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233 Cards in this Set

  • Front
  • Back
What is the heart?
Four chambered organ located in the upper left thoracic cavity.
What is the purpose of the heart?
Pumps the blood around the body so that oxygen and nutrients can be distributed to all areas of the body.
What is the cardiac cycle?
A series of electric, chemical and mechanical events that happens simultaneously.
What is it called when the heart contracts?
Systole.
What is it called when the heart relaxes?
Diastole. (Di- like in Dilate)
What happens during systole?
Depolarization, Na+ in and K+ out.
What happens during diastole?
Repolarization, K+ in and Na+ out.
Describe the electrical event.
Depolarization, sodium in and potassium out and then repolarization, potassium in and sodium out.
Describe the chemical event.
It is an exchange of electrolytes in and out of the cell, sodium and potassium pump and calcium.
What is the SA node?
Sinoatrial node, the primary pacemaker of the heart.
What is the AV node?
Atrioventricular node.
What is the Bundle of His?
A bundle of Purkinje fibers located at the atrioventricular junction.
One normal sinus beat or electrical event in the heart is displayed how on the ECG?
By the letters PQRST.
What does an abnormality in the P wave represent in the ECG?
An atrial arrhythmia.
What is an atrial arrhythmia?
An abnormal rhythm in the atria of the heart.
What does the bundle of His branch into?
Right and left bundle branches.
What do the left and right bundle branches branch into?
Purkinje fibers
What is the primary pacemaker of the heart?
The sinoatrial mode.
What does BPM stand for and what is the normal range?
Systole, or beats, per minute. The number of times the heart is beating. Normal range is about 60-90 BPM. Ranges can vary between institutions.
What is Bradycardia and give a range.
A slow heart beat. Less than 60 BPM.
What is Tachycardia and give a range.
A fast heart beat. Faster than 90 BPM.
What does the autonomic nervous system do?
commands your heart to speed up, slow down and blood vessels constrict or dilate. (fight or flight)
What does the parasympathetic nervous system do?
Slows down the heart rate, releases acetylcholine on the vagus nerve.
What does the sympathetic, or adrenergic, nervous system do?
Increases the heart rate, cardiac output and BP by releasing epinephrine (or adrenaline). It is a powerful vasoconstrictor. Feeds the fight or flight system.
What is another name for epinephrine?
Catecholamine.
Name a cardiac glycoside and state what it does.
Digoxin. Increases cardiac output by increasing the force of the contraction. Is used to treat heart failure. Produces a positive "inotropic" effect. Decreases electrical conduction.
Name some antiarrhythmics.
Beta blockers, Ca+ channel blockers and adenosine.
What are Calcium channel blockers and what do they do?
They are calcium antagonists and block the receptor for calcium in the heart to help lower blood pressure in patients with hypertension.
What are Beta blockers?
A class of drugs that Block the adrenergic receptors. Used to control heart rhythm, treat angina and reduce high blood pressure.
What is adenosine used for?
It is used to try to restore a normal heart rate and rhythm when there is an episode of supraventricular tachycardia.
What does inotropic mean?
Controlling the contraction of the heart muscle.
What can be a negative side effect of Digoxin?
Bradycardia
When do you not give Digoxin?
If the heart rate is below 60.
What is a loading dose.
A higher dose given before a maintenance dose to reach a therapeutic level quicker.
What is important when administering Digoxin?
Must always get a serum/ blood level to watch for Digoxin toxicity. Therapeutic levels and toxicity levels are close to each other.
What is a very important nursing consideration when administering Digoxin?
Always take an Apical Pulse for 1 min before administering.
What does apical mean?
Take a pulse by listening to the heart rather than by feeling it on the neck or wrist.
What are some adverse GI side effects of Digoxin?
Nausea, vomiting, anorexia, diarrhea
What are some adverse neurological side effects of Digoxin?
Drowsiness, headache, possibly confusion, vision changes and irritability.
What is an adverse cardiac side effect of Digoxin?
Cardiac arrhythmias.
What can complicate the use of Digoxin?
The use of diuretics. Diuretics can cause the loss of potassium as well as Digoxin. This puts patients more at risk of Digoxin toxicity. Be sure to check renal function!**
What can be given to reverse the toxic effects of Digoxin in a life threatening situation?
Digibind.
How are arrhythmias corrected?
Some need drugs to correct. Some need electricity.
What does it mean when the heart beat doesn't come from the SA node?
Ectopy.
What are the three ways that anti-arrhythmias work?
1. Decrease the “abnormal” automaticity of cardiac tissues in the ectopic sites” (decrease ectopy)
2. Alter the rate of conduction of electrical impulses through the heart. (speed/up slow down)
3. Alter the refractory period (PQRST) of cardiac muscle between consecutive contractions.
What is the refractory?
The normal cardiac cycle "PQRST"
What are the 6 anti-arrhythmics that we covered?
A. Amiodarone
B. Beta Adrenergic Blockers
C. Calcium Channel Blockers
D. Digoxin
E. Adenosine
F. Lidocaine
How do Lidocaine and Amiodarone work?
They work as a heart anesthetic, relaxing it. They treat ventricular arrhythmias. They treat premature ventricular arrhythmias (PVCs)
What are the adverse effects of Lidocaine and Amiodarone?
Hypotension, Bradycardia and lightheadedness
How do Beta Adrenergic Blockers (beta-blockers) work?
They inhibit alpha and beta receptor sites. They reduce heart rate, decrease atrial and ventricular rhythms and decrease blood pressure.
Where is the receptor site for Beta 1?
In the heart.
Where is the receptor site for Beta 2?
The lungs.
(We have 1 heart but 2 lungs)
Where are the alpha receptor sites?
In the periphery.
What are the adverse effects of beta blockers?
Bradycardia, hypotension, The non-selective beta blockers can cause bronchoconstriction. Not safe for people with lung issues like asthma.
Give examples of selective beta blockers.
Atenolol (which is Tenormin) and Metoprolol (which is Lopressor).
What is the non-selective beta blocker?
Propanolol (which is Inderal). Not safe for people with lung issues because of bronchospasm.
How do calcium channel blockers work?
Reduce the influx of calcium into the cell. Prevents spasms in the coronary arteries. Used mostly in atrial arrhythmias.
What are calcium channels responsible for?
Muscle contraction. Ca+ stimulates actin and myosin in the muscle to stimulate a contraction.
What is the adverse effect of Calcium channel blockers?
Hypotension.
Give examples of Calcium channel blockers.
Diltiazem (Cardizem), Verapamil (Calan) Adenosine (Adenocard) and Nifidipine (Procardia)
How does Adenosine work?
Slows conduction through the AV node. Cardioverts paroxysmal supraventricular tachycardia (PSVT).
What are the side effects of Adenosine?
Facial flushing
Shortness of breath
Headache
Nausea and vomiting
What is a sympathomimetic?
An agent that mimics the stimulation of the sympathetic nervous system. Vasopressor.
What are adrenergic drugs?
Drugs that stimulate alpha or beta adrenergic receptor sites.
What does adrenergic mean?
Activated by epinephrine or any of various substances having epinephrine-like activity.
How do you treat shock?
1. Mimic epinephrine and/or norepinephrine
2. Cause increase in heart rate
3. Cause vasoconstriction
4. Reverse hypotension from shock
5. Increase force of contraction
What are some commonly seen vasopressors?
1. Dopamine IV, dosed mcg/kg/min
2. Dobutamine IV, dosed mcg/kg/min
3. Neo-Synephrine IV, dosed mg’s (Can get IM & SC)
4. Levophed/Norepinephrine IV, mcg/min - VERY strong!
5. Epinephrine IM,IV,SC,ETT
What is Nipride and what is it used for?
A blood pressure medication used only in hypertensive emergencies.
Name a true cardiac stimulant and what it's used for.
Atropine. It is given for symptomatic bradycardia in all situations. If it doesn't work, then they may be hooked up to a pacemaker.
What is ischemia?
Lack of oxygen & blood flow to a specific tissue/muscle in the body. Without adequate blood flow to a specific tissue, any tissue = any organ, the tissue will eventually die and become “necrotic”.
What is necrosis?
Dead tissue.
What is Coronary Artery Disease?
A build up of plaque in the heart causes narrowing of the coronary arteries. Hence, causing decreased blood flow to the coronary arteries called “Ischemic Heart Disease”.
What are the major objectives of coronary vasodilators?
1. Prevent MI death.
2. Vasodilate coronary arteries to restore perfusion to heart.
3. Increase blood flow to ischemic heart muscle.
4. Decrease myocardial oxygen demand. Meaning the heart is not working so hard because it is more relaxed (dilated).
What is angina?
Narrowing of vessels in the heart causes an ischemic state which has related pain called angina. It can be acute or chronic.
What is acetylsalicylic acid (ASA)?
It is a drug that is an analgesic, an antipyretic and an anti-inflammatory. It also has an antiplatelet effect and is often given to patients at risk for MI.
What is Plavix?
A drug used to prevent clots in patients who have recently had a heart attack or stroke.
What is nitroglycerin, or nitrates?
The most commonly used vasodilator to treat angina (ischemic chest pain).
What does nitroglycerin do?
Causes coronary vasodilation, relaxes smooth muscles.
What is vasodilation?
The opening, or widening of a blood vessel.
What is vasoconstriction?
The narrowing of a blood vessel.
When the supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart and the heart muscle aches, what is this called?
Angina
What are the different forms of nitroglycerin?
Sublingual, Ointments and patches, spray and intravenous.
How is nitroglycerin given sublingually?
It is given under the tongue three times over 15 minutes or "Q5". BP should be taken before and after each time. Must have an IV inserted before given. Also should do a 12 lead EKG to note ischemic changes.
How is nitroglycerin given by ointment?
Paste is put on a piece of paper and taped to the patient. Usually about 1 inch. It must be thoroughly wiped off before the next dose. Gloves must be worn during administration!!! Be sure to date, time and initial the paper.
How is nitroglycerin given by patch?
It is self-adhesive and taken off before given the next dose. Sites should be rotated and patches should be dated, timed and initialed. They are changed daily.
How is nitroglycerin given by spray?
It is squirted under the tongue and carried in ambulances.
How is nitroglycerin given by IV?
The most effective form of nitroglycerin. Patient is typically on the cardiac floor, on a monitor and on a nitro IV drip. Vitals should be taken Q15 - Q1 hour - maximum.
What is the nitro IV typically used for?
Ischemic chest pain, Myocardial Infarction, Hypertension, Congestive heart failure & Pulmonary Edema
What does it mean when “MD order” reads “Titrate to affect to maintain a systolic BP of 100 or better..”?
Meaning the nurse adjusts the drip, goes up & down, because he/she has an MD order to titrate (or adjust) to make pt. PAIN FREE, the ultimate goal.
What are the general or adverse side effects of Nitroglycerin?
Headache and postural hypotension.
What is Postural hypotension?
Also called orthostatic hypotension, it is a drop in blood pressure associated with sitting up from a lying position or standing from a sitting position.
Why does a patient get dizzy or a headache from being on nitroglycerin?
Because the blood pressure is too low to get enough blood flow to the head and brain.
What symptoms are associated with postural hypotension?
Weakness, dizziness and syncope.
What is syncope.
Fainting or passing out.
How are oral Nitroglycerin products stored?
In original container with the cap tight and in a cool place. Must be discarded once it's expired or after 6 months.
How is transdermal Nitroglycerin stored?
Does not have to be kept in a cool place. Must be discarded once it's expired or after 6 months.
What does burning or a tingling sensation mean when taking nitroglycerin sublingually?
It indicates a positive sign of effectiveness of the drug.
How is IV nitroglycerin stored?
Always in a glass container mixed by the manufactuer.
What does "Q" mean for doctor's orders?
Every
What should a nurse instruct a patient being given nitro sublingually?
Not to chew or swallow it.
What are the home instructions for sublingual nitro?
Take nitro every 5 minutes for 15 minutes (three times). If still in pain call 911.
What is aspirin?
Acetylsalicylic acid inhibits platelet clumping. It is given as a preventative agent. Is also given when a person is experiencing an MI. Must watch bleeding times. Will increase bleeding time, especially for those on anticoagulants like coumadin.
What is an acute myocardial infarction (AMI)?
Occurs when there is an acute lack of blood flow to the heart that can result in myocardial tissue/muscle death/necrosis if not quickly intervened. Two direct causes 1. A thrombus formation from plaque or blood clot or 2. A spasmodic event
What are the goals for AMI care?
Limit or reverse damage to heart/myocardial muscle.
Restore coronary artery blood flow to preserve myocardial function and prevent cardiogenic shock.
What are the initial drugs given for AMI?
Combination of many pharmacologic agents used.
Primary initial agents.
- Nitroglycerine to dilate the coronary arteries
- Aspirin to keep platelets from sticking
- Morphine Sulfate
Why is morphine sulfate given for MI pain?
Causes coronary vasodilation and has anagelsic effects so it reduces the work load of heart.
Careful for hypotension with Morphine.
Preferred in specific types of AMI’s over others.
Why would you want to block the beta receptor sites with beta-adrenergic blocking agents?
To Reduce heart rate, Reduce contractility and Reduce blood pressure
Give some examples of beta blockers and state which one is non-selective.
Atenolol, Propanolol and Metoprolol. Propanolol is the non-selective agent, or Enderol.
What are the side-effects of non-selective beta blockers?
Flushing, bradycardia, and bronchospasm. They are never given to patients with COPD or asthma.
What does COPD stand for?
Chronic obstructive Pulmonary Disease.
Why are people with asthma put on a selective beta blocker?
A non-selective beta blocker will affect both beta one and beta two sites, the heart and the lungs. Beta one will vasodilate, but beta two will bronchoconstrict. One drug does both, unless it is a selective agent.
What kind of drugs typically end in "ol".
Beta blockers.
What do Ace and ARBs inhibitors do?
Decreases O2 demand. Should be given 24 hour following a STEMI.
What are some examples of ACE and ARB inhibitors?
Captopril, Lisinopril and Losatran.
What is a STEMI?
A heart attack characterized by the ST elevation in the EKG, very serious.
What do calcium channel blockers do?
Reduces calcium ion influx: Reduction of myocardial oxygen demand and increasing oxygen supply. Slows down the hearts contraction.
Give some examples of calcium channel blockers.
Verapamil, Cardizem, Amlodipine and Nifedipine.
What are the side effects of calcium channel blockers?
Hypotension, Dizziness and flushing
What are the drugs that typically end in "il"?
Calcium channel blockers.
What are diuretics used for?
To remove sodium and water.
What are Antihypertensives used for?
To lower blood pressure.
What are diuretics and antihypertensives used together for?
To treat hypertension.
What is fluid balance dependent on?
The reabsorption of sodium.
Where does the reabsorption of sodium happen?
In the glomerulus of the nephron of the kidney.
What is the glomerulus?
The filtering factory of the nephron of the kidney.
What happens in a compromised kidney, like one with Chronic Renal Failure or Polycystic Kidney Disease?
Sodium is not reabsorbed or excreted efficiently.
What happens when sodium accumulates in the body?
Sodium will hold onto to fluid and it will build up in the body leading to generalized body edema or anasarca or ascites.
What is anasarca?
A pronounced, generalized edema throughout the body.
What is ascites?
Fluid buildup in the peritoneal cavity of the abdomen.
What does a patient need when they have anasarca or ascites?
Diuretics.
What is the Renin-Angiotensin System?
A hormone system that regulates blood pressure and water (fluid) balance.
What are the classifications of Diuretics?
1-Thiazide diuretics
2-Loop diuretics
3-Potassium-sparing diuretics
4-Osmotic diuretics
5-Carbonic anhydrase inhibitors
6-Combination potassium-sparing and hydrochlorothiazide diuretics
What does the removal of excess fluid result in?
Decreased preload and Decreased total peripheral resistance. Essentially, a Decreased workload of the heart, and decreased blood pressure.
What is important to keep in mind regarding sodium and potassium?
Where there is activity with sodium, there is a concurrent exchange with Potassium. Too much/not enough potassium can lead to lethal arrhythmias.
What are the adverse side effects of thiazide diuretics?(important!!)
Hypokalemia - patient's on thiazide often need potassium supplements, Hyperglycemia, Hyperuricemia and cardiac glycoside toxicity.
What is hypokalemia?
Lack of potassium, muscle weakness.
What is hyperglycemia?
High blood sugar
What is hyperuricemia?
Too much uric acid/ gout.
What is cardiac glycoside toxicity?
Bradycardia, visual disturbances and nausea/ vomiting.
What are the most commonly seen thiazides?
Indapamide/Lozol & hydrochlorothiazide HCTZ, given PO only.
What are the nursing implications for thiazide diuretics?
Input and outputs should be monitored, Blood pressure should be monitored (orthostatic hypotension is a possibility), the patient's weight should be monitored, as well as potassium levels and teaching should include potassium rich foods as part of the diet.
How do loop diuretics work?
They inhibit sodium and chloride reabsorption and their site of action is directly on the ascending limb of the loop of Henle. They are more potent than thiazides.
What are the side effects of loop diuretics?
1. Dry mouth
2. Potassium depletion (hypokalemia)
3. Hearing loss/Ototoxic
4. Fatigue
5. Dehydration
6. Hypotension
7. Cardiac glycoside toxicity - bradycardia, visual disturbances, N/V
What are the most common Loop diuretics?
Lasix (Furosemide) - PO, IM and IV
Bumex (Bumetanide) - PO, IM and IV
What are the nursing implications for loop diuretics?
Input and output should be monitored, BP and weight should be monitored, potassium levels should be monitored and it's very important to remember that lasix needs to be pushed very slow because it is ototoxic.
What does ototoxic mean?
Having a toxic effect on the ear, especially on its nerve supply.
How do potassium-sparing diuretics work?
They inhibit aldosterone, which holds onto water and they also inhibit potassium excretion, so these drugs conserve potassium. They are not as potent as loop and thiazides, so they are often used with loop and thiazide diuretics and so potassium levels should be monitored as they may be too high.
What are the nursing implications for administering potassium-sparing diuretics?
Watching potassium levels as they may be too high and patient teaching should include avoiding a high potassium diet and making sure the patient isn't taking potassium supplements.
What are the most common potassium-sparing agents?
Aldactone/Spironolone PO only
Made to hold onto potassium because Thiazides & Loop diuretics spill lots of potassium.
If on supplements can have too much potassium. Always monitor levels!!!
How do osmotic diuretics work?
They produce a profound diuretic effect by osmotic pressure. Mostly seen to treat increased intracranial pressure
Example: Mannitol - IV only
Describe carbonic anhydrase inhibitors.
Carbonic anhydrase is a normal enzyme found in the body. It is a very weak diuretic, not used often. Most commonly used to decrease intraocular pressure and to treat glaucoma.
Methazolamide PO
Why are Potassium-Sparing and Hydrochlorothiazide Diuretics used in combination?
Made to decrease the adverse effects of Hypokalemia from thiazides and Hyperkalemia from potassium-sparing diuretics.
What are the most commonly seen combination diuretics?
Aldactazide (Spironolactone) & HCTZ (Hydrochlorothiazide)
Diazide (Triamterene) & HCTZ
Why should diuretics be taken in the morning?
Because the patient will be peeing a lot and it wouldn't make sense to take it before bed.
What is hypertension?
An abnormal increase in arterial blood pressure.
What are the risk factors for hypertension?
Age, race, obesity, smoking, drinking, genetics, sedentary lifestyle, too much sodium in the diet, stress, high cholesterol, diabetes, kidney disease and sleep apnea.
What is CO and how is it calculated?
Cardiac Output is calculated by multiplying heart rate by stroke volume.
What is the cardiac output for an average adult?
4-8 liters/minute
What does SVR stand for and what's another name for it?
Systemic Vascular Resistance also known as peripheral resistance.
What is a normal blood pressure?
120mm Hg/80mm Hg
How do Diuretics and antihypertensives work to decrease high BP?
Diuretics remove sodium and water as well as extracellular fluid (edema). Antihypertensives lower blood pressure, systemic/peripherally. Together they effectively control blood pressure.
What are the classifications of antihypertensives?
1-Diuretics
2-Central-acting antiadrenergics
3-Peripherally acting antiadrenergics
4-Beta-adrenergic blocking agents
5-Vasodilators
6-Angiotensin-converting enzyme inhibitors
7-Angiotensin II antagonists
8-Calcium channel blockers
9-Direct Renin Inhibitor
Why are diuretics considered an anti-hypertensive?
Because it removes fluid from the body which in turn decreases BP.
What are the two theories on how centrally acting anti-adrenergic agents work?
Theory 1: replaces norepinephrine in adrenergic storage sites or
Theory 2: sympathetic outflow from the central nervous system is decreased. Epinephrine and norepinephrine is decreased hence, no vasoconstriction.
What are the side effects of centrally acting anti-adrenergic agents?
Orthostatic hypotension and Sedation
What are the nursing implications for centrally acting anti-adrenergic agents?
- Do not abruptly stop, can have HTN crisis
- Instruct clients to change positions slowly because of orthostatic hypotension.
- High protein snack at bedtime will help with AM orthostatic hypotension.
- Better to take at HS because of sedative tendencies.
What are two commonly seen centrally acting anti-adrenergic agents?
Methyldopa (Aldomet) Mostly given PO, rarely IV.
Clonidine (Catapres) PO, Topical, SL
Also given for dope sickness/ withdrawl.
What are the two actions of the peripherally acting anti-adrenergic agents?
- Depletes/blocks norepinephrine, preventing vasoconstriction
- Blocks Alpha-adrenergic receptor sites
Name a Peripherally Acting anti-adrenergic.
Cardura (Doxazosin)- PO. Watch for Postural Hypotension
What is the action of the Beta-adrenergic blocking agents?
Inhibit beta1 and beta2 sympathetic receptors sites.
What do Beta-adrenergic blocking agents do?
Reduce heart rate
Decrease atrial and ventricular rhythms
Decrease blood pressure
What are Beta-adrenergic blocking agents also classified as?
Anti-arrhythmics.
What are the adverse side effects of Beta-adrenergic blocking agents?
Some can cause broncho-constriction. The non-selective agents effect Beta1 and Beta 2. They dilate the arteries, but constrict the bronchial tubes. Only the selective agents are safe for patients with lung issues because it blocks Beta1 only.
Name the five most seen Beta-adrenergic blocking agents.
Atenolol (Tenormin) PO
Metoprolol (Lopressor) PO & IV
Propanolol (Inderal) PO
Labetalol (Normodyne) PO & IV
Carvedilol (Coreg) PO
Of the five most seen Beta-adrenergic blocking agents, which one is non-selective?
Propanolol (Inderal) PO
Why are Vasodilators also considered an “anti-hypertensive agent”?
Anything that vasodilates lowers BP. Directly dilates the peripheral arterioles. Lowers the blood pressure by vasodilating smooth muscle
What is the action of Angiotensin-converting enzyme inhibitors, aka ACE Inhibitors?
Targets the KIDNEY. Antagonists to the renin angiotensin-aldosterone system.
What does angiotensin II do?
Produces potent vasoconstriction and stimulation of aldosterone.
What does aldosterone do?
Vasoconstricts and holds on to H20 from holding to NA.
What do ACE inhibitors do?
They prevent Angiotensin I conversion to angiotensin II, thereby preventing vasoconstriction and edema.
What kind of agents typically end in "il"?
ACE inhibitors.
What are the side effects of ACE inhibitors?
- Fatigue
- Dizziness
- Headache
- Dry, nonproductive cough
What are the most commonly seen ACE inhibitors?
Captopril (Capoten)
Enalapril (Vasotec)
Monopril (Fosinopril)
Lisinopril (Zestril,Prinivil)
- all PO
What are Angiotensin II Antagonists also known as?
Angiotensin Receptor Blockers (ARB’s)
What do ARBs do?
Allow angiotensin I to be converted to angiotensin II, but blocks some the receptors that receive angiotensin II resulting in reduced aldosterone in blood. Block vasoconstriction and release of aldosterone. Lowers blood pressure. It is Well-tolerated because Coughing is not a concern.
Name two commonly seen ARBs.
Cozaar (Losartan)
Diovan (Valsartan)
What is the action of calcium channel blockers?
- Dilate peripheral arterioles and reduce peripheral resistance
- Reduce the influx of calcium into the cell
What does it mean for a calcium channel blocker to reduce the influx of calcium into the cell?
Prevents spasms of the coronary arteries and Calcium responsible for muscle contraction. It is Used mostly in atrial arrhythmias, so they're known as antiarrhythmias.
What are the side effects of calcium channel blockers?
- Hypotension
- palpitations
- rash
- flushing
- dermatitis
What are the most commonly seen calcium channel blockers?
Diltiazem (Cardizem)
Verapamil (Calan)
Norvasc (Amlodipine)
Procardia (Nifedipine)
Describe the Renin inhibitor.
It is the Newest class of antihypertensives.
It Works by directly blocking Renin.
Only one drug is currently FDA approved.
Aliskiren Hemifumarante (Tekturna)
Describe Nipride (Nitroprusside Sodium).
It is given by IV only. Number one treatment in a HTN emergency. Must be on ICU. Do not stay on usually longer than 48 hours. Try to get off in 24. Risk for cyanide toxicity. Can be mixed by RN. Always covered in a dark bag
What is the alpha beta blocker used in HTN emergencies?
Labetolol HCL
What is the common cold?
A virus, such as the rhinovirus.
What does the rhinovirus do?
Initiates the inflammatory response invading the respiratory tract causing Nasal congestion, local edema (stuffy head), Resulting in post nasal drip from sinus’s
Sinus edema leads to decreased blood flow creating as greater medium for further infection.
What does a secondary infection typically consist of?
Sore throat (Pharyngitis)
Mucus builds up, throat irritated
Cough develops
How does inflammation work with the common cold?
Edema, vasodilation, decreased blood flow to affected area leading to possibly further infection.
Describe the allergic reaction.
When the allergen enters the body, mast cells, similar to an H2O balloon, breaks releasing histamine, secretions, mucus and inflammation.
Where is histamine 1 found?
The nose, eyes, respiratory tree, skin, and vasculature
What kind of agents typically end in "ol"?
Beta Blockers
What would be the treatment for a histamine reaction?
Anti-histamine
Where is histamine 2?
GI tract
If histamine 1 is found in the vasculature, what happens in a reaction?
Major vasculature collapse, no BP, anaphylactic shock.
What is the pathophysiology of the inflammatory response of an allergen in the respiratory tract?
Mast cells trigger the release of histamine 1 in response to the allergen. The histamine will dilate small blood vessels in the nasal sinuses, produce nasal congestion from mucus production and itching.
What is the treatment for histamine 1?
Antihistamines will dry out the sinuses.
What is the treatment for histamine 2?
GI meds
What are the effects of antihistamines?
Prevent dilation
Prevent increased permeability
Helps with itching
What are antihistamines used for?
Nasal allergies
Seasonal or allergic rhinitis
Allergic reactions
Motion sickness
What are the most common antihistamines?
Benadryl
Zyrtec (newer)
Chlor-Trimeton
Tavist
Dramamine- Used for motion sickness
Allegra (newer)
Claritin (newer)
Antivert- Given for vertigo & motion sickness
Phenergan-Given as an anti-emetic alone or in conjunction with an analgesia to prevent nausea
Name a very powerful antihistamine used for major allergic reactions.
Epinephrine
What does epinephrine do?
Stimulates Alpha, Beta 1 and Beta 2 sites.
How do the newer antihistamines stand out from the older ones?
They work peripherally and do not affect the central nervous system (CNS) therefore they eliminate sedation.
In the agents Allegra D and Claritin D, what does the "D" stand for?
Decongestant
If the decongestant in Claritin D is pseudoephedrine, who should not be taking it and why?
People with ischemic heart disease or high blood pressure because it can cause blood pressure to go higher.
What are the nursing implications (client teaching) for traditional (sedating) antihistamines?
Avoid driving
No alcohol
No central nervous system depressants
What are the two main types of nasal decongestants used?
1. Alpha adrenergics which stimulate, or constrict dilated blood vessels, drying nasal mucosa
2. Corticosteroids which reduce inflammation
What are the two forms that nasal decongestants come in?
Oral and Topical (nasal spray).
What are the adverse side effects for decongestants (PO & spray)?
Nervousness
Insomnia
Palpitations and tachycardia
Tremors
What are the adverse side effects of nasal steroid spray?
Local mucosal dryness and irritation.
What are Oral/Nasal Decongestants & Nasal Steroids spray used to treat?
Acute or chronic rhinitis
Common cold
Sinusitis
Hay fever
Other allergies
What is the most commonly seen oral decongestant?
Pseudoephedrine. Not good for people with ischemic heart disease because it can give unwanted cardiac side effects like palpitations and tackycardia.
What is the most commonly seen nasal spray?
Afrin
What are the most commonly seen nasal steroids?
Flonase, Nasonex & Beconase
What do expectorants do?
Aid in the expectoration (removal) of mucus
Reduces the viscosity of secretions by loosening and thinning sputum
The tendency to cough is diminished.
What do antitussives do?
Diminishes cough reflex
Drugs that are used to control coughing
Opoid and non opiod forms
Used for productive and non productive coughs.
What is a sympathomimetic?
An agent that mimics the stimulation of the sympathetic nervous system.
Name the bronchodilators.
1-Sympathomimetic agents
2-Xanthine bronchodilators
3-Leukotriene receptor antagonists
4-lipoxygenase inhibitors (review on own)
5-Phosphodiesterase Type 4 (PDE 4 Inhibitor
6-Anticholinergics
What are the Nursing Implications for patients taking inhaled medications?
Patients with asthma/COPD may be on a combination of bronchodilators, mast cell stabilizers & inhaled steroids.
Take only as prescribed…..
Take the bronchodilator FIRST!!
Bronchodilator’s can be used in acute situations..
Instruct patient not to take inhalers as much as they like, only as prescribed.
What are bronchodilators?
Medications used to relax and open the airways
Open or maintain the bronchial airways
Treat several disease syndromes such as
Chronic obstructive pulmonary disease
Asthma
What happens during an allergic reaction?
An antigen/irritant enters the body.
The antigen binds with a mast cell.
When cell is re-exposed to the antigen over time it responds by releasing the following chemical substances.
Histamine (See previous Chapter)
Leukotrienes: Fatty Molecules that trigger inflammation when exposed to an allergen and “alter cellular activity” Ie some say it can weaken the cell wall of Mast cells
Explain the Concept of giving multiple types of bronchodilators and other Respiratory agents.
Patients are prescribed a mix of classifications of bronchodilators because some are immediate/quick acting.
IE Albuterol
Some are long acting.
IE Steriods (Solumedrol, IV form & Prednisone, PO form)
Why would you Stimulate Beta2-adrenergic receptors ?
Used during the acute phase of asthmatic attacks and as preventive measures
Quickly reduce airway constriction and restore normal airflow.
What are sympathomimetics used for?
Treat acute attacks, Albuterol (Lasts 4-6 hrs.), as well as prevent attacks,
Longer acting, Serevent, lasts (10-12 hours)
Quickly reduce airway constriction and restore normal airflow
Relief of bronchospasm, bronchial asthma, bronchitis, and other pulmonary diseases.