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165 Cards in this Set
- Front
- Back
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Positive inotropic
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drugs that increase the force of the myocardial contraction
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What drugs are beneficial in treating a failing heart muscle, positive or negative inotropic?
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positive inotropic
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Positive chronotropic
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drugs which increase the heart rate
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Positive dromotropic
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drugs which accelerate electrical impulse travel through the conduction system of the heart
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Left sided heart failure will result in what?
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pulmonary edema, wet lung sounds, anxious, fatigued, dyspnea, and cough
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Right sided heart failure will result in what?
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pedal edema, jugular venous congestion, ascites, and hepatic congestion
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What is a normal ejection fraction?
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65%
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Which meds decrease preload?
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ace inhibitors, beta blockers, phosphodiesterace inhibitors, diuretics, nitrates, nesitiride, nitroprusside
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Which meds decrease afterload?
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ace inhibitors, BB, phosphodiesterace inhibitors, CCB, nesitiride, nitroprusside, hydralazine
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What is another name for cardiac glycosides?
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digitalis glycosides
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What is the most common cardiac glycoside?
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Digoxin
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What class is digoxin?
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cardiac glycoside
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What is the primary beneficial effect of cardiac glycosides?
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increase in the strength of cardiac contractillity
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In english, what does digoxin do?
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slow and strengthen the heart beat
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What is the drug of choice for CHF?
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digoxin
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How does digoxin work?
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positive inotropic, negative chronotropic, negative dromotropic
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Digoxin is used to treat which problems?
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CHF and supraventricular tachycardia
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What problem is digoxin contraindicated in?
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2nd and 3rd degree heart block
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What is a big problem for pts that take dig?
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narrow therapeutic window (0.5-2.0) and is difficult on the kidneys
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What are the S&S of dig toxicity?
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dysrhythmias, colored vision, halo vision, flickering lights, n/v, diarrhea, headache, malaise, confusion, "I just don't feel good"
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What conditions predispose to dig toxicity?
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hypokalemia, hypercalcemia, hypermagnesemia, hypothyroid, renal dysfunciton, advanced age, patients on diuretic
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What is a normal dig level?
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0.5-2.0
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If you suspect a pt is dig toxic what do you do?
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stop the medication, EKG monitoring may be needed, serum dig and electrolyte levels, supportive therapy, call doctor, may administer antidote (digoxin immune fab or digibind)
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What are the antidotes for dig?
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digoxin immune fab or digibind
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How are the digoxin antidotes given?
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IV
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When is it acceptable to administer digibind?
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serum K+>5, life threatening dysrhythnmias, dig overdose >10 mg in adults and >4mg in children
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After digibind is administered, the dig levels will immediately drop.
True or False |
False: dig levels will remain elevated for days and the RN must rely on clinical signs and symptoms as to how a patient is doing
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When are phosphodiesterase inhibitors given?
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for acute problems
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What do phosphodiesterase inhibitors do?
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a positive inotropic response and VD
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What are the two phosphodiesterase inhibitors?
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inamrinone and mirionine
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What are the side effects of inamrinone?
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thrombocytopenia, dysrhythmia, nausea, hypotension, long-term may increase LFTs
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What is the main side effect of milrinone?
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ventricular arrhythmias which causes hypotension
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What is the antidote to PDI?
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isn't one
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What is the side effect of PDI?
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hypotension due to vasodilation
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True of False: IV forms of inamrinone should not be mixed with dextrose.
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True
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True or False: IV inamrinone is a cloudy yellow solution?
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False: clear yellow solution
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What should the nurse do prior to giving Digoxin?
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check the apical pulse for one minute: don't give if pulse is <60 or >120
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True or False: Digoxin can be given with food
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False: food alters dig absorption
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A common cardiac dysrhythmia involving atrial contractions
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Atrial Fibrillation
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the period when the myocardium is unable to respond to electrical stimulation
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Refractory period
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A serious adverse effect of inamrinone that is more frequent when high does are given over longer periods of time
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Thrombocytopenia
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A condition that may indicate the need for digoxin-immune fab
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hyperkalemia
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A condition that leads to an increased potential for dig toxicity
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hypokalemia
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Drugs that influence the rate of the heartbeat
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Chronotropic drugs
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Drugs that influence the conduction of electrical impulses
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dromotropic drugs
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Drugs that influence the force of cardiac muscle contractions
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Inotropic drugs
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The range of drug levels in the blood which is considered beneficial as opposed to toxic
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Therapeutic window
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A property of the hearts pacemaker cells that allows self-activation
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Automaticity
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When anything interferes with an adequate blood supply of oxygen to the myocardium
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angina pectoris
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Poor blood supply to an organ
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ischemia
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Ischemia when it involves the heart muscle
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ischemic heart disease
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The primary cause of heart disease
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atherosclerosis
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The buildup of fatty plaques in the lumen of the vessels
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Atherosclerosis
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When atherosclerosis causes the lumen to become narrowed and it becomes increasingly difficult to meet the O2 supply demands of the heart
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coronary artery disease (CAD)
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What occurs when blood flow is completely blocked so part of the heart muscle is unable to receive blood flow
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myocardial infarction
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What produces angina?
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the accumulation of lactic acid and other by-products stimulate pain receptors around the heart
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What do nitrates do to lower BP?
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dilate all blood vessels
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What are the contraindications for nitrates?
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severe anemia, hypotension, severe head injury, closed angle glaucoma
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What are the adverse effects of Nitro?
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most common side effect is headache, tachycardia, postural hypotension, reflex tachycardia
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What is reflex tachycardia?
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nitrate induce vasodilation occurs too fast, the cardiovascular system overcompensates and increases the heart rate
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What inactivates nitro?
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when exposed to light or older than 6 months
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What can be done to reduce/prevent tolerance?
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nitrate-free periods
(patches removed at bedtime) |
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Can a patch get wet and still work?
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yes
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What drugs enhance the effects of nitro?
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alcohol, BB, CCB, phenothiazines, and erectile dysfunction drugs
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What is the primary cause of chronic stable angina?
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atherosclerosis
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What triggers chronic stable angina?
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exertion or other stress such as cold, emotions
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What are the characteristics of chronic stable angina?
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pain is typically intense but subsides in 15 minutes with rest or with anti-anginal therapy
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What is unstable angina?
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early stage of CAD and often culminates in MI in years
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What is the characteristics of unstable angina?
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pain increases in intensity as does the frequency of attacks, pain may even occur at rest
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What is vasospastic angina?
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results from spasms of the layer of the smooth muscle that surrounds atherosclerotic coronary arteries
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True or False
Nitro has a huge first pass effect |
True
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Does nitro ointment need to be applied to a hairless area?
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yes
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What kind of tubing is used for IV nitro?
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non-PVC tubing
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How long after prep is IV nitro good for?
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96 hours
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How many SL nitro can be taken and for what time period?
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one tablet ever 5 minutes not exceeding 3 tablets
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True or False:
If a SL nitro is used and there is burning or stinging, the pt should call 911. |
False
If there isn't a burning or stinging the nitro may be ineffective |
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What type of angina is treated by BB?
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exertional angina
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After an MI, which class of meds are given?
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BB
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Why are BBs great after MI?
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MI causes circulating catecholamines which increase HR, BBs decrease the HR
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What are the contraindications to the use of BB
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systolic heart failure, serious conduction disturbances, use with extreme caution in bronchial asthma
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What are the adverse effects of BB?
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dysrhythmias, tachycardia, hypo/hyperglycemia, constipation, bradycardia, blocks the symptoms of hypoglycemia
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Which is more worrisome, high systolic or diastolic?
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Diastolic
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What values prove prehypertension?
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120-139 systolic
80-89 diastolic |
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What values prove stage 1 hypertension?
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140-159 systolic
90-99 diastolic |
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What values prove stage 2 hypertension?
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> 160 systolic
> 100 diastolic |
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How ling is therapy for idiopathic hypertension?
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life long
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What do BB end in?
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olol
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What are the two types of BB?
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cardio selective or non-cardio selective
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How do BB work?
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block catecholamines
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What do BB cause?
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decrease HR
decrease cardiac output decreased cardiac contractility |
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Who shouldn't take BB?
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systolic heart failure, pt with conduction problems, pt with respiratory problems
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What are the adverse effects of BB?
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dysrhythmias, decreased AV/SA node conduction, mask hypoglycemia, hyper/hypglycemia, bradycardia, depression when first started, insomnia, and wheezing (depending on selectivity)
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What pt teaching is included with BB?
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increase fiber and fluids to prevent constipation, diabetics need to monitor glucose, assess for weight gain, don't stop abruptly
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What drugs are cardio selective?
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BB
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What drug treats pre-eclampsia?
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methyldopa (Aldomet)
class: adrenergics |
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What is methyldopa (Aldomet) used for?
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pre-eclampsia
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What adrenergic is used for opiate withdraw and BP?
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clonidine
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What is clonidine used for?
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decrease BP and opiate withdraw
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How is clonidine prescribed? (patch, pill, IV)
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Patch
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What do ACEI end in?
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pril
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How do ACEI work?
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inhibit aldosterone to get rid of H2O
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What class of med would you get a pt with CHF?
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ACEI
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Which class is renal protective?
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ACEI
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What are the side effects of ACEI?
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non-productive hacky cough, hyperkalemia, angioedema
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What are prodrugs?
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inactive drugs that are activated by liver
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What are the only ACEI that aren't prodrugs?
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captopril (capoten) & Lisinopril (Prinivil)
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Which class of drugs are produrgs?
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ACEI
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What is the pt teaching for ACEI?
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no salt substitutes, limit K+ in diet, take med at same time every day, drink alcohol in moderation
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Which ACEI has a short half-life? What pt is this good for?
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Captopril (Capton) very ill pt
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What is the only ACEI available in oral and parenteral?
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Vasotec (Enalopril)
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What's so special about Vasotec (Enalopril)?
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available in oral and parenteral
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What do ARBS end in?
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Sartan
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On an EKG what indicates hyperkalemia?
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high T waves
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What are ARBS so special?
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work almost as well as ACEI with no cough
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What do alpha blockers end in?
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osin
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What are alpha blocker typically used for?
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BPH
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What is the most important pt teaching for an alpha blocker?
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take first dose in bed
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What class of drug should be taken for the first time in bed?
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alpha blockers
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What type of pt do you not want to give coreg to and why?
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diabetics - can cause hyperglycemia
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What do CCB end in?
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pine
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Who benefits the most from CCB?
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african americans
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What are the side effects of CCB?
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constipation, peripheral edema, dysrhythmias, Steven Johnson's syndrome
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When are vasodialators used?
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hypertensive crisis
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Who are vasodilators contraindicated for?
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head injuries - would increase ICP
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What drugs are used to manage hypertensive crisis?
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diazoxide and sodium nitroprusside (NAN)
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If a pt gets profound hypotension, what do you do?
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put in trendelenburg
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What is one of the biggest side effects of NaN?
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cyanide toxicity
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A nurse would not question which of the following orders?
NAN over 10 minutes NAN over 15 minutes NAN over 5 minutes |
NAN over 10 minutes
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What is a clot?
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thrombus
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What is a dislodged clot?
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embolus
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What is heparin monitored by?
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aPTT
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What is lovenox monitored by?
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CBC
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What is coumadin monitored by?
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INR
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What class is arixtra?
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anticoagulant
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What specific OTC herbals should not be taken with anticoagulants?
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feverfew, garlic, ginger, ginseng, and capsicum pepper
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What are the S&S of anticoagulant toxicity?
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hematuria, melena, petechiae, ecchymosis, gum and mucous membrane bleeds
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What is the antidote for heparin?
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protamine sulfate
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How long until you see a response when giving an antidote for heparin?
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within minutes
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What type of needle do you use with heparin?
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1/2 to 5/8 length
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What is the preferred injection site for SQ heparin?
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abdomen
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What is the most highly prescribed anticoagulant?
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coumadin
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What is the antidote for coumadin?
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Vit K+
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What do they do if vit K+ doesn't work for coumadin?
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fresh frozen plasma
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What test monitors coumadin?
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PT/INR
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What is the range for INR?
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2-3 seconds
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How long does coumadin take to go into effect?
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4-5 days
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Should a pt on coumadin take aspirin for a headache?
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no-no NSAIDS
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What is guaic?
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occult blood
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What is melena?
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black tarry stool (higher in the GI tract)
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What is hematochezia?
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marroon colored blood (lower in the GI tract)
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What is epistaxis?
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nose bleed
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What drugs are antiplatelet drugs?
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ASA, aspirin, persantine, trental, pletal
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What is the lifespan of a platelet?
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7 days
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What is the recommendation for stroke precaution?
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50-325 mg of ASA
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What is the first symptom of salicytic toxicity?
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ringing in the ears
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What is plavis used for?
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reducing risk of stroke, TIA's and thrombus post MI
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What is trental (Pentoxifylline) used for?
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improves blood flow and treats peripheral vascular disease
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What is pletal (Cilostozal) used for?
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intermittent claudication (pain in calf muscles)
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What do antifibrinolytics do?
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prevent fibrin lysis - promotes clots formation
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When would you use antifibrinolytics?
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post-op, decrease bleeding at surgical site
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What drugs are antifibriniolytics?
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Amicar and DDAVP
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What do thrombolytic drugs do?
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destroy thrombi
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what drugs are thrombolytics?
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TPA adn streptokinase
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How soon must thrombolytics be used?
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within 3 hours of S&S
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What is the most common side effect of thrombolytics?
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internal, intracranial, and superfical bleeding
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