Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
169 Cards in this Set
- Front
- Back
|
What are the 3 anxiety drugs?
|
Diazepam (Valium)
Pentobarbital (Nembutal) Buspirone (Buspar) |
|
|
What drug specifically treats insomnia?
|
Zolpidem (Ambien)
|
|
|
What are the three anti depressants drugs used to treat anxiety?
|
Paxil
Lexapro Effexor |
|
|
Describe Diazepam (Valium)
Use Action Side Effects Treatment How to D/C |
Diazepam (Valium)
*Benzodiazepine Use: Anxiety, Insomnia, Seizures Action: potentiate actions of GABA Side Effects: Less CNS depression than barbiturates *Sedation *Forgetfulness *Resp Depression is given IV and in combo w/other CNS depressants (alcohol) *Potential for abuse but less than barbiturates *Anxiety ( d/c if this occurs) Treatment *Assess after pt has been on med for 2 weeks D/C *Do not stop abruptly, monitor pt |
|
|
How does the dosage of Diazepam (Valium) differ when being used to Tx anxiety vs insomnia?
|
A higher dose is used to treat insomnia compared to the lower dose used to treat anxiety
|
|
|
What is GABA? How does Valium effect it?
|
It is an inhibitory neurotransmitter in the CNS. Valium and other benzodiazepines intensify GABA but does not mimick GABA. For this reason there is a limit to how much CNS depression that can occur. This makes it safer than barbiturates.
|
|
|
Are benzodiazepines like Valium an antagonist or agonist of GABA?
|
Niether, they simply potentiate the actions of GABA, they do NOT mimick or block
|
|
|
Do benzodiazepines like Valium prevent or control a seizure?
|
They are used to bring a seizure under control they are not used for prevention.
|
|
|
How can the side effects and tolerance of benzodiazepines like Valium be minimized or prevented?
|
Give the lowest dose for the shortest amount of time
|
|
|
After a pt has started taking Valium when should they be assessed?
|
Two weeks after starting the drug
|
|
|
Describe Zolpidem (Ambein)
Use Action Side Effects |
Use: short term management of insomnia
Action: potentiate the actions of GABA Side Effects: Dizziness CNS depression |
|
|
How are benzodiazepines like Valium similar and different to Sedatives like Ambein
|
They are chemically different but have the same action (potentiating GABA)
|
|
|
What are short acting, intermediate, and long acting barbiturates used for. And what detirmines how low they act?
|
Short Acting: General Anesthesia
Intermediate: anxiety and sleep disorders Long Acting: Seizures *Lipid Solubility- the less soluable the med the longer acting it is |
|
|
What is the main concern when a pt is using barbiturates such as pentobarbital
|
Tolerance....when this happens the dosage is increased which is also a concern b/c this may cause more side effects and dosage might get into toxic range
|
|
|
What should the nurse do if a doctor orders a barbituate such as pentobarbital for a pt that has a hx of drug abuse and suicide attempts?
|
Question the order
|
|
|
Describe Pentobarbital (Nembutal)
Use Action Side Effects |
(barbiturates)
Use: anxiety, insomnia Action: Mimics action of GABA Side Effects: CNS depression Resp depression, high potential for abuse and tolerance, physical dependence, watch for suicidal tendencies *Avoid other CNS depressants |
|
|
What should be monitored closely when pt is on a barbiturate such as pentobarbital?
|
RR, BP, daytime sedation
|
|
|
Describe Azapirones
Buspirone (Buspar) Use Action Side Effects |
Use: anxiety (short term treatment) It has a delayed onset so it can be used for longer
Side Effects: well tolerated, dizziness, nausea, headache nervousness, lightheadedness, excitement |
|
|
Put the following meds in order from most safest to least safest Valium, Nembutal, Buspar
|
1. Buspar
2. Valium 3. Nembutal |
|
|
Which anxiety drug has no evidence of abuse or tolerance and can be used long term
|
Buspar
|
|
|
Describe why barbituates are more dangerous than benzos in relation to GABA
|
Benzo only potentiate GABA so there is a limit to how much CNS depression that can occur whereas barbituates mimick GABA so this is not limit to how much CNS depression that can occur
|
|
|
How long does it take for anti depressent meds to have full effect when treating anxiety and what issue does this cause?
|
It takes 4-8 weeks so compliance is an issue
|
|
|
If a pt asks why they have to try different meds to treat anxiety, why can't the doctor presecribe them the correct drug in the first place? What should the nurse say?
|
We don't know exactly how the drugs will effect the CNS, which is why different drugs and doses tried until the right one is found
|
|
|
Amphetamines (Adderall)
Use Action Side Effects |
USE: ADHA and Narcolepsy
Action: release dopamine, serotonin, norepinephrine from neurons, which causes the pt to be more alert, improved ability to focus Side Effect: dysrhythmias, HTN, tolerance, physical dependence, abuse, paranoid psychosis |
|
|
How is ADHD diagnosed?
|
Pt should have at least 6 characteristics in 2 different setting, and be under the age of 7
|
|
|
How should a pt on Adderall be assessed?
|
The pt should be assessed before use of the drug and while taking the med. Pt should also be assessed for the need to use the med one year after taking it. Pt might need to go on drug holiday to see how they do w/out it
|
|
|
Discuss Addiction and Adderall
|
There is a potential for abuse but the drug doesn't elicit a high that would normally cause abuse
|
|
|
Methylphenidate (Ritalin)
Use Action Side Effects Complicance |
Use: ADHD
Action: Stimulate CNS Side Effects: Insomnia, impaired appetite= growth suppression, lethargy, listlessness Compliance: make sure child is taking it and its not being abused by parents and siblings |
|
|
When in the day should ritalin be taken and why
|
It should not be taken after 4 pm because of insomnia issues
|
|
|
Which med is a non stimulant for the Tx of ADHD
|
atomoxetine (Strattera)
|
|
|
Which ADHD med is used for adults with ADHD
|
atomoxetine (Strattera)
|
|
|
Atomoxetine (Strattera)
Use Side Effects |
Use: ADHD in children and adults
Side Effects: well tolerated, less potential for abuse, not as effective as other drugs, newer drug so no long term studies |
|
|
Diet and ADHD
|
Diet sometimes can affect ADHD and changes in diet can help manage it
|
|
|
Caffeine
Use Action Side effects |
Use: enhance pain relief, apnea in infants, dilates airways
Action: Blocks adenosine receptors Side Effects: dysrhythmias, gastric ulcers, tachycardia, it vasodilates blood vessels but constricts the CNS |
|
|
Should a pt with a cardiac problem avoid caffeine?
|
YES!
|
|
|
When were drugs for schizophrenia developed?
|
1950's
|
|
|
What is schizophrenia?
|
Disordered thinking, lack of reality, hears voices, pt cognitive ability to think things through is impaired, cant focus
|
|
|
What are positive and negative symptoms of schizophrenia?
|
Postitve- exaggeration of normal functions (combative, aggitated, hallucinations)
Negative- loss of regular functions ( lack of motivation, poor speech, poor self care, social isolation) |
|
|
What is the difference in low potency vs high potency antipsychotics?
|
they are both equally effective
High potency can cause more EPS issues but cause less sedation and other side effects b/c a smaller dose it needs. Low potency causes more side effects b/c a higher does must be given |
|
|
What are the 6 drugs used to treat schizophrenia?
|
1. Clorpromazine (Thorazine)
2. Haloperidol (Haldol) 3. Clozapine (Clozaril) 4. Risperidone (Risperdal) 5. Aripiprazole (Abilify) 6. Olansapine (Zyprexa) |
|
|
Clozapine (Clozaril)
Use Action Side Effects |
Use: Severe Schizophrenia, psychosis related to levodopa
Action: Blocks receptors for dopamine 2, also blocks receptors for serotonin, norepinephrine (alpha 1), histamine, acetylcholine Side Effects: low risk for EPS, agranulocytosis so weekly hematologic monitoring needed, seizures, weight gain |
|
|
Risperidone (Risperdal)
Use Action Side Effects |
Use: schizophrenia
Action: blocks dopamine2 receptors and serotonin receptors Side Effects: fewer EPS side effects than tricyclic antidepressants |
|
|
What is the main concern when taking Clozapine (Clozaril)
|
This med deceases WBC so pt needs to come in 1x per week to monitor CBC
|
|
|
Olansapine (Zyprexa)
Use Action Side Effects |
Use: Schizophrenia
Action: blocks receptors for serotonin , dopamine, histamine, acetylcholine, and norepinephrine Side Effects: somnolence, constipation |
|
|
Which schizophrenia drug can cause a pt to develop diabetes?
|
Clozaril
|
|
|
What are the 3 atypical schizophrenia drugs and why are they worth the extra money they cost?
|
They are Clozaril, Risperdal, Zyprexa
*Although they cost more there is less chance of relapse when using the med so cost evens out |
|
|
Which schizophrenia drug is a Dopamine System Stabilizer?
|
Aripiprazole (Abilify)
|
|
|
Aripiprazole (Abilify)
Use Action Side Effects |
(Dopamine System Stabilizer)
Use: Schizophrenia Action: Modulate activity of dopamine receptors Side Effects: well tolerated, headache, nervousness, anxiety, insomnia, nausea, vomiting, dizziness, somnolence *less potential of typical side effects of the older atypical antipsychotic agents |
|
|
Discuss Abilify's half life and when pt should take it
|
It has a long half life so pt only needs to take it 1x per day. Also, pt should take it at bedtime b/c of sedation effects
|
|
|
Clorpromazine (Thorazine)
Use Action Side Effects |
*Phenothiazine (low potency)
Use: Schizophrenia, delusional disorders, acute mania, depressive psychoses Action: Blocks various receptors- dopamine, acetylcholine (muscarinic), histamine, norepinephrine (alpha 1) - but unsure of receptors cause therapeutic effects Side Effects: (result of dopamine being blocked) 1. Extrapyramidal Reactions- acute dystonia, parkinsonism, akathisia can occur early 2. Tardive Dsyskinesia- occurs late, causes constriction of facial and mouth muscles 3. Anticholinergic effects- dry mouth, blurred vision, photophobia, urinary hesitancy, constipation, tachycardia** 4. Neuroleptic Malignant symdrome- muscle rigidity, herpyrexia, cardiovascular collapse 5. Seizures 6. Sedation* 7. orthostatic hypotension 8. sexual dysfunction |
|
|
Butyrophenone (high potency)
Haloperidol (Haldol) Use Action Side Effects |
Use: schizophrenia, acute psychosis
Action: Blocks various receptors: dopamine, acetylcholine, histamine, norepinephrine Side Effects: EPS reactions, tardive dyskinesia, neuroleptic malignant syndrome |
|
|
Discuss depot preparations in relation to schizophrenia
|
They can be used for low or high potency meds and are used for long term therapy and help promote compliance. The advantages are lower occurance of relapse, and need for decrease doses so less chance for tardive dyskinsia. An injection is needed every 2-4 weeks which helps maintain constant blood levels.
|
|
|
Describe depression
|
Caused by signifigant life events, doesn't have to be negative. Also caused by neurotransmitters (dop, epi, nor)
Must have have at least 5 symptoms for at least 2 weeks to be diagnosed |
|
|
Postpartum Depression
|
Caused by hormone level chg after giving birth
|
|
|
What are the 3 types of antidepressants
|
1. Tricyclic
2. Selective Serotonin Reuptake 3. MAO inhibitors |
|
|
Imipramine (Tofranil)
Use Action Side Effects Admin Overdoes |
Use: first choice for treating depression
Action: Block Monoamine (norepi & serotonin) reuptake, which intensifies these neurotransmitter effects Side Effects: sedation, orthostatic hypotension, anticholinergic effects (constipation, dry mouth), cardiac toxicity Administration: gradually d/c med, monitor pt for at least mo after they are off the med, they should be treated for - mo after s/s subside Overdose: B/C of narrow therapeutic range toxicoty can occur, only 8x daily dose can cause death, Only give 1 week worth of med at a time |
|
|
Selective Serotonin Reuptake Inhibitor
fluoxetine (Prozac) Use Action Side effects |
Use: depression
action: selective inhibition of serotonin reuptake Side Effects- sexual dysfunction which leads to compliance issues, nausea, headache, CNS stimulation (nervousness, insomnia, anxiety), weight gain |
|
|
what part of the day should a pt take prozac?
|
Early in the day b/c it may cause insomnia
|
|
|
Why is Prozac safer than Tofranil
|
B/C it does not cause cardiac toxicity
|
|
|
Which antidepressant is the most common with the least amount of side effects?
|
Prozac
|
|
|
How long does it take for antidepressant meds to reach full effect?
|
2 mo
|
|
|
When is a pt most at risk for suicide when taking an antidepressent
|
2 weeks after taking it- the med has given them more energy but has not reached full therapuetic effects
|
|
|
MAO inhibitors
phenelzine (Nardil) Use Action Side Effects |
use: usec when other depression drugs did not work
action: inhibits intraneuronal MAO, which will increase the amount of norepinephrine and serotonin available for release from the neurons of the CNS Side effects: cns stimulation, hypertensive crisis with tyramine |
|
|
What foods have tyramine
|
processed meats, hotdogs, cheese, alcohol, chocolate
|
|
|
St John's Wort
|
Herbal med to treat depression.
When mixed with SSRI can cause seratonin syndrome |
|
|
Seratonin Syndrome
|
too much serotonin
S/S: altered mental status, sweating, tremor, fever,hyperreflexia |
|
|
What two antidepressant drugs can cause serotonin syndrom?
|
Prozac (SSIR) and St John Wart
|
|
|
Norepinephrine and Dopamine Reuptake Inhibitor
Bupropion (Wellbutrin) use action side effect |
*can be used in combo w/ other drugs
Use: depression Action: Unknown Side Effects: weight loss, agitation, insomnia, seizures |
|
|
what is the main concern for a pt when taking Wellbutrin
|
Seizures
|
|
|
Serotonin and norepinephrine reuptake inhibitors
Venlafazine (Effexor) use action side effect |
use: major depression with GAD. Most likely to produce complete remission
Action: blocks serotonin, norepinephrine, dopamine reuptake Side Effect: Nausea |
|
|
Alpha-2 Receptors
Mirtazapine (Remeron) use action side effects |
use: depression
action: increase release of serotonin and norepinephrine side effects: somnolence |
|
|
Selective Norepinephrine Reuptake Inhibitor
Reboxetine (vestra) use action side effects |
Use: depression
action: enhances transmission of norepinephrine at receptors Side effects: dry mouth, hypotension, constipation, urinary hesitancy, deceased libido |
|
|
Combined reuptake inhibitors and receptor blockers
Trazodone (desyrel) use action side effects |
Use: depression, anti depressant induced insomnia
Action: selective blockade of serotonin reuptake Side Effects: sedation, dry mouth, orthostatic hypotension, nausea |
|
|
What is Bipolar Disorder
|
recurrent fluctuations in moods, highs and lows, caused by alteration in brain physiology
|
|
|
Lithium (Eskalith)
use action side effects |
Mood Stabilizer
Use: Manic depressive illness Action: unknown Side effects: fine hand tremor, gi upset, thirst, muscle weakness, polyuria, increased WBC, renal toxicity |
|
|
What is the therapeutic range for Lithium
|
very narrow- 0.4-1.0
toxicity at 1.5 or above |
|
|
does lithium have a long or short half life and how does it affect dosing?
|
Short half so med must be taken 4x per day
|
|
|
Discuss sodium levels and lithium
|
When sodium levels are low the kidneys will retain lithium, so pt should maintain normal sodium levels
|
|
|
Valproic Acid
Use Side effects |
use: Bipolar disorder, seizures
Side effects: GI disturbances, N/V, diarrhea, dyspepsia, weight gain |
|
|
Valproic Acid compared to lithium
|
Valproic acid is just as effective as lithium, it works faster, and has a higher therapeutic index
|
|
|
What 3 things can occur when valproic acid becomes toxic?
|
1. thrombocytopenia
2. pancreatitis 3. liver failure |
|
|
What are non drug therapies used to Tx bipolar disorder
|
Counsling, edu, supportive therapy, electroshock therapy
|
|
|
Diuretics
Use Action |
Use: pt with HF, HTN to pull off extra fluid
*It mainly influences kidney function of maintaing volume and composition of ECF Action: prevents reabsorption of fluid and ions at various places along the collecting ducts *Most diuretics prevent reabsorption of sodium and chloride- and therefore water *The more sodium and chloride reabsorption that is blocked, the more diuresis *Diuretics that act higher up in the collecting duct will retain more sodium and chloride= greater diuretic effect |
|
|
Loop Diuretics
Lasix action use side effects |
use: pulmonary edema, edema, HTN, renal impairment, HF
Action: blocks reabsorption of NA &CL at loop of henle so causes large amounts of diuresis Side Effects: dehydration, hypotension, electrolyte imbalances (hypokalemia) |
|
|
S/S of Hypokalemia
|
Occurs when K level is below 3.5
S/S= weakness of skeletal muscle, dysrythmias, ileus, cramping of muscles |
|
|
S/S Hyperkalemia
|
confusion, anxiety, dyspnea, muscle weakness, altered cardiac rhythm
|
|
|
Potassium sparing diuretics
spironolactone (Aldactone) Action Use Side Effects |
Action: blocks actions of aldosterone in the distal nephron= minimal diuresis
Use: HTN, HF, in combo w/ other diuretics to prevent hypokalemia Side effects: Hyperkalemia, we want k level below 5. |
|
|
Osmotic Diuretics
mannitol (osmitrol) Action Use Side Effects |
Action: increases osmolarity in nephron which will increase osmotic pressure, works in PCT
Use: prevent renal failure, reduce cerebral edema Side Effects: Fluid Overload |
|
|
ACE Inhibitors
Captopril (Capoten) Action USE SIDE EFFECTS |
Action: inhibits angiotensin II which is a vasoconstrictor so it dilates the arteries, decreases blood volume, and prevents pathologic changes in heart and blood vessels, blocks aldosterone
Use: HTN, HF, MI, Renal disease Side Effects: first does hypotension, persistant non productive cough, hyperkalemia |
|
|
Which drug helps decrease mortality in pt who recently had an MI or have HF
|
Ace Inhibitosrs
Captopril (Capoten) |
|
|
Why should the nurse give the first dose of Captopril (capoten)
|
Because of First Dose Hypotension
|
|
|
Angiotensin II Receptor Blockers (ARB's )
Losartan (Cozaar) Action Use Side Effects |
Action: Block Angiotensin II receptor sites
Use: HTN, HF, Diabetic Neuropathy Side Effects: Angioedema= usually hypersensitivity reaction causing edema of skin, mucous membranes or internal organs (swelling of face) *Does Not cause significant hyperkalemia or persistent cough |
|
|
Which drug should a pt be switched to when the ace inhibitor Capoten is causing the pt to have a persistant cough?
|
Losartan (Cozaar)
|
|
|
If pt is currently on diuretics what should the nurse do before giving the pt ACE Inhibitor Capoten?
|
Diuretics should be held 2-3 days before giving pt an ACE inhibitor b/c of the first does hypotension
|
|
|
Selective Aldosterone Receptor Blocker
Eplerenone (Inspra) action use side effects |
Action: promote excretion of sodium and water
use: HTN pt who do not respond to traditional treatment Side effects: hyperkalemia |
|
|
Nifedipine (Procardia)
Action Use Side Effects chemical grouop |
Action: prevents Calcium from entering the cell which decreases contractility in coronary arteries and peripheral arteries but has little effect on the veins
Use: HTN, angina,supraventricular dysrhythmias, prevents vasospams Side Effects: Reflex tachycardia, constipation Chemical Group: Dihydropyridnes |
|
|
Define Reflex tachycardia and what drug it is a side effect of
|
It is when BP drops and the heart compensates by increasing the pulse
|
|
|
Nimodine (Nimotop)
Action Use |
Action: a calcium blocker that prevents vasospasms of cerebral vessels
Use: Cerebral Bleeds, use for head injury pt |
|
|
When a pt have a cerebral bleed what are they at risk for?
|
Vasospams
|
|
|
Verapamil (Calan)
Action: Side Effects: |
Action: slows HR, decreases contractility, dilates arteries
Side Effects: Constipation, peripheral edema |
|
|
Veins
|
Veins alter their diameter easier than arteries. They can become a holding tank for blood which decreases preload and helps maintain forward blood flow
|
|
|
Cardiac Output
|
Amount of blood pumped out of heart with each beat...it is based on preload, afterload, and contractility
|
|
|
Preload
|
The amount of blood returning to the heart, an increase in fluid volume will increase the preload
|
|
|
Afterload
|
resistance the heart has to pump against
|
|
|
Contractility
|
ability of the heart to pump
|
|
|
Autonomic Nervous System and Blood Pressure
|
The ANS is activated by receptors. The SNS is activated if BP is low, and PNS is activated if BP is to high
|
|
|
What does angiotensin II do
|
vasoconstriction and stimulates the release of aldosterone
|
|
|
What does Aldosterone do
|
causes the retention of sodium and water which increases the BP
|
|
|
When is the Renin-Angiotensin-Aldosterone mechanism activated?
|
When blood pressure is too low
|
|
|
What does the release of renin do?
|
decreasees BP
decreases Blood Volume decreases Renal Perfusion |
|
|
What are the 4 classes of drugs used to treat HF
|
1. vasodilators
2. diuretics 3. beta blockers 4.inotropic agents |
|
|
Captopril (Capoten)
Class Action Side Effects |
Vasodilators= ACE inhibitor= blockes angiotensin enzyme which prohibits ang 1 from becoming ang 2
Use: HF Action: Dilates arteries primarily, dilates veins Side Effects: 1st dose hypotension, persistant cough, hyperkalemia |
|
|
Diuretics in general
Action Side Effects |
Action: decreases fluid volume
Side Effects: Fluid and Electrolyte imbalances |
|
|
Spironolactone (Aldactone)
|
Potassium Sparing Diuretic
Action: blocks receptors for aldosterone Use: prolong life in pt with HF Side Effects: hyperkalemia, gynecomastia |
|
|
What are the effects of Aldosterone
|
1. retains water and sodium
2. fibrosis of cardiac muscle |
|
|
Digoxin (Lanoxin)
|
Cardiac glycoside
Action: decreases HR, increases contractility Use: HF, Dysrhythmias, A FIB Side Effects: Narrow therapeutic range, dysrhythmias, Visual disturbances (yellow & green halos), blurred vision, anorexia, N/V |
|
|
What side effect is uniqie to Digoxin and what will occur after this?
|
Yellow Green Halo
Dysrhythmias can occur after halos |
|
|
What can potentiate Digoxin
|
hypokalemia
|
|
|
How or why does a dysrhythmia occur
|
If there is any alteration in the normal pathway of the heart one can occur
|
|
|
What is the normal pathway of the heart?
|
1. SA node (60-100)
2. Atrium 3. AV Node (40-60) 4. Purkinje fibers |
|
|
Action Potential
|
mvt of ions across the cell membrane
|
|
|
Where is a higher concentration of K and NA
|
K is higher inside the cell
Na is higher outside the cell |
|
|
Describe the phases in a a fast action potential
|
Phase 0 = stimulation of the cell, sodium moves into the cell causing depolarization
Phase 2= contraction of muscle and calcium moves into the cell Phase 3= potassium exists the cell= repolarization-during repolarization a stimulus can't cause an action to occur |
|
|
What does a slow action potential affect?
|
the automaticity of SA and AV node
|
|
|
Quinidine (Quinidex)
|
Sodium Channel Blocker that works at phase 0
Use: treat any dysrythmia supra or ventricular Action: slows impulse conduction Side Effects: Cardiotoxicity (widened QRS), dysrhythmia, hypotension |
|
|
What drug can quinidine potentiate?
|
digoxin
|
|
|
What does a widen QRS indicate if a pt is using quinidine
|
Cardiotoxicity
|
|
|
Lidocaine (Xylocaine)
|
*short half life
Action: slows impulse conduction, accelerates repolarization, numbs irritable area Use: Ventricular dysrhythmia Side Effects: drowsiness,confusion, paresthesia *Admin IV only b/c of fist pass effect *closely monitor ecg and BP |
|
|
Flecanide (Tambocor)
|
Action:affects Na coming into cell, slow impulse conduction, decreases repolarization
Use: Life threatening dysrythmias Side Effects: severe dysrythmias, CHf |
|
|
Propranolol (Inderal)
|
non cardio selective beta blocker
Action: blocks beta receptors, decreases contractility and heart rate Use: Atrial and ventricular dysrhythmias, angina, HTN Side effects: bradycardia, hypotension, edema, HF, dysrythmias, bronchoconstriction *Affects phase 2= ca coming in |
|
|
amiodarone (Cordarone)
|
affects phase3
Action: delay repolarization, Use: atrial and ventricular dysrhythmias Side Effeccts: pulmonary fibrosis, dysrhythmias, has long half life...so side effects can last for months |
|
|
Verapamil (Calan, Isoptin)
|
calcium channel blocker
affects phase 2 Action: blocks the influx of calcium, decreases heart rate and contractility, vasodilation Use: Supraventricular dysrythmias Side Effects: dysrythmias, HF, hypotension |
|
|
If a pt BP is less than 60/90 what should nurse do if pt on verapamil?
|
hold the med
|
|
|
Atropine
|
Action: blocks receptors in PNS so it will increase HR and contractility
Use: Bradycardia Side Effects: dysrythmia-tachycardia, constipation, urinary retention, blurred vison, angina if HR increased |
|
|
What med should be used if a pt codes?
|
Epinephrine
|
|
|
Epinephrine
|
Action: Mimicks SNS, so it will increase HR and contractility
Use: Ventricular dysrythmias, cardiac arrest Side effects: dysrythmias, angina, necrosis at I site |
|
|
Adenosine (Adenocard)
|
Action: decreases automaticity and slows conduction
Use: Supraventricular tachycardia Side Effects: Bradycardia, bronchoconstriction, hypotension, chest discomfort |
|
|
Ilbutilide (Corvet)
|
Action: prolongs action potential
Use: atrial dysrhythmias (Afib and Aflutter) Side Effects: prolongs QT interval |
|
|
Which cardiac drug should be given as close to heart as possible?
|
Adenosine
|
|
|
Digoxin (Lanoxin)
|
Action: slows HR and increases contractility
Use: atrial dysrhythmias, HF Side Effects: dysryhthmias, anorexia, N/V, halos |
|
|
What does calcium cause the heart to do?
|
Contract
|
|
|
What do beta blockers and calciuim channel blockers have in common?
|
Both decrease contractility
|
|
|
What foods are rich in potassium
|
oranges, citrus, bananas, spinich, potatoes,
|
|
|
What happens when there is atrial dilation
|
afterload is decreased
|
|
|
What happens when veins are dilated?
|
preload is decreased
|
|
|
How is the CO decreased?
|
by decreasing preload of afterload
|
|
|
hydralazine (Apresoline)
|
Dilates arteries
Action: Unknown Use: HTN, HF, increase cardiac contractility Side Effects: postural hypotension, reflex tachycardia |
|
|
Nitropress
|
decreases preload and afterload
Use: HTN emergencies Side Effects: Hypotension |
|
|
Nitroglycerine
|
dilates veins
Action: decreases preload Use: angina, HF Side Effects: hypotension, headache Admin for Angina: sublngually, 3 tabs 5 min apart, take as soon as pain starts, allow tab to dissolve, sit or lie down Angina Prevention: transdermal, prevent tolerance by not wearing to bed |
|
|
What level do we want HDL to be at?
|
40-60
|
|
|
Ideal level of LDL
|
below 100
|
|
|
Do we want triglycerides to be high or low
|
low
|
|
|
Where is cholesterol produced?
|
liver
|
|
|
What enzyme is needed to produce cholesterol?
|
HMG-CoA
|
|
|
When does cholesterol production increase?
|
at night
|
|
|
What is the HMG-CoA reductase inhibitor prototype drug?
|
Lipitor which is a statin
|
|
|
Lipitor
|
Action: lower LDL by increasing # of LDL receptors on the liver, elevates HDL
Use: decrease cholesterol level in pt with heart disease risk Side effects: myopathy, hepatotoxicity |
|
|
Niacin (Nicotinic Acid)
|
Action: Decrease LDL and triglycerides, increase HDL
use: alteration of all components of cholesterol Side effects: flushing, itching, GI upset, hepatoxicity, increase in homocystene, hyperglycemia |
|
|
Cholestyramine (Questran)
|
Action:Lower LDL
Use: Combined w/ statins they have a greater impact on lowering LDL Side Effects: very safe, NOT absorbed from GI tract, constipation |
|
|
gemfibrozil (Lopid)
|
Use: decrease triglyceriides
well tolerated, increased risk for bleeding when mixed with Warfarin |
|
|
Ezetimibe (Zetia)
|
action: blocks cholesterol absorption, lowers LDL, triglycerides, apolipoprotein B, slightly increases HDL
Use: may be used alone or in combo with other cholesterol meds Side Effects: few, monitor hepatic function |
|
|
Heparin
|
Action: disrupt clotting cascade to prevent clots from forming
Use: Treatment of evolving clot, not effective once clot develops Side Effects: bleeding Monitor PTT Antidote: Protamine Sulfate *If pt has HTN they have risk for cerebral bleed *PUD or surgery risk for bleeding *Only given Injection |
|
|
Warfarin (Coumadin)
|
taken PO, avoid aspirin
Action: suppresses coagulation by acting as a Vitamin K antagonist Use: Prevent thrombosis, DVT Side Effects: bleeding Monitor PTT and INR Antidote: Vitamin K *Stop 2 days prior to elective procedures, avoid other meds that cause bleeding |
|
|
Aspirin
|
Action: prevents platelet aggregation
Use: Prevention of MI or stroke Side Effects: Bleeding (GI, cerebral) One does will last 7-10 days, so stop taking at least 1 week prior to surgery |
|
|
Ticlopidine (Ticlid)
|
Action: inhibits ADP- mediated aggregation, prevents clots
Use: prevent MI or Stroke Side Effects: Bleeding, neutropenia *More expensive than ASA (aspirin) but just as effective |
|
|
abciximab( ReoPro)
|
Super Aspirin, Most effective anti platelet drug
Action: inhibit final step of platelet aggregation Use: Short term prevention of acute MI Side Effects: Major Bleeding *May be given w/ ASA and heparin |
|
|
Streptokinase (Streptase)
|
Action: dissolves the clot in the heart only
Use: Acute MI, DVT, massive pulmonary emboli Side Effects: Major bleeding |
|
|
What 3 categories of meds should all post MI pt get?
|
1. Beta Blockers
2. ACE inhibitors 3. antiplatelet |
|
|
What 3 med categories are used to prevent complication from MI
|
1. Dysrhythmias
2.Inotropic agents 3.vasodilators |
