
Q

dysrhythmia drugs: diltiazem, verapamil indication

A

tachy-dysrhythmias

61
Q

dysrhythmia drugs: diltiazem, verapamil side effects and nursing

A
  • 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
62
Q

all dysrhythmia drugs nursing

A
  • 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

Pharm Exam 3 (9 decks)

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