Exam 4 Cardiac Stuff Flashcards by John Ross Robertson

What is sudden deep swelling or welts under the skin, particulalry arouond the eyes and lips?

angioedema

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What a decrease or block the effects of sympathetic nerve stimulation?

antiadrenergic

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What is high blood pressure for which no cause can be found?

essential hypertension

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What is first dose phenomenon?

orthostatic hypotension with palpitations, dizziness, and perhaps syncope 1-3 hours after first dose of a drug or increase dose

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What is Secondary hypertension?

high blood pressure from an identified cause, such as kidney disease

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What categories of drugs treat HTN?

Renin-angiotensin Aldosterone System Suppressants (RAAS)
Calcium Channel Blockers (CCB)
Sympatholytic (Antiadrenergic)
Direct-acting Vasodilators

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What can cause HTN?

increased cardiac output,
peripheral resistance, or both

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What can long term HTN cause?

irreparable kidney damage
left ventricular failure
increased risk for CVAs (strokes)

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What are examples of meds under the RAAS category?

Angiotensin-converting Enzyme (ACE) Inhibitors
Angiotensin II Receptor Blockers (ARBs)
Aldosterone Antagonists
Direct Renin Inhibitors (DRIs)

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What do ACE inhibitors do?

reduce amount of blood heart needs to pump

end in -pril

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What do we use ACE inhibitors for?

HTN
HF
Slowa renal impairment
Reduce proteinuria

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What are side effects of ACE inhibitors?

dry, nonproductive cough
hyperkalemia
angioedema
orthostatic hypotension
metallic taste in mouth

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What education do we provide patient’s on ACE inhibitors (or any BP med)?

get up slowly

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What are contraindications/precautions of ACE inhibitors?

less effective in african americans
increased risk of angioedema

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What do we use ARBS for?

HTN
HF
DM
not monotherapy for african american population

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What is an example of ARBS?

losarrtan
ends in -sartan

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What are black box warnings for ARBS?

injury and death to developing fetus

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What are advers effects of ARBS?

angioedema

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What is an example of an aldosterone antagonist?

eplerenone

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What do aldosterone antagonists treat?

hypertension
s/s of HF following MI

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What are adverse effects of aldosterone antagonists ?

hyperkalemia

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What education to we provide to pts on aldosterone antagonists?

Do not take potassium supplements,
use potassium-containing salt
substitutes or drugs that raise
potassium levels unless prescribed
Report palpitations, muscle twitching,
weakness, or paresthesia in
extremities to the provide

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What are examples of calcium channel blockers?

diltiazem
nifedepine
verapamil
amlodipine

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What drug class is best for use in african americans?

calcium channel blockers

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What are uses for calcium channel blockers?

HTN angina pectoris dysrhythmias

What are adverse effects of nifedipine?

* Reflex Tachycardia * Acute Toxicity * Ortho Hypotension * Peripheral Edema

What are adverse effects of verapamil/diltiazem?

* Peripheral edema * Constipation * ↓ Cardiac Function * Dysrhythmias * Acute Toxicity

What do we teach patients taking calcium channel blockers like diltiazem?

Lifestyle; check BP pulse * Avoid Grapefruit/Grapefruit juice * Good dental hygiene: can discolor teeth

What nursing interventiosn do we perform on patients on calcium channel blockers

Monitor EKG and HR, have equip on standby * Diltiazem or verapamil is approved for atrial tachy-dysrhythmias

What do ARBS block?

angiotensin II

What are the 3 antiadrenergics?

Beta-blockers 2. Alpha Adrenergic Blockers 3. Centrally acting alpha2 agonist

What is an example of a beta blocker?

propranolol metoprololWh

at doe beta blockers do?

block beta 1 receptors

What do we use beta blockers for?

HTN tachycardia angina tachy-dysrhythmias MI HF Hyperthyroidsim

What are advers effects of beta blockers?

bradycardia SOB Edema COugh CHD Angina MID orthostatic hypotension

What do we teach pt on beta blockers?

* Avoid activity requiring mental alertness first 12-24 hours * Slow position change * Lie down if dizzy or faint * Taper off med slowly over 1 to 2 weeks * If Hx of angina, report worsening or new onset to HCP * Instruct s/s/ HF to monitor * Self-monitor HR and BP daily

What are examples of alpha adrenergic blockers?

prazosin

What do we use alpha adrenergic blockers for?

Doxazosin and Terazosin decrease Benign Prostatic Hyperplasia (BPH)

What are examples of Centrally Acting Alpha2 Agonists?

Clonidine

What does centrally acting alpha 2 agonists do?

Inhibits Sympathetic Nervous System; slows heart rate and relaxes blood vessels; works at CNS level- decreased Cardiac Output, BP, HR, Peripheral Vascular Resistance.

What do we use centrally acting alpha 2 agonist for?

HTN- alone, w/diuretic, or w another antihypertensive

What are adverse effects of centrally acting alpha 2 agonist?

HTN- alone, w/diuretic, or w another antihypertensive

What are side effects of centrally acting alpha 2 agonists?

* First dose phenomenon * Drowsiness/sedation

What do we teach patients on centrally acting alpha 2 agonists?

Patch – rotate site, don’t cut, clean/dry non-hairy area * Drowsiness will decrease as use continues

How do we administer centrally acting alpha 2 agonists?

Transdermal patch-reapplied q 7 days clean, dry, hairless skin on torso or upper arm, and rotate sites * Epidural

What meds do we use for hypertensive crisis?

nitroprusside

What is the antidote for nitroprusside?

thiosulfate

What is the only direct renin inhibitor?

aliskiren

What do DRIs do?

As a result, blood vessels relax and widen, making it easier for blood to flow through the vessels, which lowers blood pressure

What are adverse effects of DRIs?

Diarrhea, abdominal pain – more likely in high doses

What are contraindications of DRIs?

* Pregnancy risk – teratogenic * Hyperkalemia, hypercalcemia, or in dehydration

What do we teach pts on DRIs?

* Do not take potassium supplements, use potassium-containing salt substitutes or drugs which raise potassium levels unless prescribed * Report palpitations, muscle twitching, weakness, or paresthesia in extremities to provider

What nursing interventions do we do for pts on DRIs?

* Monitor for signs of hyperkalemia * Monitor periodic potassium levels, BUN and creatinine in clients at risk for hyperkalemia * Ensure client is not taking potassium-sparing diuretics or other drugs that raise potassium) * Monitor for and report persistent cough to provider * Monitor and report angioedema

What do these s/s represent? restless confused orthopnea cyanosis fatigue pulmonary congestion (wheezes, cough etc.)

left sided heart failure

What do these s/s represent? fatigue ascites enlarged liver/spleen distended jugular veins weight gain

right sided HF

What is the first line drug type for HF?

diuretics RAAS

What are indications for hydrchlorothiazide?

HTN edema mild/mod HF liver and kidney disease

What are complications of hydrochlorthiathingy?

dehhydration hyponatremia hypokalemia hypochloremia hyperglycemia hypercalcemia hyperuricemia increased LDL hypomagnesemia

What do we teach pts on hydrocholorothiazide?

reduce sodium diet weigh daily you will be photosensitive increase fluid intake to 1500 mL day change position slowly may take K+ supplement log BP Low Mg

What do thiaizde duiretics do?

waste potasisum

When is the latest you should take a diuretic?

2 pm (they will go pee a lot)

What do thiazides do?

excrete potassium

What is an example of a potassium sparing drugs?

spironolactone

What do we use potassium sparing drugs for?

weight loss acne HTN edema liver cirrhosis nephrotic syndrome

What are complicatiosn of potassium sparing drugs?

hyperkalemia deepened voice in males impotence irreg. menstruation drowsiness metabolic acidosis

What do we teach pts on potassium sparing diuretics?

No potassium foods weigh daily daily BP teratogenic

What are examples of loop diretics?

furosemide

What are complications of loop diuretics?

hypokalemia hypotension tinnitus/ototoxicity dehydration drop BP

How do you loop diuretics interact with digoxin?

digoxin toxicity

How do loop diuretics interact with antihypertensives?

lower BP

How do loop diuretics interact with lithium?

increase lithium levels

What is the second line meds for HF?

glycosides (digoxin)

What are side effects of glycosides?

bradycardia cardiotoxicity fatigue weakness vision changes

What should you check before giving digoxin?

check apical pulse

What are examples of adrenergic agonists?

catecholamine dopamine epinephrine norepinephrine