Quiz 6 Flashcards
Contraindication of captopril
Pregnancy: teratogonic
Salt substitues containing potassium
Potassium-sparing diuretics
Lorsatan side effects
dizziness, hypotension, electrolyte imbalance: Hyperkalemia
Fluid loss
Nursing interventions of losartan
Monitor electrolytes
Taper
Fall precautions
education on orthostatic hypotension
Which receptors does anti-adrenergics/sympatholytics include
Alpha 1 and beta 1 adrenergic blockers
Alpha 2 agonists
Side effects of beta adrenergic blockers
Hypotension, dizziness, fatigue, depression, sexual dysfunction, bradycardia
Side effects of Alpha 1 and beta 1 adrenergic blockers
Hypotension, bradycardia, dizziness,
Insomnia, sexual dysfunction
Nasal Congestion
Nursing interventions of beta-adrenergic blockers
VS
Tapering = rebound hypertension
Avoid OTC drugs without first checking with a health care provider
Nursing interventions for clonidine
Hypoactive bowel sounds
Take off old patch and rotate
Caution when standing up
Hydralazine, minoxidil
MOA
Direct-acting arteriolar vasodilatiors
Vasodilation of smooth muscles of blood vessels
Hydralazine side effects
Tachycardia (HR increases to compensate), palpitations, headache, dizziness, nasal congestion, edema, lupus-like symptoms
AKA Minoxidil
How can antihypertensives lower BP
- Decrease HR
- Dilate blood vessels
- Decrease fluid volume
Function of aldosterone
responsible for renal absorption of sodium & excretion of potassium
Adverse effects of captopril
Persistent cough: do not stop taking
Angioedema: life threatening, stop taking
Electrolyte imbalance
Hypotension
Hyperkalemia
MOA of captopril
What is it?
Vasodilation and fluid loss
ACE inhibitor
ACE vs ARBS
ACE inhibitors block the PRODUCTION of angio II, ARBs block the ACTIONS of angio II
MOA of losartan
What is it?
Vasodilation and fluid loss
ARBs (angiotensin receptor blockers)
Amlodipine MOA
What is it
Slow calcium channels in vascular smooth muscle
Causes vasodilation
Calcium channel blocker
Adverse effects of amlodipine
Flushing, headache, hypotension, peripheral edema
Nursing interventions of amlodipine
monitor VS
telemetry
What are anti-adrenergics/sympatholytics
Drugs that block the activation of adrenergic receptors
Types of beta-adrenergic blockers
Nonselective: inhibit beta 1 and beta 2 receptors
Cardioselective beta blockers: selective to beta 1
MOA of beta adrenergic blockers
Decreases heart rate by inhibiting beta 1 and beta 2 receptors
Nursing interventions for beta-adrenergic blockers
Hold for low BP
Hold if HR is lower than 60
Clonidine
Action
Administration type
Alpha 2 agonist
Stimulate alpha 2 receptors- cause vasodilation
PO and transdermal
Adverse reactions to clonidine
Decreased peristalsis
Decreased acid production
Nursing interventions for minoxidil
Seizure precautions, monitor weight, telemetry
AKA hydralazine
What is variant (prinzmetal, vasospatic) angina?
occurs during rest
MOA nitroglycerin
Causes vasodilation & < O2 demand. > oxygen supply
Decrease preload and afterload
Action of atenelol
Decreases HR=Decrease in O2 demand
Block the action of epinephrine and norepinephrine
Function of coronary artery
Perfuse the heart (supply oxygen to the heart)
What is coronary artery disease
plaque buildup
Why can coronary artery disease lead to myocardial infarction (acute coronary syndrome)
Chest pain due to lack of O2 to the heart
What is classic angina (stable)
Occurs with predictable stress or exertion
Ex walking up stairs
What is unstable angina (preinfarction)
Coronary atherosclerotic disease unpredictable regarding stress/exertion and intensity
Side effects of nitroglycerin
Headache, hypotension, and flushing
Routes of administration nitroglycerin
sublingual, IV, oral, topical
Routes of administration Nitro-Bid
Sublingual, IV
3x5 rule
take 3 tabs 5 min apart. Take 1 tab, let it absorb and wait 5 min if pain goes away you can stop, but if pain remains repeat after 3 tabs they might be having a heart attack
Long-acting nitrates
Isosorbide (Imdur)- BID
Transderm-Nitro (nitroglycerin) 12 on, 12 off (put it on when going out and take it off when at home)
Long-acting nitrates caution
do no abruptly discontinue
Taper-chest pain can come back = heart attack/spasms
Discontinuing of beta-blockers
tapering
take daily
Nifedipine action
Relax coronary and peripheral arteries
Take every day for prevention
Nifedipine adverse effects
relax tachycardia
Classic angina pectoris suggested steps for treatment
Step 1: Nitrates
Step 2: + beta blockers
Step 3: + calcium blockers
Step 4: coronary artery bypass graft
Variant angina pectoris suggested steps for treatment
Step 1: nitrates/calcium blockers
Step 2 + clacium blockers
Step 3: coronary artery bypass graft
Causes of heart failure
Heart muscle weakens and enlarges
Compensatory mechanisms fail
Loses ability to pump blood adequately
Lungs and periphery become congested
Nonpharmacologic treatment of heart failure
Limit salt and saturated fat intake.
Limit or avoid alcohol intake; stop smoking.
Perform mild exercise.
Positive inotropic
Increases myocardial contractility = strength
Side effects of digoxin
Bradycardia, cardiac dysrhythmias, anorexia, N/V/D, headache, blurred or yellow vision
Phosphodiesterase inhbitors
MOA
Positive inotropic effects
Vasodilation: decrease stress of the heart
Administration considerations of phosphodiesterase inhibitors
Only given IV for acute exacerbations
decrease HR and BP
Pathophysiology of heart failure
High preload (volume) = > stretching of heart
High afterload (pressure) = > pressure on heart
Laboratory tests-Diagnosis
Heart failure
Atrial natriuretic peptide (ANP): natural diuretic
Brain natriuretic peptide (BNP): natural diuretic
MOA digitalis/digoxin
Positive inotropic
Negative chronotropic
Negative dromotropic
Increases stroke volume = > cardiac ouptut
Negative chronotropic
Slowing/decreasing heart rate (how many times it contracts in a minute)
Negative dromotropic
Decreases conduction. How fast nerve signals gets to the heart
Therapeutic range of digoxin
Heart failure: 0.5-0.8ng/ml (narrow range)
Digitalis toxicity side effects
slow -irregular pulse
confusion
headache
delirium
Green vision
halos around dark objects
NVD
>2 ng/mL
Antidote of digoxin
digoxin immune FAB
How does hypokalemia affect the heart
Causes increases sensitivity to digoxin = digoxin toxicity
drug interactions of digoxin: antacids
Decrease digitalis absorption, causing increased excretion
Drug interactions of digoxin: glucocorticoids
Cause hypokalemia
Other agents used to treat heart failure
Beta blockers: decrease heart rate
Diuretics
ACE inhibitors
A patient is ordered to receive digoxin to treat congestive heart failure. The nurse is most concerned about which assessment finding?
A. Heart rate 56 beats/min
B. BP 138/90 mm Hg
C. RR 21 breaths/min
D. 1+ pitting edema of the lower extremities
A.Heart rate 56 beats/min
A nurse is preparing to administer digoxin to a patient. Which laboratory result is the nurse most concerned about?
A. Sodium 140 mEq/L
B. Potassium 3.0 mEq/L
C. Digitalis level 1.8 ng/mL
D. BNP 200 pg/mL
B. Potassium 3.0 mEq/L
A nurse is administering digoxin, 0.125 mg, to a patient. Which nursing interventions will the nurse implement? (Select all that apply.)
A. Checking the apical pulse rate before administration.
B. Monitoring the patient’s serum digoxin level.
C. Instructing patient to report pulse rate less than 60.
D. Advising patient to avoid foods high in potassium.
E. Always giving an antacid with digoxin to reduce GI distress.
Checking the apical pulse rate before admin
Monitoring the pt’s serum digoxin level
Instructing pt to report pulse rate < than 60
MOA of medication of dysrhythmias
Blocks adrenergic sitmulation of the heart
< myocardial excitability and strength
< conduction velocity in cardiac tissue
> recovery time of myocardium
Suppresses automaticity
Adverse effects of antidysrhythmics
Cardiac dysrhthmias, chest pain, bradycardia, hypotension: dizziness, lightheadedness, CNS changes (weakness, dizziness)
Nursing interventions for dysrhythmias
VS
ECG abnormal patterns
Education: side effects and what to warn to provider
Avoid alcohol, caffeine, and tobacco
MOA of sodium channel blocker
Decrease automaticity
Slow conduction velocity
Prolong refractory period (reduces influx of sodium into cells = slower, regular heart rhythm)
MOA beta-adrenergic blockers
< HR & BP and < fluid
< blood glucose, < peristalsis and acid, and < RR
(blocks impulse that may cause irregular heart rhythm, slows speed of impulses, increase recovery, prevent spontaneous action potentials)
MOA of potassium channel blockers
Prolong action potential duration
Prolong repolarization (prolong relaxation stage of action potential)
MOA of calcium channel blockers
Slow conduction velocity (slows down the speed of an electrical impulse)
Prolong refractory period (prolong recovery phase, phase after a neuron has fired action potential)
What is hemodynamic shock
Severe hypotension that leads to a decreased perfusion
Drugs that can be used to treat shock
Dopamine, epinephrine
Increases contractility and heart rate thus increasing blood pressure
