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Nur210 Cardiac

Pharmacology cardiac

What promotes compliance with medication treatment of HTN? Patient education - why are they taking it? Self-monitoring Minimize ADRs Simplify regimen Keep costs down
What are the first things you can do to affect high BP? Lifestyle modifications Lose weight, exercise, reduce stress, stop smoking, restrict alcohol, restrict caffeine, restrict cholesterol, Na+ restriction
How is arterial pressure calculated? AP = cardiac output X peripheral resistance
When does BP Increase? When CO increases When peripheral resistance increases
What are the three different ways drugs can help the heart? Preload - cardiac output Afterload - peripheral resistance Contractility - strength of the contraction
How is peripheral resistance defined? Pressure in the aorta If the systolic BP is 170, would need the heart to pump at 171 in order to overcome the pressure in the aorta
How is cardiac output defined? It's the amount of blood pumped in one beat of the heart; stroke volume
What is the objective of treating HTN? Reduce morbidity (complications) and mortality (deaths) without decreasing quality of life with the drugs employed
What are long-term effects of HTN? MI Heart failure Kidney disease Stroke PAD - peripheral artery disease Retinopathy - affects vision
What are short-term effects of HTN? Majority are asymptomatic
What are identifiable causes of HTN? Renal disease -renin/angiotensin loop not work CAD - blocks and plugs Toxemia of pregnancy Drug therapy - oral contraceptive therapy Sleep apnea - vasoconstriction
What is secondary HTN? Have identifiable causes
What is primary (essential) HTN? No identifiable causes
What are risk factors for primary (essential) HTN? Genetics Age > 60 vessels get stiffer Obesity - more volume to pump to Smoking - vasoconstriction Diabetes - thicker blood from glucose Hyperlipidemia - resistance High Na+ diet; more Na+, more H2O
What are contributing factors to primary (essential) HTN? Hyperactivty of sympathetic fibers; increases HR, vasoconstriction increases BP Hyperactivity of renin-angiotensin system; retain Na+, retain H2O, BP goes up Endothelial dysfunction - damage to inner layer of arteries
What is considered normal BP? Systolic below 120; diastolic below 80
When does HTN begin to need medication? Stage 1: systolic > 139, diastolic > 89
What is considered pre-HTN? Systolic between 120 and 139; diastolic between 80 and 89
What is correct posture for taking BP? Feet flat on floor, arm at heart level Smoking or caffeine in last 1/2 hour before test will make it abnormally high
What are three different HTN medications (classes)? Beta blockers - end in -olol Diuretics ACE inhibitors - end in -pril
What are actions of beta blockers? Decrease HR (affects preload), so decreases amount of O2 heart needs Decreases conductive system (slows things down) Decreases force of contraction (contractility)
What are ADRs of beta blockers? Hypotension Bradycardia Bronchial constriction Drowsiness/depression
What are some nursing implications regarding beta blockers? Need to know what "normal" BP is for the client Be aware of postural hypotension
What are therapeutic uses of diuretics? Hypertension Removal of edematous fluid
What are actions of diuretics? Affect preload (stroke volume) Promote renal excretion of H2O and lytes Increase urinary output - kidneys reabsorb 99% of the fluid that goes through them People with kidney disease can swell-up quickly
How are diuretics categorized? Categorized by part of kidney they work on 65% of Na+ is reabsorbed at PCT Loop of Henley - loop diuretics; most diuretics DCT - Thiazide diuretics
What are mechanisms of action of diuretics? Blockade - block Na+/Cl- reabsorption; if you don't reabsorb Na+, you won't retain H2O Site of action - where/what part of kidney they act on
What are ADRs of diuretics? Hypovolemia Electrolyte imbalance
What are some nursing implications for diuretics? Daily weights Monitor BP Administer early in the day Prevent orthostatic hypotension
What are the actions of thiazide diuretics? Hydrochlorothiazide Work at DCT Reduction of blood volume (preload) Reduction of arterial resistance (afterload)
What are some ADRs of thiazide diuretics? Hypokalemia - lose K+ Dehydration Hyperglycemia - inhibits insulin production so sugar goes up Hyperuricemia - too much uric acid; gout Hyperlipidemia
What are some nursing implications with thiazide diuretics? Daily weight; accurate I & O Fluid status check Edema check Electrolyte balance check Administer in AM Check lung sounds before and after
What are ADRs of loop diuretics? Lasix - most common Hypotension Hyponatremia Hypokalemia Hyperlipidemia Hyperglycemia Hyperuricemia Ototoxicity
What are some nursing implications for loop diuretics? Daily weight; accurate I & O Fluid status check Edema check Electrolyte balance check Administer in AM Check lung sounds before and after
What are the actions of potassium-sparing diuretics? Aldactone Blocks aldosterone in the distal nephron, so you don't get Na+ retention Get retention of K+
What are ADRs of potassium-sparing diuretics? Weaker diuretic - works in further end of kidney Hyperkalemia - retain too much K+ Avoid taking with ACEs and ARBs since they also retain K+
What are the nursing implications of potassium-sparing diuretics? Daily weight; accurate I & O Fluid status check Edema check Electrolyte balance check Administer in AM Check lung sounds before and after
What are the actions of ACE inhibitors? Angiotensin-converting enzyme inhibitors Prevent activation of aldosterone, which retains Na+ and thus H2O All end in -pril (lisinopril)
What are adverse effects of ACE inhibitors? First-dose hypotension Persistent cough Hyperkalemia Interact with NSAIDs - retain fluid Angioedema - throat swells shut (rare) Fetal harm
What are nursing implications for ACE inhibitors? Check for hypotension Inform about cough Assessment for fluid
Heart circulation highlights Blood pressure is also known as afterload If your left ventricle does not work well, blood backs up into left atrium and back into lungs Heart gets its O2 from its own coronary arteries
Heart conduction highlights S.A. node --> AV node --> Bundle of HIS -->perkinje fibers of ventricle Make the ventricles contract as a unit
What are the actions of cardiac glycosides? Digoxin - lanoxin Slows the transmission of cardiac impulses through the conduction system Increases force of cardiac contraction Used to make pump more efficiently (CHF) Most prescribed drug over 65
What are the ADRs of cardiac glycosides? Very low TI; many bad side effects; very long half-life (36 hours) Anorexia, nausea Bradycardia Arrythmias Yellow vision (later sign)
What are the nursing implications of cardiac glycosides? Check apical pulse Monitor digoxin and K+ levels - both compete for the same receptors, so if K+ is low, more digoxin will "dock" and cause toxicity
What is angina pectoris? Chest pain Beneath the sternum and radiates up left shoulder and arm and up the neck In women, describe it as jaw pain and back pain
What causes angina pectoris? Oxygen demand greater than oxygen supply A "Charlie Horse" in your heart
What are the types of angina? Stable - chronic and exertional in nature Variant - any time; even at rest Unstable - medical emergency
What are the actions of nitrates? Nitroglycerine Increases blood flow to the coronary arteries by expanding and dilating the coronary arteries; more blood flow, more O2 Dilates the peripheral arteries - decreases afterload, lowers BP and increases O2
How are nitrates administered? Highly lipid soluble Very short half-life
What are ADRs of nitrates? Orthostatic hypotension (decrease BP) Headache
What are nursing implications of nitrates? Sit up slowly on side of bed before getting up (orthostatic hypotension) Give them something for headache Monitor vital signs Does chest pain go away?
What are the routes of administration of nitrates? Sublingual - rescue - drink H2O before taking, will feel tingling; if pain not relieve in 5 minutes, call 9-1-1 Topical - transdermal - do not touch! Oral sustained release IV - immediate impact on acute situation
Created by: ssbourbon



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