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Pharm 2: EXAM 1 > Diuretics, HR, Antidysrhythmic > Flashcards

Diuretics, HR, Antidysrhythmic Flashcards

1
Q

Thiazide Diuretics

A

hydrochlorothiazide (HCTZ)

-K+ wasting

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2
Q

Hyrdrochlorothiazide (HCTZ)

MOA

A

Inhibits resorption of Na+, K+, & Cl: results in osmotic water loss

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3
Q

Hyrdrochlorothiazide (HCTZ) Indications

thiazide diuretic

A 
Edema
Adjuncts in treatment in HF
Diabetes insipidus
Hypertension
Idiopathic hypercalciuria (excess CA+ in urine)
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4
Q

Hyrdrochlorothiazide (HCTZ) Contraindications

Thiazide diuretic

A 
Allergy
Hepatic coma
Anuria
Severe renal failure
(These patients already have electrolyte imbalances)
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5
Q

Hyrdrochlorothiazide (HCTZ) AE’s

A 
Related to electrolyte & metabolic disturbances they cause:
Hypokalemia
Hypercalcemia
Hyperglycemia 
Elevated lipids
Uric acid levels 
Hyponatremia?
Dehydration
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6
Q

Hyrdrochlorothiazide (HCTZ) Interactions

A

Corticosteroids
Digoxin
Oral hypoglycemic drugs

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7
Q

Potassium-Sparing Diuretics

A

Spironolactone (Aldactone)

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8
Q

Spironolactone (Aldactone) MOA

A

Interfere with sodium-potassium exchange

works in the collecting ducts & distal convoluted tubules

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9
Q

Spironolactone (Aldactone) Indications

K+-sparing diuretic

A
  • Hyperaldosteronism
  • Hypertension
  • Hypokalemia caused by K+-wasting diuretics
  • HF in Pediatric patients
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10
Q

Spironolactone (Aldactone) Contraindications

A
  • Hyperkalemia
  • Severe renal failure
  • Anuria
  • Allergy
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11
Q

Spironolactone (Aldactone) AE’s

K+-sparing diuretic

A
  • Gynecomastia (male swollen breast tissue
  • Amenorrhea (absence of period)
  • Irregular menses
  • Postmenopausal bleeding
  • Hyperkalemia
  • Dizziness
  • HA
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12
Q

Spironolactone (Aldactone) Interactions

K+-sparing diuretic

A
  • ACE inhibitors
  • Lithium (increased lithium)
  • NSAIDs (more bleeding)
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13
Q

Loop Diuretics

A

furosemide (Lasix)

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14
Q

furosemide (Lasix) MOA

A

Block chloride & Na+ resorption

Renal, cardiovascular & metabolic effects

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15
Q

furosemide (Lasix) Indications

A
  • Edema
  • HF
  • hepatic & renal disease
  • Hypertension
  • Hypercalcemia
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16
Q

furosemide (Lasix) Contraindications

Loop diuretic

A
  • Hepatic coma
  • Severe electrolyte loss
  • Allergy
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17
Q

furosemide (Lasix) AE’s

A
  • Hypokalemia
  • Photosensivity
  • Dizziness
  • HA
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18
Q

furosemide (Lasix) Interactions

A
  • NSAIDs
  • vancomycin
  • corticosteroids
  • digoxin
  • lithium
  • aminoglycoside antibiotics
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19
Q

Toxicity & overdose of hydrochlorothiazide & furosemide (Lasix)

A

K+ wasting =hypokalemia:

  • alkalosis
  • shallow respirations
  • irritability
  • confusion
  • weakness
  • arrhythmias
  • lethargy
  • thready pulse
  • decreased intestinal motility
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20
Q

Toxicity & overdose of spironolactone (aldactone)

A

K+-sparing = hyperkalemia:

  • muscle twitches, cramps, paresthesia
  • Irritability & anxiety
  • Decreased BP
  • EKG changes
  • Dysrhythmias
  • Abdominal cramping
  • Diarrhea
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21
Q

Heart Failure drugs

A
  1. Cardiac Glycosides: (digoxin)

2. Phosphodiesterase inhibitors (Milrinone)

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22
Q

Older Adults & Diuretics

A

Effects of diuretics are typically more exaggerated in older adults
Start with lower doses and gradually increase
Monitor for s/s of hyperkalemia, hypokalemia, dehydration
Change positions slowly
Have alternate methods for urination available (i.e. bedside commode, urinal)

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23
Q

Drug classes for Heart Failure

A
  1. Angiotensin-converting enzyme inhibitors (ACE) inhibitors
  2. Angiotensin receptor blockers (ARBs)
  3. Beta blockers
  4. Loop diuretics
  5. Remember, cardiac glycosides (i.e. digoxin) are used last!
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24
Q

Inotropic Drugs

A

Force of contraction

  • (Positive) Increase force of myocardial contraction
  • (Negative) Reduce force of contraction
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25
Q

Chronotropic Drugs

A

Heart Rate

  • (Positive) increase HR
  • (Negative) decrease HR
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26
Q

Dromotropic Drugs

A

Conduction

  • (Positive) accelerate conduction
  • (Negative) slow down conduction
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27
Q

Cardiac Glycoside

A

digoxin (Lanoxin)

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28
Q

digoxin (Lanoxin) MOA

A

Positive inotropic effect (increase force of contraction)
Negative chronotropic effect (Decreased HR)
Negative dromotropic effect (decreased conduction)

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29
Q

digoxin (Lanoxin) Indications

A

systolic HF

atrial fibrillation

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30
Q

digoxin (Lanoxin) Contraindications

A
  • 2nd/3rd degree heart block
  • ventricular tachycardia & fibrillation
  • diastolic HF
  • subaortic astenosis
  • Allergy
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31
Q

digoxin (Lanoxin) AE’s

A
  • bradycardia or tachycardia
  • hypotension
  • HA
  • fatigue
  • confusion
  • convulsions
  • colored vision, halo vision
  • anorexia
  • N/V/D
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32
Q

digoxin (Lanoxin) Interactions

A

-Amiodarone
-quinidine
-verapamil
These drugs increase digoxin levels by 50%!

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33
Q

Digoxin normal therapeutic levels

A
  1. 5-2 mg/mL

- Low K+/Mg levels may increase potential for digoxin toxicity

34
Q

digoxin (Lanoxin) Toxicity S/S

A
  • bradycardia
  • HA
  • Dizziness
  • Confusion
  • Nausea
  • Visual disturbances (blurred or yellow)
35
Q

digoxin (Lanoxin) Antidote

A

digoxin immune Fab

36
Q

Who is at increased risk of digoxin toxicity?

A
  1. Older adults

2. Hypokalemia

37
Q

digoxin (Lanoxin) toxicity management

A
  1. Discontinue drug
  2. Begin ECG monitoring -give antidysrhythmic meds as ordered
  3. Determine serum digoxin & electrolyte levels
  4. Administer K+ supplements for hypokalemia
  5. Institute supportive therapy for GI symptoms
  6. Administer digoxin immune Fab
38
Q

Phosphodiesterase inhibitors:

A

Milrinone (Primacor)

39
Q

Milrinone (Primacor) MOA

A 
Positive inotropic (increases force of contraction)
Causes vasodilation
40
Q

Milrinone (Primacor) Indications

A

used in intensive care setting for short-term management of acute HF

41
Q

Milrinone (Primacor) contraindications

A
  • severe aortic or pulmonary vascular disease
  • HF caused by diastolic dysfunction
  • Allergy
42
Q

Milrinone (Primacor) AE’s

A
  • Ventricular dysrhythmias occur in 12%
  • Hypotension
  • Angina
  • Hypokalemia
  • tremor
  • Thrombocytopenia
43
Q

Milrinone (Primacor) interactions

A
  • diuretics-may cause hypovolemia & reduced cardiac filling pressure
  • Additive inotropic effects when also taking digoxin
44
Q

Milrinone (Primacor) Nursing Considerations

A
  • Most often used in ICU setting for acutely ill HF
  • Monitor tele for ventr. dysr
  • IV Pump
  • Do not give in same line IV line as other drugs
45
Q

Antidysrhythmic:

Class 1A Sodium channel blockers

A

quinidine (Quinide)

46
Q

quinidine (Quinide) MOA

A

Blocks entry of Na+ into cardiac cells causing slower impulse conduction, decreased automaticity of ventricles & longer resting period

47
Q

quinidine (Quinide) Indications

A

Atrial Fibrillations

Atrial Flutter

48
Q

quinidine (Quinide) Contarindications

A
  • Severe heart block
  • Severe HF
  • Asthma
  • Myasthenia gravis
  • low WBCs
49
Q

quinidine (Quinide) AE’s

A
  • GI
  • Hypotension
  • Ventricular dysrhythmia (toxicity)
  • Arterial embolism
  • cinchonism (tinnitus, visual disturbances, HA, N/V)
50
Q

quinidine (Quinide) Interactions

A
  • Anticholinergics
  • Antidysrhymics
  • Cholinergics
  • Antihypertensives
  • Digoxin
  • Grapefruit
51
Q

Antidysrhythmic Drugs

A
  1. quinidine (Quinidex) 1A Sodium channel blocker
  2. Flecainide (Tambacor) 1C sodium channel blocker
  3. amiodarone (Cordarone, Pacerone) 3 potassium channel blocker
  4. verapamil (Calan) IV Calcium Channel Blocker
  5. adenosine (Adenocard) unclassified
52
Q

quinidine Interventions

A
  1. Monitor HR, BP, GI symptoms
  2. Keep patient supine during IV therapy (ortho hypo)
  3. Monitor ECG
  4. Monitor blood levels for toxicity
  5. Use an IV pump for
  6. Monitor & report s/s of cinhonism
53
Q

flecainide (Tambocor) MOA

Sodium channel blocker

A

Blocks entry of Na+ into cardiac cells

54
Q

flecainide (Tambocor) Indications

A
  • Serious supraventricular & ventricular tachydysrhythmias not controlled by other drugs
  • Used long-term for some supraventricular dysrhythmias
55
Q

flecainide (Tambocor) Contraindications

A
  1. 2nd/3rd degree AV block
  2. Prolonged QT interval
  3. Recent MI
  4. Shock
  5. Electrolyte Imbalance
56
Q

flecainide (Tambocor) AEs

A
  1. Blurry vision (difficulty focusing)
  2. Worsening of HF
  3. Edema
  4. Widening of QRS complex
  5. Potential for 1st degree AV block & multiple dysrhythmias
57
Q

flecainide (Tambocor) Interactions

A
  1. Digoxin
  2. beta blockers
  3. Calcium channel blockers
58
Q

flecainide (Tambocor) Interventions

A
  1. Monitor for & report visual changes
  2. Monitor for crackles in lungs, edema, weight gain
  3. Monitor ECG
  4. Monitor blood levels to detect toxicity
  5. Oral use only!
  6. Begin w. lowest dose & gradually increase no more than every 4 days
59
Q

amiodarone (cordarone, pacerone)

Potassium channel blocker MOA

A

Block K+ channels, decrease automaticity, decrease contractility, & dilates coronary and peripheral vessels

Widens QRS complex, prolongs both PR & QT intervals

60
Q

amiodarone (cordarone, pacerone) Indications

A

Manage life-threatening ventricular tachycardia or fibrillation that is resistant to other drugs

Treats Atrial fib

61
Q

amiodarone (cordarone, pacerone) Contraindications

A
  • Pregnancy
  • Lactation
  • Shock
  • Bradycardia
  • Heart block
  • sinus node dysfunction
  • Severe hepatic disease
  • Allergy
62
Q

amiodarone (cordarone, pacerone) AEs

A
  1. GI
  2. Pulmonary toxicity (lungs become fibrous)
  3. visual
  4. cardiac
  5. blue-grey discoloration of skin
  6. CNS
63
Q

amiodarone (cordarone, pacerone) Interventions

A
  1. Monitor & report GI
  2. Baseline & periodic chest x-ray & pulmonary function tests
  3. Auscultate breath sounds & report changes
  4. Monitor changes in vision or light sensitivity
  5. Monitor HR & BP
  6. Watch cardiac rhythm constantly during IV infusion
  7. Monitor for wt. changes, edema, skin discoloration, CNS effects
  8. Oral & IV
64
Q

verapamil (Calan)

Calcium channel blockers MOA

A

Block calcium channel blockers in the myocardium, prolongs PR interval

65
Q

verapamil (Calan)

Calcium channel blockers Indications

A
  1. convert supraventricular tachycardia to regular sinus rhythm,
  2. slow rate of atrial fibrillation & flutter
66
Q

verapamil (Calan)

Calcium channel blockers Contraindications

A
  • Sever hypotension
  • Cardiogenic shock
  • Liver or kidney dysfunction
67
Q

verapamil (Calan)

Calcium channel blockers AEs

A
  • Hypotension
  • Bradycardia
  • HF
  • Peripheral edema of feet & legs
  • Lightheadedness
  • Dizziness
68
Q

verapamil (Calan)

Calcium channel blockers Interactions

A

Antihypertensive
Lithium
Grapefruit juice

69
Q

verapamil (Calan)

Calcium channel blockers intervetnions

A
  1. Monitor VS & cardiac rhythm w/ IV meds. (keep patient supine for 1 hour)
  2. Monitor BP
  3. Withhold dose and notify provider for: BP lower 90 & pulse slower than 60
  4. Monitor for & report edema, low urine output, crackles in lungs & lightheadedness
  5. Oral & IV
  6. Give PO dose with food
70
Q

unclassified antidysrhythmic

A

adensosine (Adenocard)

71
Q

adensosine (Adenocard)
unclassified antidysrhythmic
MOA

A

slows conduction through AV node, very short half life (less than 10 secs!)

72
Q

adensosine (Adenocard)
unclassified antidysrhythmic
Indications

A

convert PSVT to sinus thythm

73
Q

adensosine (Adenocard)
unclassified antidysrhythmic
Contraindications

A
  • 2nd/3rd degree heart block
  • sick sinus sundrome
  • Allergy
74
Q

adensosine (Adenocard)
unclassified antidysrhythmic
AEs

A
  • commonly causes asystole for a period of seconds

- all other AEs are minimal due to short half-life

75
Q

adensosine (Adenocard)
unclassified antidysrhythmic
Interactions

A

Rare b/c of short half life

76
Q

Contradictions/Cautions for ALL Antidysrhythmics

A
  • allergy
  • 2nd/3rd degree AV block
  • bundle branch block
  • cardiogenic shock
  • sick sinus syndrome
  • any other ECG changes depending on clinical judgement of cardiologist
  • other antidysrhythmic drugs
77
Q

AEs of ALL antidysrhythmics

A
  • Dysrhythmias
  • Hypersensitivity reactions
  • N/V/D
  • dizziness
  • HA
  • Blurred vision
  • Prolongation of QT interval
78
Q

Antidysrhythmic Nursing implications

A
  • Thorough drug & medical history
  • Baseline BP, HR, I/O, cardiac rhythm
  • Serum K+ levels before starting
  • Contraindications (specific drugs)
  • Potential drug interactions
79
Q

Antidysrhythmic Nursing implications

During therapy

A
  • Monitor cardiac rhythm, HR, BP, general well-being, skin color, Temp., heart & lung sounds
  • Assess plasma drug levels
  • Monitor for AE & toxic effects
80
Q

Antidysrhythmic Education

A

-Take meds as scheduled
-Do NOT skip doses or double up for missed doeses
-Do NOT crush or chew oral sustained release
Notify:
-SOB
-Edema
-Dizziness
-Syncope
-Chest pain
-GI distress
- Blurred vision
-

81
Q

Antidysrhythmic Nursing Evaluations

A

This is what we want to see:

  • Decreased BP
  • Decreased edema
  • Decreased fatigue
  • Regular HR
  • Improved regularity or rhythm
  • Improved cardiac output

Pharm 2: EXAM 1 (3 decks)

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