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51 Cards in this Set

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What assessments are necessary for administration of Digoxin and what actions are appropriate?
Apical pulse greater than 60bpm and check e-lytes too.
If apical pulse less than 60bpm contact Dr.
Part of Vital Signs and typical lab work<br />
What condition predisposes to Digitalis Toxicity?
e-lyte disorders(hypokalemia)
People with low___ should eat a banna a day
What is a negative chronotropic effect?
decrease in heart RATE
chronotropic means decrease
What is Digibind and why is it indicated?
Digibind is a antidote for severe Digitalis toxicity. It binds to free Digoxin and negates its effect
Digibinds actions are part of its name
What are the adverse effects/risks associated with Milrinone(Primacor)administration?
Ventricular dsyrhythmias and Hypotension
What is the normal therapeutic levels of Digoxin?
0.2 to 2ng/l
Narrow therapeutic index
What drugs interact with Digitalis?
Adrenergics, antacids, beta blockers amioderone verapimil, anticoagulants and additional antidysrhythmics
What is the drug of choice for ventricular dysrhythmias with MI?
Also is used as anesthetic
What are the adverse effects of Lidocaine?
CNS toxicities (confusion, lethargy, etc..), decrease heart rate, decrease BP and respirations
think of anesthetic actions and what it does for pain
What should you monitor for with the Class IV antidysrhythmics?
Hypotension, heart failure, sick sinus syndrome, edema AV conduction
You monitor these signs with any heart patient
What are the classic symptoms of Digitalis toxicity?
Anorexia, nausea and vomiting
you have no___ when you are sick. you may even have ___ and ___ with the flu.
What are some life-threatening effects of Digitalis toxicity?
Severe bradycardia, advanced heart block and ventricular tachycardia or fibrillation
These signs appear just before MI
What are the 2 main categories of Positive Inotropic Agents?
Cardiac Glycoside and Phosphodiesterase
P part of ATP and another name for sugar
What is the path of conduction in the heart?
SA node-> AV node->Bundle of HIS->Perkinje Fibers
What is the definition of Ejection Fraction?
amount of blood ejected with each contraction compared with the total amount of blood in the ventricle before contraction (should be 65%)
Symptoms of Congestive Heart Failure?
Dyspnea, cough, jugular vein distention, ascites (fluid build up in abd. or chest cavity)
Route of Blood flow
R atrium, R ventricle, lungs, L atrium, L ventricle, body
Causes of CHF
Cardiac defect ie: MI, valve insufficiency

Diabestes, Cornary Artery Disease, Increased workload ( Hypertension, anemia, thyroid disease hyperbolemia(excess fluid))
Definition of Positive Inotropic effect
increases FORCE of and VELOCITY of myocardial contraction
Definition of Negative Inotropic effect
decreases heart RATE
Definition of Negative Dromotropic effect
decreases CONDUCTION at the SA node
Therapeutic uses of Cardiac Glycosides
Supraventricular Arrhythmias
Side and Adverse effects of Cardiac Glycosides (Digoxin)
bradycardia, any dysrhythmia, anorexia, nausea, vomiting, headache, fatigue confusion, visual disturbances
What to do for Digitalis toxicity/overdose
possibly skip next dose ( if ordered)
check K+ levels
heart monitoring
Patient teaching for Digoxin
take same time of day
never double/skip doses, don't change brands, whatch for side effects, eat high K+ Foods
Therapeutic uses for Phosphodiesterase
end stage heart failure
What to assess before adminstration of milrinone (Primacore)?
e-lytes, cardiac function, BP
When to use Amiodarone (Cordarone)
LAST CHOICE! for V-tach or V-fib resistant to other drug therapy
Side/adverse effects of Amiodarone (cordarone)
Numbness/tingling, uncontrolled shaking, headache, weakness, fatigue, N/V, visual disturbances, fainting episodes
Class IV antidysrhythmics
Cardizem (Diltiazem)
Calan, Isoptin (verapamil)
Drug interactions with Class IV (cardizem, diltazem, verapamil,calan)
Digoxin, antihypertensives, sulfonamides
Proper adminstration of Nitroglycerin ointment
1-2 in ribbon q8h up to 4-5 inch ribbon q4h
Proper andminstration of IV Nitroglycerin
non PVC bags
only with infusio pumps
dilute in 5% dextrose or 0.9% sodium choloride
Patient teaching for sublingual nitroglycerin tablets
take at first sing of angina
take in supine postion (on back)
1 tab q5min for 15 min(up to 3 tabs)
NEVER swallow tabs
Types of Angina
Chronic stable angina
Unstable angina
Vasospastic angina
Definition of Chronic stable angina
Long term but stable level of obstruction in 1 or more coronary arteries. Caused by atherosclerosis. Exertion or stress triggered
Definition of Unstable angina
early stage of progressive CAD. Increase in severity and frequency
Definition of Vasospastic angina
Ischemia induced caused by spasms of the coronary arteries. Happens often at rest and without precipitating factors
How does smoking interact with use of nitrates and nitrites?
reduce effectiveness
Administration of transdermal nitroglycerin patches
Hairless part of body
clean skin before new patch is attached
How can you avoid tolerance when using transdermal nitroglycerin?
remove patch for 8 hours at night
Patient teaching for MINIPRESS
DO NOT stop abruptly
careful with warm temps
Watch otc's and herbal
4-6 weeks for full therapeutic effects
change positions slowly
call M.D. if weight gain greater than 5lbs/wk
ACE inhibitors with patients having MI and with liver dysfunction
MI= minimize/prevent ventricular remodeling (L ventricular dilation/dysfunction). decreases risk for heart failure
What factors influence the regulation of atrial blood pressure?
Cardiac outputxSystemic Vascular Resistance
What common side effect with male patients taking antihypertensives?
sexual dysfunction
What group of drugs has a persistent cough as and adverse effect?
ACE inhibitors
Patient Teaching for Natrecore and Primacore (milrinone)
take at same time daily, NEVER double dose, don't change brands, watch otc's and herval remedies, Pt. check own pulse, don't take with dairy products or antacids, consume high Potassium foods, don't d/c abruptly
Adrenergic Agent Mechanisms of Action
Centrally acting
Stimulate alpha2 receptors
Peripherally Acting
Depletes store of NE
Decreases stimulation of
not commonly used
Alph 1 Blockers
decrease the BP by
blocking stimulation
ACE inhibitors mechanism of action
prevent breakdown of bradyjkinin (vasoditating substance), prevent the formation of angiotensin II, prevent sodium and water resorption
Side and Adverse Effects of ACE inhibitors
Dizziness, mood changes, headaches, first dose hypotensive effect
Nursing Consideration of ACE inhibitors
May take several weeks before full benefits, report signs of infection and easy bruising, report any weight gain or loss, impaired taste goes away in 2-3 months, don't take potassuim supplemnets