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Cardiac Drugs
Questions on cardiac drugs
| Question | Answer |
|---|---|
| Digoxin is contraindicated when? | HR is <60 bpm |
| This electrolyte imbalance increases the effect of digoxin | Hypokalemia |
| Classic s/s of Digoxin toxicity | visual disturbances - Halos around objects |
| Digoxin's action | Increases contractility, dereases AV conduction |
| Antidote for Digoxin | Digibind |
| Nitrates action | vasodilation |
| Nitrates are used for what? | Angina |
| Side effects of nitrates | headache, hypotension, dizziness, syncope, circulatory collapse |
| Nitroglycerin comes in what forms | sublingual, transdermal patch, extended release tablet, translingual spray |
| How is nitrogylcerin stored? | dark, glass bottle (not child proof) |
| Client should feel this when nitro is put under tongue? | A tingle or burning |
| How is nitro taken for angina? | can take one tablet under tongue every 5 minutes for a total of 3 doses |
| What s/s may the client have after taking nitro? | headache, dizziness, syncope, - client can take Tylenol for headache |
| When dc'ing nitro patch what is the procedure? | taper down over several weeks |
| What is important to know about IV nitroglycerin? | Must use special tubing |
| What is the action of sodium channel blockers? | decreases the rate of conduction in Purkinjie Fibers |
| Antihypertensives are contraindicated for what conditions? | 2nd and 3rd Degree heart blocks |
| Side effects of lidocaine (Xylocaine) and mexiletine (Mexitil) important to teach men about? | Impotence, may be permanent |
| Lidocaine (Xylocaine) is admin in what form? | IV |
| Flecaindide (Tambocor) and propafenone (Rythmol) are used for what heart rhythms? | life threatening ventricular dysrhythmias |
| What is the action of Beta Blockers? | Block catecholamines and cause peripheral vasodilation |
| Beta Blockers are used for what heart conditions? | Hypertension, some tachy arrhythmias and angina |
| Beta Blockers are contraindicated in what heart conditions? | 2nd and 3rd degree heart block and bradycardia |
| What are side effects of Beta Blockers? | Bradycardia, complete heart block, hypotensin, Raynaud's phenomenon, insomnia |
| What can Beta Blockers mask the signs of that is important for Diabetics to know? | It can mask the signs in hypoglycemia (client should do more finger stick blood sugar tests) |
| What do all clients need to do before taking a Beta Blockers? | Check pulse, do not take if <60 bpm. |
| What can occur if Beta Blockers are stopped abruptly? | Rebound Hypertension |
| Beta Blockers may cause this what type of dysfunction? | sexual |
| What is the action of potassium channel blockers? | increases refractory period (slow HR) |
| What are potassium channel blockers used for? | atrial fibrillatin, venricular fibrillation, and V-tach |
| Potassium channel blockers are contraindicated in what heart conditions? | 2nd & 3rd Degree Heart block, bradycardia, SA node dysfunction |
| What are the side effects of potassium channel blockers? | Photophobia, hypotension, dysrhytmias |
| What is important to know about Amiodarone when given IV? | A filter is required, it precipitates. |
| What labs must be monitored with potassium channel blockers? | potassium and magnesium levels |
| What is the action of calcium channel blockers? | decrease AV conductivity and SA & AV automaticity |
| CCBs are used for what heart conditions? | Angina, SVTs, Hypertension |
| What are side effects of CCBs? | Hypotension, Palpitations, Tachycardia, rash & flushing, peripheral edema |
| CCBs are contraindicated with what heart condition? | AV node dysfunction |
| What are important teaching topics for clients taking CCBs? | Take BP and pulse and watch for orthostatic hypotension |
| What is adenosine used for? | Chemical cardioversion, causes temporary asystole! |
| CO x PR = | Blood Pressure |
| SV X HR = | Cardiac output |
| Normal BP | <120 <80 |
| Prehypertension | 120-139 80-89 |
| Stage 1 hypertension | 140-159 90-99 |
| Stage 2 hypertension | >160 >100 |
| What is the action of centrally acting adrenergics? | stimulate alpha 2 receptors, inhibits alpha 1 (decreases sympathethic activity) |
| Name two centrally acting adrenergics | clonidine(Ctapress) and methyldopa (Aldomet) |
| What are the side effects of alpha adrenergics? | hypotensino, drowsiness, dry mouth, dizziness |
| What can happen if centrally acting alpha adrenergics are stopped suddenly? | rebound hypertension |
| What is the action of peripherally acting adrenergics? | inhibits release of norepinepherin and diminishes NE stores |
| What are is a more serious side effect of peripherally acting alpha adrenergics? | depression (also diminishes serotonin) |
| What are side effects of peripherally acting adrenergics? | hypotension, dry mouth, drowsiness, sedation, constipation, orthostatic hypotensin |
| What is the action of ACE inhibitors? | blocks the conversion of angiotensin I to angiotensin II and blocks release of aldosterone |
| ACE inhibitors decrease ? | preload |
| What diuretic can cause ototoxicty when admin too fast with IV infusion? | Lasix (furosemide) |
| What group of diuretics is commonly combined with ACE inhibitors? | Thiazide diuretics |
| What are common electrolyte imbalances with thiazide diuretics? | Hypokalemia, hypomagnesemia, hypercalcemia |
| What other imbalances can thiazides cause? | hypergylcemia, hyperuricemia, hyperlipidemia |
| Thiazides are contraindicated in what patients? | renal faliure patients |
| What must the nurse monitor for in patients taking thiazides? | VS, weight, I/Os, E-lytes |
| What are signs of hypokalemia to teach patients? | muscle weakness, leg cramps, dysrhythmias |
| What else must you teach clients taking thiazides to do or watch for? | Take BP, watch for orthostatic hypotension, use sun block, eat foods rich in potassium |
| Loop diuretics are more potent than thiazides as diuretics, why are not not prescribed as often? | less effective as antihypertensives |
| What drug does loop diuretics have a major interaction with? | Digoxin --> can cause digoxin toxicity |
| Clients should take diuretics at what time of the day? | Early morning to prevent nocturia |
| What is important to teach about potassium sparring diuretics? | monitor potassium levels periodically, do not take potassium supplements |
| Potassium sparring diuretics should not be taken with what class of heart medications? | ACE inhibitors (both can cause hyperkalemia) |
| What is the action of vasodilators? | act directly on arteriole smooth muscle; decrease stroke volume resistance = decreases afterload |
| When are vasodilators used? | hypertensive emergenices and cute heart failure |
| Name the 3 vasodilators and what form are they admin in? | hydralazine (apresoline) oral, minoxidil (oral) and sodium nitroprusside (Nipride) IV - for malignant hypertension |
| What do platelet inhibitors do? | inhibit aggregation of platelets (decrease clotting) |
| What are side effects of platelet inhibitors? | uncontrolled bleeding |
| Do platelet inhibitors affect existing clots? | no effect on thrombi |
| What platelet inhibitor is commonly given after and acute MI? | aspirin |
| GP IIB and IIIA inhibitors are classified as what? | potent platelet inhibitors |
| What are IIB and IIIA inhibitors used for? | unstable angina, some heart attacks, angioplasty with or without stent placement |
| What is a common drug from the IIB IIIA inhibitors? | colpidogrel (Plavix) |
| How long before surgery must a client stop taking Plavix? | 7 days |
| The IIB IIIA drugs are contraindicated for clients with what conditions? | bleeding ulcer or intracranial hemorrhage |
| What is the action of antiplatelets? | interrupt clotting process |
| When are anticoagulants used? | after MI, PE, DVT and ischemic CVA |
| What is a posible serious side effect of heparin and LMWHs? | Herparin indiced thrombocytopenia, platelet count below 150,000 |
| Name a common LMWH. | enoxaparin (Lovenox) |
| What are some advantages to LMWHs? | no need to monitor PTT, once day dosing, lower incidence of HIT |
| What is the antidote for Heaprin? | Protamine Sulfate |
| What is the disadvantage for LMWHs overdose? | protamine sulfate has no effect and it has a longer duration of action |
| Name a very LMWH and what is its advantage of LMWHs? | fondaprinux (Arixta) - greater reduction of rick for HIT |
| What is the antidote for Coumadin (warfarin)? | Vitamin K |
| What lab do you monitor for Heparin? | aPTT |
| What labs are monitored for Coumadin (warfarin) | PT or INR |
| What should PT be? | 1.5 - 2.5 X control |
| What should INR be? | 2.0 - 3.0 |
| What is the normal platelet count? | 150,000 - 450,000 |
| Client teaching for clients taking anticoagulants? | tell dentist, use soft toothbrush, use electric razor, carry medical ID, do not smoke, do not take aspirin, do ot take herbs (many interact with anticoagulants), avoid alcohol |
| If clients expericen bleeding when taking anticoagulants what do they need to do? | apply firm, direct pressure for 5-10 minutes |
| Clients taking anticoagulants need to report what s/s to MD | petechiae, bruising, tarry stools, epistaxis, expectoration of blood |
| What foods must clients taking anticoagulants avoid? | green leafy veggies, fish, liver, coffee, tea (all rich in vitamin K) |
| What do thrombolytics do? | directly break up clots |
| What is the antidote for thrombolytics? | aminocaproic acid (Amicar) it is given to stop bleeding |
| What are some s/s of thrombolytics? | itching, ever, flushing, hives, dyspnea, bronchospasm, hypotension |
| What dtugs must must be avoided when taking thrombolytics? | NSAIDs |
| Total cholesterol level goal | <200 |
| trigylceride level goal | 40-150 |
| LDL goal | <100 |
| HDL goal | >40 |
| What are serious side effects of statins? | elevation of liver enzymes and rhabdomylosis |
| How long does it take for full therapeutic effect take for statins? | 2-4 weeks |
| What can happen if client abruptly stop taking statins? | 3 fold rebound effect on cholesterol; can cause death from AMI |
| What food must be avoided when taking statins? | Grapefruit and grapefruit juice |
| What is the combination drug that decreases synthesis if cholesterol in the liver and decreases serum lipid levels? | Vytorin (ezetimbie/simvastatin) |
Created by:
TBess
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