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NURS 3303 > CVD > Flashcards

CVD Flashcards

1
Q

furosemide (Lasix) class

A

parenteral and enteral loop diuretic

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2
Q

furosemide (Lasix) MOA

A

acts in the thick segment of ascending limb of Henle’s loop to block reabsorption of Na and Cl to prevent passive reabsorption of water

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3
Q

furosemide (Lasix) indications

A
  • pulmonary edema from HF
  • edema non-responsive to other agents
  • HTN not controlled by other agents
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4
Q

furosemide (Lasix) AEs

A
  • decreased Na, Cl, K, and BP
  • transient ototoxicity; increased risk with other ototoxic meds
  • dehydration; with increased risk for thrombosis emboli
  • ventricular dysrhythmias with concurrent digoxin use
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5
Q

furosemide (Lasix) nursing considerations

A
  • monitor: I/O, VS, weight, hearing, electrolytes
  • slow IVP (10-20 mg/min)
  • admin in morning or early afternoon
  • education on potassium-rich sources in diet
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6
Q

hydrochlorothiazide (Thiazide) class

A

enteral thiazide diuretic

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7
Q

hydrochlorothiazide (Thiazide) MOA

A

acts in the early segment of the DCT to block reabsorption of Na and Cl to prevent passive reabsorption of water and modest diuresis

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8
Q

hydrochlorothiazide (Thiazide) indications

A
  • essential HTN
  • edema secondary to HF, hepatic or renal disease
  • DI
  • postmenopausal osteoporosis
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9
Q

hydrochlorothiazide (Thiazide) AEs

A

similar to loop diuretic, but no ototoxicity

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10
Q

hydrochlorothiazide (Thiazide) nursing considerations

A
  • contraindicated in pts with low GFR
  • monitor: I/O, VS, weight, electrolytes
  • admin in morning or early afternoon
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11
Q

spironolactone (Aldactone) class

A

enteral potassium-sparing diuretic/aldosterone antagonist

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12
Q

spironolactone (Aldactone) MOA

A

blocks the action of aldosterone in the distal nephron to produce diuresis; little UOP as monotherapy, often combined with others

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13
Q

spironolactone (Aldactone) indications

A
  • essential HTN when co-administered with potassium-wasting diuretics
  • edema
  • HF
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14
Q

spironolactone (Aldactone) AEs

A
  • hyperkalemia
  • endocrine effects: menstrual irregularities, impotence, deep voice, and hirsutism
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15
Q

spironolactone (Aldactone) nursing considerations

A
  • monitor: I/O, VS, weight, electrolytes
  • educated pt on monitoring intake of potassium-rich sources in diet
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16
Q

mannitol (Osmitrol) class

A

parenteral osmotic diuretic

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17
Q

mannitol (Osmitrol) MOA

A

once filtered in nephron, creates osmotic force that inhibits passive reabsorption of water; increases serum osmolality to draw fluid back into vascular and extravascular space

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18
Q

mannitol (Osmitrol) indications

A
  • prophylaxis of renal failure w/ hypovolemic shock and severe hypotension
  • reduction of intracranial and intraocular pressure
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19
Q

mannitol (Osmitrol) AEs

A
  • edema (especially with existing HF)
  • fluid and electrolytes imbalance
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20
Q

mannitol (Osmitrol) nursing considerations

A
  • use filter needles and IV tubes
  • store at room temp to prevent crystallization
  • monitor for changes in ICP (if severe decline in urine output STOP MED!)
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21
Q

lisinopril (Zestril) class

A

ACE inhibitor

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22
Q

lisinopril (Zestril) MOA

A

reduce level of angiotensin II through inhibition of ACE and increase levels of bradykinin to dilate blood vessels, reduce blood volume, and prevent/reverse changes in heart and blood vessels mediated by angiotensin II and aldosterone

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23
Q

lisinopril (Zestril) indications

A
  • HTN, HF, and post-MI
  • prevention of MI, CVA, and death in pts with high CV risk
  • diabetic neuropathy
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24
Q

lisinopril (Zestril) AEs

A
  • first dose (syncope) hypotension
  • dry cough
  • angioedema (due to increased bradykinin)
  • hyperkalemia (secondary to suppression to aldosteron release)
  • fetal injury
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25
Q

lisinopril (Zestril) nursing considerations

A
  • monitor: BP, electrolytes, daily weights
  • educate pt: changing positions slowly, contact provider if angioedema or dry cough occurs, and potassium intake
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26
Q

losartan (Cozaar) class

A

angiotensin II receptor blocker (ARB)

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27
Q

losartan (Cozaar) MOA

A

blocks the actions of angiotensin II by blocking blocking access to its receptors in blood vessels, adrenals, and other tissues to cause dilation of vessels, prevent cardiac structural changes, and release of aldosterone

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28
Q

losartan (Cozaar) indications

A
  • HTN
  • HF
  • reduce stroke risk, MI, and death in pts with high CV risk
  • diabetic neuropathy and retinopathy
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29
Q

losartan (Cozaar) AEs

A
  • angioedema (lower risk than ACE)
  • fetal injury
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30
Q

losartan (Cozaar) nursing considerations

A
  • ARBs used if pt not tolerating ACE due to cough
  • monitor BP
  • educate pt to contact provider if angioedema occurs
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31
Q

liskiren (Tekturna) class

A

enteral direst renin inhibitor

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32
Q

liskiren (Tekturna) MOA

A

binds with renin to inhibit cleavage of angiotensinogen into angiotensin I to reduce influence of entire RAAS

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33
Q

liskiren (Tekturna) indications

A

hypertension

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34
Q

liskiren (Tekturna) AEs

A
  • diarrhea
  • fetal injury
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35
Q

liskiren (Tekturna) nursing considerations

A

monitor: VS, I/O, weight, electrolytes

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36
Q

nifedipine (Procardia) class

A

duhydropyridine calcium channel blocker

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37
Q

nifedipine (Procardia) MOA

A

blocks calcium channels on vascular smooth muscle with minimal activity on heart

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38
Q

nifedipine (Procardia) indications

A
  • HTN
  • angina pectoris
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39
Q

nifedipine (Procardia) AEs

A
  • peripheral edema
  • flushing
  • headache
  • dizziness
  • reflex tachycardia
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40
Q

nifedipine (Procardia) nursing considerations

A
  • assess BP before admin
  • monitor: reflex tachycardia, edema, daily weight
  • add diuretic for peripheral edema
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41
Q

verapamil (Calan) class

A

non-dihydropyridines calcium channel blocker

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42
Q

verapamil (Calan) MOA

A

blocks calcium channels on the heart and blood vessels

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43
Q

verapamil (Calan) indications

A
  • HTN
  • angina pectoris
  • dysrhythmias
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44
Q

verapamil (Calan) AEs

A
  • constipation
  • cardiac depression risk in pts with bradycardia, HF, and AV heart block
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45
Q

verapamil (Calan) nursing considerations

A
  • assess BP before admin
    -monitor edema and daily weight
  • monitor interactions with other cardiac meds
  • avoid grapefruit juice (toxicity!)
  • if toxicity occurs: gastric lavage, activated charcoal, IVF, IV calcium gluconate, and trendelenburg
46
Q

hydralazine (Apresoline) class

A

enteral and parenteral vasodilator

47
Q

hydralazine (Apresoline) MOA

A

causes dilation of arterioles through actions on vascular smooth muscle to reduce peripheral resistance and BP. Not much significance on vein, which decreases risk of orthostatic hypotension

48
Q

hydralazine (Apresoline) indications

A
  • essential HTN
  • hypertensive crisis
  • HF
49
Q

hydralazine (Apresoline) AEs

A
  • reflex tachycardia
  • renin release
  • fluid retention
  • SLE-like syndrome
50
Q

hydralazine (Apresoline) nursing considerations

A
  • monitor BP (for hypotension)
  • reducing reflex tachycardia renin release by combining with beta-blocker
  • combine with diuretic to reduce risk of sodium and water retention
  • combine with isosorbide dinitrate to treat HF
51
Q

nitroprusside (Nipride/Nitropress) class

A

parenteral vasodilator

52
Q

nitroprusside (Nipride/Nitropress) MOA

A

causes both venous and arteriolar dilation to decrease BP

53
Q

nitropursside (Nipride/Nitropress) indications

A
  • used only for hypertensive emergencies
  • controlled hypotension during surgery to reduce bleeding
54
Q

nitropursside (Nipride/Nitropress) AEs

A
  • excessive hypotension
  • cyanide poisoning
  • thiocyanate toxicity
55
Q

nitropursside (Nipride/Nitropress) nursing considerations

A
  • continuous monitoring of BP and electrocardiogram
  • initial infusion rates range from 0.3-0.5 mcg/kg/min then titrate slowly to bring down BP (avoids cyanide poisoning)
  • simultaneously coadminister with PO antihypertensives
  • immediate effects trigger Na and water retention (manage with furosemide administration)
56
Q

metoprolol (Lopressor) class

A

beta-blocker

57
Q

metoprolol (Lopressor) MOA

A

decreases contractility which allows ventricles to fill by decreasing/blocking SNS to reduce electrical transmission in heart’s conduction system to decrease HR and BP

58
Q

metoprolol (Lopressor) nursing considerations

A
  • assess BP and HR before administration
  • start with low dose (full benefits seen between 1-3 months)
59
Q

What is the drug of choice for severe HF?

A

furosemide

60
Q

digoxin (Lanoxin) class

A

cardiac glycoside

61
Q

digoxin (Lanoxin) MOA

A

inhibition of Na, K, ATPase leads to increased inotropic action, which then leads to increased CO (inc. inotrope action = increases forces of contractions)

62
Q

digoxin (Lanoxin) indications

A
  • 2nd line therapy for HF pts due to its toxicity
  • multiple drug interactions
    treats symptomatic HF and a-fib
  • does not prolong life
63
Q

digoxin (Lanoxin) AEs

A
  • GI upset
  • CNS effects = fatigue, HA, blurred vision
  • dysrhythmias (hypokalemia secondary to diuretic use)
64
Q

digoxin (Lanoxin) nursing considerations

A
  • potassium supplements
  • monitor EKG, K levels, establish baseline vitals
  • monitor digoxin level (normal daily dose: 0.125mg PO QD)
  • narrow therapeutic range (0.5-2ng/mL)
  • check apical pulse before ( < 60 bpm)
  • reinforce lifestyle modifications
  • antidote for severe toxicity = Digiblind/Digifab/Questran
65
Q

SVT meds

A
  • BB = class II
  • CCB = class IV
  • digoxin and adenosine = class V
66
Q

a-fib meds

A
  • BB = class II
  • CCB = class IV
  • anticoagulants = warfarin, apixiban, dabigtran, rivaroxaban, edoxaban
  • antiplatelets = ASA, clopidogrel (Plavix)
67
Q

atrial flutter meds

A
  • Class I Na channel blocker
  • amiodarone = Class III K channel blocker
68
Q

v-tach meds

A

immediate tx: cardioversion
- amiodarone = class III K channel blocker
- lidocaine = class IB- Na channel blocker

69
Q

Torsades de Pointes meds

A
  • IV mag sulfate
  • Class I Na channel blocker
  • Class III K channel blockers - amiodarone
70
Q

v-fib meds

A
  • defibrillation is priority
  • Class I Na channel blockers
  • Class III K channel blockers = amiodarone
71
Q

quinidine (Quinidex) class

A

Class I Na channel blocker (Class 1A - immediate action)

72
Q

quinidine (Quinidex) MOA

A
  • prolonged depolarization and delay repolarization
  • EKG shows widened QRS and prolonged QT interval
73
Q

quinidine (Quinidex) indications

A
  • drug of choice for malaria
  • SVT
  • ventricular dysrhythmia
74
Q

quinidine (Quinidex) AEs

A
  • watch for vasodilatino and hypotension (lightheadedness)
  • diarrhea frequent
  • blurry vision
  • bitter taste
  • tinnitus
75
Q

quinidine (Quinidex) nursing considerations

A

if taken with digoxin, it doubles digoxin levels

76
Q

lidocaine (Xylocaine) class

A

Class I Na channel blocker (Class 1B - very fast action)

77
Q

lidocaine (Xylocaine) MOA

A
  • local anesthetic
  • decreased automaticity and accelerated repolarization
  • EKG shows little to no effect
78
Q

lidocaine (Xylocaine) indications

A
  • local anesthesia
  • short term therapy for ventricular dysrhythmias only
79
Q

lidocaine (Xylocaine) AEs

A

CNS effects (confusion and drowsiness)

80
Q

lidocaine (Xylocaine) nursing considerations

A
  • given IV
  • can also be given intradermal, topical
81
Q

flecainide (Tambocor) class

A

Class I Na channel blocker (Class 1C - very slow action)

82
Q

flecainide (Tambocor) MOA

A

reduce conduction velocity in atria, ventricles, and His-Perkunje system; delays repolarization and increased refractory period; EKG shows prolonged PR interval and widening of QRS

83
Q

flecainide (Tambocor) indications

A

severe ventricular dysrhythmias not responsive to other meds

84
Q

propanalol (Inderal) class

A

beta-blocker

85
Q

propanalol (Inderal) MOA

A
  • BBs blocks B1 and B2 adrenergic receptors which slows HR/slows time for conduction and decreases force of contraction
  • beta blockage results in: decreased automaticity of SA node, decreased velocity through AV node, decreased myocardial contractility
  • EKG shows prolonged PR interval
86
Q

propanalol (Inderal) indications

A
  • afib
  • tachycardias
87
Q

propanalol (Inderal) AEs

A
  • heart failure/AV block
  • hypotension
  • bronchospasm
  • contraindicated in pts with astham/COPD
88
Q

amiodarone (Pacerone) class

A

K potassium channel blocker (Class III)

89
Q

amiodarone (Pacerone) MOA

A
  • delay repolarization = prolonged action potential duration and effective refractory period
  • EKG shows widening QRS, prolonged PR and QT intervals
90
Q

amiodarone (Pacerone) indications

A

serious dysrhythmias due to toxicities (v-tach and v-fib)

91
Q

amiodarone (Pacerone) AEs

A

severe organ toxicities (lung damage, visual impairment, sun exposure turns the skin blue-gray)

92
Q

amiodarone (Pacerone) nursing considerations

A
  • monitor drug interactions (increases digoxin, warfarin, and statin levels)
  • grapefruit juice increases levels
93
Q

verapamil (Calan) and diltiazem (Cardizem) class

A

Ca channel blockers (Class IV)

94
Q

verapamil (Calan) and diltiazem (Cardizem) MOA

A

decreased contractions, vasodilates blood vessels, similar to BBs

95
Q

verapamil (Calan) and diltiazem (Cardizem) indications

A
  • effective in controlling Afib and ventricular dysrhythmias
  • chronic HTN as second-line therapy
96
Q

verapamil (Calan) and diltiazem (Cardizem) AEs

A

for verapamil: constipation, dizziness, pedal edema, bradycardia

97
Q

verapamil (Calan) and diltiazem (Cardizem) nursing considerations

A

for verapamil: food and drug allergies (digoxin, grapefruit juice, beta blockers), verapamil toxicity (severe hypotension, bradycardia, AV block)

monitor: VS, increase fluids, daily weights, I/O

98
Q

adenosine (Adenocard) class

A

other antidysrhythmic

99
Q

adenosine (Adenocard) MOA

A

decreases electrical activity in SA node and slows conduction through AV node to decrease heart rate

100
Q

adenosine (Adenocard) indications

101
Q

adenosine (Adenocard) AEs

A
  • passes quickly
  • sinus bradycardia
  • dyspnea due to bronchoconstriction
102
Q

adenosine (Adenocard) nursing considerations

A
  • requires fast IVP
  • give IV via PICC or central line
  • must be on a monitor
103
Q

nitroglycerin class

A

organic nitrates

104
Q

nitroglycerin MOA

A
  • in chronic stable angina, nitroglycerin dilates veins and decreases venous return (preload) = decreased cardiac oxygen demand
  • in variant angina, nitroglycerin prevents or reduces coronary artery spasm = increased oxygen supply
105
Q

nitroglycerin indications

A
  • acute angina attacks
  • prophylaxis of chronic stable or variant angina
106
Q

nitroglycerin AEs

A
  • HA
  • hypotension
  • reflex tachycardia
  • tolerance
107
Q

nitroglycerin administration

A
  • nitrostat (PO) = given 3x every 5 minutes (don’t take more than three doses)
  • topical = 1-2 inches every 4-6 hrs during the day
  • IV = may be needed if SL is ineffective
108
Q

nitroglycerin nursing administration

A
  • monitor drug interactions with antihypertensives
  • educate pt on avoiding alcohol, AEs, and proper use of medication
  • assess BP and HR before administration
109
Q

ranolazine (Ranexa) class

A

antianginal

110
Q

ranolazine (Ranexa) MOA

A

lowers cardiac oxygen demand; improves exercise tolerance and decreases pain

111
Q

ranolazine (Ranexa) indications

A

angina (not used for variant)

112
Q

ranolazine (Ranexa) AEs

A
  • may prolong QT interval
  • if being used for ventricular dysrhythmias it can cause Torsades de Pointes

NURS 3303 (10 decks)

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