Week 7 Flashcards
Pulmonary edema clinical manifestations
short of breath
pink frothy sputum
crackles
Diuretic medication increase the production of ________
urine
Diuretic Meds:
- bumetanide
- Furosemide
- Hydrochlorothiazide
- Spironolactone
- Mannitol
Clients should take their diuretic before ______ to prevent nocturia
2 PM
Bumetanide and furosemide are ________ diuretics
loop (work in the loop of henle)
Bumetanide & furosemide are great for treating _________ and ________
edema
heart failure
(sometimes for hypertension)
bumetanide and furosemide cause the excretion of too much _______
potassium
Hypokalemia signs
Weakness fatigue
muscle cramps
dysrhythmias
nausea and vomiting
Normal potassium range _______
3.5 to 5
Patients can counteract hypokalemia by eating __________ foods
potassium rich
furosemide can cause _______ loss
hearing (ototoxicity)
Hydrochlorothiazide is a __________ treatment for hypertension
First line
True or false?
HCTZ is safe, effective and inexpensive
True
HCTZ cause the kidneys to excrete too much ________
potassium
Spironolactone is a potassium _______ diuretic
sparing
Clients taking spironolactone should avoid _________ foods. It causes ________
- potassium rich
- hyperkalemia
Mannitol is administered ________
intravenously
Mannitol causes the blood to become _________
hypertonic
Mannitol is used to treat ________ edema
cerebral
Key problems with mannitol:
1.
2.
- It leaks out of regular capillaries causing edema
- It crystallizes at room temp. (Store in warmer, use IV filter, and foley catheter to monitor urinary output)
Beta-blocker meds
Cardioselective agents
1. Atenolol
2. Metoprolol
Nonselective Agents
1. Carvedilol
2. Labetalol
3. Propranolol
Atenolol and Metoprolol block ________ receptors
beta 1
Carvedilol, labetalol, and propranolol block ______, ______, ________ receptors
alpha 1
beta 1
beta 2
Propranolol blocks _______ and _____ receptors
beta 1
beta 2
Beta blockers are prescribed for ______, _________, ________ and _________ following a heart attack
hypertension
angina pectoris
atrial fibrillation
cardioprotection
Alpha receptors are located in the _______ and veins
arteries
Alpha receptors cause ________
vasoconstriction
Blocking alpha receptors cause _________
vasodilation (decreased blood pressure)
Beta 1 receptors are located in the _______
heart
Blocking beta 1 receptors decreases _______, _______ and _________
heart rate,
strength of contractions,
blood pressure
Beta 2 receptors are located in the _______
lungs
Blocking beta 2 receptors can cause _____________
bronchoconstriction (not good effect)
If beta blocker worked to well it would cause _________ and __________
bradycardia and hypotension
Hold beta block and notify prescriber if patient’s heart rate is less than _____ and SBP is less than ______
50, 100
Beta blocker cause 2 issues for diabetics.
- Beta 2 receptors are blocked which inhibits the ________ response.
- Its harder to recognize when they become _____________
- blood glucose response (fight or flight response)
- hypoglycemic
Bronchoconstriction is a contradiction for ________- and ______ patients
COPD, asthma (they should avoid nonselective beta blockers)
Depression and erectile dysfunction is caused by ___________
beta blockers
ACE inhibitor meds:
1.
2.
3.
- enalapril
- lisinopril
- Ramipril
the liver produces a substance called ____________
angiotensinogen
an enzyme called ______ cleaves part of the molecule and leaves ___________
renin,
angiotensin-I
ACE enzyme cut off another part of the molecule and leaves us with ___________
angiotensin-II
Angiotensin-II causes:
1.
2.
3.
- vascular smooth muscle to contract
- release of aldosterone
- harmful changes in the heart muscle
ACE inhibitors block the enzyme that converts _________ into its active form
angiotensin-I
ACE inhibitors cause _______, _______, ________
vasodilation,
production of more urine,
lower blood pressure
ACE inhibitors four major effects:
- hypotension
- hyperkalemia (aldosterone is blocked which increases potassium)
- Persistent dry cough (#1 reason for discontinuation)
- Angioedema (less than 1% develop, looks like wheals and edema, african descent has highest risk)
Angiostensin II receptor Blockers (ARBs) meds:
1.
2.
3.
- losartan
- Olmesartan
- Valsartan
ARBs block _________ in blood vessels and adrenal glands
angiostensin-II
ARBs cause ________ and increases ____________ of sodium and water
vasodilation,
renal excretion
ARBs cause ____________ and __________
hypotension and angioedema
Calcium Channel Blockers (CCBs) meds
Dihydropyridines
1.
2.
Nondihydropyridines
1.
2.
- Amlodipine
- Nifedipine
- Diltiazem
- Verapamil
Clients must avoid __________ juice when taking CCBs
grapefruit
CCBS are prescribed
for ___________, _________, __________ (nondihydropyridines only)
hypertension, chest pain, (atrial fibrillation*)
CCBs block calcium channels in arteries causing _________ and _________ blood pressure
vasodilation, decreased
Nondihydropyridines CCBs cause a decreased _________
heart rate
CCBs HYC:
1.
2.
3.
- Vasodilation (hypotension and swelling)
- Bradycardia (diltiazem and verapamil)
- Constipation (verapamil)
If the left side of the heart fails, blood backs up into the _______
lungs
Clients with right sided heart failure develop _______
edema
Signs of right sided heart failure:
1.
2.
3.
- jugular vein distension
- weight gain
- cardiogenic shock
when the heart is not able to pump sufficient amounts of blood and oxygen to the brain is _________
cardiogenic shock
Digoxin is prescribed for __________ and __________
- heart failure
- cardiac dysthymia (atrial fibrillation)
Digoxin MOA
1.
2.
- vagal nerve stimulation
- sodium potassium ATPase inhibition
The vagus nerve releases ________ and slows the ________
acetylcholine
heart rate
Digoxin stimulates the vagus nerve which ______ the release of acetylcholine
increase (helps atrial fibrillation)
Digoxin inhibits _______ and increases calcium which causes the heart to ________ with more force
1.sodium, potassium ATPase
2. contract
(helps with heart failure)
Low potassium can cause digoxin _________
toxicity
high potassium levels decrease digoxin effects and lead to treatment ________
failure
Digoxin has a ________ therapeutic range
narrow
blood level before the next dose is in a ________
trough
Did you check your dig because you have to means
- heart failure between 0.5 and 1.0
- atrial fibrillation between 1.0 and 2.0
Digoxin toxicity signs :
VAND
vomiting, anorexia, nausea, diarrhea
As digoxin toxicity worsens, patients report blurred or ______ vision
yellow
Most feared outcome of digoxin toxicity is ______________
Signs: dizziness, fatigue, syncope, death
bradydysrhythmias
If heart rate is less than _____ or change in rhythm, withhold digoxin
60
Digoxin toxicity antidote is ________
digoxin immune fab (binds digoxin floating in the bloodstream)
_________ is a side effect of the digoxin antidote
hypokalemia
Adrenergic Agonists meds
1.
2.
3.
4
- epinephrine
- Dopamine
- Dobutamine
- Norepinephrine
_________ is the treatment for severe allergic reactions, cardiac arrest, and upper airway restriction
Epinephrine
Dopamine is administered to clients with extremely low __________.
Low doses help _______ blood flow to the kidneys
blood pressure
increase
Short term medication treatment of heart failure is _________
Dobutamine
____________ is a treatment for severe hypotension
Norepinephrine
adrenergic agonist meds activate the same adrenaline receptors as __________ meds
blood pressure
______________ causes vasoconstriction and pupil dilation
alpha 1 activation
___________ causes the heart to beat faster and stronger
beta 1 activation
____________ causes the airways to open up (bronchodilation)
beta 2 activation
At high dose, dopamine ________ blood flow
restrict
Adrenergic meds HYC:
1. Cardiac complication symtoms?
2. necrosis route and issues
- tachycardia, hypertensive crisis, and heart attack
- give meds through a central line. Cause so much vasoconstriction that fingers, toes, and nose lose blood flow and die (necrose)
