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30 Cards in this Set

  • Front
  • Back
Pharmacokinetics of Cardiac Glycosides
1. absorption- varies btw manufacturer & loading dose is often required (digitalizing dose - IV Dig is given)
2. Distribution - 8 hr distribution time to get to heart and draw drug levels 8 hrs after admin. (give Dig at night so labs can be drawn in the morning)
Metabolism and excretion of Cardiac Glycosides
1.has 36 hr half-life
S&S of Digitalis (Dige) toxicity
2.nausea, vomiting & diarrhea (NVD)
3.visual disturbances
5.increased urine output
what predisposes pt to dige toxicity - elderly(80+)have decreased liver and renal function - has a long half life - should not use with diuretics which cause hypokalemia (low K+)(when K+ is low it contributes to dig toxicity, causing what would usually be a normal therapeutic level to become toxic)
digoxin immune fab -
this drug reverses the effects of dig-dig levels remain high though so labs are useless-so must assess S&S, compute half-life and treat systematically (once used then you lose the ability to measure dig in the bloodstream)
Nursing implications of Digoxin
1.assess apical pulse/teach pt to take radial pulse/hold if less than 60/min.
2.follow dig levels(particularly if not eating)
3.check K+ and renal function studies(karatony test for K+)
4.instruct pt to eat foods high in K+
5.weigh daily/call MD if gain of 5lbs/wk
6.if pt misses a dose, instruct to take when next scheduled (long half-life)
7. honor drug holidays
What assessments would you make to determine if dige is working effectively for your pt?
check HR & BP, pulse
urinary output,
check for fluid in lungs and
for edema
Most common causes:
1.decreased oxygen supply to the heart
2.increased use of oxygen by the heart (b/c increased HR afterload, heart has to work too hard)
(most meds directed toward oxygination issues)
other causes:
electrolyte imbalances
Most antiarrythmics work by
1.decreasing the oxygen need of the heart by decreasing its workload
2.and/or increasing the O2 level supply to the heart
Sodium channel blockers- Class 1A -
Quinidine Sulfate (generic)(this drug decreases the workload of the heart)
use is declining-find it does not prolong survival
often given in sustained release form due to its rapid absorption -it is highly protein bound
side effect - diarrhea (lots of, so med must be stopped)
To Decrease the workload of the heart:
1.decrease automaticity, contractility,conductivity,excitability (chronotropic,inotropic,dromotrophic, excitablity)

Class 1B for emergencies, an IV push drug-
decreases automaticity in the ventricles (decreases myocardial irritability)
it creates electrical impulses in the heart muscle instead of the SA or AV node
Admin of Lidocaine
1.given IV push (using pre-filled syringes) followed by IVPB
2.this is done to create a steady state blood concentration
3.half-life is 90 minutes
(load then hang IV drip)
S&S of Toxicity of Lidocaine
1.paresthesias- tingling in fingers and toes
2.light headedness
3.visual disturbances
4.hearing disturbances
5.confusion (take off drug for a while-short half life)
there is a narrow therapeutic range so assess the pt well - CNS effects this drug it crosses the blood/brain barrier - short half life 90 min
Contraindications of Lidocaine
1. allergy to local anesthestics (used during dental procedures, etc)
Cardioselective Beta Blockers
Subtype of Beta Blockers - only select beta 1 cardiac cells
1.blocks only beta 1 receptors
2.advantage-doesn't cause bronchoconstriction assoc. with non-selective beta blockers (no wheezing)
Side effects (non selective)for cardioselective beta blockers
4.uncompensated hypoglycemia-diabetic (low glucose levels)
5.impotence (leads to non-compliance issues)
DO NOT stop abruptly
causes rebound effect (due to supersensitivity) recepters over react
taper dose over 1-2 weeks
Nursing implications of Cd beta blockers
1. hold if BP is less than 90 systolic
2. Hold if HR is less than 60
3.assess lung sounds (wheezing if not cardioselective)
4. review patient history for asthma
5. uncompensated hypoglycemia-diabetic because glucose release (beta 2)
Beta Adrenergic Blockers

class II - Inderal/propranolol
1. negative chronotropic effect (decreases HR)
2.negative inotropic effect (decreases contractility)
3. negative dromotropic effect (decreases conductivity)
4.decreases renin response (beta 1)(renin response causes vasoconstriction/hypertension which is good it stops it)
5.decreases glucose release (beta 2)
Calcium Channel Blockers
Class IV - verapamil/Isoptin
1.dilates peripheral and coronary arteries(decrease workload to the heart)
2.decreases cardiac contractility (-inotropic effect-decreases workload)
3.decreases cardiac conductivity (-dromotropic effect)
4.calcium blockers decrease arrythmias by:
a. decreasing the workload and increasing the amt of O2 supplied to the heart
verapamil (superdrug of 90's) dilates peripheral and coronary arteries which increases O2 levels but causes edema
Side effects of Calcium Channel Blockers
1.hypotension (dilates arteries, decreases contractility-if dilating vessels then results in hypotension)
2.bradycardia (decreases conductivity-when you slow slow HR)
3.peripheral edema
Nursing implications of Calcium Channel Blockers
1.assess for orthostatic hypotension, bradycardia (BP, and hypotension decreases BP thus decreasing contractility thus decreasing the workload)
2. assess for pedal edema and flushing
(not enough oxygen)
2.Beta Blockers
3.Calcium Channel Blockers
they decrease the workload and/or increase O2
1.dilates peripheral vessels-causes decreased Preload and afterload (blood stays in peripheral vessels and does not return so forcefully to the heart) decreases workload and increase O2
2.dilates healthy coronary arteries
3.results in a decreased blood pressure and decreased cardiac workload and increased blood flow to the heart (because dilates cardiac arteries, w/in the heart (see chart) 25 miles of vessels when they dilate then blood pools in the peripheral
Nitrate admin
1.Oral (prevention)
2.Buccal spray(treatment)
3.Sublingual (treatment)
4. Transdermal Patch (prevention)
5. IV (treatment)
Transdermal Patch Application
1.wear gloves
2.remove previous patch
3.wash previous patch site
4.absorption varies with placement site
5. apply to non-hairy site not shave area to apply patch
7. assess for side effects
Sublingual Nitrate Tablet Admin .
1.replace tablets every 3 months
2.keep cool and in dark place
3.sign of freshness-stinging under the tongue
4.maximum of 3 tablets at 5 minute intervals
Side effects of Nitrates
1.hypotension (dilates vessels)
2.headache-usually temporary
3.flushing (vasodilation)
4.nitrate tolerance (requires 8-12 hr break)put on in am take off in pm
if pt become symptomatically hypotensive after the application of a transdermal nitroglycerin patch?
check BP
take off patch
wash site
look for other patches
How do beta blockers act to relieve angina?
decrease workload but does not increase delivery of O2 to heart so decreases HR/contractility which decreases O2 demand which decreases angina
How do calcium channel blockers act to relieve angina
decreases workload
& causes coronary vasodilation -decrease workload by decreasing stroke volume and bring O2 to heart to stop angina