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73 Cards in this Set
- Front
- Back
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Overdose of Anticoagulant (Heparin)
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D/C and give Protamime
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Labs to check Anticoagulant
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PTT
Warfarin or Coumadin checked with PT/INR |
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Warfarin Overdose
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Give Vitamin K IM or IV
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Transition period from Warfarin (Coumadin)
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take 4-5 days to get to therapeutic level- overlap Heparin and coumadin to prevent clotting
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Nursing Considerations- Anticoagulants
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Teach Patient to watch of signs of OD
-Bleeding gums while brushing teeth -unexplained nose bleeds -bruising -Abdominal Pain -Back Pain -Bloody/Tarry stools -Bloody Urine -Blood in Sputum -Severe/Continuous headache -Vomiting blood or coffe ground emesis |
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How does the drug lower LDL
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Increasing LDL receptors= less in blood stream
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LDL (levels)
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less than 100 optimal
130-159 borderline high 160-189 high >190 very high |
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HDL (levels)
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<40 low
>or= 60 is high |
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Total Cholesterol
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<200 optimal
200-239 borderline >or= 240 high |
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Statins (Basic)
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Most widely used
atovastatin (Lipitor) simvastain (Zocor) end in -statin |
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Statins treat
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-Hypercholesterolemia
-Elevated HDL -Lower risk for CV event in those who have never had CV event -Lower risk of CV events in diabetics (Type 2 expecially) even without an elevated cholesterol |
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Contraindications and Side Effects
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Contraindications-Pregnancy, allergies, liver disease and elevated liver levels
Side Effects: HA, dizziness, blurred vision, fatigue, nightmares, insomnia, constipation, cramps, diarrhea, nausea, changes in bowel function, and skin rashes |
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SERIOUS side effect of Statins
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Rhabdomylysis- The break down of muscle protein. Leads to myoglobinuria. This causea a sever stain on the kidneys and can lead to actue renal failure and death
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What to teach a patient who is on Statins
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Teach the patient to report any unexplained muscular pain or discomfort
Limit grapefruit juice Take medication at night Takes 2-6 weeks to see a lower LDL |
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Drug Interactions of Statins
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Anticoagulants
Oral antidibetics Insulin Grapefruit Juice |
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Bile Acid Sequestrants (Basic)
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Therapeutic Effects- Lower LDL and Elevate HDL
Prevent the reasprtion of bile acids from the small intestine. This means more bile acid is synthesized in the liver and cholestrol is needed to make bile acids. LDL receptors are increased |
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Side Effects of Bile Acid Sequestrants
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Constipation, bloating, indigestion, nausea, and rarely a decrease in fat soluable vitamin absorption
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Interactions of Bile Acid Sequestrants
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May bind with other drugs. If the drugs are bound, then they are not absorbed.
-Thizide diurects, digoxin, warfarn, and some antibiotics (Therefore must take meds 1 hour prior to or 4 hours after taking the bile acid sequestrant) |
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Nicotinic Acid- Niaspan (Basic)
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Therapeutic Effect:
-Lower LDL -Lower TG -Raise HDL Action: Lower the production of VLDL. LDL are byproducts of VLDL degradation. |
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Side Effects of Nicotinic Acid
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Intense Flushing. Can be prevented by taking 325 mg of ASA 30 minutes prior
-GI Upset -N/V -Diarrhea -Hepatoxic-expecially with slo niacin |
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Fibric Acid Derivatives- Fibrates (Basic)
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More effective on lowering TG and raising HDL
Does NOT impact LDL |
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Side Effects and Drug Interactions with Fibrates
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Side Effects: Rashes, GI distrubances
Drug Interactions: -Increased risk of bleeding with patients on Warfarin -Increased risk of Rhabdomyolysis with patients taking statins |
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Ezetimibe (Zetia) Basic
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Action: Cholesterol absorption inhibitor
Therapeutic effects- Lower plasma levels of total cholesterol (LDL, Cholesterol and TG) |
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Side Effects of Ezetimibe (Zetia)
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-Myopathy
-Rhabdomyolysis -Hepatitis -Pancreatitis -Thrombocytopenia (Low thrombocytes) |
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Drug Interactions of Ezetimibe (Zetia)
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-Statins increase the risk of liver damage
-Fibrates increase risk of gall stones and myopathy (Do not mix) -Sequestrants- can interfere with the absorption of drug *Food does not interfere with the absorbtion |
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Antihypertensive Agents (Basic)
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HTN ia a major risk factor for:
-Stroke CAD and Heart Failure Renial Failure HTN is defined as blood pressure greater than 140/90 |
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7 Categories of Antihypertensive Agents
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-Diuretics
-Adrenergic Agents -Vasodilators -ACE inhibitors -ARB's -CCB's |
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Diuretics (Basic)
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-Decreases fluid (plasma/extracelluar) to decrease cardiac output and perpheral resistance
-Removes Na+ and H20 from body |
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Diaretic Agents (Basic)
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Classiffied by site of action in the nephron and the chemical structure
-CAI's (Carbonic anhydrase inhibitors) -Loop Diuretics -Osmotic Diurectics -K+ Sparing Diurectics -Thiazides |
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CAI's (Use and side effects)
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Used For: Glaucoma, edema, epilepsy, high altitude sickness
Side Effects- Acidosis, drowsiness, parathesias (numbness in feet), photosensitivity |
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Loop Diuretics (Basic)
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-Check Sulfer allergy
-Blocks Na+ Reasoption -Activates renal prostaglandins=dialate BV in Kidneys to reduce vascular resistance -Treats: edema, Right side heart failure, cirrhosis, renal disease (works even when kidneys are not functioning well) Caution with NSAID's-because they have the opposite effect on Prostaglandin |
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Loop Diuretics (Side Effects)
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-Electolyte imbalance (Na+, K+, Ca+)
-CNS: dizzyness, H/A, tinnitus, blurred vision -GI: N/V, diarrhea -Metabolic:Hypokalemia, Hyperglycemia, hyperuricemia |
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Osmotic Diuretics
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-Works along the nephron to increase osmotic pressure=pulls in fluid to the renal tubulers
-Inhibits reabsorption of water and solutes -Reduces cellular edema -Increses urine production -Only slight loss of electolytes |
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Potassium Sparing Diuretics
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-Aldosterone inhibiting-blocks receptors (it is used to regulate K+/Na+ pump)
-Used to Elevate K+ and Chloride levels Side effects: CNS-Dizziness and H/A GI-Cramping, N/V, Diarrhea -Urinary frequency, weakness, hyperkalemia (which can cause dsyrthemias) |
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Thiazides & Thiazide like Diuretics (Basic)
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Used to treat: Heart failure, cirrhosis, edema, diabetes insipidus
-Works on the distal tubule to inhibit Na+, K+, and Chloride resorption -Osmotic water loss -AS RENAL FUNCTION DIMINISHES, EFFICACY DEMINISHES -Check for sulfa allegy |
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Side Effects of Thiazides
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-Electrolyte distubances (reduces K+, increase Ca+, increased lipids, increased Glucose, and increased uric acid
-Dizziness, vertigo -H/A, decreased libido -GI disturnances-rashes, photosensitivity, thrombocytopenia |
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Nursing Actions (Diuretics)
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-Close monitoring of fluid status, I&O, weight, skin tugor, vital signs
-May need K+ supplements or foods high in K+ -Hypokalemia= leg cramps, weakness, constipation, irregular HR |
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Name foods high in K+
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Bananas, oranges, dates, apricots, plums, fresh veggies, potatoes with skins, meat and fish
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Adrenergic Side Effects
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Postural Hypotension, DRY MOUTH, Sedation, constipation, H/A, sleep disturbances, nausea, rash, palpitations
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Vasodilators
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Act on Arteriolar or venous smooth muscle to cause relaxation
Side Effects: -Dizzyness, H/A, orthostatic hypotension, dysrhythmias, sodium/water retention, N/V, HYPERGLYCEMIA IN DIABETIC PATIENTS |
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Angiotensin Converting Enzyme (ACE) Inhibitors (Basic)
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-Affects cardiac and renal. Decreases BP by decreasing ventricular afterload
-Cardioprotective -Prodrug- need to be broken down in liver to become active |
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Side effects of ACE Inhibitors
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Fatigue, dizzyness, mood changes, DRY NON-PRODUCTIVE COUGH,
-Tends to promote K+ reabsorbtion and NA+ excretion so monitor fluid and electolytes -Interacts with NSAIDS and ASA, reducing the effect |
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Angiotension II Receptor blockers (ARBs)
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Blocks vasoconstriction and secretion of aldosterone
Side effects: -Upper respiratory infection, H/A, Hyperkalemia |
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Calcium Channel Blockers (CCBs) (Basic)
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Used to treat HTN and angina
-Causes smooth muscle relaxation by blocking Ca+ from its receptor, preventing conduction (SA node and AV junction) |
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Nursing (CCBs)
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Hypotension-avoid alcohol, hot tubs, saunas. Teach about othostatic hypotension
-NICOTINE REDUCES EFFECTIVENESS -GIVE ON EMPTY STOMACH -DON'T DISCONTINUE ABRUPLY-may give angina -Monitor BP and HR (<60 withhold) -Assess I&O, weight, edema -Labs: K+, hepatic, and renal fuction |
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What should you report for I&O?
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Edema or weight gain >2 lbs/day
Edema or weight gain >5 lbs/week |
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What to teach for orthostatic hyotension
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Avoid prolong sitting, standing, laying, change position slowly, raise slowly
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What should you assess on a patient who is on HTN agents?
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Eye exam every 6 months-HTN changes vasculature of the eye
Assess electrolytes: -Na+ -K+ -Cholride -Magnesium -Ca+ Assess renal and hepatic function |
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Inotropic
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-Force or energy of muscular contractions
+inotropic increase the force of myocardial contractions -inotropic agents decrease the force of myocardial contractions |
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Chronotropic
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-Rate of the heartbeat
+chronotropic increases the heart reate -chronotropic decreases the heart rate |
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Dromotropic
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The conduction of electrical impulses
+increase electrical conduction through the heart -decreases electrical conduction |
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+ inotropic agents
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2 main types
1)Cardiac (digitalis) glycosides- treat heart failure and dysrhythmias 2)Phosphodiesterase inhibitors -short term management of heart failure |
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Digoxin (+inotropic:cardiac glysosides) Basic
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Treats heart failure and supravascualar dysrhythmias, atrial fibrillationa and atrial flutter
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Digoxin side effects
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-Very narrow therapeutic window (THERAPEUTIC LEVEL 0.5-2 ng/mL
-Low K+ increases its toxicity -Cadio-dysrhythmias, bradycardia, tachycardia -CNS- H/A, fatigue, confusion, seizures -Eye- Colored vision (Green, yellow, purple) halos, flickering -GI: N/V, diarrhea |
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Digoxin anidote
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Digibind- give over 30 min (levels will still appear high for several weeks)
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Nursing: + Inotropic agents
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Assess:
-APICAL PULSE FOR 1 FULL MINUTE *IF LESS THAN 60 BPM OR ERRATIC-HOLD DRUG AND NOTIFY HCP -Heart sounds, breath sounds, BP -weight gain -I&O -Visual disturbances -Confusion -N/V, diarrhea, early signs of toxicity |
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Teaching +Intropic agent
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-LARGE AMOUNTS OF LICORICE INCREASE TOXICITY
-high fiber diet especially bran will bind to the digitalis, decreasing absorbtion -High K+ diet decreases therapeutic effects -Hawthone decreases effectiveness -don't double up if dose is missed,take at the same time every day -TAKE DOSE 2 HOURS BEFORE OR AFTER DIGESTING DIARY PRODUCTS OR ANTACIDS -TEACH PATIENT TO TAKE RADIAL PULSE FOR 60 SECONDS |
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4 Major groups of Antidysrhmia drugs
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-Class I-membrane stabilizing agents
-Class II-Beta Blockers (End in LOL) -Class III-Prolong the repolorization during phase 3 (Most commonly used) -Class IV-CCB's (Ca+ Channel Blockers) |
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Class I
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Local anesthetic properties, acts on Na+ (fast) Channels
Ib class-Lidocaine |
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Class II
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Beta Blocker- Cardio protective.
-Decreases SA node activity -Decreases cardiac output and B/P -Depresses Phase 4 depolarization |
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Class III
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Increases APD by prolonging repolarization in Phase 3
Treats dysrhymias Treats Artial Fibrillation or artrial flutter Treats Ventricular tachycardia or Fibrillation |
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Class IV
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Calcium Channel Blocker (CCB's)
Depresses phase 4 depolarization and prolongs repolorization during phases 1&2 Decreases AV node conduction Decreases rapid venticular conduction due to atrial flutter |
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Nursing in Antidysrhythmia drugs
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Monitor of hypotension
dizzyness, blurred vision, H/A, breath sounds, dry mouth, constipation Monitor ECG and vital signs Call HCP if increase in edema, SOB, chest pain, dizziness or syncope |
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Antianginal agents
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Used for ischemic heart disease #1 killer
Nitrates Beta Blockers CCB's |
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Nitrates/Nitrites (Basic)
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Causes vasodilation due to relaxation on the smooth muscle wall of ateries and veins
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Nitroglycerin (NTG)
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Patch-may remove 8 hours a day to decrease tolerance
Sublingual-potency is lost in about 3 months, should be stored in the dark in a glass bottle with a metal lid, no cotton Teach to take 3 tablets 5 minutes apart is no relief in 15 minutes call 911 |
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Nitrates Side effects
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Flushing of the face
Postural Hypotension Tachycardia (Blurred vision, dry mouth, severe H/A may be sign of OD) |
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Antianginal- Beta Blocker
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Blocks Beta 1 receptors which would be stimulated by catecholamines
Slows the heart rate Slows down the SA node and slows down the conduction through the AV node |
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Nursing-Beta Blocker
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Constipation is a common problem:Instruct patient to take in fluids and high fiber foods
May cause hypotension fatigue, depression Hot tubs, ETOH consumption, saunas may increase hypotension |
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Beta Blocker side effects
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Altered glucose or lipid metabolism
Impotence, wheezing, dyspnea Dizziness, fatigue, depression, unusual dreams, drowsiness |
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Antianginal CCB's (Basic)
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Ca+ works in the excitation-conduction process in skeletal and smooth muscle= relaxation
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CCB's Side effects
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Constipation, nausea, dyspnea, dermatitis, rash, flushing, peripheral edema, wheezing, hypotension, palpitations
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Nursing- CCB's
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Take pulse before taking medication <60 call HCP
Oral CCB's before Meals Monitor therapeutic drug levels Grapefruit juice reduces metabolism of CCB's |
