Nursing 1St Semester- Pharm: Cardio

Front 1

What is the major cause of death in the US?

Back 1

cardiovascular disease

Front 2

3 main causes of CVD (cardiovascular disease)

Other contributing factors....

Back 2

HTN
Diabetes Mellitus
Increased Lipids

Inactivity
Smoking
Obesity

Front 3

What is one of the most common admitting diagnoses after age 70?

Back 3

CHF

Front 4

What is one of the oldest, most effective groups of cardiac drugs that have been used for as the mainstay therapy for heart failure for over 200 years?

Back 4

cardiac glycosides

Front 5

What is the most frequently prescribed cardiac glycoside? This medication is derived from a plant, the foxglove. What type of effect on the heart do cardiac glycosides have?

Back 5

Digoxin (Lanoxin) also digitalis
positive inotropic effect

Front 6

Which drug type affect the heart rate? (chronotropic, inotropic, dromotropic)

Back 6

Chronotropic

Front 7

Which drug type affect the conduction of electrical impulses through the heart?

Back 7

Dromotropic

Front 8

Which drug type affect the force of myocardial contraction?

Back 8

Inotropic

Front 9

The word "positive" before chronotropic, dromotropic, or inotropic means there is an ______ in contractility, rate, or conduction

Back 9

increase

Front 10

The word "negative" before chronotropic, dromotropic, or inotropic means there is an ______ in contractility, rate, or conduction

Back 10

decrease

Front 11

What effect do cardiac glycosides have on the inotropic?

Back 11

positive (increased force of contraction, strengthens heart beat)

Front 12

What effect do cardiac glycosides have on chronotropic?

Back 12

negative (decrease heart rate)

Front 13

What effect do cardiac glycosides have on dromotropic?

Back 13

negative (decreased rate of electrical conduction, prolongs refractory period in conduction system.
multiple effects, but especially ↓ AV nodal conduction

Front 14

Cardiac glycosides ___ and _____ the heart beat.

Back 14

Slow and strengthen

Front 15

Indications (uses) of Digoxin

Back 15

CHF/ Heart Failure, supraventricular dysrhythmias, atrial fibrillation

Front 16

A digoxin level that is too high is very serious and can be fatal. What is this known as?

Back 16

Dig toxicity

Front 17

Digoxin has a very narrow therapeutic range. What is it?
Digoxin helps control _____ response in atrial fib/flutter, thereby controlling rapid ___ ___ in these ________. It promotes _____ due to improved ____ perfusion.

Back 17

Nurses must monitor the digoxin level, therapeutic is 0.8 - 2.0 ng
Digoxin helps control ventricular response in atrial fib/flutter, thereby controlling rapid heart rates in these dysrhythmias. It promotes diuresis due to improved renal perfusion (more blood flow to kidneys).

Front 18

Before giving Digoxin, the nurse must know what 3 things?

What are some side effects of digoxin?

Back 18

Apical pulse
Dig level
Potassium level

Side Effects: Can be very serious (fatal dig toxicity)
CV- any type of dysrhythmia!
GI- N/V, anorexia, diarrhea
CNS- H/A, fatigue, malaise, confusion, convulsions
Eye- flickering lights, colored vision (?), yellow lights or halos around objects.

Front 19

Hold Digoxin if:

Back 19

Pulse is greater than 100 less than 60
(some books say greater than 120 or less than 50)

Dig level is high

Potassium level is low

Front 20

Low potassium levels potentiate the action of digoxin, leading to....

Back 20

dig toxicity (Potassium can facilitate dig toxicity)

Front 21

Nursing Implications for digoxin
What is the antidote?
Patient teaching for digoxin

Back 21

Monitor dig level, K level, apical pulse
Monitor heart rhythm (telemetry)
If toxicity is suspected, hold drug, call MD
Antidote- digoxin immune fab

Teaching: Teach pt. to take pulse, when to hold drug, when to call doctor. Instruct on importance of regular dig levels.
Take in am, daily, don't double up if forgotten.
Know s/s of dig toxicity and to report these
Teach about s/s of worsening HF (as dig is used to treat CHF): SOB, ↑ fatigue, cough, wt. gain
Report palpiations, dizziness (signs of tachcardia)

teach how to take pulse and when to hold drug

Front 22

Nitrates are drugs that ____ blood vessels by relaxing _____ muscle cells in blood vessel wall. This causes the lumen of the vessel to get bigger and allows some fluid to be trapped in the periphery, which _____ the work load on the heart. They primarily cause venous vasodilation, reducing venous return, (the ___load). Nitrates have another effect on the heart.... what's that?

Back 22

Nitrates are drugs that dilate blood vessels by relaxing smooth muscle cells in blood vessel wall.
This causes the lumen of the vessel to get bigger and allows some fluid to be trapped in the periphery, which decreases the work load on the heart. They primarily cause venous vasodilation, reducing venous return, (the preload) which reduces work load of heart. However, nitrates have potent vasodilating effects on coronary arteries, which improves coronary blood supply and decreases ischemia (angina). Nitrates also decrease BP.

Front 23

Nitroglycerin is a commonly prescribed nitrate often prescribed for people with ____ pectoris. There are long acting forms for stable AP for the routine prevention of anginal attacks. An example of this type is ____ (isosorbide dinitrate) and is given via ____ ____.

An _____ attack can be treated with a nitroglycerin via what route? This is taken episodic, PRN.

Back 23

Nitroglycerin is a commonly prescribed nitrate often prescribed for people with angina pectoris (AP). There are long acting forms for stable AP for the routine prevention of anginal attacks. An example of this type is Isordil (isosorbide dinitrate) and is given via transdermal patch (24 h).

An angina attack can be treated with a nitroglycerin sublingual, which is taken episodic, PRN.

Front 24

Nitroglycerin is stored in an ____ bottle because light can degrade the drug. Once opened it is good for ___ to ___ months even if exp. date is still current.

Back 24

amber,
3-6 months

Front 25

Nitroglycerin comes in two forms:

Back 25

transdermal and sublingual

Front 26

Patients taking nitroglycerin should be taught to do what when taking drug? (2 things)

Back 26

sit or lay down
Don't give on an empty stomach

Front 27

Nitroglycerin can cause a ____ because blood vessels in brain are _____. This usually diminishes over time. ______ or postural hypotension can also occur. Reflex _____ can occur as well because of vasodialtion which leads to SNS activation and then an increase in HR)

Back 27

headache, dilated.
orthostatic
tachycardia

Front 28

2 adverse effects of nitroglycerin are

Back 28

orthostatic hypotension, reflex tachycardia

Front 29

Before administering nitroglycerin, the nurse should check the patient's ___ _____. Change _____ gradually. Watch for possible additive, interactive effects: keep ointment off ____.
Assess for s/s of angina, change in pattern. Do patient teaching.

Back 29

Before administering nitroglycerin, the nurse should check the patient's blood pressure. (You want a baseline and you don't want BP to get too low) Change positions gradually. Watch for possible additive, interactive effects: keep ointment off hands (wear gloves).
Assess for s/s of angina, change in pattern. Do patient teaching.

Front 30

Patient teaching for nitroglycerin includes instruct to change position slowly, take with ____ to decrease headache, report ______ that doesn't get better over time. Instruct about 3 by 5 rule. Caution about additive effects from what 4 things?

Back 30

Patient teaching for nitroglycerin includes instruct to change position slowly, take with food to decrease headache, report headache that doesn't get better over time. Instruct about 3 by 5 rule. Caution about additive effects from alcohol, Beta Blockers, Calcium Channel Blockers, **Viagra!** (sildenafil)

Front 31

Patients taking nitroglycerin need to follow what rule? What does this mean?

Back 31

3 by 5 rule: When angina occurs, the patient puts one nitroglycerin under the tongue and waits 5 min. If pain is still present, they can put another nitroglycerin under the tongue and wait 5 more minutes. Do this one more time if pain still present and if pain is not relieved, call an ambulance.

Front 32

Beta Blockers are drugs that block the ....

Back 32

beta 2 receptors

(They bind to beta receptor cells and block beta activity of the heart).

Front 33

Actions of Beta Blockers (3)

Back 33

decrease force of myocardial contraction
decrease heart rate
decrease rate of conduction through heart's electrical system (negative chronotropic, dromotropic, ionotropic)

Front 34

Beta Blockers reduce work of heart and also reduce the ______ ______ demand. Cardiac Output is vital to ____ supply of tissues.

Back 34

myocardial oxygen

oxygen

Front 35

When are Beta Blockers used?

Back 35

patients with angina
following an MI
HTN
migraines
dysrhythmias (fast rhyhtms)

Front 36

Use caution when giving Beta Blockers with ____ because symptoms can get worse.

Back 36

asthma (causes constriction of bronchiols)

Front 37

What are 6 indications for beta blockers?

What are some nursing implications for the administration of beta blockers?

Teaching?

Back 37

angina
post MI
HTN (not 1st choice med)
dysrhythmias
migraines
stage fright (not FDA approved yet)

Take BP and pulse before admin.
Monitor telemetry
Expect to see a blunted response to exercise
Additive/drug interactive effects with diuretics, anti-hypertensives
Change positions slowly

Teach patient how to take pulse.
Monitor response to exercise by using "body signs" like SOB, fatigue (HR response will be decreased)
Report SOB, asthma attach, especially in COPD or asthmatic patient.
Diabetics need to monitor blood sugars.

Front 38

Many Beta Blockers end in ....

Beta blockers can mask the s/s of _______ so diabetics should be taught to closely monitor their insulin levels when taking these meds.

What are some adverse effects of beta blockers?

Back 38

OL

hypoglycemia (especially masks tachycardia)

Adverse Effects: bronchoconstriction due to blocking of beta 2 receptors in lungs which cause bronchodilation
↓ HR
↓ cardiac contractility
↓ CO
dysrhythmias
fatigue, weakness

Front 39

____ is a mineral needed for muscle contraction. Calcium Channel Blockers (CCB's) prevent calcium influx into ____ muscle ______ of heart and blood vessels. This promotes decreased ______ of heart muscle and vasodilation of ____ in body. Depressed conduction through SA and AV node (due to effect on Calcium channels) leads to decreased ___ ____ (esp. verapimil, diltiazem).

Back 39

Calcium is a mineral needed for muscle contraction. Calcium Channel Blockers (CCB's) prevent calcium influx into smooth muscle channels of heart and blood vessels. This promotes decreased contractility of heart muscle and vasodilation of *arteries* in body. Depressed conduction through SA and AV node (due to effect on Calcium channels) lead to decreased heart rate (esp. verapimil, diltiazem).

Front 40

There are calcium channels in ____ muscle and ____ walls.

CCB's have many uses. What are some?

Back 40

myocardial, vessel

angina
HTN
supraventricular tachycardias
coronary vasospasm
Migraines (vasospasm)
Raynaud's disease

Front 41

When taking a Calcium Channel Blocker, the calcium channels are blocked and the vessels in the body _____

Back 41

dilate

Front 42

Calcium Channel Blockers are often used for people with ____because as the vessels dilate, the heart muscle receives more _____ ____

Back 42

angina, oxygenated blood

Front 43

Calcium Channel Blockers are also used for patients with h_____ and m_____. CCBs are generally well tolerated. What are some adverse effects?

Back 43

HTN, migraines

CV: hypotension, palpitations, tachy/brady, dysrhythmias, heart failure (due to decreased contractile force of heart)
GI: nausea, constipation
Peripheral Edema
Less common: rash, skin reaction

Front 44

4 main Adverse effects of Calcium Channel Blockers

Back 44

hypotension, palpitations, dysrhythmias, heart failure

Front 45

Nursing implications & Patient Teaching for administrations of Calcium Channel Blockers

Back 45

check Pulse and BP 30 min prior to admin
Monitor telemetry if ordered
Monitor adverse/ additive effects
Hold med for excessive therapeutic response & contact MD (low BP, low HR, heart block)
Grapefruit jiice may interact, reduce metabolism of CCB

Teaching:
Instruct on home monitoring of BP, HR
Diet modifications: grapefruit juice
Report excessive fatigue, palpiations, low BP ↓ or ↑ HR
Clarify calcium misconceptions (bone loss)
(CCBs have nothing to do with bones)

Front 46

ACE inhibitors are Angiotensin-converting enzyme inhibitors.
They block the enzyme, ACE, from converting Angiotensin ___ to Angiotensin ___.
Angiotensin II is a potent _______ and leads to secretion of _____, a corticosteroid that causes the kidneys to hold on to water and sodium.
ACE inhibitors block effects of Angiotensin II which results in ____ and _____ aldosterone secretion.

Back 46

ACE inhibitors are Angiotensin-converting enzyme inhibitors.
They block the enzyme, ACE, from converting Angiotensin I to Angiotensin II..
Angiotensin II is a potent vasoconstrictor and leads to secretion of aldosterone, a corticosteroid thAt causes the kidneys to hold on to water and sodium.
ACE inhibitors block effects of Angiotensin II which results in vasodilation and decreased aldosterone secretion.

Front 47

ACE is produced in the _____ and travels to the _____ where angiotensin I is converted to angiotensin II

Back 47

liver, kidneys

Front 48

ACE inhibitors block the conversion of this potent ________ so the vessels can vasodilate. Vasodilation leads to decreased b____ p____. Decreased aldosterone leads to less ___ and ____ retention in the body. This is good for CHF and other fluid overload states, less circulating fluid decreases the work on the heart.

Back 48

ACE inhibitors block the conversion of this potent vasoconstrictor, so the vessels can vasodilate. Vasodilation leads to decreased blood pressure. Decreased aldosterone leads to less fluid and sodium retention in the body. This is good for CHF and other fluid overload states, less circulating fluid decreases the work on the heart.

Front 49

Vasodilation leads to a decreased BP. The body also gets rid of sodium and when that happens, water follows. The body tries to retain____ so it is important to check the level.

Back 49

potassium

Front 50

ACE inhibitors is often used for ____ and ____

Back 50

HTN and CHF

Front 51

ACE inhibitors usually end in 2 letters

Back 51

iL

Front 52

ACE inhibitors cause an adverse effect of a very annoying....

What are some other adverse effects?

Back 52

dry, nonproductive, acking cough, stops if med is stopped. Some patients can't handle it.

Fatigue
dizziness
H/A
Hyperkalemia (with NA excretion K is retained)
Hypotension
Angioedema (rare but serious hypersensitivity reaction)

Front 53

When giving ACE inhibitors, nurse must assess patient's _____ _____ before administering. Also monitor electrolytes, especially ______. For CHF patient, monitor daily ____, ___ sounds, and other s/s of heart failure. Assess for development of ___ over time. Also, with the elderly, assess renal function, especially ____ and ___ ___ tests.

Patient teaching....

Back 53

When giving ACE inhibitors, nurse must assess patient's blood pressure before administering. Also monitor electrolytes, especially potassium. For CHF patient, monitor daily weight, lung sounds, and other s/s of heart failure. Assess for development of cough over time. Also, with the elderly, assess renal function, especially BUN and creatinine clearance test.

Patient teaching: Change position slowly, monitor BP regularly, take with food if you get a headache.
If CHF, report s/s of fluid retention and monitor DW.