Cardiac Flashcards
(45 cards)
1
Q
angina
A
- episodes of chest pain - can progress to MI
- myocardial oxygen supply vs demand
- atherosclerotic plaque in coronary arteries
- angina, variant angina (spasms of coronary artery - at rest) and unstable angina (comes from advanced CAD)
- signs of angina with women are different - fatigue, SOB
2
Q
nitroglycerin (NTG) (Nitro-BID, Nitrostat, Nitro-dur)
isosobide (Isobid, Isordil, Imdur)
A
(nitrates)
- relaxes smooth muscle in blood vessels, vasodilate
- decreases preload (amt/volume dumped in right atrium and stretch in right atrium)
(—and afterload is the resistance felt when the heart tries to pump blood out of left ventricle) - fight line defense in prevention and treatment
- use: acute attacks, chronic angina
- adverse: HA, hypotension, dizziness, N/v, flushing, tachycardia
nitroglycerine
- po sublingual
- topical gel (in hospital)
- sprays underneath tongue
- patches - 24 hours
- IV
isordil - long term
imdur - immediate and sustained release (commonly used)
3
Q
nitrates
A
- sl, po, IV
- interactions: alcohol, beta blockers and erectile dysfunction drugs
- may take 3 NTG pills, 5 mins apart, if no relief call EMS
4
Q
Nursing Implications for nitrates
A
- assess pain, monitor BP/HR
- wear gloves with ointment, patches
- patches: on for 12 hours, off for 12 hours
- SL tabs must fizzle or burn
- sit/lie down
- spray NTG - on or under tongue
- avoid smoking
- pills must be stored in original container
5
Q
atenolol (Tenormin)
metoprolol (Lopressor)
A
(beta blockers)
- block beta 1 and/or 2
- use: angina, MI, HTN, dysrhythmias
- used for chronic stable angina - not attack
- drugs given to all patients post MI unless strongly contraindicated
6
Q
agents to lower lipids
A
- abnormally elevated serum lipid and triglycerides
- total serum cholesterol < 200 mg/dl
- –LDL > 100
- –HDL high > 60, Low < 40
- –triglycerides < 150
- high cholesterol linked to arteriosclerosis, HTN, CAD, PVD, and MI
- first line treatment = diet and exercise
7
Q
colestipol (Colestid)
cholestyramine (Questran)
A
(bile acid sequestrants)
- inhibit or increase excretion of bile acid in GI tract
- adverse: constipation, bloating, flatulence, nausea
- precautions: patients with bile obstructive disease
Nursing:
- monitor serum cholesterol
- take before meals
- high fiber foods
- power mixed with foods/fluid
- watch for bleeding
8
Q
atorvastatin (Lipitor)
simvastatin (Zocor)
A
(HMG-CoA reductase inhibitors)
- blocks synthesis of cholesterol in liver
- may increase or maintain HDL
- adverse: constipation, abdominal distention, belching
- caution: liver failure
9
Q
Nursing Implications for HMG-CoA reductase inhibitors
A
- give at night
- watch serum levels
- do not become pregnant
- monitor liver function tests
- change diet, exercise
- restrict alcohol and stop smoking
- report muscle pain
10
Q
gemfibrozil (Lopid)
A
(fibric acid derivative)
- reduce plasma triglycerides in increasing enzyme lipoprotein lipase
- short term use
- use with patients with hyperlipidemia who fail diet
- adverse: abd pain, diarrhea, fatigue, HA
11
Q
Nursing Implications for fibric acid derivatives
A
Contraindicated - renal/liver/gall bladder disease
Nursing:
- monitor triglyceride levels and liver function tests
- monitor for signs of gall stones
- need extra fiber and fluid
12
Q
ezetimbe (Zetia)
A
(cholesterol absorption inhibitors)
- acts in small intestine
- Zetia used for people who are intolerant to other therapies
- –sometimes also used in conjunction with statins
13
Q
Heart failure symptoms
A
dyspnea fatigue ankle edema JVD pulmonary edema
14
Q
lisinopril (Prinivil, Zestril)
capatopil (Capoten)
A
(angiotensin-converting enzyme [ACE] inhibitors)
- inhibits the conversion of angiotensin I to angiotensin II
- use: heart failure, HTN
- adverse: severe hypotension, renal tubular damage, cough
- caution: renal disorder, do not take if pregnant
- ACE inhibitor is a cardioprotective drug - ventricular remodeling after MI
- common for diabetics
- protective of kidneys when there’s no renal failure - otherwise it’s more detrimental
15
Q
Adverse and Nursing Implications for ACE inhibitors
A
Adverse:
- angioedema - strong vascular reaction involving inflammed submucosal tissue
Nursing:
- monitor K
- monitor BP, weight, I&O
- risk of rebound hypertension with abrupt stop
- watch NSAIDs w ace inhibitors
16
Q
losartan (Cozaar)
valsartan (Diovan)
A
(angiotensin II receptor blockers [ARBS])
- complete with angiotensin II for tissue binding sites
- use: HTN, heart failure
- adverse: severe hypotension, less cough
- caution: liver failure, do not take if pregnant
- nursing: monitor BP, weight
17
Q
nesiritide (Natrecor)
A
(B-type natriuretic peptides)
- increase cardiac output, stroke volume and contractility without significantly altering HR or BP
- use: acute heart failure
- given IV
- adverse: severe hypotension, dysrhythmias.
- monitor BNP (brain natriuretic peptide), gives in ICU only
BNP - shows how hard the heart is working - higher the #, the harder its working
18
Q
milrinone (Primacor)
inamrinone (Inocor)
A
(phosphodiesterase inhibitor)
- inhibit action phosphodiesterase enzyme
- use: short term treatment acute heart failure
- adverse: severe hypotension, thrombocytopenia (inamrinone), dysrhytmia (milrinone)
- ICU care only, use only after other treatments fail
19
Q
digoxin (Lanoxin)
A
(cardia glycocides)
- positive inotrope: slow rate, increase force of contractions, increase cardiac output
- use: heart failure, tachyarrhythmias
- adverse: bradycardia, heart block
- –toxicity: anorexia, upset stomach, hypokalemia, vision changes (yellow/green vision)
- contraindications: heart block, bradycardia
- digoxin is no longer the 1st line treatment - too many side effects and incompatibilities
- –watch therapeutic blood levels
- –pateints already on digoxin, will stay on it, but new patients will not be put on digoxin
20
Q
Toxicity and Nursing Implications for digoxin
A
Toxicity:
- blood level (0.5-2.0ng/mL)
- elderly, impaired renal function, electrolyte imbalances
- digoxin exclusively excreted via kidneys
- digoxin immune Fab (Digibind) - used for digoxin toxicity but its not for everyone
Nursing:
- start with loading doses and followed by maintenance dose
- hold for HR < 60
21
Q
Other drugs for heart failure
A
Diuretics
- loop diuretics for fluid overload
- K+ sparing for heart failure progress
hydralazine/isosorbide (BiDil) - used to treat the african amercian pop
22
Q
dysrhythmias
A
- disturbances in electrical conduction
- benign or life threatening
- –sinus, atrial, nodal
- –ventricular and heart block - life threatening
- uses classification system: I, II, III, IV
23
Q
Class 1A
quinidine (Quinidex)
procainamide (Pronestyl)
disopryramide (Norpace)
A
- Na+ channel blockers
- membrane stabilizing drugs
- use: supraventricular/ventricular arrythmias
- adverse: blood disorders and lupus like syndome (Pronestyl), tinnitus (quinidine), diarrhea, N/V, hypotension, dizziness, dysrhythmias
- contraindicated: kidney/liver disorders
- nursing: take APR, BP, many drug interactions, take on time schedule
24
Q
Class 1B
lidocaine (Xylocaine)
A
- decreases automaticity in ventricles
- use: serious ventricular dysrhytmias
- adverse: bradycardia, heart block, hypotension, confusion
- precautions: pregnancy, elderly, acute MI
- nursing: lidocaine IV only, monitor rate/rhythm/ BP, safety
25
Class 1C
propafenone (Rythmol)
flecainide (Tambocor)
- decrease conduction to ventricles
- use: life-threatening ventricular arrythmias
- adverse: dysrhythmias, dizzines, fatigue
- caution: heart failure, liver disease, K+ imbalances
- Nursing: monitor serum K+, rate, rhythm
26
Class II
propranolol (Inderal)
esmolol (Brevibloc)
sotalol (Betapace)
- beta blockers
| - use: treatment of supraventricular tachycardia
27
Class III
amiodarone (Cordarone)
- prolong duration of the action potential, slow repolarization, prolong refractory period in atria and ventricles
- use: ventriculr dysrhytmias
- adverse: hypotension, N/V, visual disturbances
- precautions: liver or pulmonary diseases
- nursing: monitor for HR, dysrhythmias, BP, thyroid function
28
Class IV
verapamil (Calan)
diltiazem (Cardiazem)
- calcium channel blockers, slow inward flow of calcium
- use: prevent/control supraventricular arrythmias, HTN
- adverse: nausea, leg cramps, hypotension, bradycardia, heart block
- precautions: pregnancy, heart block, hypotenstion, elderly
- nursing: monitor BP/HR, give with food
29
Unclassified
adenosine (Adenocard)
- slows conduction time through the AV node
- use: conversion of PSVT (proximal supraventricular tachycardia) to sinus rhythm
- used after failure of other treatments
- 10 sec half life, given fast IV push
- causes asystole for period of seconds
30
Hypertension
- diagnosed SBP > 140 and/or DBP > 80
- need lifestyle changes to prevent CAD
- thiazide diuretics - first line treatment
- patients with HTN will need 2 or more meds
31
types of anti-hypertensives
- ace inhibitors
- arbs
- beta blockers
- diuretics
- vasodilators
- calcium channel blockers
32
diuretics
- first line treatment for HTN
- used as monotherapy or in combo with HTN
- decrease plasma and ECF volumes, decrease preload
- give in AM!
- types: loop, K+ sparing, thiazide
33
furosemide (Lasix)
(loop diurectic) - very potent
- increase water excretion by blocking reabsorption of Na+ and Cl- in loop of Henle
- decrease preload
- used when patients are in fluid overload
- use: pulmonary edema, edema, HTN
- adverse: *hypokalemia, dehydration, lower BP, ototoxic (hearing)
- nursing:
- --monitor weight daily, electrolytes (K), BP, I&O
- --decrease effectiveness with NSAIDs
- --prolonged use of high doses - hearing loss
- --po or IV
34
spironolactone (Aldactone)
(potassium sparing diuretic)
- causes loss of Na+ in urine, inhibit aldosterone
- relatively weak diuretic
- use: heart failure, HTN, edema, ascites (liver failure)
- adverse: hyperkalemia
- nursing:
- --monitor K+, I&O, and weight
- --po only
35
hydrochlorothiazide (Hydrodiuril)
(thiazide diuretic)
- decrease reabsorption of Na+, water, Cl- and HCO3 in distal convulated tubules
- use: hypertension, heart failure
- advers: electrolyte imbalance, dehydration
- nursing:
- --monitor BP, weight, electrolytes, I&O
- --photosensitive
- --not for use with renal failure
- -- po only
36
hydralazine (Apresoline)
| nitroprusside (Nipride)
(vasodilators)
- cause direct vasodilation
- use: severe HTN emergencies
- advers: tachycardia
- given IV in ICU to produce controlled hypotension
- cyanide is a metabolite of drug - prolonged use can cause cyanide poisoning
- Apresoline
- --given IV or po, less commonly used
- --given in combo with isosorbide (BiDil)
37
amlodipine (Norvasc)
| diltiazem (Cardizem)
(calcium channel blockers)
- causes smooth muscle relaxation by blocking calcium
- use: HTN, Reynaud's subarachnoid hemorrhage
- adverse: hypotension, tachycardia
- may be given in combination
- po, SR, IV
38
drugs that affect blood coagulation
- anticoagulants
- antiplatelets
- thrombolytics
- most dangerous drugs used to today
- commonly associated with adverse drug reactions
39
```
Aspirin
clopidogrel (Plavix)
```
(anti-platelet drugs)
- decrease platelet aggregation
- use: prevent MI, CVA, improve graft patency (stent)
- nursing: monitor bleeding, safety
40
heparin
enoxaparin (Lovenox)
fondaparinux (Arixtra)
(anti-coagulants)
- interfere with coagulation cascade
- use: thrombotic disorders, prevent clot extension and formation
- caution: bleeding disorders, ulcers, pregnancy
41
Heprain
anticogulant
- subQ or IV push or infusion (DVT/ after MI)
- monitor PTT for infusions
- antidote - protamine sulfate
- used for central line flushes
- start with loading dose then continuous drip
- short half life
- patients coming in for surgery (who were on Coumadin) can be put on a heparin drip
42
enoxaparin/fondaparinux
anti-coagulants
enoxaparin
- no lab work needed
- subQ only
- can be given at home
fondaparinux
- prophylaxis for DVT for hip fracture surgery, knee replacement surgery, or abdominal surgery
- subQ
43
warfarin (Coumadin)
anticoagulant
- interferes with vit K dependent clotting
- given po
- 3-5 days for effect
- monitor PT or INR (international normalized ratio) - 1.5-2.5x control
- dosage adjusted daily until therapeutic
- vit k antidote for too much coumadin
- many drug interactions
- watch K intake - green leafy veggies
44
alteplase (Activase)
thrombolytics
- dissolve clots, reestablish blood flow, prevent or limit tissue damage
- use: acute MI, stroke, PE
- adverse: bleeding
- precaution: pregnancy or delivery within 10 days, bleeding
- decrease use of thrombolytics for MI due to advances in PTCAs
45
Nursing Implications of thrombolytics
- given immediately following symptoms
- check bleeding every 15 min during first hour, every 30 mins for next hour and then every 4 hours
- oral temps only
- check pulse every hour
- maintain bed rest
- avoid trauma
