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222 Cards in this Set

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How do Loop and Thiazide diuretics work?
Loop-Furosemide (Lasix)
Thiazide-Hydrochlorothiazide (HydroDIURIL). They prevent Na/Cl reabsorption which pulls water into the renal tubule to be excreted as urine.
How do K+ sparing diuretics work?
Spironolactone (aldactone) Alter Na+ and K+ exchange in the distal tubule to conserve potassium. Always combined with a loop or thiazide to prevent hypokalemia during diuretic therapy.
How do osmotic diuretics work?
Mannitol (Osmitrol). Create an osmotic pressure within renal tubule whcih pulls in water to be excreted as urine; same principal within cranial capillaries; creates osmotic force that pulls excess fluid from the brain into the vascular system.
What major side effects are paired with loop and thiazide diuretics?
volume depletion; decreased BP; electrolyte imbalances
What major side effects are paired with K+ sparing diuretics?
hyperkalemia
What major side effects are paired with osmotic diuretics?
peripheral edema.
Which loop, thiazide, or potassium sparing diuretics produce the greatest amount of diuresis? Why?
Loops b/c they have the ability to affect the greatest percentage of Na absorption
What things must be monitored during diuretic therapy?
BP, weight, electolytes: Na,K,Cl ... I&O
What are the prototypes for each group or diuretics?
Loop:Furosemide (Lasix) Thiazides: Hydrochlorothiazide (HydroDiuril) K+ Sparing: Spironolactone (aldactone) Osmotic: Mannitol (Osmitrol)
Why are diuretics used? Are they used or contraindicated in heart failure?
To eliminate excess fluid from the body: pulmonary edema; edema of hepatic or cardiac origin: to aid in hypertension therapy. Diuretics are used in heart failure except mannitol.
Why do we monitor potassium levels in patients taking diuretics? Why is it especially important to monitor potassium when the patient is taking digoxin and diuretics?
Hypokalemia is a common side effect of diuretic therapy; thus monitoring K+ levels is essential especially in Pts taking digoxin b/c K+ competes with digoxin for receptor sites in the heart. If K+ levels are low, then that will allow more dig to bind to receptors which could cause toxic effects including ventricular arrhythmias.
What blood pressure numbers would indicate prehypertension?
120-139/80-89
What bp numbers would indicate stage 1 hypertension?
140-159/90-99
What bp numbers would indicate stage 2 hypertension?
greater than 160/100
How do ACE inhibitors and Angiotensin II Receptor Blockers (ARBs) work to treat Hypertension/heart failure?
ACEs prevent the conversion of angiotensin 1 to angiotensin II and ARBs block angiotensin II receptors which both lead to decreased vasoconstriction and decreased Na and water retention.
What are the prototypes for ACEs and ARBs?
ACE: Captopril (Capoten) ARB: Losartan (Cozaar) & Valsartan (Diovan)
What are the major AE of ACE and ARB prototypes? What are important nursing implications?
First dose hypotension; dizziness; hyperkalemia with ACEs;angioedema......... monitor BP, educate on K+ salts and high K+ foods for ACEs; no use during prego; if angioedema occurs the Pt should not be given that class of drugs again (allergy)
How do Ca Ch. blockers work to treat HTN? What are the prototypes?
Block Ca. channels of vascular smooth muscle to control contraction which leads to vasodilation.... Verapamil (cardiac effects - can be used for dysrhythmias) Nifedipine (little cardiac effect)
What are major AE of Ca. Ch. blocker prototypes? What are important nursing implications?
AE: flushing, headache, peripheral edema, constipation... monitor BP; increase fluids/fiber to prevent constipation; education. Swallow whole
What is digoxin used for?
Heart failure to increase cardiac contractility; atrial fibrillation.
What is digoxins mechanism of action?
Promotes Ca+ accumulation within cardiac muscle cells which increases force of contraction. Indirectly decreases afterload and preload.
What physiological responses should we see when a Pt is on Dig in other words how do we know if our Tx is effective?
Decreased HR; decreased peripheral edema (possibly decreased weight)
Wat are important nursing implications with digoxin?
initial therapy beings with digitalization- loading dose to decrease time to plateau as half life is 1.5 days.. Count HR for one full minute b4 admin- hold and contact MD of rate is less than 60... Monitor K+ levels - educate: high K+ foods and salt substitutes.. Monitor dig levels
Which medication is primarily used for angina pectoris? What is the mechanism of action of this drug?
Nitroglycerin-dilates veins
Discuss important admin and nursing implications for nitroglycerin..
Many admin routes: sublingual, buccal, transdermal, PO, IV.. Tolerance develops quickly- when taking scheduled doses, there must be at least an 8 hr "nitro free" period.. Acute anginal attacks: 1st sublingual dose.. call 911 if no relief in 5min and take 2nd dose.
What do anticoagulant drugs do?
Decrease coagulation (lengthen clotting time) which decreases blood viscosity and prevents intravascular clot formation
What are major AE of the anticoagulants?
bleeding- hemorrhage; thrombocytopenia.
How is heparin admin and monitored?
IV,SC. Activated partial thromboplastin time should be increased.
What is the antidote to Heparin OD?
Protamine Sulfate
How does Heparin differ from the Low Molecular Weight Heparins?
No aPTT monitoring required. Once daily dosing via SC injection - home therapy. Less risk of bleeding than unfractioned heparin.
How is Coumadin admin and monitored?
PO only. PT should be increased. INR should be between 3 and 4.5
What is the antidote to Warfarin (Coumadin) OD?
Vitamin K.
What is the definition of high cholesterol (numbers for HDL, LDL, and total cholesterol)?
HDL>60 LDL>100 total cho<240
ACE inhibitor. name 1
Captopril (Capoten)
Angiotensin II Receptor Blocker name 1
Losartan (Cozaar)
Ca+ Ch. Blocker name 3
Verapamil (Isoptin), Nifedipine (Procardia) and Diltiazem (Cardizem)
Cadiac Glycoside Name 1
Digoxin (Lanoxin)
Vasodilator Name 3
Hydralazine (Apresoline), Nitroglycerin, and Sodium Nitroprusside.
HMG-CoA Inhibitor name 2
Lovastatin (Mevacor) and Atorvastatin (Lipitor)
Anticoagulant name 2
Heparin, Warfarin (coumadin)
antiplatelet drug name 1
aspirin
OTC anti cholesterol agent name 1
nicotinic acid (Niacin)
Heparin antidote name 1
protamine sulfate.
Cholesterol meds: HMG-Coa reductase inhibitors- mech of action? AE? how admin? Nursing imp? OTC?
Limits the rate of Cho procution and increases LDL receptor sites in the liver. AE:Hepatotoxitiy, myopathy.
Admin. PO at night.
Life long therapy; liver funcion monitoring, edu. diet& exercise.
Cholesterol meds: Bile acid binding resins- mech of action? AE? how admin? Nursing imp? OTC?
Form complex with bile acids in intestine.. decreased bile triggers liver to produce more which requires cholesterol. AE:GI related-constipation, bloating, indigesteion, decreased absorption of fat soluble vitamins. can bind with certain meds in GI tract. Admin PO with plenty of water. Timing of other drug admin. one hr b4 or 4 hrs after bile acid binders.
Cholesterol meds: Nicotinic acid- mech of action? AE? how admin? Nursing imp? OTC?
Decreases production of VLDL. AE:facial flushing/itching d/t prostaglandin mediation cutaneous vasodilation (diminishes over time); GI upset. Admin PO with or after meals.
Prototype beta adrenergic blockers? 2
Propanolol (nonselective) and Atenolol (selective)
3 approved beta blockers for heart failure management..
Sustained release Metoprolol - selective beta1 adrenergic blocker.. Bisoprolol (Zebeta) selective beta 1adrenergic blocker.. Carvedilol (Coreg) alpha1/nonselective beta blocker NO others approved for Tx of Heart failure and are contraindicated.
What are diuretics used for?
1.edema assoc.with CHF 2. acute pulmonary edema 3. liver disease 4. renal disease 5. hypertension 6. conditions that cause hyperkalemia
What diuretics are the most effective and why?
Loop diuretics (High ceiling) b/c their site of action is the loop of henle.
Furosemide (Lasix) is a loop diuretic what is it especially useful for?
Pts with severe renal impairment.
adverse effects of loop diuretics (furosemide or lasix)
hyponatremmia, hypochloremia, dehydration, hypotension, hypokalemia, ototoxicity, hyperglycemia, hyperuricemia.
If treatment alone is insufficient with a loop diuretic what might be added to the regimen?
a thiazide diuretic (hydrochlorothiazide or HydroDIURIL).
What are some contraindications of loop diuretics?
CV disease, renal impaired, diabetes mellitus, Hx of gout, pregnancy.
Drug interactions of loop diuretics?
digoxin(monitor K+ levels), ototoxic drugs (gentamicin) and potassium sparing diuretics, lithium, NSAIDS, antihypertensive agents.
Thiazides.. Hydrochlorothiazide (HydroDIURIL) action?
blocks reabsorption of Na+ and Cl in early segment of the DCT. Dependent on adequate kidney function NOT EFFECTIVE IN SEVERE RENAL IMPAIRED.
Therapeutic uses for thiazides?
Essential hypertension, edema, and diabetes insipidus.
AE of thiazides?
hyponatremia, hypochloremia, dehydration, hypokalemia, hyperglycemia, hyperuricemia, and impact on lipids Ca+ and Mg+.
drug interactions of thiazides?
digoxin, potassium sparing diuretics, antihypertensive agents, NSAIDs, and ototoxic agents.
Contraindications of thiazides?
CV disease, renal impaired, diabetes mellitus, Hx of gout, pregnant or breast feeding. NOT IN PTS WITH SULFA ALLERGY
Why are thiazides and loop diuretics alike?
they both increase renal excretion of Na+, Cl, K+, and H20 and increase levels of uric acid/glucose
Potassium sparing diuretics? prototype
Spironolactone (aldactone)
What are K+ sparing diuretics used for?
counteract potassium loss caused by thiazide and loop diuretics, hypertension, edema, heart failure, primary hyperaldosterone, pms, polycystic overy syndrome, and acne in young women.
What are some nursing implications of K+ sparing diuretics?
baseline: serum K+, weight, BP, HR, RR, Na+ and Cl.
What are some AE of K+ Sparing diuretics?
hyperkalemia, lethargy, benign and malignant tumors, endocrine effects.
What are some contraindications of spironolactone?
hyperkalemia, Pts taking K+ supplements or another K+ sparing diuretic, Caution with ACE inhibitors, angiotensin receptor blockers.
drug interactions of spironolactone?
thiazide and loop diuretics (counteract effects), DO NOT COMBINE WITH K+ SUPPLEMENTS OR OTHER K+ SPARING DIURETICS, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors, aspirin, pepto bismol.
Osmotic diuretics prototype?
Mannitol (Osmitrol)
What is the action of Mannitol?
promotes diuresis by crating an osmotic force within the lumen of the nephron. More the drug = more diuresis.
Uses of Mannitol (osmotic diuresis).
prophylaxis of renal failure, reduction of intracranial pressure, reduction of intraocular pressure, acute renal disease.
AE of Mannitol?
edema, headache, n/v, fluid/electrolyte imbalance.
contraindications of Mannitol?
heart disease Pts, crystaluria, end stage renal disease, CHF, dehydration, edema, and hypovalemia.
Nursing considerations for diuretics?
baseline: weight, BP (sitting and supine), HR, RR, and electrolytes. daily: BP, HR, weight, evaluate for decreased edema and I&O.
Definition of Hemodynamics?
Study of the movement of blood throughout the circulatory system, along with regulatory mechanisms and driving forces involved.
Circulatory system has 2 functions what are they?
1. delivery of O2, nutrients, hormones, electrolytes, and other essentials to cells. 2. removal of CO1, metabolic wastes and other from cells.
Elements that determine BP? 5
Heart rate, stroke volume, total peripheral resistance, baroreceptors, renin angiotensin system.
Consequences of untreated hypertension? 4
CAD and cardiac death, stroke, renal failure, and loss of vision
What ethnicity is at greatest risk for hypertension?
African Americans.
Treating hypertension requires 2 things sometimes can be resolved with one what are they?
lifestyle modifications and drug therapies.
What are some lifestyle modifications to treat hypertension?
weight loss, sodium restriction, the DASH eating plan, alcohol restriction, aerobic exercise, smoking cessation, maintenance of K+,and Ca+ intake.
What are drug therapies for hypertenison?
1. beta blockers, verapamil and diltiazem, and other drugs that decrease HR 2. diuretics and other drugs that decrease bld volume. 3. venodilators which decrease venous return.
What are 3 diuretics used for hypertension?
Thiazide, Loop and Potassium sparing diuretics.
SNS blockers. hypertension drug therapy. 5?.
beta blockers, alpha blockers, alpha adrenergic blockers, alpha1blockers, alpha2agonists.
ACE Inhibitors prototypes? 3.
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Prinivil, Zestril).
What are the actions of ACE Inhibitors?
reduce levels of angiotensin II increase levels of bradykinin.
What are the uses for ACE Inhibitors?
hypertension, heart failure, acute MI, Left Ventricular dysfunction, and diabetic and nondiabetic nephropathy. Prevents MI, stroke, death in increased CV risk.
Some AE of ACE Inhibitors.
1st dose hypotension, cough, hyperkalemia, renal failure, fetal injury, angioedema, dysgeusia, rash, and neutropenia.
Drug interactions of ACE Inhibitors?
diuretics, antihypertensive agents, drugs that raise K+ levels, lithiu, NSAIDs.
ARB (Angiotensin II Receptor Blockers) prototype.
Losartan (Cozaar)
What is the action of ARBs?
block access of angiotensin II to its receptors on bld vessels. dilates arterioles and veins.
Therapeutic Uses of ARBs?
hypertension, heart failure, diabetic nephropathy, MI, stroke prevention.
AE of ARBs?
angioedema, fetal harm, renal failure.
drug interactions of ARBs?
other antihypertensive drugs
Nursing considerations for ARBs?
baseline: BP & WBC count.
Calcium channel blockers prototype? 2
diltiazem (Cardizem) Verapamil (Calan SR).
What is the action of Ca Ch. Blockers?
blocks Ca+ ch's in the heart and bld vessels.
Ther. Uses for Ca ch blockers?
angina pectoris, essential hypertension, cardiac dysrhythmias, prophylaxis for migraines.
AE of Ca ch blockers?
constipation, dizziness, facial flushing, headache, peripheral edema, cardiac effects.
What are cautions with Ca ch blockers?
not used in Pts with sick sinus syndrom or 2nd or 3rd degree AV block.
drug interactions of Ca ch blockers?
digoxin, beta adrenergic blocking agents. Grapefruit juice.
Nursing implications of Ca ch blockers?
BP, HR, LAB for liver and kidney function. Diltiazem causes less constipation than verapamil!.
Prototype for vasodilators? 2
Nitroprusside (Nitropress) and Hydralazine (apresoline)
action of vasodilators?
fastest antihypertensive. breaks down to release nitric oxide.
Therapeutic uses for vasodilators?
hypertensive emergencies, controlled hypotension during surgery. Hydralazine - heart failure as well.
AE of Nitroprusside?
excessive hypotension, cyanide poisoning, thiocyanate toxicity...
AE of Hydralazine?
reflex tachycardia, increased bld volume, systemic lupus, headache, dizziness, weakness and fatigue.
drug interactions of vasodilators?
drugs that lower BP, care with other antihypertensive agents.
Brief pathology of heart failure.
muscle damage, muscle working too hard, hypertension or valvular disease, abnormal heart structure, fluid retention.
Drugs used for CHF? What categories?
Vasodilators (ACE inhibitors and nitrates) and ARBS.-- helps prolong life. .... diuretics, beta adrenergic agonists.
What is the first line drug for all pts with signs of volume overload?
Diuretics.
Action of diuretics?
decrease in bld volume therefore decrease in venous pressure, arterial prssure, pulmonary edema, peripheral edema and cardiac dilation. SYMPTOM REDUCTION ONLY
Thiazide diuretics how do they help with HF?
long term therapy of HF when edema is not too great.
How do high ceiling diuretics help with HF?
Severe HF>
How do K+ sparing diuretics help with HF?
prolongs survival of Pts with HF by blocking receptors for aldosterone.
Vasodilators how do they help with HF?
ACE Inhibitors can improve functional status and prolong life.
Beta adrenergic agonist how do they help with HF? Carvedilol
Can prolong survival and be used with severe disease.
Cardiac Glycosides prototype?
Digoxin (Lanoxin)
Action of Digoxin?
increase force of ventricular contraction and can thereby increase CO.
Digoxin does not do what?
DOES NOT prolong life. increases myocardial contractile force. decreases symptoms of HF>
Why is Digoxin dangerous?
b/c at therapeutic levels can cause severe dysrhytmias.
Hemodynamic benefits in HF when talking about Digoxin?
CO improves, HR decreases, heart size decreases, constriction of arterioles and veins decreases, water retention reverses, bld volume decreases, peripheral and pulmonary edema decrease, weight loss.
AE of Digoxin?
visual disturbances, n/v, fatigue, dysrhythmias, hypokalemia, elevated digoxin levels, heart disease.
Cautions in digoxin?
Pts experienceing Vfib, ventricular tachycardia or digoxin toxicity, hypokalemia, partial AV block, renal impaired.
drug interactions with digoxin?
diuretics, ACE inhibitors, ARBs, sympathomimetics, Quinidine, Verapamil.
Nursing implications with digoxin?
baseline: s&s of HF, ECG, serum electrolytes, measurement of ejection fraction, evaluation of kidney function.
What do LDLs do?
initiate and fuel development of atherosclerosis.
What are the most effective drugs for lowering LDL and total cholesterol? increase HDL and decrease TGs?
HMG-CoA Inhibitors or Statins
What are HMG CoA Inhibitors or Statins prototype? 3
Vtorvastatin (Lipitor), Simvastatin (Zocor) and Rosuvastatin (Crestor)
What is the action of Atorvastatin (Lipitor)?
decrase of LDL cholesterol, elevation of HDL cholesterol, decreas of TG levels, nonlipid beneficial CV actions, increased bone formation.
What are the uses for Atorvastatin (Lipitor)?
hypercholesterolemia (young and adults), primary and 2ndary prevention of CV events, Post MI therapy, diabetes etc.
AE of Atorvastatin (Lipitor).?
headache, rash, GI disturbances, constipation, abd pain, hepatotoxicity, MYOPATHY.
Cautions with Atorvastatin (Lipitor)?
not in pregnant women!!
and No grapefruit juice!
drug interactions with Atorvastatin (Lipitor)?
other lipid lowering drugs, macrolide antibiotics, azole antifungal drugs, HIV protease inhibitors, amidarone and cyclosporine. Avoid grapefruit juice.
Antihyperlipidemia Agents (Bile acid sequestrants)prototypes? 2
Colesevelam (Welchol) and Cholestyramine (Questran).
What is the action of Bile acid sequestrants?
nonabsorbable resin that binds (sequesters) bile acids and other substances in GI tract. Preventing absorptim and promoting excretion.
What are some therapeutic uses for Bile acid sequestrants?
decreases LDL cholesterol in Pts with primary hypercholesterolemia.
What are some AE of Bile acid sequestrants?
constipation, bloating, indigestion, nausea.
What are some drug interactions of bile acid sequestrants?
thiazide diuretics, digoxin, warfarin, and some antibiotics take 1hr b4 or after taking bile acid sequestrants.
Cholesterol Absorption Inhibitor Prototype?
Ezetimide (Zetia)
What is the action of cholesterol absorption inhibitors?
acts on cells of the brush border of the sm. intestine to inhibit cholesterol absorption.
What are some Therapeutic uses of Ezetimibe (Zetia) or cholesterol absorption inhibitors?
decrease in total cholesterol, decrease in LDL cholesterol and apoliprotein B in Pts with primary hypercholesteremia. (decrease in plasma levels, LDL cholesterol, TGs & apolipoprotein B).
What are some AE of Ezetimibe (Zetia) or cholesterol absorption inhibitors?
myopathy, rhabdomyolysis, hepatitis, pancreatitis, and thrombocytopenia.
What are some drug interactions of Ezetimibe (Zetia) or cholesterol absorption inhibitors?
statins, fibrates, bile acid sequestrants, and cyclosporine.
What are some cautions for cholesterol absorption inhibitors?
hepatic impairment.
What are some cautions for cholesterol absorption inhibitors?
hepatic impairment.
Other lipid lowering agents prototype?
Nicotinic Acid (Niacin).
Other lipid lowering agents prototype?
Nicotinic Acid (Niacin).
What is the action of lipid lowering agents?
increase HDL cholesterol and lower TGs.
What is the action of lipid lowering agents?
increase HDL cholesterol and lower TGs.
When is it recommended someone takes Nicotinic acid?
with meals or immediatedly after for effercitveness.
When is it recommended someone takes Nicotinic acid?
with meals or immediatedly after for effercitveness.
What exactly is Niacin and what does it do?
Vitamin B3, inhibits release of free fatty acids from adipose tissue and increases rate of tg removal from plasma.
What exactly is Niacin and what does it do?
Vitamin B3, inhibits release of free fatty acids from adipose tissue and increases rate of tg removal from plasma.
What are some AE of nicotinic acid (lipid lowering agents)?
flushing, hepatotoxicity, hyperglycemia, hyperuricemia.
What are some AE of nicotinic acid (lipid lowering agents)?
flushing, hepatotoxicity, hyperglycemia, hyperuricemia.
What are some therapeutic uses of nicotinic acid?
decrease LDL levels, VLDL and TGs and increase HDLs.
What are some therapeutic uses of nicotinic acid?
decrease LDL levels, VLDL and TGs and increase HDLs.
What are some cautions of nicotinic acid?
active liver disease or sever or recurrent gout, diabetes, PUD, asymptomatic hyperuricemia.
What are some cautions of nicotinic acid?
active liver disease or sever or recurrent gout, diabetes, PUD, asymptomatic hyperuricemia.
What are some Nursing considerations when it comes to lipid lowering agents?
Baseline: lipid profile, all and monitor all levels.
What are some Nursing considerations when it comes to lipid lowering agents?
Baseline: lipid profile, all and monitor all levels.
What are some cautions for cholesterol absorption inhibitors?
hepatic impairment.
CAD- angine is like what?
Suffocation of the chest (ischemia).
CAD- angine is like what?
Suffocation of the chest (ischemia).
Other lipid lowering agents prototype?
Nicotinic Acid (Niacin).
What is the action of lipid lowering agents?
increase HDL cholesterol and lower TGs.
When is it recommended someone takes Nicotinic acid?
with meals or immediatedly after for effercitveness.
What exactly is Niacin and what does it do?
Vitamin B3, inhibits release of free fatty acids from adipose tissue and increases rate of tg removal from plasma.
What are some AE of nicotinic acid (lipid lowering agents)?
flushing, hepatotoxicity, hyperglycemia, hyperuricemia.
What are some therapeutic uses of nicotinic acid?
decrease LDL levels, VLDL and TGs and increase HDLs.
What are some cautions of nicotinic acid?
active liver disease or sever or recurrent gout, diabetes, PUD, asymptomatic hyperuricemia.
What are some Nursing considerations when it comes to lipid lowering agents?
Baseline: lipid profile, all and monitor all levels.
CAD- angine is like what?
Suffocation of the chest (ischemia).
what are the three types of angina?
stable angina, unstable angina, and Prinzmetals angina.
What do antianginal drugs do?
dilate blood vessels, decrease work of the heart.
What is the prototype for Nitrates?
Nitroglycerin (Nitro-Bid).
What is the action of Nitrates?
(stable angina). cardiac O2 demand, dilating veins, decrease venous return to the heart, variant relaxing and preventing spasm in coronary arteries and increase O2 supply.
What are AE of Nitroglycerin?
headache, hypotension, tachycardia, ortho-hypo, reflex-tachycardia.
What are some drug interactions of Nitroglycerin?
hypotensive drugs (beta blockers, Ca ch. blockers, diuretics, etc) alcohol, PDE5 inhibitors (Viagra, Cialis) Verapamil and diltiazem.
How fast does tolerance develop with nitroglycerin?
Tolerance can develop quickly! Withdraw slowly! Can develop within a day.
What routes can be used when administering Nitroglycerin?
IV, sublingual, translingual spray, transmucosal tablet, Oral, SR tablet, topical ointment, and transdermal.
What are prototypes for beta blockers in angina?
Metoprolol (Toprol), Nadolol (Corgard), and Propanolol (Inderal).
What is the action of beta blockers?
decrease cardiac O2 demand, blockade of beta1 receptors in the heart, decrease HR and contractility.
What do you not do with Beta blockers?
DO NOT ABRUPTLY STOP!!!
what are some therapeutic uses for beta blocker?
stable angina
What are some AE of beta blockers?
bradycardia, decrease in AV conduction, and decrease of contractility, insomnia, and bizarre dreams.
What are some cautions with beta blockers?
Pts with sick sinus syndrome, heart failure, and 2nd or 3rd degree AV heart block, asthma, diabetes.
What are the prototypes for Ca Ch. blockers?
verapamil, diltiazem and nifedipine.
What are the actions of Ca. ch. blockers?
block Ca ch's in VSM, primarily in arterioles, dilating arterioles, and decrease in peripheral resistance and decrease HR.
What are therapeutic uses for Ca ch. blockers?
stable and variant angina.
What are some AE of Ca ch. blockers?
CV dilation, decrease in BP, reflex tachycardia (greatest with nifedipine).
What are some cautions and drug interactions with ca ch blockers?
beta blockers, bradycardia, heart failure, or AV bloack - not with nifedipine.
What are some nursing implications for Ca ch. blockers?
risk factors, place of attack, factors that precipitate, Pt. record frequency and intensity of attacks.
What are prototypes of Anticoagulants? 2
Heparin (injection, avoid IM injections) Warfarin PO (Coumadin) all carry a significant risk of bleeding.
What is the action of Heparin ?
suppress coagulation by helping antithrombin inactivate clotting factors. (interfere with the clotting cascade and thrombin formation)
What are some therapeutic uses of Heparin?
prophylaxis of venous thrombosis, pregnancy, pulmonary embolism, evolving stroke, and massive deep vein thrombosis, open heart surgery, renal dialysis, prevent postop venous thrombosis, acute MI.
What are some AE of anticoagulant drugs?
hemorrhage, heparin induced hypersensitivity Rxs, local irritation, hematoma, vasospastic Rxs, osteoporosis.
What are some cautions of anticoagulant drugs?
thrombocytopenia, uncontrollable bleeding during and after surgery of the eye, brain and spinal cord, lumbar puncture, and regional anesthesia. Caution in all pts with likelihood of blding-hemophilia, increased capillary permeability, dissecting aneurysm, PUD, severe hypertension, threatened abortion, liver and kidney disease.
What should you monitor in the labs for anticoagulant drugs?
tests of coagulation aPTT - normal 40 sec. test every 4-6 hrs during initial therapy.
What do you give in case of a Heparin OD? What is a drug interaction of anticoagulant drugs?
protamine sulfate- works immediately and up to 2h after dosage. aspirin.
Low Molecular Weight Heparins prototypes?
Enoxaparin (levenox) and Dalteparin (fragmin)
What are low molecular weight heparins?
simply heparin preps composed of molecules that are shorter than those found in unfractionated heparin and easier to use (as effective as well) fixed dose schedule and don't require aPTT monitoring.
What is the action of low molecular weight heparins?
inactivate factor Xa some thrombin as well.
What are some therapeutic uses of anticoagulants?
prevention of DVT following abd surgery, hip replacement, or knee replacement surgery. Tx of est DVT with or without PE. Prevention of ischemic complications in Pts with unstable angina, non Q wave MI and ST elevation MI. off label for prevention after general surgery and in Pts with multiple trauma and acute spinal injury.
Some AE of anticoagulants?
bleeding, thrombocytopenia, (OD Tx with protamine sulfate as well), severe neurologic injury.
Some cautions of anticoagulants?
aspririn, ticlopidine, warfarin, epidural/spinal bleeds.
What is Warfarin used for? another anticoagulant.
prevent thrombosis - delayed onset... suppress coagulation by decreasing production of 4 clotting factors - VII, IX, X, and prothrombin.
What are some therapeutic uses of Warfarin?
long term prophylaxis of thrombosis, decreased risk of recurrent TIAs and recurrent MI. NOT IN EMERGENCIES LIKE HEPARIN!!
What are some AE of Warfarin?
hemorrhage, fetal hemorrhage, teratogenesis from use druing pregnancy, use during lactation not advised, skin necrosis, fever, GI disturbances, red-orange discoloration of urine,.
What are some drug interactions of warfarin?
heparin, aspirin, nonaspirin antiplatelet drugs (clopidogrel, dipyridamole, ticlopidine) acetaminophen MONITOR PT IN LABS>
What are some cautions with warfarin?
sever thrombocytopenia (uncontrollable bleeding), Pts undergoing LP, regional anesthesia or surgery of the eye brain or spinal cord, hemophilia, increased capillary permeability, dissecting aneurysm, GI ulcers, severe hypertension, women anticipating abortion, Vit K deficiency, liver disease, alcoholism, pregnancy and lactation.
What is the prototype for antiplatelets?
aspirin.
What is the action of antiplatelets (aspirin)?
irreversibly inhibits cyclooxygenase and thereby blocks synthesis of TXA2.
What are some therapeutic uses or antiplatelets (aspirin)?
ischemic stroke, TIAs, chronic stable angina, unstable angina, coronary stenting, acute MI, previous MI, primary prevention of MI.
What are some AE of antiplatelets?
increased risk of bleeding, hemorrhagic stroke, peptic ulcers.
What are some prototypes of thrombolytic agents?
streptokinase (Streptase)
What is the action of thrombolytic agents (streptokinase)?
binds to plasminogen to form an active complex. Promote conversion of plasminogen to plasmin, an enzyme that degrades the fibrin matrix of thrombi.
What are therapeutic uses of thrombolytic agents (streptokinase)?
1. acute coronary thombosis (acute MI) 2. DVT 3. Massive pulmonary emboli.
Some AE of thrombolytic agents (streptokinase)?
increased risk of hemorrhage (bleeding), intracranial hemorrhabe, hypotension, fever.
What are some drug interactions of thrombolytic agents?
anticoagulants (heparin, warfarin) and antiplatelet drugs (aspirin).
what are some cautions of thrombolytic agents?
hypertension, dementia, prego, peptic ulcer, aortic dissection, etc.
What are some nursing considerations of thrombolytic agents?
HR, bld cts, platelet cts. hematocrit, aPTT, PT....