Nclex-Pharm-Cardiac Drugs

Front 1

What are side effects are important to watch with calcium channel blockers?

Back 1

Hypotension, peripheral edema, flushing headache and GI upset.

Front 2

What side effects are important to watch with beta-adrenergic blockers?

Back 2

Bradycardia, Lethargy, GI disturbance, hypotension, CHF, bronchospasms, depression and impotence.

Front 3

What is the action of ACE inhibitors?

Back 3

Blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor. This block causes vasodilation and therefore decreases PVR, resulting in a decrease in sodium and water retention.

Front 4

What is the action of Beta-adrenergic blockers?

Back 4

Prevent sympathetic stimulation of the heart (blocks beta-receptors in the heart) which causes:

Decreased HR, Decreased Force of contraction and decreased rate of AV conduction.

Front 5

What is the action of Calcium Channel Blockers?

Back 5

Blocks calcium influx into the beta-receptors, decrease the force of the myocardial contraction, reduce the heart rate and decrease PVR>

Front 6

What is the typical drug therapy plan for a patient beginning anti-hypertensive therapy.

Back 6

The initial drug selection starts with a thiazide diuretic, typically followed by a beta-adrenergic blocker or an ACE inhibitor or CCB.

Front 7

When using Beta-adrenergic blockers, ACE inhibitors or Calcium Channel Blockers what is one very important nursing teaching the refers to how they should be taken?

Back 7

DO NOT stop taking medication abruptly.

Front 8

What are important nursing actions to do prior to administering a Beta-blocker?

Back 8

-Evaluate BP and pulse for significant changes.
-Hold is SBP is below 90 mmHg

Front 9

What is important to know about diabetic patients taking beta-blockers?

Back 9

Tachycardia (a symptom of hypoglycemia) is often masked as a result of beta1 blockade.

Front 10

What hint can be used to identify beta-blockers?

Back 10

They end in OLOL.

ex: Propranolol (Inderal), Atenolol (Tenormin)

Front 11

What is the difference between a cardioselective beta blocker and a nonselective beta blocker? Give examples of each.

Back 11

Propranolol has both beta1 and beta 2 receptor blockign actions and is considered nonselective.

-Metopropolol (lopressor) is cardioselective, meaning it only blocks beta1

-Atenolol (Tenorim) is considered a cardioselective beta1 blocker, but it blocks beta 2 at high doses.

Front 12

What is the hint to identifying an ACE inhibitor? And give examples.

Back 12

The name ends in PRIL.

Capotopril (Capoten), Enalapril (Vasotec) and Benazepril (Lotensin).

Front 13

What is the action of ACE inhibitors?

Back 13

Decreases perpipheral vascular resistance without increasing:

Cardiac output, cardia rate and cardiac contractility.

Front 14

What are the important side effects of ACE inhibitors.

Back 14

Dizziness, Orthostatic hypotension, GI distress, cough and headache.

Front 15

What is important patient teaching with ACE-inhibitors?

Back 15

-Rise slowly to reduce postural hypotensive effects.
-Teach client to notify health care provider if cough develops.
-Teach client to avoid potassium supplements or potassium containing salt substitutes.

Front 16

What is important nursing implications when administering ACE inhibitors?

Back 16

-Monitor blood pressure, especially for 2 hours after the first dose--severe first-dose hypotension often develops.
-Assess the client for history or presence of renal impairment
-Administer on a empty stomach for best absorption.

Front 17

What is the action of calcium channel blockers?

Back 17

Blocks calcium access to cells causing a decrease in contractility and a decrease in the conductivity of the heart.

-These decrease the demand for oxygen.

Front 18

What are the side effects of Calcium channel blockers?

Back 18

Hypotension, bradycardia, may precipitate AV block, headache, abdominal discomfort (constipation, nausea), Peripheral edema.

Front 19

What is a way to remember some of the calcium channel blockers?

Back 19

VERy, NIce, Drugs

Verapamil (Calan), Nifedipine (Procardia) and Diltaizem (Cardizem)

Other drugs include: Amlodipine (Norvasc)

Front 20

What are important nursing considerations when administering Calcium Channel Blockers?

Back 20

-Do not crush or allow client to chew sustained-release medication preparations
-Monitor vital signs and watch for low blood pressure
-Weight client; report any edema or weight gain

Front 21

What are important patient teaching points for a person taking Calcium channel blockers?

Back 21

-Postural hypotension education.
-Teach client to avoid GRAPEFRUIT
-Constipation can be minimized by increasing dietary fiber and fluid.

Front 22

What are the uses of Beta-blocker?

Back 22

Uncomplicated hypertension, dysrhythmias and angina.

Front 23

What are the various uses for ACE inhibitors?

Back 23

Hypertension and Heart Failure.

Front 24

What are the various uses of Calcium Channel Blockers?

Back 24

Angina, hypertension (nifedipine) and dysrhythmias (verapamil and dilitiazem)

Front 25

What are the various uses of Nitroglycerin?

Back 25

-Relief of Anginal pain
-In conjunction with beta blockers or calcium channel blockers to suppress tachycardia.

Front 26

What are the side effects of Nitroglycerine?

Back 26

Orthostatic hypotension, headaches, tachycardia, dry mouth and blurred vision.

Front 27

What are the important patient teaching points for a patient on Nitroglycerine?

Back 27

-Clients with angina pectoris should carry nitrates with them at all times
-teach client to call 911 if pain is not relieved within 5 minutes of taking. May take one table every five minutes for a total of three tables while waiting for emergency care.

Front 28

What is the mechanism of action of sodium channel blockers when used as an antidysrhythmics.

Back 28

Blocks sodium, slowing the impulse in the atria, ventricles, and nodal and Purkinje systems (Quinidine, Procainamide)

Front 29

How do Beta-adrenergic blockers work when used as a antidysrhythmic?

Back 29

Reduce calcium entry and automaticity in the sinoatrial (SA) node, slow conduction velocity in teh atrioventricular (AV) node, and reduce contractility in the atria and ventricles (Propranolol [Inderal])

Front 30

How are potasssium channel blockers used as an antidysrhythmic?

Back 30

Delays the repolarization of fast potentials, prolong action potential duration and effective refractory period (Amiodarone)

Front 31

How are calcium channel blockers used as an antidysrhythmic?

Back 31

Reduce the automaticity in the SA node, delay conduciton through the AV node, and delay reduction of myocardial contractility (Diltiazem).

Front 32

What are the major side effects of antidysrhythmics?

Back 32

Dizziness, bradycardia and pulmonary toxicity (with amiodarone)

Front 33

What are the two most important nursing interventions when administering Digitalis [Digoxin]?

Back 33

-Get baseline vital signs, including a full-minute apical pulse (at a minimum of 60 bpm),
-Check lab values for digitalis and potassium levels.

Front 34

What side effects need to be monitored for with a patient on Digitalis [Digoxin]?

Back 34

Watch for fatigue, dysrhythmias, visual distrubances, anorexia and hypokalemia.

Front 35

What is the function and use of Digitalis [Digoxin]?

Back 35

Has the power to control cardiac output and ventricular response in atrial fibrillation.
-Used in Heart failure (improves cardiac output), and Atrial fibrillation and flutter.

Front 36

What are important client teaching topics for those taking Digitalis [Digoxin]?

Back 36

-Teach clients to take their pulse
-Teach client to recognize early signs of hypokalemia (muscle weakness) and digitalis toxicity (nausea, vomiting, diarrhea, blurred or yellow visual distrubances), and to notify primary health care provider if they occur.

Front 37

When giving Digitalis [Digoxin] to a pediatric patient, what is an important nursing action?

Back 37

-Monitor pulse rate, if it is below 100 mmhg, hold the dose and notify the primary health care provider.

Front 38

What are the s/s of lidocaine Toxicity?

Back 38

SAMS

-Slurred or difficult speech (Paresthesias, numbness of lips/tongue)
-Altered central nervous system (Drowsiness, Dizziness, Dysrhythmias, Restlessness, Confusion)
-Muscle twitching (Tremors)
-Seizures (Convulsions, respiratory depression, respiratory and cardiac arrest).

Front 39

When giving lidocaine IV, what actions does the nurse need to take in order to monitor for toxicity?

Back 39

-Assess LOC and orientation
-Protect for possible seizure activity
-Check VS frequently
-Monitor ECD and report unusual activity
-Assess respiratory system, bentilation, and gas exchange (oxygen saturation).

Front 40

What is the effects of lidocaine on the heart and ECG?

Back 40

-Blocks sodium channels and slows conduction
-REduces automaticity in ventricles and HIS-Purkinje system
-Accelerates repolarization.

Front 41

What drugs are used for Bradycardia and decreased BP?

Back 41

bright IDEA:

-Isoproterenol [Isuprel]
-Dopamine
-Epinephrine [Adrenalin]
-Atropine

Front 42

What type of drug is Isoproterenol and what is its mechanism of action?

Back 42

-Sympathomimetic, catecholamine
Action: Increases heart rate and cardiac output, and cuases bronchodilation.

Front 43

What are the adverse effects of Isoproterenol [Isuprel]?

Back 43

Tachycardia and angina

-May cause hypergycemia in diabetics.

Front 44

What type of drug is Dopamine and what is its MOA?

Back 44

-Sympathomimetic, catecholamine

At low doses, causes renal vasodilaiton. Moderate doses increase cardiac contractility, stroke volume and cardiac output. Higher doses increase peripheral resistance, blood pressure and renal vasoconstriction.

Front 45

What are the adverse effects of Dopamine?

Back 45

Tachycardia, dysrhythmias, vasoconstriction leading to tissue necrosis with extravasion (serious/life threatening).

Front 46

What type of drug is Epinerphrine [Adrenalin] and what is its MOA?

Back 46

-Adrenergic agonist, catecholamine

Causes vasoconstriction and increases heart rate, bronchodilator and is the treatment of choice for anaphylactic reactions.

Front 47

What type of drug is Atropine and what is its MOA?

Back 47

-Anticholinergic, antidysrhytmic

Acts on smooth muscle of the heart and increases cardiac rate.

Front 48

What is the adverse effects of epinephrine [adrenalin]?

Back 48

Hypertension, dysrhythmias, anginal pain, restlessness.

Front 49

What are the adverse effects of Atropine?

Back 49

Tachycardia, dry mouth, drowsiness, urinary hesitancy.

Front 50

What are the major side effects of Adrenergic Antagonists? (Alpha-blockers)

Back 50

Orthostatic hypotension, Tachycardia, Vertigo, Sexual dysfunction.

Front 51

What are examples of Adrenergic Antagonists?

Back 51

Doxazosin (Cardura)
Prazosin (Minipress)

Front 52

What is the MOA of Alpha Adrenergic Antagonists (Alpha Blockers)?

Back 52

Stimulate central alpha receptors, which decreases sympathetic outflow from the central nervous system, causing a decrease in peripheral vascular resistance and a slight decrease in cardiac output.

Front 53

What are the uses of Alpha-Adrenergic Antagonists (Alpha-Blockers)?

Back 53

Mild to moderate hypertension.

Front 54

What are important nursing implications for Alpha-Adrenergic antagonists?

Back 54

-Watch for orthostatic hypotention, which is intensified with prolonged standing, hot baths or showers, hot weather, alcohol use and strenuous exercise.
-Discontinue slowly to avoid rebound hypertension

Front 55

What are important teaching points for a patient taking Alpha-adrenergic antagonists (Alpha-blockers)?

Back 55

-Client should take at bedtime to avoid drowsiness during the day.
-Teach client about the first dose effect of severe orthostatic hypotension and to avoid hazardous activities and driving for 12 to 24 hours after the initial dose. To decrease risk instruct client to take the first does at bedtime.

Front 56

What is the difference between the action of cardioselective and nonselective beta blockers?

Back 56

-Beta1 blockers (cardioselective) have a predominant effect on the heart by decreasing rate and contractility and decreasing velocity of impulse conduction at the atrioventricular (AV) node.
-Beta2 blockers (nonselective) have the same actions as beta1 blockers, however, they also affect the lungs, causing bronchoconstriction, and they block blood vessel receptors, causing vasoconstriction.

Front 57

Give examples of beta1 blockers.

Back 57

Metoprolol (Lopressor, Troprol XL) used for angina and hypertension.

Front 58

Give examples of nonselective beta blockers.

Back 58

Propranolol (Inderal) used for angina, hypertension and dysrhythmias.

Front 59

What are the contraindications of nonselective beta blockers?

Back 59

Bradycardia or cardiac block, hypotension.

Front 60

What is the contraindications of beta2 blockers?

Back 60

Chronic obstructive pulmonary problems.

Front 61

What are the side effects of beta2 blockers?

Back 61

Bronchospasm, bradycardia.

Front 62

What are the side effects of adrenergic antagonists (beta-blockers)?

Back 62

Hypotension, bradycardia (AV block), symptoms of heart failure, drowsiness and depression.

Front 63

What is the mechanism of action of antihyperlipidemics (Statins)?

Back 63

HMG-CoA reductase is an enzyme made in our livers, which helps the liver produce cholesterol, Statins lowers cholesterol levels by inhibiting the formation of HMG-CoA reductase.

Front 64

What are the uses of HMG-CoA Reductase Inhibitors (Statins)?

Back 64

Hypercholesterolemia, Primary and secondary prevention of cardiovascular events and Clients with type II diabetes and coronary heart disease.

Front 65

What are the side effects of HMG-CoA Reductase Inhibitors (Statins)

Back 65

Myopathy--Rhabdomyolysis (severe form)

Hepatoxicity--liver injury with increases in serum transaminases.

Front 66

What are important patient teaching for HMG-CoA Reductase Inhibitors (Statins)?

Back 66

-Instruct client to report unexplained muscle pain or tenderness
-Inform women of childbearing age about the potential for fetal harm should they become pregnant.
-Instruct client about dietary changes to reduce weight and cholesterol.

Front 67

What are important nursing implications for HMG-CoA Reductase Inhibitors (Statins)?

Back 67

-Monitor liver function studies
-Administer medications in the evening without regard to meals.