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221 Cards in this Set

  • Front
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Antidote for versed (midasolam) =

how do you give IV?
on case study
-flumazenil (Romazicon)

stop the blood, flush with NS, give the med in the port closest to the insertion site. Remember SAS(H) – flush with saline, administer, saline, and start the blood again
Antidote for heparin =
protamine sulfate
Normal Saline 0.9% sodium chloride
-what kind of solution is this?
isotonic solution

-action: crystalloid and will keep fluid in the intravascular space increasing
intravascular volume
Normal Saline 0.9% sodium chloride
-why is this often used?
-what is the purpose of giving this?
-it can also be infused with any blood product
-increases plasma volume
Lopressor (metoprolol) SE (2)

what do you look at on the EKG before adminstering this?
-bradycardia
-hypotension

-EKG for heart block (lopressor will sow down the HR.. if the person has a block, you don’t want to slow the HR down anymore)
NTG (nitroglycerin)
-side effects (4)
-headache
-N/V
-diaphoresis
-hypotension
Lanoxin (Digoxin) :
-does it have a position or negative inotropic action?
-what does it do to heart rate and conduction?
-positive inotropic action (contraction)
-decrease the conduction through the AV node slowing the HR (chronotropic action)
Lanoxin (Digoxin) :
-what does it do to cardiac output?


what does it do to preload?
-CO increases because of increase stroke volume from improved contractility


-decreases preload
Digitalsis toxicity
-dysrhythmias such as:
-what electrolyte does it affect?
-bradycardia is most common

-hypokalemia (dig and K compete for the same binding sites)
Digitalsis toxicity
-what does it do to one's visual acuity?
-visual disturbances (yellow haze)
Digitalsis toxicity

-digoxin is absorbed where?
-where is it excreted?

-what do you teach a patient based off of knowing where it is absorbed?
-the GI tract
-renal excretion

do not take at the same time as antacids or laxatives
Diuretics
-increase or decrease preload?
decreases preload
(preload is the stretching of the muscle fibers in the ventricles as they fill with blood)
is Heparin an anticoagulant or an antiplatelet?
Anticoagulants:
is Coumadin (Warfarin) an anticoagulant or an antiplatelet?
Anticoagulants:
Anticoagulants (Heparin and Warfarin) are used when (3)
thrombi,
pulmonary embolism,
prophylaxis
Anticoagulants (Heparin and Warfarin)
-contraindicated:
-GI bleed
-recent trauma or surgery
-aneurysms
-NSAIDS

-thrombocytopenia
--renal, liver, pancreas disease
-alcoholism
-pregnancy

"gran trap" is a way to remember
Heparin
-what does it do to a clot?
-delays clotting time,
-does not resolve clot,
Heparin
-what is the mechanism of action? it blocks......
-blocks conversion of prothrombin to thrombin and finbrinogen to fibrin
-inhibits synthesis of thrombin to prevent development of fibrin clot
Heparin
-what is the dosage based off of?
-what is the dosage also determined by?

-what is normal?
-what is therapeutic?
-dosage is weight based
-dosage determined by monitoring activated partial thromboplastin time (aPTT)

-normal: 25-35 seconds
-therapeutic is 1.5-2.5 x the nromal (50-70 seconds)
-aPTT (activated partial thromboplastin time)
-what is it?
-what is normal?
-what is therapeutic?
evaluates clotting factors.
-normal is 25-35 seconds
-therapeutic is 1.5-2.5 X the normal (50-70 seconds)
-PT (prothrombin time)
what is it?
what is normal?
time required to form a fibrin clot.
Normal is 10-14 seconds
-INR:
what is it?
PT value divided by the standard.
-Example: how long it takes a person on antiplatelets (blood thinners) to clot vs a normal person.

-measures the effects of oral anticoagulants
-INR:
-what is normal?
what a person is anticoagulated/therapeutic, what should their #s be?
-if a pt has a valve replacement, what should their numbers be?
-normal: 0.75-1.25
-when anticoagulated/therpeutic: 2-3
-valve replacement 2.5-3.5 (different for a pig valve, this is only mechanical valve)
-Lovenox or “parin” is an example of what class of medication?
Low molecular weight heparins
-PT (pro time)
what is it?
what is normal?
time required to form a fibrin clot.
Normal is 10-14 seconds
-aPTT (activated partial thromboplastin time)
-what is it used for?

-what is normal?

-what is therapeutic?
evaluates clotting factors and used to determine dosage in Heparin

-normal is 25-35 seconds

-therapeutic is 1.5-2.5 X the normal (50-70)
-INR:
what is it?
PT value divided by the standard.
-Example: how long it takes a person on antiplatelets (blood thinners) to clot vs a normal person.
Low molecular weight heparins such as Lovenox or “parin” are used most often for what?
preventing and treating DVTs
-Lovenox or “parin” do not require PTT or aPTT monitoring (true or false)
true
Low molecular weight heparins such as Lovenox or “parin”
-when giving this, where on the body is it administered?
-angle of insertion of needle?
-what do you make sure you don't do after giving the injection?
-administering either IV or subq (give in fatty tissue – abdomen or thigh), insert needle at right angle to skin, do not rub site (bruising can result)
Pt education of Heparin: avoid
NSAIDS, trauma, use soft bristle toothbrush, report signs of bleeding: gums, nose, urine, stool, emesis, bruising
SE of Herparin and LMW Herparins:
-5
alopecia,
flushing,
bleeding,
osteoporosis,
rashes
Caution when using heparin and LMW heparins:
-if given SC, what do you make sure you do not do?
-what about the elderly?
do not stretch skin or rub injection site,

use smaller doses in the elderly
Coumadin (Warfarin)
-action? inhibits synthesis of...
-inhibits synthesis of clotting factors (II, VII, IX, and X) by blocking formation of prothrombin from vitamin K (which is necessary for the synthesis of clotting factors) = disrupts coagulation cascade
Coumadin (Warfarin)
-dosage:
what is the starting dosage for coumadin?
start with 10-15 mg/day
Caution when using heparin and LMW heparins:
-if given SC, what do you make sure you do not do?
-what about the elderly?
do not stretch skin or rub injection site,

use smaller doses in the elderly
Coumadin (Warfarin)
-how many days does it take for this drug to reach therapeutic levels?
-then what does the dosage go to for maintance?
- takes 2-3 days to achieve therapeutic levels, then 2.5-7.5 mg/day as maintenance up to 6 months
Coumadin (Warfarin)
-action? inhibits synthesis of...
-inhibits synthesis of clotting factors (II, VII, IX, and X) by blocking formation of prothrombin from vitamin K (which is necessary for the synthesis of clotting factors) = disrupts coagulation cascade
Coumadin (Warfarin)
-what 2 levels are you monitoring to determine the dosage??
monitor PT and INR
-dosage is determined by PT time (1.5-2.5 times control or international normalized ratio (INR) 1.5-3.0)
Coumadin (Warfarin)
-dosage:
what is the starting dosage for coumadin?
start with 10-15 mg/day
Coumadin (Warfarin)
-how many days does it take for this drug to reach therapeutic levels?
-then what does the dosage go to for maintance?
- takes 2-3 days to achieve therapeutic levels, then 2.5-7.5 mg/day as maintenance up to 6 months
Caution when using heparin and LMW heparins:
-if given SC, what do you make sure you do not do?
-what about the elderly?
do not stretch skin or rub injection site,

use smaller doses in the elderly
Coumadin (Warfarin)
-what 2 levels are you monitoring to determine the dosage??
monitor PT and INR
-dosage is determined by PT time (1.5-2.5 times control or international normalized ratio (INR) 1.5-3.0)
Coumadin (Warfarin)
-action? inhibits synthesis of...
-inhibits synthesis of clotting factors (II, VII, IX, and X) by blocking formation of prothrombin from vitamin K (which is necessary for the synthesis of clotting factors) = disrupts coagulation cascade
Coumadin (Warfarin)
-dosage:
what is the starting dosage for coumadin?
start with 10-15 mg/day
Coumadin (Warfarin)
-how many days does it take for this drug to reach therapeutic levels?
-then what does the dosage go to for maintance?
- takes 2-3 days to achieve therapeutic levels, then 2.5-7.5 mg/day as maintenance up to 6 months
Coumadin (Warfarin)
SE:
-weakening of bone with long term use
-red/orange urine
-alopecia at injection site
-bleeding tendencies
-nausea and vomiting
-anorexia
-diarrhea and cramping
Coumadin (Warfarin)
-what do you teach a pt who is taking this about their diet, what should they avoid?
-Teach pts to decrease the intake of green leady veggies
Coumadin (Warfarin)
-what is the antidote?
-Vitamin K is the antidote
Platelet inhibitors (Antiplatelet)
-examples are:
aspirin (ASA) and plavix
Platelet inhibitors (Antiplatelet) –prevents
platelet aggregation (prevents them from sticking together)
ASA (Aspirin) - used for 4 diseases:
PVD,
Acute coronary syndrome
prophylaxis against stroke and MI
-if pt is experiencing an MI at home, instruct them to do what?
take 4 baby aspirin and
chew (81 mg each)
ASA (Aspirin)
-what does it do when giving it for an MI?
-decreases inflammatory effects of MI
ASA (Aspirin)
-ASA inhibits platelet aggregation and ________
vasoconstriction
ASA (Aspirin)
-when does this drug start working in the body?
-how long does it last in the body?
-what does it do to bleeding time?
-antiplatelet effects begin with 1 hr of use and continues for 7-10 days

-prolongs bleeding time to inhibit the aggregation of platelets
-assess for what that may indicate ASA toxicity?
-assess for ringing of the ears (tinnitus may occur with aspirin toxicity)
Antiplatelets, such as aspirin prevent the clot from getting bigger, it doesn’t dissolve the clot (true or false)
true
Platelet inhibitors (Antiplatelet)
-if given IV, what is the dosage based off of?
weight based
Contraindications to antiplatelets?
-pregnancy & lactation,
-bleeding disorders,
-recent surgery,
-closed head injuries,
-recent history of viral infection (flu or chicken pox) in children puts them at risk for Reyes syndrome
Teaching of antiplatelets
-should they take this with food? why?
-what may they do prior to surgery?
-give with milk , food, or full glass of water to decrease gastric irritation
-may hold drug 7-10 prior to surgery
-ASA toxicity: 4 SE
tinnitus,
itching,
severe HA,
sweating

("tiss")
SE of aspirin:
SE:
-bleeding
-bruising
-hematuria
-tarry stools
-headache
-dizziness
-weakness
- skin rash
-n/v
-abdominal pain
ASA”
-is an antiplatelet. it also has 2 other actions.
ASA”
-anti inflammatory – helps decrease inflammatory response and antipyretic, keeps down the fever
Nitrates (vasoconstrictor or vasodilator)
vasodilator
-helps decrease pain
Nitroglycerin – nitrate vasodilator
-what does it do to the oxygen demand on the heart?
(decreases oxygen demand on the heart)
Nitroglycerin – nitrate

what does it do to preload?
-relaxes veins which decreases preload
Nitroglycerin – nitrate

-what does it do to afterload?
-relaxes arteries which reduces system vascular resistance which decreases afterload
work directly on vascular smooth muscle producing coronary and peripheral vasodilation
isosorbide dinitrate (Isordil)
erythrityl tetranitrate (Cardilate)

are examples of?
nitrates

nitroglycerin (NTG)
Nitroglycerin – nitrates

-Used (4)
-angina pain
-acute MI
-heart failure
-hypertension
Nitroglycerin – nitrate

Contraindications:
-what 2 other meds?
-what 3 other conditions?
-beta blockers
-erectile dysfunction medications (Viagra)


-hypotension
-hypovolemia
-increased ICP
Nitroglycerin – nitrate

Sublingual is _____ acting. how many can you instruct them to take?
-short acting: take up to 3 pills SL, 5 minutes apart
Nitroglycerin – nitrate
-what is important to teach pt who are using the patches?
-patches = intermittent therapy so don’t develop high tolerance. take off at night for 10-12 hrs
Nitroglycerin – nitrate

-monitor:
-instruct them to do what (2)
-if dizzy or lightheaded after taking, sit down
-monitor HR and BP
-change positions slowly

SE: reflex tachycardia and orthostatic hypotension
Nitroglycerin – nitrate

-what can they take prophylactically?
-prophylactic acetaminophen for headache
Nitroglycerin – nitrate
-if they get a dry mouth when taking the sublingual tablets, what can you tell them to do?
-what should they take these with?
-if dry mouth, take sips prior to taking SL
-take on empty stomach with glass of water
-don’t crush or chew
Nitroglycerin - nitrates
-what does the nurse have to know when this drug is being discontinued?
-can you push this medication IV?
-taper slowly when discontinued b/c aprubt withdrawl can cause the rebound effect of severe pain from an MI

-never push this medication IV
-SL nitroglycerin tablets are light sensitive. where do you teach pts to store them?

how long are they good for after opening?
store in dark bottle with cap on tonight

(good for 6 mo after opening)
Side effects of nitroglycerin - nitrates?
-hypotension *
-syncope
-dizziness
-headache*
-orthostatic hypotension*
-dry mouth
Nitro paste – must always use the paper. do not rub in, tape on skin (true or false)
true
where should you place the nitro paste?
close to the heart , it is absorbed locally.
make sure you do not go over bone (shoulder blade) because it wont be absorbed
-nitro causes what side effect that bothers people?
head ache, so give tylenol
-when you put on a nitro patch, what should you make sure of?
make sure old one is off and wipe down the old area
-date time and initial patch
Nitro spray and sublingual tablets for pts with angina are instructed the same: take 3 doses, 5 minutes apart. true or false
true
how do they tell if nitro is working?
gives you a tingling/burning sensation under the tongue
“statins” are what class of drugs
antilipidemic or HMG-CoA Reductaste inhibitors
"statins"
-what do they do?
-decrease cholesterol or triglyceride levels
Statins
-what is their action? inhibits formation of......
- inhibits formation of HMG-CoA reductase which is an enzyme that is required to make cholesterol in the liver
-increases removal of LDL from plasma by liver
crestor (rosuvastatin calcium)

SE (3)
--statin
muscle weakness, cramps, rhabdomyolysis
(rhabdomyloysis -muscle break down, they urinate red urine, it is not
blood, it is muscle breakdown)
crestor (rosuvastatin calcium)

-what is an example of a disease that would be contraindicated in someone taking this drug?
-what test should you always monitor?
-someone with Heb B would not continue on crestor, the crestor causes the liver
to decreases the synthesis of cholesterol so if there is liver damage, the liver
can’t do its job and as a result it can cause further liver damage
-always have liver tests done to make sure the crestor isn’t damaging the liver (It
works in the liver)
niaspan (Niacin)
-what about the dosage?
-what does it do in the body?
-what organ does it affect?
--statin and B vitamin
-need high doses (750 mg) for it to work. do not take it OTC. it will lower cholesterol. you need a prescription. it can ruin the liver.
niaspan (Niacin)
-major side effect
-what intervention can you do?
flushing = take aspirin to help that SE
WelChol (colesevelam): bioacid sequestrant

-where does this action take place in the body?
-what SE do you watch for?
it binds with cholesterol in the intestines and prevents it from being absorbed)
- n/v is a SE that you watch for because it works in the GI tract
Interventions for statins:
-monitor?
-instruct them to get what kind of exam?
-when time of day should they take this drug?
Interventions:
-monitor LFT
-eye exams because they can cause cataract formation
-best to take drug in the evening
Contraindications to statins:
2
-liver disease
-hepatitis
SE of statins:
-GI
-rash
-elevated liver enzymes*
-lens opacities (caractacts)*
-myopathy = rhabdomyolysis = leg pain*
-hepatotoxicity*
-muscle damage (increase in CK)*
Teaching when taking statins:
-tell them to report
any muscle pain or tenderness (adverse reaction is myopathy and muscle damage)
Niaspan (niacin)
-what does it do to LDL and HDL?
- inhibits synthesis and secretion of VLDL and LDL from liver, increases HDL levels
Niaspan (niacin)
-given to pts with high _____
triglycerides
Niaspan (niacin)
-insturct them to take this when?
-when should they take ASA to counteract the flushing?
-take with meals
-take ASA 30 min prior to prevent flushing
Niaspan (niacin)
SE:
-SE: flushing, itching, nausea, ingestion, diarrhea, hyperglycemia
"pril" is what drug class?
ACE inhibitors
ACE inhibitors (pril)
-what does it improve?
-improves cardiac output, how?????




-helps ventricular remodeling (helps prevent stretching of the ventricles), decreasing vascular resistance & afterload
ACE inhibitors (pril)
-action: what do they prevent?
they prevent peripheral vasoconstriction by blocking conversion of angiotension I to angiotension II, decreasing vascular resistance and reducing afterload

they also help ventricular remodeling (prevent stretching)
ACE inhibitors (pril)
-uses: 3
heart failure
MI
hypertension
ACE inhibitors (pril)
Interventions:
-instruct them to take this medication when?
-give before meals (on empty stomach) to enhance absorption
ACE inhibitors (pril)
-teach them to avoid which kind of foods , supplements, and meds??
-avoid potassium rich foods
-potassium supplements
-potassium sparing diuretics
ACE inhibitors (pril)
-change position slowly
-what does this do to ones taste?
-loss of taste --> anorexia
ACE inhibitors (pril)
-monitor what organ function?
-monitor for what else?
-monitor renal function
-monitor for bleeding
ACE inhibitors (pril)
-instruct them not to use OTC ____?


what should you teach them about discontinuning this med?
don’t use OTC cold/cough preps


if you discontinue this med, rebound hypertension can occur
ACE inhibitors (pril)
Contraindications:


what about the use of this drug in a diabetic pt?
-renal artery stenosis
-renal artery insufficiency
-2nd and 3rd trimester pregnancy

-can cause a hypoglycemic reaction in the pt with DM
ACE inhibitors (pril)

SE:
-granulocytopenia
-hemolytic anemia
-proteinuria
-stomatitis
-loss of taste*
-tongue ulcers
-fever
-rash
-dry nagging cough*
-hyperkalemia*
-angioedema (fluid around eyes)*
ACE inhibitors (pril)

SE:
-hyperkalemia or hypokalemia?
-hypertension or hypotension?
-hyperkalemia

hypotension
ACE inhibitors (pril)

SE:
-angioedema (fluid around eyes)
-nagging, dry cough
-loss of taste
-hyperkalemia (avoid K+ rich foods)
Diuretics
-what does it do to fluid volume?
-does it control preload, afterload, or contracility?
-decreases the amount of fluid volume (therefore decreasing edema and controlling afterload so they heart does not have to work as hard to pump the blood out)
Diuretics
-action is where in the body?
-what does it do there?
-action: nephrons of kidney increases excretion of electrolytes (Na, Cl)
Diuretics
-what do they do to BP?
-as urine sodium increases, additional water is excreted to dilute the urine. this results in a decrease of total body water and BP, and increase urine output
Loop diuretics
-action:
-inhibit sodium and choloride reabsorption from the loop of Henle and the distal tubule

-renal excretion of sodium, water, and potassium.
-initial decrease in blood volume and cardiac output
what is this an example of?

-bumetanide (Bumex)
-furosemide (Lasix)
-ethacrynic acid (edecrin)
-torsemide (Demadex)

Loop diuretics
-what are examples
-DRUG OF CHOICE FOR CHF IS?
-furosemide (Lasix) --Loop diuretic
Diuretics
-Thiazide:
action:

-not effective for:


-what electrolyte imbalances does this cause?


2 other side effects
inhibit sodium reabsorption in the distal tubule, not as potent as the loop diuretics

immediate diuresis



hypercalcemia
hyperglycemia
hyperuricemia

hypokalemia
hyponatremia


photosensitivty --- use suncreen
constipation
Diuretics
-K+ sparing:
action?
inhibits aldosterone, thus causing renal excretion of sodium and water and
retention of potassium
-spironolactone (Aldactone)
is an example of what?
Diuretics
-K+ sparing:
Diuretics
-uses? 3
-Heart failure
-Edema
-HTN
-________is the drug of choice for afib
Digoxin
Interventions for diuretics:
-instruct them to take at what time of the day?
-give early in the day to prevent nocturia (urinating at night)
Interventions for diuretics:
-electrolytes
what one in particular should you monitor?
-monitor electrolytes (especially potassium)
-monitor S/S of hypokalemia (weakness, fatigue, muscle cramps)
Interventions for diuretics:

-what else should the nurse monitor?
-monitor I/O
-monitor weight
-monitor BP
-monitor for s/s of digitalis toxicity
-monitor for hearing loss
Interventions for diuretics:

-instruct them to eat what kind of foods?
-give potassium rich foods (green seedless grapes, potatoes, tomatoes, OJ, bananas, hamburger, romaine lettuce, peanuts)
Contraindications for loop and thiazide diuretics
-diseases
-renal failure
-hepatic disease
-lactation/pregnancy
-hypokalemia
-gout
-diabetes
-peripheral vascular disease
Contraindications for loop and thiazide diuretics
-what drugs
-digoxin (hypokalemia can acuse dig toxicity)
-antihypertensive meds (increases hypotension)
-lithium (dieresis can cause toxicity)
-NSAIDs (reduces diuretic effect)
Contraindications for potassium sparing diuretics
-what disease (3)
-renal failure
-hyperkalemia
-diabetes
Contraindications for potassium sparing diuretics
-what drugs
-calcium channel blockers
-ACE inhibitors (they retain K+)
SE for loop and thiazide diuretics:
-decreased BUN and creatinine (due to dehydration)**
-hypokalemia**
-hypocalcemia = muscle cramps**
-hypovolemia (dehydration, polyuria, vertigo, thirst, dry mouth)
-hyperglycemia
-restlessness
-GI disturbances
-agranulocytosis
-gynecomastia
- photosensitivity**
SE for potassium sparing diuretics:
-hypokalemia or hyperkalemia
-hyponatremia or hypernatremia
-hyperkalemia
-hyponatremia
-gynecomastia
-irregular menses
-rash
-lethargy
-confusion
-vertigo
-headache
-dry mouth
SE for potassium sparing diuretics:
-hypoglycemia or hyperglycemia
hyperglycemia
Dopamine (Intropin)
--Classification:
catecholamine (positive inotropic)
Dopamine (Intropin)
-Action: what does it increase (3)
increase cardiac output, BP, and SVR...how does it improve CO??




by activating beta 1 receptors
Dopamine (Intropin)
-at low doses (5mcg), what does it do? (2)
dilates renal arteries and increases urine output
Dopamine (Intropin)
moderate doses (10mcg)
-what does it stimulate in the body?
-what does it increase?
stimulate beta I and increase cardiac contractility, stroke volume, and cardiac output
Dopamine (Intropin)
moderate doses (10mcg)
-what does it do to the kidney?
-does it cause vasoconstriction or vasodilator?
– increases blood to kidney


vasoconstriction
Dopamine (Intropin)
high doses (20mcg)
-what does it stimulate in the body?
-what does it do to BP?
stimulate alpha 1, causing vasoconstriction --> increases BP
Dopamine (Intropin)
-purpose of dopamine and how it affects cardiac output
- improve cardiac output by activating the beta 1 receptors
Dopamine (Intropin)
-Uses:
(3)
-decreased renal perfusion
-decrease CO,
-shock (hypovolemic and septic)
Dopamine (Intropin)
-it is a vasoconstrictor to raise BP. what do you want to make sure they hae before you give this
make sure they have adequate fluid because if they don’t, they will have nothing to push from the constricted vessels to the core of the body
Dopamine (Intropin)
Nursing interventions:
-monitor for what?
-correct what first?
-monitor for ischemia due to increased HR
-correct any pre-existing hypovolemia first
Dopamine (Intropin)


-positive inotropic drug that decreases contractility (true or false)
false, it increases contractility
Dopamine (Intropin)
Nursing interventions:
-monitor for what?
-what should you monitor in regards to urine output?
-monitor for hypertension
-monitor for decreased renal output (should increase UO if effective)
Dopamine (Intropin)
Nursing interventions:
-monitor for signs of HF. why?
-monitor for signs of heart failure (if dopamine is not effective, HF gets worse)
Dopamine (Intropin)
-adverse affects (4)
-tachycardia
-dysrhythmias
-angina pain
-vasoconstriction
Beta blockers – “olol”

are they positive or negative inotropic drugs?
(negative inotropic drug - lessens the hearts workload by decreasing the rate and strength of heart beat)
Beta blockers – “olol”

-what does it do to oxygen demand?
-what does it do to contractility?
-decrease oxygen demand by decreasing HR and contractility,
Beta blockers – “olol"

-what does it prolong?
increases coronary filling by prolonging diastole
-slows down the HR and allows for better filling. allows more efficient contraction
Beta blockers – “olol"

-how does it affect cardiac output?
-decreases cardiac output by decreasing the oxygen demand, prolonging diastole, allowing for more efficient contraction
Beta blockers – “olol"

action: block.....
block beta adrenergic receptors located in the heart muscle and body
Beta blockers (olol)
•Beta 1 works primarily in the heart
--what happens if you block beta 1?
o if you block Beta 1, you will get decrease HR, decrease or more efficient contraction, decrease automaticity, decrease myocardial O2 demand
Beta blockers (olol)

•Beta 2 = works primarily in the lungs, bronchioles, and vascular bed.
-what happens if you block beta 2 ?
-if you block beta 2 you will see bronchospasms and vasoconstriction
Beta blockers (olol)

Uses:
-angina
-hypertension
-tachyarrhythmia’s
-prophylaxis for MI
Beta blockers (olol)

-give meds when in regards to food?
-what can this cause in the elderly?
-give medication before meals
-in elderly, can cause sensitivity to cold
Beta blockers (olol)
-don't miss or stop a dose
-if the drug causes drowsiness, tell them to do what?
-if drug causes drowsiness, take at night
-change positions slowly
Contraindications to beta blockers
-diabetes
-conditions that cause bronchospasms (asthma, COPD)
-heart failure (CHF, cardiomegaly)
-sinus bradycardia
-renal or hepatic impairment
-after major surgery
-peripheral vascular disease
-1st or 2nd degree heart block
Contraindications to beta blockers (what other class of drug)
MAO inhibitors
beta blockers SE neuro:
-lethargy, fatigue, depression
-vertigo, insomnia
-headache
beta blockers SE in the lungs:
-bronchospasm & bronchoconstriction
-dyspnea
beta blockers SE to the cardiac system?
-bradycardia
-palpitations
-orthostatic hypotension
beta blockers SE in the GI system:
nausea, vomiting, diarrhea, fluid retention
beta blockers SE in diabetic patients?
-hypoglycemia (don’t give to DM pt. it will decrease blood flow to renal arteries. monitor for tachycardia which is a CM of hypoglycemia)
beta blockers SE in the reproductive system
-impotence
PEDS: supraventricular tachycardia (SVT)

treatment:
ice water, bending over, stand on head
Calcium Channel Blockers

are they positive or negative inotropic drugs?
(negative inotropic drug)
(lessens the hearts workload by decreasing the rate and strength of heart beat)
Calcium Channel Blockers
end in what " "
“pine” ending, except diltiazem, (Cardizem) and verapamil (Calan, Isoptin)

-think “VND – very nice drugs” Verapamil, Nifedipine, Diltiazem
-Calcium helps maintain muscle tone & _______ secretion
-transmision of:
-contraction of:
, hormone secretion,
transmission of nerve impulses,
contraction of skeletal and heart muscle
Calcium Channel Blockers
-what do they do to smooth muscle?
they promote vasodilation of the coronary and peripheral vessels
Calcium Channel Blockers
-how does it affect afterload?
inhibits calcium ion movement across cell membranes causing dilation, reducing peripheral vascular resistance, and increasing output

it also slows conduction through the SA and AV node = slows HR
Calcium Channel Blockers
-Action: what does it do to increase cardiac output
inhibits calcium ion movement across cell membranes causing vascular smooth muscle to relax and coronary arteries to dilate and reduce peripheral vascular resistance, thus increasing cardiac output
Calcium Channel Blockers
-how does this slow HR?
-slow SA and AV node conduction and slows HR
Calcium Channel Blockers
Uses:
-angina
-hypertension
-supraventricular tachycardia
-migraine headache
Calcium Channel Blockers
-Nursing interventions:
what should you monitor (2)
-monitor BP for hypotension
-monitor EKG for bradycardia and dysrhythmias
Calcium Channel Blockers
-assess for what?
-check labs, specifically for what tests?
-assess for CHF
-check labs for LFTs
Calcium Channel Blockers
-tell me about the weight?
-weight pt and check for edema or weight gain

SE include fluid retention and peripheral edema
Calcium Channel Blockers
-teach aboout what?
-avoid what?
-administer when in regards to food?
-teach about postural hypotension
-avoid grapefruit
-administer before meals
Calcium Channel Blockers

SE:
-big one is what?
what can you teach about this
-constipation (teach pt to increase fiber and fluid in diet)
Calcium Channel Blockers

SE:
-peripheral edema*
-fluid retention*
-palpitations
-tachycardia*
-flushing
-hypotension*
-nausea
-bradycardia
-muscle aches, tremors, and cramps
Thrombolytics
-what do you have to remember when repositioning them?
-reposition them carefully ( they bruise easily)
Thrombolytics AKA __________drugs
Fibrinolytic
Thrombolytics break down fibrin threads already present in the formed blood clot / they dissolve the clot (true or false)
true
Thrombolytics
-action:
-to degrade fibrin, these drugs activate plasminogen to its active form, plasmin.
-fibrin is what holds the clots together. thus, the action breaks down formed clots with less effect on clot formation
Thrombolytics
-dissolves thrombi in the coronary arteries and restores myocardial blood flow (true or false)
true
Thrombolytics

-dissolve clots through enzyme activation
of plasmin “ase”
ateplase (tPA tissue plasminogen activator)
reteplase (retavase)

are examples of:
thrombolytics
Thrombolytic
Indications:
blood clots, MI, stroke, PE, DVT
-used for treatment of acute MI within 6 hrs of start of pain
Thrombolytic
Interventions:
prior to giving through an IV, what should you do:
-prior to giving – start 2-3 IVs, draw all labs. 2-3 b/c if you start an IV or draw blood after giving a thrombolytic, they can have impaired bleeding)
Thrombolytic
Interventions:
-what do you do when punturing a patient?
-Apply pressure and then pressure dressing with any punctures
Thrombolytic
-after giving this, what do you make sure to follow up with?
-Follow with anticoagulant (thrombolytics work anywhere from a few hours to 24 hours and follow with an anticoagulant for long term management of clot formation) blood pools and clots form
Thrombolytic
-monitor for what in the heart?
-Monitor for reperfusion dysrhythmias (expect inflamm process to irritate heart muscle, breakdown and increase blood flow
Thrombolytics
-what is their activity?
-is this pricey?
- maintain in bedrest
-very expensive. do not open package until you know 100% that u will give it
-tPA can only be given by a trained personnel

true or false
true
Thrombolytics
-Contraindications: works on the whole body
-if active internal bleeding
-history of CVA/stroke (fresh clots are broken down or dissolve)
-surgery or trauma in the last 2 months
-aneurysm
-uncontrolled hypertension
-bleeding/clotting disorder (DIC)
-history of GI bleed
Thrombolytics

SE:
-bleeding and (tachycardia or bradycardia)
bradycardia
Morphine
-prescribed to relieve discomfort that doesn’t respond from the use of ______________________


how does it relieve MI pain?


what does it cause in the periphery?



what does it do to HR and BP?
nitroglycerin


decreases the oxygen demand on the heart


peripheal vasodilation



lowers HR and BP
Morphine
-what does it do to the oxygen demand of the heart?
-what does it do to smooth muscle?
-it relieves MI pain, decreases myocardial oxygen demand,
-relaxes smooth muscle
Morphine
-what does it do to catecholamines?
reduces circulating catecholamines (chemicals release in SNS activation)
Morphine
-adverse effects:
respiratory depression,
hypotension,
bradycardia,
severe vomiting
Morphine
-what can happen if you give this IM?
– it may not be absorbed as fast and the IM may increase your CK. CK rises from muscular damage.
Digoxin (Lanoxin)
-absorbed where

-excreted/metabolized by the ________
GI tract



kidney
Digoxin (Lanoxin)
-what does it do to conduction of the heart?
-slows AV node conduction, slows ventricular response to atrial dysrhythmias
Digoxin (Lanoxin)
-what does it do to the contraction of the heart?
-what does it do to cardiac output?
-what does it do to heart rate?
increase the strength of contraction (inotropic) by slowing AV node conduction


increases CO because of increased stroke volume from improved contractility

lowers HR (chrontopoic)
Digoxin (Lanoxin)
-cardiac output is increased because of what?
-CO increases because of increased stroke volume from improved contractility
Digoxin (Lanoxin)
-what does it do to conduction?
-increase filling of ventricles, slows conduction
Digoxin (Lanoxin)
-Uses: (3)
afib, a-flutter, heart failure
Digoxin (Lanoxin)
Nursing interventions:
-what do you do before administering this drug
fcheck pulse for 1 minute prior to giving (hold if less than 60 or 100 if they are under age 7)
Digoxin (Lanoxin)
-toxicity easily occurs (optimal range is
0.5-0.8 ng/mL)
Digoxin (Lanoxin)
-level over ___ng/mL is toxic
2
Digoxin (Lanoxin)
-what electrolyte level should you check?
-can give with K+ rich food, check potassium levels
Digoxin (Lanoxin)

Contraindications:
-digoxin toxicity
-WPW syndrome
-ventrical dysrhythmias
-hypokalemia
-renal insufficiency
Digoxin (Lanoxin)

Drug interactions:
-quinidine
-diuretics
-beta blockers
-antacids
-antilipidemic
-antidiarrhea meds
-OTC cold preps (they stimulate the heart)
Digoxin (Lanoxin)

SE:
-anorexia
-n/v
-headache, fatigue, confusion, restlessness
-impaired color perception
Digoxin (Lanoxin)
-tell me about Dig and potassium. what should you watch for?
-hypokalemia (compete for binding sites.. S/S is muscle weakness)
Digoxin (Lanoxin)

Toxicity of Digoxin
(what happens to adults)



(what happens in children)
-dysrhythmias (bradycardia is most common)
-hypokalemia
-visual disturbance

-dysrhythmias
-fatigue
-loss of appetite
-muscle weakness
-confusion
Digoxin (Lanoxin)
-hypokalemia (Dig and K compete for the same binding sites)
-what happens to vision?
-visual disturbances (blurred vision & yellow haze)
Digoxin (Lanoxin)
-early S/S of toxicity in kids is:
dysrhythmias