Unit 10 - Pharm affecting Perfusion Flashcards
T/F: medications can replace healthy lifestyle changes
F
cardiac output is too low to meet the body’s needs
pump failure
Staging of HF depends on symptoms:
- no symptoms during activity
stage 1
Staging of HF depends on symptoms:
- “slight limitations” during activity
stage 2
Staging of HF depends on symptoms:
- “marked limitations” during activity
stage 3
Staging of HF depends on symptoms:
- not able to be active, have symptoms at rest
stage 4
Symptoms of Heart Failure for R side
JVD and pedal edema
Symptoms of Heart Failure on L side
pulmonary edema, cough, ortopnea
First choice drugs used to treat heart failure
ACE inhibitors
second choice: ARBs
3 main goals for pharmacology of Heart Failure
- increase effectiveness of the heart
- decrease the workload of the heart
- inhibit the RAAS and Sympathetic nervous system
Drugs Used to Treat Heart Failure:
- inhibition of the sodium/potassium pump on heart muscle cells causing increased intracellular calcium concentration and therefore increased efficiency of cardiac muscle fiber contractions
Cardiac Glycosides
Cardiac Glycosides direction action on cardiac muscle and electrical conduction system:
- positive inotropic effect
- negative chronotropic effect
- ultimate result: increased cardiac output
- decreased SNS activity, increased PNS activity
saturating the heart muscle tissue so that the s/s of heart failure will decrease or go away…very similar to loading dose
Digitalization
T/F: range between therapeutic and toxic effect with Digoxin is narrow
T
Digoxin can be given ___ or ___
PO, or IV (emergency situation)
What drug:
used to treat HF for those not responding well to ACE inhibitors or in late stages, Atrial flutter, Atrial fibrillation, increased force of contraction, increased cardiac output, increased tissue perfusion, decreased ventricular HR, increase urine production, decreased pulmonary congestion
Digoxin
contraindication for Digoxin
- hypokalmeia (= toxic levels of Digoxin)
- heart block
- ventricular dysrhythmias related to heart failure problems
- geriatric pt’s more susceptible to adverse effects
- renal disease (this med is excreted in urine)
adverse effects of Digoxin
- halo vision, changes in color perception
- severe bradycardia (causing heart to slow down)
- dysrhythmias (danger) (K+ deficiencies due to diuretic use = most common)
- AV block (danger)
Nursing Considerations/pt. teaching for Digoxin
- monitor Digoxin blood levels (draw 6-12 h after last oral dose in administered…therapeutic range 0.5-2.0, toxic - > 2.0)
- take apical pulse for one whole minute (hold if bpm < 60)
- monitor electrolyte levels, specifically K+, Ca+. Mg+
- NEVER give IM (only IV or PO)
- encourage K+ rich foods
T/F: adults are more prone to toxicity with Digoxin
T
Adult toxic effects with Digoxin
- problems with vision: halo, yellow around objects
Warfarin and heparin are examples of _____
anticoagulants
the pt. has a thrombus/clot/clotting too much, DVT
thrombolytic disorder
pt has hard time coagulating, hemophilia
coagulation disorder
route of Warfarin
PO
route of heparin
SQ
Warfarin:
lab tests involved
route
antidote
Lab: PT, INR
route: PO
antidote: vitamin K
Anticoagulants avoid injury:
use soft toothbrush
don’t use straight raiser, only electric
avoid things that will cause nose bleeds
…
most common oral anticoagulant
warfarin
T/F: Warfarin in highly protein bound
T = interacts with other drugs
What drug:
depression of hepatic synthesis of Vitamin K clotting factors; prevention or slowing of blood clotting; prevent formation of vitamin K = prevent formation of new clotting factors
Warfarin
Contraindications of Warfarin
*- pregnancy
Adverse effects of Warfarin
*- purple color in feet
Nursing Considerations/Pt. teaching of Warfarin
- use barrier method in addition to birth control pills
- avoid alcohol
Heparin:
lab tests involved
route
antidote
labs: PTT, aPTT
route: SQ
antidote: protamine
What drug:
inhibits thrombin, which prevents the conversion of fibrinogen to fibrin; prevention or slowing of blood clotting; prevent a clot from being formed; used for DVT, pulmonary embolism, preventing thombosis
Heparin
Contraindications of Heparin
…
Adverse effects of Heparin
- fever, chills (allergic reaction)
- hemorrhaging (higher dose, higher risk for bleeding)
- heparin-induced thrombocytopenia
Nursing considerations/pt. teaching for Heparin
- don’t massage SQ site after administration
- watch for petechia or purpura of skin
- NEVER IM!
T/F: anticoagulants break up existing clots
F! The just prevent the clot from growing
what is the preferred anticoagulant used in pregnancy
Heparin (doesn’t cross BBB), discontinue 1 wk before delivery date
T/F: you can take NSAIDS for pain when on Heparin
F!!!
What drug:
Directly inhibits thrombin to prevent clot formation; prevention or slowing of blood clotting
Dabigatran
Contraindications of Dabigatran:
*- valvular problems
Adverse Effects of Dabigatran:
- bleeding
* - hemorrhage
Nursing Considerations/pt. teaching of Dabigatran:
- monitor for bleeding
- encourage to utilize practices that decrease risk for bleeding
- monitor KF labs
clopidogrel is an example of…
an antiplatelet
What drugs:
prevent platelets from sticking together; ex. aspirin; work by inhibiting platelet aggregation, used to prevent clot formation in arteries, used to prevent complications of a stroke or MI, usually change platelet membrane irreversibly, can cause life-threatening bleeding especially when used with anti-coagulants
Antiplatelets
Antiplatelets prevent clots from forming in _____
arteries
anticoagulants prevent clots from growing in ____
veins
What drug:
inhibits platelet aggregation; prevention of arterial thromboembolism to reduce risk of MI or stroke
Clopidogrel
Contraindications of Clopidogrel:
- any drugs that affect liver metabolism (ex. NSAIDS)
- any meds that increase risk for bleeding
Adverse effects of Clopidogrel:
- bleeding
- flulike symptoms
- hemorrhage
s/s of bleeding
black, tarry stools, oozing injuries
s/s of bleeding
black, tarry stools, oozing injuries
drug used for hyperlipidemia
atorvastatin
what drug:
used to lower LDL & VLDL cholesterols & triglycerides, used to prevent MI & stroke
atorvastatin
Contraindications of atorvastatin:
- hepatic impairment
- pregnancy
- lactation
- interaction: antibiotics increase levels = increase risk of rhabdmyolysis
Adverse effects of atorvastatin:
- rhabdomyolysis
- joint or muscle pain
- liver failure
Nursing considerations/pt. teaching for atorvastatin:
- s/s severe myopathy/rhabmyolysis
* - report muscle/joint pain/weakness
route of atorvastatin
PO
Q: Which is NOT an effect of digoxin?
A. increased heart muscle contraction strength
B. decreased heart rate
C. increased diuresis of fluid
D. decreased sympathetic nervous system activity
C. increased diuresis of fluid
Q: Which condition requires cautious use of digoxin? A. hyperglycemia B. hypokalemia C. tachycardia D. liver dysfunction
B. hypokalemia
Q: What is the antidote for warfarin? A. protamine sulfate B. flumazenil C. potassium D. vitamin K
D. vitamin K
Q: What is the antidote for heparin? A. protamine sulfate B. flumazenil C. potassium D. vitamin K
A. protamine sulfate
Q: What is a potential life-threatening adverse affect of dabigatran? A. stroke B. suicidal thoughts C. bronchospasm D. hemorrhage
D. hemorrhage
Q: True or False: anticoagulants such as heparin and warfarin dissolve existing clots.
A. True
B. False
B. False
Q: How does the medication, clopidogrel, work to prevent blood clots?
A. It inhibits the formation of clotting factors.
B. It prevents clotting factors from binding to receptors on platelet membranes.
C. It irreversibly binds to platelet membranes and inhibits platelet aggregation.
D. It prevents fibrinogen from converting to fibrin, therefore preventing the aggregation of platelets and red blood cells.
C. It irreversibly binds to platelet membranes and inhibits platelet aggregation.
Q: What symptom related to a serious adverse effect of atorvastatin should the nurse warn the patient about who is taking it? A. joint or muscle pain B. hearing loss C. urinary retention D. dilated pupils
A. joint or muscle pain
Q: What is the class of medication that is the first-line drug for heart failure?
ace inhibitors
