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51 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What assessments are necessary for administration of Digoxin and what actions are appropriate?
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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 />
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What condition predisposes to Digitalis Toxicity?
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e-lyte disorders(hypokalemia)
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People with low___ should eat a banna a day
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What is a negative chronotropic effect?
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decrease in heart RATE
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chronotropic means decrease
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What is Digibind and why is it indicated?
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Digibind is a antidote for severe Digitalis toxicity. It binds to free Digoxin and negates its effect
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Digibinds actions are part of its name
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What are the adverse effects/risks associated with Milrinone(Primacor)administration?
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Ventricular dsyrhythmias and Hypotension
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What is the normal therapeutic levels of Digoxin?
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0.2 to 2ng/l
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Narrow therapeutic index
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What drugs interact with Digitalis?
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Adrenergics, antacids, beta blockers amioderone verapimil, anticoagulants and additional antidysrhythmics
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What is the drug of choice for ventricular dysrhythmias with MI?
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Lidocaine
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Also is used as anesthetic
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What are the adverse effects of Lidocaine?
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CNS toxicities (confusion, lethargy, etc..), decrease heart rate, decrease BP and respirations
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think of anesthetic actions and what it does for pain
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What should you monitor for with the Class IV antidysrhythmics?
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Hypotension, heart failure, sick sinus syndrome, edema AV conduction
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You monitor these signs with any heart patient
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What are the classic symptoms of Digitalis toxicity?
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Anorexia, nausea and vomiting
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you have no___ when you are sick. you may even have ___ and ___ with the flu.
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What are some life-threatening effects of Digitalis toxicity?
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Severe bradycardia, advanced heart block and ventricular tachycardia or fibrillation
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These signs appear just before MI
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What are the 2 main categories of Positive Inotropic Agents?
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Cardiac Glycoside and Phosphodiesterase
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P part of ATP and another name for sugar
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What is the path of conduction in the heart?
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SA node-> AV node->Bundle of HIS->Perkinje Fibers
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What is the definition of Ejection Fraction?
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amount of blood ejected with each contraction compared with the total amount of blood in the ventricle before contraction (should be 65%)
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Symptoms of Congestive Heart Failure?
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Dyspnea, cough, jugular vein distention, ascites (fluid build up in abd. or chest cavity)
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Route of Blood flow
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R atrium, R ventricle, lungs, L atrium, L ventricle, body
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Causes of CHF
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Cardiac defect ie: MI, valve insufficiency
Diabestes, Cornary Artery Disease, Increased workload ( Hypertension, anemia, thyroid disease hyperbolemia(excess fluid)) |
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Definition of Positive Inotropic effect
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increases FORCE of and VELOCITY of myocardial contraction
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Definition of Negative Inotropic effect
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decreases heart RATE
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Definition of Negative Dromotropic effect
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decreases CONDUCTION at the SA node
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Therapeutic uses of Cardiac Glycosides
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CHF
Supraventricular Arrhythmias |
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Side and Adverse effects of Cardiac Glycosides (Digoxin)
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bradycardia, any dysrhythmia, anorexia, nausea, vomiting, headache, fatigue confusion, visual disturbances
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What to do for Digitalis toxicity/overdose
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possibly skip next dose ( if ordered)
check K+ levels heart monitoring digibind |
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Patient teaching for Digoxin
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take same time of day
never double/skip doses, don't change brands, whatch for side effects, eat high K+ Foods |
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Therapeutic uses for Phosphodiesterase
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CHF
end stage heart failure |
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What to assess before adminstration of milrinone (Primacore)?
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e-lytes, cardiac function, BP
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When to use Amiodarone (Cordarone)
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LAST CHOICE! for V-tach or V-fib resistant to other drug therapy
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Side/adverse effects of Amiodarone (cordarone)
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Numbness/tingling, uncontrolled shaking, headache, weakness, fatigue, N/V, visual disturbances, fainting episodes
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Class IV antidysrhythmics
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Cardizem (Diltiazem)
Calan, Isoptin (verapamil) |
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Drug interactions with Class IV (cardizem, diltazem, verapamil,calan)
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Digoxin, antihypertensives, sulfonamides
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Proper adminstration of Nitroglycerin ointment
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1-2 in ribbon q8h up to 4-5 inch ribbon q4h
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Proper andminstration of IV Nitroglycerin
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non PVC bags
only with infusio pumps dilute in 5% dextrose or 0.9% sodium choloride |
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Patient teaching for sublingual nitroglycerin tablets
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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 |
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Types of Angina
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Chronic stable angina
Unstable angina Vasospastic angina |
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Definition of Chronic stable angina
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Long term but stable level of obstruction in 1 or more coronary arteries. Caused by atherosclerosis. Exertion or stress triggered
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Definition of Unstable angina
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early stage of progressive CAD. Increase in severity and frequency
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Definition of Vasospastic angina
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Ischemia induced caused by spasms of the coronary arteries. Happens often at rest and without precipitating factors
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How does smoking interact with use of nitrates and nitrites?
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reduce effectiveness
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Administration of transdermal nitroglycerin patches
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Hairless part of body
clean skin before new patch is attached |
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How can you avoid tolerance when using transdermal nitroglycerin?
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remove patch for 8 hours at night
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Patient teaching for MINIPRESS
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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 |
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ACE inhibitors with patients having MI and with liver dysfunction
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MI= minimize/prevent ventricular remodeling (L ventricular dilation/dysfunction). decreases risk for heart failure
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What factors influence the regulation of atrial blood pressure?
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Cardiac outputxSystemic Vascular Resistance
(COxSVR) |
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What common side effect with male patients taking antihypertensives?
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impotence
sexual dysfunction |
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What group of drugs has a persistent cough as and adverse effect?
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ACE inhibitors
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Patient Teaching for Natrecore and Primacore (milrinone)
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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
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Adrenergic Agent Mechanisms of Action
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Centrally acting
Stimulate alpha2 receptors Peripherally Acting Depletes store of NE Decreases stimulation of heart not commonly used Alph 1 Blockers decrease the BP by blocking stimulation |
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ACE inhibitors mechanism of action
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prevent breakdown of bradyjkinin (vasoditating substance), prevent the formation of angiotensin II, prevent sodium and water resorption
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Side and Adverse Effects of ACE inhibitors
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Dizziness, mood changes, headaches, first dose hypotensive effect
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Nursing Consideration of ACE inhibitors
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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
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