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74 Cards in this Set

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Describe the clinical syndrome seen in Congestive heart failure
1. weight gain
2. edema
3. SOB
4. pulmonary congestion
5. and a variety of other symptoms.
pharmacological Management of CHF includes:
A. Cardiac Glycosides
B. Diuretics
C. Vasodilators (ACE inhibitors, Nitrates)
D. Beta Adrenergic Blockers
Drug Management objectives for CHF:
A. Correction of NA, water retention and volume overload.
B. Reduction of cardiac workload.
C. Improvement of myocardial contractility.
D. Control of precipitating and complicating factors.
Cardiac glycoside class includes the drugs:
1. digoxin* (Lanoxin)
2. digitoxin (Purodigin)
Cardiac glycoside mechanism:
Act by inhibit sodium-potassium pump there by increase intracellular calcium making cardiac muscle fibers contract more efficiently
Cardiac glycoside provide effective treatment of CHF by:
1. Exerting a positive inotropic action on the heart.
- Increase the force of myocardial contraction.
- Reduction of heart size.
- Increase blood flow to the kidneys.
2. Exerting a negative chronotropic and dromotropic action on the heart.
3. Increase stroke volume.
Cardiac glycoside Results:
1. Increase myocardial contractility
2. Increase cardiac output
i. increase cardiac, peripheral, kidney function
ii. decrease preload
3. Improve blood flow to periphery and kidneys
4. decrease edema and increase fluid excretion.
What is the Digitalizing dose of Cardiac Glycoside?
loading dose to bring serum level of the drug up to a desirable therapeutic level (2 mg IV).
What is the Daily maintenance dose of Cardiac Glycoside?
dose intend to replace medication that has been metabolized or eliminated by the body.
normal range: 0.125 - 0.5 mg daily.
What is the Conventional dose of Cardiac Glycoside?
dose in place of digitalizing dose, used from the very onset of therapy, particularly when a relatively short-acting cardiac glycoside, such as digoxin is used. Plateau at 7 days. Have narrow therapeutic range: 0.5 - 2 ng/ml in blood.
Identify signs of toxicity which may result from cardiac glycosides.
1. Nausea
2. vomiting
3. anorexia
4. Visual disturbances (green and yellow vision)
5. diplopia
6. bradycardia
7. headaches
8. dizziness
9. fatique
What is the antidote for digitalis glycosides?
digoxin immune fab (Digibind).
Works by binding to digoxin then excreted in urine.
Discuss nursing implications for the care of person taking cardiac glycosides
1. Always check apical rate for 1 full minute.
2. Withhold these drugs if the apical pulse rate is
<60 bpm
3. Check for signs of peripheral and pulmonary edema.
4. Report bigeminy or significant deviation in the heart rate and rhythm.
5. Assess for toxicity by checking serum level (0.5-2 ng/ml), heart rate and rhythm and observing for neurological signs, such as headache, visual disturbances and changes in color vision and gastrointestinal symptoms such as nausea, vomiting, and anorexia.
6. Monitor mental status.
7. Monitor potassium level and report level less than 4 ml.
8. To minimize pain and possible tissue damage, IM must be given deep into a large muscle mass.
9. Teach client and family members how to recognize signs of toxicity and assess heart rate.
What is the action of diuretics?
Increase urine flow resulted in:
1. Reduced blood volume
2. Reduced cardiac workload
3. Metabilize edematous fluid.
What are the 3 categories of Diuretics?
1. Thiazide
2. Loop
3. Potassium-sparing
Mechanism of:
Thiazide Diuretics
act by inhibiting sodium and chloride reabsorption in the early portion of the distal tubule, although they may block chloride reabsorption in the ascending Loop of Henle.
Adverse effects of:
Thiazide Diuretics
1. potassium depletion and hypokalemia which leads to:
cardiac arrhythmias and
muscle weakness.
2. Chloride depletion
3. metabolic alkalosis.
Uses of:
Thiazide Diuretics
1. Hypertension
2. Peripheral edema
Adverse effects of:
Thiazide Diuretics
a. electrolytes imbalances:
bicarbonate loss
b. Hyperglycemia
c. Hyperuricemia
d. hyperlipidemia
e. Sensitivity-skin rashes
example of short acting Thiazide diuretic
1. Chlorothiazide (Diuril)
2. hydrochlorothizide (HydroDiuril, HCTZ)
example of immediate acting Thiazide diuretic
metolazone (Zaroxolyn)
example of Long acting Thiazide diuretic
indapamide (Lozol)
Drug Class:
Chlorothiazide (Diuril)
Thiazide diuretic
Therapeutic action:
Chlorothiazide (Diuril)
Inhibits reabsorption of sodium and chloride in distal tubule, increasing the excretion of sodium, chloride, and water by the kidney.
Indication of:
Chlorothiazide (Diuril)
i) Adjunctive therapy in edema associated with CHF, cirrhosis, corticosteroid, and estrogen therapy, renal dysfunction.
ii) Treatment of hypertension, alone or with other antihypertensive.
Dosage of:
Chlorothiazide (Diuril)
Edema: 0.5 - 2 g PO or IV qid or bid.
hypertension: 0.5-2 g/d PO as a single or divided dose.
Adverse effects of:
Chlorothiazide (Diuril)
Dizziness, vertigo, nausea, anorexia, vomiting, dry mouth, diarrhea, constipation, polyuria, nocturia, impotence.
Nursing implications for:
Chlorothiazide (Diuril)
i) take drug early in the day
ii) weigh yourself daily and record weights.
iii) protect skin from exposure of the sun or bright light.
iv) Report: rapid weight change,
swelling in ankles or fingers,
oral bleeding or bruising,
muscle cramps.
Mechanism of:
Loop diuretics
act by inhibiting the reabsorption of sodium and chloride in the ascending loop of Henle, thereby reducing the ability of the kidneys to concentrate Urine.
Uses of:
Loop diuretics
1. HF
2. Hepatic cirrhosis
3. chronic renal failure
example of:
Loop diuretics
*all ending with "ide"*
1. furosemide (Lasix, Novo-Semide)
2. bumetanide (Bumex)
3. toremide (Demadet)
Main adverse effects of:
Loop diuretics
electrolyte imbalances
Drug class of:
Furosemide (Lasix, Novo-Semide)
Loop diuretics
Therapeutic actions of:
Furosemide (Lasix, Novo-Semide)
Inhibits the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of Henle, leading to a sodium-rich diuresis.
Uses of:
Furosemide (Lasix, Novo-Semide)
· Edema associated with CHF, cirrhosis, renal disease (oral, IV)
· Acute pulmonary edema (IV)
· Hypertension (oral)
Contraindications/cautions of:
Furosemide (Lasix, Novo-Semide)
allergy to furosemide, sulfonamides;
allergy to tartrazine (in oral solution);
electrolyte depletion;
anuria, severe renal failure;
hepatic coma;
Use cautiously with SLE, gout, diabetes mellitus.
Adverse effects of:
Furosemide (Lasix, Novo-Semide)
electrolytes imbalances
Nursing implementation for
Furosemide (Lasix, Novo-Semide)
1. Administer with food or milk to prevent GI upset.
2. Reduce dosage if given with other antihypertensives
3. Give early in the day.
4. Avoid IV use if possible.
5. Do not mix parenteral solution with highly acidic solutions with pH below 3.5.
6. Do not expose to light, Discard diluted solution after 24 h.
7. Refrigerate oral solution.
8. Measure and record weight to monitor fluid changes.
9. Arrange to monitor serum electrolytes, hydration, liver function.
10. Arrange for potassium-rich diet or supplemental potassium as needed.
Mechanism of:
Potassium-sparing diuretics
exert action on the distal tubule.
Uses of:
Potassium-sparing diuretics
1. CHF
2. Hepatic cirrhosis
3. Nephrotic syndrome
example of:
Potassium-sparing diuretics
1. Spironolactone (Aldactone)
2. Triamterene (Dyrenium)
3. amiloride HCl (Midamor)
Main Adverse effects:
Potassium-sparing diuretics
Drug class of
Triamterene (dyrenium)
Potassium-sparing diuretic
Therapeutic actions of
Triamterene (dyrenium)
directly block sodium reabsorption in the distal tubule independently of aldosterone.
Indications for
Triamterene (dyrenium)
Edema associated with:
Congestive Heart F
nephrotic syndrome
hepatic cirrhosis;
secondary hyperaldosteronism
(alone or with other diuretics for
added diuretic or antikaliuretic effects)
Triamterene (dyrenium)
□ Contraindications:
allergy to triamterene
renal disease
(except nephrosis)
liver disease
□ Use cautiously with
diabetes mellitus
Adverse effects of
Triamterene (dyrenium)
1. headache
2. drowsiness
3. weakness
4. Nausea
5. anorexia
6. vomiting
7. dry mouth
8. diarrhea
9. Hyperkalemia.
Nursing Implementation for:
Triamterene (dyrenium)
□ Administer with food
or milk if GI upset occurs.
□ Mark calendars or provide other
reminders of drug days for outpatients
if alternate-day or 3- to 5-d/wk
therapy is optimal for treating edema.
□ Administer early in the day so that
increased urination does not disturb sleep.
□ Measure and record regular weights
to monitor mobilization of edema fluid.
□ Arrange for regular evaluation of serum electrolytes, BUN.
what are the two types of Vasodilators?
1. ACE inhibitors
2. Nitrates
List the 4 goals of vasodilators therapy.
1. Increase venous capacity
2. Improve ventricular contraction
3. Decrease ventricular dysfunction
4. Decrease heart size
List example of
Angiotensin Converting Enzyme (ACE) inhibitors drugs.
generic name ends in "pril"
1. Captophil* (Capoten)
2. Enalapril* (Vasotec)
3. Fosinopril (Monopril)
4. Benazepril (Lotensin)
5. Lisinopril* (Prinivil, Zestril)
Describe the MOA of
Angiotensin Converting Enzyme (ACE) inhibitors.
The drugs interfere with the conversion of angiotensin I to angiotensin II by inhibiting the action of ACE, the enzyme that permits the conversion. This action results in the dilation of peripheral blood vessels and a reduction in BP
List 4 systemic effects of
Angiotensin Converting Enzyme (ACE) inhibitors.
1. Lower peripheral resistance
2. Reduce blood volume
3. Decrease after load
4. Increase cardiac output
What should client taking
Angiotensin Converting Enzyme(ACE) inhibitors be monitor for.
clients receiving ACE inhibitors should be monitored for
1. development of renal and
2. hematologic changes that may be caused by these drugs.
Adverse effects of
Angiotensin Converting Enzyme (ACE) inhibitors
1) Hypotension
2) Chronic cough
3) Renal insufficiency
Nursing Implication for
Angiotensin Converting Enzyme (ACE) inhibitors
1) Obtain CBC before starting therapy and every month for the first 3 to 6 months of treatment.
2) Monitor tests related to renal function and blood glucose levels.
Patient education for
Angiotensin Converting Enzyme (ACE) inhibitors
1) Not to abruptly discontinue use of captopril
2) Instruct how to monitor blood pressure
3) Inform not to take OTC drugs (cold or allergies meds) without first contacting provider.
State 2 theories that may explain how nitrates reduce anginal pain.
Theory 1: Nitrate improve the delivery of oxygen to ischemic tissue by increasing coronary blood flow and by causing favorable redistribution of blood flow to ischemic areas.

Theory 2: Nitrate reduces oxygen consumption by coronary blood vessels and thereby relieve the ischemic state.
What is
Amyl nitrate
- Is a volatile liquid package in a crushable glass capsules surrounded with cotton and gauze.
- Inhaled by client.
Identify the common routes of nitroglycerin administrations.
1. Sublingually
2. Transdermal patches
3. Extended release - buccal
4. Sustained release - oral tablets
5. Ointment
6. IV
Example of Nitrate that are administered
Example of Nitrate that are administered
Transdermal patches
Example of Nitrate that are administered in
Extended release buccal form
(Nitrogard SR)
Example of Nitrate that are administered in Sustained release oral tablets form.
What is the storage requirements necessary for nitroglycerin tablets to retain their potency?
- Avoid extreme temperature and humidity.
- Should not be refrigerated
Describe the effect of Nitrates on the heart.
a. Dilates large myocardial arteries to increase blood supply to the heart.
b. Reduces cardiac preload by reducing venous tone thereby allows for blood pooling in the periphery.
List major adverse effects associated with the use of nitrates.
headaches, dizziness, nausea or vomiting
agitation, facial flushing, increase
PR, dry mouth, rash, blurred vision
What are the contraindications with the use of nitrates?
1. clients with head trauma
2. cerebral hemorrhage
3. hypertension
4. Glaucoma
What are nursing implications for clients taking Nitrate by IV?
Nitrate cannot be given directly by IV, must be diluted.
What are the Nursing implications for clients taking Nitrate by transdermal route?
- Do not use finger to spread
- Rotate site
- Do not massage or rub
What are the Nursing implications for clients taking Nitrate by sublingual route?
- Pt. should sit or lie down to take medication
- potency of drug usually noted by burning or stinging sensations under tongue (newer drugs may not do this).
- Dose repetition - q 5 min X 3 doses. Notify provider if pain not relieved in 15 minutes.
What are some patient teaching regarding nitrate?
1. Avoid ETOH - shock-like syndrome such as flushing, weakness, pallor, hypotension, syncope may occur.
2. Dizziness, lightheadedness and slight headache may occur with administration.
3. Recognize overdose symptoms.
What are symptoms of nitrate overdose?
1. blurred vision
2. dry mouth
3. severe headaches
What is the only Beta-adrenergic blocker approved for the treatment of CHF?
carvedilol (Coreg)