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Pharmacology Cardiac
Pharm Exam 5
| Question | Answer |
|---|---|
| What are some drugs used for heart failure | Digoxin (Lanoxin) cardiac glycoside |
| List the prototypes for antianginals | Organic Nitrates; Nitroglycerine (Nitrol) Calcium Channel Blockes; nifedipine (Procardia) Beta andrenergic blockers; propranolol (inderal) |
| Name the hypertensive antiadrenergics | Prazosin(minipress) Alpha Blockers Proppranolol(inderal) Beta Blocker also an antidysrhythmics metoprolol (Lopressor) Clonidine (Catapres) Cental alpha 2 receptor agonist |
| Name the antihypertensive calcium channel blockers | nifedipine (procardia) also known as an antianginal |
| Diuretic Antihypertensive | hydrochlorothiazide (Hydrodiuril) |
| Vasodilator antihypertensive | hydrazlazine (Apresoline) |
| Angiotension II receptor blockers | losarten (CozaarI |
| Angiotensin converting enzyme (ACE) inhibitors | captopril (Capoten) |
| Anilipemic Bile Acid sequestrants | cholestyramine (Questran) |
| Anilipemics HMG-CoA reductase inhibitors | atrovastatin (Lipitor) |
| Antilipemics cholesterol absorption inhibitor | ezetimibe (Zetia) |
| Name some drugs that affect coagulation | Heparin, LMW heparin (Lovenox), Warfarin (Coumadin) |
| Name the prototypes of diuretics | Thiazides-hydrohchlorohthiazide (HydroDiruil) Loop Diuretics-furosemide (Lasix) Potassium sparing diuretics-spronolactone (Aldactone) Osmotic diuretics-mannitol (Osmitrol) |
| How do phophodiesterase inhibitors work? (Inocor, Primacor) | inibit phophodiesterase which increases levels of cyclic adenosine monophophate in mycocardial cells that relax smooth muscle to produce vasodilation and decease preload and after load and increase conractility |
| Are phosphodiesterase inhibitors for short term or long term management of heart failure | used in short term management of acute sever HF that is not controlled by digoxin, diuretics, and vasodilators |
| how is phsphodiesterase given? | Given IV by bolus followed by continuous infusion |
| How does human B-type natriuretic peptide work? (nesiritide(Natrecor) | it is identical to endogenous human BNP and is secreted primarly by ventricles in response to fluid and pressure overload; it decreases preload and afterload, increases diuresis and secretion of Na. |
| What is digoxin (cardiac glycosides) made of? | derived from foxglove plants |
| What are some main effects of Lanoxin (digoxin)? | increases force of contractility (positive inotropic effect) depresses heart conduction tissues decreases heart conduction velocity (negative dromotropic effect) stimulates vagus nerve |
| What are the indication of digoxin? | A-fib HF atrial tachydysrhythmias such as AF and atrial flutter |
| What are some adverse effects that a nurse should observe while giving this medication to a client? | cardiac dysrhythmias GI effects such as N/V or anorexia CNS effects: headache, drowsiness, confusion in the elderly |
| What are the therapeutic ranges of digoxin? | 0.5-2ng/ml |
| What are some symptoms of digoxin toxicity? | N/V, diarrhea, anorexia, abdominal cramps dysrrhythmias Drowsiness, muscle weakness, agitation, confusion, hallucination, HA, dizziness, paresthesias blurred vision, photophobia, light flashes dots, yellow-green halos around objects and diplopia |
| What are some predisposing factors for toxicity? | rapid digitalization (loading dose) impaired renal/hepatic function age extremes (old and young) hypokalemia, hypomag, hypercalcemia hypoxi hypothyroidism concureent treatment with other heart drugs such as quinidine, verpamil, nifedpine |
| What are some drugs that increase interactions with cardiac glycosides? | andrenergics, antidysrhythmics, anticholinergics, calcium perparations, calcium channel blockers |
| What things decrease effects of cardiac glycosides? | antacids, some antilipemics laxatives, oral aminoglycosides |
| What is a very important nursing consideration before administering digoxin? | check apical pulse and radial pulse. Pulse deficit can be indicative of A-fib. hold and contact physician if pulse is less than 60 or dysrhthmias occur |
| How much weight gain is significantt? | report weight gain of 1-2 pounds a day. |
| What are fast acting organic nitrates used for? | acute angina and prophylaxix before precipitating events (SL/chgewable tabs, transmucosal spray) |
| What are long acting organic nitrates used for? | recurrent angina |
| What is IV organic nitrates used for? | angina unresponsive to organic nitrates via other routes or beta blockers and to decrease preload/afterload in severe congestive heart failure Decreased blood pressure in perioperative/emergency situations |
| What are calcium channel blockers used for? (antianginal) | angina, hypertension and supraventricular dysrhytmias |
| What are some side effects of organic nitrates? | (think vasodilation) hypotension, dizziness, lightheadedness, tachycardia, palpatations, headache and flushing, orthostatic hypotension topical-skin irritation |
| What are some side effects of calcium channel blockers? | (decreased smooth muscle contraction) hypotension, dizziness, lightheadedness, weakness, peripheral edema, heart failure, pulmonary edema, headache, Nausea/constipation, bradycardia with some tachycardia with otehrs |
| What are some drugs that will increase the effets of antianginals? | antidysrhythmics, antihypertensives, diureteics, phenothiazines, antipsychotics, cimetidine |
| What are some things that will decrease effects of antianginals? | calcium salts, carbamazepine, phenytoin, rifampin` |
| What are some important nursing considerations for antianginals? | check vital signs before administration withold if BP is less than 90 or pulse is less than 50-60 |
| What are some non drug countermeasures for antianginals? | stop smoking, lose weight, excercise, and decrease the amount of stress in your life. Do not use with viagra due to hypotension |
| What are some important patient teaching tips that need to be given to the patient? | take at firs indication of angina, rest, take, med, check vitals, record. Do not use OTC cold medications b/c heart stimulation take 3 to 5 times apart until angina relieved if no relief after third tab get medical attention normally kept at bedside |
| Which classes of antidysrhytmics are being used more? which class is being used less? | class I beta blockers are being used more as well as class III potassium channel blockers; backing off of class I b/c mortalitiy |
| What are some non-drug measures that are increasingly being used? | surgical procedures (maze procedures); pace makers, inserition of implantable defribulater CD, and radio frequency catheter |
| What effect do the first 3 actions have on the heart? (antidysrhythmics) | decrease automacity (spontaneous depolarization of the cardiac cells), slow conduction of impulses through the heart, prolong refractory period of cardiac cells |
| What is the refractory period? (antidysrhytmics) | period of time where the heart muscle has not been completely repolarized an can not be affected by another impulse |
| How do class I antidysrhythmics work? | block movement of Na into cells, decreased formation and conduction of electrical impulses |
| Class II beta blockers work? (antidysrhythmics)? | block sympathetic stimulation of beta receptors in heart, decreased automaticity and increased refractory period |
| Class III antidys work? | slow repolarization and increased refractory period |
| Class IV calcium channel blockers work? | block movement of calcium into both conductile and contractile cardiac cells, decreased automaticity of SA and AV nodes |
| What is the goal of antidysrhythmic therapy? how has this changed? why? | stop or depresss dysrhythmia; prevent and relieve symptoms of dysrhythmia and prolongning survival |
| What drugs that are not in the antidysrythmic category used to treat bradydysrhythmias? a fib? | andrenergics |
| What are some side effects and adverse reactions? | heart block due to depressent effect on cardiac conduction system; dysrhythmias and aggravation of existing dys. tachycardia, bradycardia |
| What are some side effects of quinidine? | cinchonism, tinnitus, vomiting, sever diarrhea, vertigo, headache |
| What is cinchonism? | oxicity due to cinchona alkaloid overdosage; symptoms are tinnitus and slight deafness, photophobia and other visual disturbances, mental dullness, depression, confusion, headache, and nausea. |
| What assessments must be done before administering a antidysrhythmia? | radial/apical pulse, BP |
| What are some important nursing considerations for antidysrhytmic therapy? | monitor pulse to detect heart blook and blood presure before administration and every 4-6 hours during initial use. monitor lab values CBC, electrolytes, renal/hepatic function tests, and serum drug levels |
| What might dizziness or fainting indicate? | syncope/hypotension |
| why are patients taught to avoid OTC cold/ashtma medications appetite suppressants, and antisleep medications | dont take anything that will stimulate the heart |
| What is the advantage of treating HTN early? | prevent further heart complications, kidney, or brain stroke problems, or blindness |
| What is the implication of teaching for patients? | let the know that they need to check their BP regularly, not to stop taking their meds, and that this is not a cure but a way to control hypertension |
| How do each of the 6 hypertension medications work? | suppress the andrenergic system, allows the PSNS to take over; peripheral vasodilation; decrease water and sodium retention; calcium blockers dilate peripheral arteries |
| Besides HTN what else are calcium blockers used for? | they are also used for antianginals block calcium entry into the cell, decreased smooth muscle contraction, peripheral vasodilation, and decreased blood pressure |
| How do diuretics (Thiazides) work? | decrease sodium and water retention which would decrease the amoun tof blood coulme and cardiac output |
| How do vasodilators (apresoline) work? | acts directly on blood vessels, and decreases afterload whihch is why it is used in heart failure |
| The vasodilators have limited effect on HTN. why? | SNS will kick in due to compensation of vasodilation which will increase HR, B, and peripheral vasoconstriction |
| What effect does ANG II have on blood vessels and thus BP? | It will decrease BP by decreasing aldosterone production, and vasodilation |
| How do ANG II receptor blockers work? | block receptors for vasodilation and decrease systemic vascular resistance causing decreased arterial BP |
| Which group of antihypertensives are the first line agents for diabetics? | ACE inhibitors of ARB's |
| There are many antihyperteensive and diuretic combination. What is the advantage of the combination drugs? | hopefully reduce side effects, and encourages compliance |
| What are some non drug treatments used to treat mild HTN? | lose weight, excercise, stop smoking, and less sodium in diet |
| What is the primary adverse effect of the antihypertensives? | hyperkalemia it must be discontinued |
| What can happen if an antihypertensive is discontinued abruptl? | rebound HTN |
| What assessment must be made before the administaration of an antihyprtensive? | check BP and pulse |
| How long is the usual treatment of HTN? | It is usually lifelong unless lifestyle factors are the issue |
| What are some things that a client should avoid while taking HTN? | avoid conditions that cause vasodilation such as hot tubs, working out in 100 degree weather, etc |
| What is the action of anilipemic drugs? | decrease/remove existing plaque in arteries |
| Which antilipemics is used most widely? | statins |
| How do bile acid sequestrants (questran) work? | binds with bile acids in intestines, elimination of bile acids, increased oxidation of cholesterol to bile acids, decreased LDL cholesterol |
| How does lipitor work? (Statin) | inhibit HMG-COA reductase which is an essential enzyme in the hepatic synthesis of cholesterol. Decrease chol, decrease LDL, VLDL, and trig. |
| How does cholesterol absorption inhibitors work? (Zetia) | acts in small intestine to inhibit absorption of cholesterol and decrease delivery of intestinal cholesterol to liver. increases HDL and lowers trig and total cholesterol |
| are the antiliipemics used for hyperlipidemia instead of a low fat diet and/ or exercise? | no, they must be used with low fat diet, excercise, adn other nondrug measures used in clients with significant risk for atherosclerosis and eunable to lower lipids with non drug measures |
| what else is cholestyramine used for? | antidiarrheal for diarrhea due to bile and an antipruritic for pruritis due to bile |
| What additional nursing considerations are imporatant with cholestyramine (questran)? | need increased fluids and fiber and exercise to prevent constipation. Give before meals, dont swallow dry to prevent irritation to mucous membrane and possible esophageal instruction |
| What are antiplatelet drugs used for? | use dto prevent arterial thrombosis and act by different mechanisms to inhibit platelet activation, adhesion, aggregation , or procoagulant activity |
| Why is ASA used for it's antiplatelet effect rather than the other NSAIDS? | ASA's antithrombotic effect lasts for the life of the platelet (prevention) NSAIDS only last as long as the drugs are in teh body |
| How does ASA work? | thromboxane A2 inhibitor, enzyme in platelets tha t synthesizes thromboxane A2 , a protaglandin product that causes platelet aggregation and prevents thrombus formation |
| is ASA long term or short term? | used for long term prevention of MI or CVA in lclints with prosthetic heart valves; also used for immediate treatment of acute MI |
| How do NSAIDS work in coagulation? | inhibit cyclooxygenase reversibly so antiplatelet effects subside when drugs are elimintated from circulation. |
| How does Plavix work? (anticoagulation) | prevents ADP induced beinding between platelets and fibrinogen and inhibits platelet aggregation for lifespan of platelet |
| Do anticoagulatns dissovle clots? | no. will prevent clot from getting bigger |
| What is the difference in action between coumadin and heparin? | Coumadin-liver synthesis of vitamin K Heparin-inactivates clotting factors and inhibit conversion of prothromin to thrombin |
| Compare and contrast indications for heparin and coumadin | heparin-prevention of DVT and PE coumadin-long term prevention/treatment of DVT and PE |
| When heparin is used for low dose prevention of DVT and PE what rout is it given? | subQ |
| Heparin is given subQ or IV. Why isn't it given PO or IM | Heparin is not given PO because it can't be absorbed from GI tract due to it's large molecular size and polariy. Heparin is not given IM dude to the risk of hematomas and irritation an necrosis at injection sites because muscles are very vascular |
| Which route is coumadin given? | PO because it is well absorbed from the GI tract |
| What is the onset of heparin? | immediately 20-30 minutes |
| What is the onset of coumadin? | 3-5 days, may need to remain on heparin until coumadin reaches therapeutic levels in the system |
| What is the main adverse effect of heparin and coumadin? | bleeding |
| Why should you not give heparin or coumadin with ASA | increased risk of bleeding |
| is heparin or coumadin preferred if the patient is pregnant? | heparin; coumadin is contraindicated during pregnancy because of increased risk of congenital malformations |
| What areas should the nurse assess for bleeding? | skin, gums, nose, menstrual bleeding, urine, stool, emesis, sputum, internal bleeding, cold and clmmy skin, abdominal/lumbar sweling, severe headache due to the intercranial bleeding |
| if the nurse notes bleeding in a patient on an anticoagulant what should she do? | hold medication and call MD STAT; if given ocontinuous IV turn off heparin drip and replace with NS |
| What is the antidote for heparin? coumadin? | |
| What other measures can be used to prevent bleeding when patients are taking heparin or coumadin? | avoid inserting anything in rectu. If must puncture skin for treatment apply pressure for ten minuetes. apply ice to any site of bleeding. dont floss; no anal intercourse |
| What changes in diet need to be made by the patient taking coumadin? | avoid large amounts of vitamin K rich foods such as green leafy vegetables, tomatoes, bananas, and fish |
| How should heparin be administered subQ? | 25-27g 3/8 to 5/8 needle. best to use TB suyringe; leave small air bubble when drawing up; grap skinfold at 90 degree angle. If very thin may decrease angle. apply pressure for count of ten. rotate injection sites; count to ten before withdrawing |
| Why should you check concentration of heparin carefully? | because heparin comes in different strengths |
| Why type of diuretic is the most potent? | loop diuretics |
| Which group of diuretics should be used cautiously if the patient is allergic to the sulfonamides? | Thiazide |
| In general how do diuretics work? | incrase urine output by holding Na and Cl |
| How are the thiazide diuretics and loop diuretics alike? Different? | They are both called potassium loosing diuretics in the urine |
| How do thiazide diuretics work? | most Na reabsorbed before it reaches distal convulted tubule, not strong diuretics so not effective when immediate diuresis is required, and ineffective with decreased renal function |
| What is the onset, peak, and duration of loop diuretic? | O: 2h P: 4-6h D: 6-24h |
| How do loop diuretic work? (lasix) | inhibit reabsorption of Na and Cl in asceniding loop of henle where reabsorption of most Na occurs thus have a strong diuretic effect. |
| What is the onset, peak, and duration of Lasix or loop diuretic? | if given PO O: 30-60 min P: 1-2 h D: 6-8h IV O: 5min P 30 min D: 2 h |
| How do potassium sparing diuretics work? (aldactone) | act at distal tubule to decreases Na reabsorption and K excretion, diuresis |
| How do osmotic diuretics work? | increase osmolarity of glomerula filtrate, causes water to be pulled from extravascular sites into blood streem increases blood volume and decreases reabsorption of H2O electrolytes in renal tubules. (more concntrated, pull water from body into the urine) |
| Why are combination diuretics? | may use combinations of thiazide diuretics and antihypertensives to ensure compliance and give less meds to take |
| Which diuretics is used when renal function is impaired | loop |
| which group is used for long term treatment of HF and HTN? | thiazides |
| Which of the following adverse effects are the most significant in diuretics? | fluid and electrolyte imbalance and dehydration |
| When is hypokalemia more likely to occur with k losing diuretics? | if their food or liquid intake is poor; vomitting, diarrhea, GI suctioning, and chronic laxative use |
| what changes in serum urinary calcium occur with the thiazide diuretics? with the loop diuretics? | Thiazides increase serum Ca and decreases urinary . Loop diuretics decreases serum calcium and increases urinary Ca |
| What might diabetics taking the K losing diruetics need to do? | increase oral hypoglycerin ablet |
| what condition can hyperuricemia lead to? | gout and kidney stones |
| What time of day should diuretics be taken? | morning |
| What changes of diet needs to be made with the thiazide and loop diuretics? with the K sparing diuretics? | Increase potassium intake, such as bananas, tomatoes, and potatoes. Limit NA intake |
Created by:
jshawell
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