Perfusion Flashcards
Diuretics for hypertension
Thiazides
1st line therapy
Decrease blood volume = excretion of water
Watch out for dehydration (elderly), hypotension, and electrolyte loss
CCBs for hypertension
Amlodipine
- Stops Ca+ from entering cell > limits muscular contraction > decreases workload on heart > decreases oxygen demand
- low doses > smooth muscle arterioles relax > decrease peripheral resistance > decrease BP
Side effects: dizziness, reflex tachycardia
ACEIs for hypertension
Lisinopril
Benefits HF and diabetes (decrease renal damage)
Contraindicated in 2nd and 3rd trimester
SE: 1st dose hypotension, persistent cough, angioedema
ARBs for hypertension
Losartan Dilates arterioles and veins Blocks angiotensin 2 after formation Give ARBs if ACEIs produce a cough Less likely to cause hyperkalemia (renal insufficient patients) Angioedema
Adrenergic agents for hypertension
Suppress SNS on heart, blood vessels, etc.
A1 blockers - terazosin: orthostatic hypotension, increase HR w 1st dose
Beta Blockers - metoprolol: mask hypoglycemic symptoms, decrease libido, bronchospasm
Nonselective beta blockers: slow HR, bronchoconstricton, check pulse
General teaching for hypertension therapy
Thiazides are 1st line therapy
Drug selection based on comorbidities (race and ethnicity)
African Americans: BB and ACEIs less effective, salt sensitivity = diet & lifestyle changes,
Children/adolescents: treat underlying cause first, dont give ACEIs or ARBs to sexually active girls
Elderly: thiazides and CCBs, elderly women at higher risk
Self-monitoring!!!
Follow up on missed appointments
Simplify the regimen
Drugs for heart failure
Cardiac glycosides ACEIs Vasodilator Diuretics Beta blockers
Cardiac glycosides (HF)
Digoxin \+ inotrope Decrease heart rate Narrow therapeutic effect = low: no therapy, high: toxic Increased CO Used for A-Fib AE: dysrhythmias, yellow green halo Digibind = antidote Heart rate has to be 60+ and no sudden changes Monitor K+ levels
ACEIs for HF
Lisinopril (also used for hypertension
Decrease release of aldosterone
Decrease pre and after load = decrease workload on heart (different from hypertension bc it lowers BP)
May take 2-3 weeks to work
Vasodilator for HF
Give instead of ACEIs if not working
Diuretics for HF
Decrease blood volume, edema, pulmonary congestion Monitor K+ levels if also on digoxin Better breathing Starts working right away Furosemide prescribed commonly Thiazides for long term
BB for HF
Metoprolol & Carvedilol
- inotrope
Decrease BP & HR = decrease workload
CAD
Coronary artery disease
Builds up over time = fatty diet, smoking, genetics, lifestyle
Narrowing or occlusion
Angina
Acute chest pain
Comes and goes with activity
Insufficient O2
MI
Clot, plaque, scar tissue
Acute obstruction
Muscle death
Drugs for angina Nitrates
Nitroglycerin
Relaxes venous muscles
Decrease preload, afterload, work load, O2 demand, and pain
Nitroglycerin
Effective, fast acting, inexpensive
Stable angina: opens the veins and decreases preload
Variant angina: relaxes and prevents spasms
AC: vasodilation
Effects increase with hypotension drugs
BB affect nitrates
Viagra increases vasodilation
8 hours “patch free” = avoid tolerance
Sublingual tabs: 3 tabs in 15 mins = call 911 if pain not relieved
Transdermal: avoid tolerance
Topical ointment: wear gloves = side effects will affect nurse
IV: use correct tubing
Don’t stop nitroglycerin suddenly = rebound effect
Drugs for angina = BB
Change positions slowly Masks hypoglycemia Use for stable angina Cause rebound if stopped Don’t give if hr is <60
CCBs for angina
Nifedipine
Use for vasospastic angina
Avoid grapefruit juice
Antidysrhytmic drugs
Adenosine = fast IV push, saline bolus immediately
Digoxin = A-Fib
Prodysrhythmic
Worsen existing condition
Make new ones
Nonpharm: pace maker, cardio version (synchronized defibrillation), ablation ( zaps dysrhythmia)
Drugs for shock
Colloids = proteins, increase oncotic pressure, use blood products
Crystalloids = resemble plasma (normal saline)
Monitor for volume overload
Drugs for shock + hypotensive states
Vasopressors Must have adequate volume before administration \+ inotrope IV only Irritating to IV site Ongoing assessment
Lipid control drugs
Atorvastatin & simvastatin Stops cholesterol synthesis and LDL receptors Rhabdomyolysis = muscle pain (report) Category X Avoid grapefruit juice Liver dysfunction
Other lipid control drugs
Ezetimibe and fibrates (avoid with anticoagulants)
