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Pharm Exam 2 > Cardiac > Flashcards

Cardiac Flashcards

(141 cards)

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1
Q

Loop Diuretic Drug

A

Furosemide

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2
Q

Furosemide MOA

A

Rapid acting loop diuretic inhibits Na and Cl reabsorption in ascending loop of henle
Decreasing edema and BP

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3
Q

Furosemide Use

A

Powerful diuretic given for massive movement of fluids (trying to unload cardiac system)
Both acute and chronic heart failure
-early or small amounts of fluid retention thiazide diuretics are normally given

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4
Q

Furosemide A/E

A 
Postural hypotension 
Hypo K, Mg, Na, Cl
N/V
Dehydration-- leads to circulatory collapse 
Tinnitus *
Aplastic anemia *
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5
Q

Furosemide Route/Dose

A

IVP starts acting in 5 minutes, duration about 2 hr

give 20mg/min, too fast can cause cardiac arrest

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6
Q

Furosemide Drug interactions

A 
Digoxin: ↓ K = ↑ risk for dig toxicity
↳Dysrhythmias
Ototoxic drugs (aminoglycosides) 
↳Hearing loss
Lithium: ↑Na level
Other antihypertensives: hypotension
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7
Q

Furosemide Monitoring

A

BP (>110/60): hypotension due to high volume diuresis can cause circulatory collapse (before giving)
Weight (Daily)
K level ( 3.5-5) (before giving)

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8
Q

urine output needs to be greater than

A

30mL/hr

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9
Q

Thiazide diuretic Drug

A

Hydrochlorothiazide

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10
Q

Hydrochlorothiazide MOA

A

Blocks reabsorption of Na and Cl in early segment of the distal convoluted tubule
-not effective if GFR <15-20 mL

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11
Q

Hydrochlorothiazide Use

A

Hypertension: 1st choice especially in AA (most effective)
Mild-Moderate heart failure
Mobilize edema associated with hepatic and renal disease (GFR cant be too low though)

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12
Q

Hydrochlorothiazide Contraindications

A

Pregnancy and breast feeding

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13
Q

Hydrochlorothiazide A/E

A

Hypo K, Na, Cl
Dehydration
Increased BG in diabetes
May precipitate gouty arthritis

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14
Q

Hydrochlorothiazide Drug interactions

A

Digoxin toxicity due to loss of K

Other antihypertensives: causes hypotension

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15
Q

Osmotic Diuretic Drug

A

Mannitol

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16
Q

Mannitol MOA

A

In the proximal convoluted tubules, mannitol creates osmotic action that inhibits passive reabsorption of water
– no significant effect on excretion of K

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17
Q

Mannitol Use

A

Can prevent/ slow onset of renal failure in severe hypotension → not excreted like other drugs so it raises BP
Hypovolemic shock
Reduction of intraocular pressure in cases not responding to usual therapy (Glaucoma)

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18
Q

Mannitol Solution

A

normally icy/ crystallized → need to warm in water

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19
Q

Mannitol dose

A

given at a rate for 30-50mL/hr of urine output

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20
Q

Mannitol A/E

A 
HA
N/V
Electrolyte imbalance 
Pulmonary edema
Congestive heart failure edema
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21
Q

K Sparing (Aldosterone) Diuretic Drug

A

Spironolactone

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22
Q

Spironolactone MOA

A

Blocks action of aldosterone in the distal nephron
Since aldosterone promotes Na uptake in exchange for K secretion
Inhibition of aldosterone causes retention of K and excretion of Na

Works slowly over days

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23
Q

Spironolactone Use

A

Hypertension
Edema
Usually given in combo w/loop/ thiazide diuretic due to low diuresis

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24
Q

Spironolactone A/E

A

Hyperkalemia resulting in cardiac dysrhythmias such as V. fib
Gynecomastia
Menstrual irregularities

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25
Hyperkalemia treatment
Injection of insulin
26
Spironolactone Patient educations
Never use salt substitutes or K replacements | Don't increase intake of K or take another K sparing drug
27
K Sparing (Non Aldosterone Sparing) Diuretic Drug
Triamterene
28
Triamterene MOA
Disrupts Na-K exchange directly in the distal nephron Works quickly over a few hr
29
Triamterene Use
Hypertension Edema Mainly to counteract the K wasting effects of other diuretics *
30
Triamterene A/E
N/V Leg cramps: increase K Dizziness Hyperkalemia
31
Triamterene Drug interactions
ACE, ARB, Direct renin inhibitors ↑ K and can be deadly
32
K replacement Drug
KCl (potassium chloride)
33
KCl Use
When theres a loss of K from vomiting, diarrhea, wound drainage, prolonged diuresis, DKA
34
KCl A/E
Irritate GI tract: abdominal discomfort N/V/D Large pills can cause intestinal ulcers and result in bleeding/ perforation Hyperkalemia -mild: 5-7: prolonged PR, and tented T waves -Severe: >7: cardiac arrest due to V-tac/ V-fib. IVP will cause instant death
35
KCl Nursing considerations
ONLY given through IV pump 10meq/hr or slower Never add KCl to an existing IV Dilute 10 meq in 100ml, 40 meq in 500-1000ml (x3 doses) Check K level before giving each dose Mix KCl well in the IV solution PO pill: patient needs to be sitting up right Liquid KCl: dilute in orange juice according to directions
36
Removal of Excess K
1. hold K containing food and meds 2. infuse calcium gluconate (counteract cardiotox) 3. infuse insulin and glucose to push k into cells 4. infuse sodium bicarbonate to increase pH and cellular intake of k 5. give either PO or enema Kayexalate to remove K through the intestines 6. peritoneal or hemodialysis to remove (Last resort)
37
Hyperkalemia S/S
``` Cardiac Confusion Anxiety Dyspnea Heaviness and tingling of legs Numbness and tingling of hands, lips and feet ```
38
Atropine MOA
Muscarinic antagonists, selectively blocks the effects of acetylcholine at the muscarinic receptors Increases heart rate
39
Atropine Use
``` Significant Bradycardia (symptomatic or doesnt respond to waking the patient up) Surgical pretreatment to prevent bradycardia during surgery ```
40
Atropine A/E
``` *Tachycardia* Dry mouth Blurred vision Photophobia Increased intraocular pressure Urinary retention Anhidrosis (decreased in sweating) ```
41
Atropine Drug interactions
Antihistamine Phenothiazine Antipsychotics TCA
42
Alpha 1
Arterioles and vein constriction
43
Alpha 2
Nerves
44
Beta 1
Heart: increase rate, force, AV conduction speed Kidney: release of renin
45
Beta 2
Bronchi: dilation, arterioles, heart, lung, skeletal muscles
46
Dopamine stimulates
Alpha 1, Beta 1 and dopamine
47
Epinephrine stimulates
Alpha 1,2 and Beta 1,2
48
Norepinephrine stimulates
Alpha 1,2 and Beta 1
49
Alpha Adrenergic antagonist Drug
Prazosin
50
Prazosin MOA
Inhibits alpha 1 receptors (arterioles and veins) causing vasodilation, resulting in decreased BP and CO
51
Prazosin Use
Essential hypertension BPH Raynaud's (due to vasodilation)
52
Prazosin A/E
``` Dizziness HA Drowsiness Impotence Reflex tachycardia (decreased CO) Nasal congestion Edema Postural hypotension ```
53
Prazosin Drug interactions
Diuretics and other hypotensive agents potentiate effects
54
Prazosin Nursing considerations
Monitor for 1st dose effect | Impotence is a major reason for nonadherence in men
55
Beta Adrenergic Antagonist Drug
Propranolol | Metoprolol
56
Propranolol MOA
NON-SELECTIVE Beta 1 and 2 adrenergic blocker (lung, heart, kidney) Blocks adrenergic receptors in the cardiac (beta 1) and the lungs (beta 2); renal (beta 1) suppresses renin secretion
57
Propranolol Use
MI CAD HTN - better at lowering HR but still used as a 1st line treatment for HTN Cardiac dysrhythmias
58
Propranolol Therapeutic effect
Antihypertensive | Reduced HR, CO
59
Propranolol A/E
``` Hypotension Bradycardia Bronchoconstriction Depression Rapid withdrawal can cause angina or dysrhythmias that will lead to another MI ```
60
Propranolol Drug interactions
Ca Channel Blockers: cause cardiac suppression, very low HR/BP
61
Propranolol Contraindications
Bronchitis COPD T1DM T2DM
62
Propranolol Nursing implementations
・Take apical pulse and BP before giving ↳ Do not give if pulse is <60 or BP is <90-110 and call MD ・May mask tachycardia symptoms of hypoglycemia
63
Beta blocker Indications
``` Angina HTN Cardiac dysrhythmias MI Heart failure ```
64
Metoprolol MOA
Selective beta blocker (better for those who have lung problems) Blocks Beta 1 cardiac receptors (Heart and Kidneys) Reduces HR, force contraction, AV duration through the nodes, reduces secretion of renin
65
Metoprolol Use
1st choice antihypertensive Angina MI Heart failure
66
Metoprolol A/E
``` Bradycardia Decreased CO AV heart block 1st, 2nd degree Heart failure Cardiac excitation (when suddenly stopped can cause another MI if previously had one) ```
67
Centrally acting Alpha 2 agonist Drug
Clonidine
68
Clonidine MOA
Activates the central Alpha 2 receptors (nerves) in the brainstem and this reduces sympathetic outflow to blood vessels and the heart
69
Clonidine Use
Hypertension | Sometimes pain
70
Clonidine A/E
``` Drowsiness Sedation Xerostomia (dry mouth) Constipation Impotence Rebound hypertension (when stopped abruptly) Fetal harm Euphoria Hallucinations Abuse ```
71
ACE Inhibitor Drug
Captopril, Lisinopril, Enalapril
72
Captopril MOA
Lowers BP by inhibition of Angiotensin Converting Enzyme - This disrupts the conversion of angiotensin 1 to 2 in the kidneys - Since angiotensin 2 is a powerful vasoconstrictor, vasodilation occurs and BP is lowered
73
Captopril Use
Hypertension Heart failure MI BP med of choice for DM since it slows progression of ESRD
74
Captopril A/E
1st dose hypotension Arthralgia Cough (increased bradykinin in lungs) - may need to change to a different class Angioedema Bradycardia Neutropenia (will occur within the 1st week) Agranulocytosis (will occur within the 1st week) Fetal injury Hyperkalemia
75
Captopril Drug interactions
other antihypertensives: hypotension
76
Captopril Nursing implementation
・Take BP and apical pulse before giving ・Report unexpected fever ・May cause hypoglycemia in Dm → check BG
77
Angiotensin 2 Receptor Blocker (ARB) Drug
Losartan
78
Losartan MOA
Blocks access of angiotensin 2 to its receptors in blood vessels, the adrenals and other tissues -causing dilation of arteries and veins
79
Losartan Use
Hypertension Diabetic retinopathy (type 1) - slows development Those who cannot tolerate ACE inhibitors
80
Losartan A/E
Angioedema | Renal failure
81
Losartan Drug interactions
Other antihypertensives
82
Ca Channel Blockers Drugs
Verapamil Diltiazem Nifedipine
83
Verapamil MOA
Inhibits Ca influx through slow channels into myocardial muscle cells Increases myocardial O2 delivery Blocks influx of Ca in both blood vessels and the heart
84
Nifedipine MOA
Dilates coronary artery and inhibits coronary spasm | -Prevents Ca influx into the slow Ca channel, only works on the arteries not the heart its self
85
Verapamil Use
``` Hypertension Reduces HR Antiarrhythmic for SVT (supraventricular tachycardia) Antianginal Decreases force of contraction ```
86
Nifedipine Use
Hypertension | Angina
87
Verapamil A/E
``` Dizziness HA Fatigue Sleep Disturbances Hypotension Bradycardia Constipation (not with Nifedipine) Nausea Edema in legs (more common and serious) Elevated LFTs Severe: Hypotension, Cardiogenic shock, CHF ```
88
Nifedipine A/E
Flushing Reflex tachycardia Along with the all from Verapamil
89
Verapamil Drug interactions
Grapefruit juice ↑ drug level (no large amounts) ↑ level of digoxin Potentiates other antihypertensives
90
Verapamil patient education
Monitor grapefruit intake - avoid large amounts | Report wt gain
91
Verapamil Nursing implementations
Take BP and HR before giving
92
Verapamil Monitoring
LFTs BUN Cr
93
Hydralazine
Vasodilator Selective dilation of arteriole, no effect on veins HR increases
94
Hydralazine Use
Essential hypertension Hypertensive Crisis Heart failure
95
Hydralazine A/E
Reflex tachycardia ↑ Blood volume lupus like syndrome
96
Hydralazine Drug interactions
Combo w/ beta blockers to avoid reflex tachycardia | -excessive hypotension
97
Hydralazine IV
Most commonly given to HTN crisis BP >220/180
98
Nitroglycerine MOA
Vasodilator (Anti-anginal) Relaxes smooth muscle vasculature by unknown mech. Reduces preload, afterload, and myocardial O2 consumption
99
Nitroglycerine Use
Reduces BP, Chest pain, | Angina
100
Nitroglycerine A/E
HA (give Aspirin or Tylenol) Postural hypotension Facial flushing
101
Nitroglycerine Sublingual dosing
Give 1 tab every 5 minutes 3x if chest pain did not subside with the previous dose -If not better after 3rd dose call 911 or use MI protocal
102
Nitroglycerine IV
Titrate IV drip according to BP | -Used when chest pain isn't being subdued by Morphine
103
Nitroglycerine Cream
Measured in increments Will not stop sudden chest pain and can take Sublingual tabs for it Applied to hairless area (chest, upper back, arm, legs)
104
Nitroglycerine Patch
Applied same as cream Clean area before application and after removal Can be worn in shower or while swimming Local buring can happen and is not significant Remove at night to prevent tolerance
105
Nitroglycerine Capsule
Prevent chest pain
106
Nitroglycerine Drug interactions
Alcohol: worsen hypotension | IV nitro may antagonize heparin ( don't give in same IV line)
107
Nitroglycerine Nursing implementations
Take before known chest pain causing activity Take BP before giving and 1 hr after for transdermal Unrelieved chest pain after 15 minutes is usually indicative of MI
108
Digoxin MOA
``` Increases force of myocardial contraction (slow hard pumps) Increases contractility (positive inotropic action) -- antiarrhythmic (changes heart rhythm) ```
109
Other Inotropes
Dopamine, Dobutamine: Used when BP is too low and will not go up with other drugs, will turn finger and toes black, for those who had MI or Open heart surgery
110
Digoxin Therapeutic action
Increases diuresis
111
Digoxin Use
A. Fib CHF Heart failure: 2nd line drug
112
Digoxin A/E
``` Bradycardia Heart blocks: slows conduction from SA→AV→Purkinje fibers (1st, 2nd, 3rd degree heart blocks) Other dysrhythmias Visual disturbances N/V Confusion Agitation ```
113
Digoxin toxicity
More common in elderly
114
Digoxin Drug interactions
``` Many! Antacids Antibiotics Amiodarone Verapamil Quinidine ```
115
Digoxin Nursing implementations
❊Absolutely must take apical pulse for 1 full minute before giving (must be above 50-60 in adults and 60-70 in children)
116
Digoxin Monitoring
Digoxin level: daily when first started then periodically | K level: hypokalemia can increase risk for Digoxin Toxicity and it's the most common reason for toxicity
117
Digoxin antidote
Digibind
118
Adenosine MOA
Decreases automaticity in the SA node and slows conduction through the AV node Inhibits cyclic AMP-induced Ca influx -Basically stops the heart and resets the automaticity
119
Adenosine Use
Terminating SVT | Wolff parkinson white syndrome
120
Adenosine Route
IV bolus closest to the heart | Short half life: 1.5-10 seconds
121
Adenosine A/E
Sinus bradycardia | Bronchoconstriction
122
Amiodarone MOA
K channel blocker Slows AV conduction and prolongs AV refractoriness Blocks repolarization
123
Amiodarone Use
Recurrent V. fib Unstable V. tach AKA: cardiac arrest
124
Amiodarone A/E
Severe hypotension Bradycardia Will most likely need pacemaker after
125
Lipid lowering drugs
'Statin' Atorvastatin Lovastatin
126
Statins MOA
Reduce LDL-C Elevate HDL May lower Triglycerides but not prescribed for that HMG-CoA reductase inhibitor
127
Statin A/E
``` Dyspepsia Camps Flatulence Constipation Abdominal pain Myopathy/ Rhabdo (Calf pain) ↳increase CK levels ```
128
Statin Toxicity
Nephrotoxic | Hepatotoxic
129
Statin Patient education
Cannot eat or drink grapefruit | Inhibits CYP3A4 enzyme
130
Statin Nursing implementations
Most effective for lowering LDLs and total cholesterol Improve cardiac outcomes: lower risk for HF, MI, sudden death Rovastatin has the highest risk: dosages need to be reduced in asians
131
LDL goal for Heart disease patients
70
132
Statin Monitoring
Lipids Q6 mo-annually
133
Ezetimibe MOA
Cholesterol blocker Inhibits dietary absorption of cholesterol secreted in bile Treatment reduces total cholesterol, LDL-C, TG, slight rise in HDL
134
Ezetimibe A/E
Rhabdo | Hepatitis when combo with statin
135
Ezetimibe Toxicity
Pancreatitis
136
Fibrates
Gemfibrozil
137
Gemfibrozil MOA
Decreases VLDL's there by lowering TG levels Increase HDL's No effect on LDL-C
138
Gemfibrozil Use
Treatment usually limited to those in which dietary restriction of saturated fats fails
139
Gemfibrozil A/E
Gallstones | Statin induced myopathy
140
Gemfibrozil Toxicity
Hepatotoxicity
141
Gemfibrozil Drug interactions
Displaces warfarin from albumin Increasing anticoagulation Should not be given w/statins

Pharm Exam 2 (4 decks)

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