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153 Cards in this Set
- Front
- Back
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what is an inotropic?
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an inotropic is a medication that increases the force of myocardial contraction.
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what is the prototype for inotropics?
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digoxin (lanoxin)
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why do you give digoxin to a patient?
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digoxin is given to a patient that has a heart that isn't pumping efficiently.
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how does digoxin effect cardiac output?
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digoxin increases cardaic output
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how does digoxin effect heart rate?
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digoxin decreases heart rate
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what is used for atrial arrhythmias?
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digoxin
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how does digoxin work on atrial arrhythmias?
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digoxin depresses the AV node, negative dromotropic. stimulates the PSNS to bring heart back to normal.
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which medication is an indirect diuretic?
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digoxin
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what does digoxin depend on?
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normal electrolytes
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what is the normal range for K+?
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3.5- 5.0
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how does the body react if it has low K+ and receive digoxin?
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when patients have low K and receive digoxin it increases the risk of didge toxicity.
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what is the normal level for Ca2+?
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8.5-10
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what happens when a patient has elevated Ca2+ and are given digoxin?
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if calcium levels are more than 10 digoxin increases the risk of didge toxicity
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what is calcium's role in heart contractility?
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Ca2+ increases contractility of the heart
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what is the normal limit of Mg+?
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the normal limits of Mg is 1.3- 2.5
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does low or high Mg increase the risk for didge toxicity?
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low Mg can increase risk of didge toxicity.
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what effect does digoxin have on the heart rate?
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digoxin slows the heart rate
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how is the heart's efficiency related to urine production?
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patients with a failing heart cannot circulate blood to the kidneys efficiently. An efficient heart circulates blood to the kidneys allowing the kidneys to produce more urine and help them get rid of fluid.
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what is digitalization of digoxin?
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digitalization is a "loading dose" or a dose to get the patient's heart going. 0.75 mg
1.0 mg in 3+ doses |
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which medication can treat CHF, atrial arrhymias, and sinus tachycardia?
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digoxin
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what is the therapeutic level of digoxin?
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0.5 -2.0, experts say 0.5 - 0.8 due to narrow margin of therapeutic and adverse effects
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what are the GI ADEs of digoxin?
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n/v, anorexia
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what are the CNS ADEs of digoxin?
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digoxin causes blurred vision, dipolpia (double vision), halos (too much didge, see blue green halo around it)
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what are the ADEs digoxin has on the heart?
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tachycardia, premature ventricular contractions (PVC)
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what is the most serious ADE of digoxin?
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ventricular fibrillation
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which contraindications should clinicians be aware of before they prescribe digoxin?
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digoxin can cause ventricular tachycardia, ventricular fibrilation, heart block, bradycardia
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what is heart block?
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conduction defect, conduction is blocked at AV node or further down
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what are the signs and symptoms of digoxin toxicity?
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low levels of K,
n/v confusion blurred vision bradycardia PVCs, |
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how do you treat for didge toxicity?
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stop dig, KCl, anti-arrhythmic, atropine for bradycardia, digibind that's given PO, binds with digoxin in GI and helps patient excrete it.
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how fast do SA nodes pump?
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SA nodes pump between 60-110 bpm
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how fast do AV nodes pump?
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AV nodes pump at 40-60 bpm
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how fast do ventricles pump?
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20-40 bpm
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what is the contribution of Na and glucose on heart function?
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Na and glucose hold fluid where it needs to be
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what does fibrinogen do?
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fibrinogen helps with clotting and homeostasis
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what are the two components of red blood cells?
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HCT (hemoatocrit) and HGB (hemoglobin)
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what are thrombocytes?
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platelets
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What helps circulate hormones, protect against microorganisms, and regulates temperature
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Conduction of the heart and blood circulation
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list the movement of heart conduction
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SA node --> AV node--> bundle of his --> right & left bundle branches --> Purkinje fibers
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which medication treats CHF?
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digoxin
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which medication treats atrial arrhythmias?
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digoxin
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which medication treats sinus tachycardia?
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digoxin
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what are the contraindications for digoxin?
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ventricular tachycardia
ventricular fibrillation heart block (2nd or 3rd degree) bradycardia |
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what do you want to assess before prescribing digoxin?
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allergies
HR- apical pulse for 60 seconds signs and symptoms of toxicity K level |
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what kind of nursing care interventions do you use with patients using digoxin?
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explain med regime, when they're supposed to take it
administer with meals or water to ensure it gets to the stomach encourage them to eat bananas due to K+ check radial pulse daily prior to taking medication to ensure it's 60 or higher do not skip a dose or double dose report ADEs |
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what is a dysrhythmia
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abnormal heart rhythm
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what are arrhythmias or dysrhythmias caused by?
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change in automaticity (change in rate)
change in conductivity (change in rhythm) |
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what brings on arrhythmias or dysrhythmias?
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hypoxia (low O2 levels)
ischemia (restriction of blood flow to tissues) myocardial infarctions, dying muscle K levels -- too high or low |
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what are the four types of arrhythmias?
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sinus arrhythmias
atrial arrhythmias nodal or junctional arrhythmias ventricular arrhythmias |
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how are sinus arrhythmias treated?
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bradycardia- atropine
tachycardia- beta blockers |
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where do nodal or junctional arrhythmias originate?
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nodal or junctional dysrhythmias originate in the AV node
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what is a ventricular arrhythmia?
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the heart has premature ventricular contraction
the most dramatic arrhythmias |
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what are the three states of the Na-K pump?
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1. polarized, resting, steady state
2. depolarization/ discharge state 3. repolarization or recovery state |
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what does the P wave in the EKG correspond with?
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The P wave corresponds with K moving extracellularly from the cell.
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what happens in the polarized/resting/ready state?
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Na & Ca are extracellular
K is intracellular |
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how does an anti-arrhythmic work?
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an anti-arrhythmic rudes the rate & conduction of an elecrical impulse
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what do class I anti-arrhythmics do?
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class I anti-arrhythmics are Na channel blockers
Block movement of Na into cardiac cells to slow conduction |
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what is the class IA anti-arrhythmic prototype?
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the class IA prototype is quinidine
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what is the class IB prototype?
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the class IB prototype is lidocaine (xylocaine)
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what is lidocaine used for?
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lidocine is used for rapid carduac arrythmics
givin IV |
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how is lidocaine metabolized?
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lidocaine is metabolized by the liver and excreted by the kidney.
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what are the side effects of lidocaine?
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hypotension, bradycardia,
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what are the lidocaine crazies?
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patients beocme dizzy, lightheaded, fatigued, euorpic or hallucinate
sometimes have to stop the drug and go to something else |
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what is the most serious ADE for lidocaine?
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cardiac arrest & seizures
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what is the prototype for class IC?
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flecanide (tambor)
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what do the class II anti-arrhythmics do?
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class II anti-arrhythmics are beta adrenergic blockers
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what is the prototype for class II beta adrenergic blockers?
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propranolol (inderal)
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how does propranolol (inderal) work?
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propranolol (inderall) blocks SNS to slow heart conduction
blocks SNS, slows down the heart, negative dromotropic negative inotropic |
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what do class III anti-arrhythmics do?
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class III anti-arrthymic meds block K channels, prolongs repolarization and prolongs repolarization
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what is the prototype for class III K channel blockers?
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amidarone (cardarone)
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what is the first line choice for tachyfibrilation?
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amidarone (cardarone)
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what are the ADEs for amiodarone?
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exacerbate the rhythm
pulmonary toxicity dypsnea |
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what are the contraindications for amiodarone?
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heart block
bradycardia |
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what are class IV drugs?
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class IV drugs are calcium channel blockers
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what is the prototype for class IV drugs?
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verapamil (calan)
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how do calcium channel blockers (IV) work?
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calcium channel blockers (IV) slow depolarization, decrease ventricular rate, slow movement
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what does verapamil (calan) treat?
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verapamil treats hypertension, angina, chest pain
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what is the ADE for verapamil (calan)?
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constipation
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which drug has an ADE of constipation?
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verapamil
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what are some non-pharmacological causes of arrhythmias?
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a severe infection or hypoxia
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What is valsalva?
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carotid artery massage
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what does a defibrillator do?
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a defibrillator is an electrical stimulus to stimulate the heart & get the AV node to take over again
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what is an ablation?
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an ablation is a procedure where clinicians put a cath inside the heart to map out the walls of the ventricle to stimulate the ventricle
uses electrical conduction to destroy non working cells |
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what is a ACID?
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automatic implantable cardioverter defibrillator
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what is angina?
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chest pain due to poor blood flow
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what causes increased myocardial O2 demand resulting in angina?
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exercise, stress, anxiety, cold weather, smoking
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what causes decreased myocardial O2 supply resulting in angina?
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atherosclerosis- hardening of arteries
arteriosclerosis- thickening or hardening of the arteries, plaque diabetes due to vascular changes |
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what are non-pharmacological therapy remedies for angina?
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stop & rest
stop smoking weight loss decrease fat intake relaxation stress management |
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what are the three classifications of anti-anginal medication?
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1. nitrates
2. beta blockers 3. calcium channel blockers |
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how do anti-anginal medications work?
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all work by decreasing myocardial O2 demand
increasing blood supply to the myocardium |
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what is the prototype for organic nitrates?
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the prototype for organic nitrates is nitroglycerine (nitrostat)
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how do nitrates (nitroglycerine, nitrostat) work?
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dilates veins to decrease preload
dilates coronary arteries to increase myocardium flow dilates arterioles to decrease afterload bringing oxygenated blood to the area where it is needed lower blood pressure pressure in the left ventricle will contract up and out of demand for O2 decreases, angina decreases |
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what is the contraindication of nitrates?
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can't use with viagra or levitra because it will lower blood pressure
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someone with ______ BP should not take nitrates
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less than 90
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what form can nitrates be given?
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IV or via patch
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when a patient gets angina at home, how should you instruct they should take it?
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apply the patch, wipe it off and put it in a place where children cannot get it
take once and if the pain doesn't go away, take another and call 911. |
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what is the prototype of anti - anginal, beta adrenergic blockers?
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propranolol (inderal)
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how does propanolol (inderal) work?
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propranolol decreases heart rate, negative chronotropic/ negative inotropic
decreases blood pressure, decreases myocardial workload and O2 demand |
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is propranolol used for daily management?
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yes, propranolol is used for daily management.
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what are the ADEs for propanol?
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bradycardia, hypotension, bronchoconstriction
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what is the prototype of calcium channel blockers?
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verapamil (calan)
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how does calan work?
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More O2 to the heart while the oeripheral arteries get decreased BP
decreased in afterload so the heart doesn't have to work as hard slows depolarization, the movement of extracellular Ca into the cell |
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how does calan affect the coronary and peripheral artery?
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calan dilates the peripheral artery to decrease afterload
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how does calan effect myocardial contraction?
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calan decreases contraction, negative inotropic
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how does calan affect heart conduction?
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calan is a negative dromotropic that depresses conduction
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what are the ADEs of calan?
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constipation, ventricular arrhythmias
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what are normal levels of electrolytes?
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Na: 135- 153
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what are normal levels of K?
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3.5- 5.2
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what is the prototype for thiazides?
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cholorothiazide (diruil)
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what are the uses for cholrothiazide?
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HTN, edema, CHF
not for immediate diuresis |
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what is the prototype for loop?
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the prototype for loop is furosemide (lasix)
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what are the uses for furosemide?
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HTN, edema, CHF/renal diuresis
rapid, immediate diuresis |
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that is the prototype for K+ sparing diuretics?
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spironolactone (aldactone)
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what are the uses for aldactone?
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HTN, liver disease
not used in renal disease/ do NOT use K supplements |
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what is the prototype of osmotic diuretics?
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prototype: mannitol (osmitrol)
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what are the uses for mannitol (osmitrol)?
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increased ICP, glaucoma, oliguria/anuria
short term IV use |
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how does nitroglycerine affect the coronary arteries
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dilates coronary arteries to increase the mycardiaum blood flow
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how does nitroglycerine affect the arterioles?
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nitroglycerine dilates the arterioles to decrease afterload
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how does nitroglycerine affect the left ventricle?
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nitroglycerine pressures the left ventricle to contract up and out when O2 decreases so angina decreases
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if a patient has a sulfa-antibiotic allergy, which medication would they also be allergic to?
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any of the thiazides
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are thiazides for daily use?
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yes, thiazides are for daily use
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what is the first line force for a patient with hypertension and needs a diuretic?
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thiazide (cholorthisize, diuril)
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how long does it take a thiazide to work?
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2-4 hours, not for acute situtations
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where does furosemide (lasix) work in the kidney?
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furosemide (lasix) works in the loop of henle
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is mannitrol (osmitrol) for long or short term use?
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short term use, IV
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What is the normal electrolyte level for Cl?
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95-110
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how does mannitol (osmitrol) affect the kidney?
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mannitol (osmitrol) delivers additional fluid to the kidneys
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what is thiazie-thrombocytopenia?
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thiazie-thrombocytopenia is low platelets level
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what does HTN increase the patient's risk for?
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MI, CHF, CVA, hemorrhage, rental disease
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what does CO equal?
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HR * SV (systolic pressure)
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What does BP equal?
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combination of CO & PVR (pulmonary vascular resistance)
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what other two systems also regularly BP?
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nervous system & hormonal system
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is the renal system fast or slow at regulating BP?
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The renal system is slow at regulating BP
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what is the first choice of diuretic for HTN treatment?
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thiazide or loop
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If one medication doesn't work, then what should the clinician do?
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if one medication doesn't work then the clinician should prescribe another in a small dose to minimize ADEs.
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what are the three first line HTN drugs?
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angiotensin converting enzyme inhibitors
antiotensin II receptor blockers (ARBs) Ca channel blockers |
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what is the prototype of angiotensin converting enzyme inhibitors?
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the prototype of angiotensin converting enzyme inhibitors is captopril (capoten)
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what does captopril (capoten) do?
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captopril (captoen) blocks enzyme that causes ANG I to convert to ANG II
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does captotril increase or decrease blood afterload?
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captotril decreases blood afterload
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does captopril increase or decrease aldosterone production? How does it affect preload?
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Captropril decreases aldosterone production: decreasing preload
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what is captropril often used with?
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captropil is often used with thiazide diuretic
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What is the ADE of captropril?
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dry cough (interferes with sleep)
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What is the serious ADE of captopril?
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angioedema- swelling around airways/face
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what is captropril's black box warning?
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captropril cannot be used in the second or third trimester of pregnancy
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what is the prototype for angiotensin II?
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the prototype for angiotensin II receptor blockers is iosartan (cozaar)
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how does iosartan (cozaar) work?
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iosartan blocks ANG II from acting by blocking the receptor iste
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what affect does isosartan have on the arterial BP? How does it work?
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Isosartan decreases arterial BP by decreasing PVR
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what does isosartan treat?
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HTN, heart failure
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what are the ADEs for iosartan (cozaar)
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upper respiratory infections, dizziness
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what is the black box warning for isosartan?
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avoid isosartan in the 2nd or 3rd trimester of pregnancy
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how does verapamil (calan) treat HTN?
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antiarrhythmic, antiaginal, antihypertensive
decreases BP by decreasing PVR dilate peripheral arteries by slowing Ca movement into smooth muscle |
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what is verapamil good for?
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good for patient with migraines and cannot take beta blockers due to pulmonary problems
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what is verapamil's category for tetragenicity?
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category C
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what does verapamil treat?
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HTN & heart failure
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