perfusion/ cardiac + HTN - part 2 Flashcards
What does the RAAS system regulate in the body?
blood pressure + sodium and water absorption
When BP is low ______ is released from the kidneys into the blood stream. Renin is a key part in the conversion of angiotensin 1 to 2. Angiotensin 2 then __________ the small arteries, which increases BP. This also stimulates ______ + ________ to be released. These 2 hormones is what causes water + sodium ________, which increases BP +blood ________.
-renin
-vasoconstricts
- Aldosterone + ADH (vasopressin)
-retention
-volume
Drugs that end in “-pril” like Captopril belong to which drug class?
ACE Inhibitors - Angiotensin Converting Enzyme Inhibitors
What is Captopril mainly used to treat?
-hypertension
-HF
What are the 4 main side effects of Captopril?
hypotension
dry, non productive cough
angioedema
hyperkalemia
if Captopril is taken with NSAIDs, will it become more or less effective?
captopril will become less effective
What 3 other drug classes would increase the risk of hypotension if taken with Captopril?
antihypertensives
nitrates
diuretics
Drugs that end in “-artan” like Losartan belong to which drug class?
ARBs - Angiotensin 2 Receptor Blockers
ARBs are very similar to ACE inhibitors, what is the key difference that makes them the second choice behind ACE inhibitors?
ARBs aren’t able to protect against acute cardiac events.
BUT they don’t have the side effects of cough or hyperkalemia
if ARBs are blocking Angiotensin 2 receptors, what is happening in order to bring blood pressure down?
vasodilation
sodium + water excretion
potassium retention
What are the 3 things ARBs are used to treat or prevent?
-treat HTN + HF
-Prevent stroke
What are the 5 side/ adverse effects of Losartan?
angioedema
dizziness
hypotension
headaches
insomnia
if angioedema occurs, what medication is given IV to reverse it?
epinephrine
true or false?
ACE Inhibitors and ARBs are both contraindicated in patients who are pregnant or breastfeeding?
true
If you’re taking Losartan and also using NSAIDs this will _______ the effectiveness of Losartan.
decrease
Digoxin is the ONLY drug in this drug class?
digoxin is a CARDIAC GLYCOSIDE
Digoxin is used to treat atrial ______ or _______ and paroxysmal atrial ___________, by reducing the HR and helping the heart pump blood more effectively.
-fibrillation or flutter
-tachycardia
Cardiac dysrhythmias is a sign of digoxin toxicity. What are the early signs of digoxin toxicity?
-N/V
-fatigue + restlessness
-visual changes
What are the 2 key points in education, when is comes to the patient taking digoxin at home?
-take their own pulse
-take it at the same time everyday
if a patient is experiencing digoxin toxicity, what would you give them as the antidote?
digoxin immune fab, which are antigen binding fragments that carry the digoxin out of the bloodstream and excrete it through the kidneys
Metoprolol is a betablocker used to treat hypertension, but also an _______ used to treat angina pectoris.
antianginal
Metoprolol is going to decrease HR + contractility and decrease release of renin which is going to do what 3 things?
-decrease cardiac output
-vasodilate and decrease fluid retention
if you stop taking Metoprolol suddenly it can cause rebound excitation which can cause…..
angina and MI
Metoprolol can cause HF + decreased cardiac output, so it is important to monitor and report what S+S? (4)
bradycardia
SOB
edema
coughing
can you crush metoprolol?
no
what kind of conditions would be contraindicated with Metoprolol? (5)
sinus bradycardia
> 1st degree heart block
HF
cardiogenic shock
asthma or COPD
Milrinone is a PDE-3 inhibitor used to treat HF by vasodilation and helping the heart pump more effectively. If PDE-3 is inhibited, it is preventing the breakdown of what?
cAMP - cyclic adenosine monophosphate
What are the 2 things that are continuously monitored during the Iv infusion of Milrinone?
vital signs and cardiac rhythm
what are the 4 adverse effects of Milrinone?
ventricular dysrhythmias
hypokalemia
hypotension
angina
if a patient is taking a medication that can increase their potassium, therefor causing hyperkalemia, what conditions do we need to watch for that would, combined, put them at an even higher risk? (4)
-kidney impairment
-diabetes
-hypoaldosteronism
-eat a potassium rich diet
Sacubitril/ valsartan is a combination drug used to treat HF +HTN. Valsartan vasodilates + increases sodium + fluid excretion. Sacubitril is inhibiting Neprilysin, which also allows vasodilation + excretion of excess fluid + sodium. What is this doing in the body to help w/ HF + HTN?
these drugs are reducing afterload + BP, which is helping the heart pump more effectively
Normally a patient shouldn’t be taking Sacubitril/ valsartan along with an ACE inhibitor or ARB because it can increase effects and increases the risk of angioedema or an allergic reaction. BUT if this patient does need to take them concurrently, how long do they need to wait in between therapies?
36 hours
If Sacubitril/ valsartan wasn’t being an effective therapy, you’d monitor for S+S of heart failure. What would you see in your patient?
-weight gain/ edema
-JVD
-SOB
-crackles
If a patient is on Sacubitril/ valsartan they should avoid _________ supplements due to them increasing the risk of hyperkalemia.
potassium
Ivabradine is an HCN blocker, that blocks HCN channels in the SA node which makes it less effective. If the SA node is less active, what 2 things are happening?
heart rate is lowered and ventricles are filling more effectively
There are specific guidelines that need to be met in order for a patient to be put on Ivabradine. What are those 4 guidelines?
-EF <35%
-Cardiac rhythm needs to be NSR
-Resting HR >70 bpm
-either already on the max dose of beta blockers or have contraindications to use of beta blockers
Why is it so important that Ivabradine is taken 2x a day WITH food?
to keep consistent medication levels in the blood
Which 2 natural substances should be avoided while taking Ivabradine due to it decreasing its effectiveness?
grapefruit juice and St. John’s Wort
As a nurse educating a patient on Ivabradine, you tell them to be cautious with driving due to the drug causing ________ ________. They should also notify the provider of any _________, ______ ________ or ______, due to the risk of lethal cardiac rhythms.
-visual impairment
-palpitations
-chest pain
-SOB
if you take atorvastatin and warfarin together, what are you at an increased risk of due to PT and INR becoming increased?
bleeding
medications like fibrate, erythromycin and other lipid lowering medications put the at an increased risk of what? if taken with atorvastatin?
-myopathy + rhabdo.
-liver/ kidney toxicity/ damage
-increased blood levels of atorvastatin- which increases risk of adverse effects
Statins, like atorvastatin, inhibit HMG-CoA reductase in the liver. When that is inhibited, what is being increased and decreased in the body?
HDL is being increased
LDL and triglyceride’s are being decreased
(to treat hyperlipidemia)
What are the 2 most serious complications/ side effects of Atorvastatin? And what should a patient taking that drug report right away?
-myopathy and rhabdo.
-hepatotoxicity
which can lead to kidney damage
The patient should report:
-muscle pain
-jaundice
-Abd pain
-unusual fatigue
What 2 of the signs you would assess if a patient was experiencing rhabdomyolysis?
muscle pain and elevated creatinine kinase (CK)
If you were assessing your patient for signs of liver injury after taking Ezetimibe, what kind of manifestations would you see?
-jaundice
-fatigue
-poor appetite
-ABD pain
-dark urine
Ezetimibe is a cholesterol absorption inhibitor, this means it is inhibiting the absorption of cholesterol in the ________ _________.
small intestine
While taking Ezetimibe, your labs need to be monitored. Liver enzymes, CK, kidney function and lipid panels all need to be monitored in order to assess for what adverse effects/ complications?
rhabdomyolysis
hepatotoxicity
renal injury
and to assess for effectiveness of the drug
How does Nitroglycerin treat and prevent angina? How does it act on the body?
-dilates blood vessels to decrease the oxygen demand and cardiac work of the heart
relaxes artery spasms in variant angina
What are 4 side effects of Nitroglycerin related to it vasodilating the cardiac arteries?
-hypotension
-headache
-tachycardia
-dizziness
lidocaine is a class ___ antiarrhythmic that is a _________ channel blocker.
Ib; sodium
When sodium channels are blocked it is reducing the amount of sodium that’s entering the heart cells. What 3 things are being decreased in the heart to treat these ventricular dysrhythmias?
-decreased automaticity
-slowed impulse conduction
-shortened refractory period
slowing the rate of electrical impulses
Sodium channel blockers are used to treat ventricular dysrhythmias caused from? (3)
MI
cardiac surgery/ procedure
digoxin toxicity
what kind of side effects do sodium channel blockers like lidocaine cause?
CNS effects
like, confusion, paresthesia, seizures etc.
what 2 things will be monitored with basically all kinds of cardiac meds.?
vitals and cardiac rhythm
does lidocaine be ran in the IV tubing with other medications or does it need its own IV tubing for the infusion?
lidocaine needs its own separate tubing
-allergy to amide anesthetics
-SVT, bradycardia, heart block
-respiratory depression
-low blood oxygen level
-hypovolemia
-myasthenia gravis
-hx. of malignant hyperthermia
these are all contraindications or cautions for which medication?
Lidocaine
-sodium channel blocker
