exam 1 Flashcards
Atropine (class/action/dose)
anticholinergic (or muscarinic antagonist)
blocks muscarinic (Ach) receptors causing decreased parasympathetic nervous system activation
dose: 0.5-1 mg IVP
Atropine (AE)
decreased GI/GU
dry mouth
mydriasis
Atropine (CI/Nurs)
CI: Hypersensitivity, Narrow-Angle Glaucoma, Severe Gastrointestinal Obstruction, Myasthenia Gravis, Prostatic Hypertrophy, Certain Cardiovascular Conditions
Nursing: Monitor Vital Signs, Assess for Side Effects, Monitoring for Toxicity, Temp regulation
Adenosine (class/action/ indication/dosage)
Class V antidysrhythmic
hyperpolarize cardiac membranes = no AP can occur
** set up for code, 6 mg, 12mg, 12mg**
Given for PAT, symptomatic narrow complex tachycardia,
(kinda stops the heart for a sec!)
Adenosine (AE)
flushing
transient hypotension
transient flat line
transient chest pain
Adenosine (CI/Nurs)
Admin: rapid IV push followed immediately by rapid saline flush,
CI: Hypersensitivity, Second- or Third-Degree AV Block, Sick Sinus Syndrome, Bronchoconstrictive Diseases
Nursing: Continuous ECG Monitoring, Vital Signs, Monitor for Respiratory Effects, patient is often positioned in a supine
Nitroglycerine (class/action)
Organic nitrates
Vasodilation → decreases preload (decreased O2 demand)
decreases coronary artery spasm
Nitroglycerine (AE)
headaches (cerebral vasodilation), postural hypotension, reflex tachycardia (can prevent with beta adrenergic antagonist or calcium channel antagonists)
Nitroglycerine (CI/Nurs)
sublingual ASAP
Q5mins, take another dose if no relief (up to 3 doses)
Can only give if BP adequate
*pt should be calling 911 as an outpatient after the first dose
Transdermal – rotate patch sites, take off at night bc tolerance can develop
Drug Interactions: other drugs that < BP, Sildenafil, Tadalafil, Veradenafil super contraindicated
Epinephrine (class/action)
catecholamine and a sympathomimetic drug and alpha- and beta-adrenergic agonist
alpha-1 receptors: Causes vasoconstriction → increased blood pressure.
Alpha 2: specific blood vessles that need to vasodilate, acts as a negative feedback loop
Beta-1 receptors: Increases heart rate and myocardial contractility.
Beta-2 receptors: Causes bronchodilation, useful in conditions like asthma or anaphylaxis
Epinephrine (AE)
Common:Tachycardia,
Hypertension,
Palpitations, Anxiety or nervousness, Tremors, Dizziness, Headache
Epinephrine (CI/Nurs)
CI: Absolute: Hypersensitivity to the drug
Relative Contraindications:Patients with severe hypertension, Tachyarrhythmias, Coronary artery disease, Hyperthyroidism, Diabetes mellitus, Glaucoma
Nursing: Monitor vital signs Assess for signs of an allergic reaction, Observe cardiac function, Monitor blood glucose levels
Norepinephrine (levophed) (AE)
Hypertension, Bradycardia, Arrhythmias, Peripheral ischemia, Anxiety or nervousness, Headache, metabolic acidosis
Norepinephrine (levophed) (class/action)
Sympathomimetic (Adrenergic Agonist)
Alpha-1 receptors: Causes vasoconstriction, leading to increased systemic vascular resistance and elevated blood pressure
Beta-1 receptors: Increases heart rate and myocardial contractility
Norepinephrine (levophed) (CI/nurs)
CI: Relative Contraindications:Hypovolemia, Patients with peripheral vascular disease, Recent myocardial infarction, Pregnancy
Nursing: Monitor vital signs, Assess perfusion, Monitor IV site (risk for tissue necrosis with extravasation), Phentolamine to reverse, Fluid resuscitation, Taper dosing carefully, Monitor urine output
Calcium Channel blockers dihydropyridines (mechanism and AE)
-dipine
calcium channels on vascular smooth muscle blocked → arteriole vasodilation → vasodilation and decreased vascular resistance
Hypotension, Dizziness or lightheadedness, Headache, Peripheral edema, Flushing, Reflex tachycardia
Calcium channel blockers, nondihydropyridines (mechanism and AE)
arteries (arterial vasodilation) AND on the heart (decreased contractility, HR, AV node conduction)
bradycardia, hypotension, AV block, HF, peripheral edema, constipation, liver/kidney disease > risk of toxicity
CCB (CI/Nurs)
Drug Interactions:
Beta blockers (additive cardiac depressant and elevates digoxin levels)
CI: Absolute: Severe hypotension or cardiogenic shock.
Second- or third-degree AV block, Sick sinus syndrome, Severe heart failure
Nursing: Monitor vital signs, Assess cardiac rhythm, Monitor for signs of heart failure, Avoid grapefruit juice, Titrate doses carefully, Assess renal and hepatic function
Digoxin (class/mechanism of action/ use)
cardiac glycoside
Na+/K+ ATPase inhibition = increased Na+ and therefore increased Ca++
= increased contractility
Uses: A flutter
Digoxin therapeutic level
0.5 - 2.0 ng/mL
digoxin (CI)
Contrindications: heart block
hypokalemia (can lead to drug toxicity)
WPW
advanced CKD
Acute MI
renal impairment
digoxin (Nurs)
Nursing: Monitor digoxin levels
Loading doses
Assess heart rate
Monitor for signs of toxicity: confusion, loss of appetite, nausea, vomiting, diarrhea, or vision problems.
Monitor electrolytes: Particularly monitor potassium, magnesium, and calcium levels
Renal function assessment
Monitor for drug interactions
Patient education: Instruct patients to report symptoms of toxicity
Beta blockers (mechanism of action/ use)
-lol
block B1 receptors causing decreased HR, decreased contractility, and decreased conduction thru the AV node
Use: A fib, MI, cardiogenic shock
Beta blockers (AE)
AE: bradycardia, hypotension
Beta blockers (CI/Nurs)
CI: Absolute Contraindications:
Severe bradycardia or heart block
Cardiogenic shock.
Severe heart failure
Hypersensitivity to the drug or other beta-blockers.
Nursing:
Monitor blood pressure and heart rate
Assess for signs of heart failure
Monitor for bronchospasm
Educate diabetic patients
Do not abruptly discontinue
Monitor renal and hepatic function
Assess for depression
ACE inhibitors (drug/mechanism)
-pril
inhibits ACE (angiotensin-converting enzyme) causing decreased blood volume (aldosterone decrease), vasodilation, decreased SNS adrenergic activity → decreased myocardial oxygen supply, prevention of CV remodeling
ACE-I (AE)
dry persistent cough, first dose hypotension, hyperkalemia, renal failure
Rare: angioedema and neutropenia
ACE-I (CI/Nurs)
Note first dose hypotension can occur (limit other hypotension causing drugs and educate patients)
avoid drugs that can elevate levels of K+ or that are heavily impacted by K+ levels
Toxic to fetus – avoid in pregnancy
caution in patients with renal issues
ARBs (drugs/mechanism)
-artan
Angiotensin II receptor blocker
Blocks the effects of angiotensin II at the receptor causing decreased blood volume (aldosterone decrease), vasodilation, decreased SNS adrenergic activity → decreased myocardial oxygen supply, prevention of CV remodeling;
difference from ACE-I – doesn’t block kinase II → less side effects, and more aldosterone is released causing lower risk of hyperK+
ARBs (AE)
first dose hypotension, hyperkalemia (but lower risk than ACEs), renal failure, dizziness headache, fatigue
Rare: angioedema and neutropenia
ARBS (CI/Nurs)
Note first dose hypotension can occur (limit other hypotension causing drugs and educate patients)
avoid drugs that can elevate levels of K+ or that are heavily impacted by K+ levels
Toxic to fetus – avoid in pregnancy
caution in patients with renal issues
Less evidence to reduce CV morbidity and mortality, so ACEs are first line
Heparin (Mechanism of action/class)
Anticoagulant
Inhibition of Thrombin and Factor Xa: reducing the formation of fibrin and preventing clot formation
Heparin (AE)
Bleeding or easy bruising
Pain or irritation at the injection site
Elevated liver enzymes
thrombocytopenia
aspirin (class/mechanism of action)
Nonsteroidal Anti-Inflammatory Drug (NSAID)
irreversible (aka lasts entire lifetime of platelet), inhibition of Cyclooxygenase (COX) → decreased platelet aggregation/activation, decreases vasoconstriction
Heparin (CI/Nurs)
CI: Absolute Contraindications
Severe Thrombocytopenia
Hypersensitivity to Heparin
Known allergic reactions to heparin or its components.
Relative Contraindications:
Recent Surgery
History of HIT
Renal or Hepatic Impairment
Nursing
Monitor Activated Partial Thromboplastin Time (aPTT):
Monitor Platelet Counts
Assess for Signs of Bleeding
Injection Site Care
Prepare for Reversal - protamine
Aspirin (AE)
Gastrointestinal symptoms
Mild gastrointestinal bleeding or ulcers
rarely: hemorrhagic stroke
Aspirin (CI/Nurs)
CI: Absolute Contraindications:
Active Peptic Ulcer Disease
Allergy to Aspirin or Salicylates: Known hypersensitivity or allergic reactions to aspirin or other salicylates
Severe Renal or Hepatic Impairment
Avoid use in children or adolescents with viral infections due to the risk of Reye’s syndrome.
Relative Contraindications:
History of Gastrointestinal Bleeding or Ulcers
Asthma
Pregnancy
Nursing
Monitor for Gastrointestinal Symptoms:
Assess for Signs of Allergic Reaction:
Be vigilant for signs of hypersensitivity reactions, including rash, itching, or respiratory symptoms.
Patient Education:
Adherence to Dosage
Bleeding Risks
Avoid Alcohol
Drug Interactions
Monitor Renal and Hepatic Function
Monitor Tinnitus or Salicylism:
Clopidigrel (Plavix) (class/mechanism)
Antiplatelet Agent
Inhibition of ADP-Induced Platelet Aggregation: This inhibition reduces platelet activation and aggregation, decreasing the risk of clot formation
Clopidigrel (Plavix) (AE)
Bleeding or easy bruising
Gastrointestinal symptoms
Rash
Clopidigrel (Plavix) (CI/Nurs)
CI:
Absolute Contraindications:
Active Bleeding
.Hypersensitivity to Clopidogrel: Known allergic reactions or hypersensitivity to clopidogrel or any of its components.
Relative Contraindications:
History of Bleeding Disorders
Severe Liver Disease
Pregnancy
Nursing:
Monitor for Signs of Bleeding
Inform About Bleeding Risks:
Adherence to Medication
Avoid Certain Activities
Drug Interactions
Monitor for signs of hematologic reactions, including thrombocytopenia and TTP.
Management of Gastrointestinal Symptoms
Protoamine Sulfate (class/mechanism)
Anticoagulant Reversal Agent
Reversal of Heparin: It binds to heparin, neutralizing its anticoagulant effect. This is achieved through the formation of a stable, inactive heparin-protamine complex
Retaplase and altaplase (class and mechanism)
thrombolytic, shorter duration
best used in 30 mins of arrival to ED
binds plasminogen → plasmin → digests fibrin meshwork and degrades clotting factors
Retaplase and altaplase (AE and Nurs)
bleeding
Nursing – minimize manipulation of the patient, avoid IM/sub Q injections, minimize invasive procedures, minimize use of concurrent anticoagulants,
Morphine sulfate (class/mechansim)
Opioid Analgesic
produces most of its analgesic effects by binding to the mu-opioid receptor within the central nervous system (CNS) and the peripheral nervous system (PNS).
Morphine Sulfate (AE)
Nausea, vomiting, constipation.
Drowsiness, dizziness, and lightheadedness.
Respiratory Effects
Morphine Sulfate (CI/Nurs)
CI: Absolute Contraindications:
Hypersensitivity: Known hypersensitivity or allergy to morphine or other opioids.
Acute or Severe Asthma
Severe Respiratory Depression
Relative Contraindications:
Pregnancy and Lactation
Liver or Renal Impairment
Concurrent Use with Other CNS Depressants
Nursing:
Monitoring Pain Relief, Respiratory Status, Gastrointestinal Effects, Dependence and Abuse
Dobutamine (class/action)
Beta 1 selective, alpha 1 if high dose
Increases CO without increasing HR
Dobutamine (AE)
Hypertension
Tachycardia
Premature ventricular contractions
Arrhythmias
Shortness of breath
Dobutamine (CI/Nurs)
CI
Tachycardia
Hypersensitivity
Can be difficult on kidneys
Monitor BP, HR, CO and EXG
milrinone (Class/action)
Iontrope
Amiodarone (class/ mechanism)
Type III antidysrythmIc
Blocks potassium exit to delay repolarization, increase action potential and effective refractory period
Prolongs QT to allow more time for ventricles to fill
Amiodarone (use/dose)
150 mg bolus for PVCs
300 mg bolus if dead
Amiodarone (AE)
Pulmonary fibrosis
Hypothyroidism
Hepatotoxicity
Corneal microdeposits
Skin discoloration
Prodysrhythmic: torsades, bradycardia, AV block
Amiodarone (CI/Nurs)
Side effects can begin up to 60 days after dose
Long ½ life
Baseline chest x-ray and pulmonary function tests
Many drug interactions
Not approved in pregnancy
Lidocaine (Class/ mechanism/use)
Class Ib antidysrhythmic
Decreases action potential and effective refractory period
Affects ischemic tissues
Use: V tach, PVCs
Lidocaine (AE)
Toxicity at high doses: confusion, blurry vision, nausea, twitching, dizziness
Signal from SA node is effective
Seizures
Cardiac arrest
Lidocaine (CI/Nurs)
Children under 3
Hypersensitivity
Local anesthetic so be careful with dosing
Monitor ECG, BP and respiratory status
