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62 Cards in this Set
- Front
- Back
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Angina/Coronary heart disease |
Episode of chest pain caused by demand for oxygenated blood for body is greater than supply Caused by: atherosclerotic plaque in coronary arteries, high levels of catecholamines Results in: MI or heart attack |
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Types of Angina (3) |
1. Stable 2. Variant 3. Unstable |
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Stable Angina |
chest pain, squeezing, suffocating, may go down arm or up into jaw Nurse: women also see fatigue and SOB |
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Variant Angina |
spasms of coronary artery during rest Nurse: pain relieved by nitroglycerin |
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Unstable Angina |
common/intense chest pain, spasms, squeezing, suffocating due to advanced coronary artery disease |
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Nitrates |
Action: relax smooth muscle in blood vessels, vasodialator, decrease pre+afterload Use: used for/prophylactically for angina and MI Adverse: HA, hypotension, dizziness, N/V, flushing, tachycardia Nurse: wear gloves, hold ptn at 30 pts less than normal systolic, no beta blockers of ED meds, telemetry these patients Teach: for short term attacks take 3 pills, 5 mins apart. call EMS if condition doesn't improve. no smoke/ETOH. sit/lie down when taking |
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3 types of Nitrates |
1. NTG 2. Isordil - long term prophylactic 3. Imdur - sustained release taken once/day |
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NTG |
Type: Nitrate (most common) Use: angina, MI (for and prophylactic) Given: pill under tongue, cream, patch, IV, spray Nurse: Patch 12 hrs on/off, rotate site. Pills must be stored in original dark container. should fizzle under tongue. if they don't then they are expired. |
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Beta 1 blockers |
Action: decrease energy demands of heart Use: chronic stable angina, MI, HTN, dysrhythmia Adverse: hypoglycemia Nurse: monitor VS's, change positions slowly, taper dose, avoid hot tubs/hot showers, saunas, no ETOH, want HR > 60. Types: Tenormin (improves MI survival rate) and Lopressor |
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Normal cholesterol levels (4) |
Total: <200/dL LDL: <100 HDL: >60 (problem if under 40) Tiglycerides: <150 |
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High cholesterol is linked to: |
arteriosclerosis, HTN, CAD, PVD, MI -agents to lower lipids attempt to lower lipid/triglyceride levels in serum |
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Lipitor and Zocor |
Type: lipid lowering agent Class: HMG-COA reductase inhibitor (aka statin) Action: block cholesterol synthesis in liver Use: lower LDL by 30-40%, maintain HDL Adverse: constipation, abd distention, burping Contra: don't give to ptns with liver failure Nurse: first line cholesterol drugs, give at night, don't get pregnant, restrict ETOH, starts in 1-2 weeks, max effect in 4-6 weeks |
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Questran |
Type: lipid lowering agent Class: bile and acid sequestrants Action: inhibit or increase excretion of bile in GI Adverse: constipation, bloating, farting Contra: no ptns with bile obstruction disease Nurse: take powder in mixed with food/drink before meal, increase fiber |
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Lopid |
Type: lipid lowering agent Class: fabric acid derivatives Action: reduce plasma triglycerides by increasing enzyme lipoprotein lipase Use: short term for hyperlipidemia patients who fail diet Adverse: abd pain, diarrhea, Nurse: signs of gall stones, need fiber and fluid |
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Zetia |
Type: lipid lowering agent Class: cholesterol absorption inhibitor Action: acts in small intestine Nurse: used in adjunct with statins for those who are intolerant to other therapies |
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What is heart failure and what are the symptoms? |
Heart not being able to meet the demands of the body Symptoms: dyspnea, fatigue, ankle edema, jugular vein distention, pulmonary edema
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What are the 6 classes of drugs that treat heart failure? |
1. Ace inhibitors 2. angiotensin II blockers (ARBS) 3. Phospodiesterase inhibitors 4. Cardiac glycocides 5. Diuretics 6. beta blockers |
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Lisinopril and Captopril |
Type: drug for heart failure Class: ACE inhibitor Action: inhibits Angiotensin I to II Use: heart failure, HTN Adverse: hypotension, renal tubular damage, cough, angioedema Contra: no renal disorder or pregnant patients Nurse: monitor weight, I&O, rebound hypertension w/ abrupt stop, monitor K, no NSAIDS |
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What is the function of Angiotensin II? |
potent vasoconstrictor |
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2 cool things about ACE inhibitors |
1. they are heart protective following an MI - stop progression of ventricular hypertrophy 2. protect kidney in diabetics when there is no existing kidney failure |
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Losartan and Valsartan |
Type: drugs for heart failure Class: ARBS Action: compete w/ Angiotensin II for binding site Adverse: hypotension, less cough Conatra: no liver failure or pregnant patients Nurse: monitor weight, I&O, rebound hypertension w/ abrupt stop, monitor K, no NSAIDS |
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Netrecor |
Type: drug for heart failure Class: B-type natriuretic peptide Action: increase CO, SV and contraction without altering HR/BP Use: given IV in ICU for Acute heart failure Adverse: hypotension, dysrhythmias Nurse: Monitor BNP |
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Primacor and Inocor |
Type: drug for heart failure Class: Phospodiesterase inhibitor Action: vasodilation to decrease pre+afterload, inhibit action phosphodiesterase enzyme Use: given in ICU for acute heart failure only after other treatment failure Adverse: hypotension, hysrhythmias Inocor can cause thrombocytopenia |
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Digoxin |
Type: oldest heart failure drug Class: Cardiac glycocides Action: slow HR and increase force of contrations Use: heart failure, tachyarrhythmias Adverse: bradycardia, heart block Nurse: no new patients RX'd this drug b/c not shown to decrease mortality, start with loading dose, hold HR <60 |
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Cardiac Glycocides Toxicity symptoms |
-anorexia, hypokalemia, yellow/green eyes -Elderly more likely to experience toxicity -Normal blood level of drug should be .5-2 ng/mL |
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Bidil |
-Combination of Apresline/isosorbide (vasodilators) -shown to treat heart failure and HTN in African american population |
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What is a Dysrhythmia, what are the 5 types and which are life threatening? |
Disturbance in the hearts electrical conduction 1. Sinus 2. Atrial 3. Nodal 4. Ventricular (LT) 5. Heart block (LT) |
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Quinidex, Pronestyl an Norpace |
Type: dysrhythmia drug Class: I-A Action: block Na+ channel, membrane stabilizing Use: supraventricular/ventricular arrhythmias Adverse: Pronestyl - can cause blood disorder/lupus like syndrome, Quinidex - can cause tinnitus Caution: those with liver/kidney disorders Nurse: many drug interactions, take on time schedule |
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Lidocaine |
Type: dysrhythmia drug Class: I-B (not used as much now) Action: decrease automaticity in ventricles Use: local anesthetic, serious dysrhythmias Adverse: bradycardia, heart block, confusion Caution: pregnant, elderly, acute MI Nurse: IV in ICU only - monitor ptn very closely |
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Rythmol and Tambocor |
Type: dysrhythmia drug Class: I-C Action: decrease conduction of ventricles Use: given PO for ventricular arrhythmias Adverse: sudden death, dizziness, fatigue Caution: heart failure, liver dz, K+ imbalance Nurse: monitor K+, given to ptn in hospital to see for adverse effects, black box warnings on both |
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Propranolol, esmolol and sotalol |
Type: dysrhythmia drug Class: II Use: supraventricular tachycardia Adverse: decreases cardiac output too much after a while Nurse: must monitor ptn closely |
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Describe supraventricular tachycardia and which drugs are given for this? |
Happens above the ventricle -"narrow rhythm"
Class II drugs
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Cordarone |
Type: dysrhythmia drug Class: III Action: prolong action potential and refractory period in atria and ventricles, slow repolarization Use: ventricular/problamatic dysrhthmias that can't be tx with other drugs Caution: liver/pulmonary dz |
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Class III dysrhythmia drugs adverse effects and nurse implications |
Adverse: pulmonary toxicity, vision probs, can deposit in fat, hypo/hyperthyroidism -75% of ptns will experience adverse effect Nurse: super long 1/2 life (2-3 months), monitor VS, thyroid function, drug interaction with Coumadin -Black box warning due to lung/liver damage |
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Calan and Cardiazem |
Type: dysrhythmia drug Class: IV Action: Ca+ channel blocker and slow inward flow of Ca+ Use: prevent/control supraventricular arrhythmias, HTN Adverse: leg cramps, bradycardia, heart block Caution: pregnant, heart block, hypotension, elderly Nurse: monitor VS, give with food |
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Adenocard |
Type: dysrhythmia drug Action: slows conduction time through the AV node Use: conversion of PSVT to sinus rhythm, after failure with other tx's Nurse: given fast IV push in CC unit, asystole for a few seconds, then heart starts back up in reg rhythm |
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HTN diagnosis and what is first line treatment? |
Diagnose: SBP>140 and/or DBP>80 Prehypertensive: SBP 120-139 or DBP 80-89
Treatment: Thiazide Diuretics <- especially for women
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The 7 types of Antihyperstensives |
1. ACE inhibitors 2. ARBS 3. Antiadrenergics 4. Beta adrenergic blockers 5. Ca+ channel blockers 6. Vasodilators 7. Diuretics |
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Lasix |
Type: Anti-HTN Loop Diuretic - VERY POTENT Class: diuretic Action: increase water excretion by blocking reabsorption of Na+ and CL in loop of Henle Use: pulmonary edema, edema, HTN, for rapid diuresis Adverse: hypokalemia, dehydration, hypotension, ototoxic with high dose Nurse: keep accurate I&O and weight, hold drug and contact MD if K+ level <3.5 in morn |
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General guidelines for diuretics |
-Give in morning -started singularly then other meds will likely be added |
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Aldactone |
Type: Anti-HTN Class: Diuretic (K+ sparing - pretty weak) Action: causes Na+ loss in urine, inhibits aldosterone Use: heart failure, HTN, edema, ascites Adverse: hyperkalemia Nurse: monitor K+, I&O, weight |
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Hydrodiuril |
Type: Anti-HTN Class: Diuretic (Thiazide) Action: decrease reabsorption of Na+, water, CL and HCO3 in distal convoluted tubules Use: given PO for HTN, heart failure Adverse: electrolyte probs, dehydration Contra: not for those with renal failure Nurse: monitor VS's, photosensitive |
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Nifedipine, Norvasc and Cardizem |
Type: Anti-HTN Class: Ca+ channel blockers Action: inhibit influx of Ca+ entering channels, produces vasodilation thus lowering BP Use: Angina, HTN, Raynaud's Adverse: hypotension, fusing, lower limb edema Nurse: can't eat grapefruit due to synergitic effect, don't crush pill |
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What is Raynaud's and what medication should be used? |
- Vascular disease usually seen in hands making them intolerant to cold
-Ca+ channel blockers |
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Nipride |
Type: Anti-HTN Class: Vasodilator Action: direct vasodilation Use: HTN emergencies - not first line tx Adverse: tachycardia Given: IV in ICU to produce controlled hypotension Nurse: check HR/BP every 3-5 mins, cyanide poisoning possible with long term use |
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Apresoline |
Type: Anti-HTN Class: Vasodilator Given: PO or IV Nurse: less commonly used |
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The 3 class's of blood coagulation drugs |
1. Anticoagulants 2. Antiplatlets 3. Thrombolytics
-Most dangerous drugs used today |
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Plavix and ASA |
Type: blood coagulation durgs Class: Antiplatelet Action: decrease platelet aggregation Use: prevent MI, CVA, Plavix used to improve graft potency (stent), Adverse: bleeding Nurse: monitor LOC |
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Anticoagulants (Action, Use, Adverse, Caution) |
Action: interfere with coagulation cascade - can't break apart already formed clots but can help that they don't get larger Use: thrombotic disorders, Angina, those with mechanical heart valves, atrial fibrillation, keep central lines from clotting, non-mobile patients usually going into surg Adverse: HIT Caution: those with bleeding disorders, gastric ulcers, pregnant |
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What is HIT and what drug can possibly cause it? |
Heparin induced thrombocytopenia -when someone has a catheter inserted into vein and clot forms. -Heparin - not being used as much though b/c of this |
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Heparin |
Type: blood coagulation drug Class: Anticoagulant Use: central line flushes Given: IV infusion after DVT, IV push, SubQ Nurse: given to patients who were previously on coumadin prior to surgery, give loading dose, very short half life |
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Protamine sulfate |
Given in the case of an heparin OD |
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Levenox |
Type: blood coagulation durg Class: anticoagulant Use: prophylactic to prevent clots Given: SubQ ONLY, can be given at home, dosed by weight Nurse: no lab work needed but VERY EXPENSIVE |
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Arixtra |
Type: blood coagulation drug Class: Anticoagulant Use: prophylactic for DVT after hip fracture sugery, knee replacement, abd surgery Given: SubQ |
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Coumadin |
Type: blood coagulation drug Class: anticoagulant Action: interferes with Vit K dependent clotting Given: PO, dosage adjusted daily Nurse: 3-5 days for effect, many drug interactions, watch K intake (green leafy veggies), PT/INR should be between 2-3, Vit K antidote |
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Activase |
Type: blood coagulation drug Class: Thrombolytics (clot busters) Action: dissolve clots, restore blood flow, prevent/limit tissue damage Use: Acute MI, stroke, PE (not used as much in MI due to advances in PTCA's) Adverse: bleeding Caution: pregnancy, delivery w/in 10 days Nurse: give right after symptoms, check for bleeding every 15 mins/1st hour, 30 mins/next 4 hours, oral temp only, bed rest |
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What system do Adrenergic drugs mimic, what are the 3 receptors, and what are the 4 drugs? |
Mimic: SNS "fight or flight" 1. Alpha - vasoconstrictor 2. Beta 1 - increase HR 3. Beta 2 - open up airway - Epinephrine, Levophed, Dopamine, Neo-Synephrine |
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Adrenergic Agents (Action, use, adverse, nurse) |
Action: mimic SNS - widespread action Use: emergency CA, hypotension, bronchospasm, anaphylaxis, HF, bleeding Adverse: arrhhthmias, HTN, palpatations, angina, nervousness Nurse: can't be used with TCA and MAO anti-depressents, extreme care with calculations, monitor VS's, tolerance can develope |
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Epinephrine |
Type: Adrenergic agent prototype |
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Levophed |
Type: Adrenergic agent Action: stimulates alpha receptors Adverse: may see hands/feet turn purple
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Dopamine |
Type: Adrenergic agent Action: stimulates alpha/beta Nurse: dose determines effect Low: increase urine Med: increase cardiac output High: increase BP
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Neo-Synephrine |
Type: Adrenergic agent Action: stimulates alpha Use: nasal decongestant |
