Heart Flashcards
Cardiac catheterization
Radiopaque catheter inserted through peripheral blood vessel into chamber of heart, usually used w/ angiography, purpose is diagnostic or intervention in congenital heart defects. Post-procedure: assess pulses, temp, bleeding, pain/hematoma, paresthesia, paralysis, and color of extremity, HR q15 for a min. Hydration. Hold Metformin for 48 hrs post procedure, worried about kidneys
Isosorbide (isordil)
Sublingual. Antianginal. Nitrate vasodilator. SE- HA, dizziness, weak, postural HTN, syncope, flushing, n/v. Overdose can be fatal. Don’t drink alcohol
Digoxin
Cardiac glycosides. Inc the force of myocardial contraction. Slows the HR. CO inc. SE- bradycardia, asystole. Toxicity- anorexia, n/v, arrhythmias and vision changes. Maintenance dose- 0.125 to 0.5mg. Check pulse before. Hypokalemia + dig= toxicity.
Antidysrhythmics
A- interfere w/ electrical excitability of heart. Use- A-fib and flutter, tachycardia, PVCs. Ex- atropine sulfate, lidocaine, pronestyl (procainamide), quinidine, isuprel (isoproterenol). SE- lightheadedness, hypotension, urinary retention. Nx- v/s, rhythm.
Verapamil
CCB. Prevention of angina. Dec BP by causing vasodilation of coronary arteries. Dec after load and inc oxygen to heart. Tx of supraventricular tachycardias. Check HR prior to admin
Furosemide (lasix)
Prevents systemic overload. Causes diuresis and vasodilation which traps more blood out in the arms and legs and reduces preload and afterload. Slow IV push 1-2 min to prevent hypotension and ototoxicity.
Amiodarone (cordarone)
Tx of PVCs, v-tach w/ a pulse, (pulseless vtach, v-fib: resistant to tx), a-fib and atrial flutter. Prevent second episode of vfib. Antiarrhythmic, contains high levels of iodine and may affect thyroid function. SE- hypotension that can lead to further arrhythmias.
Angina
Nitroglycerin (dec pre/after load; peripheral artery dilation). BB(prevention): propranolol, metoprolol, atenolol, carvedilol (Block beta cells which are receptor sites for catecholamines (epi/norepi)). CCB(prevention): nifedipine, verapamil, amlodipine, diltiazem (dec BP, vasodilator, dec afterload). Acetylsalicylic acid- keep blood flowing, doesn’t dec pain.
Fibrinolytics
Given to dissolve the clot blocking blood flow to the heart. Streptokinase, alteplase, tenecteplase (one time push), reteplase. Should be administered within 6-8 hrs of onset of MI pain. Complication- bleeding
Follow up therapy for MI
Antiplatelets (inhibit platelet aggregation)- acetylsalicylic acid, clopidogrel (plavix), abciximab (reopro), eptifibatide (integrilin)
Nesiritide (natrecor)
hBNP- allows blood vessels to relax for better blood flow to heart. Hold 2 hrs prior to drawing a BNP- false high. BNP can be positive for HF when CXR does not indicate a problem
HF
ACEI (drug of choice) and ARBS. Both block aldosterone. Result is loss of Na and water, retain K+. Watch for hyperkalemia. Pt will be sent home with ACEI and/or BB. This dec afterload and inc CO
ACEI
Drug of choice for HF. Suppress the renin angiotensin system (RAS). Prevent conversion of angiotensin I to II. Results in arterial dilation and inc stroke volume
ARBS
Block angiotensin II receptors and cause a dec in arterial resistance and dec BP
Digitalis (lanoxin), digoxin
Used with sinus rhythm or a-fib and accompanying chronic HF. Given w/ ACEI, ARB, BB or diuretics. Makes contractions stronger, HR slows down, CO inc, kidney perfusion inc. First dose is higher. Normal 0.5-2 ng/ml. SnS- early: anorexia, n/v. Late: arrhythmias and vision changes (halos, yellow). Before admin check apical pulse (5th IC space left MC line). Watch for hypokalemia + dig= toxicity.
