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133 Cards in this Set
- Front
- Back
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nitroglycerin - actions
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decreases oxygen demand on heart
dialates arteries and veins reduces blood volume decreases preload on heart |
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nitroglycerin - uses
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angina pectoris
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nitroglycerin - common adverse effect
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excessive hypotension
prolonged headache tolerance |
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nitroglycerin - indication
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most common drug to treat angina pectoris (drug of choice)
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nitrate - medication administration forms
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sublingual tablets
substance release - capsules, tablets, ointment, transmucosal tablets, transdermal patches translingual spray amyl nitrite for inhalation (glass vials) |
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nitrates - sublingual tablets
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Disolves rapidly. Primary for acute attacks
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Nitrates - substance release - capsules, tablets, ointment, transmucosal tablets, transdermal patches
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used prophylactically to prevent angina attack
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Nitrates - translingual spray
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used prophylactically and acute to prevent angina attack
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Nitrates - amyl nitrite for inhalation
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glass vials
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chronic stable angina
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Precipitated (caused) by stress or exertion
Short duration Relieved by rest or nitroglycerin Probable cause: fixed atherosclerotic obstruction (fix the plaque = fix the pain) |
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Unstable Angina
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Unpredictable; changes in frequency, duration, and onset
Probable cause: atherosclerosis and thrombus formation |
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Variant Angina
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Occurs at rest,
characteristic ECG changes Probable cause: vasospasm of the coronary artery |
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Angina Pectoris
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Chest discomfort arising from the heart due to lack of oxygen to the heart muscle
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Angina pectoris - signs and symptoms
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Squeezing in the chest, pressure, tightness, choking, burning, heaviness, may radiate to neck, shoulder, jaw
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Angina Pectoris - Causes (precipitating factors)
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Physical activity, exposure to cold, drinking caffeine-containing beverages, smoking, emotional stress, sexual intercourse, eating large meals
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Angina Pectoris Treatment - Goals
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Prevent myocardial infarction and death
Pain relief |
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Angina Pectoris Treatment - treatment
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drug therapy - nitrates/beta blockers
step 1 - Coronary angioplasty - they place a stent (hollow metal tube) where the blockage occurred. Step 2 - Coronary artery bypass surgery - they take a good vessel from a leg and replace it with the bad coronary vessel |
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Angina Pectoris - Patient education
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Avoid precipitating factors (cause)
Reduce risk factors Exercise |
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Angina attack duration
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30 seconds to 30 minutes
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Drugs to treat Angina Pectoris
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Nitrates
Beta-adrenergic blocking agents ACE inhibitors Calcium channel blockers Fatty oxidase enzyme inhibitors Statins Platelet-active agents |
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Angina pectoris - treatment
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Morphine - pain and vasodialating effects
Oxygen - reduces workload of the heart Nitro - vasodialator Aspirin - antiplatelet/reduces/prevents blood clots |
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Angina Pectoris - Patient education
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Correct use of prescription medications
Common adverse effects from prescription medication Avoid fatigue and cold weather Lifestyle modifications Smoking cessation referral, if necessary Always stop activity or exercise when chest pain is present |
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Nitro-BID
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topical ointment
onset 30 minutes duration 3 hours |
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Nitro-Dur
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Patch, Transmucosal
onset 30-60 minutes Duration - less than 24 hours |
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Nitrolingual
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Spray, translingual
onset 2 minutes Duration 30-60 min |
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Nitroglycerin IV
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IV Fluid
onset 1-2 minutes Duration 3-5 minutes |
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NitroStat
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Tablet sublingual
Onset 1-2 minutes duration less than 30 minutes |
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Beta blockers - Use
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Reduce the number of anginal attacks
Reduce nitroglycerin use (patient will use less nitro if on beta blockers) Anti-hypertensive (reduces blood pressure) |
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Beta blockers - actions
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Block beta adrenergic receptors in heart (reverses sympathetic nervous responses)
Reduce myocardial oxygen demand Reduce blood pressure (reduces hypertension) slows heart rate down slows cardiac output inhibits renin release = prevents vasoconstriction |
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digoxin antagonsist
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Digibind (Digoxin Immune Fab)
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Narcotic antagonist
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Narcan (naloxone)
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Benzodiazapine antagonist
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Romazicon (Flumazenil)
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Heparin Antagonist
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Protamine
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Coumadin antagonist
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Vitamin K (Phytonadione)
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Tylenol antagonist
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Mucomyst ( Acetylcysteine)
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Diuretics - uses
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Used to increase flow of urine to reduce excess water in the body
Primarily used to treat heart failure, hypertension Other uses: liver disease,(spironolactone) renal disease,(Lasix) cerebral edema & increased intraocular pressure (mannitol) treat hypercalcemia (lasix) |
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Diuretics - therapeutic outcomes
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reduce edema
improve symptoms of excess fluid |
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Pathologic Conditions Contributing to Excess Fluid
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Heart failure - leads to:
Edema, adventitious (abnormal) lung sounds, dyspnea, change in mental status Liver disease - leads to: Jaundice (yellow skin) , ascites (edema of the stomach area) , disorientation, history of alcohol dependence, overdose of OTC medications |
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Adverse outcomes if diuretics not given
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renal failure (kidney)
pulmonary congestion (water in the lungs) edema hypertension stroke death |
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Renal Function Assessement
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History of related causative disorders/factors
History of current symptoms Pattern of urination - frequency nocturia Medication history Hydration status Electrolyte imbalance (low/high na or K) Often subtle changes, such as in mental status, muscle strength/cramps, tremors, nausea, general appearance |
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Nursing assessment for hydration status - (ways to know diuretics are working)
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Evaluate for dehydration: skin turgor, oral mucous membranes
Monitor laboratory values for changes Evaluate location of edema, signs of reduction Obtain daily weights- 1 liter= 1kg Measure intake and output Orthostatic Vital signs |
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Diuretics - Electrolyte Imbalance
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Susceptible people: history of renal or cardiac disease, hormonal disorders, massive trauma or burns
Assess mental status, muscle strength and cramps, tremors, nausea, general appearance Serum potassium < 3.5 mEq/L (hypokalemia), > 5.5 mEq/L (hyperkalemia) Serum sodium < 135 mEq/L (hyponatremia), > 145 mEq/L (hypernatremia) |
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Patient education - diurectics
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Accurate measurement of fluid intake and output
Purpose of diuresis (HTN, glaucoma, CHF, Renal disease) Medication considerations (take in AM) Nutrition- Na+ sodium , K+ potassium alert (avoid or increase high K/NA foods) depending on type of diuretic taken (potassium sparing or not). Potassium sparing diuretics can cause hyperkalemia. Health maintenance Written record/patient self-assessment form- extremely important for pt to track. At least in the begin of therapy. |
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Carbonic Anhydrase Inhibitor - Actions
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Weak diuretic; inhibits the enzyme carbonic anhydrase in kidney, brain, eye
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Carbonic Anhydrase Inhibitor - Uses
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Reduces intraocular pressure with glaucoma (high eye blood pressure- glaucoma can cause blindness)
reduce seizure activity with certain types of epilepsy Not used frequently, but effective for decreasing IOP. |
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Carbonic Anhydrase Inhibitor - drug
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Acetazolamide (Diamox)
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Sulfonamide-Type Loop Diuretics - Drugs
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Bemetanide (Bumex),Furosemide(Lasix)
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Sulfonamide-Type Loop Diuretics - Actions
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Actions
Inhibit sodium and chloride reabsorption in ascending limb of the loop of Henle |
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Sulfonamide-Type Loop Diuretics - uses
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Uses
Treat conditions such as edema resulting from heart failure, cirrhosis of the liver, renal disease (proteinuria) |
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Sulfonamide-Type Loop Diuretics - Adverse effects
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Common adverse effects
Oral irritation, dry mouth; orthostatic hypotension Serious adverse effects Abdominal pain; electrolyte imbalance, dehydration; hyperuricemia (too much uric acid in your blood) hyperglycemia; hives, pruritus (r/t sulfa) |
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Thiazide Diuretics - drugs
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HCTZ all end in (azides)
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Thiazide Diuretics - actions
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Block reabsorption of sodium and chloride ions from the distal tubule
less effective over time - due to tolerance |
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Thiazide Diuretics - Uses
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Uses
Treat edema associated with heart failure, renal disease, hepatic disease, pregnancy, obesity, premenstrual syndrome |
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Thiazide Diuretics - Adverse effects
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Common adverse effects
Orthostatic hypotension (mild) Serious adverse effects Electrolyte imbalance, hyperuricemia, hyperglycemia |
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Potassium-Sparing Diuretics - drugs
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Drugs: amiloride (Midamor), spironolactone (Aldactone), triamterene (Dyrenium)
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Potassium-Sparing Diuretics - actions
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Induce retention of potassium; excrete sodium at the distal renal tubules. Weak anti-hypertensive activity.
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Potassium-Sparing Diuretics - uses
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In combination with other diuretics to treat edema,hypertension or heart failure, prevent hypokalemia
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Potassium-Sparing Diuretics - Adverse effects
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Common and serious adverse effects: N/V, anorexia,headache,electrolyte imbalance, dehydration.
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Potassium values
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Serum potassium less than < 3.5 mEq/L = hypokalemia
Potassium greater > 5.5 mEq/L = hyperkalemia |
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Sodium Values
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Serum sodium less than < 135 mEq/L = hyponatremia
Sodium greater than > 145 mEq/L = hypernatremia |
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Drugs that affect potassium
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Beta blockers - increase potassium
Ace inhibitors - increase potassium Diuretics - decrease potassium except for potassium sparing diuretics. |
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diuretic that work on loop of henle
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furosemide - lasix
bumetanide - bumex toresemide - demadex ethacrynic acid - edecrin |
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diuretics that work on distal convolution
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spironolactone
triamterene amiloride Thiazides |
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diuretics that work on the proximal convolution
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osmotic diuretics
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Thrombolitic disease
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the process of forming a blood clot or thrombus
Fragments of a thrombus can break off and circulate until trapped in a capillary, creating an embolus Clotting cascade is activated when a blood vessel is injured, or with increased viscosity |
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Intrinsic clotting pathway
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Is initiated by the blood coming in contact with exposed collagen in the blood vessel wall, i.e., material within the blood or blood vessel wall.
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Extrinsic clotting pathway
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Is initiated with material outside of or "extrinsic" to the blood.
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Conditions that cause clots to form (Risk factors)
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Immobilization with venous stasis
Surgery, trauma to lower limbs Heart failure, vasospasm Cancers of the lung, prostate, stomach, pancreas Pregnancy, oral contraceptives Diabetes Truck Drivers Bed Ridden |
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Stasis prevention
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leg exercises
wearing stockings leg elevation sequential compression devices - device that includes a wrap on your legs and is connected to a pump that squeezes so blood circulates back to the heart. |
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Revascularization treatments
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(treatments that reroute blood flow through vessels)
percutaneous coronary intervention - stent (metal tube creating opening of clogged vessel) coronary artery bypass graft - take a vessel from elswhere in the body and graft it on the coronary artery |
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Drug Therapy Goals for Thromboembolic Diseases
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Primary purpose is to prevent platelet aggregation or inhibit steps in the clotting cascade
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4 types of thrombolitic treatments
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Platelet inhibitors
Anticoagulants Glycoprotein IIb/IIIa inhibitors Thrombolytics |
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Anticoagulation therapy treatment
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Prevents new clot formation
Treats existing clots |
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Thrombus interventions
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Do not massage area that may have a clot. Clot can dislodge and go to brain or lungs
evaluate pulse color temperature of skin |
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Coagulation tests (blood test)
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PT (prothrombin time) - pt value will determine adjustment of coumadin.
aPTT (activated partial thromboplastin time) - aPTT value will determine the adjustment of Heparin. INR (international normalized ratio) Platelet counts |
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PT (protrombin time) lab value
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determine increase or decrease adjustment of coumadin medication
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aPTT (activated partial thromboplastin time) lab value
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Determines the increase or decrease adjustment of Heparin.
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Aspirin - uses
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antiplatelet therapy
reduces frequency of: TIA - transient ischemic attack - temporary stroke due to temporary lack of blood to the brain. Ischemia= lack of blood flow Reduces frequency of MI - Myocardio Infarction |
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Aspirin - Actions
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Inhibits platelet aggregation for the life of the platelet (stops clumping)
Prolongs bleeding time |
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MI - Myocardio Infarction
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heart attack
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Plavix - uses
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reduce risk of ADDITIONAL: (for people who already have had the following)
myocardial infarctions (MI) Strokes Vascular death (vessel death) may be used together with aspirin |
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Plavix - actions
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Inhibits/disrupts the ADP pathway (aggregation process) required for platelet aggregation
Prolongs bleeding time - person will bleed longer prolonged bleeding time is beneficial for patients with weak hearts so that the blood will not thicken due to weak contractions of the heart. Same applies to Aspirin |
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lovenox (eoxaparin) - actions
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Low molecular weight heparin (LMWH)
Less potential for hemorrhage longer duration of action Prevents coagulation cascade no antiplatelet activity does not affect PT or aPTT |
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Lovenox - uses
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prevent DVT (deep vein thrombosus) after hip, knee or abdominal surgery
Treat DVT along with coumadin Treatment of STEMI (ST elevation MI) Derived from pigs - should not be given to patients allergic to pork |
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Heparin - action
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natural substance extracted from gut of pigs and cows
inhibits clotting factors No fibrinolytic qualities (cannot bust a clot) |
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Heparin - Uses
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treats
DVT Pulmonoary embolisms peripheral arterial embolisms MI hemodialysis (filtering of blood by machine outside the body) PCI - percutaneous coronary interventions (stent placement) |
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Heparin - administration points to remember
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never give po
do not aspirate this drug can be given subq or IV |
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Platelet inhibitors - common adverse effects
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Abdominal distress
hypotension |
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Platelet inhibitors - serious adverse effects
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Serious adverse effects
Neutropenia agranulocytosis - low white blood cells bleeding |
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Anticoagulant - patient education
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Diet and nutrition
Limit intake of leafy green vegetables Drink six to eight 8-ounce glasses of fluid daily Exercise and activity after surgery to prevent venous stasis Do not flex knees or place pressure under knees; avoid being motionless Medication regimen Dose and timing, common and serious adverse effects, drug interactions |
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Anticoagulants - adverse effects
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Common adverse effects
Hematoma formation (blood collection under the skin) bleeding at injection site Serious adverse effects Bleeding thrombocytopenia (low blood platelets) |
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Anticoagulants - assessment for bleeding
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Monitor to detect hemorrhage
Symptoms of internal bleeding Decreased blood pressure, increased pulse, cold clammy skin, faintness, disorientation Consider all areas of the body that could begin to bleed (visible and internal) Monitor laboratory values aPPT, platelets, hematocrit |
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Drug Class: Glycoprotein IIb/IIIa Inhibitors - drugs
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Drugs: abciximab (ReoPro), eptifibatide (Integrilin), tirofiban (Aggrastat)
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Drug Class: Glycoprotein IIb/IIIa Inhibitors - Actions
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Actions
Block receptors on platelets, preventing aggregation and clot formation |
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Drug Class: Glycoprotein IIb/IIIa Inhibitors - Uses
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Uses
Prevent clots forming from the debris often released during percutaneous coronary intervention (PCI) procedures |
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Drug Class: Glycoprotein IIb/IIIa Inhibitors - Serious side effects
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Serious adverse effects
Bleeding thrombocytopenia |
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Fibrinolytic Agents - uses
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Uses
Dissolve fibrin clots secondary to coronary artery occlusion (MI), pulmonary emboli, cerebral emboli, deep venous thrombosis |
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Fibrinolytic Agents - actions
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Actions
Stimulate the bodies own clot-dissolving mechanism, converting plasminogen to plasmin, which digests fibrin |
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Fibrinolytic Agents - drugs
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Drugs: streptokinase, alteplase (Activase), reteplase (Retavase), tenecteplase (TNKase)
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Fibrinolytic - contraindications
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active internal bleeding recent (within 2 months)
cerebrovascular accident intracranial or intraspinal surgery severe uncontrolled hypertension pregnancy |
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Heart Failure - Definition
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Cluster of signs/symptoms that arise when the ventricles (left, right, or both) lose ability to pump enough blood to meet the body’s circulatory needs
Systolic dysfunction (contraction dysfunction) |
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Heart Failure - Symptoms
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decreased exercise tolerance
poor peripheral tissue perfusion Diastolic dysfunction (filling dysfunction) pulmonary congestion pulmonary edema |
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Heart Failure - how it works
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Body Compenates by:
Releases epinephrine and norepinephrine (stimulate stronger/faster) heart beats RAAS stimulates renal distal tubule to retain sodium and water Increases production of vasopressin (anti-diuretic) Kidneys increase sodium reabsorption, increasing blood volume, causing increased pressure within capillaries, resulting in edema formation Heart muscle hypertrophy (increase muscle size) |
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Heart Failure - Treatment
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Correct underlying disease (e.g., coronary artery disease, hypertension, dyslipidemia (high cholesterol/trigycerides), thyroid disease)
Bed rest when necessary Sodium-restricted diet Control symptoms with combination of drugs |
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Heart Failure - Goals
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Reduce signs/symptoms associated with fluid overload
Increase exercise tolerance Prolong life |
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Heart Failure - Drug Therapy
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Vasodilators – reduce strain on left ventricle by reducing systemic vascular resistance (afterload)
Inotropic agents – boost cardiac output by stimulating the heart to increase force of contractions Diuretics – enhance sodium and water excretion, reducing preload |
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Heart Failure - Nursing Assessment
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Obtain history of heart disease, related cardiovascular diseases
Six cardinal signs of heart disease Presence of altered cardiac function |
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Heart Failure - Diagnostic Tests
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Echocardiogram
ECG nuclear imaging studies chest x-ray laboratory tests |
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Heart Failure - Related diseases and causes
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Related diseases
hypertension, hyperlipidemia, diabetes mellitus, lung disease. Causes of systolic dysfunction coronary artery disease MI - if muscle damage congestive heart failure congenital heart disease cardiomyopathy |
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Heart Failure - Six cardinal signs of heart disease
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dyspnea - sob
chest pain, fatigue edema - swelling syncope palpitations - heart racing |
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Heart Failure - Digoxin - actions
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Actions
Positive inotrope Negative chronotropy |
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Digoxin - Uses
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Treat moderate to severe systolic failure not responding to diuretics and ACE inhibitors
initial treatment for heart failure = ace and diuretics |
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Digoxin - Side effects
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Digoxin toxicity
drowsiness, nausea/vomiting, loss of appetite (anorexia), diarrhea, disturbed color vision (yellow or green halos around objects), confusion, dizziness, agitation, and/or depression |
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Digoxin - notes
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Always take the apical pulse for 1 full minute before administration; do not administer when heart rate is less than 60.
Maintenance dosing given daily. Digoxin toxicity related to long half-life. Digoxin immune Fab (ovine) (Digibind) is the antidote. |
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Heart failure drug - Inamrione & milrione - actions
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Actions
vasodialtor and ionotrope Increase the force and velocity of myocardial contractions |
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Heart failure drug -Inamrione & milrione - uses
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Short-term management of systolic dysfunction heart failure in patients not responding adequately to digoxin, diuretics, or vasodilator therapy
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Heart failure drug -Ace Inhibitors - actions
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Actions
Reduce afterload by blocking angiotensin II-mediated peripheral vasoconstriction; reduce preload |
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Ace inhibitors - Uses
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Treat mild to moderate systolic dysfunction heart failure
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Beta Blockers - Actions
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Actions
Inhibit cardiac response to sympathetic nerve stimulation; inhibit renin release |
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Beta blockers - uses
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Uses
In combination with ACE inhibitors to treat heart failure |
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Natriuretic Peptides - drugs
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Drug: nesiritide (Natrecor)
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Natriuretic Peptides -Actions
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Actions
Reduce preload and afterload pressures, increasing diuresis and sodium excretion Suppress RAAS Reduce secretion of norepinephrine |
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Natriuretic Peptides -uses
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Uses
Treat severe heart failure |
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Natriuretic Peptides
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Natriuretic peptide is a hormone normally secreted by the cardiac ventricles in response to fluid and pressure overload.
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Ace inhibitors - Therapuetic outcome
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Improved cardiac output with improved tissue perfusion; improved tolerance to exercise.
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Heart Failure Drug therapay - therapuetic outcomes
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Therapeutic outcomes: reduce systemic vascular resistance (afterload); reduce preload.
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Heart failure - Facts
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Affects an estimated 5 million Americans.
The number of other conditions that complicate its treatment increases as people live longer. |
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Diastolic dysfunction
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heart fills during diastolic contraction but does not allow release of proper amount of blood.
If heart fills up too much blood backs up to the lungs causes pulmonary edema wet cough pulmonary congestion |
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stimulating factors to the sympathetic nervous system - all do the same thing
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cathacolemines
epinephrine norepineprine sympathetic stimulate sympathetic neuro transmitters |
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Left sided heart failure symptoms
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reduced exercise tolerance, fatigue, dyspnea, weakness
cough, cardiac enlargement, pulmonary crackles (water sounds in lungs) elevated jugular venous pressure is positive ( neck veins are distended) peripheral edema S3 gallop rhythm - 3 heart sounds lub dub dub |
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Right sided heart failure symptoms
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edema,
elevated jugular venous pressure, S3 gallop over the right ventricle often ascites or anasarca |
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Causes for Left sided heart failure - usually not pulmonary in nature
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Ischemic heart disease (ST-segment elevation myocardial infarction (STEMI) is the most common cause of heart failure in the U.S.)
Hypertension (untreated or inadequately treated hypertension is the second most common cause of heart failure in the U.S.) Arrhythmias (especially atrial fibrillation) Valvular disease (aortic stenosis, aortic insufficiency, mitral insufficiency) Cardiomyopathy High-output states (anemia, hyperthyroidism) Congenital heart disease Volume overload (eg, in renal failure patients who miss dialysis) |
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Causes for Right sided heart failure - Usually pulmonary in nature
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Chronic pulmonary disease (COPD)
Pulmonary embolism Primary pulmonary hypertension Valvular disease (mitral stenosis) |
