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Cardiac Drugs

Questions on cardiac drugs

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