Ch. 21, 23, 24 lilk8tob-Cardiac drugs
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| Drugs that increase myocardial contractility | inotropic
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| drugs that increase the rate at which the heart beats | chronotropic
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| drugs that accelerate conduction- electrical | dromotropic
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| Most commonly prescribed Cardiac Glycoside: | Digoxin
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| Cardiac glycosides help clients w/ heart failure by causing: | an increase in myocardial contractility (+inotropic)
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| Cardiac glycosides- MOA | Increase SV, Reduce heart size during diastole, decrease BP, increase coronary circulation
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| Tropic effects of Digoxin | +inotropic, -chronotropic(reduces HR), -dromotropic(prolongs referactory periods)
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| Digoxin (Lanoxin) drug class: | cardiac glycosides
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| Digoxin used for: | heart failure and atrial fibbrilation and flutter
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| Normal therapeutic level of Digoxin: | 0.5 to 2 ng/ml
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| Digoxin increases the force of contraction, thus: | increases the ejection fraction- as more blood is ejected w/ each contraction, there is less blood remaining in the ventricle (less pressure built up)
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| Cardiac glycosides SE: | dysrhythmias (brady or tachy), HA, confusion, colored vision, halo vision, flickering lights
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| Digoxin *classic* side effects: | bradycardia, N/V, colored vision, halo vision
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| What will increase digoxin's toxicity? | low potassium levels
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| Digoxin drug interactions: | K+ wasting diuretics (low K+=toxic), antiepileptics (decrease absorption)
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| What do you check before administering Digoxin? | serum K+ levels, and creatinine, Ca, Mg, Na
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| Large amts of ___ decrease digoxin absorption | bran
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| Need to do this before administer digoxin (not a serum level) | Take pulse- must 60-120 bpm
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| Antidote to digoxin | Digibind
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| Digoxin: increase or decrease urine: | increase
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| Digoxin- edema increased or decreased? | decreased
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| Digoxin- SOB, dyspnea & rales increased or decreased? | these are all decreased
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| Can you eat ice cream or antacids while on digoxin? | yes, but take dose 2 hrs before or after these products
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| What are the 3 antianginal classes? | nitrates, beta-blockers, calcium channel blockers
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| How do nitrates work as antianginals? | dilate constricted coronary arteries- increases O2 & nutrient supply to heart muscle
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| Nitroglycerin (Nitrostat) drug class: | nitrate- antianginal
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| Isosorbide (Imdur) drug class: | nitrate- antianginal
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| Procardia drug class: | nitrate- antianginal
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| nitrates used for: | coronary artery spasms, narrowed arteries from atherosclerosis
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| most common side effect from nitrates for anginal pain: | headache most common, also tachycardia, postural hypotension
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| Which antianginal agent has a tolerance develop? | nitrates if taken around the clock
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| How do beta-blockers work for anginal pain? | slow the HR (-chrono), decrease myocardial contractility (-ino)
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| Beta blockers chronotropic and inotropic effect are both: | negative
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| Beta blockers used for: | angina & MI, hypertension
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| Atenolol drug class: | Beta blocker (antianginal)
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| Metaprolol (Lopressor) drug class | beta blocker (antianginal)
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| Calcium channel blockers work by: | potent peripheral vasodilating properties
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| CCBs decrease O2 demand by | causing peripheral artery vasodilation and by a neg. inotropic action (-contractility)
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| CCBs effect on BP: | reduced from dilated peripheral vessels
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| CCBs used for: | angina, hypertension, supraventricular tachycardia, migraines, Raynaud's disease
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| CCBs Side effects: | hypotension, palpitations, heart failure, peripheral edema, constipation, flushing, wheezing
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| Diltiazem drug class: | calcium channel blockers d - antianginal
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| Nifedipine drug class: | calcium channel blockers n - antianginal
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| Verapamil drug class: | calcium channel blockers antianginal
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| These work by decreasing venous return to the heart (preload) and decreasing systemic vascular resistance (afterload) | nitrates for anginal pain
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| These work by decreasing the calcim influx into the sm. muscle- vascular relaxation | calcium channel blockers for anginal pain
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| These work by slowing the HR and decreasing contractility, thereby decreasing oxygen demands | beta-blockers for anginal pain
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| Take sublingual nitroglycerine in what position (sitting, standing, laying down)? | Supine @ 1st sign of angina to prevent fainting
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| How do you store nitroglycerine? | In the dark in a non-warm place
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| What antianginal drug will always give you a headache? | nitrates
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| How do you take nitrates for anginal pain? | 1 sublingual every 5 minutes (up to 3)
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| Nitrate bottle can be open for how long? | 3 months- know it is too old if no longer burns
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| Which antianginal class will cause constipation? | Beta blockers
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| Which antianginal class can exacerbate respiratory conditions? | Beta blockers
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| Centrally acting alpha2 adrenergic agents are used for: | hypertension
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| SNS stimulation causes: | Increased HR & force of contraction, constriction of blood vessels, release of renin from kidney = hypertension
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| the alpha2 adrenergic agents reduce: | sympathetic outflow from the CNS, reducing BP
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| Clonidine (Catapres) drug class: | centrally acting alpha 2 adrenergic (antihypertensive)
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| Clonidine (Catapres) uses: | hypertension, managing opioid withdrawal, migraines
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| Clonidine (alpha2) side effects | hypotension, dry mouth, drowsy, constipation, HA, rebound hypertension
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| ACE inhibitors work by inhibiting: | the angiotensin converting enzyme (ang I ->II blocked)
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| What does angiotensin II do? | A potent vasoconstrictor & stimulator of aldosterone secretion - stimulates Na+ and H2O resorption, which can raise BP
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| ACE inhibitors are used for these conditions: | hypertension, used as adjunctive agents in treatment of heart failure, can stop left ventricular hypertrophy (seen post-MI)
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| ACE inhibitors are good for diabetic pts because: | have nephroprotective effect on kidney
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| Main side effect of ACE inhibitors | Nonproductive cough
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| When on ACE inhibitors, monitor what levels? | Serum Potassium levels
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| ACE inhibitors side effects | cough, loss of taste, proteinuria, hyperkalemia
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| ACE inhibitors- interactions: | NSAIDS reduce effects; K+sparing diuretics may cause hyperkalemia
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| Captopril (Capoten) drug class: | ACE inhibitors
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| What does Captopril (Capoten) do? | prevents left ventricular dilation (ventricular remodeling) after an MI
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| Calcium Channel blockers cause: | smooth muscle relaxation by blocking the binding of calcium to its receptors (prevents contraction)
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| deltiazem drug class | calcium channel blockers
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| nifedipine drug class: | calcium channel blockers
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| verapamil drug class: | calcium channel blockers
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| Vasodilators work: | directly on arteriolar smooth muscle to cause relaxation
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| Vasodilators do NOT work through : | adrenergic receptors
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| Vasodilator uses: | hypertension, restore hair growth
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| Vasodilator side effects: | dizziness, HA, anxiety, edema, nasal congestion, tachycardia, dyspnea, N/V
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| hydralazine hydrochloride (Apresoline) drug class: | vasodilators
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| when is hydralazine hydrochloride (apresoline) used? | essential hypertension (no known cause), injectable for hypertensive emergencies
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| What antihypertensive should not be 1st line, and why? | ACE-inhibitors, because of their serious side effects (may cause acute renal failure, hyperkalemia, proteinuria)
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| Use ACE-inhibitors cautiously if have: | hyperkalemia, HF, reduced renal function
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| When should you take alpha blockers (time of day) | bedtime- sleep through hypotensive effects
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| These can cause exacerbation of respiratory diseases- asthma, bronchospasm COPD: | nonselective beta-blockers
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| how do nonselective beta blockers exacerbate respiratory diseases? | their negative inotropic (lower contractility) effect
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| Angiotensin II receptor blockers work by: | blocking vasoconstriction and the secretion of aldosterone
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| Difference between ARB's and ACE inhibitors | ACE has cough, ARB doesn't
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| losartan (Cozaar) drug class: | Angiotensin II receptor blockers (ARB's)
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| How long for alpha blockers to work? | 4-6 weeks
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| On ACE inhibitors, should NOT take what supplement? | potassium
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| With ARB's, report what: | any unusual SOB, dyspnea, weight gain, chest pain, palpitations
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| Something pts on vasodilators should do daily: | weigh self
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| What do loop diuretics block? | chloride & sodium resorption
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| Loop diuretics cause dilation of: | the blood vessels of the kidneys, lungs, and the rest of the body
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| Loop diuretics- slow or fast onset? | rapid onset of action
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| Side effects of Loop Diuretics | hypokalemia, photosensitivity, aplastic anemia
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| Don't take _____ with loop diuretics | NSAIDS (they have the opp. effect on prostaglandin activity)
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| Furosemide (Lasix) drug class | loop diuretics
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| Furosemide (Lasix)- loop diuretic used for: | managing pulmonary edema & edema from HF, liver disease, nephrotic syndrome & ascites, hypertension from HF
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| Potassium sparing diuretics cause: | sodium and water to be excreted and potassium to be retained
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| Spironolactone (Aldactone) drug class: | K+ sparing diuretic
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| How does spironolactone (Aldactone) work? | competitively binds to aldosterone receptors & therefore blocks the resorption of Na and H2O
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| Spironolactone (Aldactone) used for: | hyperaldosteronism, hypertension, reversing K+ loss from Kaliuretic diuretics
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| K+ sparing diuretics - SE: | gynecomastia, amenorrhea, post-menopausal bleeding
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| Drug interactions- K+ sparing diuretics | No ACE-inhibitors or K+ supplements (can cause hyperkalemia), no lithium (lithium toxicity), NSAIDS decrease blood flow to kidneys
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| Monitor what when no Spironolactone (Aldactone) | K+ levels
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| Thiazides: uses | adjunct agents in the management of HF, hepatic cirrhosis, and edema
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| Thiazides work by inhibiting: | sodium, potassium & chloride resorption
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| Thiazides - side effects | dizziness, HA, blurred vision, pancreatitis, photosensitivity, hypokalemia, hyperglycemia, hyperuricemia
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| Thiazides - drug interactions | +digoxin-> digoxin toxicity; hypokalemia ; hypoglycemics-> antagonistic (reduced effect)
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| hydrochlorothiazidine (HydroDIURIL) drug class: | Thiazide diuretic
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| Diabetics taking ____ or _____ diuretics should closely monitor their blood sugar levels because these drugs can raise them. | thiazide and/or loop diuretics
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| Signs and symptoms of hypokalemia: | muscle weakness, constipation, irregular HR, lethargy
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| least expensive & most commonly used diuretics: | Thiazide diuretics (hydroDIURIL)
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