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Cardiac Meds Flashcards

(61 cards)

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1
Q

ACE Inhibitors

A

-pril

enalopril (Vasotec)

ACE your NCLEX in April

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2
Q

ACE Inhibitor Intended Response

A

vasodilation of blood vessel, diuresis, lower BP and workload of the heart and blood volume (stops aldosterone)

stops conversion of angiotensin 1 -> 2 by inhibiting ACE

can help slow kidney damage in people with diabetes

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3
Q

ACE Inhibitors SE

A

orthostatic hypotension
hyperkalemia
taste disturbance
HA
persistent dry cough

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4
Q

ACE Inhibitors ADE

A

angioedema!
fever/chills
hoarseness
stomach/chest pain
rash/itchy skin
yellow eyes/skin
neutropenia/agranulocytosis

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5
Q

ACE/ARB Inhibitors Nursing Interventions

A

kids more sensitive
older adults greater risk for OH
CI in pregnancy and potassium sparing diuretics (ex. spironolactone)
no salt substitutes!
check renal function (BUN/creatinine) and monitor electrolytes (K!)
assess BP prior (hold if <60)
monitor EKG (peaked T waves) or muscle spasms
fall precautions
can take weeks to be effective (ARB)

AA adults don’t respond with ACEI monotherapy

DONT STOP TAKING ABRUPTLY DUE TO REBOUND HTN

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6
Q

Angiotensin II Receptor Blockers (ARBs)

A

-sartan

valsartan (Diovan)

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7
Q

ARBs Intended Response

A

same as ACE inhibitors w/slightly different action; block the effects of angiotensin 2 (vasoconstriction, Na and water retention)

vasodilation and reduced BP

fewer SE, better tolerated

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8
Q

ARBs SE

A

hypotension
dizziness
HA
diarrhea/GI upset (n/v/d)
heartburn (pyrosis)

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9
Q

ARBs ADE

A

hyperkalemia
hyperglycemia

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10
Q

Calcium Channel Blockers (CCB)

A

SELECTIVE: nifedipine/amlodipine (-dipine); dihydropyridine

NON-SELECTIVE: diltiazem/verapamil; nondihydropyridine

Very Nice Drugs

CAN BE GIVEN WITH DIURETICS

blocks movement of Ca to slow conduction and HR

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11
Q

CCB Mechanism of Action

A

blocks Ca; lowers contractability, conductibility through nodes, and O2 demand

relaxes smooth muscle/blood vessels, increases blood supply to heart and reduces workload

selective: artery and arteriole vasodilation for BP (vascular smooth muscle only)
non-selective: also affects heart (used for A-Fib)

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12
Q

CCB SE

A

hypotension
bradycardia
flushing
constipation
nausea
HA
rash
drowsiness/fatigue
dizziness

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13
Q

CCB ADE

A

dysrhythmia
edema in legs (avoid in pts with HF)
worsening HF with verapamil and diltiazem
SJS
reflex tachycardia

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14
Q

CCB Nursing Interventions

A

NO GRAPEFRUIT DUE TO SEVERE OH

telemetry

DAILY WEIGHTS 1KG=1 L

no pediatric or pregnancy research

older folks more sensitive to SE; monitor symptoms of HF (REPORT INCREASED SOB OR ORTHOPNEA)

monitor BP/HR (hold for BP less than 90/60 (<100) or HR less than 60)

take with food or milk to help with absorption

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15
Q

Beta-Adrenergic Blockers (Sympatholytic)

A

-olol

atenolol (Tenormin) or propranolol

slows the speed of electrical conduction through the heart

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16
Q

Beta-Adrenergic Blockers Mechanism of Action

A

lowers HR, force of contraction, workload and BP (for SVT, rapid Afib or flutter)

blocks effect of epinephrine on CV system

leads to decrease O2 demand by heart

Beta 1: heart
Beta 2: lungs (bronchoconstriction, decreased airway to breathe)

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17
Q

Beta-Adrenergic Blockers SE

A

impotence
dizziness/light headedness
weakness
lethargy/fatigue
insomnia/nightmares
SOB
depression
cold hands/feet
peripheral edema

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18
Q

Beta-Adrenergic Blockers ADE

A

slow, fast or irregular HR (usually bradycardia)
dyspnea/bronchospasm (use Metoprolol for asthmatics; can cause/exacerbate asthma or HF) (only with propranolol)
chest pain
severe dizziness or fainting
cyanotic nail beds
seizures
hypotension

affect diabetic pts glucose lvls (blood sugar masking symptoms, no warning signs!)

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19
Q

Beta-Adrenergic Blockers Nursing Interventions

A

teach pt to check own BP and HR at home before taking meds
masks hypoglycemia (affects diabetics)
can cause or worsen asthma, COPD and HF
monitor VS, labs (BUN, creatinine, AST, LDH) and blood glucose
assess for signs of HF
avoid OTC meds

don’t abruptly stop due to rebound HTN!

cat C for pregnancy

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20
Q

Alpha Adrenergic Antagonists (Sympatholytic)

A

-zosin

prazosin (Minipress)

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21
Q

Alpha Adrenergic Antagonists Mechanism of Action

A

relax blood vessels and causes vasodilation and decreased BP by blocking alpha-1 receptors in arteries and smooth muscle

oppose effects of norepinephrine

intended response same as BBs; CI in pregnancy and hypotensives

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22
Q

Alpha Adrenergic Antagonists SE

A

impotence
dizziness
weakness
lethargy
insomnia/nightmares
SOB
1st dose hypotension common; start at bedtime

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23
Q

Alpha Adrenergic Antagonists ADE

A

slow, fast or irregular HR
dyspnea

avoid ED meds due to OH

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24
Q

Centrally Acting Alpha 2 Adrenergic Agonist

A

clonidine (Catapres)

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25
Centrally Acting Alpha 2 Adrenergic Agonist Mechanism of Action
stimulate CNS receptors (alpha-2) to decrease constriction of blood vessels, dilate arteries, lower BP used for difficult to control HTN patches
26
Centrally Acting Alpha 2 Adrenergic Agonist SE
similar to BBs, but occur more often DONT ABRUPTLY STOP DECREASED HR AND BP DRY MOUTH DROWSINESS DIZZINESS CNS DEPRESSION (don’t combine with others)
27
Centrally Acting Alpha 2 Adrenergic Agonist Nursing Interventions
not researched with pregnancy; methyldopa used instead **for patches, rotate sites, remove old one before placing new one, wear gloves, no hairy sites; can stay on for 7 days** monitor BP and HR avoid activities that require mental alertness suck on hard candy/ice chips for dry mouth
28
Direct-Acting Arteriolar Vasodilators
hydralazine (Apresoline) HTN CRISIS!!
29
Direct-Acting Arteriolar Vasodilator Mechanism of Action
acts directly on peripheral arteries, dilates, RAPIDLY lowers BP and workload of the heart
30
Direct-Acting Arteriolar Vasodilator SE/ADE
reflex tachycardia hypernatremia **SJS with minoxidil** include more often
31
Direct-Acting Arteriolar Vasodilator Nursing Interventions
telemetry, monitor VS (HR); teach pt to monitor own HR can be given IV assess for fluid retention and SJS monitor serum Na **report sustained increase in pulse >20 BPM** hydralazine safe to use for pregnancy weight based dosing for peds
32
Cardiac Glycosides
digoxin (Lanoxin) for Afib (slows and strengthens heartbeat) HF med; **VERY NARROW TR OF 0.5-2** improves CO and inhibits the Na/K pump, increasing intracellular Ca negative chronotrope (*slows HR, lowers rate of conduction and O2 demand*) positive chronotrope (*raises myocardial contractility*) negative DROMOTROPIC (*slows electrical impulses through AV node, lowers conduction speed for controlling arrhythmias*)
33
Cardiac Glycosides Nursing Interventions
**look at potassium; Mg and Ca** **monitor HR, take apical pulse >60 for 1 min (hold if HR <60)** **hypokalemia increases toxicity** **be mindful of loop/thiazide diuretics** teach pt to check own pulse and s/s of toxicity obtain a baseline apical pulse rate for 1 full min before administration and future comparisons determine signs of peripheral and pulmonary edema older adults= confusion and delirium check serum digoxin and K levels take at same time everyday; don’t double doses if missed consume high K foods to prevent hypoK
34
Digoxin Antidote
digoxin immune Fab (ovine, Digibind)
35
S/S of Digoxin Toxicity
**green/yellow halos in vision; blurred vision** n/v PVC HA diarrhea confusion and delirium anorexia bradycardia and dysrhythmias (hypoK increases risks) malaise
36
Organic Nitrates
nitroglycerin (Nitrostat) short acting; FOR ANGINA
37
Organic Nitrates Mechanism of Action
vasodilation of both arterial and venous smooth muscle, helps reduce venous return to the heart, which decreases workload (preload and afterload) and lowers O2 demand sublingual or patch (bypass 1st pass metabolism) **isosorbide dinitrate is longer acting for preventing angina attacks** converted to nitric oxide in body
38
Organic Nitrates SE
**HA (tylenol)** hypotension reflex tachycardia flushing dizziness
39
Organic Nitrates ADE
anaphylaxis circulatory collapse (rare)
40
Organic Nitrates Nursing Interventions
avoid tachyphylaxis (overuse won’t work); give them drug free period at night to prevent tolerance wear gloves! in 5 min., if pain is still present take another and wait 5 min; can do up to 3 in a row…MORE THAN 3 CALL 911 lay pt down when administrating for OH no alcohol!! 0 research done for pediatrics class C for pregnancy requires lower starting dose for older people monitor VS (BP/HR) before and after administering
41
Anticholinergics (Parasympatholytics)
**atropine**
42
Anticholinergics Mechanism of Action
treats symptomatic bradycardia (dysrhythmia med) blocks action of vagus nerve on heart to increase HR AND CO often given pre-op to dry up respiratory secretions
43
Anticholinergics SE
can’t see, can’t spit, can’t pee, can’t shit tachycardia ADE are rare! not used for long term
44
Anticholinergics Nursing Interventions
no alcohol, caffeine or tobacco can cause tachycardia in fetus not for long term use monitor HR and ECG and SEs (increase fluids, fiber, etc.)
45
Potassium Channel Blockers
amiodarone (Cordarone) prolonged repolarization; slows conduction leading to decreased HR
46
Potassium Channel Blockers Mechanism of Action
converts afib/flutter to normal sinus rhythm and for life threatening ventricular dysrhythmias lowers blood vessel constriction and HR raises blood flow slows impulse conduction delays repolarization and prolong the action potential to slow down fast contraction
47
Potassium Channel Blockers SE
**unique to amiodarone** neurological changes photosensitivity (Blue Man Syndrome; blue-gray skin discoloration due to iodine) peripheral neuropathy n/v hypo/hyperthyroidism (iodine) microdeposits in corneas hypotension bradycardia
48
Potassium Channel Blockers ADE
(**unique to amiodarone**) ARDS pulmonary fibrosis worsening of HF and dysrhythmias (QT prolongation and Torsades de Pointes) decreased liver function TEN (toxic epidermal necrolysis)/SJS
49
Potassium Channel Blockers Nursing Interventions
monitor for SE and arrhythmias requires baseline and periodic monitoring of lungs, liver, thyroid, ECG (QT interval) and eyes avoid excessive sun exposure (use sunscreen) can cause blue/gray discoloration takes consistently with/without food report cough, vision changes, weight changes or SOB
50
Regulators of BP
kidneys catecholamines baroreceptors in aorta and carotid sinus vasomotor center in medulla hormones (*ADH, ANP, BNP*)
51
HF
clinical syndrome that develops in response to myocardial insult, resulting in decline in function of the heart triggers a neurohormonal response #1 cause is HTN
52
Compensatory Mechanisms for HF
hypoxia stimulates the SNS to release catecholamines (**increases force, speed of contractions; creates more work for heart**) RAS is activated (**releases angiotensin II, a powerful vasoconstrictor and aldosterone, a sodium saver; creates more work for heart**) hypertrophy results as heart works harder (**heart gets too big and outgrows blood supply and stiffens**)
53
HFrEF (Reduced HF)
heart failure reduced ejection fraction EF < 40 old systolic HF
54
HFpEF (Preserved HF)
HF preserved ejection fraction EF > 50 old diastolic HF
55
CAD
one of leading causes of death in the US narrowing/occlusion of a coronary artery with myocardial ischemia, even death typically due to artherosclerosis
56
Angina Pectoris
acute chest pain due to insufficient O2 to myocardium accompanies physical exertion or emotional excitement causes increases O2 demand
57
Angina
STABLE: occurs with predictable stress/exertion UNSTABLE: occurs frequently unrelated to activity; unpredictable; PREINFARCTION VARIANT (PRINZMETAL, VASOSPASTIC): occurs at rest
58
Myocardial Infarction (MI)
blockage and reperfusion following MI; blockage of left coronary artery with MI (1), infusion of thrombolytics (2), blood supply returning to myocardium (3), thrombus dissolving and ischemia clearing (4)
59
A Fib
electrical signals chaotically bombared AV node ventricular response nearly always irregular
60
ACE/ARB Pt Teaching
change positions slowly avoid K supplements or K rich foods (*dark green leafy veggies, bananas, oranges, potatoes, spinach, avocados*)
61
Sodium Channel Blockers
Quinidine slows conduction and repolarization

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