topic 7 cardiac drugs Flashcards
nonpharmalogical ways to treat HF
limit salt and saturated fat
limit/stop alc intake, no smoking
mild exercise
class of digoxin
cardiac glycoside
MOA of digoxin
inhibits sodium potassium pump, slowing down the heart, allowing it to contract more easily
- results in increased cardiac output and increased tissue perfusion
what assessment do you do before giving digoxin
take apical pulse for 1 min
lab considerations for digoxin
check potassium
why is digoxin given
for dysrythmias
what effect does digoxin have on heart muscle
Increases myocardial contractility
Decreases heart rate
Decreases conduction
Increases cardiac output
digoxin contraindications
renal and hepatic dysfunction, bradycardia, electrolyte imbalance, older adults
signs of digoxin toxicity
nausea, weakness, diarrhea, vomiting, HR below 60, green/yellow halos, confusion
digoxin range for HF
0.5-1 ng
patient teaching for digoxin
take apical pulse, eat dried fruits and potatoes, ensure you have enough medication
what class is nitroglycerin
antianginal
CAM interactions with digoxin
st johns wort decreases absorption
licorice, aloe, ephedra increases risk of toxicity
uses for nitroglycerin
angina, heart attack
MOA of nitroglycerin
decreases myocardial demand for O2, vasodilates
normal side effects of nitroglycerin
dizziness and headache, blurred vision, GI distress
how long do you leave the nitroglycerin patch on for?
leave on for 12, take off for 12
what should you do if angina doesn’t go away after one sublingual tab of nitroglycerin
after 5 min call 911, do 2 more doses (3 in total)
drug interactions with nitroglycerin
don’t give with other drugs that impact BP
priority assessment with nitroglycerin
BP first then HR
caution with nitroglycerin
renal or hepatic disease
acute MI
head trauma
pregnancy, breastfeeding
normal BUN range
10-20 mg
normal creatinine range
.5-1.3mg (over 2 bad)
classification of atenolol
beta 1 blocker
uses of atenolol
hypertension, angina, prophylaxis is treatment of acute MI
what does atenolol do?
lowers HR
lowers contractility
lowers O2 demand to heart
atenolol nursing considerations
don’t stop abruptly, will cause rebound hypertension,
monitor BP and HR
contraindications for atenolol
Sinus bradycardia, heart block
Pulmonary edema (decreases contractility so it would cause even more edema) , acute bronchospasm
caution for atenolol
renal dys, diabetes
interactions with atenolol
atropine and anticholinergic drugs (increases)
decreased effects w/ NSAIDs
risk of hypoglycemia with insulin
side effects of atenolol
CNS effects, depression, erectile dysfunction, GI distress, cool extremities
what does a pt taking atenolol need to report if they feel?
report complaints of excessive dizziness, lightheadedness, early morning insomnia, mental depression, or chest pain
what class is diltiazem?
calcium channel blocker
what is the action of calcium channel blockers
blocks calcium access to cells, relaxing coronary artery spasms
- decreases contractility and O2 demand (less cardiac workload, relaxes heart)
side effects of diltiazem
low BP, bradycardia, headache, edema, nausea
pt education for diltiazem
stand up slowly, do not stop abuptly can cause angina episode, monitor BP
what is the most effective anginal for African Americans
calcium channel blockers (diltiazem)
CAMs with diltiazem
no st johns or ginsing – decreased effectiveness
garlic and hawthorn – inc. hypotensive effect
what class is hydrochlorothiazide
thiazide diuretic
what does hydrochlorothiazide hold onto
calcium
use of hydrochlorothiazide
lowers BP by excreting potassium, sodium, water
- increase urine output
- treats hypertension, edema, heart failure
MOA of hydrochlorothiazide
acts of renal distal tubules, excretion of electrolytes decreases preload and cardiac output, causes vasodilation, lowers BP
is hydrochlorothiazide fast acting or intermediate
intermediate, not used for pt with renal impairment
labs for hydrochlorothiazide
electrolytes: Na, K, Mg
side effects of hydrochlorothiazide
electrolyte imbalance, hyperlipidemia, hyperglycemia, PHOTOSENSITIVITY, muscle cramps, ORTHO HTN
life-threatening: hypokalemia
CAMs for hydrochlorothiazide
no licorice root or aloe (decrease potassium)
no gingko (increase BP) no hawthorn (decrease BP)
what class is furosemide
loop diuretic - heavy hitter, used in emergent situations
can furosemide cause ototoxicity?
if IV pushed too fast
patho of furosemide
acts on loop of henle, inhibits chloride transport of sodium and passive reabsorption of sodium
what does furosemide excrete
sodium
water
potassium
calcium
magnesium
what can furosemide increase
blood glucose and uric acid levels
indications for furosemide
ascites, edema, hypertension
side effects of furosemide
electrolyte imbalance, hypotension, skin disturbances, photosensitivity, GI upset
interactions with furosemide
no alcohol, no anticoagulants, increase dig toxicity
adverse reactions of furosemide
Hypokalemia, hyponatremia, hypomagnesemia
ORTHO HTN, tinitis
CAM interactions furosemide
licorice decrease potassium
no ginsing or hawthorn
pt education furosemide
take first thing in morning, take w food, monitor I/O, watch for signs of hypokalemia, notify provider if weight gain over 2 lbs
what class is spironolactone
potassium sparing diuretic
uses of spironolactone
edema, circulatory overload, HTN, HF hypokalemia
MOA of spironolactone
acts of distal renal tubules to promote sodium and water excretion and K retention
side effects spironolactone
hyperkalemia, headache, GI upset, electrolyte imbalance
labs for spironolactone
monitor potassium, do EKG
education for spironolactone
avoid potassium rich foods, monitor potassium, take with food, monitor BP, take daily weight, I/O, avoid ACE inhibitors (increase RAAS system)
Nonpharmacological ways to lower HTN
Stress-reduction techniques
Exercise
Salt restriction
Decrease alcohol ingestion
Smoking cessation
what effect does hydrochlorothiazide have with potassium sparing diuretic (spironlactone)
antihypertensive
what class do ACE inhibitors, beta blockers, ARBs fall under
antihypertensive
what class is metoprolol
antihypertensive
uses of metoprolol
controls HTN, acute MI, angina, HF
contraindications of metoprolol
heart block, cardio shock, hypotension, acute HF, bradycardia
MOA of metoprolol
decreases cardiac output by diminishing SNS, lowers contractility, blocks renin release
labs to run for metoprolol
liver enzymes (metoprolol increases hepatic enzymes)
pt education for metoprolol
log BP and HR, don’t stop abruptly, report HR under 60 and dizziness, slow pulse, GI upset
side effects of metoprolol
bradycardia, lethargy, tinnitus, erectile dysfunction, HYPOTENSION
CAMs for metoprolol
no ephedra, no black licorice, no parsley, ginsing, milk thistle
class of prazosin hydrochloride
alpha adrenergic blocker antihypertensive
use of prazosin hydrochloride
to control hypertension
MOA of prazosin hydrochloride
dialates blood vessels, lowers BP
caution for prazosin hydrochloride
angina, pregnancy, breastfeeding, ortho hypertension
pt considerations for prazosin hydrochloride
good for pt with diabetes, and lipid abnormalities.. it raises HDL and lowers HDL, does not impact respiratory at all
is prazosin hydrochloride highly protein bound
yes
client education for prazosin hydrochloride
change position slow, monitor BP, takes 4 weeks to work, call provider if you see sudden change in HR or BP
** can cause sodium + water retention, monitor weight
side effects of prazosin hydrochloride
tinnitus, CNS effects, GI effects, erectile dysfunction, ORTHO HTN
drug interactions with antihypertensives
NSAIDs decrease the antihypertensive effect
what class is lisinopril
angiotensin antagonist ACE inhibitor
use for lisinopril
hypertension
MOA of lisinopril
blocks angiotensin 2, excretes sodium, holds onto potassium
pt considerations for lisinopril
african americans will need diuretic w this drug to lower BP, safe for increased renin, no pregnant women, renal insufficient pt need lower dose
pt education lisinopril
take BP, avoid K rich foods, can cause Angioedema, Cough, Elevated K.. call provider
follow safety for ortho htn
what class is valsartan
angiotensin 2 receptor blocker (ARB)
MOA of valsartan
blocks angio. receptors which causes vasodilation, blocks release of aldosterone
indication for valsartan
hypertension
pt considerations valsartan
not ideal with renal or hepatic insufficiency, less effect in African Americans, may increase liver and kidney labs, no pregnant/breastfeeding
