CH 35 Cardiac MED THERAPY ETC
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| Name drug therapy for cardiac events | Cardiac glycosides, antianginals, antidysrhytmic, ACE inhibitors, diuretics, anticoagulants, antiplatelets, antifibrinolytics, Lipid Lowering, Analgesics
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| Generic and trade name for cardiac glycosides | digoxin/lanoxin
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| antianginals end with: | olol and remember nitroglycerin
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| ACE end with: | pril
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| How does Cardiac glycosides work | slows heart rate, increases force myocardial contraction = increase stroke volume and cardiac output (CO)
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| Cardiac Glycosides are used for what cardiac conditions | 1) HF 2) a-fib 3) a flutter
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| Cardiac Glycosides interventions | 1) obtain baseline vitals, ECG and electrolytes before admin of first dose 2) Apical 3) hold and notify physician if less than 60
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| What condition puts pts at risk for Glycoside toxicity? | renal failure
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| Glycoside toxicity symptoms | 1) dysrhythmias, 2)pulse < 60 3) anorexia, nausea, syncope, visual disturbance, abdominal pain
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| toxic Glycoside lvl | > 2.0
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| name 3 types of Antianginals | nitrates, beta-blockers, calcium channel blockers
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| nitrates are for? | actual angina episodes and prevention of angina
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| long term drug therapy for angina | beta and calcium
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| what did Mrs. Gorcyca say to do if pt at home is using nitrates 3x's and it does not relieve pain. | call 911
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| Antianginals nursing interventions | Assess BP and pulse before admin; apply on paper provided; apply to nonhairy skin, ROTATE sites, DO NOT TOUCH with skin (causes headaches)
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| Antianginals teaching | sit or lie down at onset of angine; place tablet under tongue (tingling means its working), repeat q 5 mins for 3 times; if not relieved call 911; headache decrease with tolerance; take before sex or exercise
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| Mrs. Gorcyca says to keep glycoside tablets in container: what is the rationale? | light and air decomposses drug so keep ORIGINAL container
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| why can't you sleep w/ a nitro patch? | you build tolerance
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| Nadolol action/classification | selective beta-blocker, used in hypetension, prophylactically for chronic stable angina
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| nadolol side effects | hypotension if dc'ed abruptly ****Mrs. G emphasized another drug Propranol is a beta II and causes bronchospasms...DO NOT GIVE TO PT W/ RESPIRATORY Problems
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| nadolol pt teaching | 1) hold meds and contact DR. if HF 2) monitor weight (report gain of 3-4lbs) 3) do not dc aburuptly= taper off 1-2 weeks
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| Atenolol action/classification | beta blocker; treats angina and hypertension
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| Diltiazem (cardizem) action/classification | calcium channel blockers, dilates coronary arteries, used in chronic stable angina, coronary artery spasm, HYPERTENSION
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| Review of Glycoside nursing considerations | take apical, VS before admin, smoking contraindicated, ECG may be needed, know toxic symptoms
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| drug class that treat abnormal cardiac rhythm | antidysrhythmics
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| antidysrhythmics action | slows rate of impulse conduction, depressing automaticity, increase resistance to premature stimulation
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| amiodarone: points mentioned by Mrs. Gorcyca | an antidysrhythmia; PHOTOPHOBIA, PHOTOSENSITIVITY, monitor pulse daily, observe thyroid dysfunction, tremors, insomnia;
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| What is the rationale Mrs. G gave for assessing thyroid dysfunction for Amiodarone | Amiodarone has iodine in it. Iodine affects the thyroid (like Goiter etc).
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| used to prevent recurrent PVCs and V-tach | disopiramide/norpace
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| disopiramide/norpace should be withheld if apical pusle is: | apical pulse hold if < 60 > 120 (that is what the book says)...
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| disopiramide/norpace nursing considerations | Monitory BP; I&O; weigh daily and observe for edema; change position slowly (severely brings down BP); photosensitivity
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| dilate arteries and decrease resistance to blood flow (reduce afterload) by working against the renin-angiotensin-aldosterone | ACE inhibitors
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| what does ACE stand for | angiotensin-converting enzyme
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| Ace inhibitors are prescribe for pts w/: | HF, some HTN, and after MI.
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| Ace Inhibitors end in: | pril
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| What did Mrs. G say was a side effect of ACE inhibitors | dry cough
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| ACE inhibitors nusring considerations | monitor blood cell count, report changes in urine output because ACE inhibitors cause less fluid retention
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| Why are diuretics given to pts w/ cardiac disorders? | many pts w/ heart problems have fluid retention. Also more fluid in your blood causes hypertension. So Diuretics are also an antihypertensive drug
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| name the 3 most frequently types of diuretics and give a name of a med for each one | loop diuretics (furosemide/Lasix), Thiazide (hydrochlorozid, Esidrix), Potassium Sparing (aldactone)
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| What conditions would diuretics be prescribed for other then those who have edema | CHF, HTN
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| why is it called Loop diuretic? | loop diuretics work on the kidneys. Remember anatomy that the Loop of Henle is part of the kidney and helps in excretion and reabsorption of sodium/potassium
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| DIURETICS: What did Mrs. G say were nursing considerations | I&Os, weight, encourage POTASSIUM RICH FOODS for potassium wasting diuretics (Loop and Thiazide), INTERVENTIONS for possible hypotension (dangle feet, slowly get up, gait belt)
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| DIURETICS: what did Mrs. G say were side effects | Hypokalemia, hypotension/orthostatic
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| drug the PREVENT clot formation by decreasing the ability of blood to prevent clots. | Anticoagulant: it does NOT dissolve clots just prevents more clots from being made
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| name 3 types of Anticoagulatns | heparin, LMWH, warfarin
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| Heparin is administered initially how? and how is it administered when stabilzed | initially: continuous IV drip; STABILIZED: subq
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| what factor is taken into consideration when adjusting the dose of Heparin | aPTT-activated partial thromboplastin time
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| why are pts hospitalized when taking heparin | it is never given orally
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| Heparin is used in conjunction w/ what other type of drug | Firbrinolytic agents
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| Derived from heparin that prevents clots and blocks formation of thrombin | LMWH (low molecular weight heparin)
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| Example of LMWH | Lovenox
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| LMWH advantages | anticoagulant effect is more PREDICTABLE; SUBQ once or BID; NO NEED FOR CLOSE MONITORING OF aPTT
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| LMWH is recommeded for pts w/ what conditions | DVT; unstable angina; AMI
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| What anticoagulant is can be given orally | Warfarin/Coumadin
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| Heparin is regulated by what while Warfarin is regulated by what? | Hep = aPTT; War = PT/INR
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| When Heparin and Coumadin are being used together, what did Mrs. G say is the usual routine. Warfarin taken away or Heparin is taken away after a time? | Heparin: explanation on next card
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| What did Mrs. Gorcyca say is the rationale for giving both Hep and War together and why hep is taken away | Heparin and Warfarin work on different factors of blood clotting. Heparin works quicker so is uesd for immediate purpose. Warfarin takes longer (days) to reach PT/INR therapeautic lvl. Once that is reached then Heparin is no longer needed.
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| Decreases platelet aggregation (prevents platelets from sticking together) Prolongs bleeding time | Antiplatelet
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| uses of antiplatelets | used after AMI, prevents futher AMI events and strokes
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| Plavix considerations | monitor bleeding time, CBC w/ differential, platelet count. AVOID OTC w/ aspirin or NSAIDs
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| Plavix pt. teaching | report bleeding; keep appt for bloodwork
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| Destroys clots | Firbrinolytics
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| Main example of Firbrinolytic mentioned by Mrs. G | Streptokinase
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| when are firbonolytics best used | as sooon as there is evidence of clot formation
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| how are fibronilytics administered | IV
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| Uses: Fibrinolytics | occlusive stroke and AMI happing right now
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| Inhibits cholesterol lvls from elevating by affecting LDL, HDL, and triglycerides | Lipid Lowering agents
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| Lipid lowering Agents: overall teaching | adhere to diet and exercise; quit smoking; may need to take w/ meal
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| many lipid lowering agents end w/ ____. Mrs. G says this "ending" is a substance that damages what organ | Statin; liver (most work in liver or gut)
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| what tests are done for lipid lowering agents | lipid profile/liver function (serial lab tests)
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| When a pt has an AMI w/ severe chest pain what is given first | Analgesic (Nitroglycerin)
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| What did Mrs. G say about Side effects of nitroglycerin regarding BP and pulse? What is the intervention? | Lowering BP, rising pulse; lie down
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| What did Mrs. G say to remember about Nitro topicals. | take a break
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| When nitroglycerin does not relieve chest pain what is given? What does it do? | morphine = reduces workload of heart, reduce anxiety
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| what is an alternative to morphine | demorol/meperdine
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| Morphine and Meperdine are most effect by what route? | IV
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| Mrs. G said when giving Morphine to hold if resperations are | below 12
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| When you have extra Morphine left over, what are the appropriate actions? | Have a witness, flush, put in sharps
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| Cholesterol intake should be __mg/day. Sodium __g/day. | 200; 2
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| When fluid retention accompanies heart problems what is restricted | sodium
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| when chest pain is unrelieved by nitro what is administered | Oxgyen per NC or face mask
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| This device restores the regular rhythm and improve CO and perfusion. | Pacemakers
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| name two types of pacemakers | temp and perm
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| name 3 types of temporary pacemakers and describe each | transq = impluse sent thru skin; transvenous = threaded through a vein into the right side of the heart; epicardial = impulse into epicardial wall during cardiac surgery
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| Permanent pacemakers is placed subq through an artery: T or false | False: it is subq but through a vein not artery
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| Temp pacemakers are used for elective and ___ situations | emergency
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| T or F: pacemakers increase heart rate beyond set point | False
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| Permanent pacemaker battery life is 9-10: true or false | false: 8-10
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| For Permanent pacemaker procedure, pts rest for how long after the procedure? What intervention follows rest? | 24hrs; ambulation and encourage to resume activities
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| Pt. teaching for permanent pacemakers | how to take pulse, and proper rest
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| After insertion of temp pacemaker what interventions follow? | microshock precautions; portable ECG when transporting pt; a nurse must be in attendance
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| name 3 major problems that occur w/ pacemakers | 1) failure to pace; 2) failure to capture 3) failure to sense
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| pacemaker did not initiate electrical stimulus is called: | failure to pace
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| what are causes of failure to pace | battery failure; lead wire displacement
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| how can you recognize that failure to pace occurs on an ECG | lack of pacer spike
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| Electrical impulse from pacemaker occurs but doesn't result in contraction is called: | failure to capture
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| causes of failure to capture | dislodged of the lead or pacemaker output setting is too low
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| how is failure to capture recognized | presence of spike w/o ECG activity following the spike= meaning it spikes then there is no P wave or QRS complex
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| pacemaker initiates impulse when not needed | failure to sense
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| cause of failure to sense | displacement of the electrode
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| how can you regonize failure to sense | spikes that fall too close to pt's rhythm
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| Delivery of a sync shock to terminate atrial or ventricular tachy (abnormal rapid heart rhythms) | Cardioversion
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| In cardioversion the shock is synced w/ which wave? Why | R to avoid shocking during the vulnerable T. Means that T waves is when ventricles are at rest. If shock is delivered you can cause V Fib
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| during cardioversion what did Mrs. G say we need to have at the bedside | emergency equipment
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| If pt is receiving digoxin during a cardioversion, what is done? | drug is held for 24 hours
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| what emergency drug is made available for a cardioversion procedure in pts who took digoxin | digiband (thanks Bryce)
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| During cardioversion the electrodes are placed where? | right = sternum just below clavicle; left = apex of heart
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| After a cardioversion (the pt was given a sedative) the pt recovered very quickly from the sedative but doesn't remember the event. The nurse see's this as abnormal or normal | Normal: in cardiversions pts usually recover quickly from sedatives and do not remember the event
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