Pharm 101-Cardiac

Front 1

Dromotropic (negative)

Back 1

decreased conduction velocity through AV node.

Front 2

dromotropic (positive)

Back 2

increased conduction velocity through AV node.

Front 3

Chronotropic (negative)

Back 3

decreased Heart Rate

Front 4

Chronotropic (postive)

Back 4

Increased heart rate

Front 5

Inotropic (negative)

Back 5

decreased strength/force of myocardial contraction

Front 6

Inotropic (positive)

Back 6

increased strength/force of myocardial contraction.

Front 7

Inotropic drugs

Back 7

Digitalis Glycosides (digoxin)
Dopamine (Inotropin)
Dobutamine (Dobutrex)
Depinephrine
Isoproterenol (Isuprel)
Amrinone (Inocor)
Milirone (primacor)

Front 8

What does Digoxin/Lanoxin do?

Back 8

Alters balance of intracellular Na and extracellar K by inhibiting the Na-K pump.

Front 9

How is Digoxin/Lanoxin administered?

Back 9

by IV (5-30 min.) or PO 1/2 to 2 hours
**Titrate carefully b/c narrow window between Therapeutic effect and toxicity.*****

Front 10

What is the #1 reason for Digitalis toxicity?

Back 10

Hypokalemia

Front 11

What does Digoxin used for?

Back 11

to increase cardiac output
+ Inotropy
- Chronotropic (Decrease HR)

Front 12

What is another name for Digoxin?

Back 12

Lanoxin

Front 13

What class of drugs is Digoxin?

Back 13

Cardiac Glycoside

Front 14

What is the normal serum range for digoxin?

Back 14

Therapeutic range
(0.5-2.0 ng/ml)

Front 15

What are the expected Therapeutic responses of Digoxin r/t CHF?

Back 15

Increase Cardiac Output
slows A/V node
Recuction of Blood volume
relieves pulmonary congestion

Front 16

What lab values would you check for digoxin?

Back 16

Electrolyets
Ca-b/c it can cause dysrythmia
K-this drug inhibits
Na-this drug inhibits
Mg
Hgb
HCT

Front 17

What are the interventions/implications when administering digoxin po?
Parameters for w/holding?

Back 17

Check recent serum dig level
Take apical pulse (1 min)
*if pulse is >60 dont give
hold if K levels are abnormal

Front 18

Side effects for Dig toxicity?

Back 18

Palpatations/dysrythmias (glycoside is irritant)
n/v/d anorexia visual disturb.
brady or tachy
Moodchanges (irritability)
Muscle cramps (low K)

Front 19

When is the onset of digoxin?

Back 19

30-90 minutes

Front 20

What is digoxin's half life? or duration?

Back 20

3-4 days

Front 21

what would dig combined w/ Lasix do to the body?

Back 21

increase chance of dysrythmias
edema should go down
respiratory probs down
measure I & O

Front 22

Dopamine Inotropin

Back 22

Sympathomimetic vasopressor
Low=dilation (0.5-2.0)
Mod=beta 1 (2-10)
High=alpha (10 or more)

Front 23

Dobutamine (dobutrex)

Back 23

sympathomimetic inotrope
Beta 1
Decrease risk for arrhythmias
improved contractility leads to increased cardiac output

Front 24

Epinephrine

Back 24

natural catecholamine
sympathomimetic inotrope
biologic response
stimulates beta and alpha 1
+inotropic
+chronotropic
increased force and cardiac output
increases HR by stimulating the SA node.
Potent renal vasoconstrictor
causes metabolic acidosis
decreased urinary output

Front 25

Isoproteronal (Isuprel)

Back 25

sympathomimetic inotrope
beta 1 (^CO d/t ^ HR, but not stroke volume)
beta 2
^ contractility, impulse conduction velocity, HR
Smooth muscle relaxation
Pulmonary vascular resistance
Tachycardia possible!
**given in emergencies**

Front 26

ANTI-ANGINAL DRUGS ARE USED FOR?

Back 26

THERAPY FOR ANGINA BASED ON DECREASING MYOCARDIAL OXYGEN REQUIREMENTS AND/OR INCREASING BLOOD FLOW TO ISCHEMIC MYOCARDIUM.

Front 27

name some anti-anginal drugs.

Back 27

nitroglycerin (SL, Ointment, patch, IV, metered spray, disc)
Isosorbid or Isordil (long-term)

Front 28

what are the actions of anti-anginals?

Back 28

1.they are direct acting nonspecific vasodilators affecting all smooth muscles. 2.relieves spasms
3.decreases vagal tone
4.decreases preload
5.b/p drop resulting in reflux tachycardia
6.peripheral edema (long-term)

Front 29

What are uses of anti-anginals?

Back 29

1.used for acute treatment of anginal attacks.
2.long-term prophylactic mgt. of angina pectoris
3. CHF
4.IV for severe C.P.
-can potentially decrease MI size and reduce mortality rate.

Front 30

What are some precautions of anti-anginals?

Back 30

Floppy valve syndrome
HTN
Hypotension/Hypovolemia
renal/hepatic dysfunction
pericarditis
HALF LIFE = 1-4 min.

Front 31

What are some contraindictions of anti-anginal drugs?

Back 31

severe anemia
head trauma/cerebral hemmorage
severe hypotension/hypovolemia

Front 32

What are the side effects of anti-anginals?

Back 32

flushing
pounding pulsating HA
N/V light headed/dizy
hypotention
reflex tachycardia
palpatations

Front 33

what is a drug interaction when taking anti-anginal drugs?

Back 33

don't drink alcohol

Front 34

coronary vasodilators
What would you teach a pt who is being prescribed this type of med?

Back 34

1. take at at the 1st sign of pain
2. place nitro tab under the tongue (SL)& let it dissolve & hold saliva in mouth for 1-2 min before swallowing. when pain is relieved the remaining tab is expelled.
3. take total of 3 tabs.(1 every 5 min)for a single attack.
4. if no relief. chew reg. aspirn & swallow & call 911.

Front 35

When may you want to take a nitroglycerin tab?

Back 35

3-5 min before any activity known to trigger an attack.
(excercise or sex)

Front 36

How would you want to store nitro?
(SHORT ACTING)

Back 36

in it's original container b/c they lose potency when exposed to heat, light, moisture, or other organic materials.

Front 37

How long does a nitro script last? (SHORT ACTING)

Back 37

Nitroglycerin is only stable for approximately 5 mos.

Front 38

What should one know about translingual nitroglycerin?
(SHORT-ACTING)

Back 38

that you spray 1-2 doses into the mouth. DO NOT INHALE SPRAY.Tak no more than 3 metered doses in 15 min.

Front 39

Long acting nitro products ____________________________.

Back 39

will not relieve acute anginal attacks

Front 40

Long acting coronary vasodilators are maintained at a constant rate in the blood by __________.

Back 40

taking the drug at the correct prescribed times.

Front 41

How are long acting tablets or capsules taken?

Back 41

they are taken whole...not crushed or opened.

Front 42

Why are nitroglycerin topical patches removed at bedtime?

Back 42

to retard the development of resistence.

Front 43

nitro patches.
how often do you apply?

Back 43

apply once daily to clean, dry skin. wash and dry skin where old patch removed.
**check for lost or forgotten patches.**

Front 44

why do you avoid alcohol when taking vasodilators?

Back 44

b/c bp could drop too suddenly

Front 45

what do you do if you miss a dose of a vasodilator?

Back 45

You don NOT catch up!!

Front 46

what do you do if you become dizzy or faint while taking a vasodilator?

Back 46

lower head and deep breathe. mild headache possible but if severe or lasts longer than 15-20 min notify DR to alter the dose.

Front 47

are vasodilators habit forming?

Back 47

no they are not habit forming.

Front 48

other drugs used to treat angina. (alone or in conjunction w/ vasodilators)

Back 48

1.beta-adrenergic blockers or beta blockers
2. calcium channel blockers or calcium antagonists

Front 49

beta blockers and calcium channel blockers may be used to treat:

Back 49

1.angina
2.htn
3.for prophylactic/therapeutic management of MI or post MI

Front 50

Beta adrenergic action or beta blockers

Back 50

decreases heart rate and for of cardiac contraction reducing oxygen needs of the myocardium.

Front 51

cautions w/ beta adrenergic blockers or bb

Back 51

can prevent bronchodilation in asthma pts
can prohibit tachycardia as an early sign of diabetic shock.
decrease in difficulty urination as in BPH

Front 52

calcium channel blockers or calcium antagonists actions

Back 52

completely blocks slow-channel influx of calcium into active as cardiac and smooth muscle cells causing dilation of peripheral arterie and arterioles.

Front 53

uses of calcium channel blockers of calcium antagonists.

Back 53

antidysrhythmic
HTN
MI
menstral cramps
premature labor
cerebral vascular spasm

Front 54

vasopressors action

Back 54

catecholamines increase myocardial contractile force, HR,& concuction thru heart. stimulates Purkenje fibers causing possible ventricular dysrhymias
Increases PVR & BP
To treat hypovolemic & cardiogenic shock, adequate fluid treatment is necessary.

Front 55

Vasopressors are given in emergencies to _________.

Back 55

increase blood pressure

Front 56

side effects of vasopressors

Back 56

anxiety, nervousness, tremors
increased alertness
increased dysrythmias
increased tachycardia
anginal chest pain
HA/flushing
sweating
**wide starring appearence due to contraction of radial & sphincter muscles of iris.

Front 57

nursing interventions when giving vasopressors to prevent or minimize hypotension and shock.

Back 57

1. maintain fluid balance, control hemorrhage, treat infections, prevent hypoxia and other causitive factors.
2. recognize impending shock so treatment initiated early.

Front 58

when a pt is recieving a vasopressor the nurse needs to monitor...?

Back 58

1. titrate meds to maintain BP w/o causing hypertension
2. check BP and Apical pulse every 15 min (during acute shock)
3. check peripheral pulse, UO, skin temp and cap refill.
4. maintain venous access

Front 59

Name some vasopressors.

Back 59

epinephrine, norepinephrine, phenylephrine, dobutamine, dopamine and Isoprotereonol.

Front 60

what is a precaution with epinephrine?

Back 60

do NOT inject IM b/c gas gangrene may occur!

Front 61

what is the antidote for the vesicant drugs dopamine, norepinephrine/levophed and dobutrex/dobutamine?

Back 61

it is a vesicant (if infiltrates phentolamine or regitine given)

Front 62

name some anti-hypertensive drugs.

Back 62

diuretics,angiotensin-converting enzyme (ace inhib), anti-adrenergics (sympatholytic), calcium channel blockers and vasodialators.

Front 63

anti-hypertensive drugs usually act to:

Back 63

1. decrease BP by decreasing volume of cardiac output
or
2. decrease peripheral vascular resistance (PVR) by dilating bv

Front 64

anti-hypertensive drugs are given to people who have:

Back 64

HTN, heart failure, angina pectoris/ischemia and some dysrhythmias

Front 65

when giving diuretic drugs you need to :

Back 65

be sure pt is hydrated
check kidney perfusion (GFR)
>30 ml/min give thiazide
<30 ml/min give loop diuretics

Front 66

what is the action of diuretics?

Back 66

diuretics inhibit Na and Cl reabsorption in the nephron...then fluid follows

Front 67

Loop diuretics
what is the strength?

Back 67

Loop diuretics are the strongest diuretics you can give.

Front 68

what is a common loop diuretic?

Back 68

furosemide or lasix

Front 69

what are the 3 factors responsible for BP?

Back 69

cardiac output
volume (preload)
resistance (afterload)

Front 70

what is the onset of lasix?

Back 70

PO=results in 1hr & lasts 4-6
IVP=results in 5-10 min w/ 2hr duration.

Front 71

when administering lasix how many mg do you usually give?
at high doses?
what is the risk in ^ doses?

Back 71

reg: 20 mg/min
high doses: 4 mg/min to decrease risk of transient ototoxicity.

Front 72

what is the mid or moderate diuretic?

Back 72

thiazide diuretics

Front 73

how does thiazide work?

Back 73

it kicks out Na & K and water follows.
*can cause ^ FBS & decrease glucose tolerance during long term therapy*

Front 74

what are some side effects of thiazide?

Back 74

dizziness, weakness, fatigue, orthostatic hypotension
^ BUN
hyperuricemia
sun sensitivity

Front 75

what is the weakest diuretic?

Back 75

potassium-sparing diuretic is mild but can drop sys/dia BP
*(monitor for hyperkalemia)

Front 76

what is osmotic diuretic do?

Back 76

keeps kidneys protected/flushed & perfused.
manages edema
reduces ICP
reduces Intraocular pressure
^ urinary excretion of toxic materials in toxic drug OD

Front 77

what is a side effect of osmotic diuretics?

Back 77

transient volume expansion
hypo-natremia &kalemia
*may give lasix as a chaser*

Front 78

what is acetazolmide or diamox used for?

Back 78

used to treat glaucoma

Front 79

what are ACE inhibitors used for?

Back 79

used to protect the heart and renal functions

Front 80

what do you want to do before administering ACE inhibitors?

Back 80

you want to check the BP before IVP admin.

Front 81

what are the side effects of ACE inhibitors?

Back 81

dry cough
nutripenia
angiodema
anaphlaxis

Front 82

what is the best med to use for HTN?

Back 82

diuretics

Front 83

what drugs don't you want to give for CHF?

Back 83

do not give CCB or BB for CHF.

Front 84

anti-adrenergics/sympatholytic/beta blockers are given:

Back 84

1. after MI
2. to decrease BP
3. to relieve angina

Front 85

anti-adrenergics/sypatholytic/beta blockers action is to:

Back 85

inhibit activity of sympathetic nervous system including HR, myocardial contractile force, CO, and decreased b/p.

Front 86

hytrin or terazosin is given for...

Back 86

BPH benign prostatic hypertrophy and
urinary obstruction

Front 87

calcium channel blockers are used for:

Back 87

vasodilation effects as in decreasing PVR, treat tachyarrythmias, angina and HTN

Front 88

CCB:

Back 88

cause HF to worsen.
slow HR: decrease contractility: dialate BV

Front 89

vasodilators are:

Back 89

Quick acting/short term
*Used in Emergencies*
direct acting

Front 90

hyperstat is a vasodilator used for:

Back 90

used in hypertensive crises
**given by MD only!!**
rapid IVP w/in 30 sec

Front 91

vasodilators cause:

Back 91

flushed skin
constriciton
*Can NOT sustain pt on this drug*

Front 92

anti-lipidemia drugs are used to treat _________.

Back 92

high cholesterol

Front 93

when giving lipidemia what do you need to caution w/ other drugs?

Back 93

give other meds before or after anti-lipidemic drugs b/c AL drugs might bind to them.

Front 94

what do you need to caution w/ antilipidemic drugs?

Back 94

1. Liver enzymes need to be drawn every 6 mos.
2. can cause permanent muscle break down (sore, inflammed muscles)
3. can cause hepato-toxicity

Front 95

what is caduet?

Back 95

a fairly new drug that is a anti-lipidemia and a vasodilator (2 in 1)

Front 96

how do you decrease cholesterol?

Back 96

dieting(tree nuts), exercise and no smoking.
*the body produces it's own supply of cholesterol.

Front 97

lipitor (anti-lipidemia) is used to?

Back 97

reduce LDL levels.
LDL should be under 100
HDL should be 40 or higher

Front 98

nicinamide treats ____.
what is it's food-drug interaction?

Back 98

nicinamide treats hyperlipidemia or hyperlipoproteinemia.
*not to be taken w/ grapefruit juice.

Front 99

PT and PTT are lab tests for ______?

Back 99

anticoagulation lab tests

Front 100

what is PT

Back 100

PT is Prothrombin time. it is used to monitor anticoagulation of coumadin (warafin) therapy.

Front 101

what are the lab values for PT

Back 101

it varies but 16.5-25 sec
INR is standardized. preferred INR for anticoagulation is 1.5-3.5

Front 102

what alters PT time?

Back 102

vitamin K alters values

Front 103

what is APTT or PTT?

Back 103

activated partial thromboplastin time and parial thromboplastin time. it is used to monitor anticoagulation of heparin therapy (IV or SC)

Front 104

APTT/PTT normal values

Back 104

APTT 30-40 sec x control 1.5-2.5
PTT 60-70 sec x control 1.5-2.5

Front 105

what does hemostasis mean?

Back 105

stop bleeding. when bleeding stops it clots.

Front 106

hemostasis occurs when?

Back 106

1. when there is vasoconstriction
2. plug of platelets at site
3. clotting cascade

Front 107

components of platelet plug

Back 107

1.collagen, fibrous protein and endothelial lining=plate adhesion
2. ADP(adenosine diphosphate)=stickiness (at injury site)
3. plug unstable & needs fibrin to stabilize it

Front 108

anticoagulants actions

Back 108

1.prevent or retard blood coag
2.not dissolvable if clot is present
3. use prophylactically (to prevent future clots)
4. oral route=coumidin or warfarin
5. parenteral route= heparin

Front 109

heparin is given:

Back 109

SC
*lovenox is given concurrently w/ aspirin. (it's only given in the stomach)
DO NOT ASPIRATE!

Front 110

anticoagualnts are given to treat:

Back 110

deep vein thrombosis (DVT) Pulmonary embolism(PE)
Arterial diseases (coronary artery disease, atrial fibrillation)
prophylactically for pt's on bedrest who have major sx's or have a history of clotting.

Front 111

why don't you give anticoagulants to someone who has had brain sx?

Back 111

b/c it can cause the brain to bleed (like a stroke!)