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Pharm Exam 3 > CHF / Antianginals / Antidysrhythmic > Flashcards

CHF / Antianginals / Antidysrhythmic Flashcards

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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
emergency medicine for HF, hypotension, shock - dobutamine route
IV gtt via pump in peripheral IV
26
emergency medicine for HF, hypotension, shock - dobutamine nursing
- taper dose before stopping | - needs titration, hemodynamic monitoring (MAP, PP) and cardiac rhythm monitoring
27
emergency medicine for HF, hypotension, shock - dobutamine adverse effects
- MI - tachycardia - tremors
28
what are our emergency medicines (6)
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
medicine for acute angina emergency (4)
1. Morphine 2. Oxygen 3. Nitroglycerin (SL) 4. Aspirin (aka ASA) MONA!!
30
medicine for preventing angina recurrence (3)
1. PO nitrates 2. beta-blockers (-lol) 3. CCBs (-dipine)
31
what is angina and 3 causes
chest pain associated with coronary artery disease (CAD) 1. coronary occlusion (CAD) 2. poor perfusion of myocardium 3. oxygen supply-demand mismatch
32
antianginal drug goal for acute angina emergency
correcting oxygen supply and demand mismatch
33
antianginal drug, preventing recurrence - nitrates MOA
- coronary artery dilation = increase oxygen supply | - systemic vasodilation = decrease BP = decrease workload of the heart = decrease oxygen demand
34
antianginal drug, preventing recurrence - beta-blockers MOA
- decrease HR and BP = decrease workload of the heart = decrease oxygen demand
35
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
36
antianginal drug, preventing recurrence - nitrates routes
1. SL 2. IV gtt 3. topical ointment/transdermal patch 4. PO
37
antianginal drug, preventing recurrence - nitrates side effects
- low BP - dizziness - faintness - HA - tachycardia - FALL
38
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
39
antianginal drug, preventing recurrence - nitrates contraindications (2)
1. glaucoma | 2. traumatic brain injury
40
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)
41
antianginal - nitroglycerin SL side effect (1)
causes severe throbbing headache "when you forget your nitro brew, you get a headache"
42
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”
43
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
44
antianginal - nitroglycerin IV indication (2)
- acute severe angina | - HF
45
antianginal - nitroglycerin IV nursing
- continuous infusion gtt - special tubing from a glass vial - FALL risk
46
antianginal - beta-blocker drugs
-lol 's!! | propanolol, metoprolol, atenolol, carvedilol, labetalol
47
antianginal - beta-blocker indication
- angina/MI - dysrhythmia - HTN - HF
48
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
49
antianginal - CCBs indication
- HTN - HF - angina
50
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
51
dysrhythmia drugs work on
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
dysrhythmia class I - sodium channel blocker drugs (3 main ones)
1. procainamide* 2. flecainide* 3. lidocaine 4. quinidine 5. phenytoin 6. propafenone
53
dysrhythmia class II - beta blocker drugs
1. propranolol 2. esmolol 3. acebutolol
54
dysrhythmia class III - potassium channel blocker drugs
1. amiodarone | 2. sotalol
55
dysrhythmia class IV - calcium channel blocker drugs (nonspecific)
1. verapamil | 2. diltiazem
56
dysrhythmia other drugs
1. adenosine 2. digoxin 3. magnesium 4. atropine (indication: symptomatic bradycardia, anticholinergic)
57
dysrhythmia drug side effects
1. dysrhythmia* 2. bradycardia* 3. hypotension* 4. dizziness 5. syncope = FALL risk 6. fatigue 7. edema 8. impotence
58
dysrhythmia drugs: procainamide, flecainide side effects
- anticholinergic = bear! - lupus s/s - low blood cells (monitor CBC) - dysrhythmia (monitor cardiac rhythm, VS) - paresthesia, seizure (precautions)
59
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
60
dysrhythmia drugs: diltiazem, verapamil indication
tachy-dysrhythmias
61
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
62
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

Pharm Exam 3 (9 decks)

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