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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
Q

atropine: MOA

A
  • 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
Q

verapamil: indications

A
  • 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
Q

adenosine: class

A
  • antidysrhythmic
  • naturally occurring nucleotide
28
Q

digoxin: MOA

A
  • 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
Q

atropine: SEs

A
  • dry mouth (xerostomia)
    • can cause infections, impede swallowing
  • blurred vision and photophobia
  • drowsiness
  • constipation
  • anhidrosis
  • asthma
30
Q

dronedarone: class

A
  • antidysrythmic
  • potassium channel blocker (class III)
31
Q

metoprolol: MOA

A
  • 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
Q

dronedarone: changes to EKG

A
  • PR and QT prolongation
  • widening of QRS complex
33
Q

pravastatin: nursing implications

A
  • 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
Q

dronedarone: nursing implications

A
  • 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
Q

amiodarone: indications (PO)

A
  • 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
Q

metoprolol: ADRs

A
  • bradycardia
  • HF
  • pulmonary edema
  • AV heart block
  • rebound cardiac excitement with abrupt withdrawal
37
Q

dronedarone: Indications

A
  • atrial flutter, fibrillation
  • also give to pts in sinus rhythm with a history of paroxysmal or persistent afib
38
Q

metoprolol: SEs

A
  • reduced cardiac output
  • fatigue
  • weakness
39
Q

diltizem: MOA

A
  • 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
Q

digoxin: nursing implications

A
  • 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
Q

digoxin: indications

A
  • HF
  • control of dysrhythmias
    • SVT
  • atrial fibrillation/flutter: can slow ventricular rate by reducing atrial impulses thru AV node
  • ineffective against ventricular dysrhythmias
42
Q

adenosine: Indication

A
  • termination of paroxysmal SVT–more emergent use
    • including Wolff Parkinson White Syndrome
  • test drug during stress test in cardiac cath lab
43
Q

verapamil: changes to EKG

A
  • prolong PR interval
    • reflect delayed AV nodal conduction
44
Q

metoprolol: indications

A
  • HTN–primary use for metoprolol
  • angina pectoris
  • HF
  • MI and post MI
45
Q

amiodarone: SE (PO)

A
  • dyspnea
  • cough
  • corneal microdeposits
  • photosensitivity
  • CNS effects: ataxia, dizziness, tremor, hallucinations, mood alterations
  • GI disturbances: nausea, vomiting, anorexia
46
Q

difference b/w dronedarone and amiodarone

A
  • 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
Q

diltizem: nursing implications

A
  • 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
Q

atropine: indication

A
  • 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
Q

amiodarone: changes to EKG (PO)

A
  • widen QRS complex
  • prolong PR interval
50
Q

amiodarone: ADRs (PO)

A
  • 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
Q

verapamil: MOA

A
  • 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
Q

diltizem: class

A
  • antidysrhythmic
  • nondihydropyridine calcium channel blocker (class IV)
53
Q

pravastatin: ADRs

A
  • myopathy/rhabdomyolysis
    • can cause muscles to deteriorate
  • hepatotoxicity
  • new onset diabetes
  • cataracts
54
Q

verapamil: nursing implications

A
  • 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
Q

pravastatin: SEs

A
  • headache
  • rash
  • GI: cramps, dyspepsia, flatulence, constipation, pain
56
Q

dronedarone: MOA

A
  • blocks cardiac potassium channels so delays repolarization
  • can block Na channels, beta adrenergic receptors, and calcium channels
57
Q

metoprolol: class

A
  • anti HTN
  • beta blocker–only acts on the heart
58
Q

amiodarone: MOA (PO)

A
  • 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
Q

verapamil: SEs

A
  • vasodilation–>hypoTN and peripheral edema, facial flushing, headache, dizziness
  • constipation
60
Q

metoprolol: nursing implications

A
  • 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
Q

dronedarone: contraindications

A
  • 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
Q

adenosine: MOA

A
  • 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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