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Pharmacology Test 2 > Test 2 Cardiac Drugs > Flashcards

Test 2 Cardiac Drugs Flashcards

1
Q

atropine: nursing implications

A
  • contraindicated in pts with glaucoma, tachycardia, urinary tract obstruction
  • moisten mouth before administration
  • wear sunglasses outdoors
  • void before taking meds to avoid urinary retention
  • can avoid constipation by taking a laxative and inc dietary fiber/fluids
  • avoid vigorous exercise in warm environment
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2
Q

digoxin: class

A
  • antidysrhythmic
  • cardiac glycoside
  • inotropic
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3
Q

dronedarone: ADRs

A
  • liver toxicity
  • in pts with severe HF or permanent atrial fibrillation, doubles risk of death
  • pulmonary fibrosis, pneumonitis
  • bradycardia
  • heart block
  • renal failure
  • angioedema
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4
Q

adenosine: ADRs

A
  • sinus bradycardia
  • seizures
  • stroke
  • MI
  • ventricular tachycardia
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5
Q

adenosine: SE

A
  • dyspnea (from bronchoconstriction)
  • hypoTN
  • facial flushing (from vasodilation)
  • chest comfort (from stimulation of pain receptors in the heart)
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6
Q

diltizem: ADRs

A
  • bradycardia
  • AV block
  • heart failure
  • can exacerbate heart dysfunctions
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7
Q

pravastatin: MOA

A
  • decrease LDL cholesterol
  • can also slightly inc HDL cholesterol
    • mechanism depends on number of LDL receptors on the liver cells
      • inhibits hepatic HMG CoA reductase which is the enzyme in cholesterol synthesis
      • b/c there is then dec cholesterol production, liver cells make more HMG CoA reductase, so then cholesterol synthesis is restored to pretreatment levels
      • but, inhibition of cholesterol synthesis makes liver cells synthesize more LDL receptors, so it then can remove more LDLs from the blood
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8
Q

amiodarone: class

A
  • antidysrhythmic
  • potassium channel blocker (class III)
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9
Q

atropine: class

A
  • antidysrhythmic
  • anticholinergic
  • antimuscarinic
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10
Q

Adenosine: changes to EKG

A
  • prolongs PR interval b/c of delayed AV conduction
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11
Q

dronedarone: SE

A
  • diarrhea
  • weakness
  • nausea
  • skin rxns
    • sensitivity to light’
  • abdominal pain
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12
Q

adenosine: nursing implications

A
  • ADRs/SEs are minimal and last less than 1 minute b/c the drug is cleared rapidly from the blood
  • asthma pts taking certain meds (ie. theophylline) need a larger dose of adenosine b/c those meds block adenosine Rs and even then the adenosine may not work
  • short half life (<10 sec), so must give by IV bolus
  • watch for orthostatic hypoTN and bronchospasm in asthmatics
  • 6 second flat line
  • hold arm above pt when administer
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13
Q

amiodarone: indications (IV)

A
  • tx and prophylaxis of recurrent ventricular fibrillation
  • hemodynamically unstable ventricular tachycardia
  • unapproved uses:
    • atrial fibrillation
    • AV nodal reentrant tachycardia
    • shock resistant ventricular fibrillation
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14
Q

atropine: ADRs

A
  • elevation of intraocular pressure
  • urinary retention
  • tachycardia
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15
Q

diltizem: indications

A
  • atrial fibrillation w/ RVR or flutter
    • b/c slow ventricular rate
  • AV nodal reentrant circuit
    • so terminates SVT
  • essential HTN
  • angina pectoris
  • NOT effective against ventricular dysrhythmias
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16
Q

digoxin: ADRs

A
  • cardiotoxicity: dysrhythmias
    • risk inc by hypokalemia which can result from concurrent therapy with diuretics (thiazides and loop diuretics)
    • risk inc by presence of heart dz
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17
Q

diltizem: SEs

A
  • vasodilation–>hypoTN and peripheral edema, facial flushing, headache, dizziness
  • constipation, but LESS than verapamil
  • chronic eczematous rash in older adults
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18
Q

verapamil: class

A
  • antidysrhythmic
  • nondihydropyridine calcium channel blocker (class IV)
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19
Q

amiodarone: nursing implications (PO)

A
  • contraindicated for pts w/ severe sinus node dysfunction, 2nd/3rd degree heart block, pregnant women, preexisting HF
  • very toxic so only give to pts who haven’t responded to safer drugs
  • toxicity can continue for weeks or months after withdrawal, so patient must be given medication guide
  • baseline chest x ray and pulmonary fcn
    • monitor throughout therapy
  • baseline thyroid fcn
    • monitor throughout therapy
  • baseline liver fcn
    • monitor throughout therapy
  • do not give to pregnant women or women who are breast feeding b/c lipid soluble (so crosses placenta and enters breast milk)
  • avoid sunlamps, wear sunscreen
  • do NOT consume grapefruit juice, b/c can cause toxicity
  • report any signs of changes in visual acuity
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20
Q

digoxin: SEs

A
  • GI disturbances: anorexia, nausea, vomiting, discomfort
  • CNS: fatigue, visual disturbances
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21
Q

digoxin: changes to EKG

A
  • prolonged PR interval
  • shorted QT
  • depressed ST segment
  • T wave is depressed or inverted
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22
Q

verapamil: ADRs

A
  • bradycardia
  • AV block
  • heart failure
  • can exacerbate heart dysfunctions
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23
Q

pravastatin: class

A
  • HMG CoA Reductase inhibitor
  • statin
  • lipid lowering agent
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24
Q

pravastation: indications

A
  • hypercholesterolemia: lower LDL
  • primary and secondary prevention of CV events: MI, stroke, angina
    • can reduce in ppl who have never had one: primary
    • can reduce risk of second event: secondary
  • post MI therapy: begin as soon as patient is stabilized
  • diabetes: anyone over 40 yo and with LDL greater than 100
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25
atropine: MOA
* competitive blockade of muscarinic Rs * no direct effects of its own, but all result from preventing receptor activation by endogenous acetylcholine * heart: inc HR * exocrine glands: dec secretion * smooth muscle: relaxation of bronchi, dec tone of GI tract * eyes: mydriasis (dilation) * CNS: excitation
26
verapamil: indications
* atrial fibrillation w/ RVR or flutter * b/c slow ventricular rate * AV nodal reentrant circuit * so terminates **SVT**--**more long term than adenosine** * essential HTN * angina pectoris * NOT effective against ventricular dysrhythmias
27
adenosine: class
* antidysrhythmic * naturally occurring nucleotide
28
digoxin: MOA
* positive inotropic actions: their ability to inc myocardial contractile force * can inc CO * works by inhibiting Na/K ATPase, so inhibits the uptake of K into the cell which inhibits Na moving out, so w/ each action potential, intracellular K declines, Na inc, and Ca inc, so promotes Ca accumulation in myocytes * dec conduction thru AV node by: * direct depressant effect on AV node * acting on CNS to inc parasympathetic impulses to AV node * dec automaticity of SA node by : * inc parasympathetic traffic to node * dec sympathetic traffic
29
atropine: SEs
* dry mouth (xerostomia) * can cause infections, impede swallowing * blurred vision and photophobia * drowsiness * constipation * anhidrosis * asthma
30
dronedarone: class
* antidysrythmic * potassium channel blocker (class III)
31
metoprolol: MOA
* **selective blockade of beta 1 receptors** in the heart * only binds to beta 2 with a large dose * **reduces HR** * **reduces force of contraction** * **reduces conduction velocity through AV node** * reduces secretion of renin by kidney * lowers BP
32
dronedarone: changes to EKG
* PR and QT prolongation * widening of QRS complex
33
pravastatin: nursing implications
* contraindicated in pts with **viral or alcoholic hepatitis** and pregnant women * **do not give to a pt with a liver problem, b/c this drug works in the liver** * category X * take in the evening * **Liver fcn tests** should be done before tx and during tx * if muscle pain develops, look at thyroid fcn * measure creatinine kinase levels * have lactic acid levels checked
34
dronedarone: nursing implications
* teach pts signs of liver toxicity: anorexia, nausea, vomiting, malaise, fatigue, itching, jaundice, dark urine * cannot use in pregnancy b/c proven teratogen * category X * do NOT consume grapefruit juice
35
amiodarone: indications (PO)
* long term therapy of recurrent ventricular fibrillation * recurrent hemodynamic unstable ventricular tachycardia * atrial fibrillation * most effective drug for this even though not approved for this use
36
metoprolol: ADRs
* **bradycardia** * HF * pulmonary edema * AV heart block * rebound cardiac excitement with abrupt withdrawal
37
dronedarone: Indications
* **atrial flutter, fibrillation** * **also give to pts in sinus rhythm with a history of paroxysmal or persistent afib**
38
metoprolol: SEs
* reduced cardiac output * fatigue * weakness
39
diltizem: MOA
* blocks Ca channel blockers in the heart and blood vessels * slowing of SA nodal automaticity * delay of AV nodal conduction * reduction of myocardial contractility * blockade of peripheral arterioles which causes dilation and reduces arterial pressure * blockade of arteries and arterioles which inc coronary perfusion * vasodilation
40
digoxin: nursing implications
* **watch K+ levels especially in pts taking thiazide or loop diuretics** * must be w/in normal ranges: 3.5-5.0 mEq/L * **need to monitor these--digoxin toxicity** * **narrow therapeutic range, so need to keep range b/w 0.5-0.8 ng/mL** * **​half life is 36-48 hours** * make sure pts don't double up on doses to compensate for missed dose * limit salt intake to 1500 mg/day * pts should avoid excess fluid * if drink alcohol, consume no more than 1 drink/day * help pts establish appropriate regular, mild exercise * teach pt to monitor pulse * HR must be over 60 bpm before administration * teach pt to monitor for signs of hypokalemia (muscle weakness)--inform doctor
41
digoxin: indications
* **HF** * control of dysrhythmias * **SVT** * atrial fibrillation/flutter: can slow ventricular rate by reducing atrial impulses thru AV node * **ineffective against ventricular dysrhythmias**
42
adenosine: Indication
* termination of paroxysmal SVT--**more emergent use** * including Wolff Parkinson White Syndrome * test drug during stress test in cardiac cath lab
43
verapamil: changes to EKG
* prolong PR interval * reflect delayed AV nodal conduction
44
metoprolol: indications
* HTN--primary use for metoprolol * angina pectoris * HF * MI and post MI
45
amiodarone: SE (PO)
* dyspnea * cough * corneal microdeposits * photosensitivity * CNS effects: ataxia, dizziness, tremor, hallucinations, mood alterations * GI disturbances: nausea, vomiting, anorexia
46
difference b/w dronedarone and amiodarone
* dronedarone is less toxic but also less effective than amiodarone * dronedarone doubles the risk of death in patients with permanent atrial fibrillation or HF * dronedarone has shorter half life so ADRs resolve more quickly * dronedarone DOES NOT cause thyroid, pulmonary, or ocular toxicity
47
diltizem: nursing implications
* contraindications: severe hypoTN, sick sinus syndrome, 2nd/3rd degree AV heart block * check BP, pulse, liver & kidney fcn before starting * **need to watch pts that are receiving diltizem with digoxin or a beta blocker** * can be given PO or IV, but PO undergoes extensive metabolism on first pass thru liver * do NOT consume grapefruit juice * **monitor BP**--b/c this drug will dec BP * inform pts about signs of cardiac effects and edema * tell pts that constipation can be minimized by inc fluids and fiber
48
atropine: indication
* preanesthetic medication: * sometimes procedures that stimulate baroreceptors will cause bradycardia, but since muscarinic Rs on heart, we can prevent this dangerous reduction in HR * disorders of eye: by blocking muscarinic Rs, it can cause mydriasis and paralysis of ciliary M * **bradycardia:** will accelerate HR in pts with bradycardia, b/c blockade of muscarinic Rs reverses parasympathetic slowing of heart * intestinal hypertonicity and hypermotility * muscarinic agonist poisoning * treats **AV heart block**
49
amiodarone: changes to EKG (PO)
* widen QRS complex * prolong PR interval
50
amiodarone: ADRs (PO)
* lung damage (biggest concern) * hypersensitivity pneumonitis * interstitial/alveolar pneumonitis * pulmonary fibrosis * paradoxical inc in dysrhythmic activity * sinus bradycardia * AV block * HF * hypo/hyperthyroidism * liver injury: malaise, dark urine, fatigue, jaundice * optic neuropathy * neuritis
51
verapamil: MOA
* slowing of SA nodal automaticity * delay of AV nodal conduction * reduction of myocardial contractility * blockade of peripheral arterioles which causes dilation and reduces arterial pressure * blockade of arteries and arterioles which inc coronary perfusion * vasodilation
52
diltizem: class
* antidysrhythmic * nondihydropyridine calcium channel blocker (class IV)
53
pravastatin: ADRs
* myopathy/rhabdomyolysis * can cause muscles to deteriorate * **hepatotoxicity** * new onset diabetes * cataracts
54
verapamil: nursing implications
* contraindications: severe hypoTN, sick sinus syndrome, 2nd/3rd degree AV heart block * check BP, pulse, liver & kidney fcn before starting * **can inc risk of digoxin toxicity**--so watch K+ levels * if combine with beta blocker, it will inc risk of bradycardia, AV block, HF * can be given PO or IV, but PO undergoes extensive metabolism on first pass thru liver * do NOT consume grapefruit juice * **monitor BP** * inform pts about signs of cardiac effects and edema * tell pts that constipation can be minimized by inc fluids and fiber
55
pravastatin: SEs
* headache * rash * GI: cramps, dyspepsia, flatulence, constipation, pain
56
dronedarone: MOA
* blocks cardiac potassium channels so delays repolarization * can block Na channels, beta adrenergic receptors, and calcium channels
57
metoprolol: class
* anti HTN * beta blocker--only acts on the heart
58
amiodarone: MOA (PO)
* delays repolarization so prolongs action potential and ERP * effects may be due to blockage of potassium channels * reduced automaticity of SA node * reduced contractility * reduced conduction velocity of AV node, ventricles, His Purkinje fibers * promote dilation in coronary and peripheral blood vessels
59
verapamil: SEs
* vasodilation--\>hypoTN and peripheral edema, facial flushing, headache, dizziness * constipation
60
metoprolol: nursing implications
* contraindicated in pts with bradycardia and AV block greater than 1st degree * be careful in pts with HF * masks signs of hypoglycemia so watch for hunger, fatigue, poor concentration * caution in pts with asthma, bronchospasm, diabetes * do not d/c abruptly * warn pt about signs of orthostatic hypoTN
61
dronedarone: contraindications
* class IV HF OR class II or III HF with recent decompensation requiring hospitalization * liver/lung toxicity * permanent atrial fibrillation * 2nd/3rd degree AV block or sick sinus syndrome (unless pt has pacemaker) * bradycardia * PR interval greater than 280 msec * QT interval greater than 500 msec * use of drugs or supplements that prolong QT interval * use of strong inhibitors of CYP34A * pregnancy * breast feeding * severe liver impairment
62
adenosine: MOA
* decreases automaticity of SA node and slows conduction thru AV node * inhibits cyclic AMP induced calcium influx, so suppresses calcium dependent action potentials in the SA and AV nodes

Pharmacology Test 2 (9 decks)

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