PHARM: MODULE 7: CARDIOVASCULAR & HEMATOLOGICAL AGENTS Flashcards
1
Q
Cardiovascular medications are essential tools in managing many acute physiological situations as well as common
chronic diseases such as _____________ and __________________
A
Hypertension, atrial fibrillation
2
Q
Anticoagulants are commonly prescribed to prevent
potentially life-threatening ______________ especially in populations with a history of thromboembolic events or those in a
hypercoagulable state.
A
blood clots, hypercoaguable state
3
Q
What are some types of cardiac glycoside medications used to treat diseases of the cardiovascular system?
A
DIGOXIN
4
Q
types of antianginal meds used to treat diseases of the cardiovascular system?
A
nitrates (SL nitroglycerine)
Beta- adrenergic blockers (-olol)
Calcium channel blockers
5
Q
What are some types of anti- dysrhythmic medications used to treat diseases of the cardiovascular system?
A
Beta 1 adrenergic blockers
-Potassium channel blockers
- Calcium channel blockers
6
Q
Name types of diuretic meds used to treat diseases of the cardiovascular system?
A
Loop diuretics
Thiazide and thiazide like
Potassium sparing
7
Q
types of antihypertensive meds used to treat diseases of the cardiovascular system?
A
-Calcium channel blockers
- ACE inhibitors (-pril)
- Angiotensin II receptor blockers (ARB) (-Sartan)
8
Q
types of anticoagulant meds used to treat diseases of the cardiovascular system?
A
-Heparin
- Low Molecular weight heparin
- Warfarin
- DOAC’s
9
Q
types of antiplatelet meds used to treat diseases of the cardiovascular system?
A
- Aspirin (ASA)
- ADP Receptor blockers
- Glycoprotein IIb/ IIIa receptor blockers
10
Q
NAME some antilipidemic meds that are used to treat diseases of the cardiovascular system?
A
- HMG- CoA Reductase inhibitors (-statins)
- Bile acid resins or bile sequestrants
11
Q
What is Digoxin used for? (Cardiac glycosides)
A
-congestive heart failure
-AFIB
-controls irregular heartbeats (arrhythmias)
12
Q
What are the side/ adverse effects of Digoxin? (Cardiac glycosides)
A
Fatigue, headache, weakness, blurred vision, yellow or green vision, arrhythmias, bradycardia, ECG changes, AV block/ SA block, anorexia, nausea, vomiting, diarrhea, electrolyte imbalances - toxicity
13
Q
What are the nursing considerations for Digoxin? (Cardiac glycosides)
A
-Evaluate for ventricular dysrhythmias
-history of hypersensitivity
-renal function should be assessed
-Be cautious with those with acute MI, incomplete heart block, and renal insufficiency, pregnancy, and elders
14
Q
What is Nitrates (SL Nitroglycerine) used for? (Antianginal)
A
To cause venous and arteriole dilation of smooth muscle. The vasodilation allows for a decrease in preload –> reducing cardiac output and workload of the heart, which helps to lower the myocardial oxygen demand
15
Q
What would you use a Short acting Nitrates (SL Nitroglycerine) for? (Antianginal)
A
acute angina
16
Q
What would you use a long acting Nitrates for? (Antianginal)
A
Use a transdermal patch and extended release nitroglycerin ( ISOSORBIDE)
helpful in treating hypertension
17
Q
side/ adverse affects of Nitrates (SL Nitroglycerine)? (Antianginal)
**remember the 3 H’s
A
Always check BP before giving this drug
18
Q
What are nursing considerations when administering Nitrates (SL Nitroglycerin)? (Antianginal)
A
- Give in intervals of 3 doses - one spray SL, wait 5 min, second spray 5 min, third spray, if it does not subside by third spray - call 911.
- Check BP after each spray. Patient can develop tolerance to drug.
19
Q
What do Beta- Adrenergic Blockers (-olol) do? (Antianginal)
A
Slows heart rate (negative chronotropic effect) and reduces contractility (negative inotropic effect)
20
Q
What are Beta- Adrenergic Blockers (-olol) used for? (Antianginal)
A
To decrease frequency of angina attacks by exertion
21
Q
What are the side/ adverse affects for Beta- Adrenergic Blockers (-olol)? (Antianginal)
A
What are the side/ adverse affects for Beta- Adrenergic Blockers (-olol)? (Antianginal)
-Fatigue during exercise because these drugs prevent HR increase.
- Postural hypotension
22
Q
What are some nursing considerations when administering Beta- Adrenergic Blockers (-olol)? (Antianginal)
A
-Change positions slowly
-Do not discontinue abruptly
-Do not take OTC meds or herbal supplements without discussing with a health care provider.
-Monitor pulse - >50bpm.
-Alternate periods of exercise with periods of rest
23
Q
What are calcium channel blockers used for? (Antianginal)
A
to relax arterial smooth muscle which lowers BP. –> Decreases afterload causing a decrease in myocardial oxygen demand
24
Q
What do calcium channel blockers do? (Antianginal)
A
-Slows conduction velocity –> decreases HR and cardiac workload
-Dilates coronary arteries, more O2 to myocardium
25
What are the side/adverse affects of calcium channel blockers? (Antianginal)
-Constipation
-Fluid retention
26
What are some nursing considerations when administering calcium channel blockers? (Antianginal)
- Take BP on both arms while laying down
-Keep record of frequency and severity of each angina attack
-Change positions slowly
-Alert health care provider if shortness of breath, weight gain, and slow heartbeat appear
- avoid grapefruit juice
*Do not crush or break XR tabs
27
What do Beta 1 Adrenergic Blockers do? (Anti-dysrhythmics)
- Block the effect of epinephrine and norepinephrine on the heart
- Decreases the ability of the SA node to fire spontaneously, decreasing conductivity
- Decreases cardiac contraction
28
What are the side/ adverse affects of Beta 1 Adrenergic Blockers?
(Anti-dysrhythmics)
bronchoconstriction
29
What do Potassium channel blockers do? (Anti-dysrhythmics)
-They block potassium channels !!
-cause vasodilation
-Delay the repolarization of the myocardial cells
30
What are the side/ adverse affects for potassium channel blockers?
(Anti dysrhythmics)
...
31
What are some nursing considerations when administering potassium channel blockers?
(Anti dysrhythmics)
correct hypokalemia prior to therapy
32
What do calcium channel blockers do?
(Anti dysrhythmics)
- stops the calcium influx across cardiac and smooth muscle
- Decreases excitability, conductivity, and contractility of the heart
33
What are the side/ adverse affects of calcium channel blockers?
(anti- dysrhythmics)
Bradycardia, heart failure, hypotension
34
What are some nursing considerations when administering calcium channel blockers?
(anti- dysrhythmics)
- monitor vitals
-ECG
- measure/ monitor intake and output
35
What do Loop diuretics do? (Diuretics)
Blocks the reabsorption of sodium and chloride in the loop of henle
- Reduces edema associated with HF, hepatic cirrhosis, chronic renal failure, hypertension
- Can increase urine output even when renal blood flow is lowWhat do Loop
36
What are some side/ adverse affects with loop diuretics? (Diuretics)
severe potassium loss, hypovolemia, hypotension, ototoxicity, decrease in glucose
37
What are some nursing considerations when administering loop diuretics? (Diuretics)
- Baseline weight, postural BP, electrolytes (potassium), ascites, abnormal girth, ototoxicity
- Monitor lab values for glucose and uric acid
38
What do thiazide and thiazide like medications do? (Diuretics)
Acts of distal tubule.
- Blocks sodium reabsorption and increases potassium and water excretion
39
What are some nursing consideration when administering thiazide and thiazide like medications? (Diuretics)
- Cautious in patients with hyperlipidemia. Increase potassium in diet. Monitor lab values and signs of gout
- Baseline weight, postural BP, electrolytes (potassium), ascites - abdominal girth.
40
What are some side/adverse affects of thiazide and thiazide like medications? (Diuretics)
-fluid and electrolyte imbalance
-Hyperglycemia
41
What do potassium sparing diuretics do? (Diuretics)
- Blocks exchange of sodium and potassium in distal tube --> causes sodium to stay in tubule and leave through urine and more potassium to be retained
42
What are some nursing considerations when administering potassium sparing diuretics? (Diuretics)
Not to be used in clients with renal insufficiency or hyperkalemia
43
What are some side/ adverse affects of potassium sparing diuretics? (Diuretics)
Report fever, rash, sore throat, accelerated hair growth - females, testicular - males.
Dietary restrictions: avoid potassium and salts that contain potassium
44
What do calcium channel blockers do? (Antihypertensive)
- Inhibits calcium from entering, limiting muscular contraction.
- Low doses cause smooth muscle in arterioles to relax = decrease in peripheral resistance = decreased BP
45
What are some nursing considerations when administering calcium channel blockers? (Antihypertensive)
Education, electrocardiogram, heart rate, BP should be assessed prior to therapy, vital signs should be monitored regularly.
- Grapefruit juice is a absolute no
46
What are some side/ adverse affects of calcium channel blockers? (Antihypertensive)
-heart failure
-hypotension
-bradycardia
47
What do ACE inhibitors (-prill) do? (Antihypertensive)
- Angiotensin II converting enzyme causes vasoconstriction - by blocking the effects of angiotensin II converting enzyme there is no vasoconstriction, causing a decrease in BP
- Lowered peripheral resistance and a decrease in blood volume
48
What are the side/ adverse affects of ACE inhibitors (-prill)? (Antihypertensive)
- DRY COUGH
- postural hypotension (or dizziness)
- angioedema (means swelling of the deeper layers of the skin)
- hypersensitivity
- non-inflammatory swelling of the skin
- mucous membranes
49
What do angiotensin II receptor blockers (ARB) (-sartan) do? (Antihypertensive
What do angiotensin II receptor blockers (ARB) (-sartan) do? (Antihypertensive)
- Blocks the receptors for angiotensin II in arteriolar smooth muscle and adrenal glands.
-Arteriolar dilation and increased sodium excretion.
-Normally combined.
50
What are the side/ adverse affects of angiotensin II receptor blockers (ARB) (-sartan)? (Antihypertensive)
-hyperkalemia
-low bp
-cough
-DIZZINESS
-headache
-drowsiness
-diarrhea
-abnormal taste sensation (metallic/salty)
-rash
51
What are some nursing considerations when administering angiotensin II receptor blockers (ARB) (-sartan)? (Antihypertensive)
- Avoid salt substitutes containing potassium
- potassium supplements, or other drugs that may increase potassium levels - hyperkalemia
52
What does heparin- IV do? (anticoagulant - veins)
decrease the clotting ability of the blood and help prevent harmful clots from forming in blood vessels.
53
What are the side/ adverse affects of heparin- IV ? (anticoagulant - veins)
Alopecia, rashes, urticaria, anemia, pain at site, osteoporosis, fever, hypersensitivity
54
What do Low molecular weight heparins - SC do? (anticoagulant - veins)
- Enhances the inhibitory action of antithrombin III and specifics to factor X.
- Produces a more stable response than heparin
55
What are the side/ adverse affects of Low molecular weight heparins - SC? (anticoagulant - veins)
-Dizziness
-headache
-insomnia
-edema
-constipation
-nausea
-vomiting
-alopecia
-ecchymosis
-pruritus
-rash
-urticaria
-bleeding
-anemia
-eosinophilia
-thrombocytopenia
-erythema at injection site
-hematoma
-irritation
-pain
-osteoporosis
-fever
56
What does Warfarin -ORAL do?
(anticoagulant - veins)
Treat and prevent blood clots
57
What are some side/ Adverse affects of Warfarin -ORAL?
(anticoagulant - veins)
-necrosis
-nausea
-calcium build up in blood vessels
-bleeding
-fever
58
What are some changes to note when a patient is changing over from Heparin to Warfarin?
59
What are some changes to note when a patient is changing over from Heparin to Warfarin?
Increased risk of bleeding due to the high amounts of anticoagulants in the blood
60
What does DOACs do? (anticoagulant - veins)
-Prevents stroke and venous thrombo-embolism
-Manages A-FIB
-Factor X inhibitors
-Factor II inhibitors
61
What are some nursing considerations when administering DOACs?
(anticoagulant - veins)
monitor client condition, provide education - nose bleeds, bruising, excessive menstrual flow, "coffee ground" emesis, tarry stools, tea-colored urine, bright red bleeding from rectum, dizziness, fatigue, pale or pasty looking skin
62
What are some side/adverse affects of DOACs?
(anticoagulant - veins)
nose bleeds, bruising, excessive menstrual flow, "coffee ground" emesis, tarry stools, tea-colored urine, bright red bleeding from rectum, dizziness, fatigue, pale or pasty looking skin
63
What does Aspirin (ASA) do?
(antiplatelet - arteries)
-Binds irreversibly to enzyme cyclooxygenase in platelets.
-Inhibits platelet aggregation.
-Lasts as long as a week.
64
What are some side/adverse affects for Aspirin (ASA)?
(antiplatelet - arteries)
**think blood thinner**
tinnitus, dyspepsia, epigastric distress, nausea, abdominal pain, anorexia, hepatotoxicity, vomiting, anemia, hemolysis, rash, urticaria, allergic reactions, excessive bleeding
65
What are some nursing considerations when administering Aspirin (ASA)?
(antiplatelet - arteries)
Gastritis or GI bleeding
66
What do ADP receptor blockers do?
(antiplatelet - arteries)
-Irreversibly alters receptors for ADP on plasma membrane of platelets.
-ADP = unable to bind = platelets cannot receive chemical signals for aggregation
67
What are some nursing considerations for ADP receptor and Glycoprotein IIb/IIIa receptor blockers?
(antiplatelet - arteries)
Increased bleeding risk. Avoid strenuous activity, do not take OTC containing ASA, report spontaneous bleeding - nosebleeds, gums, bruising.
68
What do Glycoprotein IIb/IIIa receptor blockers do?
(antiplatelet - arteries)
-Inhibits enzyme for platelet aggregation.
-Prevents Thrombus formation
69
What do HMG-CoA Reductase Inhibitors (-statins) do?
(antilipidemic)
-Inhibit the enzyme HMG-CoA reductase
-lowering LDL + increasing HDL
70
What are some side/adverse affects of HMG-CoA Reductase Inhibitors (-statins)?
(antilipidemic)
-GI complaints - cramping, diarrhea, constipation.
-Liver damage if grapefruit interacts with drugs -
inhibits metabolism, allowing them to reach toxic levels.
71
What are some nursing considerations when administering HMG-CoA Reductase Inhibitors (-statins)?
(antilipidemic)
Pregnancy X, monitor liver function, may cause weakness and myalgias
*Should be given at night because biosynthesis occurs at night
72
What do Bile acid resins or Bile sequestrants do?
(antilipidemic)
-Bind bile acids. Bile inhibitor - stops the breakdown/absorption of fats and cholesterol is excreted in digestive tract in stool.
-The reduction in cholesterol causes the liver to create more LDL receptors, which removes more cholesterol from blood.
73
What are the side/adverse affects of Bile acid resins or Bile sequestrants?
(antilipidemic)
Abdominal pain, bloating, diarrhea, steatorrhea, constipation, high potential for drug-drug interaction, interferes with absorption of vitamins and minerals
74
What are some nursing considerations when administering Bile acid resins or Bile sequestrants?
(antilipidemic)
Take meds before meals, space out all medication to avoid all interference, ensure to drink all of the liquid and drink immediately post mixing.
75
What are some healthy behaviours that patients can participate in to minimize symptoms of cardiovascular disease?
-Low fat, low sodium diet.
-Exercise - 30 min/5 days. Moderate.
-Decrease stress - coping strategies.
-Increase sleep.
-Maintain healthy weight.
76
Cardiovascular Medication are used to treat what disorders?
-Hypertension
-Angina
-Atrial Fibrillation
-Coronary Artery Disease
77
What is the role of the Cardiovascular System?
it transports nutrients and waste, pumps blood and circulates oxygen
78
How does the circulatory system maintain and regulate blood pressure?
By the Baroreceptors that are found in the aortic arch and the carotid sinus. When pressure builds in these areas the Baroreceptors send a signal to the ANS to LOWER blood pressure.
79
What is a way we have learned how with the baroreceptors it can lower blood pressure?
By the Cholinergic ACH
80
What is the role of the cardiovascular system in regulating body temperature? ( what does it do to the blood vessels)
1a) By DILATING blood vessels: heat from the heart can then be easily removed.
2a) By CONSTRICTING blood vessels: heat can be kept in
81
What is the role of the cardiovascular system in regulating the ACID/BASE BALANCE?
reath in oxygen and we then breath out carbon dioxide. When CO2 builds up in the blood it triggers the center in the brain to increase and blow off CO2
82
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83
What is Blood pressure?
84
What are ways that control and change Blood Pressure?
-Dehydration
-Obesity
-Diabetes
-Arteriosclerosis
-Diet and exercise
-Alcohol and drug abuse
85
What are 3 things that affect Blood Pressure? / AND describe them ALL:
1a) Blood volume: is the amount of blood being pumped by the heart each beat
b) Peripheral resistance: is the resistance to arteries and blood flow
c) Cardiac output: is the amount of blood being pumped by the heart in a minute
86
What is the BPN test:
87
How does your body compensate to changes in LOW Blood Pressure?
-It activates the sympathetic response
-increase heart rate (epinephrine and norepinephrine)
-Vasoconstriction
-increase heart contractility
88
How does the body compensate to changes in HIGH blood pressure?
-It will activate the parasympathetic response
-ACH: the heart rate will decrease
-Blood vessels will dilate
-Contractility will increase or decrease?
89
What are causes to the blood volume being decreased?
Blood loss
-Sweating
-Excess vomiting or diarrhea
-Burns: excessive inflammation from burns causes vessels to leak
90
What is stroke volume?
the amount of blood that is being pumped out of the LEFT ventricle per beat
91
What detects changes in blood pressure? And what do they detect?
1a) Barrow receptors: they inform the autonomic nervous system on changes to blood pressure
2a) Chemoreceptors: they detect chemistry composition of the blood
92
What system regulates Blood pressure?
The RAAS (renin angiotensin aldosterone system)
93
When should a diuretic be given to a patient? Day OR night?
DAY!! Or else they will pee all night and hate us
94
What are the 3 classified groups of Diuretics and explain where they work and what they do?
1a) LOOP DIURETICS: example =(Lasix/ furosemide)
-Fast acting
-Large urine output
-They work at the Loop of Henle in the kidneys and they promote secretion of sodium= INCREASE SODIUM LOSS
-Potassium excretion (ADVERSE EFFECTS!!! Where salt goes water follows- they are non-selective so other electrolytes can be pulled out especially potassium
2b) THIAZIDES: example= (DIURIL/ CHLOROTHIAZIDE)
-MOST common
-Less diuresis than Loop Diuretics
-They work by blocking sodium and chloride in the Distal Convoluted Tubules of the nephron
-If you block sodium from being reabsorbed it will then be excreted
-** REMEMBER WHERE SODIUM GOES WATER FOLLOWS!! **
3c) POTASSIUM- SPARING DIURETICS: example= (ALDACTONE/ SPIRONOLACTONE)
-Aldosterone antagonists
-Mild Diuresis
-They work by preventing sodium to be reabsorbed by being pulled out or inhibiting aldosterone receptors
95
What are some Nursing implications of what we would want to check before giving a Diuretic to a patient?
-Blood pressure
-weight
-serum electrolytes
-dizziness (orthostatic hypotension)
-low sodium diet
-take in the morning to prevent nocturia
96
A decrease in blood volume is at risk for what and what should you assess?
Dehydration and hypovolemia: assess the ankles and lower legs for pitting edema
97
v
98
What does pitting edema signify?
99
Because Calcium Channel Blockers have a potent vasodilating effect: it can cause what??
REFLEX TACHYCARDIA
100
Why can’t you drink grapefruit when taking a Calcium Channel Blocker?
because it inhibits the metabolization of the drug which causes an increased effect= could lead to TACHYCARDIA
101
Describe (ACE) inhibitors and what it stands for? And where it is found?
(ACE) Angiotensin converting enzyme that’s found in the pulmonary circulation
102
Describe what ADH stands for and where it is found?
(ADH) Antidiuretic Hormone which is found in the posterior pituitary
103
Describe Aldosterone and where it is found? And where it is produced?
Aldosterone is found in the kidneys and produced by the adrenal gland
104
What are Antihypertensives Drugs that affect the RAAS system? And their function?
-(ACE) Angiotensin Converting Enzyme Inhibitors
-They inhibit the formation of Angiotensin 11
-Persistent DRY COUGH may be triggered by bradykinins proinflammatory action
105
Antihypertensives (ACE) inhibitors usually end in what?
PRIL
106
What are side effects of ACE inhibitors?
107
What is the Antidote for WARFARIN?
108
Monitor blood pressure with NITROGLYCERIN… if you see a patient that is taking nitroglycerin and has hypotension with these symptoms you need to STOP the MED
109
