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