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91 Cards in this Set
- Front
- Back
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Factors controlling BP (3)
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-The Pump (cardiac output)
-The Pipes (Peripheral Vascular Resistance) -The Water (Blood Volume) |
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Cardiac Output includes...(The pump)
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-Heart Rate
-Stroke Volume |
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Peripheral Vascular Resistance includes..(the Pipes)
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-Vasodilation
-Vasoconstriction |
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Blood Volume includes...(the water)
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-Fluid Loss
-Fluid Retention |
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4 types of Antihypertensives
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Ace Inhibitors
Beta Blockers Calcium Channel Blockers Diuretics |
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Angiotension II
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formed by angiotensin converting enzyme (ACE)
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Angiotensin II has 3 effects..
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-**vasoconstriction**
-Release of ADH (antii diuretic hormone) - Release of aldosterone |
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Angiotensin II increases BP by...
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-increasing PVR (peripheral vascular resistance)
-increase Blood Volume (water retention) |
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Heart Failure
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ventricles of the heart cannot generate adequate cardiac output to meet body's metabolic needs
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Cardiac Output
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amount of blood pumped by each ventricle/minute (SVxHR)
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Contractility
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force of myocardial contraction
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Afterload
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pressure that the left ventricle must overcome in order to eject blood
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Preload
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degree to which the myocardial fibers are stretched prior to systole
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Frank-Starling Law
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the more the fibers are stretched, the more forceful they will contract
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Inotropic effect
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the ability to change the strength of myocardial contraction
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Chronotropic effect
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ability to change the heart rate
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Dromotropic effect
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the ability to change the speed of electrical conduction
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signs and Symptoms of Heart Failure
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-LV does not sufficiently pump
-Fluid "backs up" -fatigue, dyspnea, orthopnea, cough, crackles, pulmonary edema, peripheral edema |
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Goal for the medications to treat HF...
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increase cardiac output
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Medications to treat HF..
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-Ace Inhibitors (1st Line)
-Beta Blockers -Calcium Channel Blockers -Diuretics |
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How do ACE Inhibitors increase cardiac output? ( help HF)
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By decreasing Afterload (BP) allowing the heart to pump more effectively and therefore increasing cardiac output.
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How do Beta Blockers increase cardiac output? (help HF)
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Beta blockers reduce the heart's tendency to beat faster. Because pts with HF have excessive activation of the SNS, which damages the heart muscle.Given a low dose of BEta Blockers helps with cardiac remodeling.
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Angina
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(chest pain) acute, intense substernal chest pain caused by the insufficient supply of blood to the myocardium.
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Atypical manifestation
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mid-epigastric or abdominal pain
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Ischemia
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A decrease in the blood supply to a bodily organ, tissue, or part caused by constriction or obstruction of the blood vessels.
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Medications for Angina (NBC)
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Nitrates (1st line)
Beta Blockers Calcium Channel Blockers |
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ACE inhibitors (The Prils) MOA
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Prevent conversion of AGT I to AGT II, which lowers PVR and blood volume
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Example of ACE Inhibitor..
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Lisinopril ( Zestril)
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Contraindications of ACE inhibitors..
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Pregnancy
Angioedema |
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Angioedema
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allergic disorder in which large, localized, painless swellings similar to hives appear under the skin. The swelling is caused by massive accumulation of fluid (edema) following exposure to an allergen (a substance to which the person has been sensitized) or, in cases with a hereditary disposition, after infection or injury. The reaction appears suddenly and persists for a few hours or days, occurring most often on the face, hands, feet, genitals, and mucous membranes.
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Side Effects of ACE inhibitors
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decreased WBC's
cough hyperkalemia angioedema |
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Nursing considerations with ACE inhibitors..
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Monitor BP,WBC and K+
Profound hypotension with 1st dose |
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Patient teaching with Ace Inhibitors
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Report:
-difficulty breathing, throat tightness, facial or oral swelling -Flu-like symptoms -cough with SOB or CP -Signs of Hyperkalemia Change positions slowly Avoid KCL (salt substitute) and electrolyte beverages with K+ Take first few doses at bedtime |
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AGT Receptor Blockers (ARB)
"The Sartans" MOA |
Block AGT II receptors in arteriole smooth muscle (decrease PVR) and in the adrenal cortex(decrease blood volume)
*vessels primarily* |
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Side effects of ARB's (the sartans)
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hyperkalemia
angioadema kidney failure |
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Example drug of the ARB's (the sartans)
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Diovan (valsartan)
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Beta Blockers (the LOL's)..MOA
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Blocks the effects of SNS stimulation on the beta receptors (DECREASE HR, DECREASE CONTRACTILITY, and DECREASE CONDUCTION)
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Two types of Beta Blockers...
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-Cardioselective
-Non-Cardioselective |
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Cardioselective Beta Blockers are the...
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beta1 (heart)
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Non-cardioselective Beta Blockers are the...
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beta1 (heart) and beta2 (lungs)
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Example of cardioselective betablocker..
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Coreg (carvedilol)
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Example of non-cardioselective beta blocker...
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Tenormin (atenolol)
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What are the effects on the Beta1?
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decreased HR
decreased contractitility decreased constriction |
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What are the effects on the Beta2?
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Bronchoconstriction
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Side effects of the Beta Blockers..
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-decreased BP
-fatigue -increase or decrease of blood sugar |
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Contraindications of Beta Blockers..
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-dysrhythmias
-severe HF CAUTION: PTS With ASTHMA, COPD and Diabetes |
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Nursing Considerations with Beta Blockers..
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-check pulse (do not give if pulse is < than 60)
-Check Blood sugars (mask symptoms of Hypoglycemia) -Monitor HR and BP -DO NOT DISCONTINUE ABRUPTLY-----> REBOUND TACHYCARDIA (receptors become hypersensitive to E/EN) |
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Calcium Channel Blockers (the Pines)....MOA
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inhibits movement of calcium ions into smooth (selective) and cardiac (non-selective) muscle
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2 types of calcium Channel Blockers..
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-Selective
-Non-selective |
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Selective calcium channel blockers include....
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blood vessels only
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Non-selective calcium Channel Blockers include...
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heart and blood vessels
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Example of Selective Calcium Channel Blocker...
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Norvasc (amlodipine)
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Example of Non-Selective Calcium Channel Blocker....
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Cardizem (diltiazem)
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Effects of Selective Calcium Channel Blockers..
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relaxes smooth muscles of vasodilation---> decreasing PVR (afterload)
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Effects of Non-Selective Calcium Channel Blockers
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decrease contractility and conduction time
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Uses of Calcium Channel Blockers
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Angina
dysrhythmia (non-selective) |
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Contraindications with Calcium Channel Blockers..
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some dysrhythmias
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Side Effects of Calcium Channel Blockers....
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-Edema
-constipation (peristalsis) |
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Nursing considerations with calcium Channel blockers..
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avoid grapefruit juice, which increases absorption of calcium channel blockers.
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two types medications for HF..
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Cardiac Glycosides
Nitrates |
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Cardiac Glycosides MOA
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increase cardiac contractility by increasing Calcium and decreasing conduction.
---have a positive ionotrope effect |
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Example of cardiac glycoside..
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Digoxin
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Side Effects of Cardiac Glycosides (Digoxin)
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-Bradycardia
-arrhythmias -anorexia N/V |
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Nursing considerations with Cardiac Glycosides (digoxin)
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-monitor K+ levels (3.5-5.0)
Hypokalemia increase the risk of toxicity and dysrhythmias |
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Antidote for Digoxin
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Digibind
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Digitalization
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giving loading dose achieves more rapid therapeutic level
--therapeutic range (0.5-1.8) --1.8 = toxic |
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Duration of action in Digoxin..
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2-4 days
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Patient teaching with Digoxin..
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-increase dietary K+ rich foods
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Signs and symptoms of HF
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-Fluid increase
-weight gain (2 lbs a day) (1 liter) -Edema (lower extremities) -crackles/SOB |
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Nitrates MOA
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Dilate veins (decrease preload, decrease CW), arterioles (decrease afterload, decrease CW), and coronary arteries (decrease O2 to myocardium)
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Example of Nitrates..
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Nitroglycerin
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Route of short acting Nitrates...
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Sublingual and IV
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Route of long acting Nitrates...
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PO and transdermal
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Interactions with Nitrates
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VIagra, Cialis,Levitra-DO NOT USE with in 24 hours (bottoms out BP)
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Side effects of Nitrates
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-headaches (treat with Tylenol)
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Nursing considerations with Nitrates..
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Monitor BP and Pulse prior to and after administration.
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Pt teaching with Nitrates (SL route)
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-sit or lie down before taking SL med
-Place 1 tablet under tongue, wait 5 minutes x 3 -If no relief of CP after 3 tablets call EMS -Do not chew or swallow nitroglycerin -Keep SL med in same container away from heat, light, and moisture. -Replace supply every 6 months |
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Short acting nitrates...
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relief of acute attack of CP
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Long acting nitrates...
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prevention of angina
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Uses of Nitrates..
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Angina (acute and prophylactic treatment)
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The NBC's of Angina...
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Nitrate (1st line)
Beta Blockers Calcium Channel Blockers |
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What is given sublingually to treat Angina?
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Nitroglycerin
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Degree to which the mycardial fibers are stretched prior to constriction, which is dependent on the amount of blood in the chambers?
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Preload
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Caused by the insufficient oxygen to the myocardium?
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Angina
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The inability of the ventricles to pump enough blood to meet the body's metabolic demands?
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Heart Failure
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What increases coronary blood flow by dilating coronary arteries and produces vasodilation?
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Nitroglycerin
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What inhibits the transport of calcium into myocardial and vascular smooth muscle resulting in inhibition of muscle contraction?
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calcium Channel blockers
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diltiazem (Cardizem)
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calcium channel Blocker
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What blocks the stimulation of beta1 adrengic receptors?
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Beta-adrengic blockers
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What blocks the conversion of angiotensin I to the vasoconstrictor angiotensin II?
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ACE inhibitor
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Toprol XL (metoprolol)
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Beta blockers
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