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115 Cards in this Set
- Front
- Back
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What are 3 general causes of heart failure?
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-cardiac defect
-defect outside of the heart -supraventricular dysrhythmias |
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what are 2 examples of a cardiac defect that might cause heart failure?
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-myocardial infarction
-valve deficiency |
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what are 3 examples of defects outside of the heart that might cause heart failure?
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-coronary artery disease
-pulmonary hypertension -diabetes |
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what are 2 examples of supraventricular dysrythmias that might cause heart failure?
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-atrial fibrillation
-atrial flutter |
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what plant are cardiac glycosides derived from?
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foxglove, or Digitalis plant
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what is the main cardiac glycoside drug?
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digoxin
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When is digoxin used?
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-heart failure
-to control ventricular response to a.fib and a.flutter |
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What is the mechanism of action of cardiac glycosides?
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-increase myocardial contractility
-decrease rate of electrical conduction -prolong refractory period |
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define Inotropic effects
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increases or decreases force of muscular contractions
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define Chronotropic effects
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increase of decrease heart rate
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define dromotropic effects
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increases or decreases the conduction of electrical impulses
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what are the drug effects of cardiac glycosides?
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-positive inotropic effect
-negative chronotropic effect -negative dromotropic effect -increased stroke volume -reduction in heart size during diastole -decrease in venous BP and vein engorgement -increase in coronary circulation -promotion of diuresis due to improved blood circulation -palliation of exertional and paroxysmal nocturnal dypnea, cough, and cyanosis |
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when are cardiac glycosides indicated?
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-heart failure
-supraventricular dysrhythmias like a.fib and a.flutter |
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what are the risks of digoxin(Lanoxin)?
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-very narrow therapeutic window
-drug levels must be monitored -low K+ levels increase its toxicity -electrolyte levels must be monitored |
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what are the adverse effects of digoxin (Lanoxin)?
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-Cardiovascular: dysrhythmias
-CNS: headache, fatigue, malaise, confusion, convulsions -eye: colored vision, seeing green, purple, yellow, halo vision, flickering lights -GI: anorexia, nausea, vomiting, diarrhea |
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In case of digoxin toxicity, what antidote is given?
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digoxin immune FAB (Digibind)
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When would digoxin immune FAB (Digibind) be given?
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-hyperkalemia in a digitalis-toxic patient
-life-threatening cardiac dysrhythmias -life-threatening digoxin overdose |
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Which conditions predispose patients to digoxin toxicity?
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-hypokalemia
-having a pacemaker -hepatic dysfunction -hypercalcemia -dysrhythmias -hypothyroid, respiratory, or renal disease -advanced age |
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which 2 drugs are phosphodiesterase inhibitors
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-inamrinone
-milrinone which are inodilators |
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How do phosphodiesterase inhibitors work?
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By inhibiting the enzyme phosphodiesterase.
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phosphodiesterase inhibitors result in which actions?
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-positive inotropic response
-vasodilation |
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What are the indications for phosphodiesterase inhibitors?
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-short term management of heart failure
-given when pt. hasn't responded to digoxin, diuretics, and/or vasodilators |
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how are phosphodiesterase inhibitors given?
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-often given as weekly 6-hour infusions
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what are the benefits of phosphodiesterase inhibitors?
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-improved quality of life
-decreased readmissions for heart failure episodes |
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what are the adverse effects of inamrinone?
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-thrombocytopenia, most worrisome
-dysrhythmias -nausea -hypotension -elevated liver enzymes with long-term use |
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what are the adverse effects of milrinone?
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-dysrhythmias, mainly ventricular
-hypotension -angina -hypokalemia -tremor -thrombocytopenia |
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What are the 2 categories of positive inotropic drugs?
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-cardiac glycosides
-phosphodiesterase inhibitors |
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When administering positive inotropic drugs, assess clinical parameters including:
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-BP
-apical pulse for 1 full minute -heart sounds, breath sounds -weight, I & O measures -EKG -Serum labs -renal and liver function studies |
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which serum labs need to be assessed when administering positive inotropic drugs?
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-potassium
-sodium -magnesium -calcium |
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Before giving each dose of a positive inotropic drug, assess what?
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Apical pulse for 1 full minute.
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Before giving a positive inotropic drug, if the apical pulse is <60 or >120, what should the nurse do?
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-hold dose
-notify prescriber |
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What are the signs and symptoms of toxicity with positive inotropic drugs?
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-anorexia
-nausea -vomiting -diarrhea -visual disturbances such as: blurred vision, seeing green or yellow halos around objects |
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Avoid giving digoxin with what type of food?
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-high fiber foods
-because fiber binds to digitalis |
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Before giving a positive inotropic drug, if there are signs of toxicity, what should the nurse do?
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-hold dose
-notify prescriber |
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Pts taking a positive inotropic drug should monitor their weight and report it immediately when?
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-gain 2+ lbs in 1 day
-gain 5+ lbs in 1 week |
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What are the therapuetic effects of positive inotropic drugs?
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-increased urinary output
-decreased edema -decreased SOB and dyspnea -decreased crackles -decreased fatigue -resolving of paroxysmal nocturnal dyspnea -improved peripheral pulses, skin color, temperature |
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When giving IV inamrinone, it is important to know?
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-do not mix with dextrose
-solution color is true yellow |
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When giving inamrinone or milrinone, give it by?
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IV infusion pump
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What are the categories in the Vaughan Williams Classification?
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-Class I
-1a -1b -1c -Class II -Class III -Class IV -Other |
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What drug is part of Vaughan Williams class I?
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moricizine
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Describe the Vaughan Williams class I
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-membrane-stabilizing drugs
-fast sodium channel blockers -divided into Ia, Ib, Ic |
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what is moricizine used for?
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symptomatic and life-threatening dysrhythmias
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which drugs are part of Vaughan Williams class 1a?
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-quinidine
-procainamide -disopyramide |
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What are quinidine, procainamide and disopyramide used for?
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a.fib, premature atrial contractions, premature ventricular contractions, v.tach, Wolff-Parkinson-White syndrome(pre-excitation of ventricles)
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Describe Vaughan Williams class 1a.
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-block fast sodium channels
-delay repolarization -increase the APD (action potential duration) |
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Describe Vaughan Williams class 1b drugs.
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-block sodium channels
-accelerate repolarization -increase or decrease the APD(action potential duration) |
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Which drugs are in Vaughan Williams class 1b?
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-mexiletine
-phenytoin -lidocaine |
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What are mexiletine, phenytoin, and lidocaine used for?
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Ventricular dysrhythmias only:
-premature ventricular contractions -v.tach -v.fib |
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Describe Vaughan Williams class 1c drugs.
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-block sodium channels (more pronounced effect)
-little effect on APD (action potential duration) or repolarization |
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Which drugs are part of Vaughan Williams class 1c?
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-flecainide
-propafenone |
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What are flecainide and propafenone used for?
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-severe ventricular dysrhythmias
may be used in: -a.fib/flutter - wolff-parkinson-white syndrome -SVT dysrhythmias |
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Describe Vaughan Williams class II drugs.
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-reduce or block sympathetic nervous system stimulation, thus reducing transmission of impulses in the heart's conduction system
-depress phase 4 depolarization |
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Which drugs are part of Vaughan Williams class II?
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-Beta blockers
-atenolol -esmolol -metaprolol -propranolol |
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What are beta blockers, atenolol, esmolol, metaprolol, propranolol used for?
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general myocardial depressants for:
-supra ventricular dysrhythmias -ventricular dysrhythmias -antianginal -antihypertensive |
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Which drugs are part of Vaughan Williams class III?
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-amiodarone
-sotalol -ibutilide |
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Describe Vaughan Williams class III drugs.
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-increase APD (action potential duration)
-prolongs repolarization in phase 3 |
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What are amiodarone, sotalol and ibutilide used for?
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dysrhythmias that are difficult to treat:
-life-threatening v.tach and v.fib -a.fib/flutter resistant to other drugs -sustained v. tach |
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Which drugs are part of Vaughan Williams class IV?
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-verapamil
-diltiazem |
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Describe Vaughan Williams class IV drugs.
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calcium channel blockers:
-inhibit slow-channel calcium dependent pathways -depress phase 4 depolarization -reduces AV node conduction |
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What are verapamil and diltiazem used for?
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-paroxysmal supraventricular tachycardia
-rate control for a.fib/flutter |
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Which drugs are part of Vaughan Williams class Other?
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-digoxin
-adenosine |
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Describe Vaughan Williams class Other drugs.
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have properties of several classes and are not placed into one particular class.
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Describe adenosine(Adenocard) do?
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-slows conduction through the AV node
-very short half-life - less than 10 seconds -only administered as fast IV push -may cause asystole for a few seconds |
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What is adenosine (Adenocard) used for?
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to convert paroxysmal supraventricular tachycardia to sinus rhythm
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What are the adverse effects of Antidysrhythmics?
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-can CAUSE dysrhythmias
-hypersensitivity reactions -nausea -vomiting -diarrhea -dizziness -blurred vision -headache |
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Nursed should measure serum levels of _______ before initiating antidysrhythmic drug therapy.
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potassium
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For Vaughan Williams class 1 drugs, the ECG should be monitored for?
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QT intervals prolonged more than 50%
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Solutions of lidocaine that contain epinephrine should NOT be given as what?
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NOT given IV.
only used as local anesthetics |
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Pts taking digoxin, beta blockers and other cardiac drugs should be taught what?
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take their own radial pulse before each dose, if <60bpm notify physician
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What do diuretics do?
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they accelerate the rate of urine formation
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Diuretic drugs are the first line of treatment for what condition?
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hypertension
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20-25% (most) of all sodium is reabsorbed into the bloodstream in which part of the nephron
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the loop of Henle
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What are the 5 types of Diuretic drugs?
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-carbonic anhydrase inhibitors (CAI)
-loop diuretics -osmotic diuretics -potassium sparing diuretics -thiazide and thiazide-like diuretics |
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Name 3 drugs that are Carbonic anhydrase inhibitors (CAIs).
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-acetazolamide (Diamox)
-methazolamide -dichlorphenamide |
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What is mechanism of action of (CAIs) Carbonic Anhydrase Inhibitors?
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-helps make H+ ions available for exchange with sodium and water in proximal tubules
-block the action of carbonic anhydrase which prevents the exchange of H+ ions with sodium and water -inhibition of carbonic anhydrase reduces H+ ion concentration in renal tubules -so, increased excretion of bicarbonate, sodium, water, potassium -resorption of wter is decreased and urine volume is increased |
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Our bodies need bicarbonate, too little leads to ____________ and too much leads to ___________.
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-too little leads to metabolic acidosis
-too much leads to metabolic alkalosis |
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What are the indication of CAIs (Carbonic Anhydrase inhibitors)?
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-adjunct in long-term management of open-angle glaucoma
-used with miotics to lower intraocular pressure before ocular surgery in certain cases -edema -epilepsy -high-altitude sickness (low O2 can cause pulmonary edema) |
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acetazolamide is used in the management of edema secondary to heart failure when?
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other diuretics are not effective
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What are the adverse effects of CAIs (carbonic anhydrase inhibitors)?
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-metabolic acidosis
-anorexia -hematuria -photosensitivity -melena (tarry stools) -hypokalemia -drowsiness -paresthesias -urticaria |
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Name 3 Loop Diuretics.
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-bumetanide (Bumex)
-ethacrynic acid (Edecrin) -furosemide (Lasix) |
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What is the mechanism of action of Loop Diuretics?
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-act directly on the ascending limb of the loop of Henle to inhibit chloride and sodium resorption
-increase renal prostaglandins, resulting in the dilation of blood vessels and reduced peripheral vascular resistance |
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What are the drug effects of Loop Diuretics?
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Reduced:
-BP -pulmonary vascular resistance -systemic vascular resistance -central venous pressure -left ventricular end-diastolic pressure -potassium and sodium depletion |
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What are the indications for Loop Diuretics?
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-edema assoc. with heart failure, hepatic disease, renal disease
-control of htn -increase renal excretion of calcium in patients with hypercalcemia -certain cases of heart failure resulting from diastolic dysfunction |
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What are adverse effects of Loop Diuretics?
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CNS:dizziness, headache, tinnitus, blurred vision
GI: nausea, vomiting, diarrhea Hematologic: Agranulocytosis, neutropenia, thrombocytopenia Metabolic: hypokalemia, hyperglycemia, hyperuricemia |
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What is Agranulocytosis?
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A life threatening condition caused by a decrease in WBCs and the immune system. A pt with this condition could potentially die from a common cold.
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In order to prevent serious conditions related to the adverse effects of Loop Diuretics, make sure to...?
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do regular labs including:
Na, K, Cl, RBCs, WBCs, BUN |
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What drug is an Osmotic diuretics?
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-mannitol (Osmitrol)
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What is the mechanism of action for Osmotic diuretics?
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-work mostly in the proximal tubule
-nonabsorbable, producing an osmotic effect -pulls water into the renal tubules from the surrounding tissues -inhibits tubular resorption of water and solutes, producing a rapid diuresis (more rapid than lasix) |
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What are the drug effects of Osmotic diuretics?
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-increases glomerular filtration and renal plasma flow-helps to prevent kidney damage during acute renal failure
-reduces excessive intraocular pressure |
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What are the indications for use of osmotic diuretics?
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-used in the treatment of pts in the early, oliguric phase of acute renal failure
-used to promote the excretion of toxic substances -for reduction of intracranial pressure -treatment of cerebral edema -NOT indicated for peripheral edema |
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Osmotic diuretics are NOT indicated in which type of edema?
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NOT indicated for peripheral edema
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What are the adverse effects of Osmotic diuretics?
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-convulsions
-thrombophlebitis -pulmonary congestion -headaches -chest pain -tachycardia -blurred vision -chills -fever (no GI) |
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When administering Mannitol remember...
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-give by intravenous infusion only
-use of a filter is required, may crystallize when exposed t low temperatures |
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Which drugs are Potassium-sparing diuretics?
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-spironolactone(Aldactone)
-amiloride(Midamor) -triamterene(Dyrenium) |
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What is another name for potassium-sparing diuretics?
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aldosterone-inhibiting diuretics
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What is the mechanism of action of potassium-sparing diuretics?
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-work in collecting ducts and distal convoluted tubules
-interfere with sodium-potassium exchange -competitively bind to aldosterone receptors -block the resorption of sodium and water usually induced by aldosterone |
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What are the drug effects of potassium-sparing diuretics?
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-prevent K+ from being pumped into the tubule, thus preventing its secretion
-competitively blocks the aldosterone receptors and inhibit its action -the excretion of sodium and water is promoted |
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What are the indications for potassium-sparing diuretics?
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spironolactone and triamterene:
-hyperaldosteronism -hypertension -reversing the K+ loss caused by potassium-losing drugs -certain cases of heart failure amiloride: -treatment of heart failure |
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What are the adverse effects of potassium-sparing diuretics?
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Hyperkalemia
CNS: dizziness, headache GI: cramps, nausea, vomiting, diarrhea Other: urinary frequency, weakness |
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What are the adverse effects of spironolactone?
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-gynecomastia (men developing breasts)
-amenorrhea -irregular menses -postmenopausal bleeding |
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Which drugs are Thiazide diuretics?
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-hydrochlorothiazide (Esidrix, HydroDIURIL)
-chlorothiazide(Diuril) -trichlormethiazide(Metahydrin) |
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Which drugs are Thiazide-like diuretics?
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-chlorthalidone(Hygroton)
-metalazone(Mykrox, Zaroxolyn) |
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What is mechanism of action of Thiazide and Thiazide-like diuretics?
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-inhibit tubular resorption of NA+, Cl-, and K+ ions
-action primarily in the distal convoluted tubule -result is water, Na+, and Cl- are excreted -K+ is also excreted to a lesser extent -dilate the arterioles by direct relaxation |
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What are the drug effects of Thiazide and Thiazide-like diuretics?
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-lowered peripheral vascular resistance
-depletion of sodium and water(and potassium) |
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Thiazide diuretics and creatinine clearance, what needs to be considered?
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-should NOT be used if creatinine clearance is <30-50 mL/min. (normal is 125 mL/min)
-metolazone remains effective to a creatinine clearance of 10mL/min |
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What are the indications for Thiazide and thiazide-like diuretics?
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-htn
-edematous states -idiopathic hypercalcemia -heart failure due to diastolic dysfunction -adjunct drugs in treatment of edema related to heart failure, hepatic cirrhosis, corticosteroid or estrogen therapy |
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What are the adverse effects of Thiazide and thiazide-like diuretics?
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CNS:dizziness, headache, blurred vision, paresthesias, decreased libido
GI: anorexia, nausea, vomiting, diarrhea GU:impotence(reversible) Integumentary: urticaria, photosensitivity Metabolic: hypokalemia, glycsuria, hyperglycemia, hyperuricemia |
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Patients taking diuretics and digitalis must monitor for what?
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digitalis toxicity
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Patients with diabetes who take thiazides or loop diuretics should be told to...?
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monitor blood glucose and watch for elevated levels
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Pts taking diuretics should change positions slowly because of...
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orthostatic hypotension
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Pts taking diuretics with nausea, vomiting, diarrhea should notify physican because...
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fluid loss may be dangerous
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What does licorice have to do with diuretics?
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Excessive consumption of licorice can lead to an additive hypokalemia in pts taking thiazides.
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Cultural considerations of antihypertensives:
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-beta-blockers and ACE inhibitors are more effective in white pts than Af-Am pts
-CCBs and diuretics are more effective in Af-Am pts than in white pts. |
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What are the 6 categories of Antihypertensives?
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-adrenergic drugs
-angiotensin converting enzyme (ACE) inhibitors -angiotensin II receptor blockers (ARBs) -calcium channel blockers (CCBs) -diuretics -vasodilators |
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What are the 5 subcategories of adrenergic drugs?
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-centrally and peripherally acting adrenergic neuron blockers
-centrally acting alpha 2 receptor agonists -peripherally acting alpha 1 receptor blockers -peripherally acting beta receptor blockers -peripherally acting dual alpha 1 and beta receptor blockers |
