Test 4 - Medications Flashcards
Na Channel Blockers: main use
Ventricular dysrhythmias, PVCs, and SVT
Na Channel Blockers: examples
Lidocaine (Xylocaine)
Monitor for toxicity: numbness of tongue, CNS depression (can lead to cardiac arrest)
Propafenone (Rythmol) - can cause dysrhythmia
Beta Blockers: Function
Slow HR & contraction
Blocks adrenaline effects
Beta Blockers: Nursing Implications
- Monitor hypotension, bradycardia, bronchospasm
- CAUTION: may mask hypoglycemia s/s
Overdose s/s: hypotension, bradycardia, impaired AV conduction, bronchospasm, and HF
Prepare to give glucagon
Why is Glucagon given for Beta Blocker overdose?
Increases HR and myocardial contractility
Bypasses beta receptors
Beta Blockers: Selective
Atenolol (Tenormin)
Metoprolol (Lopressor)
Beta Blockers: Non-Selective
“-lol”
Affects both cardiac and lung function
Beta Blocker Key Points: “Busy Bees”
- BP
- Bradycardia
- Bronchospasm (non-selective beta blockers)
- Blood Sugar (drops)
Potassium Blockers: Function
Prolongs the absolute refractory and repolarization time
“-arone”
Potassium Blocker: Uses
Ventricular Dysrhythmias, A Fib RVR (bpm > 100)
Potassium Blockers: Nursing Implications (Amiodarone)
-40 day 1/2 life: monitor liver function
-Hypotension
-Prolonged QT interval
-Corneal pigmentation = visual disturbance
-Pulmonary toxicity
-Photosensitivity*
NO GRAPEFRUIT (can increase toxicity)
Calcium Channel Blockers: Function
Lower HR and contractility
Dilate coronary vessels
Calcium Channel Blockers: Uses
Atrial dysrhythmias (SVT, Rapid A Fib RVR, A Flutter)
Calcium Channel Blockers: Nursing Implications
-BP
-HF
AVOID GRAPEFRUIT
Antidote: glucagon
Calcium Channel Blockers: Types
Verapamil (Calan)
Diltiazem (Cardizem)
"-pine"
*amlodipine may cause edema
**No "Nimodipine"Adenosine (Adenocard): Uses
SVT or PSVT (chemical defibrillator)
Adenosine: Administration
Rapid IV push (1-2 seconds)
Closest port to heart
Raise arm if peripheral IV site used
Adenosine: Implications
Short 1/2 life: 7 seconds
S/E: chest pain, flushing, bradycardia, bronchoconstriction
Keep Code Cart nearby
Digoxin: Function
Increase cardiac output (Increase contractility)
Decrease O2 demand (Decrease HR)
Digoxin: Blood Levels
0.5 - 2.0
Digoxin: Toxicity S/S
- N/V
- Confusion (elderly patients)
- Blurred vision
- Cardiac dysrhythmias (PVC, AV blocks, bradycardia)
Dobutamine (Dobutrex): Function
Beta-1 stimulation = short term increase in CO
Only for patients with normal BP and volume (SBP >100)
Signs that Dobutamine is working
Increased UOP
Increased pulse strength
Skin is warmer
Dobutamine: S/E
- Chest pain
- HTN
- Tachycardia
- MI
- PVC
Dopamine (Intropin): Function
Increases contractility, HR, and BP
Dopamine: S/E
Tachydysrhythmias, ventricular ectopic, V Tach, Vesicant
Dopamine Extravasation Treatment
Regitine (phentolamine)
Leave original IV catheter, but DC tubing –> inject the Regitine
Levophed (Norepinepherine)
Vasopressor
Mainly used for septic shock
Levophed: Nursing Care
Monitor BP, EKG< HR, UOP
Monitor peripheral pulses
(may lower UOP and pulses)
Epinephrine
Cardiac stimulant, vasopressor
Mimics actions of SNS
Epinephrine: Indications
- Cardiac Arrest (V Fib, V Tach, PEA, Asystole)
- Symptomatic bradycardia
- Profound hypotension
- Second line shock tx
Epinephrine: S/E
- Increased HR, BP, and O2 demand
- Angina
- MI
Which drugs are deactivated by Sodium Bicarb?
Dobutamine
Dopamine
Norepinephrine
Atropine Sulfate: main use
Symptomatic bradycardia
Blocks vagal stimulation = Increased HR
Atropine Sulfate: Dosing
0.5 mg q3-5 min
Max 3mg total (per ACLS)
Does not work on: Post-heart transplant and AV blocks
Nitrates: function
anti-HTN (vasodilator)
Nitrates: Implications
1 S/E: Headache
SBP >90 to give
Nitrates: Types
Patch- need nitrate holidays
Sublingual- med is light sensitive only lasts 3-6 months one bottle open
IV- use special tubing
Nitroprusside (Nipride) - ONLY 1 USE
Hypertensive crisis
Nitroprusside: Implications
- MONITOR BP closely
- Avoid light (med is sensitive)
High dose = cyanide poisoning
-Watch for hypoxemia, dizziness, tachycardia
ACE Inhibitors (“-pril”): Effects
Dilates the blood vessels
Promotes NA and H2O secretion -> decreases pulmonary congestion and edema
ACE Inhibitors: Implications
Monitor for Hypotension
Monitor for Hyperkalemia
Why would ACE Inhibitors be DC?
Cough or angioedema
ARBs/Angiotensin Receptor Blockers (“-sartan”): Effect
Lowers BP
Improves CO
What is Angiotensin II?
Very powerful vasoconstrictor
What can Amiodarone be used to treat?
Ventricular Dysrhythmias, A Fib RVR (bpm > 100)
What medications can be used to treat V. Fib?
Epi
Amiodarone
Lidocaine
Magnesium Sulfate (if Torsade’s or low Mg)
NTG Admin: Implications
Pt must:
-SBP >90, HR 50-100
No Phosphodiesterase Inhibitors (ED meds) in past 24-48 hr = drastic BP drop
Morphine if unsuccessful
ACS Drugs
- Anticoagulants (ASA, Heparin): prevent new clots
- Antiplatelets (Plavix): prevent new clots
- Beta Blockers (If VS stable): reduce infarct size and dysrhythmia
- ACE Inhibitor/ARBs: reduces ventricular remodeling, prevents HF, and increases MI survival rate
- Anticholesterol (“-statin”): reduce cholesterol and inflammation (stabilizes and reduces plaque)
Anti-Cholesterol (“-statin”): Implications
- Take in evening
- NO GRAPEFRUIT
- Hepatotoxic risk
- Rhabdo risk = can cause AKI
