Test 3 - Cardiovascular Flashcards
What is Cholesterol
Helps maintain Vitamin D levels and hormones
Gemfibrozil teaching
*Class - Fibric Acid Agent
Lowers triglycerides and LDL levels
Combine with Statins for greatest decrease
TEACHING:
—May potentiate warfarin (warfarin prevents blood clots)
—monitor GI effect - TEACH TO TAKE WITH FOOD
—pregnancy B
Non pharmacological cholesterol reduction
Lifestyle changes monitor blood lipid levels maintain weight at optimum level exercise low fat diet and cholesterol increase fiber decrease tobacco use
Statin side effects
*Class - HMG-CoA Reductase Inhibitor first drug of choice to lower cholesterol should be taken in the evening SIDE EFFECTS muscle or Jt pain
RHABDOMYOLISIS
- Muscle fiber breakdown
- rare but serious
- coca cola urine
Statin side effects
*Class - HMG-CoA Reductase Inhibitor
first drug of choice to lower cholesterol
should be taken in the evening
SIDE EFFECTS
headache, fatigue, MUSCLE OR JT PAIN, and heartburn
Types of Lipids
LDL - Bad Cholesterol <100 liver—>tissues
HDL - good cholesterol >40 Tissues—>liver
Triglycerides <150 - stored fat energy
Diuretic adverse effects
Hypokalemia
Hyponatremia
Ototoxicity
SIDE EFFECTS: Dehydration, thirst, dry mouth, weight loss, headache, hypotension, dizziness, fainting
Teach safety with orthostatic hypotension
Loop Diuretic
Most effective
Block reabsorption of Na and Cl in Loop of Henle
Increase UO even when kidney blood flow is diminished
FLUROSEMIDE most frequent
BUMETANIDE 40x more potent, shorter duration
Thiazide Diuretic
Most frequently prescribed class
— less effective than loop but less side effects (does not cause ototoxicity)
Treats mild to moderate HTN
Ineffective in severe renal failure
If allergic to sulfa, may be allergic to Thiazide and Loop
May need K+
Drugs that are Nephrotoxic
NSAIDS ACE inhibitors Radiographic Dyes Aminoglycosides (antibiotics) Amphotericin B (anti fungal) Cancer Drugs Immunodepressants
During renal failure
Dose reduction
Discontinue Nephrotoxic drugs
OSMOTIC DIURETICS (mannitol) - used in acute renal failure —– Administered through a filtered IV
Hyperkalemia Treatment
Hyperkalemia: Kidneys unable to adequately excrete K+
>5 mEq/L
Administer Insulin and Glucose
Ca+ and Sodium Bicarbonate to correct acidosis
Kayexelate po or rectal
Hypokalemia signs and symptoms
Dysrthymias, cardiac arrest
Hyponatremia plan of action
<135 mEq/L
If from fluid overload —> Loop Diuretics
Oral sodium chloride if mild
Parenteral NS or LR if <130
K+ IV administration
NEVER IV PUSH
Solution Tonicity
hypotonic, isotonic, hypertonic
Tonicity: Ability of a solution to cause a cell to lose or gain water
Hypotonic: Treat dehydration with normal B/P (water moves into the cell)
Isotonic: Does not change tonicity of blood - treat dehydration w/ low B/P
Hypertonic: Treat cellular edema - Cell shrinks
Beta blocker contraindications
Asthma or Chronic Bronchitis
HR<60
Beta blocker mechanism of action
Decrease BP and HR (second line drug) Decreases workload (negative inotropic effect)
Antihypertensive Drugs
ABCD Ace inhibitors/Angiotensin II blockers Beta blockers Calcium channel blockers Diuretics
Beta blocker side effects
Bradycardia.. do not give to pt with HR <60
Heart block
HCTZ teaching
Hydrochlorothiazide - Diuretic
Used or Mild to Moderate HTN
Adverse effects: Electrolyte imbalance (esp K+)
—May need potassium
Ineffective in severe renal failure
Allergy to sulfa may have allergy to thiazide and loop diuretics
Loop diuretics lab tests
Lab Test Considerations: Monitor electrolytes (especially potassium), blood glucose, BUN (blood urea nitrogen), and serum uric acid levels before and periodically throughout course of therapy.
Non pharmacological HTN treatment
Increase exercise Low fat, low sodium diet limit alcohol consumption weight reduction eliminate tobacco use reduce stress
Ace inhibitor side effects
Anti Hypertensive Nephrotoxic "Prils" SIDE EFFECTS Dry persistent cough Most dangerous angioedema
Digoxin Therapeutic Effects
Used for HF
THERAPEUTIC EFFECTS
Causes heart to beat more forcefully and slowly (Positive Inotropic effect)
Milrinone administration alerts
Used for HF, positive inotropic effect
IV pump, microdrip set
only use for 2-3 days
Davis Drug Guide:
- High Alert… heightened pt risk with error
- —-Ventricular Arrhythmia’s
- —-Monitor ECG continuously during infusion
Angina vs MI diagnosis
ANGINA chest pain caused by insufficient O2 Short duration - goes away with stress reduction RELIEVED BY NTG (vasodilator) stable-exertion unstable-no exertion
MI
Heart attack
NOT RELIEVED BY NTG
Calcium Channel Blockers Mechanism of Action
Relax arteriolar smooth muscle thus lowering BP
Dilate coronary arteries
Reduce workload
Stop dysrhythmias
MONA
Immediate treatment of MI MORPHINE - treat pain, reduce stress OXYGEN - given b/c lacking O2 in tissues NITROGLYCERINE - vasodilation ASA (aspirin) - Anti-platelet, makes less sticky
NTG side effects
Hypotension
Severe Headache
NTG teaching
Take sublingual Q5 min x 3 PRN for pain
Retaplase Therapeutic Indication
Retaplase is a Thrombolytic
Dissolves clots obstructing coronary artery disease
Albumin Teaching
Most common colloid used
May cause fluid overload - distended neck veins, pulmonary edema, cough, HTN, tachycardia
Colloid Administration Assessment
Listen for crackles in the lungs
Chrystalloids and Colloids Defined
CHYRSTALLOIDS IV solutions contain electrolytes similar to plasma Mimic body's extracellular fluid Trauma Pt's NS, LR, D5W, HS
COLLOIDS
Proteins pull water into vessels - hypertonic
Proteins, starches or other large molecules
Albumin most common
Dopamine administration
IV only
May cause dysrhythmias
Increase BP and force of contraction
Shock Treatment Priority
ABC’s of life support
Airway
Breathing
Circulation
Antidysrhythmic side effects
Palpitations Chest Pain Weakness Fatigue New Dysrhythmias
Beta Blocker Client Teaching
Check pulse and call if <60 Do not discontinue abruptly May mask hypoglycemia Don't give with pulmonary problems, may cause bradycardia Used to prevent MI and Angina
Cardiac Output and Tachycardia
cardiac output DECREASES with tachycardia
Cardioversion Rationale
Electrodes placed on chest, send electrical shocks to restore normal rhythm
Safer with less side effects
Dysrhythmias Pathophysiology
Abnormal electrical conduction
Symptoms (none to sudden death)
Atrial fibrillation most common
Heparin Side effects
Heparin - Anticoagulant SIDE EFFECTS Watch for bleeding ---Internal s/s--- low BP High HR Pallor Weakness Low Hgb/Hct
Heparin Outcomes
Goal:
- No bleeding
- No unusual clot formations
INR values
Ideal 2-3
Lovenox Administration (enoxaparin)
Fewer follow up lab tests
More stable response
Less thrombocytopenia (low blood platelet count)
SubQ in abdomen only
Protamine sulfate - Reverse
Anticoagulant.. DVT
Warfarin lab tests
Oral anticoagulant Prothrombin times (PT) or INR frequently, 2-3 ideal
Warfarin Overdose Treatment
Warfarin - Oral anticoagulant
Immediate reversal is Vit. K
Blood and plasma if severe bleeding occurs
If not bad, withholding a dose is usually sufficient
Warfarin Teaching
Warfarin - Oral anticoagulant Avoid Vit. K Serious side effects - bleeding No alcohol, other Rx, otc or herbal products Frequent INR testing
Alcoholism and Folic Acid
Folic Acid - Needed for RBC production
Alcoholism interferes with folate metabolism in the liver
Epoetin Assessment Post Admin
Common adverse effect is HTN - Beta blockers can be given concurrently
CHECK BP BEFORE AND AFTER
Epoetin Teaching
Secreted by kidneys, TRAVELS TO BONE MARROW, interacts with stem cells to INCREASE ERYTHROCYTE PRODUCTION
HTN common adverse effect. Beta blockers given concurrently
Filgrastim Mechanism of Action
Increase neutrophil production
Iron Administration Teaching
Free iron is toxic - common cause of poison in children
IRON DEFICIENCY MOST COMMON CAUSE OF ANEMIA
TAKE WITH FOOD
STAY UPRIGHT FOR 30 MINUTES AFTER TAKING
DON’T TAKE BEFORE BEDTIME
Oprelvekin Teaching
Platelet enhancer
Stimulates production of megakaryocytes and thrombopoietin
Increases platelet count
INR
International Normal Ratio - Determines clotting rate
>6 Give Vit. K
Normal 2-3
