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Nclex Study Cards > Drugs affecting cardiovascular and vascular system > Flashcards

Drugs affecting cardiovascular and vascular system Flashcards

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1
Q

ACE AND ARBS

A

Lisino-pril (Chill pill)
Lo-sartan (relax man)

Lowers BP only not HR
Ace = 1st choice
Arbs = 2nd choice
We can give ACE and ARBs if the HR is low since they only affect the BP

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2
Q

ACE AND ARBS mechanism of action

A

Both block or inhabit the RAAS system (renin angiotensin aldosterone system) which retains fluid
Aldosterone is blocked from adding sodium and water in and letting potassium out
(no sodium and water can get in, no potassium can get out)
Problem = Retaining too much potassium

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3
Q

ACE AND ARBS Precautions

A

Avoid Pregnant women (not baby safe)
Angioedema (airway risk) = Only ACE
Cough = Only ACE
Elevated Potassium - avoid potassium rich food, salt substitutes and liver

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4
Q

First Dose phenomenon

A

Don’t leave patients bedside and assess for any adverse reactions

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5
Q

Beta Blockers

A

Ends in LOL
AtenoLOL
Lowers HR and BP
always check BP and HR before giving

Neg Chronotopic (lower rate)
Neg Inotropic (less force)
Neg Dromotopic (less beats)
or
Decreases resistance
Decreases workload
Decreases cardiac output

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6
Q

Beta Blockers Side Effects

A

Blocks beta receptors 1 and 2

Bradycardia HR less than 60, less than 100 sys

Breathing Problems: bronchospasm, Wheezing - Not for asthma, COPD

Bad for HF patients = new Edema, worsening crackles in the lungs, rapid weight gain, new JVD = question Dr. Orders

Blood sugar masking, Beta blockers hide symptoms of low sugar. Hold is sugar is less than 70. Monitor sugars closely

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7
Q

Calcium Channel Blockers

A

Calms the Heart
Lowers HR and BP

NifediPINE
CardiZEM
VerapAMIL

Blocks the movement of calcium = relaxes blood vessels and takes the strain off the heart

Neg Chronotropic (lower rate)
Neg Inotropic (less force)
Neg Dromotropic (less. beats)

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8
Q

Calcium Channel Blockers Precautions

A

Count HR and BP do not give iim BP less than 90, hR less than 60
Change positions slowly
Bad headache = normal
Stop or slow any IV meds if there is a big drop in HR or BP, big drops can kill patients

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9
Q

Digoxin

A

Lowers HR, digs for a deeper contraction and increased contractility
Inotropic Drug
Given for Afib and HF

Nothing to do with BP
No orthostatic hypotension and no need to do slow position changed

Toxic side effects
Cardiac Glycoside

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10
Q

Digoxin Precautions

A

Check apical pulse for a full 60 seconds, hold if HR less than 60
Toxicity - over 2.0 = vision changes, nausea, dizziness, notify HCP immediately
Decreased kidney function = higher risk fir digoxin toxicity, monitor BUN and creatinine Over 1.3 = kidney Injury
Potassium below 3.5 = increase risk for digoxin toxicity (does not cause low potassium only increases the risk for toxicity)

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11
Q

Digoxin Toxicity

A

Max range 2.0
1st signs of toxicity
Anorexia
Nausea and vomiting
Vision changes (difficulty reading)

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12
Q

Which patient is most at risk for digoxin toxicity

A

Patient taking potassium wasting diuretics or Kidney failure patients

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13
Q

Dilators

A

Vasodilators
Nitroglycerin

Commonly given for chest pain but also works in HF patients to lower BP
Opens up vessels (dilates vessels to decrease vascular resistance) = Decreased BP

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14
Q

Top 5 vasodilators

A

Nitroglycerin
Nitroprusside
Hydralazine
Isosorbide (caution - not a diuretic)
Minoxidil (only severe HF)

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15
Q

Dilators Precautions

A

No Viagra “afil” Sildenafil = Death
Stop if Low BP less than 100 or drop by 30mmHg sys
Stop if patient has: lack of coordination, irritability, sweating, pallor

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16
Q

Dilators side Effects

A

Headache
Hypotension (slow position changes)
Hot flushing “facial redness)

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17
Q

Diuretics

A

Potassium wasting and sparing
#1 drug used for HF
Decrease eBP
Drain FLuid
Dehydrate the body

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18
Q

Potassium Wasting Diuretics

A

Caution: Hypokalemia 3.5 or less
Decreases potassium
Eat green lady veggies, melons and avocados
avoid liquorice root

Only give potassium wasting if potassium is normal 3.5-5.0

Loop #1 worsening HF
Worsening Crackles
New Edema in legs
Rapid Weight gain

FurosemIDE
TorsemIDE
BumetanIDE
Block reabsorption of sodium in kidneys, less sodium retained = less swelling

Thiazide
HydrochlorothiazIDE
Chlorothiadone

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19
Q

Potassium Sparing

A

Caution: Avoid potassium Avoid green leafy, melons and avocados, salt substitute

Spironolactone blocks aldosterone directly

Watch for hyperkalemia
Peaked T waves
ST elevation

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20
Q

Diuretics Precautions

A

Always check the BP: hold if BP low
Monitor and check BUN and Creatinine before
Potassium imbalances, monitor potassium and place on cardiac monitor

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21
Q

Diuretic Key tips

A

Take in the morning not a night
Slow position changes
Daily wights Report 2-3 lbs
Sunburn
low sodium diet

Avoid OCT meds - contain high amounts of sodium = swells the body
Cough and Flu
Antacids like tums
Acetaminophen
NSAIDS: naproxen and ibuprofen

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22
Q

Furosemide

A

1 drug for HF

if give to fast (IV push) can be
Ototoxic (ear rining)
Hypotension Low BP not HR

if given too much can be nephrotoxic - kidney toxic, always check creatinine and BUN labs
Hypokalmia

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23
Q

Antihypertensives

A

Ace
Arbs
Beta blockers
Calcium Channel Blockers
Dilators
Diuretics

Cause low BP and Orthostatic hypotension/dizziness when standing
Change positions slowly

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24
Q

Antidysrhythmics
Class 1: Sodium channel blockers

A

Procainamide
Lidocaine
Given for: V tach and V Fib

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25
Q

Antidysrhythmics
Class 2: Beta Blockers

A

Propranolol
Given for: Hypertension, SVT, tachycardia
Afib and Aflutter

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26
Q

Antidysrhythmics
Class 3: Potassium channel blockers

A

Amidodarone
Given for: V tach and V fib

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27
Q

Antidysrhythmics
Class 4: Calcium channel blockers

A

Verapamil
Diltiazem
Nifedipine
Given for: Hypertension, SVT, tachycardia Afib and Aflutter

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28
Q

Antidysrhythmics

A

Lower BP, reassess BP every hour
Low oxygen to the brain, first sign = Dizziness
Slow position changes

29
Q

Other Drugs for Antidysrhythmics

A

Adenosine: Decreases HR given for: SVT
Give fast: IV push 1-2 seconds, saline flush immediately after

Digoxin: cardiac glycoside
Given for: Afib

Atropine (anticholinergic)
Given for: symptomatic bradycardia (less than 60 that show signs of low oxygen = mental status changes, pallor) Push medication to make HR go crazy fast

30
Q

Given for Atrial rhythms

A

Atropine
Adenosine
Beta Blockers
Calcium Channel Blockers
Digoxin

31
Q

Given for Ventricular rhythms

A

Lidocaine
Amiodarone
Procainamide

32
Q

Which drug causes Bradycardia?

A

Propanolol

33
Q

What is the intended effect for Diltiazem?

A

Ventricular rate decreased from 160 to 70

34
Q

Priority adverse effects to watch for when giving amlodipine?

A

Dizziness

35
Q

Most important patient teaching when giving verapamil?

A

Slow position changes

36
Q

A client on digoxin having difficulty reading a book or some type of vision problems

A

Toxicity for vision changes

37
Q

Client on digoxin with a history of renal failure… key lab value to monitor

A

Creatinine over 1.3 = Bad kidney

38
Q

Lidocaine Toxicity

A

Hypotension
Any neurological changes is the first sign of toxicity, neurological checks are priority
Only lasts a short while in the body - toxicity is easily treated

39
Q

Amiodarone

A

Used 2nd if lidocaine doesn’t work
Pulmonary toxicity - lung toxicity =
Dry cough and sypnea
Difficulty breathing while ambulating
SOB
report all of these to HCP

40
Q

Which drugs do we teach slow position changes due to orthostatic Hypotension

A

Atenolol
Amiodarone
Amlodipine
Diltiazem
Furosemide

41
Q

Antihypertensive Clondine

A

Given to lower BP when High BP is persistent and not responsive to other medications
Very potent

42
Q

Clondine Mechanism of Action

A

Alpha 2 antagonist
To decrease the sympathetic response from the CNS inside the brain stem to the peripheral vessels resulting in decreases peripheral vascular resistance and vasodilation = decrease cardiac output, HR and BP

Given either patch or will
Priority: never stop taking abruptly can result in rebound hypertension leading to hypertension crisis and health
Slowly tapper off over 2-4 days
Teach slow position changes

43
Q

Clonidine Precautions

A

Given either patch or pill
Change patch every 7 days, apply patch to hairless intact skin on upper arm
Sometimes used to treat ADHD

Priority: never stop taking abruptly can result in rebound hypertension leading to hypertension crisis and health
Slowly tapper off over 2-4 days
Teach slow position changes

44
Q

Clonidine Teaching

A

No Other CNS depressants
No alcohol
No antihistamines
No sedatives
No driving

45
Q

INOtropic

A

Increase cardiac contractility
Increased forceful contraction
3 D’d for Deep contraction
Digoxin
Dopamine
Dobutamine

46
Q

CHRONOtropic

A

Clock
Neg chronos - Neg Tim = less beats per min = Lower HR
Positive Chronos - positive time = more beats per minute = faster HR

47
Q

DROMOtropic

A

Rhythm of Heart Beat
Neg Dromotropic to stable heart rhythm
Electrical impulses

48
Q

Cholesterol lowering Agents

A

“Statin”
Atorvastatin
Simvastatin
lovastatin
Rosuvastatin

49
Q

Cholesterol lowering Agents Mechanism of Action

A

Prevents cholesterol production in the liver by blocking an enzyme that is needed to make cholesterol
Lowers BAD cholesterol
Increases GOOD cholesterol

50
Q

BAD Cholesterol

A

Total cholesterol 200
Triglyercides 150
LDL 100

51
Q

GOOD cholesterol

A

HDL 40

52
Q

Cholesterol Lowering Agents Indication

A

High cholesterol levels
Hypercholesterolemia
Hyperlipidemia

53
Q

Cholesterol Lowering Agents Side effects

A

Liver Toxic Monitor liver labs (ALT and AST) do not give to patients with liver problems
Muscle pain - muscle cramps, spams and aches, report to HCP
Monitor Creatinine: muscle breakdown can clog kidneys
Avoid grapefruit and st johns wort
Take at night (dinner time or bed time)

54
Q

MI Meds

A

Oxygen
Aspirin
Nitro
Morphine

55
Q

Nitro Precautions

A

3 doses Max 5 min apart
No swallow: SL under the Tonge
Headache and hypotension is normal take when sitting
Call 911 if there is pain 5min after first dose

56
Q

Morphine

A

Any chest pain after morphine indicates MI
More pain = more tissue death

57
Q

Clot Busters

A

Throbectomy
Fibrinolytics x1 dose
TPA
Streptokinase (allergy risk)
Bleed risk 8 hour window
No sections (IV, SQ, IM, ABG)
Never through central lines

58
Q

After MI

A

Rest and prevent Clots
Heparin IVL prevent and stabilize clot

Heart Rest:
Nitro IV drip
Beta blockers
CCB

59
Q

Heparin

A

therapeutic Range
PTT 46-70
(3x MAX range)
Antitode: Protamine sulfate

60
Q

Vasopressors Mechanism of Action

A

Vasopressors press on the vessel causing the blood pressure to increase and squeeze the oxygen back to the heart
Given to increase BP
During Cardiac Arrest
During Shock and decreased perfusion

Activate alpha and betas inside the heat and lining of the blood vessels

61
Q

Alpha receptors

A

Alphas are responsible for constriction of the blood vessels so the blood squeezes back to the heart
Alpha agonist: Increases Blood pressure
Alpha Antagonist: Lowers the blood pressure

62
Q

Beta receptors

A

Beta 1 = 1 heart
Beta 1 agonist = faster heart rate, stronger pump, increased cardiac output
Beta antagonist: Lower heart rate, less force

Beta 2 = 2 lungs Dilation of lungs and bronchi
Beta 2 agonist: Vasopressors and albuterol, opens up longs and vessels, lungs get more oxygen and organs get perfused. Since the blood vessels are dilated the blood pressure can drop

63
Q

Main Vasopressors

A

Epinephrine
Norephinephrine
Vasopressin
Dobutamine
Dopamine

64
Q

Epinephrine and Norepinephrine

A

EPI elevated blood pressure by activating the alpha 1receptorsto provide constriction

Epinephrine (brand: adrenaline)
Norepinephrine (brand: levophed)
Given for severe low blood pressure for example septic shock

Key difference:
Epinephrine 1st priority in:
Cardiac arrest (initiates heart contraction during cardiac arrest)
A-systole
PEA (Pulseless electrical activity)
Also used as a 1st line drug in anaphylaxis

65
Q

Phentolamine

A

used to treat dopamine and epinephrine extravasation (IV dislodged and leaks into the tissues) can cause burning and blistering
Keep IV in place and give phentolamine immediatly

66
Q

Vasopressin and Demopressin

A

Increases blood pressure
Synthetic ADH (antidiuretic hormone) does not affect the alpha and betas
Increases fluid in the body to increase blood pressure by making you stop urinating

Demopression: Given for Diabetes Insipidus

67
Q

Dobutamine and Dopamine

A

Given for a deeper contraction
inotropic = increases cardiac contractility and increased forceful contraction
Treatment for cariogenic shock
Assess BP hourly
Monitor Vital signs

Dopamine:
Activates alpha 1 and beta 1 receptors
Therapeutic effects:
Low doses act on dopamine receptors
Moderate doses act on beta 1 receptors
High doses act on alpha 1 and beta 1 receptors
Assess IV site hourly for s/s of infiltration

68
Q

Dopamine Given for a patient with hypotension what indicates effectiveness

A

Increased cardiac output

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