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49 Cards in this Set

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describe the signs and symptoms and treatments of digitalis toxicity.
overdose or accumulation of digoxin caues digitalis toxicity, signs and symptons include, anorexia, diarrhea, nausea, and vomiting, bradycardia, prmemature ventircaular contrctions, cardiac dyshthymia, headaches, maliase, blurred vision, visual illusion, confusion, delirium, older adults are more prone to toxicity.
cardiotoxicity is a very serious adverse action to digoxin:ventricular dysrhymias result there are 3 cardiacaltered functions that contribute to digoxin-induced ventricular dyrhymeas
1 suppresion of av conduction
2 increased automatcity
3 a decreased refractory period in ventricular muscle
What are antianginal drugs?
they are drugs used to treat angina pectoris, This is a condition of acute cardiac pain caused by inadequate blood flow to the myocardium resulting from either plaque occulsions within or spasms of the coronary arteries
types of antianginal drugs
antianginal drugs increase blood flow either by increasing O2 supply or by decreasing O2 demand by the mycardium
three types of antianginals are nitrates, beta blockers and calcium channel blockers
the major system effect of nitrate is the reduction of venous tone, which decreaes the workload of the heart and promotes vasodilation. beta blockers and calcium cahnnel blockers decrease the workload of the heart and decrease O2 demand.
nitrates and calcium cahnnel blockers are effective in treating variant(vasopastic) angina pectoris, beta blockers are not effective for this type of angina. with stable angina beta blockers can be effectively used to prevent angina attacks
types of
Nitrates
nitrats developed in the 1840's were the firsst agents used to treat angina. this group pd drug reduces myocardial ischemia but causes hyptension.
what is the most commonly used nitrate
SL Nitroglycerin, it is not swalloed because it undergoes first pass metabolism by the liver, which decreases it's effectiveness, instead it is given sl sublingually
what are the side effects of Nitroglycerin
Headaches are the most common side effect. others are hypotension, dizziness, waekness and faintness.
what are some adverse actions of Nitroglycerin
Hypotension, reflex tachycardia, paradoxical bradycardia
Life threatening+Circulatory collapse
What are beta-blockers
Beta adregenic blockers block the beta receptor site, they decrease the effects of the sympathectic nervous system by blocking the release of the catecholamines epinephrine and nonepinephrene thereby decreasing the heart rate and myocardial contractibility, they reduce the need for O2 consumptipn and consequently reduce anginal pain
side effects of beta blockers
nonselective and selectiv beta blockers cause a decrease in pulse rate and blood pressure, vital signs need to closely monitored in the early stage of beta bloclker therapy
what are calcium channel blockers
they were introduced in 1982 for treatment of angina pectoris, certain dysrhthmias and hypertension, calcium activates myocardiaul contraction, increasing the workload of the heart and the need for more O2, 80-90% are absorbed through the GI mucosa
What are the side effects of calcium blockers
headaches, hypotension, dizziness and flushing skin
what are some adverse reactions of calcum blockers
calcium blockers can cause changes in liver and kidney function, serum liver enzymes shoulkd be checked periodically
Explain the actions of cardiac glycoslides
cardiac or digitalis glycosides, inhibits calcium in cells. causes cardiac muscle fibers to contract
Outcome
improvement of myocardial contractibility
reduction of the hearts workload
explain the actions of antianginal drugs
used to treat Angina pectoris(chest pain), antianginal drugs increase blood flow either by increasing O2 supply or by decreasing O2 demand by the myocardium
what are the three types of antianginals drugs
Nitrates, Beta-blockers, and calcium cahnnel blockers
Describe the sing syptoms and and treatment of digitalis toxicity
Overdose or accumulation of Digoxin causes digitalis toxicity.
SIGNS AND SYMPTOMS=anorexia, diarrhea, nausea, and vomiting, BRADYCARDIA(below 60) premature ventricular contrtaction, cardiac dyrhthmias, headaches, mailaise blurred vision, viusal illusions, confusion and delirium
Digoxin immune Fab(ovine<Digibind) can be given to treat severe digitalis toxicity. this agen binds with the dogoxin to form complex molecules that can be excreted in the urine, and digoxin is unable to bind at the cellular site of action
Digitalis Toxicity can result in first degree, second degree or complete heart block
diitalis toxicity
Identify the actions, of Nitrates
nitrates developed in 1840's were teh first agents used to relieve angina, the nitrates affect the blood vessels in the venous circulation and coronary arteries, they cause generalized vascular and coronary vasodilation thus increasing bloof flow throgh the coronary arteris to the myocardial cells. the drugs in this group reduces myocardial ischemia but can cause hypotension.
what are side effects and adverse actions to Nitrates
Nitroglycerin(most common Nitrate
headaches are the most common side effects of Nitroglycerin, acetaminophen may provide may provide some releif. Other side effects include hypotension, dizziness, weakness and faintness.
when patches or ointment is discountinued it should be spread out to prevent rebond effects of severe pain caused by myocardial ischemia(lack of blood supply to the heart muscles0 in addition reflex tachycardia may occur if nitrate is given to often.
Identify the actions to beta blockers
decrease the effect of the sympathetic nervous systme by blocking the release of the catecholamines epinephrine and norephinephrine therby decreeasing the heart rate and blood pressure
what are the the side effects and adverse actions of Beta Blockers
Non seletive and selectie beta blockers cause a decrease in pulse rate and blood pressure.(bradycardia and hypotension
The nonselective beta blockers, bronchospasm, behavorial or psychotic response, impotence are potential adverse reactions
Identify the actions of calium cahnnel blockers
block calcium access to the cess, causing dexcreased heart contractibility and conductivity and leading to a decreased demand for oxygen
What are the side effects and adverse actions of calcium channel blockers
headaches, hypotension, dizziness and flushing of the skin
Adverse=Refelex tachycardia can occur as a result of hypotension, calcium channel blockers can cause changes in liver and kidney function and serum liver enzymes should be checked periodically.
What are the effects of Quinidines and procainamide
The first drug to treat cardiac dysrhythmias were quinidines.
uses=to control cardiac dysrthmias(premature ventricular contractions, ventricular tachycardia
What are the side effects of Procainidines, and quinidines
Side effects=anorexia, nausea, vomiting, diarrhea, dizziness, weakness, flush, and lupus like syndrome with rash
adverse actions=life threatening, atrioventricular block, pleural effusion, ventricular tachycaria/fibirilation
xplain the actions and uses of diuretics
to decrease hypertension(lower blood pressure, and to decrease edema in congestive heart failure(chf
Diuretics have an antihypertenion effect by promoting sodium and water loss by blocking sodium and chloride reabsorption)
iDENTIDY THE GROUPS OF DIURECTICS AND DISCUSS THEIR SIDE EFFECTS(5)
1 Thiazides and thiazide like
2 loop or celing
3 Osmotic
4 carbonic anhydrase inhibitor
5 potassium sparing
What are the side effects of thiazide and thiazde like diuretics
elctrolye imblance(hypokalemia, hpercalemia, hypomagnesemia and bicarbonate loss0 hyperglycemia(elevated blood sugar, hyperuricmia(elevated serum uric acid level) and hyperlipidemia(elevated blood lipid level)
what are the side efects of loop diurectics
Most common side efects are fluid electrolyete imbalances, such as hypokalmeia, hyponatremia, hypocalecemia, hypomagnesemia, and hypochloremia, prolonged use of loop diuretics could cause thiamine deficiency
What are the side effects of of osmotic diuretics
Mannitol is the most frequentky used loop diuretic, followed by urea
Side effects and adverse reations=fluid and elctrolyet imbalance, pulmonary edema from rapid shifts of fluids, nausea, vomiting, tachycardia from rapid fluid loss and acidosis, crystallization of mannitol int he vial may occur when drug is exposed to low temps, this drug should not be used IV
What are the side effects of carbonic anyhydrase inhibitors
This group of drug is used primarly to decrease IOP
One of the drugs acetazolamide can cause fluid electrolyte imabalnce, metabolic acidosis, nausea, vomiting, anorexia, confusion.
Hemolytic anemia and renal calculi can occur
What are the effects of potassium sparing diuretics
potassium sparing diuretics, weaker than thiazades and loop are used as mild diuretics or in combo with another diuretic, they act primarily in the collecting distal duct renal tubules to promote soduim and water excretion and K retention
side effects=the main side efect is Hyperkalemia, if they are givne with ACE inhibitor, it could become sever or life threatening becasue both drugs retain potassium
Identify the categories of antihypertension drugs 6 categories
-diuretics
-sympatholytics
-direct acting arteriolar vasodilators
-angiotension antaganost(opposite effect)
-angiotensin 11 receptor antagonist
-calcium channel blockers
Describe the pharmacologic actions and side effects of antihypertension drugs
blood pressure is regulated by cardiac output and peripheal vascular resistance (PVC) Medicaitons that influene either one of these systems leads to blood pressure control. Antihypertensive drugs that influenc these systems to lower the BP are Angiotensin-converting enzyme(ACE inhibitors, Beta adrenergic blockers, and clacium channel blockers(CCB)
identidy the actions of anticoagulants and side effects.
Used to inhibit clot formation, unlike thrombolytic it prevent new clots from forming, , HEPARIN IS A MAIN ONE GIVEN, GIVEN IN LOVE HANDLES,
Side effects=injectin site reactins, transient thrombocytopenia, large doses may suppress renal function, spontaneous bleeding at mucous membranes
watch for bleeding
identify the action and side effects of antiplatelets
are used to prevent thrombis in the arteries by suppressing platelet aggregation, heparin and coumadin prevent thrombosis in the veins
What is the drug coumadin used for
it is an anticoagulant that suppresses production of fibrin, which disrupt the coagulation cascade
avoid vitamin k foods, and decrease green leefy vegtables
Identify the action and side effects of thrombolytics
work to convert plasminogen to plasmin, an enzymethat acts to digest teh fibirin matrix of clots.
major complication is hemorraging
Identify the actions and side effects of antilipemics
lower abnormal bloop lipid levels
LDL-low density lipids-bad
HDL-high density lipids=good
one of the first antilipemics was cholestyramine
Side effects and eadverse reactiomns=constipation and peptic ulcers
identify the actions and adverse actions of peripheal vasodilators
they increase blood flow to the extremeties, all the drugs used for this promote vasodilation
side effects and adverse actions=light headness, dizziness, orostaic hypotension, tachycardia, palpitaion,flush and gi stress may occur
Explain the nursing interventions, including client teaching related to glycosides
check apical pulse before giving-hold for HR less than 60 beats per minute, monitor for hypokalmia
client teaching=teach client to take pulse before taking, explain importance of compliance, take at same time, avoid OTC meds unless cleared by MD, report side effects, discuss herb drug interaction, eat foods high in potassium
Explain nursing interventions and client teaching related to antianginals
Monitor vital signs, monitor SE, have patients sit or lie when taking for the first time
Client teaching=instruct howa nd whne usage of SL nitroglycerin, instruct rotation of sites topically, dont get paste on fingers, it's easily absorbed, avoid caffein, coffe and tabacco
Describe nursing interventions, including client teaching for antidysrhymic drugs
monitor vital signs and monitor ECG for dysrhythmia, bradycardia
client teaching=discuss drug compliance, report Side Effects, avoid alcohol, caffeine and tabacco
Describe Nursing interventins, and client teaching for diuretics
assess vital signs, weight, input and output, chemisrty values for baseline, check weight same time everyday, s/s of hypokalemia(muscle weakness) leg cramps, cardiac dysrhymias,
teaching=compliance, take early to avoid sleep disturbances, discuss herbal OTC, instruct change positions slowly-orthastatic, eat food rich in potassium, take food with meds to avoid GI stress,cultural consideration
Descibe Nursing interventions and client teachings for antihypertensive
monitor renal fumction and blood glucose, monitor for bruising, petechiae,
Teaching=compliance, dont stop abrubtly, report side effects
Describe Nursing interventions and teachings for peripheal vasodilators
monitor vital signs, especially blood pressure and heart rate, tachycardia and orthostatic hypotension can be problematic
teaching=inform client that a desird therapeutic response may take 1.5-3 months, dont smoke, smoking increases vasospasms, use aspirin or aspirin like compuounds only with doctors approval